scholarly journals Factors Associated With Response to Pilot Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury and Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Laura J. Connolly ◽  
Shantha M. W. Rajaratnam ◽  
Gershon Spitz ◽  
Steven W. Lockley ◽  
Jennie L. Ponsford
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Primary Outcome ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Injury Severity ◽  
Light Therapy ◽  
Productive Activity

Background: Fatigue and sleep disturbance are common and debilitating problems after brain injury. Light therapy shows promise as a potential treatment. We conducted a trial of in-home light therapy to alleviate fatigue and sleep disturbance. The aim of the current study was to identify factors moderating treatment response.Methods: Participants were 24 individuals with traumatic brain injury (TBI) (n = 19) or stroke (n = 5) reporting clinically significant fatigue. Outcomes included fatigue on Brief Fatigue Inventory (primary outcome), sleep disturbance on Pittsburgh Sleep Quality Index, reaction time (RT) on Psychomotor Vigilance Task and time spent in productive activity. Interactions of demographic and clinical variables with these outcomes were examined in linear mixed-model analyses.Results: Whilst there were no variables found to be significantly associated with change in our primary outcome of fatigue, some variables revealed medium or large effect sizes, including chronotype, eye color, injury severity as measured by PTA, and baseline depressive symptoms. Chronotype significantly moderated sleep quality, with evening chronotype being associated with greater improvement during treatment. Injury type significantly predicted mean RT, with stroke participants exhibiting greater post-treatment reduction than TBI. Age significantly predicted productive activity during Treatment, with younger participants showing stronger Treatment effect.Conclusion: Light therapy may have a greater impact on sleep in younger individuals and those with an evening chronotype. Older individuals may need higher treatment dose to achieve benefit.Clinical Trial Registration:www.anzctr.org.au, identifier: ACTRN12617000866303.

scholarly journals Blue-wavelength light therapy for post-traumatic brain injury sleepiness, sleep disturbance, depression, and fatigue: A systematic review and network meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246172
Author(s):  
Karan Srisurapanont ◽  
Yanisa Samakarn ◽  
Boonyasit Kamklong ◽  
Phichayakan Siratrairat ◽  
Arina Bumiputra ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sleep Disturbance ◽  
Meta Analysis ◽  
Light Therapy ◽  
Blue Wavelength ◽  
History Of ◽  
Post Traumatic ◽  
Wavelength Light ◽  
Quality Evidence

Objective This review aimed to determine the efficacy of blue-wavelength light therapy (BWLT) for post-traumatic brain injury (TBI) sleepiness, sleep disturbance, depression, and fatigue. Methods Pubmed, Scopus, Web of Science, Cochrane Library, Academic Search Complete, and CINAHL. Included trials were randomized controlled trials (RCTs) of BWLT in adults with a history of TBI. Outcomes of interest included sleepiness, sleep disturbance, depression, or fatigue. Two reviewers independently screened the searched items, selected the trials, extracted the data, and rating the quality of trials. We aggregated the data using a random-effect, frequentist network meta-analysis (NMA). Results We searched the databases on July 4, 2020. This review included four RCTs of 117 patients with a history of TBI who were randomized to received BWLT, amber light therapy (ALT), or no light therapy (NLT). Moderate-quality evidence revealed that: i) BWLT was significantly superior to NLT in reducing depression (SMD = 0.81, 95% CI = 0.20 to 1.43) ii) BWLT reduced fatigue at a significantly greater extent than NLT (SMD = 1.09, 95% CI = 0.41 to 1.76) and ALT (SMD = 1.00, 95% CI = 0.14 to 1.86). Low-quality evidence suggested that BWLT reduced depression at a greater extent than ALT (SMD = 0.57, 95% CI = 0.04 to 1.10). Low-quality evidence found that the dropout rates of those receiving BWLT and ALT were not significantly different (RR = 3.72, 95% CI = 0.65 to 21.34). Conclusion Moderate-quality evidence suggests that BWLT may be useful for post-TBI depression and fatigue.

Early versus Late Tracheostomy: Is There an Outcome Difference?

2019 ◽  
Vol 85 (4) ◽  
pp. 370-375 ◽  
Author(s):  
Adel Elkbuli ◽  
Raed Ismail Narvel ◽  
Paul J. Spano ◽  
Valerie Polcz ◽  
Astrid Casin ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Primary Outcome ◽  
Injury Severity ◽  
Future Research ◽  
Trauma Patients ◽  
Early Tracheostomy ◽  
Outcome Difference ◽  
The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

Daily Morning Blue Light Therapy Improves Daytime Sleepiness, Sleep Quality, and Quality of Life Following a Mild Traumatic Brain Injury

2020 ◽  
Vol 35 (5) ◽  
pp. E405-E421 ◽  
Author(s):  
Adam C. Raikes ◽  
Natalie S. Dailey ◽  
Bradley R. Shane ◽  
Brittany Forbeck ◽  
Anna Alkozei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sleep Quality ◽  
Blue Light ◽  
Mild Traumatic Brain Injury ◽  
Daytime Sleepiness ◽  
Light Therapy

scholarly journals Sleep Duration and Sleep Quality following Acute Mild Traumatic Brain Injury: A Propensity Score Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Ting-Yun Huang ◽  
Hon-Ping Ma ◽  
Shin-Han Tsai ◽  
Yung-Hsiao Chiang ◽  
Chaur-Jong Hu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Propensity Score ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Sleep Duration ◽  
Mild Traumatic Brain Injury ◽  
Propensity Scores ◽  
Sleep Problems ◽  
Background Information

Introduction. Mild traumatic brain injury (mTBI) has been widely studied and the effects of injury can be long term or even lifelong. This research aims to characterize the sleep problems of patients following acute mTBI.Methods. A total of 171 patients with mTBI within one month and 145 non-mTBI controls were recruited in this study. The questionnaire, Pittsburgh Sleep Quality Index (PSQI), was used to evaluate seven aspects of sleep problems. A propensity score method was used to generate a quasirandomized design to account for the background information, including gender, age, Beck’s Anxiety Index, Beck’s Depression Index, and Epworth Sleepiness Scale. The effect was evaluated via cumulative logit regression including propensity scores as a covariate.Results. Before adjustment, about 60% mTBI patients and over three quarters of control subjects had mild sleep disturbance while one third mTBI patients had moderate sleep disturbance. After adjusting by the propensity scores, the scores of sleep quality and duration were significant between mTBI and control groups.Conclusion. Our study supports that sleep problem is common in mTBI group. After adjusting the confounders by propensity score, sleep duration and subjective sleep quality are the most frequently reported problems in mTBI patients within one month after the injury.

scholarly journals Development of a Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury: Two Case Studies

2021 ◽  
Vol 12 ◽  
Author(s):  
Laura J. Connolly ◽  
Jennie L. Ponsford ◽  
Shantha M. W. Rajaratnam ◽  
Steven W. Lockley
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Side Effects ◽  
Sleep Disturbance ◽  
Case Studies ◽  
Daytime Sleepiness ◽  
Relative Proportion ◽  
Light Therapy ◽  
Lighting Conditions ◽  
Insomnia Symptoms

Background and Objectives: Fatigue and sleep disturbance negatively impact quality of life following brain injury and there are no established treatments. Building on research showing efficacy of blue light therapy delivered via a lightbox in reducing fatigue and daytime sleepiness after traumatic brain injury (TBI), this paper describes the development and implementation of a novel in-home light therapy to alleviate fatigue and sleep disturbance in two case studies.Methods: During the 8-week lighting intervention, participants' home lighting was adjusted to provide high intensity, blue-enriched (high melanopic) light all day as a stimulant and dimmer, blue-depleted (low melanopic) light for 3 h before sleep as a soporific. The sham 8-week control condition resembled participants' usual (baseline) lighting conditions (3,000–4,000 K all day). Lighting conditions were crossed-over. Outcomes were measures of fatigue, subjective daytime sleepiness, sleep quality, insomnia symptoms, psychomotor vigilance and mood. Case study participants were a 35-year old male (5 years post-TBI), and a 46-year-old female (22 years post-TBI).Results: The relative proportion of melanopic lux was greater in Treatment lighting than Control during daytime, and lower during evenings. Participants found treatment to be feasible to implement, and was well-tolerated with no serious side effects noted. Self-reported compliance was &gt;70%. Both cases demonstrated reduced fatigue, sleep disturbance and insomnia symptoms during the treatment lighting intervention. Case 2 additionally showed reductions in daytime sleepiness and depressive symptoms. As expected, symptoms trended toward baseline levels during the control condition.Discussion: Treatment was positively received and compliance rates were high, with no problematic side-effects. Participants expressed interest in continuing the ambient light therapy in their daily lives.Conclusions: These cases studies demonstrate the acceptability and feasibility of implementing a personalized in-home dynamic light treatment for TBI patients, with evidence for efficacy in reducing fatigue and sleep disturbance.Clinical Trial Registration:www.anzctr.org.au, identifier: ACTRN12617000866303.

scholarly journals Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Laura J. Connolly ◽  
Shantha M. W. Rajaratnam ◽  
Jade M. Murray ◽  
Gershon Spitz ◽  
Steven W. Lockley ◽  
...  
Keyword(s):  
Brain Injury ◽  
Sleep Disturbance ◽  
Daytime Sleepiness ◽  
Acquired Brain Injury ◽  
Light Therapy ◽  
Medium Effect ◽  
Productive Activity ◽  
Psychomotor Vigilance ◽  
The Impact ◽  
Insomnia Symptoms

Abstract Background and objectives Fatigue and sleep disturbance are debilitating problems following brain injury and there are no established treatments. Building on demonstrated efficacy of blue light delivered via a lightbox in reducing fatigue and daytime sleepiness after TBI, this study evaluated the efficacy of a novel in-home light intervention in alleviating fatigue, sleep disturbance, daytime sleepiness and depressive symptoms, and in improving psychomotor vigilance and participation in daily productive activity, following injury Methods The impact of exposure to a dynamic light intervention (Treatment) was compared to usual lighting (Control) in a randomized within-subject, crossover trial. Outcomes were fatigue (primary outcome), daytime sleepiness, sleep disturbance, insomnia symptoms, psychomotor vigilance, mood and activity levels. Participants (N = 24, M ± SDage = 44.3 ± 11.4) had mild-severe TBI or stroke > 3 months previously, and self-reported fatigue (Fatigue Severity Scale ≥ 4). Following 2-week baseline, participants completed each condition for 2 months in counter-balanced order, with 1-month follow-up. Treatment comprised daytime blue-enriched white light (CCT > 5000 K) and blue-depleted light (< 3000 K) 3 h prior to sleep. Results Random-effects mixed-model analysis showed no significantly greater change in fatigue on the Brief Fatigue Inventory during Treatment, but a medium effect size of improvement (p = .33, d = -0.42). There were significantly greater decreases in sleep disturbance (p = .004), insomnia symptoms (p = .036), reaction time (p = .004) and improvements in productive activity (p = .005) at end of Treatment relative to Control, with large effect sizes (d > 0.80). Changes in other outcomes were non-significant. Conclusions This pilot study provides preliminary support for in-home dynamic light therapy to address sleep-related symptoms in acquired brain injury. Trial registration This trial was registered with the Australian and New Zealand Clinical Trials Registry on 13 June 2017, www.anzctr.org.au, ACTRN12617000866303.

One-year costs of intensive care in pediatric patients with traumatic brain injury

2021 ◽  
Vol 27 (1) ◽  
pp. 79-86
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Social Security ◽  
Functional Outcome ◽  
Injury Severity ◽  
Pediatric Population ◽  
Favorable Outcome ◽  
Index Hospitalization ◽  
Pediatric Tbi

OBJECTIVETraumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.METHODSIn this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).RESULTSIn total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.CONCLUSIONSGreater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

scholarly journals The role of salivary vesicles as a potential inflammatory biomarker to detect traumatic brain injury in mixed martial artists

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rani Matuk ◽  
Mandy Pereira ◽  
Janette Baird ◽  
Mark Dooner ◽  
Yan Cheng ◽  
...  
Keyword(s):  
Gene Expression ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Injury Severity ◽  
Expression Profiles ◽  
High Impact ◽  
Impact Mechanism ◽  
Inflammatory Biomarker ◽  
Potential Biomarker

AbstractTraumatic brain injury (TBI) is of significant concern in the realm of high impact contact sports, including mixed martial arts (MMA). Extracellular vesicles (EVs) travel between the brain and oral cavity and may be isolated from salivary samples as a noninvasive biomarker of TBI. Salivary EVs may highlight acute neurocognitive or neuropathological changes, which may be particularly useful as a biomarker in high impact sports. Pre and post-fight samples of saliva were isolated from 8 MMA fighters and 7 from controls. Real-time PCR of salivary EVs was done using the TaqMan Human Inflammatory array. Gene expression profiles were compared pre-fight to post-fight as well as pre-fight to controls. Largest signals were noted for fighters sustaining a loss by technical knockout (higher impact mechanism of injury) or a full match culminating in referee decision (longer length of fight), while smaller signals were noted for fighters winning by joint or choke submission (lower impact mechanism as well as less time). A correlation was observed between absolute gene information signals and fight related markers of head injury severity. Gene expression was also significantly different in MMA fighters pre-fight compared to controls. Our findings suggest that salivary EVs as a potential biomarker in the acute period following head injury to identify injury severity and can help elucidate pathophysiological processes involved in TBI.

scholarly journals Study of Traumatic Brain Injury Due To Recent Earthquake in Manipal Teaching Hospital

2016 ◽  
Vol 12 (2) ◽  
pp. 63-66
Author(s):  
Bal G Karmacharya ◽  
Brijesh Sathian
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Teaching Hospital ◽  
Brain Injuries ◽  
Injury Severity ◽  
Traumatic Brain Injuries ◽  
The Body ◽  
Mild Head Injury ◽  
Associated Injuries

The objective of this study was to review the demographics, causes injury, severity, treatment and outcome of traumatic brain injuries in victims of the April 2015 earthquake who were admitted in Manipal Teaching Hospital, Pokhara. A total of 37 patients was admitted under Neurosurgery Services. Collapse of buildings was the commonest cause of head injury. The majority of them had mild head injury. Associated injuries to other parts of the body were present in 40.54% patients.Nepal Journal of Neuroscience 12:63-66, 2015

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