Journal of Head Trauma Rehabilitation最新文献

{"title":"Risk of Traumatic Brain Injury in Deployment and Nondeployment Settings Among Members of the Millennium Cohort Study.","authors":"Kalyn C Jannace, Lisa Pompeii, David Gimeno Ruiz de Porras, William Brett Perkison, Jose-Miguel Yamal, Daniel W Trone, Rudolph P Rull","doi":"10.1097/HTR.0000000000000970","DOIUrl":"10.1097/HTR.0000000000000970","url":null,"abstract":"<p><strong>Objective: </strong>To describe and quantify the prevalence and risk of deployment and nondeployment service-related traumatic brain injury (TBI) among participants of the Millennium Cohort Study.</p><p><strong>Setting: </strong>Survey data.</p><p><strong>Participants: </strong>28 759 Millennium Cohort Study participants who were active duty, Reserves, or National Guard at the time of the survey.</p><p><strong>Design: </strong>Cross-sectional secondary data analysis.</p><p><strong>Main measures: </strong>Estimates of prevalence and rates of TBI were calculated. Multivariable Poisson regression estimated rate ratios of TBI overall and stratified by deployment and nondeployment settings.</p><p><strong>Results: </strong>The rate of TBI over the 362 535 person-years (PY) was 2.95 p/100 PY. the nondeployment rate was 2.15 p/100 PY, with a significantly higher rate (11.38 p/100 PY) in deployment settings. Bullets/blasts were the most common TBI mechanisms in deployed settings, while sports/physical training and military training were common in nondeployed settings.</p><p><strong>Conclusions: </strong>The risk of TBI as well as its mechanism varies by deployment and nondeployment, suggesting that targeted prevention strategies are needed to reduce the risk for TBI among military personnel based on their deployment status.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E102-E110"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633737","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":"Shorter Telomere Length Is Associated With Older Age, Poor Sleep Hygiene, and Orthopedic Injury, but Not Mild Traumatic Brain Injury, in a Cohort of Canadian Children.","authors":"S Salberg, M J Smith, R Lamont, Z Chen, M H Beauchamp, W Craig, Q Doan, J Gravel, R Zemek, N A Lannin, K O Yeates, R Mychasiuk","doi":"10.1097/HTR.0000000000000982","DOIUrl":"10.1097/HTR.0000000000000982","url":null,"abstract":"<p><strong>Background: </strong>Predicting recovery following pediatric mild traumatic brain injury (mTBI) remains challenging. The identification of objective biomarkers for prognostic purposes could improve clinical outcomes. Telomere length (TL) has previously been used as a prognostic marker of cellular health in the context of mTBI and other neurobiological conditions. While psychosocial and environmental factors are associated with recovery outcomes following pediatric mTBI, the relationship between these factors and TL has not been investigated. This study sought to examine the relationships between TL and psychosocial and environmental factors, in a cohort of Canadian children with mTBI or orthopedic injury (OI).</p><p><strong>Methods: </strong>Saliva was collected at a postacute (median 7 days) timepoint following injury to assess TL from a prospective longitudinal cohort of children aged 8 to 17 years with either mTBI (n = 202) or OI (n = 90), recruited from 3 Canadian sites. Questionnaires regarding psychosocial and environmental factors were obtained at a postacute follow-up visit and injury outcomes were assessed at a 3-month visit. Univariable associations between TL and psychosocial, environmental, and outcome variables were assessed using Spearman's correlation. Further adjusted analyses of these associations were performed by including injury group, age, sex, and site as covariates in multivariable generalized linear models with a Poisson family, log link function, and robust variance estimates.</p><p><strong>Results: </strong>After adjusting for age, sex, and site, TL in participants with OI was 7% shorter than those with mTBI (adjusted mean ratio = 0.93; 95% confidence interval, 0.89-0.98; P = .003). As expected, increasing age was negatively associated with TL (Spearman's r = -0.14, P = .016). Sleep hygiene at 3 months was positively associated with TL (adjusted mean ratio = 1.010; 95% confidence interval, 1.001-1.020; P = .039).</p><p><strong>Conclusion: </strong>The relationships between TL and psychosocial and environmental factors in pediatric mTBI and OI are complex. TL may provide information regarding sleep quality in children recovering from mTBI or OI; however, further investigation into TL biomarker validity should employ a noninjured comparison group.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E154-E162"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633738","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: Retrograde Amnesia and Posttraumatic Amnesia in Service Members and Veterans With Remote History of TBI.","authors":"Sara M Lippa, Kelly C Gillow, Lars D Hungerford, Jason M Bailie, Louis M French, Tracey A Brickell, Rael T Lange","doi":"10.1097/HTR.0000000000000996","DOIUrl":"10.1097/HTR.0000000000000996","url":null,"abstract":"<p><strong>Objective: </strong>The recently updated American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) removed retrograde amnesia (RA) as a main criterion for mTBI, recommending it be included as a substitute criterion only when posttraumatic amnesia (PTA) cannot be reliably assessed. This study aimed to investigate the evidence base for this recommendation.</p><p><strong>Setting: </strong>Military treatment facility.</p><p><strong>Participants: </strong>A total of 752 US military service members/veterans (mean age = 36.1 years, SD = 9.4 years) with a history of TBI prospectively enrolled in the Defense and Veterans Brain Injury Center-Traumatic Brain Injury Center of Excellence 15-Year Longitudinal TBI study who sustained a total of 1015 TBIs with substantiated RA and PTA. Most participants were male (93.6%), not of Hispanic Origin (84.7%), and White (84.5%). Evaluations were conducted on average 7.6 years (SD = 6.9 years) after injury.</p><p><strong>Design: </strong>Case series.</p><p><strong>Main measures: </strong>Presence and duration of RA and PTA; and ratio of PTA and RA (PTA:RA).</p><p><strong>Results: </strong>There were no TBIs where RA was present but PTA was absent. Within the 1015 TBIs, 896 (88.3%) involved both RA and PTA, 65 (6.4%) involved PTA only, and 54 (5.3%) did not involve RA or PTA. For the 635 TBI events with substantiated recorded minutes of RA and PTA both >0, the mean ratio of PTA:RA was 31:1. In only one instance was the ratio of PTA:RA <1.</p><p><strong>Conclusion: </strong>There were no TBIs where RA was present without PTA. RA tended to be much shorter than PTA. Findings support the American Congress of Rehabilitation Medicine's decision to remove RA as a main criterion for mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E139-E143"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916905","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":"Chronic Pain Treatment Utilization in Rural Versus Urban/Suburban Inhabitants Following Traumatic Brain Injury.","authors":"Levi Bale, Mitch Sevigny, Jeanne M Hoffman","doi":"10.1097/HTR.0000000000001030","DOIUrl":"10.1097/HTR.0000000000001030","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether there are differences in healthcare utilization for chronic pain based on location (rural vs urban/suburban) or healthcare system (civilians vs Military Service Members and Veterans [SMVs]) after moderate-severe TBI.</p><p><strong>Setting: </strong>Eighteen Traumatic Brain Injury Model Systems (TBIMS) Centers.</p><p><strong>Participants: </strong>A total of 1,741 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview.</p><p><strong>Primary measures: </strong>Sociodemographic, injury, function outcome, pain, and pain treatment characteristics.</p><p><strong>Results: </strong>Participants were mostly male (72.9%), White (75.2%), civilian (76.9%), 46 years old on average, and had greater than high school education (59.9%). 32% of participants resided in rural areas and 67% in urban/suburban areas. No significant difference in healthcare utilization for chronic pain was observed between individuals living in rural versus urban/suburban locations after adjustment for relevant covariates. However, rural SMVs had odds ratios >3 for each major treatment category including medical services (OR = 3.56), exercise therapies (OR = 5.23), psychological services (OR = 4.43), complementary and alternative therapies (OR = 3.23), and pain rehabilitation program (OR = 4.16) compared to rural civilians. This same pattern of findings was seen SMVs in urban/suburban settings as well. Being married versus single, bachelor/graduate education versus high school or less, and employed versus unemployed all had odds ratios >1 for exercise therapies, psychological services, complementary and alternative therapies, and pain rehab program.</p><p><strong>Conclusion: </strong>Contrary to initial hypotheses, there were no significant differences in healthcare utilization for chronic pain treatment comparing those in rural versus urban/suburban areas. However, differences were found between SMVs and civilians across both rural and urban/suburban locations suggesting that SMVs have more access to chronic pain treatment. The improved access to social and financial services afforded by VHA programs to SMVs may serve as a model for improving healthcare utilization in similar civilian populations.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"97-106"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927316","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":"Environmental Barriers are Associated With Rehabilitation Needs 10 to 15 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study.","authors":"Marc A Silva, Jeanne M Hoffman, Therese M O'Neil-Pirozzi, Anthony H Lequerica, William C Walker, Farina Klocksieben, Alexander Irizarry-Mendez, Risa Nakase-Richardson","doi":"10.1097/HTR.0000000000001011","DOIUrl":"10.1097/HTR.0000000000001011","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between environmental barriers and unmet rehabilitation needs during chronic recovery from traumatic brain injury (TBI) in persons discharged from inpatient rehabilitation.</p><p><strong>Setting: </strong>Five Veterans Affairs Polytrauma Rehabilitation Centers.</p><p><strong>Design: </strong>Cohort study of Veterans Affairs TBI Model Systems study participants who completed a 10 or 15 year follow up (N = 474).</p><p><strong>Main measures: </strong>Craig Hospital Inventory of Environmental Factors, Short Form (CHIEF-SF); TBI Rehabilitation Needs Survey (RNS).</p><p><strong>Results: </strong>RNS scores ranged from 0 to 42 with an average score of 6.9 (SD = 7.7). The most frequent unmet needs endorsed included the need to improve memory, solve problems, and control physical symptoms. In the adjusted model, unmet rehabilitation needs (RNS total) was associated with overall environmental barriers (CHIEF-SF Total Score) and three of five CHIEF-SF subscales: Policy barriers, Attitudes/Support barriers, and Services/Assistance barriers.</p><p><strong>Conclusions: </strong>Results from this study suggest that rehabilitation needs persist for at least a decade after TBI and occur in areas that may be modifiable with intervention. Health care providers shoulder consider periodic screening for unmet needs and consider potential treatments to address them as medically indicated Also, results support the growing recognition of TBI as a dynamic and lifelong condition necessitating a chronic disease management model. Despite significant investment in healthcare infrastructure for Veterans and Service Members, knowledge gaps remain regarding understanding and addressing their long-term rehabilitation needs, as well as and how environmental barriers impact the ability to address those needs. Unmet needs among women and minority groups; as well as evaluation of systems interventions to ameliorate environmental barriers they face are important foci of future research.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":"40 2","pages":"125-136"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585954","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: Characterizing Lifetime Mild TBI Exposure Among Female and Male Military Service Members and Veterans in the LIMBIC-CENC Study.","authors":"Samuel R Walton, Jessie R Oldham, Rosemay A Remigio-Baker, Benjamin L Brett, Tara A Austin, Olivia D Cetin, Elisabeth A Wilde, Landon B Lempke, Zhining Ou, Sreekanth Kamineni, Sarah L Martindale, Maya E O'Neil, Mary J Pugh, Randel L Swanson, Monique R Pappadis, David X Cifu, William C Walker","doi":"10.1097/HTR.0000000000000989","DOIUrl":"10.1097/HTR.0000000000000989","url":null,"abstract":"<p><strong>Objective: </strong>To (1) characterize lifetime mild traumatic brain injury (TBI) exposures among male and female US military service members and Veterans (SMVs) and (2) evaluate sex-related differences in mild TBI exposures.</p><p><strong>Setting: </strong>Clinical research laboratory.</p><p><strong>Participants: </strong>Participants were enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) Prospective Longitudinal Study.</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Main measures: </strong>Lifetime history of mild TBI was measured via structured interview. All mild TBI characteristics were collected as part of this interview, including total lifetime number; environment (deployment vs. non-deployment); timing of injury (relative to military service and age); and mechanism of injury (blast-related vs. non-blast).</p><p><strong>Results: </strong>Most participants ( n = 2323; 87.5% male; 79.6% Veteran) reported ≥1 lifetime mild TBI ( n = 1912; 82%), among whom, many reported ≥2 lifetime mild TBIs. Female SMVs reported fewer total lifetime mild TBIs than male participants ( P < 0.001), including fewer deployment-related ( P < 0.001) and non-deployment ( P < 0.001) mild TBIs. There were significant sex differences for total number of mild TBIs sustained before ( P = 0.005) and during ( P < 0.001) military service but not after separation from military service ( P = 0.99). Among participants with a lifetime history of mild TBI, female SMVs were less likely to report ≥2 mTBIs ( P = 0.003); however, male SMVs were more likely to report a mild TBI during military service ( P = 0.03), including combat-related mild TBI ( P < 0.001) and mild TBI involving blast ( P < 0.001).</p><p><strong>Conclusions: </strong>These findings inform clinical and research efforts related to mild TBI in US military SMVs. It may not be sufficient to simply measure the total number of mild TBIs when seeking to compare clinical outcomes related to mild TBI between sexes; rather, it is important to measure and account for the timing, environment, and mechanisms associated with mild TBIs sustained by female and male SMVs.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E121-E128"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633736","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":"Epidemiology and Symptom Resolution in Pediatric Patients Seen in a Multidisciplinary Concussion Clinic.","authors":"Kurt J Nilsson, Kristi Pardue, Yong Gao, Naida Dillion, Rachel S Johnson, Hilary Flint","doi":"10.1097/HTR.0000000000001049","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001049","url":null,"abstract":"<p><strong>Objective: </strong>Describe epidemiology of pediatric patients with concussion and relationship of injury characteristics and demographic variables to symptom resolution.</p><p><strong>Setting: </strong>Outpatient hospital system multidisciplinary concussion clinic.</p><p><strong>Participants: </strong>N = 1653, 6- to 18-year-old patients with concussion.</p><p><strong>Design: </strong>Retrospective of patients with concussion seen between 2013 and 2019. Rivermead post-concussion symptom questionnaire was completed at each visit. Demographics and injury characteristics were extracted, and income tertiles were calculated by zip code.</p><p><strong>Main measures: </strong>Descriptive statistics. Multivariate analysis of variance and Cox regression analysis of demographic variables and injury characteristics with time to symptom resolution.</p><p><strong>Results: </strong>Patients were 44.5% (n = 735) female, 53.5% (n = 885) male, and 2% (n = 33) other/not available. About 376 (22.7%) patients were 6 to 12 years old, 1277 (77.3%) were 13 to 18 years old. Median family income tertiles were <$63 798 (n = 494 [29.9%]), $63 798 to $82 171 (n = 571 [34.5%]), and >$82 171 (n = 545 [33%]). Time to presentation was longer for female patients (P < .0005), patients with non-sports-related concussions (P < .0005), and patients in the lower family income group than the middle- (P = .02) and high-income groups (P = .003). Average symptom resolution was 41 days, with higher initial symptom scores (hazard ratio 0.97; 95% confidence interval (CI), 0.97-0.98; P < .0005), female sex (hazard ratio 1.31; 95% CI, 0.1.18-1.47; P < .0005), older age (hazard ratio 1.17; 95% CI, 1.03-1.33; P = .015), and having a psychiatric diagnosis (hazard ratio 1.33; 95% CI, 1.15-1.54; P < .0005) predicting longer recovery time.</p><p><strong>Conclusion: </strong>Pediatric patients presenting to a specialized multidisciplinary concussion clinic possess several similar predictors of protracted symptom recovery when examined against other cohorts described in the literature, including female sex, longer time to initial presentation and initial concussion symptom burden. In this study, children with non-sports-related concussion have different clinical courses than those with sports-related concussion, and children 6 to 12 years old recover more quickly than adolescents. These findings, in combination with existing literature and future prospective studies, can be used to counsel patients regarding expected resolution of concussion symptoms and help direct resources toward those patients at risk for protracted recovery.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663630","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 the Relationship Between Chronic Pain and Cognition: A NIDILRR and VA TBI Model Systems Collaborative Project.","authors":"Mackenzie Peckham, Cynthia L Beaulieu, Kaitlin Hays, Marissa Lundstern, Bria MacIntyre, Candice Osborne, Amanda Rabinowitz, Allan L Service, Mitch Sevigny, Katherine Abbasi, William C Walker, Abigail Welch, Candace Tefertiller","doi":"10.1097/HTR.0000000000001045","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001045","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the associations between current chronic pain and cognition and current chronic head pain and cognition in individuals with traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>A total of 1762 participants from the TBI Model Systems who endorsed experiencing current chronic pain and who completed the Current Chronic Pain survey.</p><p><strong>Design: </strong>Secondary analysis of a subset of data collected through a multi-site, cross-sectional observational cohort study.</p><p><strong>Main outcome measures: </strong>Cognition as measured by the Brief Test of Adult Cognition by Telephone (BTACT).</p><p><strong>Results: </strong>Individuals with TBI who reported current chronic pain exhibited lower cognitive performance compared to those who reported no pain. Among individuals who reported pain, greater pain intensity and pain interference were negatively associated with cognition, resulting in poorer cognitive performance. The negative association was even greater for individuals acknowledging chronic head pain compared to pain from other body locations.</p><p><strong>Conclusion: </strong>The negative association between current chronic pain and cognition for individuals with TBI indicates the need to consider pain intensity and pain interference as factors possibly influencing cognitive ability.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492403","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":"Traumatic Encephalopathy Syndrome: Head Impact Exposure and Blood Biomarkers in Professional Combat Athletes.","authors":"Brooke D Conway Kleven, Lung-Chang Chien, Chad L Cross, Brian Labus, Charles Bernick","doi":"10.1097/HTR.0000000000001048","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001048","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to (1) determine whether there was an association between a diagnosis of traumatic encephalopathy syndrome (TES) and changes in three specific serum biomarkers, and (2) determine head impact exposure thresholds among both TES+ and TES- groups.</p><p><strong>Setting: </strong>Data were collected from Cleveland Clinic's Professional Athletes Brain Health Study (PABHS).</p><p><strong>Participants: </strong>This study included 192 professional combat athletes, 35 years of age and older. Athletes must be actively fighting or retired with a minimum of 10 professional fights over their careers.</p><p><strong>Design/intervention: </strong>This was a retrospective observational study of the PABHS longitudinal cohort.</p><p><strong>Main measures: </strong>The generalized linear model with the generalized estimating equation for repeated measurements was used to compare various biomarkers between both active and retired TES- and TES+ groups.</p><p><strong>Results: </strong>The odds ratio for TES diagnosis was 5.44 (95% CI = 2.48, 11.94; P < .0001) among active fighters and 10.75 (95% CI = 3.52, 32.85; P < .0001) among retired fighters, indicating the odds for a TES diagnosis were over 5 times greater for active fighters with every fight completed at or beyond 30 professional fights. Retired fighters had 10 times greater odds of TES diagnosis with every fight completed at or beyond 15 professional fights. Likewise, the odds of a TES diagnosis were 2.0% (95% CI = 0.3, 3.1; P = 0.0039) greater with each pg/mL increase of glial fibrillary acidic protein (GFAP). No relationship was observed between a TES diagnosis and neurofilament light chain or P-tau231.</p><p><strong>Conclusion: </strong>This study provides preliminary evidence that progressively elevated levels of the GFAP blood biomarker increase the odds of a TES diagnosis among retired professional fighters. Further evaluation is required to improve clarity and understanding of the relationship between progressive changes in the GFAP blood biomarker and a TES diagnosis, specifically evaluating the duration of chronicity and exposure thresholds.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491981","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":"Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study.","authors":"Maree Cassimatis, Rhonda Orr, Andrew Fyffe, Gary Browne","doi":"10.1097/HTR.0000000000001039","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001039","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the relationship between exercise tolerance and post-concussion symptom deficits, cognitive function, and recovery duration; (2) examine the longitudinal effect of exercise tolerance on symptom burden over the clinical timecourse of a child's recovery from concussion; and (3) explicate whether exercise intolerance is a significant determinant of recovery in pediatric concussion.</p><p><strong>Setting: </strong>Pediatric tertiary referral concussion clinic.</p><p><strong>Participants: </strong>Children and adolescents (aged 6-18 years) presenting to the concussion clinic between January 2015 and December 2022.</p><p><strong>Design: </strong>Retrospective longitudinal study.</p><p><strong>Main measures: </strong>Graded exercise test (GXT) data, derived from a standardized treadmill test (Bruce Protocol), was used to measure exercise tolerance following concussion. Based on initial GXT times, participants were dichotomized into 2 groups: (1) exercise tolerant (GXT time ≥9 minutes), or (2) exercise intolerant (GXT time <9 minutes). Symptom burden, cognitive function, and recovery duration were compared between groups. A subgroup analysis of participants requiring multiple clinic visitations was conducted to explore the longitudinal effect of post-concussion exercise tolerance over time.</p><p><strong>Results: </strong>Of the 603 children presenting to the concussion clinic, 313 participants (mean age ± SD: 13 ± 2 years, 79% male) were eligible. Exercise-intolerant participants (mean GXT [95% confidence interval, CI], 6.9 [6.5-7.3] minutes) reported 2 times greater initial symptom severity (P < .001) and performed poorly in visual memory (P = .002) and reaction time (P = .02) cognitive domains compared to exercise-tolerant participants (mean GXT [95% CI], 12.3 [12.0-12.5] minutes). Recovery time was longer in exercise-intolerant participants than exercise-tolerant participants (mean recovery time [95% CI], 94 [71-116] vs 69 [57-81] days, P = .002). Participants requiring multiple clinic visitations showed improvements in exercise tolerance and symptom burden over time (P < .001). Significant predictors of prolonged concussion recovery were delayed presentation time (P < .001), high initial symptom burden (P < .001), and exercise intolerance (P < .001).</p><p><strong>Conclusion: </strong>GXT is a clinically relevant measure to identify children and adolescents at risk of a prolonged concussion recovery.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491993","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}