Journal of Head Trauma Rehabilitation最新文献

{"title":"Collegiate Participation in Repetitive Head Impact Sports Does Not Adversely Affect Gait Dual Task Cost.","authors":"Thomas A Buckley, Kristen Williams, Jessie R Oldham, Katherine J Hunzinger, Caitlin Gallo, Scott W Passalugo, Barry Bodt, Melissa N Anderson, Kelsey Bryk, Barry A Munkasy","doi":"10.1097/HTR.0000000000001051","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001051","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to assess gait related dual task cost (DTC) changes over the course of a collegiate athletic career in both repetitive head impact (RHI) exposed and non-RHI exposed athletes.</p><p><strong>Setting: </strong>University Research Laboratory.</p><p><strong>Participants: </strong>We recruited 47 NCAA intercollegiate athletes and grouped by RHI exposed (N = 27) and non-RHI (N = 20) sports.</p><p><strong>Design: </strong>Participants completed 5 trials of single task (ST) and 5 trials of dual task (DT) gait with a working memory cognitive challenge both prior to their collegiate athletic careers (pre) and then again after they completed their collegiate athletic careers (post) (mean 1173 ± 341 days between tests) in this prospective longitudinal design. To assess for changes over the course of a career, separate 2 (group: RHI, non-RHI) × 2 (time: pre, post) mixed design ANOVA were performed for each dependent variable of interest (DTC gait velocity and DTC step length) and the model was adjusted for concussion history at the time of test and sex.</p><p><strong>Main measures: </strong>Gait velocity and step length DTC.</p><p><strong>Results: </strong>There were no significant group by time interactions for DTC gait velocity (F = 0.517, P = .476, η2 = 0.012) or DTC step length ((F = 0.206, P = .652, η2 = 0.005).</p><p><strong>Conclusions: </strong>The primary finding of this study indicated no difference between RHI exposed and non-RHI exposed athletes gait DTC performance between the beginning and conclusion of their collegiate athletic careers. While the long-term effects of RHI remain to be fully determined, these results suggest that RHI may not adversely affect ST or DT gait performance when the individual is young.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752893","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 of Clinical TBI Severity and Military Factors With Veteran TBI Service-Connected Disability Ratings and Total Compensation: A Long-Term Impact of Military Brain Injury Consortium (LIMBIC) Study.","authors":"Clara E Dismuke-Greer, Aryan Esmaeili, Mary Jo Pugh, Terri K Pogoda, Megan Amuan, David X Cifu","doi":"10.1097/HTR.0000000000001052","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001052","url":null,"abstract":"<p><strong>Objective: </strong>To understand how traumatic brain injury (TBI) clinical severity and military factors were associated with the likelihood of receiving a TBI service-connected disability (SCD) determination and monthly total SCD compensation among Veterans.</p><p><strong>Setting: </strong>Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA).</p><p><strong>Participants: </strong>1 319 590 veterans with a VBA SCD rating who entered the VHA between October 1, 2000, and September 24, 2019.</p><p><strong>Design: </strong>This retrospective study analyzed the association of TBI severity and military factors with a TBI SCD determination, TBI SCD rating percentage, and monthly total SCD compensation. Administrative VHA and VBA records were utilized.</p><p><strong>Main measures: </strong>Any TBI SCD determination, TBI SCD rating percentage, and monthly SCD compensation.</p><p><strong>Results: </strong>93 911 (7.1%) Veterans had an SCD rating for TBI. TBI SCD increased monthly total compensation by $362 (95% CI 353, 370) in bivariate and $45 (95% CI 38, 52) in adjusted models. Females had lower TBI SCD percentage (-3.03; 95% CI -3.92, -2.14) but higher monthly compensation ($37; 95% CI 33, 42). TBI severity was associated with increasing TBI SCD percentage and monthly SCD compensation. In adjusted models, deployment (-2.36; 95% CI -3.02, -1.69) was associated with lower TBI SCD percentage but not monthly compensation, while combat exposure was not associated with TBI SCD percentage but was associated with higher compensation ($46; 95% CI 40, 53).</p><p><strong>Conclusion: </strong>TBI severity was significantly associated with TBI SCD determination and TBI SCD rating percentage, in addition to overall SCD compensation. Although deployment was significantly associated with TBI SCD determination, non-deployment was associated with higher TBI SCD percent ratings. These results may be explained by TBI occurring in non-deployment military settings, such as training. This highlights the need to study risk for TBI in the general military environment to ensure that all military-related TBI exposures are recognized and that any related disability is appropriately compensated.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752763","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":"The Accuracy of the PHQ-2 Alone and Combined With the PHQ-9 to Identify Major Depression in Traumatic Brain Injury.","authors":"Charles H Bombardier, Erin G Mistretta, Rebecca Altschuler, Jason Barber, Jesse R Fann","doi":"10.1097/HTR.0000000000001054","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001054","url":null,"abstract":"<p><strong>Objective: </strong>To assess the reliability, construct validity, and screening accuracy of the Patient Health Questionnaire-2 (PHQ-2) and the combined PHQ-2/PHQ-9 to detect major depressive disorder (MDD) in persons with traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Participants: </strong>Participants were 135 adults within 1 year of sustaining complicated mild, moderate, or severe TBI, initially recruited for a depression treatment trial.</p><p><strong>Design: </strong>Screening validity study relative to structured diagnostic assessment.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main measures: </strong>PHQ-2 and PHQ-9 depression scales, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.</p><p><strong>Results: </strong>The optimal cutoff for the PHQ-2 alone is a score of 2 or more which results in a sensitivity of .86 and a specificity of .83. When the PHQ-2 and PHQ-9 are combined in a 2-step process, the optimal cutoffs are 1 or more on the PHQ-2 and a total of 5 or more of the 9 PHQ-9 symptoms endorsed at least several days in the past 2 weeks. This resulted in a sensitivity of .93 and a specificity of .89 and only 53.6% of patients needed to be administered the entire PHQ-9.</p><p><strong>Conclusion: </strong>The 2-step PHQ-2/PHQ-9 screening process described here represents an efficient, reliable, and valid means of detecting MDD in people with TBI. Results suggest that the generic PHQ-2/PHQ-9 depression screening parameters adopted within large U.S. federal entities may disadvantage people with TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752906","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":"Erratum to \"INTIMASY-TBI Guideline: Optimization of INTIMAcy, SexualitY, and Relationships Among Adults With Traumatic Brain Injury\".","authors":"Eleni M Patsakos, Samantha Backhaus, Kathryn Farris, Marisa King, Jhon Alexander Moreno, Dawn Neumann, Angelle Sander, Mark T Bayley","doi":"10.1097/HTR.0000000000001046","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001046","url":null,"abstract":"","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752897","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":"Patient and Hospital Factors Associated With Hospital Course for Patients With Mild Traumatic Brain Injury.","authors":"Vikas N Vattipally, Kelly Jiang, Carly Weber-Levine, Patrick Kramer, A Daniel Davidar, Andrew M Hersh, Malcolm Winkle, James P Byrne, Tej D Azad, Nicholas Theodore","doi":"10.1097/HTR.0000000000001056","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001056","url":null,"abstract":"<p><strong>Objective: </strong>To characterize variation in the treatment of patients with mild traumatic brain injury (mTBI) who were reasonable candidates for hospitalization, we investigated patient-level associations with inpatient admission and hospital-level associations with length of stay (LOS). We further investigated whether patients treated at high-LOS hospitals were more likely to experience home discharge.</p><p><strong>Setting: </strong>Patients were retrospectively identified from the ACS TQIP dataset.</p><p><strong>Participants: </strong>A total of 122 406 patients with mTBI were included.</p><p><strong>Design: </strong>We performed hierarchical logistic regression to investigate associations of patient-level variables with inpatient admission. Among hospitalized patients, a hierarchical linear regression was constructed for associations with LOS, including hospitals as a random effects term. Based on random effects coefficients, hospitals were classified as high-LOS outliers or non-outliers.</p><p><strong>Main measures: </strong>Univariable comparisons on facility characteristics were performed. Patients were propensity score matched across hospital outlier status, and a multivariable logistic regression for associations with discharge to home was performed.</p><p><strong>Results: </strong>The median age was 63 years (interquartile range [IQR], 42-77 years), and 111 306 (91%) patients experienced inpatient admission. Uninsured status was associated with lower odds of inpatient admission (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.65-0.76; P < .001). After excluding very low-volume hospitals, 80 258 admitted patients were treated across 469 hospitals, and 98 were designated as high-LOS outliers. These were more likely to be Level 1 trauma centers (76% vs. 26%; P < .001). After matching, patients treated at high-LOS outlier hospitals were less likely to experience home discharge (OR, 0.89; 95% CI, 0.85-0.93; P < .001). This effect was amplified for patients identifying as non-White, non-Black, non-Hispanic other races (P = .003).</p><p><strong>Conclusions: </strong>Inpatient admission after mTBI varies by insurance status, with uninsured patients less likely to be admitted. There is significant interhospital variation in LOS, with Level 1 trauma centers more likely to be high-LOS outliers. Despite their longer LOS, patients treated at outlier hospitals experienced lower odds of home discharge.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752902","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":"Cervical Range of Motion and Pericranial Muscle Tenderness in Patients With Persistent Post-Concussion Symptoms: A Cross-Sectional Study.","authors":"Laura Westh Stenbro, Line Amalie Hellemose, Simple Futarmal Kothari, Helge Kasch, Jørgen Feldbæk Nielsen, Peter Preben Eggertsen","doi":"10.1097/HTR.0000000000001040","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001040","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the active cervical range of motion (aCROM) in 15- to 30-year-old patients with high levels of persistent post-concussion symptoms (PCS) 2-6 months after a mild traumatic brain injury (mTBI) compared with healthy individuals. Additionally, we examined the association between aCROM, the severity of PCS (measured by the Rivermead Post-Concussion Symptom Questionnaire [RPQ]), and the pericranial tenderness score (pTTS).</p><p><strong>Setting: </strong>A research outpatient clinic at a rehabilitation hospital in the Central Denmark Region. Patients were recruited by referral from general practitioners or emergency departments.</p><p><strong>Participants: </strong>Young individuals (aged 15-30 years) with high levels of PCS (n = 108) within 2-6 months after a direct head trauma. Reference data of aCROM was obtained from a published study conducted on healthy individuals (n = 100) (aged 20-29 years).</p><p><strong>Design: </strong>Cross-sectional study using baseline data from a randomized controlled trial examining the effect of a non-pharmacological intervention for PCS.</p><p><strong>Main outcome measures: </strong>aCROM measured using a CROM 3 device, pTTS, and RPQ-score.</p><p><strong>Results: </strong>Patients with PCS had a 5% lower mean total aCROM compared with a published reference mean on healthy individuals (mean group difference [95% confidence interval] = -19°[-31; -7.0], P = .002). The reduction in aCROM was primarily driven by a subset of individuals (n = 12). A significant negative correlation was found between total pTTS and total aCROM (ρ = -.43, P < .001). There was no significant correlation between the RPQ score and the total aCROM (r = -0.12, P = .214).</p><p><strong>Conclusion: </strong>The findings indicate that concomitant cervical impairment may exist in a subset of patients with PCS. A clinical implication could be to include systematic neck examination in patients with mTBI to ensure accurate diagnosis. However, further research is necessary before implementing this information into regular clinical practice.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656729","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":"Early Resumption of Physical Activity and Cognitive Outcomes at 4 Week Following Pediatric Concussion.","authors":"Veronik Sicard, Roger Zemek, Vid Bijelic, Nick Barrowman, Keith Owen Yeates, Miriam H Beauchamp, Brian L Brooks, Peter Anderson, Michelle Keightley, Naddley Desire, Andrée-Anne Ledoux","doi":"10.1097/HTR.0000000000001050","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001050","url":null,"abstract":"<p><strong>Background: </strong>Early physical activity (PA) after concussion may aid in symptom recovery, though its impact on other recovery domains, such as cognitive functioning, remains less explored.</p><p><strong>Objectives: </strong>(1) Examine the association between early PA (within 7 days post-injury) and cognitive inefficiency and impairment 4 weeks after pediatric concussion; (2) investigate the association between early PA and cognitive outcomes (memory and executive functioning, information processing speed, attention, visual-motor processing, and vocabulary) 4-week post-concussion.</p><p><strong>Setting: </strong>Emergency departments (EDs) of four Canadian pediatric hospitals within the Pediatric Emergency Research Canada (PERC) Network.</p><p><strong>Participants: </strong>Children aged 8-18 years presenting to the ED within 48 hours of a head injury and diagnosed with a concussion.</p><p><strong>Design: </strong>Planned secondary analysis of data from a prospective multicenter cohort study.</p><p><strong>Main measures: </strong>Participants' PA level was assessed at 1-week post-concussion through a self-report questionnaire in which they had to indicate their current level of recovery in terms of return to physical activities and sports. Early PA participation was defined as any level of PA other than \"no activity\" at the 1-week follow-up. Participants underwent comprehensive neuropsychological testing at 4-week post-concussion. Primary outcome measures included cognitive inefficiency and impairment (≥2 outcomes with z < -1.0 SD or <-1.5 SD below the normative mean, respectively). Secondary and tertiary outcome measures include t-scores and scaled scores from the 10 neuropsychological tasks, transformed to z-scores.</p><p><strong>Results: </strong>Early PA was not significantly associated with the likelihood of cognitive inefficiency or impairment (Ps ≥ .38). The early PA*sex interaction was related to verbal cognitive flexibility (P = .02), with females engaging in early PA having better scores. Moreover, the early PA*age interaction was associated with attention (P = .03), with younger children engaged in early PA performing worse.</p><p><strong>Conclusions: </strong>Early PA has no overall association with cognitive inefficiency or impairment but may be differentially associated with certain cognitive outcomes by age and sex.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649251","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":"Video Head Impulse Test in Survivors From Severe Traumatic Brain Injury: New Perspectives for Implementation of Assessment in Rehabilitation.","authors":"Nicola Ferri, Susan L Whitney, Luca Verrecchia, Laura Casagrande Conti, Andrea Turolla, Tommaso Lelli, Rita Formisano, Maria Gabriella Buzzi, Paolo Pillastrini, Leonardo Manzari, Marco Tramontano","doi":"10.1097/HTR.0000000000001044","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001044","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate vestibular function by instrumental assessment of the angular vestibulo-ocular reflex (aVOR) in survivors from severe traumatic brain injury (sTBI) and analyze related clinical characteristics and functional balance scales.</p><p><strong>Setting: </strong>This study was conducted on inpatients accepted at Santa Lucia Foundation-Neurorehabilitation Hospital for Research and Healthcare (Rome, Italy), from January to September 2023.</p><p><strong>Participants: </strong>Twenty-one survivors from sTBI with a median age of 48 years (IQR = 27) were included in this study, recruited through the neurorehabilitation services. Participants were included if they had a Glasgow Coma Scale Score ≤ 8 at the time of injury, Level of Cognitive Functioning ≥ 7, static and dynamic balance impairments, ability to understand verbal commands, and Functional Ambulation Classification > 3.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Main measures: </strong>Two expert physiotherapists performed an aVOR assessment using the video Head ImpulseTest by both head impulse and suppression paradigms. Furthermore, all participants completed a balance assessment using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scale. Descriptive statistical analyses were performed, and the relationship between aVOR function and balance outcomes was investigated.</p><p><strong>Results: </strong>Nineteen participants (90%) displayed aVOR with an abnormal gain at least in 1 canal. Thirty percent of all canals analyzed had abnormal gains, with a clear prevalence of the right posterior canal (71%), which presents aVOR gain lower than the functional threshold on average (mean 0.70; CI, 0.62-0.78). No correlations were found between the aVOR gain and the clinical outcome measure scores.</p><p><strong>Conclusion: </strong>Low aVOR gains were evident in people who experienced sTBI. A comprehensive evaluation of the vestibular peripheral system may detect vestibular impairments in these patients that may otherwise be unrecognized.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605168","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":"Bypassing Striatal Learning Mechanisms Using Delayed Feedback to Circumvent Learning Deficits in Traumatic Brain Injury.","authors":"Ekaterina Dobryakova, Tien T Tong, Olesya Iosipchuk, Anthony Lequerica, Veronica Schneider, Nancy Chiaravalloti, Joshua Sandry","doi":"10.1097/HTR.0000000000000947","DOIUrl":"10.1097/HTR.0000000000000947","url":null,"abstract":"<p><strong>Objective: </strong>Feedback facilitates learning by guiding and modifying behaviors through an action-outcome contingency. As the majority of existing studies have focused on the immediate presentation of feedback, the impact of delayed feedback on learning is understudied. Prior work demonstrated that learning from immediate and delayed feedback employed distinct brain regions in healthy individuals, and compared to healthy individuals, individuals with traumatic brain injury (TBI) are impaired in learning from immediate feedback. The goal of the current investigation was to assess the effects of delayed vs immediate feedback on learning in individuals with TBI and examine brain networks associated with delayed and immediate feedback processing.</p><p><strong>Setting: </strong>Nonprofit research organization.</p><p><strong>Participants: </strong>Twenty-eight individuals with moderate-to-severe TBI.</p><p><strong>Design: </strong>Participants completed a paired-associate word learning task while undergoing magnetic resonance imaging. During the task, feedback was presented either immediately, after a delay, or not at all (control condition).</p><p><strong>Main measures: </strong>Learning performance accuracy, confidence ratings, post-task questionnaire, and blood oxygen level-dependent signal.</p><p><strong>Results: </strong>Behavioral data showed that delayed feedback resulted in better learning performance than immediate feedback and no feedback. In addition, participants reported higher confidence in their performance during delayed feedback trials. During delayed vs immediate feedback processing, greater activation was observed in the superior parietal and angular gyrus. Activation in these areas has been previously associated with successful retrieval and greater memory confidence.</p><p><strong>Conclusion: </strong>The observed results might be explained by delayed feedback processing circumventing the striatal dopaminergic regions responsible for learning from immediate feedback that are impaired in TBI. In addition, delayed feedback evokes less of an affective reaction than immediate feedback, which likely benefited memory performance. Indeed, compared to delayed feedback, positive or negative immediate feedback was more likely to be rated as rewarding or punishing, respectively. The findings have significant implications for TBI rehabilitation and suggest that delaying feedback during rehabilitation might recruit brain regions that lead to better functional outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E129-E138"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751895","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":"Relationships Between Neighborhood Disadvantage, Race/Ethnicity, and Neurobehavioral Symptoms Among Veterans With Mild Traumatic Brain Injury.","authors":"Adam R Kinney, Nazanin H Bahraini, Alexandra L Schneider, Xiang-Dong Yan, Jeri E Forster, Ryan Holliday, Lisa A Brenner","doi":"10.1097/HTR.0000000000001016","DOIUrl":"10.1097/HTR.0000000000001016","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between neighborhood disadvantage and severity of vestibular, sensory, mood-behavioral, and cognitive neurobehavioral symptoms among Veterans with a mild traumatic brain injury (mTBI); and whether Veterans in underrepresented racial/ethnic groups with high neighborhood disadvantage experience the most severe symptoms.</p><p><strong>Setting: </strong>Outpatient Veterans Health Administration (VHA).</p><p><strong>Participants: </strong>Veterans with the following data available in the electronic health record (2014-2020): (1) clinician-confirmed mTBI and complete neurobehavioral symptom inventory (NSI) as part of their comprehensive traumatic brain injury evaluation (CTBIE) and (2) area deprivation index (ADI) scores assessing neighborhood disadvantage from the same quarter as their CTBIE.</p><p><strong>Design: </strong>Retrospective cohort study. Latent variable regression was used to examine unique and interactive relationships between neighborhood disadvantage, race/ethnicity, and neurobehavioral symptoms.</p><p><strong>Main measures: </strong>NSI and ADI national percentile rank.</p><p><strong>Results: </strong>The study included 58 698 eligible Veterans. Relative to Veterans in the first quintile of ADI national percentile rank, representing those with the least neighborhood disadvantage, Veterans in the ADI quintiles indicating greater neighborhood disadvantage reported more severe vestibular, sensory, mood-behavioral, and cognitive symptoms. The strongest associations between neighborhood disadvantage and neurobehavioral symptoms were observed within the sensory ( β = 0.07-0.16) and mood-behavioral domains ( β = 0.06-0.15). Statistical interactions indicated that the association between underrepresented racial/ethnic group status (vs. identifying as white, non-Hispanic) and the severity of neurobehavioral symptoms did not differ among those with severe neighborhood disadvantage versus those without.</p><p><strong>Conclusion: </strong>Veterans with mTBI living in more disadvantaged neighborhoods reported more severe neurobehavioral symptoms relative to those in the most advantaged neighborhoods, with the strongest relationships detected within the sensory and mood-behavioral domains. While neighborhood disadvantage and underrepresented race/ethnicity were both independently associated with symptoms, these factors did not interact to produce more severe symptoms. Findings suggest that addressing factors driving socioeconomic disadvantage may assist in mitigating symptoms in this population.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"65-75"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370842","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}