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To assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football.Prospective cohort injury surveillance.There were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match.There were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04-3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40-3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41-2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06-1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79-2.53).Headgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.

Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (

Micro riboneucleic acids (miRNAs) may be transcribed after brain injury and be detectable in plasma. This study aimed to assess the discriminative ability of seven miRNAs in plasma to differentiate between patients with mild traumatic brain injury (mTBI) and healthy controls. Changes in miRNA levels over 28 days were compared to changes in self-reported symptom profile. This was a prospective cohort study with longitudinal measurements of miRNA levels and symptom self-report. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) was used to determine symptom severity. Mean normalised expression ratios (NER) of miRNAs at day 0 between mTBI and healthy controls were compared. An analysis of response profiles compared the response over time of miRNA species with RPQ symptom severity. miRNA levels of subjects who were defined to have "recovered" on Day 7 and 28 were compared to "non-recovered" subjects. There were 28 mTBI patients and 30 healthy controls included for analysis. Symptom severity was significantly higher on the day of injury among mTBI subjects (p 0.001), and miRNA 32-5p levels were also higher (p = 0.009). Change of miRNA levels were similar to RPQ change at Day 7, but significantly different at Day 28. Differences were observed among miRNA levels of recovered subjects. This study demonstrated differences in miRNA levels among mTBI subjects compared to healthy controls and different miRNA levels among those who had recovered compared to those reporting symptoms. The change in profiles of miRNAs was different to symptom severity, suggesting that the two measures reflect different aspects of brain injury and recovery.

Objective To explore the potential utility of head acceleration event (HAE) measurements to augment identification of players for further concussion screening in non-helmeted contact sport. Design Prospective observational pilot study. Participants 210 (118 female) professional Australian football players in 2017 season. Methods Players wore the X-Patch® accelerometer for one match each with data collected across 14 matches. Players with HAEs above thresholds associated with concussion, 95 g (males) or 85.5 g (females), were compared to players identified to have suspected concussion by club personnel during the inspected matches. Video review of matches was undertaken by a physician blinded to HAEs to identify players with concussive signs. Results Among 26 players (50% female) with HAEs above threshold, two players were screened for concussion. Of the remaining 24 players, nine were not visible on video at the HAE time, six sustained verifiable head impacts, and nine sustained verifiable body impacts with no head impacts. Among 184 players with HAEs below threshold, five players were screened. Conclusion Players were identified to have head impacts and suspected concussion in the absence of HAEs above threshold. Use of X-Patch® was not sufficiently reliable for identifying players for further concussion screening in professional Australian football. Video review of head impacts remains essential in concussion screening.

Background Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored. Methods Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews. Discussion Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes. Trial registration ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118

Despite the widespread use of nonword repetition in child neuropsychological research and clinical practice, the specific cognitive, linguistic and motor processes that contribute to variability in performance are unclear. The aim of this work was to determine the role of phonological memory, word reading, oromotor sequencing, and oromotor control on nonword repetition performance in the context of children’s speech and language abilities. Ninety one children between the ages of 9 and 11 years, with a broad range of speech and language abilities participated in the study. Hierarchical regression was used to a) evaluate the contribution of phonological memory, word reading, oromotor sequencing and oromotor control to nonword repetition and b) determine whether speech and/or language ability moderated the relationship between these specific skills and nonword repetition performance. Results showed all four predictor variables were related to nonword repetition performance, accounting for 59% of variance. The variable with the strongest association with nonword repetition was phonological memory, followed by oromotor sequencing ability, word reading, and oromotor control. Contrary to expectations, neither speech nor language ability were significantly associated with the degree to which these specific skills were drawn upon to perform the nonword repetition task. These findings underline the multidimensional nature of the nonword repetition task and provide further evidence of the major contributions made by phonological memory, word reading, speech sequencing and control to performance on this task. Further, findings suggest that speech and language ability, as measured here, do not significantly influence the skills employed for nonword repetition performance.

Sensor devices have enabled estimations of head impact kinematics across contact sports. To quantitatively report the magnitude (linear and rotational acceleration) and frequency of game-related head impacts recorded in male contact sports athletes. A systematic review was conducted in June 2017. Inclusion criteria were English-language in vivo studies published after 1990 with a study population of male athletes aged ≥ 16 years, in any sport, where athletes were instrumented with an accelerometer device for measuring head impacts. Study populations were not limited to players with a clinical diagnosis of concussion. Twenty-one studies met the inclusion criteria with 12 conducted on American Football athletes. Six of these studies were included for meta-analysis. At a threshold of 10g, amateur rugby players sustained the most impacts per player per game (mean = 77, SD = 42), followed by amateur Australian Football (mean = 29, SD = 37) and collegiate lacrosse athletes (mean = 11.5, SD = 3.6). At thresholds of greater than 14.4g, high school American Football athletes sustained between 19 (SD = 19.1) and 24.4 (SD = 22.4) impacts per player per game. Statistically significant heterogeneity was observed among the included studies, and meta-analysis of impact magnitude was limited. The frequency of “head acceleration events” was quantified and demonstrated substantial variation in methodology and reporting of results. Future research with standardised reporting of head impacts and inclusion of non-helmeted sports is warranted to enable more robust comparisons across sports. CRD42017070065.

ObjectivesTo assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase in injury risk among HG users.DesignA systematic search in Ovid MEDLINE, Cochrane Library, Scopus, PsycINFO and SPORTDiscus was conducted in April 2020. Inclusion criteria were youth Outcome measuresIncidence rates of SRC, superficial head injury or other injuries.ResultsEight studies were eligible. The majority (n=5) reported no difference in the rate of SRC among HG users versus non-users. One rugby study identified significantly lower risk of SRC for non-HG users (risk ratio (RR) 0.63; 95% CI 0.41 to 0.98) compared with HG users, whereas a cross-sectional survey of soccer players indicated higher risk of SRC for non-HG users (RR 2.65; 95% CI 1.23 to 3.12) compared with HG users. Three of the four studies investigating superficial head injury found no significant differences with HG use, though the soccer survey reported reduced risk among HG users (RR 1.86; 95% CI 0.09 to 0.11). Increased incidence of injuries to all body regions for rugby HG users was reported in two studies with adjusted RRs of 1.16 (95% CI 1.04 to 1.29) and 1.23 (95% CI 1.00 to 1.50).ConclusionsHG use was not associated with reduced rates of SRC or superficial head injury in youth soccer and rugby. The possibility of increased injury risk to all body regions for rugby HG users was raised. The need for research specific to youth and female athletes was highlighted.PROSPERO registration numberCRD42018115310.

To investigate changes from baseline on SCAT3 as a result of football game exposure, and association with X2 Patch measured head acceleration events in amateur Australian footballers.Prospective cohort.Peak linear acceleration (PLA) of the head (10 g) was measured by wearable head acceleration sensor X2 Biosystems X-Patch in male (n=34) and female (n=19) Australian footballers. SCAT3 was administered at baseline (B) and post-game (PG).1394 head acceleration events (HEA)10 g were measured. Mean and median HEA PLA were recorded as 15.2 g (SD=9.2, range=10.0-115.8) and 12.4 g (IQR=11.0-15.6) respectively. No significant difference in median HEA PLA (g) was detected across gender (p=0.55), however, more HEAs were recorded in males (p=0.03). A greater number (p=0.004) and severity (p0.001) of symptoms were reported PG than at B. No significant association between number of HEA or median PLA, and SCAT3 change scores (p0.05 for all), was identified for either gender.Increase in symptom severity post game was not associated with X2 measured HEA. Males sustained more HEA, however HEA PLA magnitude did not differ across gender. Further work on the validation of head acceleration sensors is required and their role in sports concussion research and medical management.

OBJECTIVE This study aimed to investigate the association between white matter tracts and multiple aspects of attention and working memory deficits in a relatively acute traumatic brain injury (TBI) sample. METHOD Neuropsychological measures of attention and working memory were administered to 20 participants with complicated mild-to-very severe TBI and 20 control participants. Tract-based spatial statistics was used to assess fractional anisotropy (FA) and mean diffusivity (MD) of white matter tracts for 15 TBI participants and 20 controls. RESULTS When compared to controls, participants with TBI were found to have lower FA (p

Concussion is common in the sporting arena and is often challenging to diagnose. The development of wearable head impact measurement systems has enabled measurement of head kinematics in contact sports. The objective of this systematic review was to determine the characteristics of head kinematics measured by an accelerometer system among male athletes diagnosed with concussion. A systematic search was conducted in July 2015. Inclusion criteria were English-language studies published after 1990 with a study population of male athletes, in any sport, where objectively measured biomechanical forces were reported in the setting of a concussive event. The random effects meta-analysis model was used to combine estimates of biomechanical force measurements in concussed athletes. Thirteen studies met the inclusion criteria, the majority of which were conducted with high school and college football teams in the US. Included studies measured a combination of linear and rotational acceleration. The meta-analysed mean peak linear head acceleration associated with a concussive episode was 98.68 g (95 % CI 82.36–115.00) and mean peak rotational head acceleration was 5776.60 rads/s2 (95 % CI 4583.53–6969.67). The estimates of the biomechanical forces were consistent across studies, with I 2 values of 0 % for both meta-analyses. Head impact monitoring through accelerometery has been shown to be useful with regard to characterising the kinematic load to the head associated with concussion. Future research with improved clinical outcome measures and head kinematic data may improve accuracy when evaluating concussion, and may assist with both interpretation of biomechanical data and the development and utilisation of implementation strategies for the technology.

Executive dysfunction including impaired goal setting (i.e., planning, organization skills, strategic reasoning) is documented in children born very preterm (VP

Objectives To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. Designs Laboratory tests and prospective observational study. Methods Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. Results Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p Conclusions This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.

Attentional deficits are common following traumatic brain injury (TBI) and interfere with daily functioning. This study employed a single-case design to examine the effects of individualised strategy training on attention beyond the effects of computerised training using Attention Process Training 3 (APT-3), and to examine the participants' subjective experience of these approaches. An ABCA (baseline, APT-3, strategy training, follow-up) design was repeated across three participants with severe TBI. Outcomes were measured on alternate versions of the oral Symbol Digit Modalities Test (SDMT) and cancellation tasks; generalisation with the Test of Everyday Attention (TEA) and self and significant other (SO) ratings on the Rating Scale of Attentional Behaviour (RSAB); and participant experiences with semi-structured interviews. Planned Tau-U analyses revealed improvements in speed of processing on the SDMT and the automatic condition of the cancellation task after APT-3 and at follow-up, but with most improvement after strategy training. Limited generalisation was evident on TEA subtests and self-RSAB ratings. SO-RSAB ratings were mixed after APT-3, but demonstrated improvement after strategy training. Variability in attentional deficits and everyday attentional requirements between patients required individualised goals and approaches to rehabilitation. This study highlights the need for individualised rehabilitation of attention to improve everyday functioning after TBI.

Slowed information processing speed has consistently been documented after traumatic brain injury (TBI). Debate continues as to whether deficits in strategic control are proportionate to, or remain after controlling for, reduced speed of processing. The study aim was to investigate the association of speed of processing and strategic control of attention with working memory, selective attention, response inhibition, and mental flexibility task performance after TBI using traditional and novel clinical measures.Twenty-five individuals with complicated mild to severe TBI (post-traumatic amnesia duration, M = 39.52 days, SD = 38.34; worst Glasgow Coma Scale score, M = 7.33, SD = 4.35; time post-injury, M = 392.64 days, SD = 537.19) and 25 matched healthy controls completed assessment of attentional and executive functioning. Measures included the Symbol Digit Modalities Test (SDMT), the computerized Selective Attention Task (SAT), the Ruff 27 Selective Attention Test (27), the visual n-back, Digit Span, Hayling Test, and Trail Making Test (TMT).t tests revealed that individuals with TBI demonstrated reduced processing speed on the SDMT, n-back, SAT, 27, Hayling Test, and TMT-A (p ≤ .002 for all). Digit Span performance did not differ between groups. Mixed-model ANOVAs revealed that individuals with TBI demonstrated a disproportionate increase in reaction time with complexity, which was accounted for by speed on the SAT but remained on the Hayling Inhibition Test after controlling for speed in ANCOVAs. Mann-Whitney U tests revealed that individuals with TBI also made more errors on the Hayling Test, missed responses on the n-back and were unable to benefit from the automatic condition of the 27.While slowed speed of information processing was pervasive across tasks after TBI, residual difficulties in response inhibition remained after controlling for slowness, which suggests impaired strategic control. These findings support targeted intervention for slowed speed of thinking and inhibition following TBI.

Objectives:Preterm children demonstrate deficits in executive functions including inhibition, working memory, and cognitive flexibility; however, their goal setting abilities (planning, organization, strategic reasoning) remain unclear. This study compared goal setting abilities between very preterm (VP: Methods:Participants included 177 VP and 61 full-term born control children aged 13 years. Goal setting was assessed using several measures of planning, organization, and strategic reasoning. Parents also completed the Behavior Rating Inventory of Executive Function. Regression models were performed to compare groups, with secondary analyses adjusting for potential confounders (sex and social risk), and excluding children with major neurosensory impairment and/or IQResults:The VP group demonstrated a clear pattern of impairment and inefficiency across goal setting measures, consistent with parental report, compared with their full-term born peers. Within the VP group, moderate/severe brain abnormalities on neonatal MRI predicted adverse goal setting outcomes at 13.Conclusions:Goal setting difficulties are a significant area of concern in VP children during late childhood. These difficulties are associated with neonatal brain abnormalities, and are likely to have functional consequences academically, socially and vocationally. (JINS, 2018,24, 372–381)

Developmental language disorder (DLD) and developmental speech disorder (DSD) are highly prevalent childhood conditions. An impaired ability to repeat nonsense words ("nonword repetition"), is claimed to be a robust behavioural marker for these conditions. Yet how brain function is altered during this task remains poorly understood. Previous research suggests that DLD or DSD may be associated with reduced brain activation in the inferior frontal and posterior temporal regions when compared to controls. However, this research is limited by within and between group variability in age, speech/language phenotype, and comorbidities. Here, we used functional MRI to examine brain activation during nonword repetition. As anticipated, behavioural findings confirmed that the DLD and DSD groups had poorer nonword repetition performance compared to typical controls. In contrast, fMRI revealed no statistically significant differences in brain activation, despite the groups appearing to engage slightly different regions when compared at identical thresholds. Therefore, whilst nonword repetition is a sensitive clinical marker for DLD and DSD, the findings from this study suggest that this task is not a sensitive brain MRI marker for children with these disorders, unlike for individuals with single gene mutations like FOXP2 mutations.

There is significant variability in long-term outcomes after traumatic brain injury (TBI), making accurate prognosis difficult. In seeking to enhance understanding of outcomes, this study aimed to investigate whether COMT Val(158)Met allele status was associated with performance on neuropsychological measures of attention and working memory, executive functioning, learning and memory, and speed of information processing in the early rehabilitation phase. The study also aimed to examine whether the COMT polymorphism was associated with longer-term functional outcomes. A total of 223 participants (71.3% male) with moderate-to-severe TBI were recruited as rehabilitation inpatients to participate in a prospective, longitudinal head injury outcome study. The three COMT genotype groups (Val/Val, Val/Met, and Met/Met) were well matched for estimated full-scale IQ, years of education, age at injury, and injury severity. Results showed no significant difference between genotypes on neuropsychological measures (all p0.05) or functional outcome, as measured by the Glasgow Outcome Scale-Extended (GOS-E), after controlling for age, education, and severity of injury. The presence of frontal lobe pathology was also not associated with cognitive performance. Those with greater injury severity (i.e., longer duration of post-traumatic amnesia) performed more poorly on measures of processing speed and verbal new learning and recall. It was concluded that there was little support for the influence of COMT Val(158)Met on cognitive function, or functional outcome measures, in the acute rehabilitation phase after TBI.

OBJECTIVE:: To examine the frequency and experience of return to secondary or tertiary study over a 10-year period following traumatic brain injury (TBI). PARTICIPANTS:: A group of 295 students with moderate to severe TBI followed prospectively. SETTING:: Epworth HealthCare TBI outpatient rehabilitation program follow-up clinic 1 to 10 years postinjury. MAIN OUTCOME MEASURES:: Frequency of return to study. Also, for a subset, changes in course enrollment, utilization of additional educational supports, and experience of return to study postinjury. RESULTS:: Of those studying preinjury, 295 attended the follow-up clinic appointments, with 167 (56%) having returned to study. Those who did not return to study had significantly longer posttraumatic amnesia duration. The cross-sectional follow-up revealed that 60.4% were studying at 1 year postinjury, 37.5% at 2 years postinjury, 50.0% at 3 years postinjury, 31.1% at 5 years postinjury, and 2.0% at 10 years postinjury. Many had migrated into employment. A subsample of 95 participants reported on their educational experience. Of those, 28.7% changed their course enrollment from full-time to part-time. While supports such as tuition and special consideration were greatly increased postinjury, students reported the proportion of subjects passed of 79.0%. However, they experienced cognitive difficulties and fatigue and felt less satisfied with their studies. CONCLUSIONS:: Return to study was relatively successful; however, this was associated with the experience of fatigue and need for far greater effort, assistance and reduced study hours, and somewhat less overall satisfaction. Language: en

Objective: To investigate the feasibility, safety and efficacy of extended-release methylphenidate in enhancing processing speed, complex attentional functioning and everyday attentional behaviour after traumatic brain injury. Design: Seven week randomised, placebo-controlled, double-blind, parallel pilot study. Setting: Inpatient and outpatient Acquired Brain Injury Rehabilitation Program. Participants: Eleven individuals with reduced processing speed and/or attention deficits following complicated mild to severe traumatic brain injury. Interventions: Participants were allocated using a blocked randomisation schedule to receive daily extended-release methylphenidate (Ritalin® LA at a dose of 0.6 mg/kg) or placebo (lactose) in identical capsules. Main outcomes: Tests of processing speed and complex attention, and ratings of everyday attentional behaviour were completed at baseline, week 7 (on-drug), week 8 (off-drug) and 9 months follow-up. Vital signs and side effects were monitored from baseline to week 8. Results: Three percent ( n = 11) of individuals screened participated (mean post-traumatic amnesia duration = 63.80 days, SD = 45.15). Results were analysed for six and four individuals on methylphenidate and placebo, respectively. Groups did not differ on attentional test performance or relative/therapist ratings of everyday attentional behaviour. One methylphenidate participant withdrew due to difficulty sleeping. Methylphenidate was associated with trends towards increased blood pressure and reported anxiety. Conclusion: Methylphenidate was not associated with enhanced processing speed, attentional functioning or everyday attentional behaviour after traumatic brain injury. Alternative treatments for attention deficits after traumatic brain injury should be explored given the limited feasibility of methylphenidate in this population.

The aim of the present study was to investigate the contribution of impaired information processing speed and strategic control of attention to performance on attentional tasks after traumatic brain injury (TBI). Forty moderately to severely injured rehabilitation inpatients and 40 healthy controls completed a selection of attentional tasks. Slowed processing speed in the TBI group was identified on the Symbol Digit Modalities Test (SDMT), 2&7 Selective Attention Test (2&7), Selective Attention (SAT), and Four Choice Reaction Time (4CRT) tasks. Impaired working memory was evident on the Letter Number Sequencing (LNS) task. Structural equation modeling revealed that the group difference in RT on the complex SAT was accounted for by slowed speed of processing on the simple SAT, and not working memory. TBI participants made more errors and missed responses on the complex version of the SAT, suggesting impairment in some aspects of strategic control of attention, and appeared unable to benefit from the automatic condition of the 2&7 Test. There was little evidence of deficit on the Sustained Attention to Response Task (SART). The present study provides evidence for a significant contribution of slowed processing speed to impaired performance on attentional tasks after TBI.

This prospective longitudinal study aimed to identify rates and predictors of productivity outcomes (educational or vocational) at 1 year post-injury in young people studying prior to sustaining a traumatic brain injury (TBI).A total of n = 145 with complicated mild-severe injuries, studying at secondary (45.2%) or tertiary (54.8%) levels pre-injury, participated. Mean age at injury = 18.6 years (SD = 3.29) and mean duration of PTA = 21.9 days (SD = 27.18). Pre-injury demographic (gender, age, level of study, living situation), injury related (severity, physical injuries) and concurrent post-injury (independence in ADLs and self-reported cognitive, behavioural, emotional sequelae) predictors were entered into logistic regressions.Of those participants categorized as 'productive' (79.3%), 60% were studying, with 40% employed. Participants with longer PTA and those with reduced initiative and self-centredness were less likely to be 'productive'. The overall relationship between PTA and productivity appeared to be linear in nature, with PTA duration of more than 80 days, reducing the probability of being productive at 1 year to 50%.PTA duration and behavioural sequelae were the strongest predictors of productivity in those studying prior to injury. Allied health supports should be targeted towards reducing the impact of and compensating for barriers such as reduced initiative in order to maximize productive outcomes in this group.

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS–R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI. (JINS, 2000, 6, 568–579.)

This study investigated the relations between age at injury (AAI) and attentional functioning, and intellectual and academic achievement following pediatric head injury. The theoretical framework of attention proposed by Mirsky, Anthony, Duncan, Ahern, and Kellam (1991) provided the basis for this analysis, and the profile of attention found in uninjured children was evaluated for this sample. Thirty-three moderately head-injured individuals were recruited, with AAI ranging from 1 to 12 years. First, the development of attentional skills in this closed head injury (CHI) sample was found to be comparable to that of Mirsky et al.'s model. Second, AAI did not predict outcome and appeared not to be associated with the finding of mildly delayed acquisition of spelling and arithmetic skills. Also, AAI did not predict the behavioral symptoms of inattention present in this sample as indicated by parental report. It may be that AAI only influences development following severe CHI in which there is permanent cerebral pathology.

To investigate whether COMT Val158Met allele status was associated with (i) attentional performance and (ii) response to methylphenidate (MP) following traumatic brain injury (TBI).Forty healthy controls and 32 patients with moderate-severe TBI (Mean time post-injury = 68 days) completed a baseline cognitive assessment. The TBI cohort then participated in a randomized, cross-over, double blind, placebo controlled 2-week MP trial. MP was administered at 0.3 mg/kg twice daily. TBI genotype distribution: val/val n = 11; val/met n = 14; met/met n = 7.There were no significant differences across genotypes on baseline attentional measures. When compared with controls, the val/val group performed significantly more poorly on most measures. The met/met group performed more poorly than controls on measures of speed, but not in strategic control of attention. MP resulted in faster speed of information processing. Repeated measures mixed ANOVAs found only one significant drug × genotype interaction: (F(2,29) = 4.257, p = 0.024) the met/met group demonstrated a greater response to MP on the Symbol Digit Modalities Test.COMT allele status was not strongly associated with attentional performance or response to MP in the TBI sample. The met/met group, whilst performing slowly, had relatively preserved strategic control of attention.

Background There is a growing range of wearable non-helmet mounted devices on the market and/or in use that purport to measure head impact responses. There is potential for these devices to be useful tools in research and injury management programs. Objective Describe methods for assessing the validity of wearable head impact response devices. Design Laboratory and qualitative observational methods. Tests on an exemplar wearable head impact response measurement “device” were undertaken in a laboratory using an instrumented Hybrid III head and neck and linear impactor. Football players in competitive matches wore the device and games were videoed. A qualitative protocol was applied to correlated device head impact events were those observed on video to examine sensitivity and specificity. Setting Contact sport. Participants Community level Australian football players. Interventions None. Main Outcome Measurements Head impact responses in vitro (linear and angular accelerations) and vivo (observed head impact characteristics). Results Laboratory head impacts were performed at a number of impact sites and velocities. Laboratory tests identified significant correlations (p 30 g in game head impact events with observed head impacts, but in 18% events were not correlated with any head impact, and there were other errors. Conclusions A combination of laboratory and field tests are critical in establishing the validity of wearable head impact response devices and should be performed as the first stage of research with these devices.

Background and Objective The medial forebrain bundle (MFB) contains ascending catecholamine fibers that project to the prefrontal cortex (PFC). Damage to these fibers following traumatic brain injury (TBI) may alter extracellular catecholamine levels in the PFC and impede attention and working memory ability. This study investigated white matter microstructure of the medial MFB, specifically the supero-lateral branch (slMFB), following TBI, and its association with performance on attention and working memory tasks. Method Neuropsychological measures of attention and working memory were administered to 20 moderate-severe participants with TBI (posttraumatic amnesia M = 40.05 ± 37.10 days, median time since injury 10.48 months, range 3.72–87.49) and 20 healthy controls. Probabilistic tractography was used to obtain fractional anisotropy (FA) and mean diffusivity (MD) values for 17 participants with TBI and 20 healthy controls. Results When compared to controls, participants with TBI were found to have significantly lower FA (p

Participation rates and quality-of-life (QoL) have been a major focus of rehabilitation programmes and outcome studies following traumatic brain injury (TBI). The extent to which mobility limitations impact on participation rates and QoL has not been thoroughly explored. The main aim of this study was to investigate the relationship between mobility limitations, participation rates and QoL following TBI.Thirty-nine people who had sustained an extremely severe TBI were recruited from a major rehabilitation facility. Mobility was quantified using the high-level mobility assessment tool (HiMAT). The Brain Injury Community Rehabilitation Outcome (BICRO-39) and Community Integration Questionnaire (CIQ) were used to measure participation rates and the shorter version of the World Health Organization Quality of Life (WHOQoL-BREF) and Assessment of Quality-of-Life (AQoL-2) were used to measure QoL.Mobility was most strongly correlated with the total BICRO-39 score (r = -0.60, p 0.001) and the mobility domain (r = -0.59, p 0.001) of the BICRO-39. Although mobility had a significant relationship with health-related QoL, AQoL-2 (r = 0.60, p 0.001), it was most strongly related to the AQoL-2 independent living domain (r = 0.79, p 0.001).Greater capacity to mobilize was associated with higher participation rates and better QoL.

The role of attention and the resolution of coding conflicts in hand-hemispace spatial-compatibility effects was examined in a precueing experiment in which visual and vibrotactile precues, with various stimulus-onset asynchronies (SOAs), were presented in blocked and random order. It was expected that precues at the shorter SOAs would fail to facilitate the shifting of attention, as they occur too close to the imperative stimulus to be informative. The task would therefore approximate one of choice reaction time (RT), resulting in a hand-hemispace spatial-compatibility effect. Conversely, the longer SOAs would provide the subject with sufficient time in which to shift attention fully, and would therefore result in a task more like that of simple reaction time (SRT). It was expected that the hand-hemispace spatial-compatibility effect would then be absent. As was expected, this effect was present at the shorter SOAs, and absent at the longer SOAs. In Experiments 2 and 3, provision of a visual precue further facilitated attentional deployment, as did blocking the presentation of various SOAs in Experiment 3. Vibrotactile and visual precues did not differ in their ability to direct attention, implying that these modalities orient attention and precue location in essentially similar ways. These findings are discussed within the context of the mechanisms thought to underlie the time course of spatial compatibility and the dissipation of a fading trace of interfering spatial codes.

Objective The aim of the present study was to evaluate the safety of methylphenidate administered during inpatient rehabilitation following traumatic brain injury. Methods Forty inpatients with moderate-severe traumatic brain injury (mean 68.4 days post-injury) participated in a randomized, cross-over, double-blind, placebo-controlled trial of methylphenidate administered at a dose of 0.3 mg/kg body weight twice daily. Results Methylphenidate administration resulted in a statistically significant increase in pulse of 12.3 beats/min (95% confidence interval (CI) 9.25-15.36), diastolic blood pressure of 4.1 mmHg (95% CI 2.11-6.10), and mean arterial pressure of 3.75 mmHg (95% CI 1.79-5.72). These changes did not, however, appear to be symptomatic, as no participants were withdrawn due to adverse events, and there was no significant self-report of increased heart rate with methylphenidate. Blinding was successful. Significantly greater reporting of irritability of 0.14 points (95% CI 0.02-0.26), difficulty sleeping of 0.17 points (95% CI 0.02-0.31) and total side-effects of 0.68 points (95% CI 0.06-1.30) was associated with methylphenidate compared with placebo. Conclusion Methylphenidate given at 0.3 mg/kg body weight appears to be safe in the inpatient rehabilitation phase. This trial is registered with the Australian New Zealand Clinical Trials Registry (12607000503426).

Objectives: Most previous studies evaluating the use of methylphenidate following traumatic brain injury (TBI) have been conducted many years post-injury. This study evaluated the efficacy of methylphenidate in facilitating cognitive function in the inpatient rehabilitation phase. Methods: 40 participants with moderate–severe TBI (mean 68 days post-injury) were recruited into a randomised, crossover, double blind, placebo controlled trial. Methylphenidate was administered at a dose of 0.3 mg/kg twice daily and lactose in identical capsules served as placebo. Methylphenidate and placebo administration was randomised in a crossover design across six sessions over a 2 week period. Primary efficacy outcomes were neuropsychological tests of attention. Results: No participants were withdrawn because of side effects or adverse events. Methylphenidate significantly increased speed of information processing on the Symbol Digit Modalities Test (95% CI 0.30 to 2.95, Cohen’s d = 0.39, p = 0.02), Ruff 2 and 7 Test—Automatic Condition (95% CI 1.38 to 6.12, Cohen’s d = 0.51, p = 0.003), Simple Selective Attention Task (95% CI −58.35 to −17.43, Cohen’s d = 0.59, p = 0.001) and Dissimilar Compatible (95% CI −70.13 to −15.38, Cohen’s d = 0.51, p = 0.003) and Similar Compatible (95% CI −74.82 to −19.06, Cohen’s d = 0.55, p = 0.002) conditions of the Four Choice Reaction Time Task. Those with more severe injuries and slower baseline information processing speed demonstrated a greater drug response. Conclusions: Methylphenidate enhances information processing speed in the inpatient rehabilitation phase following TBI. This trial is registered with the Australian New Zealand Clinical Trials Registry (12607000503426).

Duration of post-traumatic amnesia (PTA) is an important index of severity of head injury. Retrospective assessment of PTA duration is arguably unreliable. Existing objective measures of PTA duration are designed for use over a 24-hour timeframe and, therefore, are not useful for assessing PTA following mild head injury (MHI). A revised version of the Westmead PTA scale was developed for assessing patients with MHI in the Emergency Department (ED) at hourly intervals. The objective of this study was the field testing of this scale in EDs and assessment of validity and reliability of test items.The scale contained 12 items, assessing orientation, memory for a face and name in a photograph and three pictures of objects. This revised scale, administered by nursing staff, was completed at least four times at hourly intervals by 147 adults with MHI in the ED and again at follow-up 1 week later. It was also completed by 109 demographically similar controls. Results were compared with Glasgow Coma scores and retrospective estimates of PTA duration based on patient report and medical records.Thirty-six per cent of MHI participants made errors on the scale in the ED, a significantly greater proportion than in MHI or controls at follow-up. Removal of the items 5 (day of week) and 9 (recall of name of face in photograph) improved the validity of the measure significantly. Scores correlated significantly with Glasgow Coma Scale scores and estimated duration of PTA.The Westmead Scale (minus items 5 and 9) is a valid measure of PTA duration in adult patients with MHI in ED. Its use will allow for more appropriate timing of discharge and accurate prognostic information.

The impact of mild head injury is variable and determinants of outcome remain poorly understood. Results of previous intervention studies have been mixed.To evaluate the impact on outcome of the provision of information, measured in terms of reported symptoms, cognitive performance, and psychological adjustment three months postinjury.202 adults with mild head injury were studied: 79 were assigned to an intervention group and were assessed one week and three months after injury; 123 were assigned to a non-intervention control group and were seen at three months only. Participants completed measures of preinjury psychological adjustment, concurrent life stresses, post-concussion symptoms, and tests of attention, speed of information processing, and memory. Subjects seen at one week were given an information booklet outlining the symptoms associated with mild head injury and suggested coping strategies. Those seen only at three months after injury did not receive this booklet.Patients in the intervention group who were seen at one week and given the information booklet reported fewer symptoms overall and were significantly less stressed at three months after the injury.The provision of an information booklet reduces anxiety and reporting of ongoing problems.

Objectives. The impact of mild head injury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psychological adjustment in children 3 months after injury. Methods. A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 children with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N = 45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury behavior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested coping strategies. Those seen 3 months after injury only did not receive this booklet. Results. Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behavioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury. Conclusions. Providing an information booklet reduces anxiety and thereby lowers the incidence of ongoing problems.

To investigate outcome in children with mild traumatic head injury (THI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems.Postconcussional symptomatology, behavior ratings, and neuropsychological test performance were examined at 1 week and 3 months postinjury.Participants were recruited from successive presentations to emergency departments of two major hospitals.130 Children with mild THI were compared with 96 children having other minor injuries as controls.Children with mild THI experienced headaches, dizziness, and fatigue but exhibited no cognitive impairments, relative to controls, at 1 week postinjury. By 3 months, symptoms had resolved. However, 17% of children showed significant ongoing problems. They were more likely to have a history of previous head injury, learning difficulties, neurological or psychiatric problems, or family stressors.Persisting problems following mild head injury in children are more common in those with previous head injury, preexisting learning difficulties, or neurological, psychiatric, or family problems. These "at-risk" children should be identified in the emergency department and monitored.

Many studies investigating self-awareness following traumatic brain injury (TBI) have been conducted more than 2 years post-injury, thereby providing limited information regarding the implications of insight for rehabilitation. The present study aimed to investigate awareness of deficits in a group of patients who were less than 2 years post-injury and still involved in rehabilitation.Thirty patients with a history of moderate or severe TBI and their significant other (SO) were studied in a cross-sectional analysis. A sub-group also participated in an interdisciplinary Memory Group at the Bethesda Rehabilitation Centre.Level of insight was measured by the degree of agreement between self and significant other (SO) report on the Awareness of Deficit questionnaire (ADQ), assessing various domains of daily functioning.There was substantial agreement between patients and their SO, although the patients with TBI were less likely to acknowledge executive problems. Interestingly, both groups reported only low-to-moderate levels of difficulty.The data indicate that SO's awareness may also be limited in the early recovery stages. A sub-group of the patients obtained benefit from participation in the Memory Group in a rehabilitation setting.