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Autonomic nervous system dysregulation is a common consequence of traumatic brain injury (TBI). Heart rate variability (HRV) is a cost-effective measure of autonomic nervous system functioning, with studies suggesting decreased HRV following moderate-to-severe TBI. HRV biofeedback treatment may improve post-TBI autonomic nervous system functioning and post-injury emotional and cognitive functioning. We provide a systematic evidence-based review of the state of the literature and effectiveness of HRV biofeedback following TBI. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two coders coded each article and provided quality ratings. Seven papers met inclusion criteria. All studies included a measure of emotional functioning and 5 studies (63%) included neuropsychological outcomes. Participants completed 11 sessions of HRV biofeedback on average (range = 1 to 40). HRV biofeedback was associated with improved HRV following TBI. There was a positive relationship between increased HRV and TBI recovery following biofeedback, including improvements in cognitive and emotional functioning, and physical symptoms such as headaches, dizziness, and sleep problems. The literature on HRV biofeedback for TBI is promising, but in its infancy; effectiveness is unclear due to poor-to-fair study quality, and potential publication bias (all studies reported positive results). [ABSTRACT FROM AUTHOR]

Objective: This paper describes the BNI Screen for Higher Cerebral Functions (BNIS) and reviews studies that comment on its reliability, validity, and clinical and research utility. The ability of the BNIS to assess non-cognitive higher brain functions is also described. Methods: We reviewed the original administration manual, studies published in the BNI Quarterly of the Barrow Neurological Institute, and peer-reviewed studies on the BNI Screen identified by an academic database, PubMed and Google Scholar. Thirty-two studies were reviewed that describe normative data, psychometric properties, sensitivity and specificity estimates, the relationship of demographic factors to test performance, and its research utility. Results: The BNIS is a time efficient screening test often taking no longer than 12–18 minutes. In addition to cognitive functioning, it aids in assessing conation, awareness of memory impairment, and affects expression and perception. Sensitivity estimates ranged from 80% to 92.3%. Specificity estimates ranged from 38.9% to 90%. Its construct, concurrent, and predictive validity have been supported by a series of international studies using different language translations of the test. Conclusion: The BNIS is a useful screening test for identifying patients with underlying brain disorders that uniquely measures domains of functioning not sampled by other existing screening tests. [ABSTRACT FROM AUTHOR]

Effective pragmatic comprehension of language is critical for successful communication and interaction, but this ability is routinely impaired following Traumatic Brain Injury (TBI) (1,2). Individual studies have investigated the cognitive domains associated with impaired pragmatic comprehension, but there remains little understanding of the relative importance of these domains in contributing to pragmatic comprehension impairment following TBI. This paper presents a systematic meta-analytic review of the observed correlations between pragmatic comprehension and cognitive processes following TBI. Five meta-analyses were computed, which quantified the relationship between pragmatic comprehension and five key cognitive constructs (declarative memory; working memory; attention; executive functions; social cognition). Significant moderate-to-strong correlations were found between all cognitive measures and pragmatic comprehension, where declarative memory was the strongest correlate. Thus, our findings indicate that pragmatic comprehension in TBI is associated with an array of domain general cognitive processes, and as such deficits in these cognitive domains may underlie pragmatic comprehension difficulties following TBI. The clinical implications of these findings are discussed. [ABSTRACT FROM PUBLISHER]

Objective: To examine sex differences in the effectiveness of a Stories intervention for teaching affect recognition in people with a traumatic brain injury (TBI)., Setting: Post-acute rehabilitation facilities., Participants: 203 participants (53 women and 150 men) with moderate to severe TBI were screened. 71 were eligible and randomized to one of three treatment conditions: two affect recognition conditions and an active control (cognition). This paper examines sex differences between the Stories intervention (n = 23, 5 women and 18 men) and the cognitive treatment control (n = 24, 8 women and 16 men)., Design: Randomized controlled trial with immediate, 3- and 6-month follow-up post-tests. Interventions were 9 hours of computer-based training with a therapist., Measures: Facial Affect Recognition (DANVA2-AF); Emotional Inference from Stories Test (EIST)., Results: A significant treatment effect was observed for the Stories intervention for women, who demonstrated and maintained improved facial affect recognition. In contrast, males in our sample did not benefit from the Stories intervention., Conclusion: This positive finding for the Stories intervention for females contrasts with our conclusions in a previous paper, where an analysis collapsed across sex did not reveal an overall effectiveness of the Stories intervention. This intervention warrants further research and development.

Mindfulness-based interventions can support recovery from mild traumatic brain injury (mTBI). Although measurement is a key determinant of outcomes, there is no comprehensive assessment of measurement approaches used to capture outcomes of these programs. Here, we review the domains targeted, measurement techniques used, and domains and techniques most affected by mindfulness-based interventions for mTBI. We conducted a scoping review. After screening and full-text review, we included 29 articles and extracted data related to measurement domains, techniques, and results. We identified 8 outcome domains, each with multiple subdomains. The most common domains were cognitive symptoms and general health/quality of life. No quantitative studies directly assessed sleep, physical-function, or pain-catastrophizing. Self-report was the most common measurement technique, followed by performance-based methods. Coping, somatic symptoms, emotional symptoms, stress response, and domains of cognition (particularly attention) were the most frequently improved domains. Qualitative results described benefits across all domains and suggested novel areas of benefit. Biomarkers did not reflect significant change. Mindfulness-based interventions for mTBI impact a range of clinical domains and are best captured with a combination of measurement approaches. Using qualitative methods and expanding the breadth of outcomes may help capture underexplored effects of mindfulness-based interventions for mTBI. [ABSTRACT FROM AUTHOR]

Although the medical literature has a long history of description and comment on concussion, the occurrence of concussion within the context of sports other than boxing was not judged to be problematic until the 1980s. Neuropsychological assessment played a critical and integral role in identifying the cognitive sequelae of concussion and mapping out the short- and long-term vagaries in recovery. This paper captures that history and expands upon current applications of neuropsychological assessment in the diagnosis and management of sport-related concussion. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a review of literature and quantify the effect that traumatic brain injury (TBI) has on oculomotor functions (OM). Methods: A systematic review and meta-analysis was conducted from papers that objectively measured saccades and smooth-pursuit eye movements in mild and severe TBI. Results: The overall impact of TBI on OM functions was moderate and significant with an effect size of 0.42 from 181 OM case-control comparisons. The heterogeneity, determined using the random effect model, was found to be significant (Q (180) = 367, p < 0.0001, I2 = 51) owing to the variety of OM functions (reflexive saccades, antisaccades, memory-guided saccades, self-paced saccades and pursuits) measured and varying post-injury periods.The overall effect on OM functions were similar in mild and severe TBI despite differences in combined effect size of various OM functions. OM functions involving complex cognitive skills such as antisaccades (in mild and severe TBI) and memory-guided saccades (in mild TBI) were the most adversely affected, suggesting that OM deficits may be associated with cognitive deficits in TBI. Conclusion: TBI often results in long-standing OM deficits. Experimental measures of OM assessment reflect neural integrity and may provide a sensitive and objective biomarker to detect OM deficits following TBI. [ABSTRACT FROM AUTHOR]

Background: Soccer is currently the most popular and fastest-growing sport worldwide. Similar to many sports, soccer carries an inherent risk of injury, including concussion. Soccer is also unique in the use of 'heading'. The present paper provides a comprehensive review of the research examining the incidence, mechanisms, biomarkers of injury and neurocognitive outcomes of concussions and heading in soccer. Methods: Seven databases were searched for articles from 1806 to 24 May 2013. Articles obtained by the electronic search were reviewed for relevance, with 229 selected for review. Ultimately, 49 articles met criteria for inclusion in the present review. Results: Female soccer players have a higher incidence of concussions than males. The most frequent injury mechanism is player-to-player contact for both genders. Few studies examined the effects of concussion in soccer players; however, neurocognitive outcomes were similar to those reported in the larger sport concussion literature, while the effect of heading is less clear. Conclusion: Despite variation in research designs and study characteristics, the outcomes of concussions in soccer align with the greater concussion literature. This review makes recommendations for future research to increase standardization of research for improved understanding of concussions in soccer as well as the effects of heading. [ABSTRACT FROM AUTHOR]

Background: Executive functioning (EF) deficits are common sequelae of traumatic brain injury (TBI). These deficits extend beyond the acute stages of recovery and pose a significant challenge in rehabilitation efforts. Current theories of EF propose a multidimensional construct. This paper provides an integrative theoretical framework with interactive dimensions for the assessment and treatment of EF that can assist the interdisciplinary team to successfully manage EF deficits secondary to TBI. Methods: This paper is a review of pertinent literature related to assessment of EF. It concludes with a case presentation that illustrates the utility of the proposed theoretical framework in the rehabilitation context. Conclusions: Formal neuropsychological, standardized psychometric measures and informal clinical observations, particularly as they relate to contextual assessment, should be incorporated in order to effectively assess EF difficulties in survivors of TBI. The paper concludes with recommendations for effective assessment and treatment of EF by the interdisciplinary team consisting of speech-language pathologists and neuropsychologists. [ABSTRACT FROM AUTHOR]

The notion of social cognition is an umbrella term which refers to a set of processes which permit the perception of social cues from the self and others, the interpretation and understanding of own and other's emotions, beliefs and behaviors, and the generation of responses to these inferences to guide social behavior. This paper is an introduction to our special issue of Brain Injury devoted to the study of social cognition after traumatic brain injury. [ABSTRACT FROM AUTHOR]

Background: Significant attention has been focused on concussions in children, but a dearth of research evidence exists supporting clinical evaluation and management. Aim: The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for children as young as 5 years old. Methods: This study reviews the CDC-funded research programme, including the development of tools for post-concussion symptom assessment involving the child and parent, measurement of specific neurocognitive functions and assessment of dynamic cognitive exertional effects. Results: A clinical approach to active, individualized, moderated concussion rehabilitation management is presented, including a 10-step guide to symptom management, with a specific focus on the school challenges faced by the recovering student. Conclusion: To better inform concussion practice across the developmental age spectrum, a significant need exists for further research evidence to refine clinical assessment methods and develop effective treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Introduced in the 1980s, the neurofunctional approach (NFA) is one of the few interventions designed primarily for clients with severe deficits following traumatic brain injury (TBI). Specifically the NFA was intended for those individuals who were limited in their ability to solve novel problems or generalize skills from one setting to another and whose lack of insight limited their engagement in the rehabilitative process. Description of the approach: The NFA is a client-centred, goal-driven approach that incorporates the principles of skill learning and promotes the development of routines and competencies in practical activities required for everyday living. Programmes based on the NFA are developed specifically to meet each client's unique needs, using a range of evidence-based interventions. Recent evidence: Recently the NFA has been found to be more effective than cognitive-retraining for some individuals with moderate-to-severe TBI who have deficits in activities of daily living. This paper aims to define the core features of the NFA, outline the theoretical basis on which it is founded and consider implications of the findings for rehabilitation after TBI in general. The NFA is highly relevant for clients living in the community who require a case manager to direct an integrated, rehabilitation programme or provide structured input for the long-term maintenance of skills. [ABSTRACT FROM AUTHOR]

Background: CBT is a potentially effective treatment for anxiety disorders following TBI; however, empirical evidence has mainly come from clients with mild TBI. This paper describes a CBT-based anxiety treatment programme adapted for clients with more severe injuries. Two case studies are provided to illustrate the implementation of the programme, as a step toward larger scale testing of the programme's feasibility. Methods and procedures: A manualised adapted CBT treatment manual was used to deliver CBT in a standardised manner to two clients, one with severe and one with moderate TBI. Outcome was evaluated using a single-subject design with repeated measures of anxiety, mood and coping style at pre- and post-CBT. Results: The two clients demonstrated positive treatment response on either a measure of anxiety or a continuous measure of distress. Although neither demonstrated a clinically significant change according to the primary outcome measure (Hospital Anxiety and Depression Scale), they showed significant change in at least one corroborated measure of anxiety. Conclusions: This study suggests the potential utility of the adapted CBT programme for clients with moderate-severe TBI. Limitations of the single case studies were discussed, while noting how they would be addressed in a follow-up randomised controlled trial. [ABSTRACT FROM AUTHOR]

Objectives: Although patients with Locked-In-Syndrome (LIS) are often stated to have normal cognitive functioning, the few reports of neuropsychological assessment in these cases suggest this is not always true. This paper (a) reviews published reports of neuropsychological assessments of LIS patients, (b) presents a detailed neuropsychological assessment of a patient to determine if she has normal cognitive functioning and (c) presents the views of the patient on what has happened to her. Methods and procedures: An in-depth single case report assessing the cognitive and emotional functioning of a young woman with LIS plus a personal account from the patient. Detailed assessments were carried out using standardized neuropsychological tests and questionnaires measuring emotional functioning, pain and quality-of-life. The patient also states her views of what happened and how she feels. Results: On most tests, cognitive functioning was average or above, but some impairments were found (consistent with published literature). No emotional problems were detected. Quality of life was satisfactory. Pain perception was normal. Conclusions: Although LIS patients have no severe cognitive deficits, some cognitive difficulties are common. Despite severe physical and communication problems and some mild cognitive deficits on visual reasoning tasks, this patient feels she has a reasonable quality-of-life. [ABSTRACT FROM AUTHOR]

Primary objective: Neurobehavioural disability (NBD) has a major impact on long-term psychosocial outcome following acquired brain injury (ABI). A recent review highlighted that a reliable and valid measure that can adequately capture the subtle and varied characteristics of NBD has yet to be developed. In this paper, the work underpinning the 'St Andrews-Swansea Neurobehavioural Outcome Scale' (SASNOS) is described using a conceptual framework underpinned by the WHO ICF. The intention is that SASNOS will provide a reliable and valid means of measuring NBD. Methods and procedures: Three hundred and thirty-six sets of ratings were made regarding ABI and neurologically healthy samples. The initial pool of 117 items was subjected to exploratory factor analysis and Rasch analysis. Reliability and validity of the new measure were determined using a range of appropriate statistical methods. Main outcomes: Forty-nine items were retained, falling into five principal factors. Content and construct validity are calculated. SASNOS has excellent discriminant/diagnostic validity. Inter-rater and test-re-test reliability are good. Conclusions: SASNOS has a range of clinical and research applications and can be employed when measuring outcome. This new measure will enable neurorehabilitation services to directly compare the clinical populations they serve using the same frame of reference for NBD. [ABSTRACT FROM AUTHOR]

Primary objective: Operant conditioning interventions are effective in the management of post-acute ABI challenging behaviour. However, when this serves an avoidance or escape function, reinforcement approaches may be ineffective. In this paper the utility of a range of operant-derived ABI interventions is considered specifically with regard to behaviour whose prime function is avoidance or escape from rehabilitation activities. Methods and procedures: Efficacy of three operant interventions was determined by describing a single case study whose aggressive behaviour served an avoidance-escape function. Two interventions comprised variants of differential reinforcement: differential reinforcement of incompatible behaviour (DRI) and differential reinforcement of low rates of responding (DRL). The third intervention comprised situational time out (STO) and sustained verbal prompting. Main outcome: Despite reports of the efficacy of DRI and DRL, neither was beneficial in this case. However, STO and sustained verbal prompting proved highly effective in reducing aggression. Conclusions: Results are discussed in relation to two levels of explanation: function and cognition. Special emphasis is laid upon the extent to which interventions actively involve the patient and the degree of intrusiveness necessary for staff to implement therapeutic procedures. The case demonstrates how a scientifically-derived formulation regarding behaviour disorder can support multiple treatment options. [ABSTRACT FROM AUTHOR]

Background: Impairments in social competence are among the most prevalent sequelae of traumatic brain injury and present a major barrier to a person returning to a productive life. The recent increased incidence of TBI among military personnel and the subsequent difficulties these individuals face reintegrating into society accentuates the need for efficacious social competence treatment interventions for the TBI population. Method and results: This paper outlines the theoretical model and clinical application of Group Interactive Structured Treatment (GIST) for Social Competence. GIST- Social Competence is a structured cognitive-behavioural group therapy model addressing the underlying cognitive, communicative and emotional impairments impeding social competence after TBI. A recent randomized control trial (RCT) funded by the National Institute on Disability and Rehabilitation Research demonstrated the efficacy of this programme. GIST integrates the principles of established cognitive-behavioural therapy, group therapy and holistic neuro-rehabilitation in a manualized 13 week intervention combining a structured curriculum with a group therapy format. The structured cognitive-behavioural approach allows even those with significant underlying deficits (including self-awareness, memory, problem-solving, etc.) to benefit from this intervention. Conclusion: The GIST model can be applied to other treatment areas in TBI rehabilitation. Clinical observations from application of GIST with military personnel are reviewed. [ABSTRACT FROM AUTHOR]

Primary objective: Several published meta-analyses indicate that mild traumatic brain injury (MTBI) is associated with a favourable course of recovery over a period of days-to-weeks, with no indication of permanent impairment on neuropsychological testing by 3 months post-injury in group studies. These meta-analyses provide important but not definitive information relating to outcome from MTBI in individual patients. The purpose of this paper was to illustrate that a sub-group of patients with residual cognitive deficits could exist, yet be obscured using group inferential statistics. Main outcome and results: A sample of 30 concussed amateur athletes and a hypothetical sample of 30 adults who had sustained MTBIs were used to illustrate these statistical issues. In both groups, a minority of subjects with residual cognitive deficits were not identified using group statistics. Conclusions: It is important to appreciate that MTBI meta-analyses represent an aggregation of effect sizes derived from multiple groups across multiple studies. Therefore, this methodology could, theoretically, obscure small sub-group or individual effects. Implications for interpreting meta-analyses are discussed. [ABSTRACT FROM AUTHOR]

Objective: It has become evident that the cerebellum plays a role in cognitive function, and Schmahmann et al. have introduced the term "Cerebellar cognitive affective syndrome (CCAS)." In the present paper we report a patient with cerebellar hemorrhage who developed CCAS. Design: A case study. Methods: The patient was a 61-year-old right-handed man who was admitted to our hospital because of sudden headache, dizziness and vomiting. The patient showed ataxia of the trunk and the extremities, but no paralysis and disturbance of sensation. He was disoriented in time and showed recent memory disturbance, disturbance of attention, impairment of executive functions and reduced volition, and due to these symptoms, his daily living was also severely impaired. Results: With the aim of returning home, the patient received exercise therapy and cognitive rehabilitation, while home modification was performed, and living at home under the supervision of his family became possible. Cognitive function improved, while memory and attention disturbance, impairment of executive function remained. Conslusion: Cognitive dysfunction in patients with cerebellar damage is assumed to develop from disturbance of the cerebrocerebellar circuit, and that rehabilitation of these patients must include assessment of not only the motor function, but also of detailed assessment of cerebral function. [ABSTRACT FROM AUTHOR]

Objective . Executive function in activities of daily living (ADL) were investigated in 10 patients with excised frontal lobe tumours. Method . The patients with frontal lesions were compared to 10 normal controls with a neuropsychological test battery, a script generation task and a realistic implementation of complex multi-task ADL (planning and preparing a meal). Results . The patients manifested numerous basic executive deficits on the paper-pencil tests, were unimpaired on the script generation task despite an aberrant semantic structure and manifested marked anomalies in the meal preparation task. Conclusion . Frontal lobe deficits in lengthy complex multi-task ADL can be explained by impairment of several executive functions, generalized slowness of performance and paucity of behaviour. [ABSTRACT FROM AUTHOR]

To determine the impact of depression and post-traumatic stress on an automated oculomotor and manual measure of visual attention, compared to conventional neuropsychological assessment. Setting: Military traumatic brain injury (TBI) rehabilitation program. 188 Active Duty Service Members (ADSM) with a history of mild TBI. A cross-sectional and correlational study with data obtained through an IRB-approved data registry study. Main measures: Bethesda Eye & Attention Measure (BEAM); brief neuropsychological battery; self-reported symptom surveys including Neurobehavioral Symptom Inventory (NSI), Patient Health Questionnaire-8 (PHQ-8), and PTSD Checklist-5 (PCL-5). Small effect sizes were found for partial correlations between both depression and post-traumatic stress and key BEAM metrics. In contrast, small-to-medium effects sizes were found across all traditional neuropsychological test measures. This study illustrates the profile of impairments associated with depression and post-traumatic stress on saccadic eye movements and manual responses to BEAM relative to conventional neuropsychological tests. Results demonstrated that among ADSM seen for mTBI, depression and PTS exert a significant negative impact on measures of processing speed, attention, executive function, and memory across saccadic, manual, and conventional neuropsychological tests. However, the unique psychometric features of each of these assessment approaches may assist in distinguishing the effects of psychiatric comorbidities within this population. [ABSTRACT FROM AUTHOR]

There is a growing demand for remote assessment options for measuring cognition after mild traumatic brain injury (mTBI). The current study evaluated the criterion validity of the Brief Test of Adult Cognition by Telephone (BTACT) in distinguishing between adults with mTBI and trauma controls (TC) who sustained injuries not involving the head or neck. The BTACT was administered to the mTBI (n = 46) and TC (n = 35) groups at 1–2 weeks post-injury. Participants also completed the Rivermead Post Concussion Symptoms Questionnaire. The BTACT global composite score did not significantly differ between the groups (t(79) = −1.04, p = 0.30); the effect size was small (d = 0.23). In receiver operating characteristic curve analyses, the BTACT demonstrated poor accuracy in differentiating between the groups (AUC = 0.567, SE = 0.065, 95% CI [0.44, 0.69]). The BTACT's ability to discriminate between mTBI and TCs did not improve after excluding mTBI participants (n = 15) who denied ongoing cognitive symptoms (AUC = 0.567, SE = 0.072, 95% CI [0.43, 0.71]). The BTACT may lack sensitivity to subacute cognitive impairment attributable to mTBI (i.e., not explained by bodily pain, post-traumatic stress, and other nonspecific effects of injury). [ABSTRACT FROM AUTHOR]

To examine the stability of former National Football League (NFL) players' recall of professional football concussion. Two-hundred-and-nine former NFL players (ceasing football participation before/in 2001) completed surveys in 2001, 2010, and 2019 and reported the number of concussions sustained during their professional careers (0, 1 ... 10, >10). Participants were categorized into four 'recall stability' groups, based upon concussion recall [e.g., 'Same' (same number recalled), 'Increased' (more recalled than in prior time point)]. In 2019, participants completed measures of functioning (e.g., PROMIS Cognitive Function, Anxiety, Depression). Fleiss Kappa and generalized linear mixed models (GLMM)-based ordinal measures Kappa assessed stability across time points. 'Recall stability group' functioning scores were compared. Overall, 45.9% recalled more concussions over time; 14.8% reported the same number. Fleiss Kappa and GLMM-based ordinal measures Kappa suggested fair (0.22, 95% CI: 0.26, 0.38) and moderate stability (0.41, 95% CI: 0.35, 0.46), respectively. Higher cognitive functioning (P = 0.002), lower anxiety (P = 0.003), and lower depression (P = 0.007) were observed in the 'Same' vs 'Increased' groups. Despite subtle time-based variations in reporting, professional football concussion history recall was relatively stable. Better cognitive and psychological functioning was associated with greater stability in concussion recall. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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 (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50). ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion. [ABSTRACT FROM AUTHOR]

Primary objective: Sports-related concussion is a frequently-occurring, serious neurological event that can produce a spectrum of potentially debilitating primary and secondary problems. Many investigators—particularly neuropsychologists—have focused their efforts on identifying cognitive changes that accompany such injuries. As such, the present review evaluated the methodological quality of neuropsychological sports-related concussion research using a comprehensive, systematic method. Research design: Of 349 studies initially selected by search criteria, a total of 43 studies were evaluated using a Cochrane-style review format. Research methods: Studies were assigned a Level of Evidence using the Centre for Evidence-based Medicine (CEMB) framework. Relevant information related to the methods of each study were extracted and rated for methodological quality using a standardized form-based evaluation tool. Results: The review revealed heterogeneity among the studies in terms of research design, as well as a number of methodological weaknesses and inconsistencies. Conclusion: Despite the proliferation of neuropsychological research on sports-related concussion over the past decade, the methodological quality of studies appears to be highly variable, with many lacking proper scientific rigour. Future research in this area needs to be carefully controlled, repeatable and generalizable, which will contribute to developing practical, evidence-based guidelines for concussion management. [ABSTRACT FROM AUTHOR]

The article discusses research concerning the effect of screening tool Linguistic Acoustic ThreaT Effect (LATTE) for semantic threat in speech processing following a brain injury. Information about the assessment of emotion-identification difficulties in speech (EID) as rehabilitation in injured patients, is provided. Also mentioned is the process of phoneme detection based on sensory input and lexical-semantic code method.

To summarize the potential therapeutic benefits of medical marijuana for patients with traumatic brain injury (TBI). A systematic search was conducted using PubMed and Cochran's library for information regard the safety and efficacy of medical marijuana as a therapeutic agent. We investigated, in depth, articles specifically evaluating medical marijuana's use in TBI, as well as articles that summarized the effects of marijuana in general. Articles from the year 2000–2020 were included. A total of 37 articles met our inclusion criteria. An additional 3 articles were obtained from reference lists. Studies have shown that medical marijuana can potentially aid the recovery from TBI by modulating the endocannabinoid system, reducing inflammation and secondary injury. Adverse cognitive and physiological effects have been observed in the acute setting as well as chronically, though more research is necessitated. There is also the concern of significant drug-drug interactions that have not been thoroughly studied. Thus, while there is evidence that medical marijuana can be beneficial in the treatment of TBI, more research is necessitated to fully explore the long-term efficacy and adverse effects. [ABSTRACT FROM AUTHOR]

Relationships are important to quality of life after traumatic brain injury (TBI). However, there has been limited research into how to support dating skills or how professionals view this area. An online 52-item survey was developed and sent to professionals in the UK involved in rehabilitation after TBI. Recruitment was through professional networks, special interest groups and social media. 125 participants from a range of professions completed the survey. Many agreed that dating skills are important in rehabilitation (81.6%), but fewer (51.2%) reported engaging in this work. Psychologists, SLTs and OTs were identified as well placed to address dating skills. Case managers also appeared aware of this work. Participants reported using a range of activities to address dating skills, including managing disinhibited behavior and teaching interaction skills. Perceived barriers were both personal and professional, including lack of resources and feeling embarrassed. This study has highlighted an awareness of the importance of dating in brain injury, but professionals face multiple barriers to supporting dating skills. It is possible to draw on recommendations from related areas, including rehabilitation for cognitive communication difficulties and sexual dysfunction with further research to specifically link these areas to dating skills. [ABSTRACT FROM AUTHOR]

Background: The effect of childhood brain tumor and its treatments on the developing brain are recognized to cause late-occurring structural and functional changes, inclusive of neurocognitive and communication disturbances. Aims: The aim of the present study was to investigate changes in function in the prospective cognitive-communication and language abilities of two children surviving childhood brain tumor (CBT) over a 12-month period post-treatment. Methods: The comprehensive language and cognitive-communication abilities of two cases (male aged 7;8–8;8, female aged 10;9–11;9) were assessed at two timepoints over a 12-month period: six months and 18 months following completion of CBT cancer treatment. Results: Findings revealed a sharp decline in problem solving abilities over a 12-month period in the early stages of recovery from CBT in both cases examined, despite no or mild-moderate deficits in cognitive-communication or language function at initial assessment. Pre-literacy skills were noted to deteriorate on one task for one child, despite intact abilities at first assessment. Conclusions: The findings of progressive deterioration of cognitive-communication skills in both children treated for CBT highlights a clear need for ongoing surveillance and full comprehensive assessment across development. The critical need for ongoing management after discharge and implementation of early intervention throughout development is highlighted. [ABSTRACT FROM AUTHOR]

Objective: Characterize the working memory (WM) profile of children and youth who have experienced concussion by systematically synthesizing existing literature on the neuropsychological outcomes of these injuries. Methods: Implemented a peer-reviewed search strategy combining key concepts of concussion/mild traumatic brain injury (mTBI), WM, and pediatrics across MedLine, Embase, PsycINFO, and CINAHL. Included studies written in English with extractable results on a WM outcome measure in individuals aged 21 and under who experienced concussion. Applied narrative synthesis to identify trends in the literature. Assessed risk of bias and quality using the NHLBI's Quality Assessment of Observational Cohort and Cross-Sectional Studies. Results: 40 articles met inclusion criteria. 34/40 studies compared WM performance in children or youth with concussion to healthy controls, pre-injury performance, or normative values, of which 15 reported significantly lower WM performance in the concussion sample. Visual/spatial WM was more consistently impacted than verbal WM. Cognitive demanding dual-task conditions were also reliably impacted. Conclusion: Literature indicated that WM is vulnerable to negative outcomes following pediatric concussion, yet the nature of outcomes is variable. Clinicians and researchers should implement comprehensive and theoretically motivated WM assessments to better understand the WM components impacted by injury. [ABSTRACT FROM AUTHOR]

The objective was to assess the relationships between neuropsychological impairments, functional outcome and life satisfaction in a longitudinal study of patients after a severe traumatic brain injury (TBI) (PariS-TBI study). Out of 243 survivors, 86 were evaluated 8 years post-injury. They did not significantly differ from patients lost-to-follow up except for the latter being more frequently students or unemployed before the injury. Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), a functional independence questionnaire, employment, mood, fatigue and satisfaction with life. Neuropsychological outcome was assessed by two ways: performance-based outcome measures, using neuropsychological tests and patient and relative-based measures. Neuropsychological measures were not significantly related to initial injury severity nor to gender, but were significantly related to age and education. After statistical correction for multiple comparisons, cognitive testing and cognitive questionnaires were significantly correlated with most outcome measures. By contrast, satisfaction with life was only related with patient-rated questionnaires. A regression analysis showed that the Trail-Making-Test-A was the best predictor of functional outcome, in addition to education duration. Cognitive measures, particularly slowed information processing speed, were significant indicators of functional outcome at a long-term post-injury, beyond and above demographics or injury severity measures. [ABSTRACT FROM AUTHOR]

Language deficits following closed head injury CHI are widely considered as impairments secondary to the cognitive disruptions common to closed head injury. In addition, the use of standardized measures to assess the functioning of the language system in closed head injury has mostly been limited to aphasia test batteries which examine primary language functions only. This has resulted in generalizations as to the integrity of the language system following closed head injury, and as a consequence, consideration of the contribution of the language system to the achievement of com municative competence in this population has been minimized. This paper presents a framework in which the functional language system is identified as a hierarchical system containing primary and higher order language processes involved in reciprocal relationships with cognitive functions at each level. A group of 25 closed head injury subjects and 23 demographically matched control subjects were examined for linguistic proficiency using a battery of standardized tests which investigated the language system across a hierarchy of complexity, structure and predicability. In addition, 23 of the closed head subjects were administered a comprehensive neuropsychological test battery in order to determine the nature and extent of concomitant impairments in cognitive processes and their relation ship with impairments in the language system. The language battery was found to consistently dis criminate between the control and clinical groups indicating that the linguistic system is significantly impaired following CHI, with the lexical-semantic system being the most vulnerable to disruption. A strong influential relationship between language and cognitive processes was statistically confirmed and the nature of the relationship between aspects of language and cognition further delineated. [ABSTRACT FROM AUTHOR]

Objective: We evaluated cognitive, emotional, and social function after encephalitis, as perceived and reported by individuals post-encephalitis and their relatives. Hypothesis: There will be differential effects on various domains as self-reported by individuals post-encephalitis. Outcomes will be worse than in prior studies of other forms of acute brain injury. Post-encephalitis relative-report will demonstrate worse outcomes than self-report. Methods and Procedures: Members of The Encephalitis Society residing in the United Kingdom and Ireland were recruited to complete a demographic questionnaire and the European Brain Injury Questionnaire (EBIQ). Results: 266 individuals affected by encephalitis and 140 relatives participated in this study. The three domains with the highest (worst) mean scores were somatic, cognitive, and communication (p <.001). Individuals post-encephalitis self-reported worse outcomes than individuals post-stroke in seven of nine domains (p <.005), but there were no differences compared to individuals post-traumatic brain injury (TBI). Relatives reported worse encephalitis outcomes in seven of nine domains than did individuals directly affected by encephalitis (p <.005). Conclusions: Individuals affected by encephalitis experience the most significant symptoms in the somatic, cognitive, and communication domains. Outcomes as assessed by relatives were notably worse than those assessed by individuals themselves in nearly all domains. [ABSTRACT FROM AUTHOR]

Objective: To investigate the characteristics of head injury (HI) and its association with offending behaviour, psychological and neurobehavioral functioning, and cognitive performance in female prisoners. Methods: Using a cross-sectional design, female prisoners in the UK reporting a HI with a loss of consciousness (LOC) over ten minutes (n = 10) were compared with a group without a HI with LOC over ten minutes (n = 41) across a range of measures; including scores on standardized clinical questionnaires and performance-based cognitive assessments. Semi-structured clinical interviews assessed HI and forensic history, with forensic history triangulated against the prison database. Results: Domestic abuse was the most frequently reported cause of HI. The HI with LOC group had been to prison a greater number of times and had committed a greater number violent offences. No significant difference was found on self-reported psychological and neurobehavioral measures, or between the groups' cognitive functioning on neuropsychological tests. Conclusions: Psychosocial factors such as trauma may contribute to higher rates of violent offending and imprisonment in those with a HI with LOC. Domestic abuse is an important factor in HI amongst female prisoners. Forensic screening and interventions need to be designed, adapted and evaluated with consideration of trauma and HI. [ABSTRACT FROM AUTHOR]

Evidence of the effectiveness of virtual reality (VR) in motor and cognitive rehabilitation for traumatic brain injury (TBI) continues to be mixed. Therefore, we conducted a systematic literature review in accordance with PRISMA guidelines to strategically evaluate the strength of evidence supporting the use of VR as a rehabilitation tool for motor function and cognition in patients with TBI. The van Tulder criteria were modified to determine the quality of the outcomes of studies deemed eligible for inclusion in the review. Twelve studies were considered eligible for inclusion in the systematic review. These studies utilized methods of varying quality such as case and quasi-experimental studies and found moderately positive support for the effectiveness of VR-enhanced rehabilitation for both motor skills and cognitive deficits. The varying quality of the included studies provides moderate support for use of VR-enhanced rehabilitation techniques per the van Tulder criteria. This highlights the continued gap in the literature for robust studies that enable providers, policy makers, and the public to draw conclusions about the effectiveness of VR-enhanced rehabilitation for traumatic brain injury. Continued pursuit of analyses in the context of newer immersive VR-enhanced rehabilitation is recommended. [ABSTRACT FROM AUTHOR]

This study determined whether initial GCS score, head CT results, cognitive performance on IMPACT testing, or APOE genotype most effectively predicted 1-month functional outcome after mild traumatic brain injury (mTBI). This study tested the hypotheses that participants with poor performance on initial cognitive testing and those with an APOEe4 genotype would exhibit a poorer 1-month recovery after mTBI. Regression analysis determined which independent variables were most effective in predicting 1-month GOS-E or DRS score. Independent t-test procedures determined whether cognitive recovery varied across APOEe4 carriers. 49 participants admitted to the hospital with mTBI received cognitive evaluation within 48 hours after injury and again one month later. DNA analysis provided participant APOE genotype. Results showed that no study variables significantly predicted GOS-E or DRS scores, however, differences were identified when APOE groups were compared. Participants who were noncarriers of APOEe4 had significantly slower reaction times compared to APOEe4 carriers. Participants who were homozygous APOEe4 carriers had significantly lower instances of impulsivity than noncarriers. Further research is needed to understand how APOE allele status and performance on initial cognitive testing may influence short-term recovery after mTBI. [ABSTRACT FROM AUTHOR]

To investigate current speech pathology practice regarding working with friends. An online survey was conducted with 68 speech pathologists who worked with TBI across metropolitan and rural settings in Australia. The survey investigated the reasons speech pathologists work with friends, barriers to working with friends and perceptions of successful friendships post TBI. Descriptive statistics and content analysis of open ended responses were used to analyze the data. There were more speech pathologists (40%) who did not include friends compared to those who did. Friends were most commonly included in the rehabilitation process, through the provision of education programs. The primary rationale for working with friends was to prevent negative psychosocial outcomes for the person with TBI. There were numerous barriers to working with friends, most commonly the inability to access friends. Making and keeping friends are a significant part of most people's lives. Therefore, it is important to consider their role in contributing to improved outcomes for people with TBI. With communication partner training being an integral component to recovery and maintenance of relationships post TBI, the development of targeted education and training materials is warranted, to enable the inclusion of friends in the rehabilitation process. [ABSTRACT FROM AUTHOR]

Introduction: Defining and measuring limitations in functional status post-concussion has been challenging, as generic measures do not accurately reflect issues most relevant to adults with persistent post-concussion symptoms. Purpose: To develop a new concussion-specific measure of functional status for use in clinical practice and intervention trials. Method: We developed a conceptual model of functioning based on concepts identified from a previous qualitative study with persons with concussion and clinicians. An initial set of questionnaire items was generated from the concepts, codes, and conceptual model. Items were refined using cognitive interviews elicit feedback on their relevance and acceptability. Results: We developed an initial set of 145 items categorized by concepts that were reduced to 50. Our final item set resulted in the COncussion REcovery Questionnaire, which contains a total of 53 items split into 3 separate scales: the Post-Concussion Functional Scale, Concussion Modifiers Scale, and Global Functional Recovery Scale. Conclusion: The new Concussion Recovery Questionnaire is a self-reported measure of functional status for monitoring outcomes in clinical practice and in clinical intervention trials following concussion. Further studies are necessary to provide evidence of the measure's psychometric properties and to determine the questionnaire's ability to facilitate clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Post-concussive depression describes an elevation of depressive symptoms following concussion that occurs in conjunction with other symptoms of concussion. Children with concussion are more likely to diagnosed with depression. The overlapping symptoms between clinical depression and concussion make the diagnosis of depression difficult. The purpose of this study is to explore how post-concussive depression relates to post-concussion symptoms and cognition by investigating symptom-reporting in youth with post-concussive depression and executive function. Methods: Adolescents (age 10–17 years) diagnosed with concussion were divided into two groups based on depression scores on the Children's Depression Inventory (post-concussion depression; non-depression groups). Symptom reporting on the Post-Concussion Symptom Inventory and performance on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) were compared. Results: Participants with post-concussive depression had heightened emotionality, irritability, and nervousness. Sadness and fatigue were reported by both groups. ImPACT was unable to distinguish between groups but the group overall demonstrated severe neurocognitive deficits. Conclusion: Reports of greater emotionality, irritability, and nervousness on concussion symptom scales may be indicators of post-concussion depression. It is important for clinicians to take note when an adolescent with concussion scores high on these three emotional symptoms as they may be indicative of greater emotional distress. [ABSTRACT FROM AUTHOR]

This comprehensive review discusses clinical studies of patients following brain injuries (traumatic, acquired, or stroke), who have been treated with amantadine or memantine. Both amantadine and memantine are commonly used in the acute rehabilitation setting following brain injuries, despite their lack of FDA-approval for neuro-recovery. Given the broad utilization of such agents, there is a need to review the evidence supporting this common off-label prescribing. The purpose of this review is to describe the mechanisms of action for memantine and amantadine, as well as to complete a comprehensive review of the clinical uses of these agents. We included 119 original, clinical research articles from NCBI Medline, published before 2019. We focused on the domains of neuroplasticity, functional recovery, motor recovery, arousal, fatigue, insomnia, behavior, agitation, and cognition. Most of the existing research supporting the use of amantadine and memantine in recovery from brain injuries was done in very small populations, limiting the significance of conclusions. While most studies are positive; small effect sizes are usually reported, or populations are subject to bias. Furthermore, evidence is so limited that this review includes research regarding both acute and chronic acquired brain injury populations. Fortunately, reported short-term side effects generally are modest, and stop soon after amantadine/memantine is discontinued. However, responses are inconsistent, and the phenotype of responders remains elusive. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review investigating the effectiveness of methylphenidate in improving cognition following brain injury in an adult population. Data sources: CINAHL, PsychINFO, MEDLINE, and PubMed databases were searched for all relevant articles published from January 1980 up to December 2017. Study selection: Studies were included if participants had a diagnosis of new onset or previous acquired brain injury and were age 16 or over. Studies must have administered methylphenidate and measured its effectiveness on cognition using at least one measure of cognitive function. Data extraction: Data extracted included study design, sample size, participant characteristics, intervention method, outcome measures, and findings. The quality of included randomized controlled trials was assessed using the Physiotherapy Evidence Database. An overall level of evidence was assigned using a modified Sackett scale. Data synthesis: Included studies consisted of seven randomized controlled trials, two pre-post trials, one prospective controlled trial, and one case study. All included studies reported improved cognitive abilities following methylphenidate treatment post-injury. Conclusions: There is the strongest level of evidence (Level 1a) suggesting methylphenidate may alleviate cognitive impairments in adults with brain injury. However, longitudinal studies are warranted examining the effectiveness and safety of long-term methylphenidate use in this population. [ABSTRACT FROM AUTHOR]

Primary objective: Motivation to initiate and persist with any kind of exercise activity is challenging. This pilot study queried adults with chronic-acquired brain injuries (ABI) regarding their perceptions about motivational facilitators of and barriers to engagement in cognitive exercise activity. Research design: A mixed methods design was used to characterize individuals' perceptions regarding exercise and their exercise experience (written questionnaire) and to obtain their input regarding exercise-related motivational strategies and obstacles (semi-structured group interviews). Methods: Thirty-four community-based individuals with chronic ABI and moderate-to-severe cognitive impairments completed questionnaires and engaged in audio-recorded scripted group interviews. Tallies of closed-ended questionnaire data and thematic analysis of open-ended questionnaire and group interview data were completed. Main outcomes and results: Participants indicated a strong preference for engaging in cognitive exercise activity with others versus alone. Frequently recurring motivational facilitators regarding exercise in general and cognitive exercise in particular included 'receipt of positive reinforcement for exercise activity', 'possession of needed information to engage in exercise', and 'possession of exercise-related goals'. Frequently recurring motivational barriers included 'absence of exercise-related goals' and 'absence of consistent structure conducive to exercise'. Conclusion: Study findings may facilitate successful engagement in cognitive exercise by chronic ABI survivors. Further research is needed. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study aimed to evaluate olfaction 24 h (baseline) and 1 year (follow-up) after a mild traumatic brain injury (TBI). We further evaluated the influence of the cognition and affective state on olfactory function. Method: At baseline, olfactory function, neuropsychological, and affective states were assessed in 42 patients (20 mild TBI; 22 orthopedic injury). At follow-up, 12 patients with mild TBI and 7 controls could be included, and we assessed olfactory function, affective states, and post-concussion symptoms. Results: At baseline, patients with mild TBI demonstrated significantly reduced olfactory function, compared to controls, with more than 55% of the patients presenting signs of hyposmia. One year later, no significant differences in olfactory scores between cases and controls were observed. However, patients with mild TBI who had exhibited hyposmia at baseline exhibited significantly higher anxiety levels and more post-concussion symptoms than patients with mild TBI with normal olfactory function at baseline. Conclusions: In the acute phase of mild TBI a majority of patients has impaired olfactory function. Further patients with olfactory dysfunction are more likely to exhibit post-concussion and anxious symptoms at follow-up. Olfactory testing in the acute phase may therefore serve as a screening tool for long-term outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess long-term outcomes in terms of oral language, intellectual ability, education, following very early moderate-to-severe TBI. Methods: Children who had been hospitalized in rehabilitation after moderate-to-severe TBI sustained before 18 months of age were contacted once they had reached school age. Detailed oral language and intellectual ability assessment were performed, and information on ongoing education was collected. Results: 52 children met inclusion criteria; 21 (40.4%) participated [13 males, mean age 7.5 years (SD = 1.9), age at injury 0.7 years (SD = 0.5), time since injury 6.8 years (SD = 1.8)]. Performance was in the clinical range (<-2SD) for: syntactic comprehension (67%; mean z-scores −2.6; SD = 3.1), syntactic expression (62%; −2.1; SD = 1.3), lexical stock extent (57%; −1.5; SD = 1.5), lexical access skills (48%; −1.9; SD = 2), and semantic organization (32%; −0.9; SD = 1.2). Full-scale IQ was <90 for 91%. Only eight children followed mainstream education without adaptations. Performance on all language tests (except lexical stock extent) was significantly poorer for children with a personal school aid or those in specialized education. Conclusions: Early moderate-to-severe TBI causes significant delayed language (especially syntactic aspects of language) and cognitive disabilities, with consequences on long-term educational outcome. These children require long-term follow-up and timely interventions. [ABSTRACT FROM AUTHOR]

Primary objective: The impact of noise sensitivity (NS) on the daily functioning of people who have experienced a traumatic brain injury (mTBI) is an understudied area, particularly following mTBI. The primary objective of this cross-sectional study was to investigate clinical markers of NS in a sample of New Zealand adults following mTBI. Research design: Cross-sectional study. Methods and procedures: A community-based sample of 151 adults who had experienced a brain injury in the last two weeks completed assessments estimating cognitive functioning, postconcussion symptoms (including NS), and affective state. Results: Over half the sample (59%) reported some degree of NS. Exploratory statistical analyses indicated that NS was associated with being female, living in a rural area, number of previous brain injuries, cognitive flexibility scores, reaction time, perceptions of recovery, anxiety, and depression. Regression analyses revealed that anxiety was the dominant correlate of NS (B =.120, p <.001, 95% CI [0.069, 1.71]). Conclusions: As the first study to explore the correlates of NS following mild TBI, the findings have important clinical and research implications. The present findings suggest that treatment approaches targeting anxiety may be effective in reducing NS in people who have experienced a brain injury. Moreover, evidence is presented suggesting that NS is unlikely to reflect malingering, and should be treated as a genuine somatic symptom of brain injury. [ABSTRACT FROM AUTHOR]

Objective: To adapt the well-validated 37-item adult Family Needs Questionnaire to make it suitable for families of children and youth with acquired brain injury (ABI). Methods: Measurement construction employed a modified Delphi technique to identify the most relevant content items for the pediatric Family Needs Questionnaire (FNQ-P). The Delphi process involved a panel of 11 ABI-team clinicians and seven family caregivers of children/youth with an ABI and four rounds of anonymous voting on each item's importance. Qualitative responses related to each item's review were incorporated into item content and wording decisions. Cognitive interviews were conducted with three parents after the Delphi to evaluate face and content validity. Results: The outcome of the final Delphi round was a set of 40 items within the original FNQ's original six categories: Health Information (n = 10), Emotional Support (n = 6), Instrumental Support (n = 4), Professional Support (n = 6), Community Support (n = 6), and Involvement with Care (n = 8). Cognitive interviews resulted in changes to formatting, rating scale, and item wording, and culminated in overall consensus about the FNQ-P's face/content validity. Conclusions: Use of the Delphi process with family and clinical partners resulted in content-endorsed pediatric FNQ that is ready for validation work prior to transfer to clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of a specialized, interdisciplinary rehabilitation (S-REHAB) with standard care (STAND) for people with persistent post-concussive symptoms (PPCS > 6 month). Design: Randomized controlled trial. Participants: Eighty-nine adults. Interventions: 22-week programme combining individual and group-based neuropsychological treatment with exercise therapy and physiotherapeutic coaching (S-REHAB), and the usual treatment offered by the public municipality services (STAND). Outcome Measures: The Rivermead Postconcussion Symptoms Questionnaire (RPSQ) (primary), The Headache Impact Test (HIT-6), Major Depression Inventory (MDI), Multidimensional Fatigue Inventory (MFI-20) and The Short Form (36) Health Survey (SF-36); all collected at baseline, post-treatment, and at 6-month follow-up. Results: The S-REHAB group showed a significant reduction in symptoms measured by RPSQ compared to the STAND immediately post-treatment (effect size [ES] = 0.28) and at follow-up (ES = 0.26). The S-REHAB groups also showed significant improvements regarding HIT-6 post-treatment (ES = 0.38) and at follow-up (ES = 0.68), MFI-20 - dimension 'mental fatigue' post-treatment (ES = 0.42), MFI-20 - dimension 'reduced activities' at follow-up (ES = 0.74) and SF-36 - dimension 'social functioning' post-treatment (ES = 0.31). Conclusions: The S-REHAB is more effective than the STAND in reducing the PPCS affecting physical, cognitive and emotional domains. This symptom reduction was associated with experienced improvement in social functioning, increased levels of activity, a decrease in mental fatigue and increased life satisfaction. [ABSTRACT FROM AUTHOR]

Primary Objective: Research studies and clinical observations of individuals with traumatic brain injury (TBI) indicate marked deficits in mentalizing—perceiving social information and integrating it into judgements about the affective and mental states of others. The current study investigates social-cognitive mechanisms that underlie mentalizing ability to advance our understanding of social consequences of TBI and inform the development of more effective clinical interventions. Research Design: The study followed a mixed-design experiment, manipulating the presence of a mentalizing gaze cue across trials and participant population (TBI vs. healthy comparisons). Methods and Procedures: Participants, 153 adults, 74 with moderate-severe TBI and 79 demographically matched healthy comparison peers, were asked to judge a humanoid robot's mental state based on precisely controlled gaze cues presented by the robot and apply those judgements to respond accurately on the experimental task. Main Outcomes and Results: Results showed that, contrary to our hypothesis, the social cues improved task performance in the TBI group but not the healthy comparison group. Conclusions: Results provide evidence that, in specific contexts, individuals with TBI can perceive, correctly recognize, and integrate dynamic gaze cues and motivate further research to understand why this ability may not translate to day-to-day social interactions. [ABSTRACT FROM AUTHOR]