Journal of neurotrauma
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Journal of neurotrauma · Aug 2019
Comparative StudyPostural limits of stability are more predominantly impaired and predictive of subjective balance symptoms than sensory organization in a cohort with Traumatic Brain Injury.
Balance problems are common after a traumatic brain injury (TBI). Symptoms of dizziness, unsteadiness, or imbalance have been most frequently attributed to sensory organization problems involving the use of visual, proprioceptive, and/or vestibular information for postural control. These problems can be assessed with the Sensory Organization Test (SOT). ⋯ Dizziness Handicap Inventory (DHI) results indicated mild disability, with the five activities most frequently endorsed as problematic being: looking up, performing quick head movements, performing ambitious such as sports or dancing activities, feeling frustrated, and performing strenuous house/yard work. Although regression analysis revealed that both tests significantly predicted subjective scores on the DHI, more LOS than SOT testing variables were important predictors of DHI results indicating disability. These results suggest that the LOS test is an informative tool that should be included in any objective balance evaluations that screen TBI patients with balance complaints.
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Journal of neurotrauma · Aug 2019
The Effects of Blast-Related Neurotrauma on Aurally-Aided Visual Search while Standing and Walking.
Service members (SMs) who have suffered mild traumatic brain injury due to blast exposure (b/TBI) often report post-concussive symptoms consistent with auditory, visual, or vestibular impairments even when they score within the normal range on traditional clinical tests of sensory function. One possible explanation for this discrepancy is that patients who score in the low normal range in more than one sensory modality may be severely impaired in tasks that require multisensory integration. ⋯ The results show the b/TBI and healthy control groups performed equivalently in the AL and VD tasks, but that the b/TBI group responded roughly 15% slower in the AAVS task and 50% slower in the VOVS task. Walking had no effect on performance in the visual-only tasks, but both groups responded faster while walking in the AL and AAVS tasks without any reduction in accuracy.
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Journal of neurotrauma · Aug 2019
Serum Neurofilament Light Is Elevated Differentially in Older Adults with Uncomplicated Mild Traumatic Brain Injuries.
Neurofilament light (NF-L) might have diagnostic and prognostic potential as a blood biomarker for mild traumatic brain injury (mTBI). However, elevated NF-L is associated with several neurological disorders associated with older age, which could confound its usefulness as a traumatic brain injury biomarker. We examined whether NF-L is elevated differentially following uncomplicated mTBI in older adults with pre-injury neurological disorders. ⋯ A high correlation was found between age and NF-L levels in the total mTBI sample (r = 0.80), within the subgroups without pre-injury neurological diseases (r = 0.76) and with pre-injury neurological diseases (r = 0.68), and in the trauma control subjects (r = 0.76). Those with mTBIs and pre-injury neurological conditions had higher NF-L levels than those with no pre-injury neurological conditions (p < 0.001, Cohen's d = 1.01). Older age and pre-injury neurological diseases are associated with elevated serum NF-L levels in patients with head trauma and in orthopedically-injured control subjects.
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Journal of neurotrauma · Aug 2019
Prognosis of 6-month Glasgow Outcome Scale in severe traumatic brain injury using hospital admission characteristics, injury severity characteristics, and physiological monitoring during the first day post-injury.
Gold standard prognostic models for long-term outcome in patients with severe traumatic brain injury (TBI) use admission characteristics and are considered useful in some areas but not for clinical practice. In this study, we aimed to build prognostic models for 6-month Glasgow Outcome Score (GOS) in patients with severe TBI, combining baseline characteristics with physiological, treatment, and injury severity data collected during the first 24 h after injury. We used a training dataset of 472 TBI subjects and several data mining algorithms to predict the long-term neurological outcome. ⋯ TBI patient physiology of the first day-post-injury did not have a major contribution to patient prognosis six months after injury. In conclusion, 6-month GOS in patients with TBI can be predicted with good accuracy by the end of the first day post-injury, using hospital admission data and information on the best motor GCS achieved during those first 24 h post-injury. Passed the first day after injury, important physiological predictors could emerge from landmark analyses, leading to prediction models of higher accuracy than the one proposed in the current research.
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Sleep disruption can occur after brain injury; however, insomnia prevalence and severity in adolescents with persistent post-concussion symptoms have not been investigated. This study examined: 1) some of the psychometric properties of the Insomnia Severity Index (ISI), 2) the prevalence and severity of insomnia symptoms, and 3) associations between insomnia symptoms and clinical measures of post-concussion symptoms, mental health symptoms, and cognitive tests in adolescents with slow recovery from concussion. Participants (N = 121) were adolescents 13-18 years of age (mean = 16.2; standard deviation [SD] = 1.2) and, on average, of 6.4 months (SD = 3.8) post-concussion. ⋯ Insomnia was significantly associated with more cognitive complaints and higher rates of failure on performance validity tests, but not with actual objectively measured cognitive abilities. Insomnia is common in adolescents with slow recovery from concussion and is associated with worse post-concussion symptoms, anxiety, depression, cognitive complaints, and performance validity concerns. Investigating evidence-based treatments for insomnia should be a priority in this population.