Journal of Head Trauma Rehabilitation最新文献

{"title":"Risk Factors for Benign Paroxysmal Positional Vertigo in an Acutely Concussed Adolescent Population.","authors":"Kayla Covert, Brittany Davis, Kendall Hammonds, Morgan O'Neil, Anne Mucha","doi":"10.1097/HTR.0000000000001161","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001161","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to describe the prevalence of benign paroxysmal positional vertigo (BPPV) in an acutely concussed, adolescent sport population and to identify factors for at-risk individuals.</p><p><strong>Setting: </strong>Specialty concussion clinic.</p><p><strong>Participants: </strong>Adolescents aged 12-19 years who were acutely diagnosed with a concussion and referred to vestibular physical therapy by the participating concussion provider (n = 334).</p><p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Main measures: </strong>Symptom severity was measured using the Post-Concussion Symptom Scale, while vestibular and ocular motor functioning was assessed using the Vestibular Ocular Motor Screening (VOMS) at the initial evaluation with the participating concussion provider. Benign paroxysmal positional vertigo-related symptoms were measured using the 5-item BPPV subscale of the Dizziness Handicap Inventory (DHI) and BPPV diagnosis and involved canal was based on standardized testing using infrared video Frenzel goggles at the initial vestibular physical therapy evaluation.</p><p><strong>Results: </strong>Thirty (9%) acutely concussed adolescents were diagnosed with BPPV. Patients with BPPV had a significantly higher 5-item DHI score (median 12 vs. 6, P < .01) and were less likely to complete the Vestibular Ocular-Motor Screening (VOMS; 50% vs. 88% completion rate). In the final multivariate analysis, both incomplete VOMS (odds ratio = 4.80, 95% confidence interval: 2.05-11.24, P < .01) and a higher 5-item DHI score (odds ratio = 1.17, 95% confidence interval: 1.06-1.29, P < .01) increased BPPV risk. The prediction model demonstrated good discrimination (area under the curve = 0.75).</p><p><strong>Conclusions: </strong>Risk factors for BPPV in acutely concussed adolescents include a higher score on the 5-item DHI and an inability to complete the VOMS.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838327","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":"Prospective Assessment of Improvement and Decline in Global Functioning After Traumatic Brain Injury Using Multistate Markov Models.","authors":"Nicola L de Souza, Cynthia L Beaulieu, Raj G Kumar, Kristen Dams-O'Connor","doi":"10.1097/HTR.0000000000001163","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001163","url":null,"abstract":"<p><strong>Objective: </strong>To describe transitions in global functional status across consecutive follow-up visits, including probabilities for improvement, decline, and stability, and to identify factors associated with transition during the first 10 years after traumatic brain injury (TBI).</p><p><strong>Setting: </strong>TBI Model Systems National Database.</p><p><strong>Participants: </strong>In total, 13,731 participants with TBI requiring inpatient rehabilitation who completed 2 follow-up assessments within 10 years post-injury, with at least 2 consecutive assessments at 1, 2, 5, or 10 years.</p><p><strong>Design: </strong>Secondary data analysis.</p><p><strong>Main measures: </strong>Global functional status measured by the Glasgow Outcome Scale-Extended, collapsed into 4 states: Good Recovery, Moderate Disability, Severe Disability/Vegetative State, and Death. Transition probabilities were estimated using multistate Markov models, and transition-specific hazard ratios were calculated for covariate effects.</p><p><strong>Results: </strong>Probability of remaining in the same state was highest among those with Good Recovery at year 1, with 68.4% (95% CI: 55.1%-80.9%) remaining stable between years 1 and 2. Improvement was common among those initially in Moderate or Severe Disability states. Among participants with Moderate Disability at year 1, 36.6% (95% CI: 18.1%-48.7%) improved and 15.4% (95% CI: 10.1%-18.3%) declined by year 2. Among those with Severe Disability at year 1, 34.5% (95% CI: 22.8%-40.1%) improved to Moderate Disability, and 13.7% (95% CI: 6.7%-21.3%) improved 2 states to Good Recovery. Trends were similar between years 5-10. Risk factors for both decline and mortality included older age at injury. Non-White race, lower education, and public insurance predicted lower likelihood for improvement and greater likelihood of decline. Protective factors included female sex, higher education, private insurance, higher functioning at hospital discharge, and residing in states offering better long-term services and supports.</p><p><strong>Conclusion: </strong>Recovery after TBI is dynamic, with higher probabilities of functional stability and improvement than decline over 10 years post-injury. Findings highlight modifiable factors with policy-level implications that may influence recovery trajectories.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838848","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":"Research Letter: Scoping Review of the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE®) to Evaluate Social Determinants of Health Among Persons With TBI.","authors":"Caitlin Synovec, Kathleen Bell, Librada Callender, Candice Osborne, Monique R Pappadis, Rick Ralston, Ronald T Seel, Jennifer Bogner","doi":"10.1097/HTR.0000000000001154","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001154","url":null,"abstract":"<p><strong>Objective: </strong>Social determinants of health (SDoH) affect health care access and outcomes. Screening for SDoH is needed to advance health care equity for persons with traumatic brain injury (TBI). The purpose of this scoping review was to examine whether the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE®), can be used successfully with persons with more severe TBI (ie, TBI of sufficient severity to require inpatient rehabilitation). We sought to determine whether the tool had been previously used with persons with TBI (or similar populations) and if any difficulties were encountered and/or if any accommodations were provided to foster completion. We also sought to determine whether findings were relevant to improving health care access for persons with TBI. We sought input from persons with TBI regarding difficulties or discomfort with responding to the questions.</p><p><strong>Setting: </strong>Community.</p><p><strong>Design: </strong>Scoping review of the literature from 2014 through December 21, 2023, using 8 databases. During the last stage, we sought input from 17 persons living with TBI.</p><p><strong>Main measures: </strong>PRAPARE®.</p><p><strong>Results: </strong>After screening 140 articles, the scoping review identified 2 studies meeting the inclusion criteria. These studies included patients with glioma (n = 100) and with chronic conditions (n > 7000). No study specified inclusion of persons with TBI. The glioma study allowed for assistance by another person. While the participants in the glioma study were low risk, the study of persons with chronic conditions found that persons with a greater comorbidity burden were more likely to be from socioeconomically disadvantaged or racial/ethnic minoritized backgrounds and have transportation and childcare needs. Input from persons with TBI suggested items are generally well understood. Six items presenting with minor challenges may require accommodations during administration.</p><p><strong>Conclusions: </strong>PRAPARE® may be used with individuals with TBI to screen for social SDoH. Screening considerations include respect of privacy, an individual's choice and priorities, availability of resources, being trauma-informed, and clarifying items that are sensitive and/or difficult to understand.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838870","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":"Buspirone for Irritability and Aggression in Chronic Traumatic Brain Injury: A 91-Day Flexible-Dose, Parallel Group, Randomized, Placebo-Controlled Study.","authors":"Flora M Hammond, James F Malec, Rebecca Runkel, Dana Waltzman, Qing Tang, Jie Ren","doi":"10.1097/HTR.0000000000001174","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001174","url":null,"abstract":"<p><strong>Objective: </strong>To test the hypothesis that buspirone reduces irritability (primary outcome) and aggression in chronic traumatic brain injury (TBI) as assessed by persons with TBI, their observer, and research clinician.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>Eighty-one participants (41 buspirone and 40 placebo) > 6 months post-TBI with moderate-to-severe irritability. Analysis samples were intention-to-treat (buspirone n = 41 and placebo n = 40) and per protocol sample (buspirone n = 33 and placebo n = 36).</p><p><strong>Design: </strong>Randomized, double-blind, placebo-controlled, parallel-group trial comparing buspirone titrated up to 60 mg in divided doses with placebo over 91 days.</p><p><strong>Main measures: </strong>Observer and participant-rated pre- and post-treatment Neuropsychiatric Inventory Irritability (NPI-I) and Aggression (NPI-A) domains, along with their associated NPI-Distress scores, as well as clinician-rated Clinical Global Improvement.</p><p><strong>Results: </strong>All observer/participant analyses were nonsignificant except participant-rated aggression, the buspirone group had a higher adjusted least square mean (2.9 buspirone versus 1.7 placebo, P = .026). The proportion improving at least 3 NPI-I points on observer ratings was substantial but not statistically significant in both groups (78.9% buspirone versus 77.5% placebo, P = .877). Participant-ratings also revealed a large proportion in both groups improved (55.3% buspirone recipients versus 45% placebo recipients improved at least 3 points, P = .365). Clinician ratings were not significantly different between groups. There were no group differences in adverse event occurrence.</p><p><strong>Conclusions: </strong>The findings do not support buspirone as effective for post-TBI irritability at the doses and duration examined. Large nonspecific effects in both groups demonstrated high placebo response rates obscuring buspirone-specific benefits. This suggests structured clinical environments and regular monitoring confer substantial therapeutic benefits independent of specific treatment mechanisms.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov Identifier: NCT01821690 https://www.clinicaltrials.gov/study/NCT01821690.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856465","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":"How Sex and Gender Differences Influence Functional Recovery in Patients With Traumatic Brain Injury: A Systematic Review.","authors":"Raffaela Maione, Maria Grazia Maggio, Rosaria De Luca, Francesco Corallo, Rosalia Calapai, Sara Lago, Sara Zago, Giorgio Arcara, Angelo Quartarone, Rocco Salvatore Calabrò","doi":"10.1097/HTR.0000000000001160","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001160","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aimed to examine how sex differences and, when available, gender-related factors affect rehabilitation outcomes in individuals with TBI.</p><p><strong>Design: </strong>Systematic review registered in PROSPERO (ID: 1018531) and conducted in accordance with PRISMA guidelines and the Cochrane Handbook. We included randomized controlled trials and observational and experimental studies published in the past 5 years (2020-2025) that explicitly analyzed sex- and/or gender-related differences in response to a rehabilitation intervention after TBI.</p><p><strong>Interventions: </strong>Various rehabilitation programs, including conventional therapy, virtual reality, and telerehabilitation.</p><p><strong>Main measures: </strong>Cognitive, motor, emotional, functional, and social outcomes, analyzed by biological sex and, when available, gender-related psychosocial traits.</p><p><strong>Results: </strong>Six studies met the inclusion criteria. Most findings referred to sex-based differences: female participants (sex: female) demonstrated better recovery in cognitive and social functioning, potentially linked to neuroprotective effects of estrogen and progesterone. However, they also reported higher anxiety and more persistent postconcussive symptoms. Only one study investigated gender as a social construct, suggesting that gender-related social traits, particularly those culturally associated with femininity, were associated with reduced access to rehabilitation services. A subset of studies evaluated technology-assisted interventions (e.g., virtual reality, telerehabilitation); however, sex/gender-differential effects were rarely tested, limiting firm conclusions about tailoring by sex or gender.</p><p><strong>Conclusions: </strong>Although current evidence predominantly concerns sex-based differences, limited data also point to a potential role of gender-related social factors. Together, these findings suggest that sex and gender may significantly shape rehabilitation outcomes after TBI. Integrating sex- and gender-sensitive strategies into clinical pathways may improve equity, enhance personalization, and optimize recovery. Standardized, gender-inclusive protocols are needed to address disparities and promote fair access to neurorehabilitation.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838898","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":"Time to Resume Oral Anticoagulant Therapy in Traumatic Intracranial Hemorrhage Patients, Balancing Recurrence, Thromboembolism, and Mortality: A Systematic Review.","authors":"Amaury Gossiome, Axel Benhamed, Anthony Labrecque-Binet, Valérie Boucher, Caroline Sirois, Eric Mercier, Pierre-Gilles Blanchard, Pierre-Hugues Carmichael, Myreille D'Astous, Karim Tazarourte, Xavier Dubucs, Marcel Émond","doi":"10.1097/HTR.0000000000001164","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001164","url":null,"abstract":"<p><strong>Objective: </strong>Managing patients on oral anticoagulant therapy (OAC) who present with traumatic intracranial hemorrhage (ICH) poses a critical challenge in balancing the prevention of thromboembolic events and the risk of progression or recurrent ICH. The objective of this systematic review was to determine the optimal timing for resuming OAC in patients with traumatic ICH, and to assess the risk of hemorrhagic and thromboembolic events, and mortality in patients for whom anticoagulation was resumed.</p><p><strong>Design: </strong>With a medical librarian, 4 databases and gray literature were searched without language or date restrictions.</p><p><strong>Participants and main measures: </strong>Eligible studies included patients with traumatic ICH undergoing OAC resumption and reporting on timing, ICH progression or recurrence, thromboembolic events, and/or mortality.</p><p><strong>Results: </strong>Of 3384 identified studies, 12 cohort studies met inclusion criteria, involving 13,528 patients with varying severities of traumatic brain injury. Most patients were treated with vitamin K antagonists; only 3 studies included patients on direct oral anticoagulants. The median time to resume OAC ranged from 8 to 67 days. In studies limited to traumatic ICH, OAC resumption was not associated with increased recurrent ICH risk with reported RR 0.70 (95% CI, 0.52-0.95) and HR 0.45 (95% CI, 0.26-0.76). All but one study reported reduced thromboembolic events with OAC resumption. The studies also suggested that complete resolution of the initial ICH allowed for safe resumption of OAC.</p><p><strong>Conclusions: </strong>This systematic review suggests that resumption of OAC after traumatic ICH may be considered in selected patients, without a clear evidence of increase in the risk of recurrent ICH and with a potential reduction in thromboembolic events. However, we were unable to define a safe timeframe, and further studies are needed to establish recommendations to guide clinical practice.</p><p><strong>Level of evidence: </strong>Level III, Systematic Review and Meta-Analysis.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838283","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":"Research Letter: Concussion Evaluation by Injury Setting Among US Children.","authors":"Todd Burus, Jennifer D Burus, Svetla Slavova, Celysse M van Zyl","doi":"10.1097/HTR.0000000000001173","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001173","url":null,"abstract":"<p><strong>Objective: </strong>To examine differences in medical evaluation for concussion after sports-related head trauma (SRHT) versus non-SRHT among school-aged children in the United States.</p><p><strong>Setting: </strong>National Health Interview Survey.</p><p><strong>Participants: </strong>Children aged 5-17 years living in the United States.</p><p><strong>Design: </strong>Caregiver-reported responses to questions on health topics among a nationally-representative sample of US children.</p><p><strong>Main measures: </strong>Experience of concussion-like symptoms after head trauma in the prior year, injury setting, and receipt of medical evaluation for concussion from health professional.</p><p><strong>Results: </strong>The study included 11,768 children aged 5-17 years in 2023-2024. An estimated 2.6% (95% confidence interval [CI], 2.3-2.9) reported concussion-like symptoms after head trauma in the prior year, with a higher prevalence among those aged 13-17 years (3.5%; 95% CI, 3.0-4.1). Most injuries occurred outside of sports settings (60.8%; 95% CI, 54.4-66.8). Overall, 67.7% (95% CI, 61.5-73.5) of injured children received a medical evaluation for concussion. Evaluations were more common among males than females (adjusted prevalence ratio [aPR], 1.249; 95% CI, 1.043-1.495) and those aged 13-17 years than aged 5-12 years (aPR, 1.366; 95% CI, 1.104-1.689). Concussion evaluations were administered to 90.4% of children with SRHT compared with only 53.1% with non-SRHT. Adjusting for relevant characteristics, we estimated medical evaluation occurred 39.2% less often for non-SRHT (aPR, 0.608; 95% CI, 0.505-0.733). Based on the 2023-2024 population estimates, this indicates approximately 388,905 (95% CI, 292,880-484,929) missed concussion evaluations for children with non-SRHT each year.</p><p><strong>Conclusion: </strong>These findings suggest substantially more missed concussion evaluations among children with concussion-like symptoms after non-SRHT compared with those with SRHT. Increasing awareness about concussion care among school personnel and health professionals that work with pediatric populations, and embedding clear guidance for referral and treatment into non-sports-related settings, may serve to reduce differences in evaluation and improve long-term recovery.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816272","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 Inter-Tester and Test-Retest Reliability of the Off-Field SCAT6 Assessment Tool In An Adult Population.","authors":"Tom McKeever, Michael Leavitt, Stephanie Valentin, Conor Hurley, Arran Fraser, David F Hamilton","doi":"10.1097/HTR.0000000000001106","DOIUrl":"10.1097/HTR.0000000000001106","url":null,"abstract":"<p><strong>Objective: </strong>No previously published repeatability and reliability data for The Sports Concussion Assessment Tool-6 (SCAT6) exists. We aimed to evaluate inter/intra-tester reliability of the off-field SCAT6 in a non-concussed adult population.</p><p><strong>Design: </strong>Inter-rater and Intra-rater reliability study design.</p><p><strong>Setting: </strong>Single university site.</p><p><strong>Participants: </strong>Twenty active adults (mean age: 27.55 ± 5.59 years) with no recent history of concussion (Concussive injury within past year).</p><p><strong>Interventions: </strong>Participants completed 3 SCAT6 tests on the same day, with 3 testers (Inter-rater testing). The same participants returned at 2 further time points to complete the remaining 2 SCAT6 tests with 1 tester (Intra-rater testing). Participants complete a total of 5 SCAT6 assessments in total across testers and time. Rater Background: Those completing the SCAT6 testing, our study rater team, comprised of 1 senior physiotherapist and PhD candidate, and 2 MSc Physiotherapy students. All raters were from Scotland, and had significant training in completing SCAT6 assessments.</p><p><strong>Main outcome measures: </strong>Off-field SCAT6 Domain scores.</p><p><strong>Analysis: </strong>ICCs were used to establish inter and intra-rater reliability for continuous, ration and ordinal data components of the SCAT6. For nominal data sets, Fleiss's kappa was calculated. Kendall's W was used for non-parametric data. Percentage error scores were calculated for SCAT6 domains.</p><p><strong>Results: </strong>Inter-tester : Symptom number, severity, and dual-task scoring demonstrated excellent reliability (ICC = 0.981; 0.984; 0.913, respectively). Total concentration score was found to have good reliability (0.827). Dual-task errors (0.398), Total mBESS (0.199), and Month recall all returned poor scores (k = 0.191). Intra-tester : Dual tasking was the only domain to report excellent reliability (ICC = 0.943). Symptom number (0.868), severity (0.831), total concentration (0.787), total mBESS (0.813), and time tandem gait (0.834) yielded good reliability scores. Dual-task error testing returned poor reliability scores (Kendall's W = 0.001). All remaining domains yielded moderate reliability. Percentage error rates ranges from 3% to 100%, demonstrating the variability between scores yielded for non-concussed individuals completing the same SCAT6 domain tests.</p><p><strong>Conclusion: </strong>SCAT6 ICC results reported good-excellent reliability for 4 and 6 domains, out of 13 domains, for inter-tester and intra-tester reliability, respectively. Notably, the domains which relied on tester error scoring yielded poor reliability results. Percentage error highlighted the failure of the SCAT6 to provide consistent domain score results in this population.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E243-E250"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957054","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":"False-Positive Rates and Associated Factors on the Vestibular/Ocular Motor Screening (VOMS) Using the Military Acute Concussion Evaluation 2 (MACE 2) Cutoffs in U.S. Military Personnel.","authors":"Karen H Lambert, Carrie W Hoppes, Aaron J Zynda, Anne Mucha, Katrina Monti, Michael W Collins, Shawn R Eagle, Anthony P Kontos","doi":"10.1097/HTR.0000000000001108","DOIUrl":"10.1097/HTR.0000000000001108","url":null,"abstract":"<p><strong>Objective: </strong>This study examined false-positive rates and associated factors on the Vestibular/Ocular Motor Screening (VOMS) in healthy US Army Special Operations Command (USASOC) personnel using the symptom provocation cutoff of ≥1 for any VOMS item as recommended in the Military Acute Concussion Evaluation 2 (MACE 2).</p><p><strong>Setting: </strong>Military site.</p><p><strong>Participants: </strong>Active-duty USASOC personnel aged 18 to 40 years with 20/20 vision, no duty limitations, and no recent concussion. Participants were excluded if they had a history of vestibular or neurologic disorder, only monocular vision capabilities, or previous moderate-to-severe traumatic brain injury. Four hundred and sixteen USASOC personnel were enrolled; 402 were analyzed.</p><p><strong>Design: </strong>This was a cross-sectional study of diagnostic accuracy. Trained research personnel administered the VOMS. Participants and research personnel were not blinded.</p><p><strong>Main measures: </strong>False-positive rates and associated risk factors on the VOMS.</p><p><strong>Results: </strong>Among 402 healthy participants (mean age 28.5 ± 5.7 years), 35.1% had at least one false positive on the VOMS. Twenty-two percent had at least one false-positive change score, 12.2% had a near-point convergence (NPC) distance ≥5 cm, and 4.2% had both. VOMS false positives on each VOMS item ranged from 4.7% to 15.7%. Participants with ≥1 false positive on the VOMS were more likely to have a motion sickness history (OR = 2.35, 95% CI = 1.35-4.12, P = .003) or a concussion history (OR = 1.97, 95% CI = 1.27-3.05, P = .002).</p><p><strong>Conclusion: </strong>The MACE 2 cutoff resulted in a higher overall rate of at least one false positive across items (35.1%) in this sample of healthy USASOC personnel compared to prior total score cutoffs. Consistent with previous research, a history of motion sickness or concussion was associated with an increased likelihood of false positives. Multivariate predictors included motion sickness and a history of concussion. Military medical providers should consider motion sickness, history of concussion, and performance on individual VOMS items.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"211-220"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000774","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":"Context Matters: Influence of Injury Context on Long-Term Psychiatric and Cognitive Outcomes in Combat Veterans With Mild Traumatic Brain Injury History.","authors":"Francesca V Lopez, Ruiyan Hu, Tanvi Krishnan, Kristine C Dell, William C Walker, Victoria C Merritt, Amy Jak","doi":"10.1097/HTR.0000000000001095","DOIUrl":"10.1097/HTR.0000000000001095","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between injury context with psychiatric and cognitive outcomes among combat-exposed Veterans and Service Members with remote mild traumatic brain injury (mTBI).</p><p><strong>Setting: </strong>Veterans and Service Members enrolled in the Long-Term Impact of Military-Relevant Injury Consortium (LIMBIC)-Chronic Effects of Neurotrauma Consortium (CENC).</p><p><strong>Participants: </strong>LIMBIC-CENC-enrolled participants who had sustained an mTBI exclusively in combat zones (c-mTBI +; n = 314), mTBI sustained exclusively in non-combat settings (c-mTBI-; n = 526), or no history of mTBI (no TBI; n = 347). Inclusion criteria for this study included (1) availability of all mTBI injury-related characteristics, (2) completion of all psychiatric symptom measures, and (3) completion of all neuropsychological measures used for this study.</p><p><strong>Design: </strong>Cross-sectional secondary analysis.</p><p><strong>Main measures: </strong>Primary outcomes of interest included total scores on self-reported psychiatric symptom measures (post-traumatic stress, neurobehavioral, and cognitive concerns) and objective cognitive composite test scores (attention, learning, processing speed, executive function, and delayed recall). All analyses adjusted for age, gender, and education.</p><p><strong>Results: </strong>Results of separate multivariate analyses of variance indicated that the c-mTBI+ group reported higher post-traumatic ( ηP2  =  .08) and neurobehavioral symptoms ( ηP2  =  .07), and cognitive concerns ( ηP2  =  .04) compared to the c-mTBI- and no TBI groups, whereas the c-mTBI- and no TBI groups did not differ except on cognitive concerns. Additionally, groups did not differ across cognitive composite performance except for significant though weak group differences on learning ( ηP2  =  .01), delayed recall ( ηP2  =  .03), and processing speed ( ηP2  =  .01). Separate hierarchical regression analyses indicated psychiatric symptom burden explained 7-18% of the total variance in cognitive composite performance as a function of mTBI group history ( p s ≤ .002).</p><p><strong>Conclusions: </strong>These findings build upon prior work showing that injury context - the context in which mTBI occurs - may play an important role in long-term psychiatric and cognitive outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E168-E177"},"PeriodicalIF":3.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847101","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}