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Purpose: This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall’s tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). Methods: This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. Results: We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p< 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. Conclusions: Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission. [ABSTRACT FROM PUBLISHER]

Background: Virtual reality (VR) is an emerging area of paediatric clinical and research practice, however the majority of research to date has focused on outcomes for adults following stroke. This paper appraises and describes current evidence for use of virtual reality interventions to improve upper limb function of children with neurological impairment. Methods: A comprehensive database search was undertaken to explore literature on the use of VR systems for rehabilitation of upper limb skills of children with neurological impairment. Studies investigating the use of robotics or other mechanical devices were excluded. Five studies were found and were critiqued using the Downs and Black scale for measuring study quality. Results: One randomized control trial and four case studies were found. No study scored over 50%% on the Downs and Black scale, indicating methodological limitations that limit generalizability. Conclusions: Current evidence for the use of VR to improve hand and arm skills is at an emerging stage. Small sample sizes and inconsistencies in outcome measurement limit the ability to generalize findings. Further studies are required to investigate the ability to maintain gains made in VR over time and to determine whether gains transfer from the VR to real life tasks and activities. [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]

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]

A high prevalence of depression exists in specific sub-samples of survivors of brain injury (BI) sustained from intimate partner violence (IPV). However, the experience of depression by survivors of IPV-related BI from general civilian populations remains unclear. This study documents the symptom profile of depression reported by individuals who screened positive for sustaining an IPV-related BI. 36 individuals who screened positive for possible IPV-related BI completed the Beck Depression Inventory-2nd Edition (BDI-II). Subscales characterizing the nature of the symptoms were created. Frequency and descriptive statistics were calculated for item responses on the BDI-II. Participants were also assigned to high or low symptom severity groups to examine between-group differences. Participants endorsed experiencing somatic symptoms more severely than self-evaluative and affective symptoms. Additionally, self-evaluative and cognitive symptoms correlated with total BDI-II scores for the high symptom severity group but not for the low symptom severity group. The findings highlight somatic symptoms of depression, in particular as a common experience among survivors of IPV-related BI. Further, self-evaluative and cognitive symptoms may be more sensitive in detecting depression after IPV-related BI. These results may aid in the development of guidelines to better diagnose and treat depression in IPV-related BI. [ABSTRACT FROM AUTHOR]

Poststroke depression (PSD) is a common complication that seriously affects the functional recovery and prognosis of an individual. As some patients with PSD fail to respond to drug therapy, it is urgent to find a viable alternative treatment. An active exercise program known as foraging exercise (FE), using food as bait, was designed. First, focal ischemia and chronic unpredictable mild stress (CUMS) were used to establish a PSD model in rats. FE was then performed for 4 weeks. Body weight and behavioral assessments were conducted at the end of the 4th and 8th weeks. After 8 weeks, the results revealed that, compared with the PSD group, the behavioral scores of the rats in the PSD/FE group were significantly improved, the expression of Iba-1 in the affected frontal lobe and striatum was decreased, and serum levels of IL-6 and the IL-6/IL-10 ratio were downregulated. However, the ratio of residual brain volume in rats that had experienced CUMS was significantly less than that in the stroke group. FE can alleviate the behavioral scores of PSD rats, and its mechanism may be related to a modulation of the immune-inflammation response of microglia. Furthermore, chronic, persistent stress may increase the volume of cerebral infarction after stroke. [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]

To examine the extent to which race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source contribute to functional status following inpatient rehabilitation in children with acquired brain injury (ABI). Retrospective cohort study from a pediatric rehabilitation hospital including 485 individuals with ABI. Functional Independence Measure for Children (WeeFIM) scores were transformed into age-corrected Developmental Functional Quotients (DFQ) to examine the effects of race/ethnicity, LOS, and payer source (public insurance vs. private) on functional outcomes while controlling for year of admission, admission DFQ, time to rehabilitation, age, and brain injury aetiology. Discharge DFQ scores tended to be lower for children with public insurance as well as those with longer LOS. There was no main effect of race/ethnicity, but a significant interaction effect for payer source×LOS (p <.001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days (p =.001). Children with ABI who have both public insurance and LOS beyond 4 weeks tend to have poorer functional outcomes after inpatient rehabilitation. Because all children were receiving services at the same facility, payer source may be functioning as a proxy for other sociodemographic factors. [ABSTRACT FROM AUTHOR]

To explore the relationship between shame and self-discrepancies and the extent that these factors predict adjustment after an acquired brain injury (ABI). 62 participants with an ABI completed the following self-report qualitative questionnaires: the Hospital Anxiety and Depression Scale, the Quality of Life after Brain Injury Scale, the Internalized Shame Scale, and the Head Injury Semantic Differential Scale – III. Data was analyzed using correlations, repeated ANOVA, and multiple regression models. A significant self-discrepancy was found between the present self and the pre-injury self, with the present self-being rated more negatively. This self-discrepancy was found to be positively correlated to shame, and these two variables were found to predict adjustment (emotional distress and quality of life). Shame and self-discrepancies both appear to play a crucial role in adjustment following an ABI. However, the relationship between shame and self-discrepancies needs more consideration to understand how these variables may interact to predict adjustment. [ABSTRACT FROM AUTHOR]

Objective: To investigate long-term effects of GOALS executive function training in Veterans with chronic TBI. In a recently completed study Veterans with chronic TBI showed improvement immediately post-GOALS but not control training on measures of executive function, functional task performance, and emotion regulation. We now examine the long-term maintenance of post-GOALS training changes in the same sample. Setting: San Francisco VA Health Care System (SFVAHCS), and VA Northern California Health-Care System (VANCHS) in Martinez. Participants and Design: 24 Veterans with chronic TBI were assessed at baseline, post-GOALS training, and long-term follow-up 6+ months following completion of training with a structured telephone interview, neuropsychological and complex functional performance measures, and self-report measures of daily and emotional functioning. Results: Participants reported an increased likelihood of involvement in competitive employment/volunteering at follow-up (61%) compared to baseline (26%; χ2 = 5.66, p <.01, ѱ =.35). Repeated measures MANOVAS indicated improvement on attention/executive function (F = 13.85, p <.01, partial η2 =.42), complex functional task performance (GPS Total: F = 9.12, p <.01, partial η2 =.38) and daily functioning (MPAI Total: F = 3.23, p <.05, partial η2 =.21), and reduction in overall mood disturbance (POMS Total: F = 3.42, p <.05, partial η2 =.22) at follow-up relative to baseline. Discussion: Training in attention regulation applied to participant-defined goals is associated with meaningful long-term improvement in cognitive skills, emotion regulation, and daily functioning in Veterans with chronic TBI. [ABSTRACT FROM AUTHOR]

Background: Minocycline is a pleomorphic neuroprotective agent well studied in animal models of traumatic brain injury (TBI) and brain ischemia. Methods: To test the hypothesis that administration of minocycline in moderate to severe TBI (Glasgow Coma Score 3-12). Fifteen patients were enrolled in a two-dose escalation study of minocycline to evaluate the safety of twice the recommended antibiotic dosage; tier 1 n = 7 at a loading dose of 800 mg followed by 200 mg twice a day (BID) for 7 days; tier 2 n = 8 at a loading dose of 800 mg followed by 400 mg BID for 7 days. Results: The mean initial GCS was 5.6 for Tier 1 patients and 5.4 for Tier 2. The Disability Rating Scale (DRS) had a trend towards improvement with the higher dose 12.5 SD ± 7.7 (N = 5) for Tier 1 at 4 weeks and 8.5 SD ± 9.9 at week 12 (N = 5), whereas for Tier 2 it was 9.7 ± 6.9 (N = 6) for week 4 and 6.0 SD ± 6.1 (N = 7) for week 12 (p = .251 repeated measures ANOVA). Liver function tests increased but resolved after the first week and there were no infections. Conclusions: Minocycline was safe for moderate to severe TBI at a dose twice that as recommended for treatment of infection. The higher dose did trend towards an improved outcome. [ABSTRACT FROM AUTHOR]

Objective: To investigate factors relevant to violence and self-harm in forensic psychiatric inpatients the cross-sectional association between four potential contributory factors; head injury, schizophrenia, drug and alcohol misuse, and self-harm or violence-related outcomes was examined. Methodology: Data were extracted from an existing dataset of routinely collected data on all patients under the care of Scotland's Forensic Mental Health Managed Care Network, of whom (n = 432) met inclusion criteria. A Factorial MANOVA and Pearson's chi-square tests were conducted to assess the relationship between potential contributory factors and self-harm and violence. Results: Forty-seven individuals had a documented head injury (10.9%). The presence of head injury was significantly associated with inpatient violence and assessed violence risk. Number of historic violent offences was significantly associated with a history of drug misuse and co-morbid alcohol misuse and schizophrenia. Self-harm was significantly associated with drug misuse and a diagnosis of schizophrenia. Conclusion: These findings highlight a significant association between head injury and actual/assessed risk in forensic psychiatry, over and above that of substance misuse and a diagnosis of schizophrenia, emphasising the need for routine assessment of head injury in clinical practice. Further examination of the impact of head injury in forensic psychiatric populations is needed. [ABSTRACT FROM AUTHOR]

Primary objective: Recent findings suggest breathing may negatively affect performance after concussion. The aim of the study was to examine group differences between individuals with and without post-concussion syndrome (PCS) in end-tidal carbon dioxide (ETCO2) and respiratory rate (RR) during neurocognitive and physical tasks. Hypothesis: Individuals in the PCS group will have elevated ETCO2 and lower RR compared to the control group. Methods: A quasi-experimental study was used in which a capnography unit collected ETCO2 and RR breathing data from 22 participants (control = 17; PCS = 5) during rest, the completion of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) battery and while slow and fast walking. Four repeated measures mixed factorial ANOVAs, with an alpha level set at p ≤ 0.05, were used to examine group and task differences. Results: Both groups displayed similar breathing responses to cognitive and physical stress; however, PCS participants had significantly elevated ETCO2 throughout the study (during rest, the ImPACT and while walking) compared to the control. Conversely, no significant group differences were found in RR. Conclusion: Cerebral physiological alterations and deficits in the autonomic nervous system may cause abnormal ETCO2 in individuals after concussion. Future research evaluating breathing patterns in PCS may be warranted. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of Solution Focused Brief Therapy (SFBT) in individuals after stroke on self-efficacy, symptoms of depression and anxiety.Design: Randomized controlled trial. Setting: Clinic of Adult Neurology of Medical University of Gdańsk and M. Copernicus Pomeranian Traumatology Centre in Gdańsk.Subjects: A total of 62 patients, aged 54.0 ± 9.6 years. Interventions: They were randomly assigned to one of the two groups: SFBT participating in 10 therapy sessions and control – not participating in any psychotherapy. Main measures: Symptoms of depression and anxiety according to Hospital Anxiety and Depression Scale, Mini-Mental Adjustment to Cancer (scale originally designed for cancer patients) and Self-efficacy Scale were examined at baseline of the study and later in the same time intervals in both groups. Results: The intensity of depression and anxiety complaints drops in the SFBT group (from 5.0 to 2.0 and 8.0 to 4.0 respectively; bothp< .001 Friedman’s ANOVA (analysis of variance)) whilst in the control group remains unchanged. In addition to the gradual reduction of destructive attitudes (from 34.5 to 17.0), the increase in the number of constructive attitudes (from 42.0 to 50.5) and increased self-efficacy (from 79.0 to 96.0) was observed after therapy but not in the control group. Conclusions: The authors suggest SFBT as a simple, beneficial and inexpensive method to manage patients after stroke. [ABSTRACT FROM PUBLISHER]

Objectives: To understand how employment services (ES) are provided to persons with brain injuries (PWBIs) in Ontario, Canada, and the impact service delivery has on competitive-employment outcomes. Design and methods: A mixed-method case study of one community-based agency that provides specialized services to PWBIs. Relationships between demographic, service-related variables and employment outcomes (2009–2014) were analysed using chi-squares and analyses of variance. In addition, 14 interviews were conducted and analysed using thematic analysis. Results: PWBIs accessed services on average of 16 years post injury; 64% secured at least one competitive-employment job, which was how employment success was defined in this study. Average job tenure was 368 days, and average job intensity was 3.8 hours/day. Employment success was significantly associated (p< 0.05) with use of job development, job coaching, case management and job retention services. Interviews revealed that PWBIs were provided five services: job goal(s) identification, assessment of work-related abilities/skills, job development, on-the-job supports and job retention assistance. Challenges to ES delivery included lack of suitable jobs and hiring incentives, and difficulties in establishing natural supports at the workplace. Conclusions: PWBIs’ employment outcomes may be supported through provision of ES to assist with: the development of realistic job goals and job-finding skills, securing work, on-the-job coaching and advocacy with employers. [ABSTRACT FROM PUBLISHER]

Objective: The Sensory Modality Assessment and Rehabilitation Technique (SMART) was developed to assess the levels of awareness, functional, sensory and communicative abilities of adults in vegetative (VS) or minimally-conscious states following severe brain injury. The current study seeks to ascertain if a total score can be derived from the individual assessments contained within SMART and to test the internal construct and predictive validity of that total score. Subjects: Persons in VS were recruited over a 3-year period and current status was determined after a 17-year follow-up. Design: Data were evaluated by fit to the Rasch model. Predictive validity for emergence from VS was ascertained through an Area-Under-the-Curve [AUC] analysis. Results: Sixty people in VS were assessed on several occasions. Average age on admission was 38.8 years; 30 had anoxic brain damage; 21 traumatic injury. The Rasch analysis indicated the raw score was a sufficient statistic for awareness. Over half [55%] failed to emerge from VS. For those with anoxic brain injury, a SMART cut point of 85 gave an AUC of 0.966 (95% CI = 0.910–1.00) for emergence, as did a cut point of 68 for those with traumatic brain injury. Discussion: The current analysis suggests that SMART may have important predictive attributes for emergence (or lack thereof). No change in status of those discharged in VS has been reported to this present day. [ABSTRACT FROM PUBLISHER]

Primary objective: The purpose of this study was to investigate the effects of mild traumatic brain injury (mTBI) on multiple postural indices that characterize body sway behaviour. Methods and procedures: The body's centre of pressure (COP) displacement was recorded from 11 individuals with a history of mTBI (29.4 ± 6.7 years old) and 11 healthy controls (26.8 ± 3.7 years old) performing bipedal stance on a force platform for 120 seconds. Spatio-temporal (area, amplitude and mean velocity of the COP displacement) and frequency characteristics (frequency containing 80% of the power spectral density) of the body oscillation, as well as its dynamic characteristics (sample entropy estimate of the COP displacement) were extracted from COP signals. Main outcomes and results: All postural indices studied were significantly affected by mTBI (p < 0.010). Participants with a history of mTBI presented a larger, slower, and more random body oscillation compared to controls. Conclusion: The results suggest that (a) balance deficits can be recognized as an effect of mTBI; (b) balance deficits induced by mTBI are multi-dimensional, affecting all three domains included in this study; and (c) the postural indices employed in this study are potential markers to detect changes in postural control following mTBI. [ABSTRACT FROM AUTHOR]

Background and objective: The benefits of progesterone have been demonstrated in the animal models of traumatic brain injury (TBI). However, the results of clinical studies are conflicting. Considering the heterogenic nature of TBI, the effect of progesterone in patients with diffuse axonal injury (DAI) was investigated in a clinical trial. Methods: In this study, 48 patients with DAI and Glasgow Coma Scale of 3-12, admitted within 4 hours after injury, were randomly assigned to the progesterone or control group. The dose of progesterone administration was 1 mg kg-1 per 12 hours for 5 days. The effect of progesterone was investigated using extended-Glasgow Outcome Scale (GOS-E), functional independence measure (FIM) scores and also mortality within the follow-up period. Results: The progesterone group exhibited higher GOS-E and FIM scores in comparison to the control group at 6 months post-injury (p < 0.01 and p < 0.05, respectively). Mortality was also found in the control group (p < 0.05). The adverse events attributed to the progesterone administration were not found throughout the study. Conclusions: Findings of this study suggest that progesterone may be neuroprotective in patients with DAI. However, large clinical trials are needed to assess progesterone as a promising drug in DAI. [ABSTRACT FROM AUTHOR]

Background: Inpatient rehabilitation with patients who have sustained an acquired brain injury (ABI), including traumatic brain injury (TBI), focuses on improving performance in activities of daily living (ADLs). Although not studied to date in patients with ABI/TBI, Task Analysis (TA) integrates assessment and the prompting/cueing levels required to complete various tasks, with the goal to achieve effective skill acquisition and rehabilitation planning. TA has demonstrated efficacy in teaching life skills in individuals with developmental disabilities and in this study is applied to teaching ADL skills in ABI/TBI rehabilitation. Primary objective: To validate the use of TA in measuring progress in teaching ADLs by comparing it with three common ADL measures: Functional Independence Measure, Barthel Index and Klein-Bell. Methods: Twenty-four inpatients were administered the Functional Independence Measure (FIM), Barthel Index (BI) and the Klein-Bell ADL Scale (KB) TA within 72 hours of admission, at 4 weeks and within 72 hours of discharge, for showering and dressing tasks. A repeated measures ANOVA compared scores across the four measures, at three time points, for both tasks. Conclusion: Concurrent validity of TA in measuring improvements in the ADL tasks was established. Improvements were associated with reductions in supervision and disability levels. TA was shown to be an effective evaluation and teaching strategy during rehabilitation, with demonstrated reductions in disability and supervision levels. [ABSTRACT FROM AUTHOR]

Aim: To examine the reproducibility in measurement of physical activity performance using the ActiGraph®GT3X+ accelerometer in children aged 8–16 years with Acquired Brain Injury (ABI). Methods: Reproducibility of standardized tasks: Thirty-two children with ABI (12 years 1 month, SD = 2 years 4 months; 20 males; Gross Motor Function Classification System I = 17, II = 15) performed the following activities on 2 consecutive days while wearing an accelerometer and a heart rate monitor: quiet sitting, slow walking (SW), moderate walking (MW), fast walking (FW) and rapid stepping on/off a block (STEP). Intra-class correlation coefficients (ICC) were calculated. Performance variability: Fifty-one participants (12 years 1 month, SD = 2 years 5 months; 27 males; GMFCS I = 26, II = 25) wore an accelerometer for 4 days in the community and reliability coefficients were calculated using standardized 12-hour time spent in moderate-to-vigorous physical activity (MVPA). Results: Test–re-test reproducibility was excellent for all activities (SW, ICC = 0.90; MW, ICC = 0.83; FW, ICC = 0.91; STEP, ICC = 0.89). Three days of monitoring produced excellent variability estimates of MVPA (R= 0.78). Conclusion: Therapists can confidently use accelerometry as a reproducible measure of physical activity under standardized walking and stepping conditions, as well as in the community for children with ABI. [ABSTRACT FROM PUBLISHER]

Objective: Dizziness is a common complaint in patients following mild head or neck trauma, but neurological signs are usually rare or absent. The aim of the study was to compare postural control in patients with different types of head and neck trauma to healthy subjects. Methods: Balance function was evaluated by computerized dynamic platform posturography (CDPP) in 57 dizzy patients with whiplash injury (n= 11), mild head trauma without loss of consciousness (HTNLC) (n= 23), whiplash injury and mild head trauma without loss of consciousness (WHTNLC) (n= 12) and mild head trauma with loss of consciousness (n= 11) and in 14 healthy subjects. Results: Compared to healthy subjects and after adjustment for inter-group age differences, sway index (SI) was significantly higher in patients with WHTNLC in three of the tests. There were no significant differences within the patient group according to type of injury. When time following the injury was considered, the SI was non-significantly higher within the first week after trauma compared to other time intervals. Conclusion: The severity of the postural abnormality in patients with head and/or neck trauma is not uniform and is influenced by the type of trauma. [ABSTRACT FROM PUBLISHER]

Primary objective: This study explored over-selectivity (executive dysfunction) using a standard unsupervised categorization task. Over-selectivity has been demonstrated using supervised categorization procedures (where training is given); however, little has been done in the way of unsupervised categorization (without training). Methods and procedure: A standard unsupervised categorization task was used to assess levels of over-selectivity in a traumatic brain injury (TBI) population. Individuals with TBI were selected from the Tertiary Traumatic Brain Injury Clinic at Swansea University and were asked to categorize two-dimensional items (pictures on cards), into groups that they felt were most intuitive, and without any learning (feedback from experimenter). This was compared against categories made by a control group for the same task. Outcomes and results: The findings of this study demonstrate that individuals with TBI had deficits for both easy and difficult categorization sets, as indicated by a larger amount of one-dimensional sorting compared to control participants. Deficits were significantly greater for the easy condition. Conclusions: The implications of these findings are discussed in the context of over-selectivity, and the processes that underlie this deficit. Also, the implications for using this procedure as a screening measure for over-selectivity in TBI are discussed. [ABSTRACT FROM PUBLISHER]

Objective: To comprehensively describe the use of dexmedetomidine in a single institutional series of adult ICU patients with severe TBI. This study describes the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status and daily narcotic requirements before, during and after dexmedetomidine infusion. Methods: This study identified 85 adult patients with severe TBI who received dexmedetomidine infusions in the Trauma ICU at Vanderbilt University Medical Center between 2006–2010. Demographic, haemodynamic, narcotic use and sedative use data were systematically obtained from the medical record and analysed for changes associated with dexmedetomidine infusion. Results: During infusion with dexmedetomidine, narcotic and sedative use decreased significantly (p< 0.001 andp< 0.05). Median MAP, SBP, DBP and HR also decreased significantly during infusion when compared to pre-infusion values (p< 0.001). Despite the use of dexmedetomidine, RASS and GCS scores improved from pre-infusion to infusion time periods. Conclusions: The findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI. Although there was an observed decrease in haemodynamic parameters during infusion with dexmedetomidine, the change was not clinically significant and the requirements for narcotics and additional sedatives were minimized. [ABSTRACT FROM PUBLISHER]

Aim: To assess heart rate (HR) and heart rate variability (HRV) at rest, during exercise and during the recovery phase post-exercise in children at the chronic phase post-severe TBI as compared to age-matched typically-developed (TD) controls. Setting: Out-patient clinic. Participants: Ten children (two girls, eight boys), 3–5 years post-severe TBI, aged 7–11 years with residual deficits and 20 TD children matched for age. Interventions: HR and HRV were determined at rest, during step test for 3 minutes, during walking on a treadmill for 6 minutes and during the recovery periods post-exercise sessions. Main outcome measures: HR and HRV parameters. Results: Children post-TBI demonstrated higher mean HR values and lower HRV at rest compared to controls (p< 0.05). During exercise a significant increase in HR and significant decrease in HRV was noted in both groups. A significant interaction was noted (p< 0.01); HR and HRV parameters in response to exercise and to exercise cessation were significantly lower among children post-TBI as compared to the controls. Conclusions: The findings of this study show that, in children, post-severe TBI at the chronic phase, the cardiac autonomic system is less efficient at rest and less adaptive to exercise and activity as compared to TD children. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of an anger management group programme for patients with acquired brain injury (ABI) on self-reported anger and to identify specific effects of intervention components at different time-points. Participants: Twenty-six participants with ABI were randomized, 24 started the programme and 19 completed it. Design: A paired-randomization was held following the first baseline (T0) and a second baseline (T1) was held several weeks later. One group (n = 8) started with an 8-week anger management programme followed by a 4-week intervention focusing on the psychosocial impact of brain injury. This order was reversed in the other group (n = 11). Assessment was carried-out every 4 weeks (T1–T4) during the 12-week intervention period. Main outcome measures: The Aggression Questionnaire-12, The State-Trait Anger and Expression Inventory-2 and The Multidimensional Anger Reaction Scale. Results: Anger levels did not significantly change between T0 and T1, but decreased significantly at T4. Adaptive anger coping strategies also increased following intervention. Inwardly expressed anger decreased following the anger management programme compared to the psychosocial adjustment programme. Conclusions: Group psychotherapy may improve parameters of anger management in patients with ABI. However, specific effects of different components of the anger management programme merit further investigation. [ABSTRACT FROM AUTHOR]

Objectives: (1) To examine whether the willingness of people to socialize with adolescents with brain injury is influenced by gender, visibility of injury and/or knowing how to interact with people with brain injury; and (2) To consider two models: the responsibility model (attributions about the cause of a condition) and the danger appraisal model (perceptions of dangerousness due to anger/aggression) for their effect on willingness to socialize and to understand how these perceptions lead to avoidant behaviour. Method and procedures: Participants were recruited either by personal approach or via Facebook advertising and completed a survey after reading a brief vignette and seeing a photo of an adolescent male or female, with or without a head scar. Vignettes for some participants were varied to represent perceptions of responsibility and dangerousness Main outcomes and results: ANOVAs and structural equation modelling revealed that participants were more willing to socialize with the adolescents with a scar than with no scar. Knowledge about how to interact with survivors impacted willingness to socialize, but familiarity did not. The full danger appraisal model was supported, but only some aspects of the responsibility model were supported. Conclusion: The results provide useful information for rehabilitation health professionals working with survivors of brain injury. The implications of these findings are discussed with regards to assisting adolescents’ re-entry into society post-injury. [ABSTRACT FROM PUBLISHER]

Objective: To explore the relationship between laterality recognition after stroke and impairments in attention, 3D object rotation and functional ability. Design: Observational cross-sectional study. Setting: Acute care teaching hospital. Participants: Thirty-two acute and sub-acute people with stroke and 36 healthy, age-matched controls. Main outcome measures: Laterality recognition, attention and mental rotation of objects. Within the stroke group, the relationship between laterality recognition and functional ability, neglect, hemianopia and dyspraxia were further explored. Results: People with stroke were significantly less accurate (69% vs 80%) and showed delayed reaction times (3.0 vs 1.9 seconds) when determining the laterality of a pictured hand. Deficits either in accuracy or reaction times were seen in 53% of people with stroke. The accuracy of laterality recognition was associated with reduced functional ability (R2 = 0.21), less accurate mental rotation of objects (R2 = 0.20) and dyspraxia (p = 0.03). Conclusion: Implicit motor imagery is affected in a significant number of patients after stroke with these deficits related to lesions to the motor networks as well as other deficits seen after stroke. This research provides new insights into how laterality recognition is related to a number of other deficits after stroke, including the mental rotation of 3D objects, attention and dyspraxia. Further research is required to determine if treatment programmes can improve deficits in laterality recognition and impact functional outcomes after stroke. [ABSTRACT FROM AUTHOR]

Objective: Although white matter hyperintensity (WMH) pathology has been observed in the context of traumatic brain injury (TBI), the contribution of this type of macrostructural damage to cognitive and/or post-concussive symptomatology (PCS) remains unclear. Methods: Sixty-eight Veterans (mTBI = 46, Military Controls [MCs] = 22) with and without history of mild TBI (mTBI) underwent structural MRI and comprehensive cognitive and psychiatric assessment. WMH volume was identified as deep (DWMH) or periventricular (PVWMH) on fluid-attenuated inversion recovery (FLAIR) images. Results: Group analyses revealed that mTBI history was not associated with increased WMH pathology (p’s > 0.05). However, after controlling for post-traumatic stress disorder (PTSD) and intracranial volume, DWMH was associated with reduced short-and long-delayed memory performance within the mTBI group (p’s < 0.05). Additionally, after adjusting for PTSD and time since injury, regression analyses revealed that WMH was not associated with self-reported ratings of PCS (p’s > 0.05) in the mTBI group. Conclusions: The results demonstrate that, in relatively young Veterans with mTBI, DWMH differentially and negatively affects memory performance above and beyond the effects of PTSD symptoms. The findings may help to clarify prior mixed results as well as offer focused treatment implications for Veterans with history of neurotrauma and evidence of macrostructural white matter damage. [ABSTRACT FROM PUBLISHER]

Introduction: Patients with mild traumatic brain injury (mTBI) may have normal neuroimaging but manifest with a broad-spectrum of cognitive-deficits, which may resolve eventually. The function of the thalamus in the process of natural-recovery remains elusive. The current study investigates the role of the thalamus in natural-recovery of cognitive-deficits in patients with mTBI. Methods: Twenty-one patients with mTBI were evaluated with an initial MRI scan, within 36 hours of injury and assessed with neuropsychological tests(NPT) at 3–4 weeks after injury. First and second follow-up MRI and NPT were performed at 3–4 months and 6–7 months, respectively. The volume and tensor measures of the thalamus and cognitive-scores were analysed at each assessment using repeated-measures of variance. The association of cognitive-scores with corresponding period imaging measures was analysed using bivariate-correlation. Results: Serial evaluation showed that all the cognitive-domains improved significantly. During this period there was a significant increase in mean thalamic volume (p= 0.049, effect-size = 0.18). After 3–4 months there was emergence of anisotropic thalamo-cortical connections. At 2–3 weeks and 6–7 months after injury, the alterations in diffusivity values were positively associated with improvement in memory-scores. Improvement in attention-scores correlated significantly with changes in tensor values at the 6–7 months after-injury. Conclusion: The correlation between improvement in cognitive-scores and changes in thalamic tensor and volume measures reflect the role of the thalamus in natural-recovery after mTBI. [ABSTRACT FROM PUBLISHER]

Objectives: (1) To evaluate cognitive and emotional impairments, disability and quality-of-life for adults with cerebral anoxia institutionalized in residential care facilities. (2) To evaluate the efficacy of medication, psychotherapy, support group and therapeutic activities. Methods: Twenty-seven persons with cerebral anoxia were recruited, on average 8 years post-injury. Only 20 went through the whole study. Over three consecutive 2-month periods, they were assessed four times to evaluate: baseline observations (T1–T2), adjustment of their medication (T2–T3); and the effect of psychotherapy, support group and therapeutic activities such as physical and artistic or cultural activities usually proposed in the facilities involved (T3–T4). Examined variables at all time points were cognitive status, anxiety and depression, anosognosia, alexithymia, disability and quality-of-life. Results: All participants exhibited cognitive and emotional impairments comparable to those reported in the literature. Statistical analyses revealed good baseline stability of their condition and no significant effects of changes in medication (between T2 and T3). Conversely, following implementation of psychotherapy, support group and therapeutic activities (between T3 and T4), quality-of-life and social participation were significantly improved. Conclusion: Social participation and quality-of-life for persons instutionalized several years after cerebral anoxia were improved by psychotherapeutic and therapeutic activities. [ABSTRACT FROM AUTHOR]

Aim: To assess the incidence and injury characteristics of hospitalized trauma patients diagnosed with TBI. Methods: A retrospective study of all injured hospitalized patients recorded in the National Trauma Registry at 19 trauma centres in Israel between 2002–2011. Incidence and injury characteristics were examined among children, adults and seniors. Results: The annual incidence rate of hospitalized TBI for the Israeli population in 2011 was 31.8/100 000. Age-specific incidence was highest among seniors with a dramatic decrease in TBI-related mortality rate among them. Adults, in comparison to children and seniors, had higher rates of severe TBI, severe and critical injuries, more admission to the intensive care unit, underwent surgery, were hospitalization for more than 2 weeks and were discharged to rehabilitation. After adjusting for age, gender, ethnicity, mechanism of injury and injury severity score, TBI-related in-hospital mortality was higher among seniors and adults compared to children. Conclusion: Seniors are at high risk for TBI-related in-hospital mortality, although adults had more severe and critical injuries and utilized more hospital resources. However, seniors showed the most significant reduction in mortality rate during the study period. Appropriate intervention programmes should be designed and implemented, targeted to reduce TBI among high risk groups. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyse the shunt placement in patients who had normal pressure hydrocephalus after poor-grade aneurysmal subarachnoid haemorrhage (aSAH). Methods: Patients diagnosed with NPH after poor-grade aSAH were divided into a treatment group and control group, based on whether they had received ventriculoperitoneal shunt placement. The treatment group was then divided into an improvement group and non-improvement group according to their recovery. The Glasgow Outcome Scale and Mini Mental Scale Examination were used for 3 month and 1 year follow-up rehabilitation measures. Results: Of the 46 total patients, significant improvement was observed at the 3 month and 1 year follow-ups (p < 0.01) after shunt implantation in the treatment group compared to the control group. Furthermore, patients who were younger (p = 0.022), had better neurological function (higher Glasgow Coma Score,p < 0.01) and less severe hydrocephalus (lower EI,p < 0.01) appears to be more likely to benefit from the shunt. Conclusions: Patients who had NPH due to poor-grade aSAH would benefit from shunt placement when given the correct candidates and timely management of shunt malfunction. Additionally, the curative effect of the shunt should have been regarded as a long-term goal of rehabilitation in these patients. [ABSTRACT FROM AUTHOR]

Primary objective: Paediatric traumatic brain injury (TBI) has been associated with acute and long-term mathematical difficulties. Little is known about the recovery of these impairments in children with mild TBI (mTBI) and their underlying pathophysiology, such as white matter abnormalities. Research design: A prospective longitudinal study followed the recovery of mathematical abilities and white matter in children with mTBI from the sub-acute (1 month post-injury) to chronic stage (6–8 months post-injury) of recovery. Methods and procedures: Twenty children with mTBI and 20 matched controls completed mathematics tests. Diffusion Tensor Imaging (DTI) metrics of white matter pathways corpus callosum (CC), superior and longitudinal fasciculi were examined with DTI-tractography. Main outcomes and results: Mathematical difficulties and white matter abnormalities in the CC observed shortly after the injury resolved after 6–8 months of recovery. Children with mTBI continued to show working memory deficits. Longitudinal DTI data suggest continued maturation of the CC in controls, but little maturation of the damaged CC in children with mTBI. Conclusions: Children with mTBI recovered in terms of mathematical abilities and white matter. These children continued to show working memory deficits, which might interfere with learning at school. [ABSTRACT FROM PUBLISHER]

Primary objective: To evaluate the behavioural and neural effects of TBI on the hemispheric integrity of three components of visuospatial attention: alerting, orienting and executive control. Method: Behavioural performance and high density event-related potentials (ERPs) were acquired while a sample of 12 patients with chronic moderate-to-severe TBI and 12 controls performed the Lateralized Attention Network Test (LANT). Neural indices of attention (posterior N1 amplitude to alerting and orienting cues, midline P3 amplitude during conflict resolution) were examined. Results: Patients with TBI exhibited smaller N1 amplitude to alerting cues, but comparable behavioural performance to controls. Participants with TBI also demonstrated poorer orienting performance to the left hemispace relative to the right. A corresponding reduction in right hemisphere N1 was found during left orienting to spatial cues in the TBI group. No group differences were observed on behavioural measures of executive control; however, patients with TBI exhibited reduced P3 amplitude overall. Conclusions: TBI may have an enduring effect on the orienting system at both neural and behavioural levels. Assessment of attention in chronic TBI can be improved by the integration of hemispheric findings that suggest disproportionate vulnerability in leftward orienting. Results may enhance clinical sensitivity to detection of subtle signs of neglect. [ABSTRACT FROM PUBLISHER]

Primary objectives: To measure common psychiatric conditions after military deployment with blast exposure and test relationships to post-concussion syndrome (PCS) symptoms and mild traumatic brain injury (mTBI) history. Research design: Cross-sectional. Methods and procedures: Service members or Veterans (n = 107) within 2 years of blast exposure underwent structured interviews for mTBI, post-traumatic stress disorder (PTSD) and multiple mood and anxiety diagnoses. Main outcomes and results: MTBI history and active PTSD were both common, additionally 61% had at least one post-deployment mood or anxiety disorder episode. Psychiatric diagnoses had a high degree of comorbidity. Most dramatically, depression was 43-times (95% CI = 11–165) more likely if an individual had PTSD. PCS symptoms were greater in those with post-deployment PTSD or mood diagnosis. However, neither mTBI nor blast exposure history had an effect on the odds of having PTSD, mood or anxiety condition. Conclusions: These findings support that psychiatric conditions beyond PTSD are common after military combat deployment with blast exposure. They also highlight the non-specificity of post-concussion type symptoms. While some researchers have implicated mTBI history as a contributor to post-deployment mental health conditions, no clear association was found. This may partly be due to the more rigorous method of retrospective mTBI diagnosis determination. [ABSTRACT FROM PUBLISHER]

Objectives: The objectives of the study were: (1) to describe the attention deficits profile of children with significant acquired brain injury (ABI) in comparison to matched controls, using the virtual classroom (VC); (2) to assess the utility of the VC in detecting attention deficits in children with ABI, as compared to classical neuropsychological tests and questionnaire-based assessment of attention; and (3) to determine how performance in the VC is affected by demographic and injury severity variables. Methods: Forty-one children with ABI and 35 age- and gender-matched controls, aged 8–16, were assessed with the VC. The results of the VC were compared to sub-tests of the Test of Everyday Attention for Children (TEA-Ch), the Conners' Parent Rating Scales-Revised: Short (CPRS-R:S) questionnaire and analysed according to demographic and injury severity variables. Results: Significant differences were found between the groups regarding the number of targets correctly identified in the VC. Significant inter-correlations were obtained between the VC variables. Significant correlations were found between the VC variables, the sub-tests of TEA-Ch and the CPRS-R:S and the demographic characteristics of the sample. Conclusion: The VC appears to be a sensitive and ecologically valid assessment tool for use in the diagnosis of attention deficits among children with ABI. [ABSTRACT FROM PUBLISHER]

Objective: The aim of this study was to prospectively investigate predictors of global functioning and employment 10 years following traumatic brain injury (TBI) compared with orthopaedic trauma. Research design: Prospective cohort. Methods: Ninety-seven individuals with complicated mild-to-severe TBI and 91 with traumatic orthopaedic injury were followed-up at 10 years post-injury. Global functioning (GOS-E) and employment status were recorded. Results: Groups did not differ on global functioning or employment status. Post-TBI, shorter PTA and less severe orthopaedic injuries were associated with better global functioning; and shorter PTA and younger age were associated with employment. Following traumatic orthopaedic injury, younger age was associated with employment, but not after excluding individuals no longer in the labour force. Conclusions: In this sample, demographic factors and injury severity contribute to long-term outcomes following TBI, but not orthopaedic trauma. PTA continues to influence outcomes 10 years following TBI. There is ongoing detrimental influence of orthopaedic injuries on global functioning for individuals with TBI, suggesting a potential benefit in greater clinical attention to these injuries. Further understanding of the complex interplay between these predictors and other personal and environmental factors will contribute to improving individualized rehabilitation. [ABSTRACT FROM PUBLISHER]

Objective: The relationship between moderate/severe traumatic brain injury (TBI) and cognitive deficits is well known. The nature, duration and predictors of cognitive difficulties post-mild TBI remain unclear. This study examined cognitive, mood and post-concussion outcomes of mild TBI over 1-year post-injury. Method: Adults (>15 years) with mild TBI (n = 260) completed neuropsychological (CNS-Vital Signs, Behavioural Dyscontrol Scale), mood (Hospital Anxiety Depression Scale) and behavioural assessments (Cognitive Failures Questionnaire, Rivermead Post-Concussion Questionnaire) at baseline, 1-, 6- and 12-months post-injury. Results: Over the 12-months post-injury self-reported cognition (p = 0.027), post-concussion symptoms (p < 0.001), depression (p < 0.001), anxiety (p < 0.001) and dyscontrol (p = 0.025) improved significantly. Assessments of memory, processing speed, executive function, psychomotor speed/reaction time, complex attention and flexibility also improved significantly. At baseline >20% of individuals produced very low scores on executive ability, complex attention and cognitive flexibility. At 1- and 6-month follow-ups >20% of participants were very low for complex attention, with 16.3% remaining so at 12-months. Executive abilities and speed were related to post-concussion symptoms, mood and self-reported cognition at 12-months. Conclusions: Whilst significant improvements were noted across measures over time, a significant proportion of individuals still perform poorly on neuropsychological measures 12-months after mild TBI; and these were linked to post-concussion symptoms, mood and self-reported cognitive outcomes. This implies a longer trajectory for recovery than has previously been suggested, which has implications for provision of assessment and rehabilitation services for more extended periods. [ABSTRACT FROM PUBLISHER]

Objective: Little is known regarding the predictors of social deficits that occur following childhood traumatic brain injury (TBI). The current study sought to investigate social problem solving (SPS) and its relationship to social adjustment after TBI. Methods: Participants included 8–13 year old children, 25 with severe TBI, 57 with complicated mild-to-moderate TBI and 61 with orthopaedic injuries (OI). Children responded to scenarios involving negative social situations by selecting from a fixed set of choices their causal attribution for the event, their emotional reaction to the event and how they would behave in response. Parent ratings of social behaviours and classmate friendship nominations and sociometric ratings were obtained for a sub-set of all participants. Results: Children with severe TBI were less likely than children with OI to indicate they would attribute external blame or respond by avoiding the antagonist; they were more likely to indicate they would feel sad and request adult intervention. Although several SPS variables had indirect effects on the relationship between TBI and social adjustment, clinical significance was limited. Conclusions: The findings suggest that, while children with TBI display atypical SPS skills, SPS cannot be used in isolation to accurately predict social adjustment. [ABSTRACT FROM PUBLISHER]

Background: Concussion is the most common athletic injury in youth who are simultaneously undergoing rapid developmental changes in the brain, specifically the development of executive functions (EF). The developing brain is more vulnerable to concussive injury with a protracted and different trajectory of recovery than that of adults. Thus, there is a critical need to enhance understanding of how concussion affects EF in youth. Objective: To investigate the effects of age, gender and concussion history (i.e. concussion incidence, recency, severity) on EF in youth hockey players. Methods: This 3-year cross-sectional and longitudinal multiple cohort study examined data from 211 hockey players of 8–15 years of age. Mixed-effects modelling was used to examine the influence of age, gender and concussion on EF in youth athletes. Findings: Baseline analyses revealed significant age and gender effects on measures of EF. Multiple effects of concussion history on measures of cognitive flexibility (F = 2.48,p = 0.03) and psychomotor speed (F = 2.59,p = 0.04) were found. Implications: This study highlights the impact of age, gender and concussion on EF in youth. These findings provide foundational knowledge to better manage cognitive sequelae following sports-related concussion. [ABSTRACT FROM AUTHOR]

Objective: Impairments in attention and memory are common sequelae following paediatric acquired brain injury (ABI). While it has been established that such impairments are long-term and, therefore, affect quality-of-life, there is a scarcity of evidence-based interventions to treat these difficulties. The current study aimed to pilot the efficacy of the Amsterdam Memory and Attention Training for Children (Amat-c: English version) using both neuropsychological and ecologically sensitive measures. It was expected that children with attention and memory difficulties post-ABI would show improved performance post-intervention on cognitive and ecological measures, with maintenance at 6 months post-intervention. Methods and procedures: Ten children with an ABI, between the ages of 8–13 years at the time of recruitment were identified through audits of presentations to a metropolitan paediatric hospital. Each child underwent screening, the 18 week intervention programme, pre-intervention, immediate and 6 month post-intervention assessments. Outcomes/results: Findings supported the hypothesis that children would show post-intervention (immediate and 6 month) improvement in areas of attention and memory, with generalization to everyday life. Conclusions/implications: Preliminary results provide support for the efficacy of the Amat-c post-childhood ABI. A larger study is needed to confirm these findings, as a reduction in attention and memory difficulties will enhance everyday functioning. [ABSTRACT FROM AUTHOR]

Purpose: To assess quantitatively the effect of luminance on VEP amplitude and latency in visually-normals (VN) and patients with mild traumatic brain injury (mTBI). Methods: VN individuals (n = 20) and those with mTBI (n = 19) participated. Those with mTBI were assessed 1–10 years post-injury (mean = 4.97 years), with the exception of one subject. Pattern VEP testing was employed using the DIOPSYS™ NOVA–TR system, with a 74 cd m−2baseline luminance. Luminance levels were reduced with five different neutral density (ND) filters (0.5, 1.0, 1.5, 2.0 and 2.5) and compared to the baseline response. All testing was performed under binocular-viewing conditions with full refractive correction in place. Results: In both groups, mean VEP amplitude reduced with decrease in luminance (p < 0.05). At each luminance level, the mean VEP amplitude was significantly lower in mTBI than in the VN population (p < 0.05). In both groups, the mean VEP latency increased progressively with reduction in luminance (p < 0.05), with it being significantly higher in mTBI than in the VN population (p < 0.05). Conclusions: High luminance levels produced an optimal VEP response in both populations. VEP amplitude was robust, whereas latency progressively increased in both groups as luminance decreased. The latency increase with decreased luminance was significantly larger in those with mTBI, thus suggesting that latency can be used to differentiate reliably between VN individuals and those with mTBI. [ABSTRACT FROM PUBLISHER]

Objective: To examine the effect of soccer heading ball speed on S-100B serum concentration, concussion sideline assessments and linear head impact acceleration. Methods: Sixteen division I soccer players participated in this pre-test post-test design study. Athletes performed five standing headers over a 10 minute period at 30 (n = 5), 40 (n = 5) or 50 (n = 6) miles per hour (mph) (randomized). S-100B serum concentration (ng mL−1) and sideline concussion assessments were measured prior to and post-heading. Peak resultant linear head acceleration (gravitational units; g) was measured during soccer heading. Results: No statistically significant interaction effects were identified between ball velocity groups over time on S100B (effect sizes ranged from 0.03–0.23) or concussion assessments tests. There was a non-significant increase (p = 0.06) in head impact acceleration from the 30 (30.6; SD = 6.2 g) to 50 mph (50.7; SD = 7.7 g) ball speed. Conclusions: In this controlled setting, an acute bout of soccer heading across various ball velocities did not affect S100B or concussion assessment test scores. These findings are preliminary, as the small sample size in each group may have played a role in the lack of significant findings. [ABSTRACT FROM PUBLISHER]

Background: Information is scant concerning enduring brain injury effects of participation in the contact sport of Rugby Union (hereafter rugby) on early adolescents. Objective: The objective was prospectively to investigate differences between young adolescent male rugby players and non-contact sports controls on neurocognitive test performance over 3 years and academic achievement over 6 years. Method: A sample of boys from the same school and grade was divided into three groups: rugby with seasonal concussions (n = 45), rugby no seasonal concussions (n = 21) and non-contact sports controls (n = 30). Baseline neurocognitive testing was conducted pre-season in Grade 7 and post-season in Grades 8 and 9. Year-end academic grades were documented for Grades 6–9 and 12 (pre-high school to year of school leaving). A mixed model repeated measures ANOVA was conducted to investigate comparative neurocognitive and academic outcomes between the three sub-groups. Results: Compared with controls, both rugby groups were significantly lower on the WISC-III Coding Immediate Recall sub-test. There was a significant interaction effect on the academic measure, with improved scores over time for controls, that was not in evidence for either rugby group. Conclusions: Tentatively, the outcome suggests cognitive vulnerability in association with school level participation in rugby. [ABSTRACT FROM PUBLISHER]

Primary objective: The role of microglial activation in traumatic brain injury (TBI) has been extensively described in established animal models. In contrast, very few studies have analysed this process in human patients, the majority being focused on the local reaction in the contused parenchyma. In this work, the main objective was the analysis of microglial activation in brain regions distant from the primary lesion. Research design: Morphological changes of microglia were evaluated in the cerebral cortex of patients deceased from TBI in comparison with control subjects. Methods and procedures: Cortical samples from five cases with TBI and 10 controls were evaluated usingRicinus communislectin histochemistry and conventional Hematoxylin-eosin staining. Main outcomes and results: It was observed that microglial cells from patients with TBI presented shorter and thicker cellular projections compared with controls. Moreover, the percentage of histological area reactive to lectin was statistically higher in samples from subjects with TBI. These signs of microglial activation were observed in all of the analysed cortical areas, thus indicating a generalized effect on the whole cerebral cortex. The results are consistent with previous imaging PET studies performed in living patients with the11C-PK11195 radiotracer. Conclusions: The findings indicate that TBI induces a widespread activation of brain microglia which affects all cortical areas, including those distant from the contusion site. [ABSTRACT FROM PUBLISHER]

Primary objective: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran’s Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology. Research design: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given). Methods and procedures: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation. Main outcomes and results: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms. Conclusions: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation. [ABSTRACT FROM PUBLISHER]

Background: Concussions exert persistent effects on asymptomatic athletes, especially women. Among chief mechanisms of concussion recovery are alterations of neuronal plasticity. Olfactory function, often impaired following a concussion, greatly involves plasticity and, therefore, appears as a good candidate to study the deleterious effects of concussions. The BDNF Val66Met polymorphism (BDNFMet), which reduces availability of BDNF in the brain, has surprisingly been associated with better recovery following concussion. Objective: This study examines the mediating effect of BDNFMet on olfactory functions in asymptomatic concussed female athletes. Methods: Participants, 105 female university athletes, were divided into four groups based on their history of concussion (Concussion/No concussion) and BDNF polymorphism (BDNF Val66Val/Val66Met). Odour threshold, discrimination and identification were measured using the Sniffin' Sticks Inventory Test. Results: Concussed female BDNFMet athletes performed significantly better than BDNFVal counterparts on threshold ( F(1, 34) = 4.73, p < 0.05), discrimination ( F(1, 52) = 5.36, p < 0.05), identification tests ( F(1, 52) = 5.65, p < 0.05) and total olfactory scores ( F(1, 34) = 9.54, p < 0.05). Conclusion: These results support a genotypic effect of the BDNF Val66Met polymorphism on long-term olfactory function following a concussion in young female athletes. [ABSTRACT FROM AUTHOR]

Objective: Cognitive recovery from sports concussion may be incomplete after resolution of other symptoms. It was hypothesized that independent effects of the number of days since last concussion (Days) and total number of concussions (Number) would predict poorer cognitive functioning. Methods and procedures: Cognition was assessed in an NCAA Division I student-athlete population ( n = 87) using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. In a MANOVA, the five ImPACT Composite scores were dependent variables, with Group (Concussion, Unaffected) as the independent variable and prior number of concussions (Number) and days since last concussion (Days; 68-2495 days) entered as covariates. Outcomes and results: The hypothesis that Days and Number would each independently affect cognitive functioning (as assessed by ImPACT Composite scores) was only partly supported. A significant, multivariate, main effect of Days ( p = 0.01) indicated that more Days predicted better cognitive functioning overall ( p = 0.01). Univariate effects emerged such that more Days specifically predicted better visual memory ( p = 0.004) and faster reaction times ( p = 0.02). A trend toward a Group*Days*Number three-way interaction for reaction time emerged ( p = 0.06), such that smaller Number and more Days each predicted slower reaction time. Conclusions: Cognitive recovery following sports concussion may take far longer than was previously thought, the aetiology of cognitive reductions may be very complex and the ImPACT appears to be sensitive to subtle changes in cognition across time. [ABSTRACT FROM AUTHOR]