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Advanced neuroimaging techniques show promise as a biomarker for mild traumatic brain injury (mTBI). However, little research has evaluated cerebral hemodynamics or its relation to white matter microstructure post-mTBI in children. This novel pilot study examined differences in cerebral hemodynamics, as measured using functional near-infrared spectroscopy (fNIRS), and its association with diffusion tensor imaging (DTI) metrics in children with mTBI or mild orthopedic injury (OI) to address these gaps. Children 8.00?16.99 years of age with mTBI (n?=?9) or OI (n?=?6) were recruited in a pediatric emergency department, where acute injury characteristics were assessed. Participants completed DTI twice, post-acutely (2?33 days) and chronically (3 or 6 months), and fNIRS ?1 month post-injury. Automated deterministic tractography was used to compute DTI metrics. There was reduced absolute phase globally and coherence in the dorsolateral pre-frontal cortex (DLPFC) after mTBI compared to the OI group. Coherence in the DLPFC and absolute phase globally showed distinct associations with fractional anisotropy in interhemispheric white matter pathways. Two fNIRS metrics (coherence and absolute phase) differentiated mTBI from OI in children. Variability in cerebral hemodynamics related to white matter microstructure. The results provide initial evidence that fNIRS may have utility as a clinical biomarker of pediatric mTBI.

Introduction After mild traumatic brain injury, service members may experience difficulty with executive functions, which could interfere with return to duty and life roles. Because performance-based multitasking assessments are sensitive to executive dysfunction, a team of military and civilian rehabilitation researchers developed the Charge of Quarters Duty Test (CQDT) to help inform duty readiness after concussion; it is a multitasking test based on a military task scenario that challenges executive functions, such as foresight and planning, set shifting, and prospective memory. Although previous study indicates that CQDT has reliability and known-groups validity, like other multitasking tests, it should not be readministered after rehabilitative care because of learning effects. The purpose of this study was to develop an alternate form of the CQDT and evaluate its equivalence to the CQDT. Materials and Methods A measurement development study was conducted in which subject matter experts on the study team used an iterative approach to create an alternate form. To evaluate equivalence, a repeated measures design was employed in which each participant performed one or both test versions twice and acted as their own control. Results The study team created the Maintenance Office Duty Test (MODT), the alternate form of the CQDT. A convenience sample of 40 adults performed both the MODT and CQDT approximately 2 weeks apart; 4 had a history of military service and 16 had a history of acquired brain injury. We compared mean scores and standard deviations of each test's 4 subscores using matched-pair t -tests and found that scores were not statistically different, suggesting that the 2 tests are equivalent. In addition, matched-pair t -tests were used to compare Time 1 and Time 2 subscores when (1) participants performed the 2 test versions (CQDT and MODT) and (2) participants performed the same test twice. None of the differences in Time 1 and Time 2 subscores were statistically significant when participants performed the 2 test versions. However, when participants performed the same test twice, three of the four Time 1 and Time 2 scores were significantly different, with Time 2 reflecting improved performance and possible learning effects (performance accuracy P  = .013; total number of rule breaks P  = .015; performance time P  = .002). Conclusions The MODT appears to be an equivalent form of the CQDT that mitigates learning effects that often accompany performance of multitasking assessments. Having developed and validated the equivalence of the CDQT's alternate form, military rehabilitation clinicians have an expanded set of clinical tools by which to identify possible executive dysfunction and evaluate service members' response to rehabilitative care via pre- and post-rehabilitation testing after mild traumatic brain injury. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to review the literature regarding the current state and clinical applicability of machine learning models in prognosticating the outcomes of patients with mild traumatic brain injury in the early clinical presentation. Design: Databases were searched for studies including machine learning and mild traumatic brain injury from inception to March 10, 2023. Included studies had a primary outcome of predicting post-mild traumatic brain injury prognosis or sequelae. The Prediction model study Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability of included studies. Results: Out of 1235 articles, 10 met the inclusion criteria, including data from 127,929 patients. The most frequently used modeling techniques were support vector machine and artificial neural network and area under the curve ranged from 0.66 to 0.889. Despite promise, several limitations to studies exist such as low sample sizes, database restrictions, inconsistencies in patient presentation definitions, and lack of comparison to traditional clinical judgment or tools. Conclusions: Machine learning models show potential in early stage mild traumatic brain injury prognostication, but to achieve widespread adoption, future clinical studies prognosticating mild traumatic brain injury using machine learning need to reduce bias, provide clarity and consistency in defining patient populations targeted and validate against established benchmarks. [ABSTRACT FROM AUTHOR]

Introduction: Sleep disorders caused by TBI are considered serious post-injury consequences and barriers to recovery. These disorders can last for years and disrupt the quality of life. Therefore, the present study investigated insomnia, its severity, and sleepiness in patients with Mild Traumatic Brain Injury. Method: The present descriptive-analytical study was conducted in 2022. A total of 329 patients with diagnosed mTBI, were examined at 2 weeks, 3, 6, and 12 months after the injury. The demographic information and medical history, pain, and Injury Severity Scores were questioned. Furthermore, the Insomnia Severity Index, Athens Insomnia Scale, and the Epworth Sleepiness Scale were used to diagnose insomnia, its severity, and sleepiness. Results: In all 4 periods, insomnia had a significant difference with sleepiness (P

IntroductionRecent developments in neuroimaging techniques enable increasingly sensitive consideration of the cognitive impact of damage to white matter tract (WMT) microstructural organisation after mild traumatic brain injury (mTBI).ObjectiveThis study investigated the relationship between WMT microstructural properties and cognitive performance.Participants, setting and designUsing an observational design, a group of 26 premorbidly healthy adults with mTBI and a group of 20 premorbidly healthy trauma control (TC) participants who were well-matched on age, sex, premorbid functioning and a range of physical, psychological and trauma-related variables, were recruited following hospital admission for traumatic injury.Main measuresAll participants underwent comprehensive unblinded neuropsychological examination and structural neuroimaging as outpatients 6–10 weeks after injury. Neuropsychological examination included measures of speed of processing, attention, memory, executive function, affective state, pain, fatigue and self-reported outcome. The WMT microstructural properties were estimated using both diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) modelling techniques. Tract properties were compared between the corpus callosum, inferior longitudinal fasciculus, uncinate fasciculus, anterior corona radiata and three segmented sections of the superior longitudinal fasciculus.ResultsFor the TC group, in all investigated tracts, with the exception of the uncinate fasciculus, two DTI metrics (fractional anisotropy and apparent diffusion coefficient) and one NODDI metric (intra-cellular volume fraction) revealed expected predictive linear relationships between extent of WMT microstructural organisation and processing speed, memory and executive function. The mTBI group showed a strikingly different pattern relative to the TC group, with no relationships evident between WMT microstructural organisation and cognition on most tracts.ConclusionThese findings indicate that the predictive relationship that normally exists in adults between WMT microstructural organisation and cognition, is significantly disrupted 6–10 weeks after mTBI and suggests that WMT microstructural organisation and cognitive function have disparate recovery trajectories.

Background: Repetitive mild traumatic brain injury (rmTBI) often occurs in individuals engaged in contact sports, particularly boxing. This study aimed to elucidate the effects of rmTBI on phase-locking value (PLV)-based graph theory and functional network architecture in individuals with boxing-related injuries in five frequency bands by employing resting-state electroencephalography (EEG). Methods: Twenty-fore professional boxers and 25 matched healthy controls were recruited to perform a resting-state task, and their noninvasive scalp EEG data were collected simultaneously. Based on the construction of PLV matrices for boxers and controls, phase synchronization and graph-theoretic characteristics were identified in each frequency band. The significance of the calculated functional brain networks between the two populations was analyzed using a network-based statistical (NBS) approach. Results: Compared to controls, boxers exhibited an increasing trend in PLV synchronization and notable differences in the distribution of functional centers, especially in the gamma frequency band. Additionally, attenuated nodal network parameters and decreased small-world measures were observed in the theta, beta, and gamma bands, suggesting that the functional network efficiency and small-world characteristics were significantly weakened in boxers. NBS analysis revealed that boxers exhibited a significant increase in network connectivity strength compared to controls in the theta, beta, and gamma frequency bands. The functional connectivity of the significance subnetworks exhibited an asymmetric distribution between the bilateral hemispheres, indicating that the optimized organization of information integration and segregation for the resting-state networks was imbalanced and disarranged for boxers. Conclusions: This is the first study to investigate the underlying deficits in PLV-based graph-theoretic characteristics and NBS-based functional networks in patients with rmTBI from the perspective of whole-brain resting-state EEG. Joint analyses of distinctive graph-theoretic representations and asymmetrically hyperconnected subnetworks in specific frequency bands may serve as an effective method to assess the underlying deficiencies in resting-state network processing in patients with sports-related rmTBI.

Objective: This report documents the effects of hearing treatment in an adult with a history of mild traumatic brain injury (mTBI) and normal peripheral hearing acuity., Design: This report details a case study of a 26-year-old female with a history of mTBI., Study Sample: A 26-year-old female with a history of mTBI presented with auditory symptoms including tinnitus, hyperacusis, listening fatigue, and speech-in-noise (SIN) difficulties despite diagnostic audiological findings showing normal peripheral auditory function and suprathreshold SIN performance within the normal range. The patient was fit with premium-level receiver-in-the-canal (RIC) hearing aids (HAs) using several different mild-gain fitting approaches involving wide dynamic range compression (WDRC) or linearized gain. A combination of objective and subjective methods was utilized to guide clinical decision making on the fitting approach and to verify/validate treatment outcomes., Results: Despite no difference in acutely aided SIN performance between the WDRC or linearized fitting approaches, the patient expressed a clear preference for the HA fitting approach involving application of 2-10 dB of shaped linearized gain > 1.5 kHz for soft, medium, and loud input levels (with greatest gain applied at 3-4 kHz). These settings were preferred in terms of loudness and sound quality even compared to the WDRC fitting approaches previously reported in literature. This fitting approach was verified and validated by SIN testing showing improved performance in the aided condition, as well as high levels of self-reported benefit and satisfaction, reduction in self-reported hearing handicap, reduction in sound sensitivity, and enhanced quality of life with HAs., Conclusions: Results add to the growing body of evidence supporting the benefits of mild-gain HAs for adults with mTBI and self-reported SIN deficits despite normal hearing acuity. Results also support the importance of using a combination of measures (e.g., SIN testing, patient report, outcome questionnaires) to guide the HA fitting process and to verify/validate treatment outcomes. Although findings were derived from a single case study and should be interpreted with caution, the patient's preference for a shaped linearized mild-gain approach is noteworthy. There exists a lack of clinical guidelines and prescriptive fitting methodology for fitting HAs in mTBI adults with SIN difficulty despite normal peripheral hearing acuity. Future research should systematically compare WDRC versus linearized gain approaches of fitting in this population to develop a clinical methodology for HA fitting and optimize outcomes in this special subpopulation.

Mild traumatic brain injuries (mTBIs) are caused by biomechanical forces being transmitted to the brain, causing neuronal connections to be subjected to sheering forces. The injury severity can be affected by a number of factors that include age and sex, however, there remains a paucity of data on how repeated mTBI (r-mTBI) impacts the female brain. In these studies, male and female juvenile rats [ postnatal day (PND) 25 - 26 ] were administered a total of eight mTBIs over a 2-day period. Following each mTBI, rats were immediately assessed for acute neurological impairment. After eight mTBIs were completed, the Barnes maze was used to assess spatial learning and memory. Axonal injury was assessed using silver stain histological analyses. We found that injured females exhibited less acute neurological impairment than males. Three days after the final r-mTBI, no significant differences were observed in spatial learning and memory, with all animals showing similar times to locate the escape platform on the reversal trial, additionally there was no main effect of sex in the Barnes maze. Silver stain uptake was significantly increased in the optic tract, corpus callosum, and cortex compared with sham animals at seven days postinjury in a sex-specific manner. Females showed significant increase in all three regions following r-mTBI, whereas males only showed a significant increase in staining in the optic tract. Overall, these findings show that females may be more susceptible to axonal damage than males, and that cognitive deficits were not evident in this population following r-mTBI. These results indicate that there may be benefits in examining biomarkers that reflect axonal injury and the therapies that target reducing axonal degradation. NEW & NOTEWORTHY Diffuse axonal injury is a hallmark feature of all severities of traumatic brain injury (TBI) yet, in preclinical mild (m)TBI research no studies have yet investigated axonal damage with silver stain immunohistochemistry in female animals. This is a critical gap in the literature as recent studies suggest that females experience mTBI more frequently than males. We found that repeated mTBI (r-mTBI) caused significant diffuse axonal injury that was more pronounced in females compared with males.

Introduction: Headache is the most overwhelmingly reported symptom following mild traumatic brain injury (mTBI). The upper cervical spine has been implicated in headache etiology, and cervical dysfunction may result in neck pain that influences the experience of headache. Sleep problem is the second most reported symptom following mTBI. We explored the contribution of neck pain (as a potential proxy for cervical dysfunction) on headache burden along with the contribution of sleep quantity following mTBI., Materials and Methods: Retrospective data from a repository consisting of service members recruited from primary care, with (N = 493) and without a history of mTBI (N = 63), was used for analysis. Portions of the Neurobehavioral Symptom Inventory, Pittsburgh Sleep Quality Index, and Orebro Musculoskeletal Pain Questionnaire were used for headache, sleep, and neck pain measures., Results: Demographic and military characteristics that differed between groups were treated as covariates in analyses. Group comparisons revealed significant differences in the expected direction on all measures: mTBI > controls on headache and neck pain; controls > mTBI on sleep quantity. Regression revealed that neck pain accounted for the most variance in headache score, followed by group membership and sleep quantity. When analyzing groups separately, no difference in the pattern of results was revealed in the mTBI group. In the control group, variance in headache score was only significantly related to neck pain., Conclusions: Amongst service members who sought service from primary care, neck pain explains more variance in headache burden than mTBI history or sleep quantity, supporting that cervical dysfunction may be a salient factor associated with headache. Neck functioning may be a potential area of intervention in the management of headaches., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: A challenge in management of patients with mild traumatic brain injury (mTBI) is the lack of objective biomarkers to guide diagnosis, classification, and prognostication. White matter hyperintensities (WMHs) on T2-weighted MRI sequences have been identified as a potential marker for this purpose. Objective: To compare WMHs on high-resolution 3-T MRI between individuals with and without mTBI and to assess associations of WMHs with clinical markers in mTBI. Methods: This prospective study recruited individuals with acute mTBI and a matched control group of individuals without mTBI from seven U.S. centers from November 2015 to January 2018. Participants underwent up to four clinical encounters (baseline through approximately 3 months after enrollment). At each encounter, clinical markers of head injury were tested, including the Rivermead Post-Concussion Symptoms Qustionnaire-3 (RPQ-3), assessing early postconcussive symptoms (physical symptoms), Rivermead Post-Concussion Symptoms Questionnaire-13 (RPQ-13), assessing late postconcussive symptoms (psychosocial functioning and lifestyle), and Balance Error Scoring System (BESS) test, assessing postural stability. Participants also underwent at each encounter 3-T MRI including a high-resolution isotropic 3D T2-weighted FLAIR sequence. Two neuroradiologists independently reviewed FLAIR sequences from baseline encounters for presence of at least one WMH and of abnormal WMHs (defined as ≥5 punctate foci, at least one focus measuring >3 mm, or at least one focus in an atypical location); discrepancies were resolved by a consensus process involving possible review by a group of four neuroradiologists. Results: The mTBI group included 303 participants (mean age, 21.6±8.2 years; 162 male, 141 female); the control group included 148 participants (mean age, 21.8±8.3 years; 71 male, 77 female). At least one WMH was present in 102 (34%) participants in the mTBI group, of which 40% (41) had abnormal WMHs, and 52 (35%) participants in the control group (p=.76), of which 35% (18) had abnormal WMHs (p=.50). Neither WMHs nor abnormal WMHs were associated with RPQ3-, RPQ-13, or BESS total score at any time point (p>.05). Conclusion: WMHs did not show significant differences between mTBI and control groups, nor significant associations with clinical markers in the mTBI group. Clinical Impact: The findings do not support WMHs as a marker of mTBI.

MicroRNAs (miRNAs) play pivotal role as biomarkers for various diseases, with salivary miRNAs offering a non-invasive diagnostic tool. For mild traumatic brain injury (mTBI), salivary miRNAs like miR-let7a, miR-21, and miR-30e show promise for early detection of subtle injuries lacking reliable indicators. To advance the detection of mTBI-related salivary miRNAs, this study integrates anti-miRNA and miRNA hybridization-based sensing with the development of a nanoscale covalent-organic framework (COF) platform. COFs, with their highly customizable structures, large surface area, and biocompatibility, serve as a versatile foundation for biosensing applications. Here, post-synthetic modification (PSM) of COFs is introduced for essential covalent conjugation of streptavidin for further immobilization of methylene blue-labeled and biotinylated Anti-miRNAs. Furthermore, the layer-by-layer assembly of conductive polymers enhanced the biosensor's electrical performance, enabling ultrasensitive and multiplexed detection of salivary miRNAs. Validated with samples from mixed martial arts participants and confirmed by polymerase chain reaction (PCR), this COF-based platform demonstrates robust accuracy and reliability. By combining COF functionalization with advanced electrode design, it offers a powerful, non-invasive solution for early mTBI detection and broader biomedical applications., (© 2025 The Author(s). Small published by Wiley‐VCH GmbH.)

With almost 2.9 million people in the United States seeking medical attention for head trauma each year,1 emergency clinicians face the critical task of efficiently and accurately identifying those with potentially life-threatening intracranial trauma. Due to the heterogeneity of patients, there is no one-size- fits-all approach to managing patients with suspected mild traumatic brain injury. This issue of Emergency Medicine Practice: Trauma EXTRA! reviews clinical guidelines, challenges in care for patients at extremes of ages, and strategies for managing patients with bleeding disorders or those taking anticoagulants or antiplatelet agents. Indications for imaging are also discussed, as well as which patients are at increased risk for intracranial injury and post-concussive syndrome. Management of patients with mild traumatic brain injury includes neurosurgery consultation, hospital admission for further observation, repeat imaging, or discharge home with careful discharge instructions.

In this narrative review, we explore the insights from current research in functional neuroimaging following mild traumatic brain injury (mTBI), with a specific focus on alterations in functional connectivity and its relationship to deficits in executive functioning. Secondly, we identify implications that changes in functional connectivity have for language processing and management of cognitive-communication disorders. The search included CINAHL, PubMed, and APA Psychinfo databases, including terms mTBI, functional connectivity, cognitive deficits, and associated functional imaging tools. After all exclusionary criteria were applied, 19 studies were included. This review shows that alterations in functional connectivity networks following mTBI are sensitive for presence of injury. However, the presentation appears widely heterogeneous as of this time, highlighting the need for further research, especially investigating differences of within-subject methods and between-subject/group comparisons. While functional magnetic resonance imaging is the most commonly applied resource, functional near-infrared spectroscopy has become an easily accessible alternative, which may prove more useful for future studies. The roles for neuroimaging technology and measurements of functional connectivity are continuing to take shape, and they will likely represent a significant step forward for more personalized and effective strategies in assessment and treatment of mTBI.

Importance: There is unclear evidence on when to initiate physical therapy after mild traumatic brain injury (mTBI) in a non-athlete, adult population., Objective: The objective of this study was to investigate physical therapy timing after mTBI through changes in patient-reported and clinically-assessed tools and objective and mechanism measurements of sensorimotor balance control., Design: This study was an investigator-blinded randomized control trial (NCT03479541)., Setting: The study took place at an academic research center., Participants: Two hundred and three participants were randomized to earlier physical therapy (n = 82) or to later physical therapy (n = 121)., Intervention: After enrollment, the earlier physical therapy group started rehabilitation within 1 week and the later group started rehabilitation after a 6-week wait period. All participants received similar rehabilitation; 6-week program administered and progressed by licensed physical therapists., Main Outcomes and Measures: The primary outcome was the Dizziness Handicap Inventory (DHI). Secondary outcomes included common patient-reported/clinical assessments of mTBI and objective/mechanism measurements of balance, including novel measures of central sensorimotor integration. Differences between and within the groups on outcomes were examined with linear mixed-effect models, t tests, and effect sizes., Results: While both groups significantly improved and reached similar levels on patient-reported outcomes (DHI and secondary outcomes), the earlier physical therapy group had significantly larger and faster rates of improvement compared to later physical therapy. There were differential effects of physical therapy timing on the objective/mechanism-measured outcomes. Specifically, there were significant improvements in sensorimotor time delay for the earlier physical therapy group and no change in the later group. Further, the later group worsened in the motor activation components for balance control while there was no change in the early group., Conclusion and Relevance: Earlier physical therapy after mTBI can improve symptoms at a faster rate relative to later physical therapy. Earlier physical therapy also showed improvements in sensorimotor aspects of balance control, not seen in the later group. There may be an important window to address central sensorimotor deficits after mTBI., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Purpose: It is estimated that 18%-30% of patients with concussion experience symptoms lasting more than 1 month, known as persistent post-concussion symptoms (PPCS). Symptoms can be debilitating, and include headache, dizziness, nausea, problems with memory and concentration, sleep and mood disruption, and exercise intolerance. Previous studies have used quantitative susceptibility mapping (QSM) to show altered tissue susceptibility levels in adults acutely following concussion, however this finding has yet to be investigated in participants with PPCS., Materials and Methods: In this exploratory case-controlled study, we measured tissue susceptibility using QSM in 24 participants with PPCS after mild traumatic brain injury (mTBI) and 23 healthy controls with no history of concussion. We compute tissue susceptibility for 7 white matter tracts and 3 deep gray matter regions and compare tissue susceptibility between groups using ANCOVA models controlling for age and sex. We also assess the relationship between regional tissue susceptibility and symptoms., Results: There were no significant differences between tissue susceptibility in participants with PPCS compared with control subjects in any of the evaluated regions. However, we show lower tissue susceptibility across 4 white matter tracts was generally associated with worse symptoms in the PPCS group. Specifically, we saw relationships between white matter susceptibility and headache ( p = .006), time since injury ( p = .03), depressive symptoms ( p = .021), and daytime fatigue ( p = .01) in participants with PPCS., Conclusions: These results provide evidence in support of persistent changes in the brain months to years after injury and highlight the need to further understand the pathophysiology of PPCS, to determine effective prevention and treatment options., (© 2025 by American Journal of Neuroradiology.)

Purpose: The aim of this study was to describe the development of and pilot feasibility outcomes for a strategy-based, brief, intensive cognitive rehabilitation intervention delivered to U.S. service members and veterans with mild traumatic brain injury in a recently completed 3-year pragmatic clinical trial: Symptom-Targeted Approach to Rehabilitation for Concussion (STAR-C)., Method: To develop STAR-C, we used the Rehabilitation Treatment Specification System to identify core elements and principles from a previous randomized clinical trial of cognitive rehabilitation, and incorporated principles of neuroplasticity (e.g., high-dose spaced practice of personally meaningful tasks), best clinical practices (e.g., client-centered goal setting), health psychology (e.g., a focus on self-efficacy and motivation), and community-based participation research (e.g., the protocol was co-designed by clinicians and researchers). Treatment was based on a resource-allocation theory of everyday cognitive challenges, which predicted that automatic strategy use would reduce cognitive demands of everyday activities and therefore reduce cognitive symptoms. Treatment was delivered by speech-language pathologists (SLPs) and occupational therapists (OTs), using a protocol that included a problem-focused intake questionnaire, manualized treatment, and clinician resources. Therapy was delivered individually in six to 10 virtual or in-person sessions over 3-4 weeks. Therapy focused on desired changes in function, scaled using Goal Attainment Scaling., Results: Trained SLPs and OTs delivered STAR-C to 53 U.S. service members and veterans, with treatment fidelity > 95%. Participants and clinicians rated STAR-C as acceptable, feasible, and appropriate, and most participants attained and maintained targets., Conclusion: STAR-C appears to be a feasible method for improving everyday cognitive performance and efficacy should be tested in a controlled study., Supplemental Material: https://doi.org/10.23641/asha.28222613.

Background: Secondary insults such as brain edema is commonly observed after traumatic brain injury (TBI) and remains an important cause of neurological deterioration. Based on the corticosteroid randomisation after significant head injury (CRASH) trial findings, Brain Trauma Foundation guidelines recommend against giving steroids in TBI. However, the findings of two recent clinical studies suggest that there may be a subset of patients who may benefit from steroids., Methods: This study was a retrospective, single-center, 4-year study. The study analyzed patients who had received systemic corticosteroids for pericontusional delayed edema after TBI. The time interval to steroid prescription, drug dosage, time to symptomatic improvement, and complications were analyzed., Results: There were 19 males and eight females. Mean age was 42.1 years (range, 21-91 years). Except for one, all were mild TBI categories. All patients had brain contusions on computed tomography. Dexamethasone was used in tapering doses over 5-10 days, starting with 12 mg/day. The mean interval to steroid prescription after the trauma was 5.9 days, and the mean and median duration was 7 days. All, except one, had symptomatic improvement. The mean time to complete improvement in symptoms was 2.8 days. There were no complications pertinent to steroid usage in any of our cases., Conclusion: This is the third clinical study to document the efficacy of systemic corticosteroids for delayed cerebral edema after TBI. As steroids are excellent drugs for vasogenic edema, the timing and dosage of steroids are two important factors that will determine their efficacy in TBI. We strongly feel that there needs to be more robust clinical trials with good patient numbers to confirm these findings., Competing Interests: There are no conflicts of interest., (Copyright: © 2025 Surgical Neurology International.)

Objective: The new diagnosis-related group (NDRG) payment combines the original diagnosis-related group (DRG) and the fee-for-service (FFS) system, covering basic hospital services through fixed hospitalization costs based on the DRG assigned to the patient, while separate fees were applied for surgical and procedural interventions by physicians. This study aimed to evaluate the impact of payment methodology on medical costs and outcomes in patients with mild traumatic brain injury (TBI)., Methods: This retrospective study included 1,247 patients who underwent inpatient neurosurgical treatment at a single regional trauma center from January 2016 to December 2022. Since the implementation of the NDRG payment system in 2019, patients were classified into the FFS and NDRG payment groups. Outcomes were evaluated using the Extended Glasgow Outcome Scale (GOS-E) at discharge and 3 months post-traumatic event; admission days were also assessed. Total medical and out-of-pocket expenses incurred at the time of discharge were also analyzed., Results: The NDRG payment group demonstrated poorer results in GOS-E at discharge and 3 months post-TBI. However, the admission days were notably shorter. Out-of-pocket expenses were significantly lower in the NDRG payment group. While age, total medical expenses, and out-of-pocket expenses were significantly associated with the GOS-E at discharge, the NDRG payment did not correlate with the GOS-E at discharge. Notably, only the NDRG payment was significantly correlated with lower out-of-pocket expenses., Conclusion: Implementing the NDRG payment system for patients with mild TBI does not impact total medical costs but effectively reduces out-of-pocket expenses, without adversely affecting the GOS-E., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2025 Korean Neurotraumatology Society.)

Objective: Older adults have an increased risk of developing persistent cognitive complaints after mild traumatic brain injury (mTBI). Yet, studies exploring which factors protect older adults with mTBI from developing such complaints are rare. It has been suggested that one such factor may be cognitive reserve (CR), but it is unknown how CR influences cognition in this patient category. Here, we therefore study how CR influences brain processes during a task that taps into attention, an important cognitive function., Methods: We studied 17 older adults (13 males, mean 68.18 (SD 5.08) years old) at the subacute stage after mTBI and 19 age- and CR-matched participants without mTBI; 9 males, mean 67.79 (SD 5.36) years old) performing a selective visual attentional processing task while recording EEG. The P2 brain event-related potential component was obtained by averaging over electrodes in the fronto-central region of interest and its amplitude and latency were derived as neural correlates of attentional processing. The inverse efficiency score (IES) was derived from accuracy and reaction times as a measure of performance. To investigate the effect of CR on performance and P2 component characteristics, three separate mixed model repeated measures analyses of covariance (RM-ANCOVA) were performed., Results: Performance did not significantly differ across groups or task conditions, nor was it significantly influenced by CR. Main effects of CR illustrated that the P2 latency was delayed (p = .03) and the P2 amplitude increased (p = .02) with higher CR across groups. Furthermore, CR correlated positively with P2 latency in both groups (older adults without mTBI: r = .370, p = .005, older adults with mTBI: r = .287, p = 0.041), and with P2 amplitude in the older adults with mTBI (r = .595-.636, p<0.001-.011). We found no main or interaction effects of group or task condition on P2 characteristics., Conclusion: Older adults with mTBI with higher CR employ more brain resources than older adults with mTBI with lower CR, accompanied by slower processing, suggesting that it may have resulted in similar performance at a selective visual attentional processing task. To better interpret these findings in the context of persistent complaints and establish that higher CR in these patients may result in better performance, our study needs to be repeated with more participants., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Balart-Sánchez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings., Methods: By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults. Of the 696 studies identified, only six met the inclusion criteria, highlighting the limited research in this area., Results: The review assessed various diagnostic tools including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), neuropsychological tests, advanced imaging, and oculomotor assessments. However, these tools are limited in their ability to confirm whether an mTBI has occurred. The American Congress of Rehabilitation Medicine's updated mTBI criteria may offer the best diagnostic potential but require validation., Conclusion: According to the findings, there is a significant gap in validated diagnostic tools for mTBI in post-acute settings, which may negatively affect patient outcomes. Developing and validating effective screening tools for mTBI in the post-acute polytrauma setting should be the priority of future research in this area.

Importance: Individuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients., Objective: To determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI., Design, Setting, and Participants: This prospective, observational, case-control study was conducted between May 2018 and November 2021. The study setting was at a level 1 trauma research hospital. Participant eligibility included adult males and females with recorded best-corrected visual acuity and normal fundus examination. Individuals in the case group had a history of mild TBI; controls had no history of TBI. Exclusion criteria included a history of ocular, neurological, or psychiatric disease, moderate-severe TBI, recent TBI, metal implants, age younger than 18 years, and pregnancy. Cases and controls were sex- and age-matched. Data analysis was performed from July 2023 to March 2024., Exposures: History of mild TBI in the case group., Main Outcomes and Measures: The single-session visit included the Neurobehavioral Symptom Inventory and measurements of oculomotor function, optical coherence tomography, contrast sensitivity, visual evoked potentials, visual field testing, and magnetic resonance imaging., Results: A total of 28 participants (mean [SD] age, 35.0 [12.8] years; 15 male [53.6%]) with mild TBI and 28 controls (mean [SD] age, 35.8 [8.5] years; 19 female [67.9%]) were analyzed. Participants with mild TBI showed reduced prism convergence test breakpoint (-8.38; 95% CI, -14.14 to -2.62; P = .008) and recovery point (-8.44; 95% CI, -13.82 to -3.06; P = .004). Participants with mild TBI also had decreased contrast sensitivity (-0.07; 95% CI, -0.13 to -0.01; P = .04) and increased visual evoked potential binocular summation index (0.32; 95% CI, 0.02-0.63; P = .02). A subset of participants exhibited reduced peripapillary retinal nerve fiber layer thickness, increased optic nerve/sheath size, and brain cortical volumes. Machine learning identified subtle differences across the primary visual pathway, including the optic radiations and occipital lobe regions, independent of visual symptoms., Conclusions and Relevance: Results of this case-control study suggest that the visual system was affected in individuals with mild TBI, even in those who did not self-report vision problems. These findings support the utility of a battery of assessments or machine-learning approaches to accurately diagnose this population.

Mild traumatic brain injuries (TBIs) are frequent in the European population. The pathophysiological changes after TBI include metabolic changes, but these are not observable using current clinical tools. We aimed to evaluate multinuclear MRI as a mean of assessing these changes. In our model, pigs were exposed to a controlled cortical impact (CCI) directly on the dura and scanned at 2 h and 2 days after injury. A multinuclear MRI protocol was used. It included hyperpolarized [1- 13 C]pyruvate MRI, which allows depiction of hyperpolarized carbon-13, through its metabolism from pyruvate to lactate or bicarbonate. At Day 2, cerebral microdialysis were performed, and tissue was obtained for analyses. At Day 0, the cerebral blood flow was reduced in the affected hemisphere (TBI: 31.7 mL/100 mL/min, contralateral: 35.6 mL/100 mL/min, p = 0.1227), and the impacted area showed reduced oxygenation (R 2 *, TBI: 33.11 s -1 , contralateral: 22.20 s -1 , p = 0.035). At both days, the lactate-to-pyruvate ratios (hyperpolarized [1- 13 C]pyruvate) were increased (Day 0: p = 0.023, Day 2: p = 0.022). However, this study can only evaluate the total injury and, thus, cannot differentiate effects from craniotomy and CCI. This metabolic difference was not found using cerebral microdialysis nor a lactate dehydrogenase (LDH) activity assay. The metabolic changes depicted in this study contributes to our understanding of mild TBI; however, the clinical potential of multinuclear MRI is yet to be determined., (© 2024 The Author(s). NMR in Biomedicine published by John Wiley & Sons Ltd.)

Cerebrovascular dysfunction following mild traumatic brain injury (mTBI) is understudied relative to other microstructural injuries, especially during neurodevelopment. The blood-oxygen level dependent response was used to investigate cerebrovascular reactivity (CVR) in response to hypercapnia following pediatric mTBI (pmTBI; ages 8-18 years), as well as pseudocontinuous arterial spin labeling to measure cerebral blood flow (CBF). Data were collected ∼1-week (N = 107) and 4 months (N = 73) post-injury. Sex- and age-matched healthy controls (HC) underwent identical examinations at comparable time points (N = 110 and N = 91). Subtle clinical and cognitive deficits existed at ∼1 week that resolved for some, but not all domains at 4 months post-injury. At both visits, pmTBI showed an increased maximal fit between end-tidal CO 2 regressor and the cerebrovascular response across multiple regions (primarily fronto-temporal), as well as increased latency to maximal fit in independent regions (primarily posterior). Hypoperfusion was also noted within the bilateral cerebellum. A biphasic relationship existed between CVR amplitude and age (i.e., positive until 14.5 years, negative thereafter) in both gray and white matter, but these neurodevelopment effects did not moderate injury effects. CVR metrics were not associated with post-concussive symptoms or cognitive deficits. In conclusion, cerebrovascular dysfunction may persist for up to four months following pmTBI., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Traumatic brain injury is one of the most common cerebral incidences worldwide. Repetitive mild traumatic brain injuries occurring, for example, in athletes or victims of abuse, can cause chronic neurodegeneration due to neuroinflammation, in which the crosstalk between reactive astrocytes and activated microglia is crucial for modulating neuronal damage. The inducible enzyme heme oxygenase-1 and its product carbon monoxide are known to be ascribed neuroprotective and anti-inflammatory properties. We caused repetitive mild traumatic brain injuries in wild-type mice compared to mice without microglial heme oxygenase-1 expression. Additionally, mice were treated daily with either air or carbon monoxide exogenously. In wild-type mice, we observed enhanced microglia activation and astrogliosis as well as vasodilation after repetitive trauma. In heme oxygenase-1 knockout mice, we observed enhanced activation of microglia and astrocytes at baseline pretrauma with a lack of an adequate inflammatory response to repetitive injury. However, the knockout led to enhanced NF-κB and IFNγ expression in the post-trauma period. Carbon monoxide exerted neuroprotection, as suggested by reduced wake-up times in mice and by beneficially altering inflammation post-traumatic brain injury. This study further underlines the crucial role of the heme oxygenase-1/carbon monoxide system in the modulation of neuronal damage and the associated neuroinflammatory response after repetitive traumatic brain injury., (© 2025 The Author(s). European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) often receive unnecessary imaging and hospital admission, leading to avoidable burdens on patients and health systems. While most of these patients do not develop critical neurological injuries, identifying those at risk would allow for a more optimal determination of the appropriate level of initial emergency care. The Brain Injury Guidelines (BIG) were developed as a triage tool to identify adult patients with mTBI and ICI who can benefit from repeat imaging, hospital admission, or neurosurgical consultation. Here, we sought to validate BIG in children at a Level I trauma center and determine if the BIG algorithm can accurately identify which patients with mTBI/ICI have critical neurosurgical injuries. We hypothesize that the BIG can identify critical neurological injuries more accurately than the Glasgow Coma Scale (GCS) alone and that more severe injury according to BIG is associated with worse patient outcome. We retrospectively reviewed TBI admissions at a single center (2017-2023) using an institutional registry. Patients included (0-17 years) had an initial head computerized tomography scan with ICI and a GCS of 14-15. Patients were retrospectively classified into the BIG categories (BIG 1, 2, or 3). Medical records were reviewed to identify clinically important TBI (ciTBI): death, neurological deterioration, neurosurgical intervention, intubation >24 h, or hospital admission >48 h due to TBI. Repeat imaging studies obtained were evaluated for progression of injury. The incidence of clinically important TBI (ciTBI) and imaging progression were recorded and compared across BIG categories. Outcomes were evaluated using the Glasgow Outcome Score Extended (GOS-E) 6 months after injury. Univariable and chi-square tests were used to analyze comparisons. Overall, 804 subjects were included in the analysis of which 551 (68.5%) were transfers. Overall, 175 (21.8%) patients had a BIG 1, 402 (50.0%) a BIG 2, and 227 (28.2%) a BIG 3 injury. CiTBI occurred among 64 (8.0%) patients overall, and in 1 (0.6%), 4 (1.0%), and 59 (26.0%) of the BIG 1, 2, and 3 injuries ( p < 0.0001). Progression on repeat imaging associated with neurological decline, neurosurgical intervention or resulting in additional evaluation was noted in 0 (0%), 2 (0.5%), and 41 (18.0%) of the BIG 1, 2, and 3 injuries ( p < 0.001). Amongst 471 patients (58.6%) with available 6-month patient outcomes, 98% had a GOS-E ≥5 and no outcome difference between BIG categories was observed. Risk stratification of mild TBI using BIG allowed for reasonable identification of children who subsequently develop ciTBI, suggesting that BIG classification can aid in triage and management of patients who might benefit from neurosurgical consultation, repeat imaging, and potentially transfer to a dedicated trauma center. More severe injury according to BIG was not associated with a worse patient outcome.

Objective: To report the symptom burden of anxiety and mood-related indicators following mTBI in collegiate student-athletes. Study Design: Retrospective cohort study of varsity collegiate athletes. Setting: University sports medicine at a tertiary care center. Patients: Division I college varsity athletes diagnosed with mTBI at a single institution between 2016 and 2019. Independent Variables: Pre- and post-injury. Main Outcome Measures: Comparisons between baseline testing and post-mTBI symptom scale assessments were made to determine changes in scores at the individual and group levels. The primary outcome was the prevalence of post-mTBI symptoms from within 72 h of injury through return to play. Associations with sport, sex, age, and return-to-play time were included. Results: Compared to baseline, mood and anxiety symptom scores were significantly higher acutely following mTBI (2.1 ± 3.3 vs. 14.3 ± 12.2; p < 0.001). A family history of migraine was significantly associated with higher mood and anxiety symptom scores (20.0 ± 14.9 with history vs. 13.3 ± 11.3 without history; p = 0.042). Mood and anxiety symptom scores were highly correlated with non-mood and anxiety symptom scores for all athletes, including the subgroup with prolonged symptoms (r = 0.769; p < 0.001). Conclusions: Symptoms of anxiety or mood disruption are common during the acute period post-injury in varsity college athletes. Risk factors for higher symptom reports immediately following mTBI and for prolonged symptoms (>10 days) included female sex, those with a family history of migraine, and those with an overall higher symptom burden post-injury.

Mindfulness-based interventions (MBIs) are emerging non-pharmacological treatments for mild traumatic brain injury (mTBI). In this systematic review, the authors aimed to evaluate the potential efficacy of MBIs to provide recommendations for treating patients with mTBI. We searched of the English literature on MBIs for patients with mTBI as of 01 September, 2023, using the PubMed, Web of Science, PsycINFO, and Scopus databases. One author performed data extraction and quality scoring of the included literature according to the proposed protocol, and another conducted the review. The review was not registered. A total of 11 studies met the final inclusion criteria, 5 of which involved military personnel (veterans). MBIs covered in this review include goal-oriented attention self-regulation (GOALS), mindfulness-based stress reduction (MBSR), acceptance and commitment therapy (ACT), and so on. Research shows that MBSR mainly reduces mental fatigue symptoms in mTBI patients, and GOALS tend to improve their cognitive function. The effect of MBIs on psychological symptoms needs further exploration. Other studies, such as mindfulness-based group therapy and intervention studies targeting mTBI military personnel, are relatively sparse. MBIs have specific effects on mental fatigue and cognitive dysfunction in patients with mTBI. However, the effect on psychological distress and the sustained effectiveness across all symptoms still need further exploration. Considering the particularity of military personnel suffering from mTBI, researchers need to do more intervention studies targeting mTBI military personnel. Therefore, the design of future MBIs trials for mTBI patients' needs to take into account all the factors, such as different populations and severity of traumatic brain injury, to verify the effectiveness of MBIs in alleviating mTBI symptoms and explore the mechanism of intervention. Supplementary Material Supplementary Material File [ABSTRACT FROM AUTHOR]

Objective: To investigate whether involvement in litigation and performance validity test (PVT) failure predict adherence to treatment and treatment outcomes in adults with persistent symptoms after mild traumatic brain injury (mTBI). Setting: Outpatient concussion clinics in British Columbia, Canada. Participants were assessed at intake (average 12.9 weeks postinjury) and again following 3 to 4 months of rehabilitation. Participants: Adults who met the World Health Organization Neurotrauma Task Force definition of mTBI. Litigation status was known for 69 participants (n = 21 reported litigation), and 62 participants completed a PVT (n = 13 failed the Test of Memory Malingering) at clinic intake. Design: Secondary analysis of a clinical trial (ClinicalTrials.gov #NCT03972579). Main Measures: Outcomes included number of completed sessions, homework adherence, symptoms (Rivermead Post Concussion Symptoms Questionnaire), disability ratings (World Health Organization Disability Assessment Schedule 2.0), and patient-rated global impression of change. Results: We did not observe substantial differences in session and homework adherence associated with litigation or PVT failure. Disability and postconcussion symptoms generally improved with treatment. Involvement in litigation was associated with a smaller improvement in outcomes, particularly disability (B = 2.57, 95% confidence interval [CI] [0.25-4.89], P =.03) and patient-reported global impression of change (odds ratio [OR] = 4.19, 95% CI [1.40-12.57], P =.01). PVT failure was not associated with considerable differences in treatment outcomes. However, participants who failed the PVT had a higher rate of missing outcomes (31% vs 8%) and perceived somewhat less global improvement (OR = 3.47, 95% CI [0.86-14.04]; P =.08). Conclusion: Adults with mTBI who are in litigation or who failed PVTs tend to adhere to and improve following treatment. However, involvement in litigation may be associated with attenuated improvements, and pretreatment PVT failure may predict lower engagement in the treatment process. [ABSTRACT FROM AUTHOR]

Objective: The Common Sense Model (CSM) describes cognitive, emotional, and psychosocial factors that influence how health threats are processed and subsequently inform health-related decisions or actions. The purpose of this study was to examine psychosocial factors influencing coherence, or usefulness, of mild traumatic brain injury (mTBI) representations and their relationship to health-related decisions and actions. Setting: Public university. Participants: There were 458 graduate and undergraduate college students who participated in a web-based survey (mean age = 22 years; SD = 3.6). Design: A mixed-methods design randomized participants into 2 groups to examine perceptions of mTBI across differing injury mechanisms, or causes, by comparing actions recommended to a friend (Other; n = 214) with those generated for self (Self; n = 244). Main Measures: Seven common injury mechanisms representative of university student mTBI experiences were presented as vignettes (cause). Each vignette included open- and closed-ended questions framed from CSM constructs (identity, consequences, action plans, timeline, and social context). Data were analyzed using a series of chi-square tests and multiple analysis of variance. Post hoc analysis identified differences in the injury vignettes. Results: Students were more likely to identify the injury as mTBI (  χ 3 2 = 8.62, P =.035) and recommend immediate healthcare (F 1,415 = 316.89, P <.001) for all causes if the injury occurred to a friend as compared with themselves. Action plans also varied by cause, with post hoc analysis revealing a higher likelihood of healthcare seeking for motor vehicle crashes and assault and a lower likelihood for falls while intoxicated. Students were generally more likely to talk to closest confidants than doctors (F 8,398 = 33.66, P <.001). Conclusion: Cause appears to be a key construct in generating illness representations and associated action plans for seeking care, with lower perceived severity causes (eg, falls) resulting in little to no health-seeking action. In addition, social support appears to be important for college students when making decisions about their health. [ABSTRACT FROM AUTHOR]