Journal of Head Trauma Rehabilitation最新文献

{"title":"A Comparative Evaluation of Two Telehealth Neurocognitive Assessments for Older Adults With and Without Traumatic Brain Injury in A Quasi-randomized Trial.","authors":"Amy M Kemp, Katy H O'Brien","doi":"10.1097/HTR.0000000000001121","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001121","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of the study was to investigate acceptable and appropriate testing modalities for older adults with and without traumatic brain injuries (TBI) and efficient service delivery models for clinicians.</p><p><strong>Setting: </strong>Two neurocognitive assessments were administered in telehealth settings to older adults with and without TBI.</p><p><strong>Participants: </strong>Forty-two older adults with no more than mild cognitive impairment, 21 with a history of TBI, and 21 without (aged 71.0 ± 4.45 years) were included. All adults with TBI were in chronic stages post-TBI (5-56 years).</p><p><strong>Design: </strong>Participants from a quasi-randomized self-management intervention study were enrolled in 2 visits. The first virtual visit included neurocognitive assessments. Assessment order was randomized, and intervention providers were blinded to the injury status.</p><p><strong>Main measures: </strong>The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) on the QInteractive platform and CNS Vital Signs (CNSVS). Both validated assessments provide a global cognitive score and subscales. Time to administer and qualitative clinical notes on participation, acceptance, and preference (patient and clinician) were also collected.</p><p><strong>Results: </strong>There was a positive correlation between RBANS and CNSVS, r = .710, P < .001, indicating that both assessments produced similar neurocognitive scores. Participants without TBI had higher global neurocognitive scores than participants with TBI across both RBANS (t = -4.29, P = < .001) and CNSVS (t = -2.97, P = .002). When examining subscale scores, CNSVS captured more differences in individual subscales than RBANS. The RBANS administration time (34.86 min, SD = 8.4) was longer than CNSVS (31.29 min, SD = 4.79), but did not differ across injury status (RBANS: t = 1.37, P = .179; CNSVS: t = -1.56, P = .127). Patient preference was unremarkable, and older adults were reported to participate well, but clinicians preferred CNSVS.</p><p><strong>Conclusion: </strong>Regardless of the assessment, both were acceptable and appropriate for older adults with and without TBI. However, CNSVS was preferred by clinicians and captured more differences, suggesting an increased sensitivity for evaluating neurocognition.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191610","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":"Physicians' Perspectives on Adolescent Return-to-Drive Post-Concussion: A Qualitative Study.","authors":"Taylor Hartlaub, Lindsay Sullivan, Vishaka Kalra, Steven Cuff, Despina Stavrinos, Jingzhen Yang","doi":"10.1097/HTR.0000000000001124","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001124","url":null,"abstract":"<p><strong>Objective: </strong>To explore physicians' views and practices regarding driving following concussion, with a particular focus on return-to-drive recommendations for adolescents.</p><p><strong>Setting: </strong>Health care.</p><p><strong>Participants: </strong>A total of 11 participating physicians from various medical specialties, with 7 in Sports Medicine, 2 in Physical Medicine and Rehabilitation, 1 in Emergency Medicine, and 1 in Family Medicine.</p><p><strong>Design: </strong>Qualitative interview study using virtual, semi-structured interviews.</p><p><strong>Main measures: </strong>Views and practices regarding return-to-drive protocols for adolescent patients following concussion.</p><p><strong>Results: </strong>Eleven interviews were conducted with 6 male and 5 female physicians. Two researchers independently coded the verbatim transcripts using systematic, open, and focused coding. Three major themes were identified regarding physicians' views and practices on return-to-drive following concussion: (1) evidence, (2) determinants, and (3) recommendations. Physicians expressed that the lack of clear evidence regarding the timing of safe return-to-drive contributed to their discomfort and infrequent discussions of the subject with their patients. The content and timing of return-to-drive discussions varied among physicians and were influenced by several factors, including the timing of initial and follow-up clinical visits, the physician's experience and comfort level, and the perceived receptivity and compliance of the adolescent with the recommendations. Physicians emphasized that return-to-drive guidelines should be tailored to each patient's unique recovery trajectory and needs, rather than following a one-size-fits-all approach.</p><p><strong>Conclusion: </strong>These findings underscore the urgent need for evidence-based clinical guidance, particularly for adolescent drivers as they face heightened risk for both concussion and motor vehicle collisions. Currently, the absence of standardized protocol leads to inconsistent practices among physicians and inadequate guidance for recovering adolescents.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191728","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":"Examining the Sensitivity of the 2023 American Congress of Rehabilitation Medicine's Diagnostic Criteria for Mild Traumatic Brain Injury Using a Sport-Related Concussion Sample.","authors":"Avi N Albert, Anthony E Bishay, Olivia Shaffer, Kristen L Williams, Samuel Fitch, Scott L Zuckerman, Douglas P Terry","doi":"10.1097/HTR.0000000000001120","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001120","url":null,"abstract":"<p><strong>Objective: </strong>To (1) retrospectively apply the updated American Congress of Rehabilitation Medicine (ACRM) mild traumatic brain injury (mTBI) criteria to a cohort of high school athletes previously diagnosed with sport-related concussion (SRC) using prior clinical definitions, and (2) compare demographics, medical history, and recovery outcomes between those who met the full mTBI criteria versus those classified as suspected mTBI.</p><p><strong>Setting: </strong>Outpatient Specialty Concussion Clinic.</p><p><strong>Participants: </strong>In total, 181 concussed athletes aged 14 to 18 years were presented to clinic within 72 hours of injury. All were diagnosed with SRC by a certified athletic trainer or physician using the Concussion in Sport Group definition, which defines SRC as any traumatic blow to the head/body causing neurologic symptoms.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Main measures: </strong>Participants were classified as having a full or suspected mTBI based on the ACRM 2023 criteria. Full mTBIs required: (1) a plausible mechanism and either (2a) a clinical sign (eg, amnesia, loss of consciousness), or (2b) at least 2 symptoms plus a clinical examination finding. Suspected mTBIs had a plausible mechanism and at least 2 symptoms or at least 2 examination findings. Groups were compared across demographics, medical history, and recovery metrics (return-to-learn, symptom resolution, return-to-play).</p><p><strong>Results: </strong>Of the 181 patients (mean age 16.3 ± 1.3 years; 35.9% female), 114 (63.0%) met the definition for a full mTBI, whereas 67 (37.0%) had a suspected mTBI. Significant differences included higher rates of family migraine history (24.8% vs 7.7%, P = .019) and on-field evaluations (50.4% vs 38.5%, P < .001) in the full group. No significant differences in return-to-learn (median [Mdn]: 4.0 vs 3.0), symptom resolution (Mdn: 11.0 vs 12.5), or return-to-play (Mdn: 15.0 vs 14.5) were noted (P > .05).</p><p><strong>Conclusion: </strong>Among high school athletes with SRC, most met the updated full ACRM mTBI criteria, with the rest meeting the suspected mTBI criteria. Results suggest high sensitivity for the ACRM definition for diverse concussion presentations.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191730","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":"Assessing and Managing Agitation During Early Recovery in Children With Moderate-to-Severe Traumatic Brain Injury in Australia: A National Survey.","authors":"Sarah J Knight, Taylor Jenkin, Vicki Anderson, Emma Tavender, Carolyn Pinto, Adam McKay, Natasha A Lannin, Adam Scheinberg","doi":"10.1097/HTR.0000000000001119","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001119","url":null,"abstract":"<p><strong>Background: </strong>Agitation is a common experience in the early stages of recovery from moderate-to-severe traumatic brain injury (TBI) at any age, but there is limited research evidence to guide best practice for children and adolescents.</p><p><strong>Objective: </strong>We aimed to explore current approaches to the assessment and management of agitation following pediatric moderate-to-severe TBI.</p><p><strong>Methods: </strong>In 2024, a cross-sectional anonymous survey was distributed via email to clinicians involved in care of children during early moderate-to-severe TBI recovery in Australia.</p><p><strong>Results: </strong>Respondents were 58 clinicians (medical, nursing, and allied health) who worked in pediatric emergency, intensive care, acute, or inpatient rehabilitation settings. Findings indicated that formal measures are rarely used to evaluate, monitor, and document agitation in children with moderate-to-severe TBI in the early stages of recovery, despite a wide range of pharmacological and non-pharmacological interventions being used in its management.</p><p><strong>Conclusion: </strong>Future research is critical to ensure that developmentally appropriate measures of agitation are implemented in clinical practice following pediatric moderate-to-severe TBI and to address the lack of evidence for the range of interventions used.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199700","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":"Long-term Risk of Hydrocephalus Following Traumatic Brain Injury and Hemorrhagic Stroke: A Nationwide Cohort Study in South Korea.","authors":"Youngoh Bae, Chaeyoon Kang, Hohyun Jung, Seung Won Lee","doi":"10.1097/HTR.0000000000001114","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001114","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide evidence on the long-term risk and comparative outcomes of hydrocephalus, a serious complication of traumatic brain injury (TBI) and hemorrhagic stroke (HS).</p><p><strong>Setting: </strong>The study analyzed data from the Korean National Health Insurance Service-National Sample Cohort (2002-2013). Data from 2002 to 2005 were used as a washout period, and cases identified from 2005 to 2013 were included in the analysis. New-onset hydrocephalus was defined as at least 2 medical claims with code G91 of the International Classification of Diseases, 10th revision.</p><p><strong>Participants: </strong>A total of 17 331 patients diagnosed with TBI or HS were matched with 86 655 controls using propensity score matching.</p><p><strong>Design: </strong>A retrospective cohort study comparing patients with TBI or HS to matched controls.</p><p><strong>Main measures: </strong>Crude incidence rates (IRs), incidence rate ratios (IRRs), and adjusted hazard ratios were estimated using time-stratified Cox models over a 9-year follow-up period.</p><p><strong>Results: </strong>The incidence of hydrocephalus was significantly higher in the case group (IR, 1.88 per 1000 person-years) than in the control group (IR, 0.10). The overall IRR was 19.64 (95% confidence interval [CI], 13.30-29.00). Stratified analyses showed an IRR of 8.21 (95% CI, 5.32-12.68) for TBI and 35.49 (95% CI, 20.53-61.36) for HS. The adjusted hazard ratios declined over time but remained elevated for up to 6 years post-diagnosis. Risk was high in younger individuals, smokers, and alcohol users.</p><p><strong>Conclusion: </strong>TBI and HS are associated with a substantially increased long-term risk of hydrocephalus, especially in the early years following diagnosis. HS confers a greater risk than TBI. These findings underscore the need for prolonged surveillance in high-risk individuals and appropriate management of hydrocephalus.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191776","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":"Cumulative and Contextual Effects of Low-Level Blast Exposure on Cognitive Function in Military Personnel: Interactions With PTSD and Mild TBI.","authors":"Sarah L Martindale, Jason M Bailie, Shannon R Miles, William C Walker, Ida Babakhanyan, Nicholas D Davenport, Anna T Magnante, Sidney R Hinds, Katherine M Craig, Jared A Rowland","doi":"10.1097/HTR.0000000000001107","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001107","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of low-level blast (LLB) exposure on cognitive functioning in combat-exposed service members and Veterans (SM/Vs), and its interaction with posttraumatic stress disorder (PTSD) and deployment-related mild traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Multi-site Department of Defense and Veterans Affairs research centers participating in the LIMBIC-CENC Prospective Longitudinal Study.</p><p><strong>Participants: </strong>1036 SM/Vs who deployed in support of combat operations and completed comprehensive baseline assessments between 2015 and 2023.</p><p><strong>Design: </strong>Cross-sectional observational study using multivariate linear regression and interaction models to evaluate associations between LLB, PTSD, deployment-related mild TBI, and cognitive outcomes.</p><p><strong>Main measures: </strong>LLB exposure was assessed using the generalized blast exposure value from the Blast Exposure Threshold Survey. Cognitive functioning was evaluated using neuropsychological tests assessing memory, attention, processing speed, executive function, and global performance. PTSD was assessed using the PTSD Checklist for DSM-5.</p><p><strong>Results: </strong>LLB was not independently associated with poorer cognitive performance. However, LLB moderated the relationship between PTSD and memory outcomes, with significantly worse visual memory in those with PTSD and high LLB exposure. Significant interaction effects were also observed between PTSD and deployment-related TBI on verbal memory, working memory, and processing speed. PTSD demonstrated the most consistent independent associations across cognitive domains.</p><p><strong>Conclusions: </strong>Although LLB exposure alone was not associated with cognitive deficits, it interacted with PTSD and TBI to influence cognitive performance. These findings support the need for integrated assessments of blast exposure, PTSD, and TBI history in evaluating cognitive health among SM/Vs.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086359","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: Safety, Feasibility, Acceptability and Preliminary Findings From Veterans' Intervention Blending NeuRomodulation and YogA for Chronic PaiN Treatment: VIBRANT-MTBI and Chronic Pain Pilot.","authors":"Krese Kelly, Alexandra L Aaronson, Kyla Z Donnelly, Rachana Shah, Sarmistha Chaudhuri, Sonia Bobra, Bella Etingen, Amy M Kemp, Sabrina Bedo, Ibuola Kale, Andrea Billups-Caldwell, Kalea Colletta, Sandra Kletzel, Theresa L Bender Pape, Dulal Bhaumik, Pei-Shan Yen, Michelle R Madore, Heide I Klumpp, Rebecca L Hasley, Sadie Walker, Amy A Herrold","doi":"10.1097/HTR.0000000000001111","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001111","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the feasibility, acceptability, safety, and preliminary findings of a blended intermittent theta burst stimulation and LoveYourBrain (LYB) Yoga (iTBS + LYByoga) intervention for improving pain among Veterans with chronic mild traumatic brain injury and chronic musculoskeletal pain (mTBI + CP).</p><p><strong>Setting: </strong>Single VA hospital.</p><p><strong>Participants: </strong>Nineteen Veterans (68.4% men) with mTBI + CP enrolled. Fourteen Veterans met full eligibility criteria and initiated iTBS + LYByoga.</p><p><strong>Design: </strong>Single group, open-label, mixed methods, pilot clinical trial of iTBS + LYByoga. Participants received iTBS to the motor cortex at 80% of the motor threshold immediately followed by group LYB Yoga once a week for 6 weeks.</p><p><strong>Main measures: </strong>To assess feasibility, intervention completion rates were assessed post-treatment. To assess safety, adverse events and 17 safety indicators were collected at each intervention session. To assess acceptability, self-reported satisfaction ratings, and semi-structured qualitative interviews were assessed post-treatment. To assess preliminary outcomes, the Brief Pain Inventory (BPI) was completed pre- and post-treatment: pain severity and pain interference scores were computed.</p><p><strong>Results: </strong>Nineteen Veterans enrolled and 14 initiated the intervention. Our sample had a 71.4% (10/14) completion rate for all 6 sessions. There were no serious adverse events. The most common side effect was headaches experienced by 3 Veterans. The self-report satisfaction ratings indicated that most Veterans (60%) rated the quality of the program \"excellent.\" Qualitative interview data support these feasibility and acceptability findings. Mean self-reported pain severity via the BPI significantly improved (P = .0026) between pre-treatment and post-treatment (Cohen's d effect size = 1.3). Mean self-reported pain interference from the BPI did not change (P = .0609) between pre-treatment and post-treatment (Cohen's d effect size = .7).</p><p><strong>Conclusions: </strong>Lack of serious adverse events suggests that the iTBS + LYByoga intervention is safe among veterans with mTBI + CP. The program's feasibility and acceptability coupled with improvements in self-reported pain outcomes warrants further research in a larger, randomized control trial.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075454","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":"Examination of the Association Between History of Self-Reported Mild Traumatic Brain Injury and Neurocognitive Performance.","authors":"Wenjing Meng, Florin Vaida, Nicola L de Souza, Emily L Dennis, Elisabeth A Wilde, Joanna Jacobus, Xia Yang, Michael Cheng, Emily A Troyer, Everett L Delfel, Tracy Abildskov, John R Hesselink, Erin D Bigler, Jeffrey E Max","doi":"10.1097/HTR.0000000000001109","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001109","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether pediatric mild traumatic brain injury (mTBI) is associated with differences in neurocognitive functioning among children.</p><p><strong>Setting: </strong>Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study.</p><p><strong>Participants: </strong>Children with mTBI were compared to two control groups: children with orthopedic injury (OI) and children with no injury (NI). After excluding those with moderate/severe TBI, 450 children were classified as having mTBI, 1604 with OI, and 9814 with NI.</p><p><strong>Design: </strong>This is a cross-sectional analysis using the baseline data from a longitudinal observational study. Neurocognitive performance was assessed using task-based cognitive tests, including the National Institutes of Health Toolbox Cognition Battery (NIHTBX), Rey Auditory Verbal Learning Test, and the Little Man Task. Multiple imputation was used to address missing data. Linear regression models were used to compare cognitive performance across groups, adjusting for age, sex, race, ethnicity, parental income, parental education, and genetic ancestry.</p><p><strong>Main measures: </strong>The primary outcomes include the principal component scores representing General Ability, Executive Function, and Learning/Memory.</p><p><strong>Results: </strong>Unadjusted analyses showed children with mTBI had significantly higher scores than NI children on all three principal components. However, no significant differences remained after adjusting for confounders. No differences were found between mTBI and OI groups. Sensitivity analyses further adjusting for behavior and white matter microstructure resulted in same findings.</p><p><strong>Conclusion: </strong>After adjusting for demographic and genetic factors, no significant differences were found between children with mTBI and OI/NI. The findings highlight the importance of accounting for demographic, socioeconomic, and genetic confounders, as well as selecting appropriate control groups, when analyzing cognitive differences of children with mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075475","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":"Patterns of Post-Concussive Symptoms Following Mild Traumatic Brain Injury: Longitudinal Data in Children and Adults to Examine Sex Differences Across the Life Span.","authors":"Skye King, Marilien Marzolla, Caroline van Heugten, Lisanne van Stratum-Bosma, Irene Renaud, Melloney Wijenberg, Christine Resch","doi":"10.1097/HTR.0000000000001091","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001091","url":null,"abstract":"<p><strong>Objective: </strong>To examine sex- and age-related differences in patterns of post-concussive symptoms (PCS), across cognitive, somatic, emotional, and behavioral domains, and their recovery within the first 6 months after mild traumatic brain injury (mTBI), and their relation to participation.</p><p><strong>Setting: </strong>Data were collected from patients visiting the emergency departments of 14 hospitals in the Netherlands.</p><p><strong>Participants: </strong>Two hundred 8 to 17-year-old children with mTBI and their caregivers, and 186 adults with mTBI.</p><p><strong>Design: </strong>Data were collected in 2 prospective cohort studies, with assessments at 2 weeks and 6 months post-injury. Data were analyzed using Multivariate Latent Class Growth Analysis to detect latent PCS patterns (classes), multivariate logistic regressions to assess age and sex differences between classes, and Kruskal-Wallis tests to investigate class differences in participation.</p><p><strong>Main measures: </strong>PCS were assessed with the Health and Behavior Inventory (children) and the Rivermead Post-Concussion Symptoms Questionnaire (adults). Participation (being involved in daily life situations) was assessed with the Child and Adolescent Scale of Participation (children) and the Utrecht Scale for Evaluation and Rehabilitation-Participation (adults).</p><p><strong>Results: </strong>Three distinct classes with unique PCS recovery trajectories were found across samples (children/caregiver, adults). In child-reported PCS, sex differences were found, driven by higher levels of somatic and emotional PCS in females. No sex differences were found in caregiver reports or in adult reports. Age differences were found in the caregiver report for the child sample, with higher ages found in the class showing decreasing somatic symptoms over time, and in the adult sample, where younger individuals were more often in the class with recovered PCS. Classes differed in their levels of participation in all samples.</p><p><strong>Discussion: </strong>Findings highlight the heterogeneity of PCS across the lifespan as well as the variation of discrepancies in sex- and age-related findings. Taking age and sex differences into account increases our understanding of recovery patterns after mTBI and allow identification of at-risk individuals and better-tailored interventions.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075437","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":"https://doi.org/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":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-02","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}