Journal of neurotrauma
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Journal of neurotrauma · Jan 2014
Randomized Controlled TrialPersistent differences in patterns of brain activation after sports-related concussion: A longitudinal fMRI study.
Avoiding recurrent injury in sports-related concussion (SRC) requires understanding the neural mechanisms involved during the time of recovery after injury. The decision for return-to-play is one of the most difficult responsibilities facing the physician, and so far this decision has been based primarily on neurological examination, symptom checklists, and neuropsychological (NP) testing. Functional magnetic resonance imaging (fMRI) may be an additional, more objective tool to assess the severity and recovery of function after concussion. ⋯ Measures of task performance revealed no significant differences between concussed versus control groups at any of the three time points with respect to any of the three n-back tasks. These findings suggest that functional brain activation differences persist at 2 months after injury in concussed athletes, despite the fact that their performance on a standard working memory task is comparable to normal controls and normalization of clinical and NP test results. These results might indicate a delay between neural and behaviorally assessed recovery after SRC.
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Journal of neurotrauma · Jan 2014
ReviewPharmacotherapy of Traumatic Brain Injury: State of the Science and the Road Forward Report of the Department of Defense Neurotrauma Pharmacology Workgroup.
Despite substantial investments by government, philanthropic, and commercial sources over the past several decades, traumatic brain injury (TBI) remains an unmet medical need and a major source of disability and mortality in both developed and developing societies. The U. S. ⋯ The Workgroup identified the six most critical research priority areas in the field of pharmacological treatment for persons with TBI. The priority areas represent parallel efforts needed to advance clinical care; each requires independent effort and sufficient investment. These priority areas will help the USAMRMC and other funding agencies strategically guide their research portfolios to ensure the development of effective pharmacological approaches for treating patients with TBI.
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Journal of neurotrauma · Jan 2014
Randomized Controlled TrialInvestigating the Properties of the Hemodynamic Response Function Following Mild Traumatic Brain Injury.
Abstract Although several functional magnetic resonance imaging (fMRI) studies have been conducted in human models of mild traumatic brain injury (mTBI), to date no studies have explicitly examined how injury may differentially affect both the positive phase of the hemodynamic response function (HRF) as well as the post-stimulus undershoot (PSU). Animal models suggest that the acute and semi-acute stages of mTBI are associated with significant disruptions in metabolism and to the microvasculature, both of which could impact on the HRF. Therefore, fMRI data were collected on a cohort of 30 semi-acute patients with mTBI (16 males; 27.83±9.97 years old; 13.00±2.18 years of education) and 30 carefully matched healthy controls (HC; 16 males; 27.17±10.08 years old; 13.37±2.31 years of education) during a simple sensory-motor task. ⋯ The interaction was the result of an earlier time-to-peak and positive magnitude shift throughout the estimated HRF in patients with mTBI relative to HC. This difference in HRF shape combined with the greater volume of activated tissue may be indicative of a potential compensatory mechanism to injury. The current study demonstrates that direct examination and modeling of HRF characteristics beyond magnitude may provide additional information about underlying neuropathology that is not available with more standard fMRI analyses.
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Journal of neurotrauma · Jan 2014
Comparative StudyTo Exclude or Not to Exclude: Further Examination of the Influence of White Matter Hyperintensities in Diffusion Tensor Imaging Research.
White matter hyperintensities (WMHIs) visible on magnetic resonance imaging (MRI) are common in both healthy adults and in those with medical or psychiatric problems. A practical methodological issue for diffusion tensor imaging (DTI) researchers is whether to include, or exclude, participants from a control group who have WMHIs. The aim of this study was to compare the influence of WMHIs on whole-brain DTI in trauma control subjects. ⋯ In the entire sample, the 2+WMHI group had a greater number of abnormal FA, MD, and RD scores, compared to the no-WMHI group (p<0.015 and Cohen's d >0.82, indicating large to very large effect sizes, for all comparisons). When controlling for the effects of age using a matched-groups design, the 2+WMHI group still had a significantly greater number of abnormal FA, MD, and RD scores, compared to the no-WMHI group (all p<0.012, all d >0.89, large to very large effect sizes). Researchers should be aware that the inclusion or exclusion of subjects with incidental WMHIs will influence the results of DTI studies.
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Journal of neurotrauma · Jan 2014
Randomized Controlled Trial Comparative StudyNeural Activation during Response Inhibition Differentiates Blast from Mechanical Causes of Mild to Moderate Traumatic Brain Injury.
Military personnel involved in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) commonly experience blast-induced mild to moderate traumatic brain injury (TBI). In this study, we used task-activated functional MRI (fMRI) to determine if blast-related TBI has a differential impact on brain activation in comparison with TBI caused primarily by mechanical forces in civilian settings. Four groups participated: (1) blast-related military TBI (milTBI; n=21); (2) military controls (milCON; n=22); (3) non-blast civilian TBI (civTBI; n=21); and (4) civilian controls (civCON; n=23) with orthopedic injuries. ⋯ These results indicate that the chronic effects of TBI are associated with abnormal brain activation during successful response inhibition. During failed inhibition, the pattern of activation distinguished military from civilian TBI, suggesting that blast-related TBI has a unique effect on brain function that can be distinguished from TBI resulting from mechanical forces associated with sports or motor vehicle accidents. The implications of these findings for diagnosis and treatment of TBI are discussed.