scholarly journals Neurorehabilitation of Traumatic Brain Injury (TBI): A Clinical Review

2019 ◽  
Vol 7 (3) ◽  
pp. 47 ◽  
Author(s):  
Michael Oberholzer ◽  
René M. Müri
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Recovery Of Function ◽  
Neuropsychological Rehabilitation ◽  
Paroxysmal Sympathetic Hyperactivity ◽  
Initial Sequence ◽  
Clinical Consequences ◽  
Severe Tbi ◽  
Post Traumatic

Traumatic brain injury (TBI) and its potential long-term consequences are of major concern for public health. Neurorehabilitation of affected individuals has some specific characteristics in contrast to neurorehabilitation of patients with acquired brain lesions of other aetiology. This review will deal with the clinical consequences of the distinct lesions of TBI. In severe TBI, clinical course often follows a typical initial sequence of coma; followed by disturbed consciousness; later, post-traumatic agitation and amnesia; and finally, recovery of function occurs. In the different phases of neurorehabilitation, physicians should be aware of typical medical complications such as paroxysmal sympathetic hyperactivity, posttraumatic hydrocephalus, and posttraumatic neuroendocrine dysfunctions. Furthermore, we address questions on timing and on existing evidence for different rehabilitation programmes and for holistic neuropsychological rehabilitation approaches.

scholarly journals Depression following traumatic brain injury: a comprehensive overview

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Marc Fakhoury ◽  
Zaynab Shakkour ◽  
Firas Kobeissy ◽  
Nada Lawand
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Health Concern ◽  
First Year ◽  
Comprehensive Overview ◽  
Symptoms Of Depression ◽  
Current State ◽  
Post Traumatic ◽  
Brain Changes

Abstract Traumatic brain injury (TBI) represents a major health concern affecting the neuropsychological health; TBI is accompanied by drastic long-term adverse complications that can influence many aspects of the life of affected individuals. A substantial number of studies have shown that mood disorders, particularly depression, are the most frequent complications encountered in individuals with TBI. Post-traumatic depression (P-TD) is present in approximately 30% of individuals with TBI, with the majority of individuals experiencing symptoms of depression during the first year following head injury. To date, the mechanisms of P-TD are far from being fully understood, and effective treatments that completely halt this condition are still lacking. The aim of this review is to outline the current state of knowledge on the prevalence and risk factors of P-TD, to discuss the accompanying brain changes at the anatomical, molecular and functional levels, and to discuss current approaches used for the treatment of P-TD.

306 GCS Does Not Predict Cognitive Outcome 30 Years After Severe Traumatic Brain Injury

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 264-265
Author(s):  
Molly E Hubbard ◽  
Abdullah Bin Zahid ◽  
Gabrielle Meyer ◽  
Kathleen Vonderhaar ◽  
David Y Balser ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Assessment Tool ◽  
Cognitive Status ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Symptom Severity Score ◽  
History Of ◽  
Severe Tbi

Abstract INTRODUCTION Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US. The effects of TBI on quality of life may not become apparent for years after the injury. There are conflicting reports in the literature regarding long term outcomes. Physicians are often asked to predict long term functional and cognitive outcomes, with limited data available. METHODS Patients with severe TBI (GCS = 9) who previously participated in a clinical trial during the 1980s were followed up with and compared to healthy controls without history of TBI. A health questionnaire, sports concussion assessment tool version 3 (SCAT3) and the Telephone Interview for Cognitive Status-modified (TICS-m) were completed over the phone and compared with controls using t-test. GCS at admission and 12-month GRS were used to predict to TICS-M at 30 years using linear regression. RESULTS >45 of the initial 168 subjects were confirmed alive, and 37 (13 females; mean age: 52.43 years S.D. 10.7) consented. Controls (n = 58; 23 females; mean age = 54 years, S.D. 11.5) had lower symptom severity score (6.7 S.D. 12.6 versus 20.6 S.D. 25.3; P = 0.005), lower total number of symptoms (3.4 S.D. 4.7 versus 7.12 S.D. 6.5; P = 0.006), higher standardized assessment of concussion score (25.6 S.D. 2.8 versus 21.2 S.D. 6.9; P = 0.001), and lower corrected MPAI-4 (22.3 S.D. 17.0 versus 43.7 S.D. 12.8; P < 0.001). GCS at admission did not predict cognitive status at 30-years assessed using TICS-M (P = 0.345). The Glasgow Outcome Scale score at 12-months was correlated to TICS-M at 30 years (R = 0.548, P < 0.001); each point decrease in GOS decreasing the score at TICS-M by 5.6 points. CONCLUSION Remote history of TBI disrupts the lives of survivors long after injury. Admission GCS does not predict cognitive status 30 years after TBI. The GOS at 12-months predicted the cognitive status assessed using TICS-M score at 30 years.

scholarly journals Prognostic Value of Admission Parameters in a Machine Learning Predictive Model in Patients With Severe Traumatic Brain Injury and Acute Subdural Hematomas

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Kevin John ◽  
Aaron McPheters ◽  
Andrew Donovan ◽  
Nicolas K Khattar ◽  
Jacob R Shpilberg ◽  
...  
Keyword(s):  
Machine Learning ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Predictive Model ◽  
Severe Traumatic Brain Injury ◽  
Acute Subdural Hematoma ◽  
High Morbidity ◽  
Radiographic Findings ◽  
Severe Tbi

Abstract INTRODUCTION Acute subdural hematoma (aSDH) in the context of severe traumatic brain injury (TBI) is a neurosurgical emergency. Predictive models have been used in an attempt to modulate the morbidity and mortality of patient outcomes. We used machine learning (ML) to identify admission risk factors predictive of long-term morbidity in the severe TBI patient population with aSDH. METHODS Between 2013 and 2016, 85 patients with severe TBI and aSDH were included in the analysis. Random forest, ML architecture, was used to create a predictive model of long-term morbidity stratification. About 46 patients were included in the high morbidity group [Glasgow Outcome Scale (GOS) 1-2] and 39 patients were in the low morbidity group (GOS 3-5). We included 30 admission input variables including medical and surgical co-morbidities, neurological examination, laboratory values, and radiographic findings. RESULTS The predictive model showed a 78% precision. The highest scoring input variable was the pupillary examination in predicting high vs low morbidity (bilaterally unreactive vs symmetrically reactive; P < .0001). GCS on admission was higher in the low morbidity group (4 [3-7] vs 7 [3-7]; P < .0101). Rotterdam scores were higher in the high-morbidity group (3 [3-5] vs 4 [4-5]; P < .0032). GCS motor examination on admission was higher in the low-morbidity group (5 [1-5] vs. 2 [1-5]; P < .0106). The basal cisterns were found to be more patent in patients with the low-morbidity group (P = .0012). CONCLUSION ML is an efficient tool that can provide a reasonable level of accuracy in predicting long-term morbidity in patients with severe TBI and aSDH. Monitoring these admission criteria can help with risk-stratification of patients into higher and low risk tracks. Integration of ML into the treatment algorithm may allow the development of more refined guidelines to guide goal-directed therapy.

scholarly journals 187 Early Post-Traumatic Seizures are Associated with Valproic Acid Plasma Concentrations and UGT1A6/CYP2C9 Genetic Polymorphisms in Patients with Severe Traumatic Brain Injury

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 249-250
Author(s):  
Yirui Sun ◽  
Jian Yu ◽  
Qiang Yuan ◽  
Jin Hu
Keyword(s):  
Traumatic Brain Injury ◽  
Valproic Acid ◽  
Brain Injury ◽  
Genetic Polymorphisms ◽  
Severe Traumatic Brain Injury ◽  
Plasma Concentrations ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Severe Tbi ◽  
Post Traumatic

Abstract INTRODUCTION Seizure is a common complication for severe traumatic brain injury (TBI). Valproic acid (VPA) is a first-line antiepileptic drug, though its metabolism is affected by genetic polymorphisms and varies between individuals. The aim of this study was to investigate such association and to explore its influence on the occurrence of early post-traumatic seizure. METHODS A case control study was conducted from 2012 to 2016 recruiting adult patients with severe TBI. Continuous electroencephalograph (EEG) monitoring was performed for 7 days. Genetic polymorphisms in UGT1A6, UGT2B7, CYP2C9, and CYP2C19 were analyzed in association with daily VPA plasma concentrations, adjusted dosages, and occurrence seizures. RESULTS >Among the 395 recruited patients, eight-three (21%) had early post-traumatic seizure, of which 30 (36.14%) were non-convulsive. Most seizures were first detected on day 1 (34.94%) and day 2 (46.99%) after injury. Patients with seizure had longer ICU length of stay and relatively lower VPA plasma concentrations. Patients with UGT1A6_19T>G/541A>G/552A>C double heterozygosities or CYP2C9 extensive metabolizers (EMs) initially had lower adjusted VPA plasma concentrations (power >0.99) and accordingly require higher VPA dosages during later time of treatment (power >0.99). The odds ratio indicated a higher risk of early post-traumatic seizure occurrence in male patients (OR 1.96, 95% CI 1.01-3.81, P = 0.043), age over 65 (OR 2.13, 95% CI 1.01-4.48), and with UGT1A6_19T>G/541A>G/552A>C double heterozygosities (OR 2.38, 95% CI 1.11-5.10, P = 0.02). CONCLUSION Continuous EEG monitoring are necessary to detect both convulsive and non-convulsive early post-traumatic seizures in severe TBI patients. UGT1A6/CYP2C9 polymorphisms have influence on VPA metabolism. UGT1A6_19T>G/541A>G/552A>C double heterozygositie is associated with occurrence of early post-traumatic seizures in addition to patients' age and gender. Further investigations with larger sample size are required to confirm the difference.

scholarly journals The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: is it feasible?

2020 ◽  
Author(s):  
Xiangyi Yin ◽  
Jie Wu ◽  
Lihui Zhou ◽  
Chunyan Ni ◽  
Minyan Xiao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Nursing Care ◽  
Severe Traumatic Brain Injury ◽  
Barthel Index ◽  
Control Group ◽  
Term Care ◽  
Severe Tbi

Abstract Background: Tracheostomy is very common in patients with severe traumatic brain injury (TBI), and long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients. Methods: Tracheostomy patients with severe TBI needing long-term care were included. All patients underwent two months long follow-up. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) (SAS) and Barthel assessment at the discharge and two months after discharge were evaluated. The tracheostomy related complications were recorded and compared.Results: A total of 60 patients were included. There weren’t significant differences between two groups in the GCS, Karnofsky, SAS and Barthel index at discharge((all p>0.05), the GCS, Karnofsky and Barthel index was all significantly increased after two months follow-up for two groups (all p<0.05), and the GCS, Karnofsky and Barthel index at two months follow-up in HCH group was significantly higher than that of control group(all p<0.05), but the SAS at two months follow-up in HCH group was significantly less than that of control group(p=0.009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all p<0.05).Conclusion: HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.

scholarly journals Dentate Gyrus Proliferative Responses After Traumatic Brain Injury and Binge Alcohol in Adult Rats

2020 ◽  
Vol 15 ◽  
pp. 263310552096890
Author(s):  
Son T Ton ◽  
Natalie S Adamczyk ◽  
Jack P Gerling ◽  
Ian C Vaagenes ◽  
Joanna Y Wu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Dentate Gyrus ◽  
Proliferative Response ◽  
Male Rats ◽  
Public Health Issue ◽  
Adult Rats ◽  
Double Labeling ◽  
Post Traumatic

Background: Traumatic brain injury is a significant public health issue that results in serious disability in survivors. Traumatic brain injury patients are often intoxicated with alcohol when admitted to the hospital; however, it is not clear how acute intoxication affects recovery from a traumatic brain injury. Our group has previously shown that binge alcohol prior to traumatic brain injury resulted in long-term impairment in a fine sensorimotor task that was correlated with a decreased proliferative and neuroblast response from the subventricular zone. However, whether binge alcohol prior to traumatic brain injury affects the proliferative response in the hippocampal dentate gyrus is not yet known. Methods: Male rats underwent binge alcohol (3 g/kg/day) by gastric gavage for 3 days prior to traumatic brain injury. Cell proliferation was labeled by BrdU injections following traumatic brain injury. Stereological quantification and immunofluorescence confocal analysis of BrdU+ cells in the hippocampal dorsal dentate gyrus was performed at 24 hours, 1 week and 6 weeks post traumatic brain injury. Results: We found that either traumatic brain injury alone or binge alcohol alone significantly increased dentate gyrus proliferation at 24 hours and 1 week. However, a combined binge alcohol and traumatic brain injury regimen resulted in decreased dentate gyrus proliferation at 24 hours post-traumatic brain injury. At the 6 week time point, binge alcohol overall reduced the number of BrdU+ cells. Furthermore, more BrdU+ cells were found in the dentate hilar region of alcohol traumatic brain injury compared to vehicle traumatic brain injury groups. The location and double-labeling of these mismigrated BrdU+ cells was consistent with hilar ectopic granule cells. Conclusion: The results from this study showed that pre-traumatic brain injury binge alcohol impacts the injury-induced proliferative response in the dentate gyrus in the short-term and may affect the distribution of newly generated cells in the dentate gyrus in the long-term.

scholarly journals Home Environment as a Predictor of Long-Term Executive Functioning following Early Childhood Traumatic Brain Injury

2017 ◽  
Vol 24 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Christianne Laliberté Durish ◽  
Keith Owen Yeates ◽  
Terry Stancin ◽  
H. Gerry Taylor ◽  
Nicolay C. Walz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Early Childhood ◽  
Brain Injury ◽  
Executive Functioning ◽  
Home Environment ◽  
Group Differences ◽  
Severe Tbi

AbstractObjectives:This study examined the relationship of the home environment to long-term executive functioning (EF) following early childhood traumatic brain injury (TBI).Methods:Participants (N=134) were drawn from a larger parent study of 3- to 6-year-old children hospitalized for severe TBI (n=16), complicated mild/moderate TBI (n=44), or orthopedic injury (OI;n=74), recruited prospectively at four tertiary care hospitals in the United States and followed for an average of 6.8 years post-injury. Quality of the home environment, caregiver psychological distress, and general family functioning were assessed shortly after injury (i.e., early home) and again at follow-up (i.e., late home). Participants completed several performance-based measures of EF at follow-up. Hierarchical regression analyses examined the early and late home environment measures as predictors of EF, both as main effects and as moderators of group differences.Results:The early and late home environment were inconsistent predictors of long-term EF across groups. Group differences in EF were significant for only the TEA-Ch Walk/Don’t Walk subtest, with poorer performance in the severe TBI group. However, several significant interactions suggested that the home environment moderated group differences in EF, particularly after complicated mild/moderate TBI.Conclusions:The home environment is not a consistent predictor of long-term EF in children with early TBI and OI, but may moderate the effects of TBI on EF. The findings suggest that interventions designed to improve the quality of stimulation in children’s home environments might reduce the long-term effects of early childhood TBI on EF. (JINS, 2018,24, 11–21)

scholarly journals Early Post-traumatic Seizure Occurrence in Pediatric Patients Receiving Levetiracetam Prophylaxis With Severe Traumatic Brain Injury

2020 ◽  
Vol 25 (3) ◽  
pp. 241-245
Author(s):  
Meghan J. Kolf ◽  
Christopher C. McPherson ◽  
Kara S. Kniska ◽  
Caitlyn M. Luecke ◽  
Michael A. Lahart ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Pediatric Trauma ◽  
Clinical Information ◽  
Concurrent Use ◽  
Initial Injury ◽  
Severe Tbi ◽  
Electrographic Seizures ◽  
Post Traumatic

OBJECTIVE Although levetiracetam is used for the prevention of early Post-traumatic seizures (EPTS) after traumatic brain injury (TBI), limited data exist describing the incidence of seizures in pediatric patients receiving levetiracetam prophylaxis. The objective of this research is to evaluate the prevalence of EPTS in children given prophylactic levetiracetam after severe TBI. METHODS This study was conducted at a Level 1 pediatric trauma center and included pediatric patients with severe TBI who received levetiracetam for EPTS prophylaxis. Demographics and clinical information were retrospectively collected and evaluated. The primary outcome was prevalence of clinical or electrographic seizures within 7 days of initial injury as noted in the EMR. RESULTS In 4 of 44 patients (9%), seizures developed despite levetiracetam prophylaxis. Concurrent use of other medications with antiepileptic properties was common (91%). There were no differences in demographic or baseline clinical characteristics between the group of patients experiencing seizures and those who did not. However, craniotomy was significantly more common in the seizure group (75% vs. 18%, p = 0.03). CONCLUSIONS Children receiving prophylaxis with levetiracetam after severe TBI had a lower incidence of seizures (9%) than had previously been reported in the literature (18%). Given the limited literature available supporting the use of levetiracetam for the prevention of EPTS in children experiencing severe TBI, further study is needed to support routine use.

scholarly journals Rescue Decompressive Craniectomy in Children with Severe Traumatic Brain Injury

2017 ◽  
Vol 07 (01) ◽  
pp. 033-038
Author(s):  
Panagiotis Poulos ◽  
Maria Kazantzi ◽  
Panagiotis Kalampalikis ◽  
Dimitrios Rallis
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Rescue Therapy ◽  
Increased Intracranial Pressure ◽  
Poor Neurological Outcome ◽  
Severe Tbi ◽  
The Impact

AbstractDecompressive craniectomy (DC) is considered a rescue therapy in patients with traumatic brain injury (TBI) with increased intracranial pressure (ICP). In this retrospective study, we examined the impact of craniectomy on ICP in children with severe TBI and their neurological outcome. A total of 14 patients were enrolled. Peak ICP was significantly lower (31 ± 2.9 to 19 ± 4.6, p < 0.001) and minimum cerebral perfusion pressure (CPP) higher (41 ± 10.5 to 58 ± 11.4, p < 0.001) postcraniectomy. The survival rate was 71%. However, 57% of our cohort had a poor neurological outcome at 6 months postinjury. In conclusion, although rescue DC was effective in controlling ICP and CPP, the long-term neurological outcome remained poor.

Post-traumatic amnesia predicts long-term cerebral atrophy in traumatic brain injury

Brain Injury ◽  
2006 ◽  
Vol 20 (7) ◽  
pp. 695-699 ◽  
Author(s):  
Elisabeth A. Wilde ◽  
Erin D. Bigler ◽  
Claudia Pedroza ◽  
David K. Ryser
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cerebral Atrophy ◽  
Traumatic Amnesia ◽  
Post Traumatic
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