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PubMed2025

Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS®) Coupled with Transcranial Photobiomodulation (tPBM) For Co-Occurring Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD).

This study provides further evidence demonstrating the beneficial effects of PrTMS® treatment in co-occurring disorders. Furthermore, this study illustrates the benefit of augmenting PrTMS® with tPBM for superior outcomes. The positive results of this novel case study can be attributed to brain wave neuromodulation and increased neuronal ATP production, resulting in synergistic enhanced neuroplasticity and brain optimization. Further, large-scale, randomized and blinded studies are recommended to validate our promising preliminary observations utilizing multifaceted interventions for co-occurring disorders.

Co-Occurring Disorders↗

PubMed1995

N of 1 study: amantadine for the amotivational syndrome in a patient with traumatic brain injury.

Severe amotivation, apathy, and abulia, significantly retard rehabilitation following traumatic brain injury. Preliminary, uncontrolled research has suggested possible benefit with amantadine for this behavioural syndrome. This N of 1, double-blind, placebo-controlled study employed amantadine 100 mg three times daily in one such patient. Therapists and nurses completed inventories scoring efforts towards initiation of therapeutic activities during each session, progress in therapy, and participation in therapy. Four treatment periods (two active medication, two placebo), of 2 weeks duration, were completed. Across four therapists, and for both treatment pairs, the average effect score increased from 0.86 on placebo to 1.74 on amantadine (possible range 0-6, 3 = 'average'). There were no side-effects. The study suggests possible benefit with amantadine for patients with amotivational syndrome after traumatic brain injury; a randomized clinical trial appears warranted and required.

Adult↗

PubMed2002

Serum S-100B and interleukin-8 as predictive markers for comparative neurologic outcome analysis of patients after cardiac arrest and severe traumatic brain injury.

OBJECTIVE: To compare S-100B and interleukin-8 serum values on scene/at admission and 12 hrs later with respect to neurologic long-term outcome 12 months after cardiac arrest and return of spontaneous circulation, as well as after severe traumatic brain injury. DESIGN: Prospective comparative cohort study. SETTING: On scene; intensive care units of a university hospital. PATIENTS: Twenty patients with out-of-hospital cardiac arrest. Twenty patients with severe traumatic brain injury. INTERVENTIONS: Therapy was adjusted to the standards of modern prehospital and intensive care management by physicians who were not involved in the study. MEASUREMENTS AND MAIN RESULTS: First median S-100B values of the cardiac arrest group (4.42 ng/mL) mounted as high as those of the traumatic brain injury group (4.11 ng/mL). Within 12 hrs, S-100B levels significantly decreased to 0.75 ng/mL in cardiac arrest patients and to 0.68 ng/mL in traumatic brain injury patients but remained significantly elevated compared with the controls (0.04 ng/mL). Interleukin-8 levels of the cardiac arrest patients on scene (30.33 pg/mL) were clearly elevated above normal (12.60 pg/mL) and increased significantly to 101.40 pg/mL after 12 hrs. They showed no significant difference compared with those of the traumatic brain injury patients (78.75 pg/mL and 96.00 pg/mL, respectively). Multivariate Cox regression analysis in cardiac arrest patients identified only the S-100B level measured 12 hrs after study entry as an independent predictor for unfavorable neurologic outcome according to the Glasgow Outcome Scale score. In contrast, S-100B as well as interleukin-8 levels quantified 12 hrs after admission significantly predicted an unfavorable neurologic course in the traumatic brain injury group. CONCLUSIONS: Significantly elevated S-100B and interleukin-8 serum levels 12 hrs after cardiac arrest suggest that primary brain damage and systemic inflammatory response are comparably serious with that of traumatic brain injury. In both collectives, increased S-100B values measured 12 hrs after insult correlated well with an unfavorable neurologic outcome after 12 months.

Adult↗

PubMed1991

Recurrent severe traumatic brain injury. Series of six cases.

Six of 141 persons treated for severe traumatic brain injury at the Medical College of Virginia were found to have a history of similar previous injury. These cases are presented in the context of the phenomenon of recurrent severe traumatic brain injury, which has received no systematic attention in epidemiologic studies of trauma.

Adolescent↗

PubMed2003

Financial and vocational outcomes 1 year after traumatic brain injury.

OBJECTIVE: To characterize financial and vocational outcomes among persons with traumatic brain injury (TBI) in terms of employment status, earned and private income, and public assistance received at the time of injury and at 1 year after injury. DESIGN: Nonexperimental, longitudinal study. SETTING: Inpatient TBI rehabilitation unit and participants' community of residence. PARTICIPANTS: Thirty-five persons with new TBI from 1 national Traumatic Brain Injury Model Systems center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status, earned and private monthly income, and public assistance received monthly at the time of injury and at 1-year follow-up. RESULTS: From the time of injury until 1-year follow-up, the percentage of persons employed decreased from 69% to 31%; the percentage unemployed increased from 11% to 49%; the average earned monthly income declined 51% (from US dollars 1,491 to US dollars 726); and the mean total public assistance received per month increased 275% (from US dollars 153 to US dollars 421). CONCLUSION: Assuming that this study sample is representative of national statistics for TBI, during the first year after injury, TBI is associated with an estimated $642 million in lost wages, US dollars 96 million in lost income taxes, and US dollars 353 million in increased public assistance.

Adult↗

PubMed1999

Psychosocial outcome risk indicator: predicting psychosocial outcome following traumatic brain injury.

This study examines the outcome of 29 individuals with traumatic brain injury (TBI) and 23 of their respective significant others, 12 months after discharge from inpatient rehabilitation services, as a means of determining the validity of a measure developed to predict psychosocial outcome. This measure consists of 18 questions that examine 12 factors and requires the rater to make a judgement about the likely impact each factor would have on the individual with TBI and significant other. Results indicate that the social work raters accurately predicted outcome according to the factors contained in the measure. Scores on the measure at discharge were also found to be associated with general psychological distress, anxiety and insomnia, depression, family functioning, and the problems related to emotion and behaviour. Although the sample size was small, there is an indication that the devised measure is useful in predicting outcome and so has clinical value in identifying adults at greatest risk of poor psychosocial outcome after a traumatic brain injury.

Adolescent↗

PubMedDate not supplied

Tau protein as a serum marker of brain damage in mild traumatic brain injury: preliminary results.

The objective of this study was to investigate the diagnostic value of serum tau protein in determining the severity of traumatic brain injury in patients with mild traumatic brain injury (mTBI) and high-risk patients. Adult patients who presented to our emergency department (ED) with mTBI over 1 year were prospectively enrolled. Patients underwent cranial computed tomography (CT) and were subdivided into high- and low-risk groups, according to the probability of resultant intracranial injury. Serum tau levels of 60 patients and 20 healthy volunteers, who served as a control group, were measured. The mean age of the 60 patients (45 males, 15 females) was 32.5 years (range, 15-66 y). Mean Glasgow Coma Scale (GCS) score was 14+/-0.6. CT scans demonstrated intracranial injury in 11 patients (18.3%) and depressed fracture in 4 patients (6.7%). Serum tau levels of patients (188+/-210 pg/mL), compared with those of controls (86+/-48 pg/mL), were relatively higher; however, differences were not statistically significant (P=.445). Also, serum tau levels of high-risk patients (307+/-246 pg/mL) were significantly higher than those of low-risk patients (77+/-61 pg/mL) (P=.001). A total of 48 patients (80%) were accessible for follow-up after 6 months. Postconcussive syndrome was observed in 8 patients, 5 of whom had serum tau protein levels that were higher than those of the other 3 patients. However, no statistically significant difference was observed (P>.05). Investigators of the present study noted that serum tau levels in patients with mTBI were increased. Therefore, it is believed that this biomarker may prove helpful in identifying high-risk patients with mTBI. However, additional studies are needed to establish the diagnostic value of serum tau in detecting traumatic brain injury in patients with mTBI.

Adolescent↗

PubMed2004

Attentional control and slowness of information processing after severe traumatic brain injury.

Attention is a basic cognitive function and a prerequisite for other cognitive processes and is frequently impaired after traumatic brain injury. In the present study, 29 severe traumatic brain injury patients and 30 control subjects completed a battery of three neuropsychological tests of attention (WCST, TMT, Stroop). The aim was to clarify the attentional mechanisms underlying tests performance and to explore the types of attentional impairment after severe traumatic brain injury. Significant differences were found between the control and clinical groups in almost all measures. However, some of these differences disappeared when the speed of information processing was controlled using covariance analysis. In addition, a factor analysis revealed a four-factor solution explaining 89.6% of the variance in the data, i.e. cognitive flexibility, speed of processing, interference and working memory. This result supports the view of at least four different subprocesses of attentional control underlie test performance and allows one to differentiate between high- and low-level processes. The implications for neuropsychological assessment and rehabilitation are discussed.

Adolescent↗

PubMed2000

The identification by physiotherapists of the physical problems resulting from a mild traumatic brain injury.

In New Zealand, over 9000 people are diagnosed with a traumatic brain injury (TBI) each year, with at least 80% being classified as mild. The cognitive deficits resulting from mild traumatic brain injury (MTBI) have been well documented, but this is not the case for the physical problems. As a result, the physical problems are not well understood and few people with a MTBI are referred for physiotherapy. The aim of this research was to use a modified Delphi Technique to gain consensus amongst physiotherapists working with TBI clients with regard to: (1) The common motor performance problems associated with MTBI; (2) The importance of assessing these motor performance problem; and (3) Whether these motor performance problems should be used in a formal assessment (FA) or included as a screening measure (SM). Following a pilot study to establish face validity and clarity of instructions, a national sample of 52 physiotherapists with a minimum of 1 year's experience working with TBI clients was recruited. In Round 1, 42 physiotherapists listed 424 physical problems which, in their clinical experience, may occur in people with a recent MTBI. A planning committee developed these listed problems into 33 items. In Round 2, these items were then rated by the physiotherapists as to their importance of being included in an assessment. Using 75% consensus criteria, 31 items were deemed as being at least 'important' for inclusion. In Round 3, the physiotherapists were asked whether these items should be used in a FA or used as a SM. Of the 31 items which were retained, seven reached consensus for FA (balance with unstable, reduced or changing base of support; dynamic standing balance; high level balance activities; quality of movement; ballistic activities; gait; proprioception). Five items reached consensus for being used as a SM (attention; behaviour; sport and leisure activities; vocational activities; quality of movement). Consensus of classification was not reached for the remaining 19 items which had previously been identified in Round 2 as being at least 'important' to be assessed. These results form the foundation for the development of an assessment/management protocol for physiotherapists working with adults with MTBI.

Activities of Daily Living↗

PubMed2004

Cerebral autoregulation in pediatric traumatic brain injury.

OBJECTIVE: The aims of this study were to document the incidence of impaired cerebral autoregulation in children with traumatic brain injury using transcranial Doppler ultrasonography and to examine the relationship between autoregulatory capacity and outcome in children following traumatic brain injury. DESIGN: Prospective cohort study. SETTING: Harborview Medical Center (level I pediatric trauma center) in Washington state. PATIENTS: Thirty-six children <15 yrs old with traumatic brain injury: Glasgow Coma Scale score <9 (n = 12, group 1), Glasgow Coma Scale score 9-12 (n = 12, group 2), and Glasgow Coma Scale score 13-15 (n = 12, group 3). INTERVENTIONS: Cerebral autoregulation testing was conducted during extracranial surgery. Mean middle cerebral artery flow velocities were measured using transcranial Doppler as mean arterial pressure was increased to whichever variable was greater: 20% above baseline or a set value (80 mm Hg for <9 yrs and 90 mm Hg for 9-14 yrs). Autoregulatory capacity was quantified by the Autoregulatory Index. Autoregulatory Index <0.4 was considered impaired cerebral autoregulation. Discharge outcome using the Glasgow Outcome Scale score was considered good if the Glasgow Outcome Scale score was > or =4. MEASUREMENTS AND MAIN RESULTS: Twenty-four (67%) of 36 children had an Autoregulatory Index > or =0.4. The incidence of impaired cerebral autoregulation was 42% (five of 12) in group 1, 42% (five of 12) in group 2, and 17% (two of 12) in group 3. Ten (42%) of the 24 children with intact cerebral autoregulation had a good outcome compared with only one of 12 (8%) children with impaired cerebral autoregulation (p =.04). Six of 12 (50%) children with impaired cerebral autoregulation had hyperemia compared with one of 24 (4%) children with intact cerebral autoregulation (p <.01). Hyperemia was associated with poor outcome (p =.01). CONCLUSIONS: The incidence of impaired cerebral autoregulation was greatest following moderate to severe traumatic brain injury. Impaired cerebral autoregulation was associated with poor outcome. Hyperemia was associated with impaired cerebral autoregulation and poor outcome.

Adolescent↗

PubMed1997

Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension.

BACKGROUND: Resuscitation with hypertonic saline/dextran (HSD) has been suggested to be efficacious in patients who have traumatic brain injury and are hypotensive. We undertook a cohort analysis of individual patient data from previous prospective randomized double-blinded trials to evaluate improvements in survival at 24 hours and discharge after initial treatment with HSD in patients who had traumatic brain injury (head region Abbreviated Injury Score > or = 4) and hypotension (systolic blood pressure < or = 90 mm Hg). METHODS: All variables and end points were defined before initiation of data handling. Investigators were blind as to the treatment. Case report forms were received from six studies. Of these, 223 patients met the inclusion for traumatic brain injury. Comparisons between HSD and standard of care were made using stratified analysis and logistic regression to assess efficacy, confounding, and interaction. Potential confounding variables of pre-fluid treatment, Glasgow Coma Scale score (3-8 vs. 9-15), injury type, and systolic blood pressure can be considered a priori factors that were known before randomization. Effects of the various trials was also considered. RESULTS: Treatment with HSD resulted in a survival until discharge of 37.9% (39 of 103) compared with 26.9% (32 of 119) with standard of care (p = 0.080). Using logistic regression, adjusting for trial and potential confounding variables, the treatment effect can be summarized by the odds ratio of 2.12 (p = 0.048) for survival until discharge. CONCLUSIONS: Patients who have traumatic brain injuries in the presence of hypotension and receive HSD are about twice as likely to survive as those who receive standard of care.

Abbreviated Injury Scale↗

PubMed1999

Current status of neuroprotection trials for traumatic brain injury: lessons from animal models and clinical studies.

Laboratory studies have identified numerous potential therapeutic interventions that might have clinical application for the treatment of human traumatic brain injury. Many of these therapies have progressed into human clinical trials in severe traumatic brain injury. Numerous trials have been completed, and many others have been prematurely terminated or are currently in various phases of testing. The results of the completed Phase III trials have been generally disappointing, compared with the expectations produced by the successes of these interventions in animal laboratory studies. In this review, we summarize the current status of human traumatic brain injury clinical trials, as well as the animal laboratory studies that led to some of these trials. We summarize criteria for conducting clinical trials in severe traumatic brain injury, with suggestions for future improvements. We also attempt to identify factors that might contribute to the discrepancies between animal and human trials, and we propose recommendations that could help investigators avoid certain pitfalls in future clinical trials in traumatic brain injury.

Animals↗

PubMed1993

Family functioning and injury severity as predictors of child functioning one year following traumatic brain injury.

This study examined changes in children's functioning in the year following traumatic brain injury (TBI) and the preinjury family and injury factors most predictive of children's overall adaptive functioning and social competence at 1 year. Ninety-four children with TBI (mild = 50, moderate = 25, severe = 19) and their families were consecutively enrolled from two regional medical centers. The age range was from 6 years to 15 years. Interviewer ratings and standard measures of family and child functioning were completed within 3 weeks of injury (measuring preinjury status), at 3 months and 1 year. Mean preinjury parent and teacher ratings of child functioning were within normal range. Older children (> or = 12 years) had worse preinjury functioning than younger children. Declines in child functioning were significantly associated with injury severity. Mild and moderately injured children had few declines in overall functioning. Severely injured children had the most dramatic early declines and improved only slightly between 3 months and 1 year; however, older children from poorly functioning families deteriorated in the same period. Injury severity and preinjury family functioning explained from 25% to 39% of the variation in child functioning at 1 year and up to 57% when the child's preinjury status was included. Children at risk for poorer adaptation following TBI can be identified and for optimal recovery should receive appropriate support services for optimal recovery.

Adaptation, Psychological↗

PubMed1993

Undetected musculoskeletal trauma in children with traumatic brain injury or spinal cord injury.

A prospective study of 82 traumatically injured patients was conducted to determine the frequency with which skeletal trauma was undetected at acute care facilities. The clinical significance of each instance of undetected trauma on the patient's rehabilitation programs was assessed. Between May 1987 and October 1988, all trauma patients who sustained a spinal cord injury (SCI) or a severe traumatic brain injury (TBI) had total body bone scans (Tc-99mMDP) prior to beginning rehabilitation. These patients were unable to indicate pain secondary to absent sensation or cognitive impairment. In 60 children with TBI, 16 had a total of 25 newly detected fracture sites and 19 had 24 newly detected areas of soft tissue trauma. In 12 children the findings were clinically significant in that they led to behavior problems or impeded therapy. Although three new fracture sites and six soft tissue trauma sites were detected in seven children with SCI, none were clinically significant. Additionally, heterotopic ossification was detected in 14 children, of which only two sites were previously known. In three children with TBI, the area of heterotopic ossification impeded functional range of motion. Based upon this data we conclude that a total body bone scan is useful in the child with TBI for the detection of undiagnosed skeletal or soft tissue trauma and heterotopic ossification not recognized during acute care.

Adolescent↗

PubMed2002

Anxiety disorders associated with traumatic brain injuries.

Anxiety disorders are common in the general population and may be even more common in people with traumatic brain injuries. This article presents a review of the literature on anxiety disorders as a result of traumatic brain injury, specifically post-traumatic stress disorder, generalized anxiety disorder, obsessive compulsive disorder, and panic disorder. Our current understanding suggests that the increased frequency of anxiety disorders after TBI may reflect an overlap between brain regions vulnerable to traumatic brain injury, and the neural circuitry of these disorders. Issues regarding treatment are largely anecdotal, and much remains unsettled. More research is needed, both in terms of diagnosis and treatment.

Anxiety Disorders↗

PubMedDate not supplied

Hypertension in traumatic brain injury.

The incidence and natural history of hypertension associated with traumatic brain injury were studied using a cohort of 80 patients discharged from a brain-injury rehabilitation centre. Although a significant incidence (15%) of hypertension is documented in traumatic brain-injured patients, the problem appears transient for most patients. Nonetheless, hypertension after brain injury merits treatment while it is an ongoing process for the anticipated few patients in whom it might persist.

Adult↗

PubMed1989

Recovery of function during inpatient rehabilitation for moderate traumatic brain injury.

This study evaluated the functional improvement of 189 patients with traumatic brain injury (TBI) who participated in a comprehensive rehabilitation program at a National Institute on Disability and Rehabilitation Research--designated Center for traumatic brain injury rehabilitation. Data were comprised of functional ratings reported by therapists in nine disciplines. Improvement in mobility, self-care, communicative, family, nursing, psychological, and recreation functions were observed. The relationship between functional level and length of stay, onset-admission interval, age, sex, education, and work history were examined. The benefits of rehabilitation are supported by this multidimensional study.

Adolescent↗

PubMed1999

Effect of moderate hypothermia on systemic and internal jugular plasma IL-6 levels after traumatic brain injury in humans.

Moderate hypothermia may reduce subsequent neuronal damage after traumatic brain injury. Interleukin (IL)-6 may have a role in the pathogenesis of traumatic neuronal damage or repair. Using the enzyme-linked immunological sorbent assay (ELISA), we serially measured IL-6 levels in plasma obtained from the radial artery (systemic) and internal jugular vein (regional) in 13 cerebral trauma patients who underwent hypothermia of 32-33 degrees C ranged from 4-9 days postinjury and 10 head-injured patients who were maintained at normothermic levels (36-37 degrees C). In both patient populations, surface cooling was used since even in the normothermic group, cooling was needed to maintain patient temperature in the normothermic range. All patients were mechanically ventilated after injection of midazolam and vecuronium. The administration of these agents were continued until the end of the study. Hypothermia was typically maintained for four days, however, in some cases based upon CT findings and/or intra-cranial pressure change, the duration was prolonged. No significant differences were found between the two groups in age, gender and Glasgow Coma Scale upon admission. Further, no differences were found in terms of the classification of computed tomography findings or the occurrence of pupillary abnormalities on admission. The patients in this study had not sustained either abdominal or thoracic trauma. Before inducing hypothermia, IL-6 levels in the arterial and internal jugular venous blood exceeded the normal range. Specifically, the internal jugular plasma levels were significantly higher than those in the arterial plasma. While IL-6 levels in the normothermic group did not decrease even at 4 days postinjury, the plasma cytokine levels fell at both sites sharply after moderate hypothermia. The cytokine suppression found in the hypothermic group continued even after rewarming in these patients showing an improved clinical course, but not in those whose condition worsened. In addition to these changes in cytokine levels, the Glasgow Outcome Scale at 6 months postinjury was significantly higher in the hypothermic group than in the normothermia group. Based on the above, this clinical study with its small patient sample size suggests the need for further prospective randomized studies to examine the role of cytokine suppression in the beneficial effects of moderate hypothermia in patients with traumatic brain injury.

Adolescent↗