Journal of Head Trauma Rehabilitation最新文献

{"title":"Implementation of a Professional Version of the Multiple Errands Test in Vocational Rehabilitation: Can It Complement Traditional Cognitive Assessment After Traumatic Brain Injury and Predict Return to Work?","authors":"Gérard Wicki, Christelle Aubert, Charles Benaim, Andréas Mühl, Michel Fédou, Philippe Vuadens, Anne Bellmann","doi":"10.1097/HTR.0000000000001222","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001222","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the sensitivity and ecological contribution of the Multiple Errands Test in a Professional Setting, a vocationally oriented executive function assessment, after traumatic brain injury (TBI), and explore its association with return to work (RTW).</p><p><strong>Setting: </strong>A Swiss neurorehabilitation center with an integrated vocational rehabilitation workshop.</p><p><strong>Participants: </strong>Fifty adults with TBI undergoing return-to-work rehabilitation and 40 control participants without brain lesions.</p><p><strong>Design: </strong>Single-center prospective psychometric study with retrospective use of previously collected data.</p><p><strong>Main measures: </strong>Multiple Errands Test in a Professional Setting error scores, conventional executive and attentional tests, a clinic-adapted Multiple Errands Test, and RTW at 12 months.</p><p><strong>Results: </strong>Participants with TBI made significantly more rule-breaking, inefficiency, partial-realization, interpretation, and judgment errors than controls. Overall, 82% of participants with TBI failed at least one Multiple Errands Test in a Professional Setting measure, including more than 70% who succeeded on conventional executive or attentional assessments. Concordance with traditional assessment was statistically significant for total and attentional assessment but low. Multiple Errands Test in a Professional Setting performance had limited predictive value for RTW, whereas attentional impairment showed a stronger association with work status.</p><p><strong>Conclusion: </strong>Multiple Errands Test in a Professional Setting detects work-relevant executive difficulties often missed by standard tests and may support individualized vocational rehabilitation planning after TBI when interpreted within a broader clinical functional assessment framework.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137048","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":"Dimensions of Military Neurotrauma: Factor Structure and Clinical Correlates of the Boston Assessment of Traumatic Brain Injury-Lifetime.","authors":"Audri Villalon, Ruosha Li, Alyssa Currao, Adam Lebas, Jennifer Fonda, Catherine B Fortier, William P Milberg, Ricardo E Jorge","doi":"10.1097/HTR.0000000000001212","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001212","url":null,"abstract":"<p><strong>Objective: </strong>To examine the dimensional structure of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) and evaluate whether derived injury dimensions are associated with neurobehavioral symptoms and functional disability in post-9/11 US military veterans and service members.</p><p><strong>Setting: </strong>VA Medical Centers in Boston, MA and Houston, TX, within the Translational Research Center for traumatic brain injury (TBI) and Stress Disorders study.</p><p><strong>Participants: </strong>A total of 752 post-9/11 veterans and service members with deployment history were included: 570 in the Boston exploratory sample and 182 in the Houston confirmatory sample.</p><p><strong>Design: </strong>This observational, cross-sectional analysis of baseline cohort data used exploratory factor analysis in the Boston sample followed by confirmatory factor analysis in the independent Houston sample. Confirmatory factor analysis-derived factor scores from the combined sample were examined in relation to clinical outcomes.</p><p><strong>Main measures: </strong>Boston Assessment of Traumatic Brain Injury-Lifetime (lifetime history of TBI and blast exposures); Neurobehavioral Symptom Inventory; World Health Organization Disability Assessment Schedule II. Adjusted models controlled for post-traumatic stress disorder and depressive symptom severity.</p><p><strong>Results: </strong>Exploratory factor analysis identified 4 clinically interpretable factors: Blast Exposure (Blast-Exp), Military Blast TBI (MBlast-TBI), Military Blunt TBI (MBlunt-TBI), and Civilian TBI (Civilian-TBI). The confirmatory factor analysis supported this structure in the Houston sample. After adjustment, MBlast-TBI showed the broadest associations with Neurobehavioral Symptom Inventory symptom burden and functional disability. MBlunt-TBI was associated with somatic symptoms and functional disability, whereas Civilian-TBI was associated only with affective symptoms. Blast-Exp was not significantly associated with either outcome.</p><p><strong>Conclusion: </strong>The BAT-L demonstrates a replicable and clinically meaningful factor structure that distinguishes blast exposure frequency from blast-related TBI severity and separates military and civilian injury contexts. These findings support the BAT-L's utility for dimensional characterization of lifetime neurotrauma and for future studies examining clinical and biological correlates of distinct TBI profiles.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039001","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":"Lobar Brain Volume Associations With Brain-Age Gap in Canadian Special Operations Forces Breachers.","authors":"Juan Fernandez-Ruiz, Nicole S Coverdale, Christopher Skinner, Betty Anne Schwarz, Rafael Glikstein, Gerd Melkus, Douglas J Cook","doi":"10.1097/HTR.0000000000001211","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001211","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether military breachers show significant positive raw brain-age gap and to identify which intracranial-volume (ICV)-normalized lobar volumes best predict bias-corrected brain-age gap (BAGc).</p><p><strong>Setting and participants: </strong>Eighty-five male (mean age 30.1 ± 4.5 years) Canadian Special Operations Forces (CANSOF) active breachers.</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Main measures: </strong>T1-weighted MRI was processed using the Brain Structure Ages (BSA) pipeline to derive global brain age and lobar volumes. Raw brain-age gap was calculated as estimated age minus chronological age. BAGc was obtained by residualizing raw BAG on chronological age and sex. Linear models tested associations between BAGc and ICV-normalized lobar volumes, adjusting for age. Multiple comparisons were controlled using Benjamini-Hochberg false discovery rate (FDR). Outlier robustness was assessed with Tukey IQR trimming.</p><p><strong>Results: </strong>Participants showed a significant positive raw brain-age gap (mean 8.81 ± 3.98 years; P < .001). After age-bias correction, smaller temporal (β = -0.41, q = 0.002) and frontal (β = -0.43, q = 0.006) lobe volumes were significantly associated with higher BAGc. Associations involving the limbic, parietal, and occipital lobes were not statistically significant after correction for multiple comparison. Findings were stable across outlier-trimming strategies.</p><p><strong>Conclusions: </strong>A positive raw brain-age gap was observed within this cohort of military breachers, with age-independent variation in brain-age deviation showing regionally patterned associations. After age-bias correction, higher BAGc was most strongly associated with relatively smaller frontal and temporal lobe volumes. These findings provide a foundation for future studies incorporating detailed exposure characterization, clinical measures, appropriate comparison groups, longitudinal follow-up, and multimodal imaging.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963164","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":"Implementation of the Agitated Behavior Scale for Hospitalized Children With Acquired Brain Injuries: A Quality Improvement Initiative.","authors":"Cara E Arpey, Jordan M Wyrwa, Brianna A Brolsma, Kilby S Mann","doi":"10.1097/HTR.0000000000001210","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001210","url":null,"abstract":"<p><strong>Introduction: </strong>Agitation occurs in up to 71% of hospitalized patients with acquired brain injuries (ABIs). Despite its prevalence, agitation in pediatric ABI is often assessed subjectively, and standardized assessment tools are inconsistently used in pediatric settings. This quality improvement initiative was designed to address this gap by implementing a standardized agitation assessment and evaluating its feasibility and impact on documentation and nursing knowledge.</p><p><strong>Objective: </strong>Use a standardized assessment tool with formal education to improve agitation documentation, nursing knowledge, and nursing confidence of pediatric, brain-injury related agitation.</p><p><strong>Design: </strong>Quality improvement initiative using a before-after design.</p><p><strong>Setting: </strong>Academic, tertiary pediatric hospital.</p><p><strong>Participants/patients: </strong>Children aged 5-18 years hospitalized with ABI and agitation who had an Agitated Behavior Scale (ABS) ordered; Nurses of these patients.</p><p><strong>Interventions: </strong>The quality improvement team developed nurse-focused education on pediatric ABI-related agitation and the ABS, administered pre- and post-tests assessing knowledge and confidence, and implemented an electronic medical record (EMR) order and flowsheet for ABS documentation. Nurses charted the ABS at least once per 12-hour shift for patients with an ABS ordered.</p><p><strong>Main outcome measures: </strong>Adherence to documenting the ABS once per shift, nursing knowledge of agitation and the ABS, and nursing confidence with agitation and the ABS.</p><p><strong>Results: </strong>ABS documentation adherence improved from 0% to 97% (205/211 shifts) over 9 months after implementation. For 8 nurses who completed pre- and post-tests, knowledge scores and confidence with ABS improved after education (P = 0.008; P = 0.016). Confidence with agitation did not improve (P = 0.063).</p><p><strong>Conclusions: </strong>Implementation of targeted nursing education combined with an electronic ABS order and flowsheet was associated with substantial improvements in adherence to objective documentation of agitation in hospitalized children with ABI. Standardized assessment of agitation in pediatric ABI may support more consistent clinical care and provides a foundation for future, multisite research.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912229","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":"Treatment of Sleep Disorders Following Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis.","authors":"Yancheng Wang, Jiaqing Yan, Liyao Su, Beibei Wang","doi":"10.1097/HTR.0000000000001155","DOIUrl":"10.1097/HTR.0000000000001155","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) often leads to sleep disorders (SDs), which significantly impact quality of life. This study aimed to compare the efficacy of various interventions for TBI-related sleep disorders (TBI-SD) through a systematic review and network meta-analysis.</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, and Cochrane were comprehensively searched for randomized controlled trials (RCTs) on pharmacological and nonpharmacological treatments up to November 15, 2025. Primary outcomes were the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) scores.</p><p><strong>Results: </strong>A total of 22 RCTs were included, involving 1299 patients. The results showed that nonpharmacological treatments, such as cognitive behavioral therapy (CBT), acupuncture, transcranial direct current stimulation (tDCS), branched-chain amino acids (BCAA), and hyperbaric oxygen therapy (HBOT), all significantly improved sleep outcomes compared with control treatments. Specifically, CBT (4 trials), acupuncture (2 trials), tDCS (1 trial), and BCAA (1 trial) were particularly effective in improving the ISI score, whereas CBT (4 trials), acupuncture (2 trials), tDCS (1 trial), HBOT (1 trial), and problem-solving therapy (PST 1 trial) showed significant effects in improving PSQI score. Furthermore, CBT (4 trials) was found to improve the ESS score. Pharmacotherapy did not demonstrate superior efficacy.</p><p><strong>Conclusion: </strong>These findings suggest that nonpharmacological interventions might be effective for managing TBI-SD, although further high-quality research is needed to confirm these results.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"e486-e499"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481116","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":"Ecological Momentary Intervention for Memory in Chronic Traumatic Brain Injury: Findings From a Mixed-Methods Pilot and Feasibility Study.","authors":"Emily L Morrow, Lyndsay A Nelson, Melissa C Duff, Lindsay S Mayberry","doi":"10.1097/HTR.0000000000001147","DOIUrl":"10.1097/HTR.0000000000001147","url":null,"abstract":"<p><strong>Objective: </strong>To examine acceptability and feasibility of a technology-delivered memory assessment and intervention tool (MEMI, memory ecological momentary intervention) and its intended delivery schedule for adults with chronic traumatic brain injury (TBI). MEMI introduces new information, cues retrieval, and assesses learning via text messages.</p><p><strong>Setting: </strong>Community sample from Vanderbilt Brain Injury Patient Registry in Nashville, TN, USA.</p><p><strong>Participants: </strong>20 adults with chronic, moderate-severe TBI and 20 non-injured comparison (NC) participants matched on age, sex, and education.</p><p><strong>Design: </strong>In this crossover study, participants used MEMI for two weeks: one in which they completed all learning in a single session to approximate standard memory rehabilitation (Blocked schedule) and one in which retrievals were spaced in short, twice-daily sessions (Spaced, intended delivery schedule).</p><p><strong>Main measures: </strong>The primary pilot outcomes were feasibility (session engagement) and acceptability (Acceptability of Intervention Measure). In a preliminary analysis, we also assessed delayed free recall of trained information. We also report supplementary data on participant surveys and cued recall.</p><p><strong>Results: </strong>Participants in both groups were highly engaged and rated the tool as acceptable. On average, the TBI group rated acceptability of the Spaced schedule higher than the Blocked schedule. Both groups remembered more words at the end of the week in the Spaced schedule (TBI: t (17) = 4.37, p <.001, 95% CI [2.79, 7.99]; NC: t (19) = 8.57, p <.001, 95% CI[5.13, 8.46]).</p><p><strong>Conclusions: </strong>In this pilot study, spaced retrieval via MEMI was feasible and acceptable for adults with chronic TBI. MEMI has potential as a memory assessment and intervention tool in both therapeutic and research contexts. Future work should include a larger trial to assess MEMI's efficacy, clinical utility, individual differences, and personalizing content.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"381-390"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529896","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":"Self-Perceived Health Status Among Patients With and Without TBI: An All of Us Analysis.","authors":"Richard Cook, Kathleen R Ran, Vikas N Vattipally, Gorbachev Jowah, Naren Gundapaneni, Rajiv Dharnipragada, Jose Suarez, John Williams, Tej Azad","doi":"10.1097/HTR.0000000000001158","DOIUrl":"10.1097/HTR.0000000000001158","url":null,"abstract":"<p><strong>Background: </strong>Self-perceived health status, defined as one's overall perception of their health, is associated with adherence to medical care, morbidity, and mortality. However, little is known about the dynamics of self-perceived health status following traumatic brain injury (TBI).</p><p><strong>Methods: </strong>Using the NIH All of Us Research Program, participants with TBI (N = 5,055) were matched with respondents without TBI (N = 14,983) through propensity score matching. Multivariable ordinal logistic regression modeled the relationship between TBI and survey questions pertinent to self-perceived health status. Race/ethnicity and income were assessed for effect modification of the association between TBI and the self-perceived health. Among the subgroup of respondents with TBI, univariate chi-squared analysis assessed the association of race/ethnicity and income with survey questions related to self-perceived health status.</p><p><strong>Results: </strong>Traumatic brain injury was significantly associated with worse self-reported fatigue (OR 1.40, 95% CI: 1.32-1.48, P < .001), pain (OR 1.59, 95% CI: 1.50-1.69, P < .001), emotional problems (OR 1.27, 95% CI: 1.19-1.34, P < .001), and ability to complete everyday activities (OR 0.70, 95% CI: 0.66-0.75, P < .001). Also, TBI was associated with worse self-reported general health (OR 0.77, 95% CI: 0.72-0.81, P < .001), mental health (OR 0.70, 95% CI: 0.66-0.74, P < .001), physical health (OR 0.78, 95% CI: 0.73-0.82, P < .001), and general quality of life (OR 0.80, 95% CI: 0.76-0.85, P < .001). Among those with TBI, respondents of more vulnerable socioeconomic status also reported worse overall health, mental health, physical health, and general quality of life. Association of TBI with self-perceived health varied by race/ethnicity, with significantly stronger effects among non-Hispanic Black respondents.</p><p><strong>Conclusion: </strong>Participants with TBI reported significantly poorer self-perceived health status, even after adjustment for potentially confounding variables. Self-perceived health status is associated with clinically meaningful outcomes, so this finding, particularly among vulnerable socioeconomic groups, is concerning and warrants further investigation into ways to improve patient quality of life.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"e524-e533"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473777","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 Association Between Traumatic Brain Injury and Cardiovascular Disease: A Systematic Review and Meta-Analysis.","authors":"Sarah Zeyad Mahasin, Bhaskar Thakur, Patricia Champagne, Parag H Joshi, Kathleen R Bell, Simon Driver, Jill D Whitfill, Rebecca Vigen, Shanti M Pinto","doi":"10.1097/HTR.0000000000001150","DOIUrl":"10.1097/HTR.0000000000001150","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) is recognized as a chronic health condition. The primary objective was to investigate the association between TBI and cardiovascular disease (CVD).</p><p><strong>Setting: </strong>Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print and In-Process, In-Data-Review and Other Non-Indexed Citations, Ovid Embase, Ovid APA PsycInfo, and the Cochrane Library were systematically searched until June 5, 2025.</p><p><strong>Design: </strong>Observational studies that compared diagnoses of CVD, including atherosclerosis, coronary artery disease (CAD), heart failure, cardiomyopathy, arrhythmias, myocardial infarction, hypertension, hyperlipidemia, and cardiac death, between adults with and without TBI were included. Studies that focused on preinjury CVD and conditions, case reports, case series, letters, editorials, conference abstracts, reviews, and interventional studies were excluded. Study quality was evaluated using the National Institutes of Health quality assessment tool. DerSimonian-Laird random-effects meta-analyses were performed.</p><p><strong>Main measures: </strong>The outcomes of interest were presence of any CVD, including atherosclerosis, CAD, heart failure, cardiomyopathy, arrhythmias, myocardial infarction, hypertension, hyperlipidemia, and cardiac death.</p><p><strong>Results: </strong>This systematic review included 21 studies, with 18 studies involving 3,954,962 participants included in the meta-analysis. Two studies were rated as poor quality, with the rest fair to good. Individuals with TBI had higher odds of any CVD (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.39-2.29), CAD (OR 1.40, 95% CI 1.20-1.63), arrhythmia (OR 1.42, 95% CI 1.12-1.80), cardiac death (risk ratio [RR] 3.07, 95% CI 2.17-3.98), hypertension (OR 1.42, 95% CI 1.07-1.90), and hyperlipidemia (OR 1.86, 95% CI 1.25-2.77) in unadjusted analysis. No association was found with heart failure (OR 1.16, 95% CI 0.96-1.39). The adjusted analysis was consistent with unadjusted findings for CAD, cardiac death, hypertension, and heart failure.</p><p><strong>Conclusion: </strong>Individuals with TBI have higher odds of CVD, hypertension, hyperlipidemia, CAD, arrhythmia, and cardiovascular death than the general population, highlighting the need for clinical screening, prevention, and management strategies after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"e543-e553"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481130","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":"Accelerated Epigenetic Aging in Veterans Exposed to Blast.","authors":"Sarah L Martindale, Kyle J Bourassa, Nathan A Kimbrel, Jean C Beckham, Melanie E Garrett, Allison E Ashley-Koch, Jared A Rowland","doi":"10.1097/HTR.0000000000001159","DOIUrl":"10.1097/HTR.0000000000001159","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether lifetime blast exposure severity is independently associated with accelerated biological aging among post-9/11 Veterans.</p><p><strong>Setting: </strong>Veterans Affairs medical centers in the southeastern United States.</p><p><strong>Participants: </strong>In total, 114 post-9/11 combat Veterans (43.0 ± 9.6 years; 88.6% male) who completed detailed clinical interviews and provided whole-blood DNA samples were included.</p><p><strong>Design: </strong>Cross-sectional analysis of participants enrolled in 2 coordinated VA research protocols: the Chronic Effects of Neurotrauma Consortium Study 34 and the Post-Deployment Mental Health Study.</p><p><strong>Main measures: </strong>Lifetime blast exposure severity (Salisbury Blast Interview), posttraumatic stress disorder (PTSD) diagnosis (Clinician-Administered PTSD Scale for DSM-5), and mild traumatic brain injury (TBI) history (Mid-Atlantic MIRECC Assessment of TBI) were assessed with clinical interviews. Biological aging was measured using DunedinPACE , an epigenetic biomarker of the pace of aging derived from whole-blood DNA methylation data. Hierarchical linear regression tested additive and interactive effects of blast exposure, PTSD, and TBI, adjusting for demographic and technical covariates.</p><p><strong>Results: </strong>Greater blast exposure severity was significantly associated with faster DunedinPACE scores (B = 0.12; P = .042), indicating accelerated biological aging. Mild TBI history was also independently associated with faster aging (B = 0.50; P = .036), whereas PTSD diagnosis was not (B = 0.01; P = .970). No significant interaction effects were observed. Exploratory analyses suggested that higher-intensity and more frequent blast exposures contributed to faster accelerated aging.</p><p><strong>Conclusions: </strong>Lifetime blast exposure severity was independently associated with accelerated epigenetic aging in post-9/11 Veterans, even after accounting for PTSD and TBI. These findings suggest that blast exposure may promote biological aging processes contributing to long-term health decline. Accelerated biological aging may represent a pathway linking blast exposure to increased vulnerability for age-related disease and could inform early identification of at-risk Veterans through biomarkers such as DunedinPACE .</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"e534-e542"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481084","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":"Navigating Health and Community Services After Traumatic Brain Injury: Experiences and Priorities of Black TBI Survivors.","authors":"Oluwadamilola Adesina, Lilcelia Williams, Mario Millsap, Daniel Cheluget, Noemi Rojas Serrano, Jessica Kersey","doi":"10.1097/HTR.0000000000001208","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001208","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) disproportionately affects Black Americans, who often experience poorer functional outcomes than their White counterparts. These disparities are exacerbated by limited access to rehabilitation and community-based services. Although current literature has examined the specific barriers Black TBI survivors face in accessing these services, few studies have identified alternative sources of support when services are unavailable. This study aimed to identify the barriers to care, existing support systems, and the services most highly prioritized by Black TBI survivors.</p><p><strong>Setting: </strong>Academic research laboratory.</p><p><strong>Design: </strong>We conducted surveys and qualitative interviews with Black TBI survivors (n = 8) and their family caregivers (n = 6). Survey data were analyzed using descriptive statistics, and qualitative data were analyzed with reflexive thematic analysis. The analysis was guided by the Community Cultural Wealth model, which describes 6 forms of capital that marginalized communities use to navigate systemic barriers.</p><p><strong>Results: </strong>Survey findings revealed that most participants (62.5%) were unaware of community-based brain injury programs. Barriers to accessing services included lack of awareness (75.0%), financial considerations (37.5%), and difficulty understanding eligibility (37.5%). We identified 3 qualitative themes: (1) participants were rich in familial and social capital, relying heavily on family and community networks for support; (2) health care and social service systems undermined navigational capital through long wait times, appointment cancellations, inadequate follow-up, and restrictive insurance policies; and (3) participants prioritized holistic, personalized care and opportunities for peer connection with others who had similar experiences.</p><p><strong>Conclusions: </strong>Findings highlight the need for culturally informed interventions, enhanced navigational support, family-centered services, peer support programs, and policy reforms to improve recovery outcomes for Black TBI survivors.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865461","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}