El Hadwe, SalimAssamadi, MouhssineBarrit, SamiHaidich, Anna-Bettina...
11页
查看更多>>摘要：In childhood， traumatic brain injury (TBI) poses the unique challenges of an injury to a developing brain and the dynamic pattern of recovery over time， inflicted TBI and its medicolegal ramifications。 The mechanisms of injury vary with age， as do the mechanisms that lead to the primary brain injury。 As it is common， and is the leading cause of death and disability in the USA and Canada， prevention is the key， and we may need increased legislation to facilitate this。 Despite its prevalence， there is an almost urgent need for research to help guide the optimal management and improve outcomes。 Indeed， contrary to common belief， children with severe TBI have a worse outcome and many of the consequences present in teenage years or later。 The treatment needs， therefore， to be multifaceted and starts at the scene of the injury and extends into the home and school。 In order to do this， the care needs to be multidisciplinary from specialists with a specific interest in TBI and to involve the family， and will often span many decades。
Lundine, Jennifer P.Ciccia, Angela H.Haider, Mohammad NadirSnedaker, Katherine Price...
8页
查看更多>>摘要：Objective Examine how demographic and injury factors impact identification and management of concussion in students。 Methods Prospective observational cohort。 Pre-K - 12th grade students within a large， urban school district reported to school with concussion during 2015-2019。 Participants were grouped into Elementary/Middle School (E/MS) and High School (HS) and compared by sex， concussion history， injury setting and mechanism， time to medical evaluation and clearance， absences， and recommended accommodations。 Results 154 E/MS and 230 HS students reported to school with physician-diagnosed concussion。 E/MS students experienced fewer concussions at school and from sports than HS。 More E/MS males than females sustained concussions， while this difference was reversed for HS。 Time-to-evaluation was longer for E/MS， specifically female E/MS students and those injured outside of school。 E/MS males were cleared more quickly than females。 In contrast， no differences were found between sexes for HS by injury setting， mechanism of injury， or management factors。 Conclusion Differences observed in E/MS students by demographic and injury factors are not observed in HS students。 Younger students， particularly females or those not injured in school or sports， may be at risk for delayed identification and prolonged time to clearance。 Future research should further characterize concussion management in E/MS children。
Esterov, DmitryWitkowski, JulieMcCall, Dana M.Wi, Chung-Il...
11页
查看更多>>摘要：Objectives The objective of this study was to identify characteristics associated with an increased risk of anxiety and mood disorder prior to 25 years of age， in children who sustained a traumatic brain injury (TBI) prior to age 10。 Methods This population-based study identified 562 TBI cases from a 1976-1982 birth cohort in Olmsted County， Minnesota。 TBI cases were manually confirmed and classified by injury severity。 Separate Cox proportional hazards regression models were fit to estimate the association of TBI and secondary non-TBI related characteristics with the risk of a subsequent clinically determined anxiety or mood disorder。 Multivariable-adjusted population attributable risk (PAR) estimates were calculated for TBI characteristics。 Results Older age at initial TBI and extracranial injury at time of initial TBI were significantly associated with an increased risk of anxiety (adjusted HR [95% CI]: 1。33 [1。16， 1。52] per 1-year increase and 2。41 [1。26， 4。59])， respectively。 Older age at initial TBI was significantly associated with an increased risk of a mood disorder (adjusted HR 1。17 [1。08-1。27])。 Conclusion In individuals sustaining a TBI prior to age 10， age at injury greater than 5 years old was the largest contributor to development of a mood or anxiety disorder。
Li, Adam Y.Durbin, John R.Hannah, Theodore C.Ali, Muhammad...
7页
查看更多>>摘要：Background High altitude may affect concussion， but prior studies are limited 。 We tested whether high altitude affects sport-related concussion (SRC) incidence， severity， and recovery。 Methods Twenty-five thousand eight hundred fifteen baseline and post-injury Immediate Post-Concussion Assessment and Cognitive Testing results were compiled from Florida and Colorado， low (27 m or 62 m) and high (1，640 m or 1，991 m) altitude locations， respectively。 Incidence， severity， and recovery of injury were compared between altitudes。 Results High altitude was associated with increased suspected concussion incidence (adjusted OR， 2。04 [95% CI， 1。86 to 2。24];P < 。0001)。 However， high altitude was associated with lower concussion severity measured by Severity Index (SI) (adjusted OR， 0。42 [95% CI， 0。37 to 0。49];P < 。0001)。 High altitude was associated with decreased recovery from post-concussive symptoms in the migraine (beta， -2。72 [95% CI， -3。31 to -2。13]; P < 。0001)， cognitive (beta， -1。88 [95% CI， -2。40 to -1。36]; P < 。0001)， and sleep symptom clusters (beta， -0。30 [95% CI， -0。52 to -0。08]; P = 。007)。 Athletes with initial SI >= 8 showed prolonged neurocognitive dysfunction at high altitude (HR， 1。38 [95% CI， 1。06 to 1。81]; P = 。02)。 Conclusions High altitude was associated with increased suspected concussions and prolonged recovery but less severe initial injury。
查看更多>>摘要：Objective Analyzing the association between hematologic parameters and abnormal cranial computerized tomography (CT) findings after head trauma。 Material and methods A total of 287 children with isolated traumatic brain injury (TBI) were divided into the 'normal' (NG)， 'linear fracture' (LFG) and 'intraparenchymal injury' groups (IPG) based on head CT findings。 Demographical/clinical data and laboratory results were obtained from medical records。 Results The neutrophil-lymphocyte ratio was markedly higher in the LFG (p = 0。010 and p = 0。016， respectively) and IPG (p = 0。004 and p < 0。001， respectively) compared with NG。 Lower lymphocyte-monocyte ratio (p = 0。044) and higher red cell distribution width-platelet ratio (RPR) (p = 0。030) were associated with intraparenchymal injuries。 Patients requiring neurosurgical intervention had higher neutrophil-lymphocyte ratio (p = 0。026) and RPR values (p = 0。031) and lower platelet counts (p = 0。035)。 Lower levels of erythrocytes (p = 0。005)， hemoglobin (p = 0。003) and hematocrit (p = 0。002) were associated with severe TBI and unfavorable outcome (p = 0。012， p = 0。004 and p = 0。006， respectively)。 Conclusions Hematologic parameters are useful in predicting the presence of abnormal cranial CT findings in children with TBI in association with injury severity; surgery need and clinical outcome。
查看更多>>摘要：Aim The Child Behavior Checklist (CBCL) includes several sleep items。 We aimed to examine the convergent validity of CBCL sleep scores with validated sleep measures， and to explore their functional correlates Methods This cross-sectional study included 44 children with moderate to severe TBI， aged 6-15 years。 Parents completed the CBCL and Sleep Disturbance Scale for Children (SDSC)， and children wore actigraphy watches Results We found significant， albeit differential， associations between CBCL and SDSC sleep scores。 Specifically: (i) "trouble sleeping" with SDSC total score， (ii) "trouble sleeping" and "nightmares" with SDSC initiating and maintaining sleep， (iii) "talks/walks in sleep" with SDSC arousal， and (iv) "overtired，" "sleeps more" and CBCL sleep composite with SDSC excessive somnolence。 The CBCL item "sleeps less" was the only significant predictor of functioning; children who slept less had lower social competence。 No associations were found between CBCL sleep scores and actigraphy Conclusions The CBCL does not provide a comprehensive assessment of sleep disturbances in children with moderate to severe TBI。 Nevertheless， certain CBCL sleep items demonstrate initial convergent validity with subscales of the SDSC assessing select types of sleep disturbances。 The CBCL may be useful in research and clinical situations when administration of more comprehensive assessment sleep tools is not viable。
查看更多>>摘要：Objective To examine sense of smell as a biomarker for both severity and duration of post-concussion symptoms。 Methods Participants were recruited prospectively from an outpatient concussion clinic。 Sense of smell was assessed using the University of Pennsylvania Smell Identification Test (UPSIT) within 7 days， and 4， 8 - or 16-weeks post-injury。 UPSIT normative data were used as normal controls。 The main outcomes were: symptom severity on the Sport Concussion Assessment Tool 3 (SCAT3) symptom inventory and time to physician-declared recovery。 Results A total of 167 participants (mean age 32。9 [SD， 12。2] years， 59% female [n = 99]) were classified at 1 week post injury as follows: severe hyposmia in 5 (3%)， moderate hyposmia in 10 (6%)， mild hyposmia in 48 (29%)， and normosmia in 104 (62%) individuals。 A convenience sample of 81 individuals with concussion were tested at follow-up。 Acute impairment of sense of smell following concussion was not associated with symptom severity on the SCAT3 or time to recovery。 Sense of smell was stable from baseline to follow-up in this population。 Conclusion This study provides evidence that routine testing of sense of smell in individuals with concussion is not warranted as a biomarker for severity of concussion and concussion recovery。
查看更多>>摘要：The purpose of this study was to test the feasibility and safety of High-Level Mobility (HLM) training on adults with Acquired Brain Injury (ABI)。 Our hypotheses were that HLM training would be feasible and safe。 This study was a pilot randomized control trial with a Simple Skill Group (SSG) and a Complex Skill Group (CSG)。 Both groups received 12 sessions over 8 weeks and completed 4 testing sessions over 16 weeks。 The SSG focused on locomotion， while CSG focused on the acquisition of running。 Feasibility was assessed in terms of process， resources， management， and scientific metrics， including safety。 Among the 41 participants meeting inclusion criteria， 28 consented (CSG， n = 13， SSG， n = 15)， 20 completed the assigned protocol and 8 withdrew (CSG n = 4， SSG n = 4)。 Adherence rate to assigned protocol was 100%。 There were two Adverse Events (AEs)， 1 over 142 SSG sessions and 1 over 120 CSG sessions。 The AE Odd Ratio (OR) (CSG:SSG) was 1。18 (95% CI: 0。07， 19。15)。 The data support our hypotheses that HLM training is feasible and safe on ambulatory adults with ABI。
查看更多>>摘要：Background The evaluation of functional cognition is a central concern in clinical practice。 However， there are few standardized or validated tools， and many of them take too long， requiring screening tests。 Aims To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury。 Moreover， to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes。 Materials and methods A cross-sectional design was applied following the guidelines of the STROBE checklist。 A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers。 A cognitive screening test and daily living activity tests were implemented， such as ACLS-5， MoCA， Barthel， and FIM+FAM。 Data were analyzed using non-parametric methods。 In addition， a structural analysis and simple regression models were performed。 Results Eighty patients with chronic acquired brain injury， with a mean age of 52， were recruited。 All tests are significantly related to the ACLS-5 score， a moderate effect size for MoCA (rho = 0。36)， and a strong effect size for the other two (rho > 0。50)。 Conclusions ACLS-5 predicts functional and cognitive performance quickly and effectively， optimizing assessment time and avoiding mental fatigue or physical exhaustion。
查看更多>>摘要：Primary Objective To examine whether vibration to the palm of the hand induces motor activity in the forearm muscles of individuals with post-stroke and healthy young adults。 We hypothesized that the vibration would induce antagonistic muscle activities via the motor cortex。 Research Design Observational study using the between- and within-subjects mixed design。 Methods and Procedures Vibratory stimulation was applied to the palm of the paretic and non-paretic hands in seven post-stroke hemiplegia， and of the right hand in 22 healthy young adults in the eyes-closed and eyes-open conditions。 Surface electromyography (sEMG) was recorded from the forearm extensors and flexors and the sEMG amplitudes were analyzed。 Main Outcomes and Results The extensor activities were significantly larger than that of the flexors in all hands。 Especially， the extensor activities were augmented when the eyes were open in the paretic and non-paretic hands。 Moreover， there was greater muscle activity in the non-paretic hand compared with the paretic hand。 Conclusions These novel findings revealed that vibration to the palm augmented the activity of the antagonistic forearm extensors， especially in the paretic hand， which was induced via top-down cortical modulation。 Thus， it can be utilized to improve the impaired forearm extensors in post-stroke rehabilitation。
NSTL
Taylor & Francis