Journal of Head Trauma Rehabilitation最新文献

{"title":"Sleep Disturbance and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury and Orthopedic Injury.","authors":"Caroline A Luszawski, Nori M Minich, Erin D Bigler, H Gerry Taylor, Ann Bacevice, Daniel M Cohen, Barbara A Bangert, Nicholas A Zumberge, Lianne M Tomfohr-Madsen, Brian L Brooks, Keith Owen Yeates","doi":"10.1097/HTR.0000000000001005","DOIUrl":"10.1097/HTR.0000000000001005","url":null,"abstract":"<p><strong>Objective: </strong>Sleep disturbance (SD) is common after pediatric mild traumatic brain injury (mTBI) and may predict increased postconcussive symptoms (PCS) and prolonged recovery. Our objective was to investigate the relation of SD with PCS in children with mTBI and those with orthopedic injury (OI).</p><p><strong>Setting: </strong>Emergency departments (EDs) at 2 children's hospitals in the Midwestern United States.</p><p><strong>Participants: </strong>Children and adolescents aged 8 to 16 years old diagnosed with either a mTBI ( n = 143) or OI ( n = 74) and recruited within 24 hours postinjury.</p><p><strong>Design: </strong>Observational, prospective, concurrent cohort study with longitudinal follow-up.</p><p><strong>Main measures: </strong>Parents rated children's preinjury sleep retrospectively shortly after injury, and postinjury sleep at 3 and 6 months postinjury, using the Sleep Disorders Inventory for Students. Parents rated children's preinjury symptoms retrospectively in the emergency department, and parents and children rated PCS at 3 and 6 months, using the Health and Behavior Inventory and the Postconcussive Symptom Interview. Weekly ratings on the Health and Behavior Inventory were also obtained remotely.</p><p><strong>Results: </strong>Postinjury SD was modestly but not significantly higher in the mTBI group compared to the OI group ( P = .060, d = 0.32). Children with mTBI who were symptomatic postacutely based on parent ratings had worse parent-rated sleep outcomes at 3 and 6 months postinjury compared to children who were not symptomatic. Greater preinjury SD also predicted more postinjury SD and more severe PCS regardless of injury type.</p><p><strong>Conclusions: </strong>The results suggest potential bidirectional associations between SD and PCS after mTBI. Studies of treatments for SD following pediatric mTBI are needed.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"157-166"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983770","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":"Barriers to Care After Intimate Partner Violence Acquired Brain Injury: Current Systems Silence Survivors and Providers.","authors":"Loretta Tsu, Maureen Varty, Desiree Reinken, Heather Coats","doi":"10.1097/HTR.0000000000001003","DOIUrl":"10.1097/HTR.0000000000001003","url":null,"abstract":"<p><strong>Objective: </strong>A qualitative meta-synthesis was conducted to answer the following question- What barriers are experienced by survivors of intimate partner violence and service providers when seeking or providing resources or care after experiencing brain injury (BI)?</p><p><strong>Setting: </strong>This approach was completed through 2 main phases-a systematic search and literature appraisal and reciprocal translation with interpretive triangulation of the extracted data. The databases searched were PubMed, CINAHL, and PsycInfo.</p><p><strong>Participants: </strong>The initial search yielded 559 articles. The final synthesis included 16 articles for the qualitative meta-synthesis.</p><p><strong>Design: </strong>After data extraction, a qualitative exploratory design evaluated the experiences of survivors and service providers when connecting with resources.</p><p><strong>Results: </strong>The findings highlight larger systemic barriers preventing smooth relationships between survivors and providers. Survivor barriers include risk-driven safety mechanisms and a lack of awareness and understanding of BI. Provider barriers are a lack of clarity within providers' scope and training limitations, diagnosis complexity, first responder's initial response to survivors, lack of open discussion, screening limitations, financial barriers, infrastructure barriers, and lack of resources. Systemic barriers include stigmatization, BI symptoms mistaken as other diagnoses like mental health, access and awareness of resources, and navigation of complex systems.</p><p><strong>Conclusion: </strong>This qualitative meta-synthesis demonstrates that survivors and providers face multiple individual and systemic barriers when seeking and providing resources after BI. Future research is needed to understand survivors' help-seeking behaviors and assistance needs and providers' education about BI and organizational relationships and networks. Recommendations are made for future research to understand how to reduce barriers for providers working with survivors, from trauma-informed education and communication to connecting with resources, where to concentrate, and initiatives for collaboration to increase the network of resources yet improve its accessibility.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"179-192"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289169","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":"Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain Injury Model Systems Study.","authors":"Natalie Gilmore, Thomas F Bergquist, Jennifer Bogner, John D Corrigan, Kristen Dams-O'Connor, Laura E Dreer, Brian C Healy, Shannon B Juengst, Raj G Kumar, Therese M O'Neil-Pirozzi, Amy K Wagner, Joseph T Giacino, Brian L Edlow, Yelena G Bodien","doi":"10.1097/HTR.0000000000000997","DOIUrl":"10.1097/HTR.0000000000000997","url":null,"abstract":"<p><strong>Objective: </strong>To determine, in persons with traumatic brain injury (TBI), the association between cognitive change after inpatient rehabilitation discharge and 1-year participation and life satisfaction outcomes.</p><p><strong>Design: </strong>Secondary analysis of prospectively collected TBI Model Systems (TBIMS) data.</p><p><strong>Setting: </strong>Inpatient rehabilitation and community.</p><p><strong>Participants: </strong>499 individuals with TBI requiring inpatient rehabilitation who completed the Brief Test of Adult Cognition by Telephone (BTACT) at inpatient rehabilitation discharge (ie, baseline) and 1-year postinjury.</p><p><strong>Main outcome measures: </strong>Participation Assessment with Recombined Tools-Objective (PART-O) and Satisfaction with Life Scale (SWLS).</p><p><strong>Results: </strong>Of 2,840 TBIMS participants with baseline BTACT, 499 met inclusion criteria (mean [standard deviation] age = 45 [19] years; 72% male). Change in BTACT executive function (EF) was not associated with 1-year participation (PART-O; β = 0.087, 95% CI [-0.004, 0.178], P = .061) when it was the sole model predictor. Change in BTACT episodic memory (EM) was associated with 1-year participation (β = 0.096, [0.007, 0.184], P = .035), but not after adjusting for demographic, clinical, and functional status covariates (β = 0.067, 95% CI [-0.010, 0.145], P = .089). Change in BTACT EF was not associated with life satisfaction total scores (SWLS) when it was the sole model predictor (β = 0.091, 95% CI [-0.001, 0.182], P = .0503). Change in BTACT EM was associated with 1-year life satisfaction before (β = 0.114, 95% CI [0.025, 0.202], P = .012) and after adjusting for covariates (β = 0.103, [0.014, 0.191], P = .023). In secondary analyses, change in BTACT EF was associated with PART-O Social Relations and Out and About subdomains before (Social Relations: β = 0.127, 95% CI [0.036, 0.217], P = .006; Out and About: β = 0.141, 95% CI [0.051, 0.232], P = .002) and after (Social Relations: β = 0.168, 95% CI [0.072, 0.265], P < .002; Out and About: β = 0.156, 95% CI [0.061, 0.252], P < .002) adjusting for functional status and further adjusting for covariates (Social Relations: β = 0.127, 95% CI [0.040, 0.214], P = .004; Out and About: β = 0.136, 95% CI [0.043, 0.229], P = .004). However, only the models adjusting for functional status remained significant after multiple comparison correction (ie, Bonferroni-adjusted alpha level = 0.002).</p><p><strong>Conclusion: </strong>EF gains during the first year after TBI were related to 1-year social and community participation. Gains in EM were associated with 1-year life satisfaction. These results highlight the potential benefit of cognitive rehabilitation after inpatient rehabilitation discharge and the need for interventions targeting specific cognitive functions that may contribute to participation and life satisfaction after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E226-E239"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Environment and Neurobehavioral Outcomes 1 Year After Severe Pediatric TBI in the Intensive Care Unit.","authors":"Aimee E Miley, Jamie Patronick, Nanhua Zhang, Rachel L Bode, Anthony Fabio, Amery Treble-Barna, Ranjit S Chima, Anna-Lynne R Adlam, Michael J Bell, Stephen R Wisniewski, Sue R Beers, Shari L Wade, Brad G Kurowski","doi":"10.1097/HTR.0000000000000943","DOIUrl":"10.1097/HTR.0000000000000943","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association of home and neighborhood environment with neurobehavioral outcomes after severe pediatric traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Domestic and international children's medical centers.</p><p><strong>Participants: </strong>Participants enrolled in the study were 18 years or younger at the time of their severe TBI (Glasgow Coma Scale [GCS] ≤ 8), admitted to the intensive care unit, and underwent placement of an intracranial pressure (ICP) monitor. Exclusionary criteria included less severe injury (GCS > 8), pregnancy, and/or ICP monitor placement occurred at a non-participating hospital.</p><p><strong>Design: </strong>A multicenter, observational cohort study.</p><p><strong>Main measures: </strong>Outcomes assessed at 12 months post-injury included measures of global functioning, intellectual ability, caregiver-report measures of family functioning, executive functioning behaviors, behavior problems, and health-related quality of life. We examined mortality risk (assessed acutely after injury), family functioning (assessed at 12 months post-injury) and parenting practices, social environment, and neighborhood stressors (all assessed > 12 months post-injury), as correlates and moderators of the 12-month post-injury outcomes.</p><p><strong>Results: </strong>Home and neighborhood factors were associated with neurobehavioral outcomes (ie, intellectual ability, executive functioning, behavioral adjustment, and health-related quality of life) but not with global functioning outcomes. A negative association between a more vulnerable home and neighborhood environment and neurobehavioral outcomes was more consistent in older children compared with younger children, based on age of injury. The influence of mortality risk on neurobehavioral outcomes was variable.</p><p><strong>Conclusion: </strong>Parenting practices and quality of social and neighborhood environment are associated with neurobehavioral outcomes 12 months after severe pediatric TBI. More research is needed to better understand the relationship between home/neighborhood stressors and TBI recovery to develop and implement strategies for patients and families to optimize outcomes. Future intervention development should focus on addressing parenting practices and social environment in a developmentally sensitive way for children who have sustained a severe TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"147-156"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988027","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":"Predictors of Psychiatric Hospitalization After Discharge From Inpatient Neurorehabilitation for Traumatic Brain Injury.","authors":"Marc A Silva, Michelle E Fox, Farina Klocksieben, Jeanne M Hoffman, Risa Nakase-Richardson","doi":"10.1097/HTR.0000000000000995","DOIUrl":"10.1097/HTR.0000000000000995","url":null,"abstract":"<p><strong>Objective: </strong>To examine, among persons discharged from inpatient rehabilitation for traumatic brain injury (TBI), the degree to which pre-TBI factors were associated with post-TBI hospitalization for psychiatric reasons. The authors hypothesized that pre-TBI psychiatric hospitalization and other pre-TBI mental health treatment would predict post-TBI psychiatric hospitalization following rehabilitation discharge, up to 5 years post-TBI.</p><p><strong>Setting: </strong>Five Veterans Affairs Polytrauma Rehabilitation Centers.</p><p><strong>Participants: </strong>Participants with nonmissing rehospitalization status and reason, who were followed at 1 year ( N  = 1006), 2 years ( N = 985), and 5 years ( N = 772) post-TBI.</p><p><strong>Design: </strong>A secondary analysis of the Veterans Affairs TBI Model Systems, a multicenter, longitudinal study of veterans and active-duty service members with a history of mild, moderate, or severe TBI previously admitted to comprehensive inpatient medical rehabilitation. This study examined participants cross-sectionally at 3 follow-up timepoints.</p><p><strong>Main measures: </strong>Psychiatric Rehospitalization was classified according to Healthcare Cost and Utilization Project multilevel Clinical Classifications diagnosis terminology (Category 5).</p><p><strong>Results: </strong>Rates of post-TBI psychiatric hospitalization at years 1, 2, and 5 were 4.3%, 4.7%, and 4.1%, respectively. While bivariate comparisons identified pre-TBI psychiatric hospitalization and pre-TBI mental health treatment as factors associated with psychiatric rehospitalization after TBI across all postinjury timepoints, these factors were statistically nonsignificant when examined in a multivariate model across all timepoints. In the multivariable analysis, pre-TBI psychiatric hospitalization was significantly associated with increased odds of post-TBI psychiatric hospitalization only at 1-year post-TBI (adjusted odds ratio = 2.65; 95% confidence interval, 1.07-6.55, P = .04). Posttraumatic amnesia duration was unrelated to psychiatric rehospitalization.</p><p><strong>Conclusions: </strong>Study findings suggest the limited utility of age, education, and pre-TBI substance use and mental health utilization in predicting post-TBI psychiatric hospitalization. Temporally closer social and behavior factors, particularly those that are potentially modifiable, should be considered in future research.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"167-178"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348139","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":"2024 NABIS Conference on Brain Injury Abstracts.","authors":"","doi":"10.1097/HTR.0000000000001029","DOIUrl":"10.1097/HTR.0000000000001029","url":null,"abstract":"","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"220"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032932","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":"Neuroinflammatory Biomarkers and Their Associations With Cognitive, Affective, and Functional Outcomes 3 to 12 Months After a Traumatic Brain Injury: A Pilot Study.","authors":"Kathryn S G Collazos, Gemayaret Alvarez, Arsham Alamian, Victoria Behar-Zusman, Charles A Downs","doi":"10.1097/HTR.0000000000000999","DOIUrl":"10.1097/HTR.0000000000000999","url":null,"abstract":"<p><strong>Background: </strong>Neuroinflammation is an important feature of traumatic brain injury (TBI) that remains poorly understood in the 3- to 12-month period post-TBI.</p><p><strong>Objective: </strong>The purpose of our pilot study was to examine the relationships between biomarkers of neuroinflammation and functional outcomes in TBI patients 3 to 12 months postinjury.</p><p><strong>Methods: </strong>TBI patients ( n =  36) 3 to 12 months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. The Disability Rating Scale, Satisfaction with Life Scale, NIH Toolbox Sorting Working Memory, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep assessments were performed. Multiple plasma biomarkers were assayed. Analysis of variance was used to compare between-group results. Linear regression was performed to analyze relationships between biomarkers and outcomes.</p><p><strong>Results: </strong>Brain-derived neurotrophic factor concentrations were higher as postinjury time interval increased and were associated with cognitive battery outcomes. S-100β and glial fibrillary acidic protein were associated with anxiety score and hospital length of stay; S-100β was also associated with depression. Interleukin 6 was associated with cognitive function score and time since injury.</p><p><strong>Conclusions: </strong>We found S-100β, glial fibrillary acidic protein, Interleukin 6, and brain-derived neurotrophic factor to play a larger role in the TBI recovery period than other biomarkers examined. Clinicians should continue to monitor for symptoms post-TBI, as the neuroinflammatory process continues to persist even into the later rehabilitation stage.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"137-146"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Resting-State Functional Connectivity and Cognitive-Affective Symptoms in Patients With Post-Concussion Syndrome Treated With N-Acetyl Cysteine.","authors":"Daniel A Monti, Vedaei Faezeh, George Zabrecky, Mahdi Alizadeh, Nancy Wintering, Anthony J Bazzan, Feroze B Mohamed, Andrew B Newberg","doi":"10.1097/HTR.0000000000000976","DOIUrl":"10.1097/HTR.0000000000000976","url":null,"abstract":"<p><strong>Objective: </strong>Concussion accounts for more than 80% of people experiencing traumatic brain injury. Acute concussion is associated with characteristic cognitive and functional deficits that may persist for weeks to months. A subgroup of these patients (from 10% to 50%) have persistent symptoms referred to as chronic post-concussion syndrome (PCS). There are limited treatment options for these patients and the pathophysiology is poorly understood, though oxidative stress is thought to be a contributing factor. The purpose of this study was to evaluate whether an antioxidant, N -acetylcysteine (NAC), might be beneficial in patients with PCS.</p><p><strong>Setting: </strong>Outpatient medicine center.</p><p><strong>Participants: </strong>Fifty patients with chronic PCS for at least 3 months post injury.</p><p><strong>Design: </strong>The patients with PCS were enrolled in this randomized unblinded clinical trial to receive the antioxidant NAC as a combination of daily oral and weekly intravenous infusions, or assigned to a waitlist control group where they would continue to receive standard of care.</p><p><strong>Main measures: </strong>Resting-state functional connectivity (FC) magnetic resonance imaging (rsFC-MRI) was performed pre and post either NAC or the waitlist period along with cognitive, emotional, and sensory symptom assessments.</p><p><strong>Results: </strong>The results demonstrated significant ( P < .05) improvements in symptoms as determined by the Rivermead Post-Concussion Symptoms Questionnaire, Spielberger State-Trait Anxiety Inventory, and Profile of Mood Scale in the PCS group receiving NAC as compared to patients receiving ongoing standard care. Importantly, there were significant ( P < .01) changes in FC in the NAC group, particularly in networks such as the default mode network, salience network, and executive control network. These changes in FC also correlated with improvements in symptoms.</p><p><strong>Conclusions: </strong>In patients with chronic PCS, NAC treatment was associated with significant changes in resting state FC and improvement in a variety of symptoms, particularly cognitive and affective symptoms.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E196-E207"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Visual Disturbances After Mild Traumatic Brain Injury-A One-Year Follow-up Study.","authors":"Möller Mona-Lisa, Mäki Kaisa, Nybo Taina, Huovinen Antti, Marinkovic Ivan, Melkas Susanna, Johansson Jan","doi":"10.1097/HTR.0000000000001010","DOIUrl":"10.1097/HTR.0000000000001010","url":null,"abstract":"<p><strong>Objective: </strong>To examine the persistence of visual symptoms in mild traumatic brain injury (MTBI) during the first months after injury. It is important to recognize visual disturbances because they can delay return to normal activities, while they might be simultaneously treated by visual therapy. Here we describe the results from a 1-year follow-up study of visual disturbances after MTBI.</p><p><strong>Participants and measures: </strong>The study group comprised 26 patients from the Brain Injury Clinic of the Helsinki University Hospital. Inclusion criterion was a high score (≥21p) on the Convergence Insufficiency Symptom Survey (CISS) at an appointment with a neurologist within 6 months after injury. The patients underwent baseline vision evaluation at 4 months on average and follow-up at 14 months after injury. The evaluation included tests for visual acuity, near point of convergence, convergence facility, near point of accommodation, accommodative facility, motility, heterophoria, binocular vision, dynamic visual acuity, and fusional vergence width at near and far distances. Further assessments included the Rivermead Post Concussion Questionnaire for posttraumatic symptoms, a visual analog scale for visual fatigue, and the Developmental Eye Movement Test for saccadic eye movements.</p><p><strong>Results: </strong>Both CISS and Rivermead Post Concussion Questionnaire scores improved significantly from baseline to follow-up. The overall level of visual fatigue according to visual analog scale score was lower at follow-up, but the increase in visual fatigue (comparing fatigue before and after assessment session) was significant both at baseline and follow-up. In visual function assessments, spontaneous recovery from baseline to follow-up could be seen in vergence facility and pursuit eye movement but not in near point of convergence, near fusion, distance fusion, heterophoria, and dynamic visual acuity.</p><p><strong>Conclusion: </strong>The results point out the importance of evaluation of visual disturbances after MTBI. Early detection of these disturbances may provide an opportunity to provide visual therapy.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E208-E215"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insomnia and Chronic Pain Mediate the Relationship Between Traumatic Brain Injury and Reduced Positive Airway Pressure Adherence Among Veterans.","authors":"Adam R Kinney, Alexandra L Schneider, Carolyn Welsh, Kathleen F Sarmiento, Christi S Ulmer, Jeri E Forster, Zachary Abbott, Nazanin H Bahraini","doi":"10.1097/HTR.0000000000001019","DOIUrl":"10.1097/HTR.0000000000001019","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether co-morbid insomnia, post-traumatic stress disorder (PTSD), depression, and chronic pain mediate the relationship between traumatic brain injury (TBI) and positive airway pressure (PAP) treatment adherence.</p><p><strong>Setting: </strong>One Veterans Health Administration (VHA) sleep medicine site.</p><p><strong>Participants: </strong>Veterans ( n = 8836) who were prescribed a modem-enabled PAP device.</p><p><strong>Design: </strong>Secondary analysis of clinical data. We used path analysis to examine: (1) whether Veterans with a history of TBI were more likely to experience insomnia, PTSD, depression, and chronic pain; (2) in turn, whether Veterans with these co-morbid conditions exhibited lesser PAP adherence; and (3) whether Veterans with a history of TBI will exhibit lesser PAP adherence, even while accounting for such co-morbid conditions. Model estimates were adjusted for sociodemographic (eg, race/ethnicity) and clinical characteristics (eg, mask leakage).</p><p><strong>Main measures: </strong>Health conditions were abstracted from the VHA medical record. PAP adherence was measured using average nightly use (hours).</p><p><strong>Results: </strong>Among 8836 Veterans, 12% had a history of TBI. TBI history was not associated with PAP adherence when accounting for the presence of insomnia, PTSD, depression, and chronic pain. Indirect effect estimates indicated that a history of mild, moderate-severe, or unclassified TBI was associated with lesser PAP adherence, as mediated by the presence of co-morbid insomnia and chronic pain. Generally, TBI was associated with an increased likelihood of co-morbid insomnia, PTSD, depression, and chronic pain. In turn, insomnia and chronic pain, but not PTSD or depression, were associated with lesser PAP adherence.</p><p><strong>Conclusions: </strong>Our study offers empirical support for insomnia and chronic pain as potential explanatory mechanisms underlying the relationship between TBI history and suboptimal PAP adherence. While additional research is needed to confirm causality, findings offer preliminary evidence that can inform the development of tailored PAP adherence interventions for Veterans with TBI and obstructive sleep apnea.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E251-E262"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}