Search

Objective: Radiologic predictors of posttraumatic amnesia (PTA) duration are lacking. We hypothesized that the number and distribution of traumatic microbleeds (TMBs) detected by gradient recalled echo (GRE) magnetic resonance imaging (MRI) predicts PTA duration. Setting: Academic, tertiary medical center. Participants: Adults with traumatic brain injury (TBI). Design: We identified 65 TBI patients with acute GRE MRI. PTA duration was determined with the Galveston Orientation and Amnesia Test, Orientation Log, or chart review. TMBs were identified within memory regions (hippocampus, corpus callosum, fornix, thalamus, and temporal lobe) and control regions (internal capsule and global). Regression tree analysis was performed to identify radiologic predictors of PTA duration, controlling for clinical PTA predictors. Main Measures: TMB distribution, PTA duration. Results: Sixteen patients (25%) had complicated mild, 4 (6%) had moderate, and 45 (69%) had severe TBI. Median PTA duration was 43 days (range, 0-240 days). In univariate analysis, PTA duration correlated with TMBs in the corpus callosum (R = 0.29, P = .02) and admission Glasgow Coma Scale (GCS) score (R =-0.34, P = .01). In multivariate regression analysis, admission GCS score was the only significant contributor to PTA duration. However, in regression tree analysis, hippocampal TMBs, callosal TMBs, age, and admission GCS score explained 26% of PTA duration variance and distinguished a subgroup with prolonged PTA. Conclusions: Hippocampal and callosal TMBs are potential radiologic predictors of PTA duration. [ABSTRACT FROM AUTHOR]

Objective: To create a profile of individuals with traumatic brain injury (TBI) who received inpatient rehabilitation and were discharged to an institutional setting using characteristics measured at rehabilitation discharge. Methods: The Traumatic Brain Injury Model Systems National Database is a prospective, multicenter, longitudinal database for people with moderate to severe TBI. We analyzed data for participants enrolled from January 2002 to June 2012 who had lived in a private residence before TBI. This cross-sectional study used logistic regression analyses to identify sociodemographic factors, lengths of stay, and cognitive and physical functioning levels that differentiated patients discharged to institutional versus private settings. Results: Older age, living alone before TBI, and lower levels of function at rehabilitation discharge (independence in locomotion, bladder management, comprehension, and social interaction) were significantly associated with higher institutionalization rates and provided the best models identifying factors associated with institutionalization. Institutionalization was also associated with decreased independence in bed-chair-wheelchair transfers and increased duration of posttraumatic amnesia. Conclusions: Individuals institutionalized after inpatient rehabilitation for TBI were older, lived alone before injury, had longer posttraumatic amnesia durations, and were less independent in specific functional characteristics. Research evaluating the effect of increasing postdischarge support and improving treatment effectiveness in these functional areas is recommended. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of participation in a memory group intervention focusing on internal strategy use on persons with traumatic brain injury-related memory impairment. Participants: Ninety-four adults with traumatic brain injury (54 in the experimental group and 40 controls) and resulting memory impairment, with seventies ranging from mild to severe. All participants were at least 18 years of age at the time of injury and at least 1 year post injury at the time of study. Design: Non randomized pre/posttest group comparison design. Main Outcome Measures: Hopkins Verbal Learning Test-Revised and Rivermead Behavioral Memory Test II. Results: Participation in the memory group intervention was associated with improved memory performance immediately postintervention, and improvements were maintained 1 month postintervention. Severe injury was associated with less improvement in memory outcomes than mild and moderate injuries. Age and preinjury education were not related to outcome. Conclusions: Individuals with traumatic brain injury may benefit from memory group intervention focusing on internal strategy use. Study hypotheses should be retested using a randomized, controlled design, and further research is needed to better delineate influences on intervention candidacy and outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Kreutzer JS, Rapport LJ, Marwitz JH, Harrison-Felix C, Hart T, Glenn M, Hammond F. Caregivers'' well-being after traumatic brain injury: a multicenter prospective investigation. Objective: To describe frequency and magnitude of caregivers'' emotional distress and life satisfaction using standardized assessment procedures; compare distress levels among spouses, parents, and other caregivers; and identify risk factors. Design: Prospective collaborative cohort study. Setting: Six Traumatic Brain Injury Model System Centers providing neurotrauma care, rehabilitation, and outpatient follow-up. Participants: Caregivers (N=273) of patients who were 1, 2, or 5 years postinjury. Interventions: Acute neurotrauma care, inpatient interdisciplinary brain injury rehabilitation, and postacute services. Main Outcome Measure: Brief Symptom Inventory-18 Depression, Anxiety, and Somatic dimensions. Results: Levels of Depression, Anxiety, and Somatic symptoms were equally prevalent, with 1 in 5 caregivers scoring above the cutoff in each area. The proportion of participants with 1, 2, and 3 elevations was 17.9%, 5.5%, and 10.6%, respectively. Conversely, approximately two thirds (65.9%) had no scores exceeding cutoffs. Distress levels among spouses, parents, and other caregivers were comparable. Higher caregiver distress was associated with caring for survivors who had worse functional status, received more supervision, were less satisfied with life, and used alcohol excessively. Conclusions: Depression, Anxiety, and Somatic symptoms are common among caregivers. Findings substantiate the importance of clinical care systems addressing the needs of caregivers in the long term as well as survivors. [Copyright &y& Elsevier]

Abstract: Strangman GE, O''Neil-Pirozzi TM, Goldstein R, Kelkar K, Katz DI, Burke D, Rauch SL, Savage CR, Glenn MB. Prediction of memory rehabilitation outcomes in traumatic brain injury by using functional magnetic resonance imaging. Objective: To evaluate the ability of functional magnetic resonance imaging (fMRI) measures collected from people with traumatic brain injury (TBI) to provide predictive value for rehabilitation outcomes over and above standard predictors. Design: Prospective study. Setting: Academic medical center. Participants: Persons (N=54) with TBI greater than 1 year postinjury. Intervention: A novel 12-session group rehabilitation program focusing on internal strategies to improve memory. Main Outcome Measure: The Hopkins Verbal Learning Test−Revised (HVLT-R) delayed recall score. Results: fMRI measures were collected while participants performed a strategically directed word memorization task. Prediction models were multiple linear regressions with the following primary predictors of outcome: age, education, injury severity, preintervention HVLT-R, and task-related fMRI activation of the left dorsolateral and left ventrolateral prefrontal cortex (VLPFC). Baseline HVLT-R was a significant predictor of outcome (P=.007), as was injury severity (for severe vs mild, P=.049). We also found a significant quadratic (inverted-U) effect of fMRI in the VLPFC (P=.007). Conclusions: This study supports previous evidence that left prefrontal activity is related to strategic verbal learning, and the magnitude of this activation predicted success in response to cognitive memory rehabilitation strategies. Extreme under- or overactivation of VLPFC was associated with less successful learning after rehabilitation. Further study is necessary to clarify this relationship and to expand and optimize the possible uses of functional imaging to guide rehabilitation therapies. [Copyright &y& Elsevier]

Objectives: To gather data on some quantifiable characteristics of residential community integration programs available to adults with brain injury. Participants: Directors, assistant directors, or coordinators of community integration programs for people with brain injury. Measurement Tools: The Community Integration Program Questionnaire (CIPQ). Design: Nationwide telephone survey of 30 residential community integration programs between June 2002 and June 2003. Results: There was tremendous variability in the areas of staffing, client, and programmatic characteristics. Staff-to-client ratio varied from 0.77 to 33. Lengths of stay ranged from 0.13 to 288 months. Times from injury to admission varied from 0.2 to 180 months. Conclusions: The considerable variability in characteristics of residential community integration programs for adults with brain injury presents significant challenges to researchers seeking to identify vital program components and to consumers attempting to compare programs. [ABSTRACT FROM AUTHOR]

During the past 20 years in pharmacology, a number of innovations have appeared that have resulted in significant changes in the drugs available for people with traumatic brain injury. Among the anticonvulsants, antidepressants, and antipsychotics, new drugs have appeared with fewer cognitive side effects. In these classes of drugs, as well as among central nervous system stimulants, once-daily or other sustained-release preparations have been introduced that make it considerable more likely that the patient will take his or her medication, with smaller fluctuations in drug levels as well. New drugs have also resulted in a greater number of medications for the clinician to choose from. The overall effect has been a dramatic change in pharmacology that has benefited people with traumatic brain injury. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a nationwide telephone survey to gather data on some of the quantifiable characteristics of community integration programs available nationwide to adults with brain injury. Design: The Community Integration Program Questionnaire was used to interview 49 outpatient facility-based community integration programs between June 2002 and June 2003. We then used descriptive statistics to analyze the characteristics of the programs. Results: There was tremendous variability in the areas of staffing, client, and programmatic characteristics. Conclusions: There is considerable variability among programs with respect to quantifiable characteristics of facility-based community integration programs. Future studies should explore which charateristics affect outcomes. [ABSTRACT FROM AUTHOR]

Presents a differential diagnosis approach to the pharmacological treatment of cognitive, behavioral and affective disorders after traumatic brain injury. Division of the search for etiology into categories including preinjury diagnosis, neuropsychological disorders, sesnsorimotor disorder, medical disorders, adverse effects of medications, reactive mood and anxiety disorders, and sleep disorders.

Presents information on the potential applications of traditional and novel pharmacotherapeutic agents following traumatic brain injury. Discussion of dopamine metabolism and receptors; Concerns regarding the use of levodopa in brain injury population; Advantage of dopamine receptor direct agonists.

The article focuses on the significance of the evidence of an increased risk of sudden cardiac death and stroke among users of antipsychotic drugs for clinicians who treat traumatic brain injury (TBI). It discusses studies that further clarify the risk of antipsychotics for sudden cardiac death and stroke. Furthermore, it shows that there is no reason other than age to think that the risk is not increased, and physicians should consider prescribing antipsychotics to weigh the risks carefully.

Presents issues related to the rehabilitation of individuals who have sustained traumatic brain injury (TBI) as well as on spasticity management. Consequence of spasticity; Challenges faced by clinicians in choosing options that address the management of spasticity after TBI; Complications in assessing outcome.