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The aim of this study was to determine the sociodemographic and MTBI-related variables associated with executive functioning (EF). Based on the theoretical model of Hou and colleagues, data on predisposing (age, education, premorbid IQ), precipitating (post-traumatic amnesia, loss of consciousness, presence of frontal lesions, post-accident time to evaluation) and perpetuating (anxious and depressive affects and post-concussive symptoms) factors were retrospectively collected from the medical records of 172 patients with MTBI. EF data based on the 3 processes included in Miyake's prediction model (2000) (updating, cognitive flexibility and inhibition) were collected using respectively the Digit span task of the Weschler – 4th edition, the Trails A and B as well as the initiation time on the Tower of London- Drexel University. Updating was significantly associated with education, premorbid IQ, age, anxiety, and depressive affect. Inhibition was associated with education and age. No variable was associated with cognitive flexibility. Following a MTBI, clinicians should consider that level of education and pre-morbid IQ may "predispose" patients to higher EF performances. They should also measure level of anxiety and depressive affect knowing that these may "perpetuate" some EF impairments (specifically the updating process). [ABSTRACT FROM AUTHOR]

Posttraumatic migraine may represent an important subtype of headache among the traumatic brain injury (TBI) population and is associated with increased recovery times. However, it is underdiagnosed in patients with mild traumatic brain injury (mTBI). This study examined the effectiveness of the self-administered Nine-Item Screener (Nine-Item Screener-SA), the Headache Impact Test- 6 (HIT-6), the 3-Item Migraine Screener, and the Rivermead Post-Concussion Questionnaire (RPQ) at discriminating between mTBI patients with (n = 23) and without (n = 20) migraines. The Nine-Item Screener demonstrated significant differences between migraine patients with and without migraine on nearly every question, especially on Question 9 (disability), sensitivity: 0.95 and specificity: 0.65 (95% CI, 0.64–0.90). The HIT-6 demonstrated significant differences between migraine and no-migraine patients on disability and pain severity, with disability having a sensitivity of 0.70 and specificity of 0.75 (95% CI, 0.54–0.83). Only Question 3 of the 3-Item ID Migraine Screener (photosensitivity) showed significant differences between migraine and no-migraine patients, sensitivity: 0.84 and specificity: 0.55 (CI, 0.52–0.82). The RPQ did not reveal greater symptoms in migraine patients compared with those without. Among headache measures, the Nine-Item Screener-SA best differentiated between mTBI patients with and without migraine. Disability may best identify migraine sufferers among the TBI population. [ABSTRACT FROM AUTHOR]

Purpose: Compared to studies on moderate and severe traumatic brain injury (TBI), less literature exists concerning the consequences of mild traumatic brain injury (mTBI) on community integration and life satisfaction, especially in the early phase of recovery. Moreover, a better understanding of the variables that contribute to community integration and life satisfaction is still needed. The aim of the study was to assess the association of mood, fatigue and post-concussive symptoms with community integration and life satisfaction early following mTBI. Research method: A total of 85 participants aged between 18 and 61 years who sustained mTBI were included. Participants answered web-based questionnaires measuring anxiety and depression symptoms, fatigue, post-concussive symptoms, community integration and life satisfaction in the first three months post mTBI. Results: Post-concussive symptoms, fatigue and anxiety were not associated with community integration or life satisfaction. However, depressive symptoms were negatively associated with community integration and life satisfaction. Conclusions: Among all acute post-concussive symptoms following mTBI, depressive symptoms seem to have strongest relationship with community integration and life satisfaction. Acute psychological intervention targeting these symptoms is strongly recommended. [ABSTRACT FROM AUTHOR]

Self-determination theory proposes that the satisfaction of basic psychological needs (competence, autonomy, and relatedness) is essential to psychological well-being. This study aims to explore the acute impact of a mild traumatic brain injury on the perception of need satisfaction as well as to better understand which variables among post-concussion symptoms and mood are associated with the satisfaction of these psychological needs. A total of 179 adults with mild traumatic brain injury were included. The Basic Psychological Needs Satisfaction Scale (BPNS) was completed retrospectively to assess need satisfaction pre-injury and after the injury to assess need satisfaction post-injury. The Rivermead Post Concussion Symptoms Questionnaire as well as the Hospital Anxiety and Depression Scale were also completed post injury. A significant difference between the perception of need satisfaction pre- and post- was found on the total BPNS score, with lower scores on the post-injury evaluation (less satisfaction). Moreover, higher levels of depression and anxiety were associated with less satisfaction. These results suggest that sustaining a mild traumatic brain injury may have a negative impact on the satisfaction of competence, autonomy, and relatedness needs. To conclude, it is recommended that these concepts be included in psychological intervention programs following mild traumatic brain injury. A significant decrease in psychological need satisfaction is highlighted following mild traumatic brain injury. It is recommended that the needs of autonomy, competence, and relatedness in intervention programs following mild traumatic brain injury needs to be addressed. The more mild traumatic brain injury patients are anxious and depressed the more likely it is that they will present a diminished satisfaction of needs, expressed by a lower level of perception of their autonomy, competence, and relatedness. Thus, integrative intervention for anxiety as well as depression following mild traumatic brain injury is also recommended. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine if the Rivermead Postconcussion Symptoms Questionnaire (RPQ) is a better tool for outcome prediction than an objective neuropsychological assessment following mild traumatic brain injury (mTBI). The study included 47 patients with mTBI referred to an outpatient rehabilitation clinic. The RPQ and a brief neuropsychological battery were performed in the first few days following the trauma. The outcome measure used was the Mayo-Portland Adaptability Inventory-4 (MPAI-4) which was completed within the first 3 months. The only variable associated with results on the MPAI-4 was the RPQ score (p < .001). The predictive outcome model including age, education, and the results of the Trail-Making Test-Parts A and B (TMT) had a pseudo-R(2) of .02. When the RPQ score was added, the pseudo-R(2) climbed to .19. This model indicates that the usefulness of the RPQ score and the TMT in predicting moderate-to-severe limitations, while controlling for confounders, is substantial as suggested by a significant increase in the model chi-square value, delta (1df) = 6.517, p < .001. The RPQ and the TMT provide clinicians with a brief and reliable tool for predicting outcome functioning and can help target the need for further intervention and rehabilitation following mTBI. [ABSTRACT FROM AUTHOR]

Objective. The goal of this study was to explore the relationship between acute psychological reactions and cognition as well as postconcussive symptoms in patients with MTBI. Research Methods. Sociodemographic andmedical history data were gathered for 59 patients diagnosed with MTBI. Validated and standardized tools were used to assess anxiety, depression, and cognitive function two weeks after trauma. Postconcussive symptoms were assessed with the Rivermead postconcussive questionnaire. Results. Despite the absence of significant neuropsychological deficits, a very high level of anxiety and depression was observed in our cohort. Level of anxiety and depression were positively related to cognitive performances and to postconcussive symptoms. Moreover, patients with preexisting alcohol and psychological problems were more likely to present with acute depression after MTBI. Conclusions. Early psychological rehabilitation should be provided to decrease the intensity and frequency of postconcussive symptoms and diminish the risk of these problems becoming chronic. [ABSTRACT FROM AUTHOR]

To compare the acute clinical profile of patients with uncomplicated vs complicated mild TBI (MTBI), socio-demographic and medical history variables were gathered for 176 patients diagnosed with MTBI and with (complicated, N = 45) or without (uncomplicated, N = 131) positive findings on cerebral imaging. Neurological examination, neuropsychological assessment and self-evaluation of post-concussive symptoms were done at 2 weeks post trauma. Patients with complicated MTBI were more likely to show auditory and vestibular system dysfunction. Surprisingly, the uncomplicated group reported more severe post-concussive symptoms than patients with positive CT scans. The groups showed no other difference in neurological, psychological, or cognitive outcome. A complete neurological examination should be done acutely in patients with MTBI to determine more specific follow-up required. [ABSTRACT FROM AUTHOR]

• A novel multidimensional intervention for patients with mild traumatic brain injury (mTBI) was developed. • The intervention targets factors that perpetuate post-concussive symptoms after mTBI. • The intervention is based on current best practices management. • This article provides support to develop, replicate and/or implement new interventions. Mild traumatic brain injury (mTBI) is associated with persistent post-concussive symptoms (PCSs) in approximately 15% of cases. These symptoms can be somatic (e.g., headache), cognitive (e.g., forgetfulness, poor attention and concentration capacities), emotional (e.g., anxiety, depression, irritability) and/or sleep-arousal complaints (e.g., fatigue, sleep problems). Although practice guidelines recommend early intervention to prevent and treat PCS, we still lack an effective, standardized, integrative, post-acute intervention based on a sound and validated theoretical model. The purpose of this article is to present the development and theoretical background underpinning a novel intervention for patients with PCSs in the post-acute phase after mTBI (1-3 months post-injury). With a biopsychosocial approach (Hou et al., 2012) and best practice recommendations, we developed a novel multidimensional intervention targeting factors that perpetuate PCSs and that can be changed with the intervention. This individual-session intervention provides practical tools for managing PCSs and is designed to provide psycho-education and reassurance, reinforce individual objectives and promote a return to activities. Each session targets one category of PCSs: Sleep/fatigue, Attention, Anxiety/depressed mood, Memory/Organization (SAAM intervention). The rationale underlying the choices of format and content for the intervention is discussed, as are the associated strengths, limitations, opportunities and challenges. This article could support researchers and clinicians to develop, replicate and/or implement interventions addressing current best practices in mTBI management. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate changes in three intrinsic functional connectivity networks (IFCNs; default mode network [DMN], salience network [SN], and task‐positive network [TPN]) in individuals who had sustained a mild traumatic brain injury (mTBI). Methods: Resting‐state functional magnetic resonance imaging (rs‐fMRI) data were acquired from 27 mTBI patients with persistent postconcussive symptoms, along with 26 age‐ and sex‐matched controls. These individuals were recruited from a Level‐1 trauma center, at least 3 months after a traumatic episode. IFCNs were established based on seed‐to‐voxel, region‐of‐interest (ROI) to ROI, and independent component analyses (ICA). Subsequently, we analyzed the relationship between functional connectivity and postconcussive symptoms. Results: Seed‐to‐voxel analysis of rs‐fMRI demonstrated decreased functional connectivity in the right lateral parietal lobe, part of the DMN, and increased functional connectivity in the supramarginal gyrus, part of the SN. Our TPN showed both hypo‐ and hyperconnectivity dependent on seed location. Within network hypoconnectivity was observed in the visual network also using group comparison. Using an ICA, we identified altered network functional connectivity in regions within four IFCNs (sensorimotor, visual, DMN, and dorsal attentional). A significant negative correlation between dorsal attentional network connectivity and behavioral symptoms score was also found. Conclusions: Our findings indicate that rs‐fMRI may be of use clinically in order to assess disrupted functional connectivity among IFCNs in mTBI patients. Improved mTBI diagnostic and prognostic information could be especially relevant for athletes looking to safely return to play, as well for individuals from the general population with persistent postconcussive symptoms months after injury, who hope to resume activity. [ABSTRACT FROM AUTHOR]

To compare the visual memory performance of uncomplicated and complicated mild TBI (mTBI) groups with that of a control group on the Rey Complex Figure Test (RCFT). We also aimed to explore the influence of factors such as age, gender, education, occupation, and intellectual functioning on visual memory in individuals with mTBI. The RCFT and the Wechsler Abbreviated Scale of Intelligence (WASI-II) were administered to 138 participants (90 uncomplicated mTBI patients, 19 complicated mTBI patients, and 29 controls). The mTBI patients demonstrated significantly lower scores than control participants on both immediate and delayed RCFT recall conditions, with performance in the low average and borderline range. However, there was no difference in performance between the two mTBI groups on the recall conditions. In addition, no significant differences were observed across the three groups on the recognition condition. The WASI-II Performance and Verbal IQ scales explained most of the variance in the immediate and delayed RCFT recall conditions but were not associated with performance on the recognition condition. In contrast with the recognition processes involved in visual memory, recall processes seem to be more vulnerable following mTBI and both verbal and performance IQ seem to be related to visual memory performance. [ABSTRACT FROM AUTHOR]

Objective: To explore the characteristics and outcome of patients with TBI over 65 years old admitted to an acute care Level 1 Trauma centre in Montreal, Canada. Methods: Data were retrospectively collected on patients ( n = 1812) who were admitted post-TBI to the McGill University Health Centre-Montreal General Hospital from 2000-2011. The cohort was composed of four groups over 65 years old (65-75; 76-85; 86-95; and 96 and more). Outcome measures used were the extended Glasgow Outcome Scale (GOSE) as well as discharge destination. Results: As the patients got older, the odds of having a poor outcome increased (OR = 2.344 for those 75-85 years old, 4.313 for those 86-95 years of age and 3.465 for those aged 96 years of age or older). Also, the proportion of patients going home or going home with out-patient rehabilitation decreased as age increased ( p = 0.001 and p < 0.001, respectively). In contrast, the proportion of patients being discharged to long-term care facilities increased significantly as age increased ( p < 0.001). Conclusion: This descriptive study provides a better understanding of characteristics and outcome of different age groups of patients with TBI all over 65 years old in Montreal, Canada. [ABSTRACT FROM AUTHOR]

Primary objective: To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA). Research design: Data were retrospectively collected on individuals ( n = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH. Methods and procedures: Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®). Main outcomes: The overall rate of patients leaving AMA was 1.9% ( n = 108). Age was negatively associated with AMA discharge (95% CI OR = [0.966;0.991]). Patients with a history of substance abuse were ∼2-times more likely to leave AMA than those not using substances before injury (95% CI OR = [1.172;3.314]) and the homeless were ∼3-times more likely to leave AMA compared to those who were not homeless (95% CI OR = [1.260;7.138]). Length of stay (LOS) was shorter for patients leaving AMA ( p < 0.001) and they showed better outcome (GOSE: p < 0.001; FIM®: p = 0.032). Conclusions: Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to compare acute outcome between men and women after sustaining a traumatic brain injury (TBI). Methods. A total of 5,642 patients admitted to the Traumatic Brain Injury Program of the McGill University Health Centre-Montreal General Hospital between 2000 and 2011 and diagnosed with a TBI were included in the study. The overall percentage of women with TBI was 30.6% (n = 1728). Outcome measures included the length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE), the functional independence measure instrument (FIM), discharge destination, and mortality rate. Results. LOS, GOSE, the FIM ratings, and discharge destination did not show significant differences between genders once controlling for several confounding variables and running the appropriate diagnostic tests (P < 0.05). However, women had less chance of dying during their acute care hospitalization than men of the same age, with the same TBI severity and following the same mechanism of injury. Although gender was a statistically significant predictor, its contribution in explaining variation in mortality was small. Conclusion. More research is needed to better understand gender differences in mortality; as to date, the research findings remain inconclusive. [ABSTRACT FROM AUTHOR]