Journal of neurotrauma
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Journal of neurotrauma · Dec 2016
The Evaluation of Magnesium Chloride within a Polyethylene Glycol Formulation in a Porcine Model of Acute Spinal Cord Injury.
A porcine model of spinal cord injury (SCI) was used to evaluate the neuroprotective effects of magnesium chloride (MgCl2) within a polyethylene glycol (PEG) formulation, called "AC105" (Acorda Therapeutics Inc., Ardsley, NY). Specifically, we tested the hypothesis that AC105 would lead to greater tissue sparing at the injury site and improved behavioral outcome when delivered in a clinically realistic time window post-injury. Four hours after contusion/compression injury, Yucatan minipigs were randomized to receive a 30-min intravenous infusion of AC105, magnesium sulfate (MgSO4), or saline. ⋯ Histological analysis revealed no significant increase in gray or white matter sparing with AC105 or MgSO4 treatment. Finally, AC105 did not result in higher Mg2+ levels in CSF than with the use of standard MgSO4. In summary, when testing AC105 in a porcine model of SCI, we were unable to reproduce the promising therapeutic benefits observed previously in less-severe rodent models of SCI.
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Journal of neurotrauma · Dec 2016
Effectiveness of automated locomotor training in patients with acute incomplete spinal cord injury: A randomized controlled multicenter trial.
The aim of this study was to evaluate whether the effect of longer training times (50 instead of 25 min per day) using a robotic device results in a better outcome of walking ability of subjects with a subacute motor complete (American Spinal Injury Association Impairment Scale [AIS]-B) and incomplete (AIS-C) spinal cord injury. Twenty-one patients were enrolled in the study, whereof 18 completed, on average, 34 trainings in 8 weeks. ⋯ It has to remain open whether even longer training times (more than 50 min) would result in a still better outcome. In any case, the extent of possible recovery in an individual patient is determined by the level and severity of spinal cord damage.
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Journal of neurotrauma · Dec 2016
Randomized Controlled Trial Multicenter StudyComputerized working memory training for children with moderate to severe traumatic brain injury: a double-blind, randomized, placebo-controlled trial.
Pediatric traumatic brain injury (TBI) places children at risk for deficits in working memory (WM; comprising a central executive [CE], and two storage systems: phonological loop [PL] and visuospatial sketchpad [VSSP]), which is strongly related to attention and academic skills in childhood. This study aimed to examine whether different components of WM can be improved following adaptive WM training (Cogmed) and whether improvements in WM generalize to other cognitive (attention) and academic skills (reading and mathematics) in children with TBI. Twenty-seven children with moderate to severe TBI were randomized to adaptive (Cogmed; n = 13) or non-adaptive training (active placebo; n = 14) and evaluated at baseline, post-training, and 3-months follow-up. ⋯ No gains were found on tests of attention. Adaptive training resulted in significantly greater gains on select academic skills (reading, but not mathematics): reading comprehension pre-post-training (ITT analyses) and reading accuracy pre-follow-up (CC and ITT analyses). This first, to our knowledge, study to examine the efficacy of adaptive WM training for children with TBI provides preliminary evidence of near and far transfer of training to WM and academic skills, respectively.
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Journal of neurotrauma · Dec 2016
Depression trajectories during the first year after traumatic brain injury.
Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. ⋯ They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).
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Journal of neurotrauma · Dec 2016
Intracranial pressure assessment in traumatic head injury with hemorrhage via optic nerve sheath diameter.
Our purpose was to improve the technique of measuring optic nerve sheath diameter (ONSD) for intracranial pressure (ICP) monitoring in cases of traumatic head injury with hemorrhage. In a retrospective study, computed tomography (CT) data of 312 adult patients were collected and analyzed. ONSDs were measured at 3 mm and 8-10 mm distance from the globe together with the eyeball transverse diameter (ETD). ⋯ We did not find a correlation between ONSD/ETD ratio and initial Glasgow Coma Scale score, but there was an inverse correlation between ONSD/ETD ratio and Glasgow Outcome Score (r = -0.83). We conclude that in cases with a traumatic head injury with hemorrhage, the ONSD is significantly enlarged, indicating elevated ICP. In ICP assessment, the most accurate results can be obtained if the ONSD is measured 8-10 mm from the globe and the ONSD/ETD ratio is calculated.