Journal of Head Trauma Rehabilitation最新文献

{"title":"Research Letter: Sexual Minority Disparities in Self-Reported Sport- or Recreation-Related Concussion Rates in a Nationally Representative US Sample.","authors":"Shawn R Eagle, Sophia Choukas-Bradley","doi":"10.1097/HTR.0000000000001002","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001002","url":null,"abstract":"","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Resting-State Functional Connectivity and Cognitive-Affective Symptoms in Patients With Post-Concussion Syndrome Treated With N-Acetyl Cysteine.","authors":"Daniel A Monti, Vedaei Faezeh, George Zabrecky, Mahdi Alizadeh, Nancy Wintering, Anthony J Bazzan, Feroze B Mohamed, Andrew B Newberg","doi":"10.1097/HTR.0000000000000976","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000976","url":null,"abstract":"<p><strong>Objective: </strong>Concussion accounts for more than 80% of people experiencing traumatic brain injury. Acute concussion is associated with characteristic cognitive and functional deficits that may persist for weeks to months. A subgroup of these patients (from 10% to 50%) have persistent symptoms referred to as chronic post-concussion syndrome (PCS). There are limited treatment options for these patients and the pathophysiology is poorly understood, though oxidative stress is thought to be a contributing factor. The purpose of this study was to evaluate whether an antioxidant, N-acetylcysteine (NAC), might be beneficial in patients with PCS.</p><p><strong>Setting: </strong>Outpatient medicine center.</p><p><strong>Participants: </strong>Fifty patients with chronic PCS for at least 3 months post injury.</p><p><strong>Design: </strong>The patients with PCS were enrolled in this randomized unblinded clinical trial to receive the antioxidant NAC as a combination of daily oral and weekly intravenous infusions, or assigned to a waitlist control group where they would continue to receive standard of care.</p><p><strong>Main measures: </strong>Resting-state functional connectivity (FC) magnetic resonance imaging (rsFC-MRI) was performed pre and post either NAC or the waitlist period along with cognitive, emotional, and sensory symptom assessments.</p><p><strong>Results: </strong>The results demonstrated significant (P < .05) improvements in symptoms as determined by the Rivermead Post-Concussion Symptoms Questionnaire, Spielberger State-Trait Anxiety Inventory, and Profile of Mood Scale in the PCS group receiving NAC as compared to patients receiving ongoing standard care. Importantly, there were significant (P< .01) changes in FC in the NAC group, particularly in networks such as the default mode network, salience network, and executive control network. These changes in FC also correlated with improvements in symptoms.</p><p><strong>Conclusions: </strong>In patients with chronic PCS, NAC treatment was associated with significant changes in resting state FC and improvement in a variety of symptoms, particularly cognitive and affective symptoms.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Visual Disturbances After Mild Traumatic Brain Injury-A One-Year Follow-up Study.","authors":"Möller Mona-Lisa, Mäki Kaisa, Nybo Taina, Huovinen Antti, Marinkovic Ivan, Melkas Susanna, Johansson Jan","doi":"10.1097/HTR.0000000000001010","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001010","url":null,"abstract":"<p><strong>Objective: </strong>To examine the persistence of visual symptoms in mild traumatic brain injury (MTBI) during the first months after injury. It is important to recognize visual disturbances because they can delay return to normal activities, while they might be simultaneously treated by visual therapy. Here we describe the results from a 1-year follow-up study of visual disturbances after MTBI.</p><p><strong>Participants and measures: </strong>The study group comprised 26 patients from the Brain Injury Clinic of the Helsinki University Hospital. Inclusion criterion was a high score (≥21p) on the Convergence Insufficiency Symptom Survey (CISS) at an appointment with a neurologist within 6 months after injury. The patients underwent baseline vision evaluation at 4 months on average and follow-up at 14 months after injury. The evaluation included tests for visual acuity, near point of convergence, convergence facility, near point of accommodation, accommodative facility, motility, heterophoria, binocular vision, dynamic visual acuity, and fusional vergence width at near and far distances. Further assessments included the Rivermead Post Concussion Questionnaire for posttraumatic symptoms, a visual analog scale for visual fatigue, and the Developmental Eye Movement Test for saccadic eye movements.</p><p><strong>Results: </strong>Both CISS and Rivermead Post Concussion Questionnaire scores improved significantly from baseline to follow-up. The overall level of visual fatigue according to visual analog scale score was lower at follow-up, but the increase in visual fatigue (comparing fatigue before and after assessment session) was significant both at baseline and follow-up. In visual function assessments, spontaneous recovery from baseline to follow-up could be seen in vergence facility and pursuit eye movement but not in near point of convergence, near fusion, distance fusion, heterophoria, and dynamic visual acuity.</p><p><strong>Conclusion: </strong>The results point out the importance of evaluation of visual disturbances after MTBI. Early detection of these disturbances may provide an opportunity to provide visual therapy.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Follow-Up Visit Timing After A Concussion and Subsequent Care Seeking in Children and Youth: A Population-Based Study in British Columbia.","authors":"Scott Ramsay, V Susan Dahinten, Manon Ranger, Shelina Babul, Elizabeth Saewyc","doi":"10.1097/HTR.0000000000001001","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001001","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between follow-up visit timing and occurrence of the first subsequent health care seeking visit.</p><p><strong>Setting: </strong>The province of British Columbia, Canada.</p><p><strong>Participants: </strong>A total of 21 029 children and youth who were diagnosed with an initial concussion from January 1, 2016, to December 31, 2017. These data were obtained from Population Data BC.</p><p><strong>Design: </strong>A retrospective, descriptive correlational study.</p><p><strong>Main measures: </strong>Follow-up timing was measured categorically as timely (4 weeks), delayed (1-3 months), or no follow-up; the occurrence of a subsequent health care visit beyond 3 months postinjury was measured up to 12 months at 3-month intervals (ie, 4-6, 7-9, and 10-12 months). These variables were measured using diagnostic codes for concussion, post-concussion syndrome, and the 17 concussion symptoms.</p><p><strong>Results: </strong>After controlling for sociodemographic characteristics, having a delayed follow-up, relative to timely follow-up, was associated with higher odds of a subsequent health care seeking visit at 4 to 6 months (odds ratio [OR] = 2.68; confidence interval [CI], 2.08-3.47), 7 to 9 months (OR = 1.71; CI, 1.21-2.40), and 10 to 12 months (OR = 1.67; CI, 1.13-2.48). In contrast to having a delayed follow-up, having no follow-up, relative to timely follow-up, was associated with not having a subsequent health care seeking visit at 4 to 6 months (OR = 0.57; CI, 0.48-0.67) and 7 to 9 months (OR = 0.79; CI, 0.66-0.96), respectively.</p><p><strong>Conclusions: </strong>Follow-up visit timing after a concussion in children and youth is associated with subsequent health care seeking. Greater efforts are needed to investigate the importance of initial follow-up visit timing, as they may play an integral role in injury prevention and symptom management following injury.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home- and Community-Based Services: A Comparison of Brain Injury Waivers Across the United States.","authors":"Erica D Bates, Elena M Redmond","doi":"10.1097/HTR.0000000000001017","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001017","url":null,"abstract":"<p><strong>Objective: </strong>Adults and children who experience brain injury may need services and support when they return to the community. Home- and community-based services waivers are one way to access those supports. Brain injury waivers do not exist in every state, and variations exist in current waivers. This article describes existing brain injury waivers and how they vary by state.</p><p><strong>Design: </strong>States were included if their most recent waiver application was approved by the Centers for Medicare and Medicaid Services. States were excluded if waivers were terminated or expired. Data were collected by analyzing each state's waiver across the areas of diagnosis definition, ages served, self-direction, service setting, persons served, services offered, budget, and assistive technology. Statistical analysis included frequency and descriptive statistics due to the limited number of participants.</p><p><strong>Results: </strong>Each state designs its own waivers. Differences exist in eligibility criteria, services provided, settings, and the rights of participants.</p><p><strong>Conclusions: </strong>Analysis of the waivers showcased differences in all areas. These factors determine which brain injury survivors can receive services from specialized waivers, what services are available to them, where they can receive services, and what rights they can exercise.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insomnia and Chronic Pain Mediate the Relationship Between Traumatic Brain Injury and Reduced Positive Airway Pressure Adherence Among Veterans.","authors":"Adam R Kinney, Alexandra L Schneider, Carolyn Welsh, Kathleen F Sarmiento, Christi S Ulmer, Jeri E Forster, Zachary Abbott, Nazanin H Bahraini","doi":"10.1097/HTR.0000000000001019","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001019","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether co-morbid insomnia, post-traumatic stress disorder (PTSD), depression, and chronic pain mediate the relationship between traumatic brain injury (TBI) and positive airway pressure (PAP) treatment adherence.</p><p><strong>Setting: </strong>One Veterans Health Administration (VHA) sleep medicine site.</p><p><strong>Participants: </strong>Veterans (n = 8836) who were prescribed a modem-enabled PAP device.</p><p><strong>Design: </strong>Secondary analysis of clinical data. We used path analysis to examine: (1) whether Veterans with a history of TBI were more likely to experience insomnia, PTSD, depression, and chronic pain; (2) in turn, whether Veterans with these co-morbid conditions exhibited lesser PAP adherence; and (3) whether Veterans with a history of TBI will exhibit lesser PAP adherence, even while accounting for such co-morbid conditions. Model estimates were adjusted for sociodemographic (eg, race/ethnicity) and clinical characteristics (eg, mask leakage).</p><p><strong>Main measures: </strong>Health conditions were abstracted from the VHA medical record. PAP adherence was measured using average nightly use (hours).</p><p><strong>Results: </strong>Among 8836 Veterans, 12% had a history of TBI. TBI history was not associated with PAP adherence when accounting for the presence of insomnia, PTSD, depression, and chronic pain. Indirect effect estimates indicated that a history of mild, moderate-severe, or unclassified TBI was associated with lesser PAP adherence, as mediated by the presence of co-morbid insomnia and chronic pain. Generally, TBI was associated with an increased likelihood of co-morbid insomnia, PTSD, depression, and chronic pain. In turn, insomnia and chronic pain, but not PTSD or depression, were associated with lesser PAP adherence.</p><p><strong>Conclusions: </strong>Our study offers empirical support for insomnia and chronic pain as potential explanatory mechanisms underlying the relationship between TBI history and suboptimal PAP adherence. While additional research is needed to confirm causality, findings offer preliminary evidence that can inform the development of tailored PAP adherence interventions for Veterans with TBI and obstructive sleep apnea.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}