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PubMed2001

Porteus Maze performance following traumatic brain injury in children.

To investigate planning in traumatically brain injured children, the authors gave the Porteus Maze Test (PMT; S. D. Porteus, 1959) to 276 pediatric patients who had sustained a traumatic brain injury (TBI) at least 3 years previously. Sensitivity of the PMT to TBI severity, age at test, and volume of focal brain lesions detected by magnetic resonance imaging was also studied. The Peabody Picture Vocabulary Test-Revised (L. M. Dunn & L. M. Dunn, 1981) was also administered as a control measure. Results indicated that the PMT was highly sensitive to TBI severity and to volume of circumscribed prefrontal lesions. In contrast to the PMT data, receptive vocabulary was related to injury severity but not to discrete prefrontal lesions. Implications for mechanisms of cognitive deficit after TBI in children are discussed.

Adolescent↗

PubMed2002

A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children.

Longitudinal neuropsychological outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries only. Neuropsychological functioning was assessed at baseline, at 6- and 12-month follow-ups, and at an extended follow-up (a mean of 4 years postinjury). Mixed model analyses revealed persistent neuropsychological sequelae of TBI that generally did not vary as a function of time postinjury. Some recovery occurred during the first year postinjury, but recovery reached a plateau after that time, and deficits were still apparent at the extended follow-up. Further recovery was uncommon after the first year postinjury. Family factors did not moderate neuropsychological outcomes, despite their demonstrated influence on behavior and academic achievement after childhood TBI.

Brain Injuries↗

PubMed2003

Delayed predictive accuracy of narrative recall after traumatic brain injury: salience and explicitness.

Fifteen adults with traumatic brain injury (TBI) and 15 adults without brain injury listened to narratives, made delayed predictions of recall, and took a delayed recall test. Narrative questions differed by salience (main ideas, details) and explicitness (implied, stated) (R. H. Brookshire & L. E. Nicholas, 1993). TBI survivors recalled less than control participants regardless of question type. All participants recalled main ideas and implied information with greater accuracy than details and stated information. Predictive accuracy for recalling stated information was strong regardless of group. Participants were unable to predict recall for implied information. The materials-appropriate-processing (MAP) hypothesis proposes that predictive accuracy is biased by text type (i.e., predictive accuracy for recalling main ideas should be higher than for details when learning narratives). However, there were no differences in predictive accuracy for recalling main ideas and details, with both groups predicting recall modestly well. Controlling for explicitness appears to be an important variable for future metamemory text studies.

Adult↗

PubMed1999

Impairments of attention following childhood traumatic brain injury.

Attentional deficits are commonly reported following traumatic brain injury (TBI) in adults, although the occurrence of such problems is less well documented in young children. This study aimed to investigate residual attentional abilities associated with TBI during childhood, by examining a number of aspects of attention including sustained, focussed, and divided attention, attentional shift, and response inhibition. Eighteen children with a history of TBI, aged between 8 and 14 years and 18 non-injured matched controls participated in the study. Results show that attentional skills may be differentially impaired after TBI, with children who have sustained moderate-to-severe TBI exhibiting significant deficits on the following attentional domains: sustain, focus, and response inhibition. These findings support the view that attentional impairments following pediatric TBI, while not global, may be more generalized than those reported for adult samples, perhaps reflecting the relative immaturity of attentional skills at the time of injury.

Adolescent↗

PubMed2001

The use of bupropion in the treatment of restlessness after a traumatic brain injury.

The occurrence of restlessness after a traumatic brain injury (TBI) is common. Severe restlessness can be a barrier in the multidisciplinary treatment of patients with TBI. The following case describes a patient with restlessness after a head-on motor vehicle accident. The patient was tachycardic, diaphoretic, demonstrating decerebrate posturing and a Rancho Los Amigos Stage II--III. Significant left lower leg restlessness was severe enough to cause bruising and ulceration. A multidisciplinary look was taken at the effects of using different neurotransmitter modulators in the treatment of restlessness after a TBI. Current biology treatment options include the use of medications that either modulate dopamine or noradrenaline alone. Bupropion effects both the dopaminergic and noradrenergic pathways. In the following case, the patient's restlessness was resistant to almost every medication employed. The only medication that proved to be effective in significantly reducing the patient's restlessness was bupropion. The evidence for the use of bupropion in the treatment of restlessness after a TBI has never been discussed previously, aside from anecdotal accounts. It is hoped that this case will prove insight into another treatment option for patients who have severe restlessness.

Adult↗

PubMed1997

Recovery and rehabilitation following traumatic brain injury.

Although most patients are discharged following traumatic brain injury (TBI) with "good recovery', recent reports indicate that many have persistent neuropsychological deficits. The purposes of this study were to: (1) determine if functional, neuropsychological and social outcome at 3 and 6 months in patients hospitalized following TBI could be ascertained via telephone follow-up, and (2) assess use of rehabilitation services in this population. Patients were identified through acute hospital admissions. A trained nurse practitioner abstracted data from acute charts. Using the Functional Independence Measure (FIM), Neurobehavioral Rating Scale (NRS), Telephone Interview for Cognitive Status (TICS), and a social questionnaire she obtained follow-up information at 3 and 6 months post-injury. Of 74 patients initially identified, 51 and 48 were available at 3 and 6 months, respectively. Most experienced mild to moderate TBI. Physical disability was minimal at follow-up as indicated by the FIM. Approximately half of the patients were rated cognitively impaired on the TICS at 3 months and over one-third remained impaired at 6 months. At 6 months 60.5% remained unemployed. Only eight of the 67 discharged survivors received any rehabilitation services. A brief telephone follow-up appears to be a cost-effective way to ascertain functional and neuropsychological outcome in TBI survivors. Since few of these patients received rehabilitation, a telephone follow-up may identify those who would potentially benefit from additional rehabilitation services.

Activities of Daily Living↗

PubMed1998

Motor performance following a mild traumatic brain injury in children: an exploratory study.

Mild Traumatic Brain Injury (TBI) is a common occurrence in the paediatric population and, as the concept of motor performance has not been assessed specifically in this population, the purpose of this study was to determine if motor performance deficits are present and can be objectively identified in a sample of children having sustained a mild TBI (Glasgow Coma Scale score 13-15). Twenty-eight children aged between 5 and 15 years were recruited immediately post-trauma. Subjects were considered normal on standard neurological exam at the time of discharge. They were assessed 13-18 days post-trauma using the Bruininks-Oseretsky Test of Motor Proficiency, a norm referenced clinical standardized assessment tool. Compared to published norms, motor performance was significantly lower in domains of balance, response speed and running speed an agility (t-test p < 0.01), and significantly higher in domains of upper extremity coordination and visual motor control (t-test p < 0.01). Although excellent performance can be observed in domains requiring upper limb coordination, motor planning and execution of motor tasks, deficits in balance and response speed can be identified in a significant number of children even after mild TBI. More specific and sensitive evaluations are necessary to identify the exact nature of the problems and evaluate their functional impact on daily activities.

Adolescent↗

PubMed1994

Protective effect of galanin on behavioral deficits in experimental traumatic brain injury.

The magnitude of behavioral deficits in traumatic brain injury (TBI) has been shown to be partly related to alterations in the balance between excitatory and inhibitory neurotransmitter release. Previous studies have demonstrated that extracellular excitatory neurotransmitter concentrations dramatically increase following experimental TBI. We examined the effects of a neuromodulatory peptide, galanin (GAL), on behavioral morbidity, as measured by sensory motor and memory performance tasks, associated with experimental TBI in the rat. A single intraventricular injection of GAL (1.0 micrograms, n = 8 or 10.0 micrograms, n = 10) or cerebrospinal fluid (CSF) vehicle (n = 10) was administered 5 minutes prior to central fluid percussion TBI in rats. Performance on sensory motor tasks was assessed prior to injury and for 5 days after TBI with beam-balance, beam-walking, and rotarod tasks. Memory performance was assessed on days 11-15 after TBI with the Morris water maze. TBI produced significant motor and memory deficits in the CSF-treated group. GAL-treated rats had significantly less magnitude of deficits compared to CSF-treated rats on beam-balance, beam-walking, and rotarod performance. The 1.0 micrograms GAL dose produced slightly greater protection than the 10.0 micrograms GAL dose. Neither GAL dose affected body weight loss or Morris water maze performance. These results suggest that the physiologic effects of GAL may reduce certain components of TBI morbidity, possibly by modulating neuronal excitability.

Animals↗

PubMed1997

Alpha 1-adrenoceptor blockade increases behavioral deficits in traumatic brain injury.

Experimental enhancement of noradrenergic activity following traumatic brain injury (TBI) accelerates behavioral recovery if performed at a time when brain norepinephrine (NE) turnover is decreased. But, since NE turnover is markedely increased immediately after TBI, the present study was undertaken to evaluate the effect of modulating these early changes in NE metabolism on recovery of function. Rats were pretrained on a modified beam walking task. Thirty minutes prior to unilateral somatosensory cortex contusion they were treated with a NE reuptake blocker [desmethy-limipramine (DMI); 10 mg/kg, ip, n = 6] or an alpha 1-adrenoreceptor antagonist [prazosin (PRZ); 3 mg/kg, ip, n = 6]. PRZ pretreatment markedly worsened beam walking performance throughout the 3 weeks following injury, whilst DMI pretreatment did not affect performance compared to injured controls (n = 4). Despite the marked behavioral deficits, PRZ-treated animals showed no apparent worsening of histological damage (n = 11 per group) and lesion size was the same in all groups. In separate experiments (n = 4 per group), PRZ lowered basal blood pressure and prevented the rise in pressure immediately following TBI. However, blood pressures in the three groups came to the same level within 20 sec following TBI. This suggest that the action of PRZ was not simply due to hypotension-induced ischemia. It is possible that blockade of alpha 1-adrenoreceptors in the immediate posttrauma period leads to enhancement of excitatory neurotransmission, which exacerbates behavioral deficits.

Adrenergic Uptake Inhibitors↗

PubMed1998

The enigma of "hidden" traumatic brain injury.

OBJECTIVE: To examine individuals with "hidden" traumatic brain injury (TBI), defined in this study as those who sustained a blow to the head, with altered mental status, and experienced a substantial number of the cognitive, behavioral, and emotional sequelae typically associated with brain injury but did not make the causal connection between the injury and its consequences. DESIGN: Comparison of four groups of individuals matched for age, gender, years of education, and duration of loss of consciousness. SETTING: This study of hidden TBI followed the identification of 143 individuals who, within a larger study of people with TBI who live in the community, identified themselves as "nondisabled" (they were to be part of the comparison sample) but who had experienced a blow to the head that left them at minimum dazed and confused. PARTICIPANTS: 21 of these 143 individuals also reported large numbers of symptoms (eg, headaches, memory problems) associated with TBI. This group (Hidden TBI-High Symptoms group) was compared to three other matched samples: one with known TBI (Known Mild TBI group) and one with no disability (No Disability group) (both of which were drawn from the larger study), and one group of individuals who identified themselves as having no disability but who had experienced a blow to the head that resulted in a few symptoms (Head Trauma-Low Symptoms group). MAIN OUTCOME MEASURES: All study participants were administered an interview that incorporated several existing instruments documenting levels of reported symptoms, emotional well-being/distress, and vocational/social handicaps. RESULTS: The Hidden TBI-High Symptoms group was found to be similar to the Known Mild TBI group in terms of the number and types of symptoms experienced, whereas the Head Trauma-Low Symptoms group was similar in this respect to the No Disability group. The two former groups also evidenced high levels of emotional distress, whereas the two latter groups did not. However, on measures of handicap, the Hidden TBI-High Symptoms and Head Trauma-Low Symptoms groups were similar to the No Disability group and dissimilar from the Known Mild TBI group in that the last group experienced vocational handicap, in particular, whereas the other groups did not. CONCLUSIONS: We conclude that hidden TBI occurs at a nontrivial level (7% of our nondisabled sample). Also, individuals with hidden TBI (with persistent symptoms), unlike those with known mild TBI, are likely to experience emotional distress but not vocational handicap following injury.

Adult↗

PubMed2000

Factors predicting return to work following mild traumatic brain injury: a discriminant analysis.

Studies of mild traumatic brain injury (MTBI) suggest that most individuals recover rapidly and return to their everyday activities. However, a percentage of MTBI patients report persistent problems with cognitive, physical, and emotional symptoms. There is also evidence that some experience changes in occupational functioning following MTBI. The current study used a stepwise discriminant function analysis (DFA) to examine the role of injury severity variables, cognitive performance, and ratings of symptoms of TBI in predicting work status following MTBI. Subjects included 121 MTBI patients who were all active-duty military personnel. The stepwise DFA revealed that age and three cognitive variables (verbal memory, verbal fluency, and a speed test of planning and strategy) were predictive of work status 3-15 months following a documented MTBI, correctly classifying work status 68.8% of the time. A cross-validation DFA was conducted, with a 66.1% correct classification rate. These findings highlight the importance of cognitive impairments in identifying those at risk for occupational impairment following MTBI.

Activities of Daily Living↗

PubMedDate not supplied

A longitudinal study of compensation-seeking and return to work in a treated mild traumatic brain injury sample.

OBJECTIVE: In patients with mild traumatic brain injury (MTBI), to assess: (1) changes in financial compensation-seeking status over time and (2) the relationship between compensation-seeking and return to work. DESIGN: Longitudinal evaluation of financial compensation-seeking status (i.e., at intake, 3 months postinjury, and 12 months postinjury) and relationship of such status to return to work. SETTING: Outpatient rehabilitation clinic. SUBJECTS: Ninety-seven patients with MTBI. MAIN OUTCOME MEASURES: Compensation-seeking status at 3 and 12 months and days taken to return to preinjury vocational activity. RESULTS: Those in litigation at intake generally continued to be in litigation at 3 and 12 months postinjury. Those seeking or receiving compensation via administrative means (e.g., sick pay or workers' compensation) at intake were generally not seeking or receiving compensation by 3 months or later, as was the case for most of those not seeking any financial compensation at intake. Patients seeking or receiving financial compensation via litigation and/or administrative means at intake took longer to return to work than did people who were not seeking or receiving compensation at intake. CONCLUSION: The present study design does not allow for determination of the reasons for the strong relationship between financial compensation-seeking soon post-MTBI and a slow return to work. However, the strength of the present findings indicates that the presence or absence of financial compensation-seeking soon post-MTBI should be routinely evaluated when return to work is an issue.

Adolescent↗

PubMedDate not supplied

Subjective reports of fatigue during early recovery from traumatic brain injury.

OBJECTIVE: To determine whether patients with traumatic brain injury (TBI) report higher levels of fatigue than do normal controls and to identify demographic and cognitive correlates of self-reported fatigue. DESIGN: Prospective study. SETTING: Inpatient neurorehabilitation unit in a medical center and neurological institute. PARTICIPANTS: Forty-seven neurorehabilitation inpatients with TBI. MAIN OUTCOME MEASURES: Barrow Neurological Institute (BNI) Fatigue Scale and BNI Screen for Higher Cerebral Functions. RESULTS: Patients reported significantly greater levels of fatigue compared to the levels reported by normal controls, although fatigue was found to be unrelated to injury severity, number of days from injury to assessment, cognitive impairment, and gender. Inspection of individual items revealed no significant differences between severe versus moderate versus mild TBI groups. However, being able to last the day without taking a nap (ie, item 10) was found to be the most sensitive item associated with fatigue in the TBI group. CONCLUSIONS: Results of this study suggest the need to integrate activities and interventions to increase endurance in patients with TBI during early rehabilitation. Accommodating regular rest breaks and increasing restful sleep should be a focus of inpatient neurorehabilitation units.

Adult↗

PubMedDate not supplied

Treatment of depression following traumatic brain injury.

Depression is a common consequence of traumatic brain injury (TBI), and is a source of substantial distress and disability for persons with TBI and their families. This article offers a practical approach to the evaluation and treatment of this condition. Diagnostic and etiologic considerations relevant to this issue are reviewed first. Next, somatic therapies for posttraumatic depression, including antidepressant medications and electroconvulsive therapy, are discussed. Use of these therapies is also considered in the context of the common medical and neurological comorbidities among persons with TBI. Finally, psychosocial interventions relevant to the care of persons with posttraumatic depression are presented.

Antidepressive Agents↗

PubMed2001

Tyrosine hydroxylase, but not dopamine beta-hydroxylase, is increased in rat frontal cortex after traumatic brain injury.

Chronic frontal lobe functional deficits after traumatic brain injury (TBI) may be associated with altered catecholamine systems in the frontal cortex. To test this, tyrosine hydroxylase (TH) and dopamine beta-hydroxylase (DBH) levels were examined by immunohistochemistry and Western blot at 1, 7, 14, and 28 days after TBI or sham surgery. No alterations in DBH levels were observed by Western blot at any time point examined, but there was a significant increase in TH expression 28 days after TBI (optical density 334 +/- 68% or 3.3-fold, ipsilateral and 218 +/- 39% or 2.2-fold, contralateral) relative to the sham controls. The increase in TH may reflect a compensatory response of dopaminergic neurons to upregulate their synthesizing capacity and increase the efficiency of dopamine neurotransmission chronically after TBI.

Animals↗

PubMed2004

Aging with traumatic brain injury: long-term health conditions.

Although traumatic brain injury (TBI) is a leading cause of death and disability in young adults, older adults over the age of 75 are also at high risk for TBI. As even mild injury can lead to disabling consequences, the long-term consequences of TBI need to be better understood, especially as the survival rate has increased dramatically in the last few decades. This research examined the prevalence of long-term health conditions after TBI. Using a retrospective cohort design, we examined consecutive records of adults with moderate to severe TBI discharged from a large rehabilitation hospital in Pennsylvania from 1974 to 1989. Baseline clinical information was abstracted from medical records. We interviewed consenting participants up to 24 years after injury. Our findings show a higher than expected prevalence of self-reported arthritis in the middle-aged population. There was also a high prevalence of problems with sleep and nerves many years post-injury. Some of the health conditions documented in this study could potentially be addressed early in rehabilitation; this study supports the screening of more physical health conditions in persons aging with TBI.

Adult↗

PubMed2001

Role of cerebral inflammation after traumatic brain injury: a revisited concept.

Neuroinflammation occuring after traumatic brain injury (TBI) is a complex phenomenon comprising distinct cellular and molecular events involving the injured as well as the healthy cerebral tissue. Although immunoactivation only represents a one of the many cascades initiated in the pathophysiology of TBI, the exact function of each mediator, activated cell types or pathophysiological mechanism, needs to be further elucidated. It is widely accepted that inflammatory events display dual and opposing roles promoting, on the one hand, the repair of the injured tissue and, on the other hand, causing additional brain damage mediated by the numerous neurotoxic substances released. Most of the data supporting these hypotheses derive from experimental work based on both animal models and cultured neuronal cells. More recently, evidence has been provided that a complete elimination of selected inflammatory mediators is rather detrimental as shown by the attenuation of neurological recovery. However, there are conflicting results reported on this issue which strongly depend on the experimental setting used. The history of immunoactivation in neurotrauma is the subject of this review article, giving particular emphasis to the comparison of clinical versus experimental studies performed over the last 10 years. These results also are evaluated with respect to other neuropathologies, which are years ahead as compared to the research in TBI. The possible reciprocal influence of peripheral and intrathecal activation of the immune system will also be discussed. To conclude, the future directions of research in the field of neurotrauma is considered.

Animals↗

PubMed2002

Factors influencing admission among children with a traumatic brain injury.

OBJECTIVES: To describe the epidemiology of traumatic brain injury (TBI) among children in Maryland and to examine factors that influence hospital admission. METHODS: Statewide mortality, hospital discharge, and ambulatory care data were used to identify all TBI-related emergency department (ED) visits, hospitalizations, and deaths that occurred in 1998 to children aged 0-19 years according to the Centers for Disease Control and Prevention's standard case definition and protocol. Inpatient admission was modeled as a function of patient, injury, and hospital characteristics. RESULTS: The overall incidence of pediatric TBI (i.e., ED visits, hospitalizations, and deaths) in 1998 was 670/100,000. After controlling for injury severity and other factors, uninsured children were 40% less likely to be hospitalized (95% CI = 0.43 to 0.82) and children with Medicaid were 90% more likely to be hospitalized (95% CI = 1.42 to 2.54) than were those with private insurance. The presence of a major associated injury significantly influenced the likelihood of hospitalization, especially among children with a minor (OR = 8.8) to moderate (OR = 11.6) TBI. Children who presented to a trauma center hospital were significantly more likely to be hospitalized than children treated at a non-trauma center hospital, although this varied depending on income (OR = 1.8 for high versus low) and hospital volume (OR = 2.6 for a small hospital and OR = 29.0 for a large hospital). CONCLUSIONS: After adjusting for TBI severity and the presence of associated injuries, significant differences in hospitalization rates may exist among different patient subgroups and hospitals for children who sustain TBIs.

Adolescent↗