Journal of Head Trauma Rehabilitation最新文献

{"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}

{"title":"Home- and Community-Based Services: A Comparison of Brain Injury Waivers Across the United States.","authors":"Erica D Bates, Elena M Redmond","doi":"10.1097/HTR.0000000000001017","DOIUrl":"10.1097/HTR.0000000000001017","url":null,"abstract":"<p><strong>Objective: </strong>Adults and children who experience brain injury may need services and support when they return to the community. Home- and community-based services waivers are one way to access those supports. Brain injury waivers do not exist in every state, and variations exist in current waivers. This article describes existing brain injury waivers and how they vary by state.</p><p><strong>Design: </strong>States were included if their most recent waiver application was approved by the Centers for Medicare and Medicaid Services. States were excluded if waivers were terminated or expired. Data were collected by analyzing each state's waiver across the areas of diagnosis definition, ages served, self-direction, service setting, persons served, services offered, budget, and assistive technology. Statistical analysis included frequency and descriptive statistics due to the limited number of participants.</p><p><strong>Results: </strong>Each state designs its own waivers. Differences exist in eligibility criteria, services provided, settings, and the rights of participants.</p><p><strong>Conclusions: </strong>Analysis of the waivers showcased differences in all areas. These factors determine which brain injury survivors can receive services from specialized waivers, what services are available to them, where they can receive services, and what rights they can exercise.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"216-220"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622097","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":"Exploring Demographic and Cognitive Predictors of Self-Management in Quasi-Randomized Fall Prevention Intervention for Older Adults With and Without Traumatic Brain Injury.","authors":"Amy M Kemp, Kim Love, Katy H O'Brien","doi":"10.1097/HTR.0000000000001006","DOIUrl":"10.1097/HTR.0000000000001006","url":null,"abstract":"<p><strong>Objective: </strong>Changes in health behavior are key to maintaining health, safety, and independence of older adults. The purpose of this study was to explore factors impacting training in self-management and behavior change in older adults with and without traumatic brain injury (TBI), informing efforts to improve safety and independent function.</p><p><strong>Methods: </strong>Forty-one older adults, 19 with TBI, completed a self-regulation intervention (mental contrasting with implementation intentions; MCII) to promote fall prevention behavior change. Participant outcomes were related to single and recurring behavior changes; implementation outcomes were measured as modifications to treatment.</p><p><strong>Results: </strong>Although participants with TBI performed more poorly on tests of neurocognitive function, there were no differences in behavior change rates following MCII, suggesting the treatment worked similarly for participants with and without TBI. Across both groups, those with higher executive function scores were more likely to complete recurring behavior changes. Participants with higher stress, higher Fall Risk Scores, or history of TBI were more likely to need modifications to treatment.</p><p><strong>Conclusions: </strong>This quasi-experimental pilot study describes cognitive and psychosocial predictors that may be critical for participation and success in health behavior change and self-management of fall prevention for older adults with and without TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E216-E225"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289170","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":"Silent Struggles: Traumatic Brain Injuries and Mental Health in Law Enforcement.","authors":"Jaclyn B Caccese, Carly R Smith, Nathan A Edwards, Angela M Emerson, Enora Le Flao, Jeffrey J Wing, Joshua Hagen, Scott Paur, Joshua Walters, James A Onate","doi":"10.1097/HTR.0000000000000986","DOIUrl":"10.1097/HTR.0000000000000986","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of head injuries (HIs), posttraumatic stress disorder (PTSD), and depressive symptoms in law enforcement officers (LEOs) and (2) the association between HIs and psychological health conditions.</p><p><strong>Setting: </strong>County-level survey administered via Research Electronic Data Capture.</p><p><strong>Participants: </strong>A total of 381 LEOs completed the survey (age = 43 ± 11 years; 40 [11%] females; time as LEO = 1-50 years, median = 15 years).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Main measures: </strong>We examined the prevalence of HIs (the Ohio State University Traumatic Brain Injury Identification Method), PTSD (PTSD Checklist-Civilian [PCL-C]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). We used Mann-Whitney U and chi-square analyses to compare PTSD and depressive symptoms between those with and without a HI history.</p><p><strong>Results: </strong>There were 282 (74%) participants who reported a lifetime history of 1 or more HIs; 116 (30%) sustained 1 or more HIs on the job. PCL-C scores ranged 17 to 85 (median = 27); 33 (10%) participants met or exceeded the clinical cutoff score of 50 to indicate a positive PTSD screening. Participants with a HI history (median = 29) had higher PCL-C scores than those with no HI history (median = 24; P < .001), but the proportion of participants who met the clinical cutoff for PTSD was not different between those with ( n = 28, 11%) and without ( n = 5, 5%) a HI history (X 2  = 2.52, P = .112, odds ratio = 2.18; 95% confidence interval, 0.82-5.83). PHQ-9 scores ranged 0 to 20 (median = 3); 124 (36%) participants reported mild or greater depressive symptoms. Participants with a HI history (median = 3) had higher depressive symptoms than those with no HI history (median = 2; P = .012). The proportion of participants with mild or greater depressive symptoms was higher among those with a HI history ( n = 99, 39%) than without ( n = 25, 27%; X 2  = 4.34, odds ratio = 1.74; 95% confidence interval, 1.03-2.93).</p><p><strong>Conclusion: </strong>HIs are prevalent in LEOs, which may have consequences for their performance, well-being, and career longevity. PTSD and depressive symptoms are higher in those with a HI history, suggesting LEOs need better traumatic brain injuries and mental health resources.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E185-E195"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897613","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":"Association Between Follow-Up Visit Timing After A Concussion and Subsequent Care Seeking in Children and Youth: A Population-Based Study in British Columbia.","authors":"Scott Ramsay, V Susan Dahinten, Manon Ranger, Shelina Babul, Elizabeth Saewyc","doi":"10.1097/HTR.0000000000001001","DOIUrl":"10.1097/HTR.0000000000001001","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between follow-up visit timing and occurrence of the first subsequent health care seeking visit.</p><p><strong>Setting: </strong>The province of British Columbia, Canada.</p><p><strong>Participants: </strong>A total of 21 029 children and youth who were diagnosed with an initial concussion from January 1, 2016, to December 31, 2017. These data were obtained from Population Data BC.</p><p><strong>Design: </strong>A retrospective, descriptive correlational study.</p><p><strong>Main measures: </strong>Follow-up timing was measured categorically as timely (4 weeks), delayed (1-3 months), or no follow-up; the occurrence of a subsequent health care visit beyond 3 months postinjury was measured up to 12 months at 3-month intervals (ie, 4-6, 7-9, and 10-12 months). These variables were measured using diagnostic codes for concussion, post-concussion syndrome, and the 17 concussion symptoms.</p><p><strong>Results: </strong>After controlling for sociodemographic characteristics, having a delayed follow-up, relative to timely follow-up, was associated with higher odds of a subsequent health care seeking visit at 4 to 6 months (odds ratio [OR] = 2.68; confidence interval [CI], 2.08-3.47), 7 to 9 months (OR = 1.71; CI, 1.21-2.40), and 10 to 12 months (OR = 1.67; CI, 1.13-2.48). In contrast to having a delayed follow-up, having no follow-up, relative to timely follow-up, was associated with not having a subsequent health care seeking visit at 4 to 6 months (OR = 0.57; CI, 0.48-0.67) and 7 to 9 months (OR = 0.79; CI, 0.66-0.96), respectively.</p><p><strong>Conclusions: </strong>Follow-up visit timing after a concussion in children and youth is associated with subsequent health care seeking. Greater efforts are needed to investigate the importance of initial follow-up visit timing, as they may play an integral role in injury prevention and symptom management following injury.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E263-E271"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622078","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":"Return to Driving Following Moderate-to-Severe Traumatic Brain Injury: A TBI Model System Longitudinal Investigation.","authors":"Thomas A Novack, Yue Zhang, Richard Kennedy, Jennifer Marwitz, Lisa J Rapport, Elaine Mahoney, Thomas Bergquist, Charles Bombardier, Candy Tefertiller, William Walker, Thomas K Watanabe, Robert Brunner","doi":"10.1097/HTR.0000000000000983","DOIUrl":"10.1097/HTR.0000000000000983","url":null,"abstract":"<p><strong>Objective: </strong>To examine longitudinal patterns of return to driving (RTD), driving habits, and crash rates associated with moderate-to-severe traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Eight TBI Model System sites.</p><p><strong>Participants: </strong>Adults ( N = 334) with TBI that required inpatient acute rehabilitation with follow-up of 197 and 218 at 1 and 2 years post-injury, respectively. Data collection at 2 years occurred almost exclusively during the pandemic, which may have affected results.</p><p><strong>Design: </strong>Longitudinal and observational.</p><p><strong>Main measures: </strong>Driving survey completed during rehabilitation and at phone follow-up 1 and 2 years after injury.</p><p><strong>Results: </strong>The rate of RTD was 65% at 1-year follow-up and 70% at 2-year follow-up. RTD at both follow-up time points was positively associated with family income. The frequency of driving and distance driven were diminished compared to before injury. Limitation of challenging driving situations (heavy traffic, bad weather, and at night) was reported at higher rates post-injury than before injury. Crash rates were 14.9% in the year prior to injury (excluding crashes that resulted in TBI), 9.9% in the first year post-injury, and 6% during the second year.</p><p><strong>Conclusion: </strong>RTD is common after TBI, although driving may be limited in terms of frequency, distance driven, and avoiding challenging situations compared to before injury. Incidence of crashes is higher than population-based statistics; however, those who sustain TBI may be at higher risk even prior to injury. Future work is needed to better identify characteristics that influence the likelihood of crashes post-TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"193-202"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893598","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":"Seizure Risk Associated With the Use of Transcranial Magnetic Stimulation for Coma Recovery in Individuals With Disordered Consciousness After Severe Traumatic Brain Injury.","authors":"David Ripley, Kelly Krese, Joshua M Rosenow, Vijaya Patil, Stephan Schuele, Marilyn S Pacheco, Eliot Roth, Sandra Kletzel, Sherri Livengood, Alexandra Aaronson, Amy Herrold, Brett Blabas, Runa Bhaumik, Ann Guernon, Catherine Burress Kestner, Elyse Walsh, Dulal Bhaumik, Theresa L Bender Pape","doi":"10.1097/HTR.0000000000000991","DOIUrl":"10.1097/HTR.0000000000000991","url":null,"abstract":"<p><strong>Objective: </strong>Repetitive Transcranial Magnetic Stimulation (rTMS) is emerging as a promising treatment for persons with disorder of consciousness (DoC) following traumatic brain injury (TBI). Clinically, however, there are concerns about rTMS exacerbating baseline seizure risk. To advance understanding of risks, this article reports evidence of DoC-TBI rTMS-related seizure risk.</p><p><strong>Setting: </strong>Acute and sub-acute hospitals.</p><p><strong>Participants: </strong>Persons in states of DoC 6.5 months to 15 years after TBI (n = 20) who received active rTMS (n = 17) or placebo rTMS (n = 3). After completing placebo procedures, placebo participants completed active rTMS procedures. These 3 participants are included in the active group.</p><p><strong>Design: </strong>Meta-analysis of data from 3 clinical trials; 2 within-subject, 1 double blind randomized placebo-controlled. Each trial used the same rTMS protocol, provided at least 30 rTMS sessions, and delivered rTMS to the dorsolateral prefrontal cortex.</p><p><strong>Main measures: </strong>During each study's rTMS treatment phase, seizure occurrences were compared between active and placebo groups using logistic regression. After stratifying active group by presence/absence of seizure occurrences, sub-groups were compared using contingency chi-square tests of independence and relative risk (RR) ratios.</p><p><strong>Results: </strong>Two unique participants experienced seizures (1 active, 1 placebo). Post seizure, both participants returned to baseline neurobehavioral function. Both participants received antiepileptics during remaining rTMS sessions, which were completed without further seizures. rTMS-related seizure incidence rate is 59 per 1000 persons. Logistic regression revealed no difference in seizure occurrence by treatment condition (active vs placebo) or when examined with seizure risk factors ( P > .1). Presence of ventriculoperitoneal shunt elevated seizure risk (RR = 2.0).</p><p><strong>Conclusion: </strong>Collectively, findings indicate a low-likelihood that the specified rTMS protocol exacerbates baseline seizure rates in persons with DoC after TBI. In presence of VP shunts, however, rTMS likely elevates baseline seizure risk and mitigation of this increased risk with pharmacological seizure prophylaxis should be considered.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"203-215"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289174","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":"Psychometric Properties of Vestibular and Ocular Measures Used for Concussion Assessments: A Scoping Review.","authors":"Keely Barnes, Heidi Sveistrup, Motahareh Karimijashni, Mark Bayley, Shawn Marshall","doi":"10.1097/HTR.0000000000000985","DOIUrl":"10.1097/HTR.0000000000000985","url":null,"abstract":"<p><strong>Background: </strong>Concussions most commonly affect the vestibular and ocular systems. Clinical measures used in the assessment of vestibular and ocular deficits should contain strong psychometric properties so that clinicians can accurately detect abnormality to guide treatment interventions.</p><p><strong>Objectives: </strong>The aim of this scoping review was: (1) to identify the measures used to evaluate the vestibular and ocular domains postconcussion and (2) to document the psychometric properties of the measures.</p><p><strong>Methods: </strong>Two databases (Medline (Ovid) and Embase) were searched from inception to May 2023. An updated search was completed in January 2024 using the same databases and search terms. Studies were screened and data were extracted independently by 2 reviewers. Measures were categorized into vestibular, ocular, or both (vestibular and ocular) domains, and relevant psychometric properties were documented.</p><p><strong>Results: </strong>Fifty-two studies were included in this review. 28 studies explored the use of vestibular measures, 12 explored ocular measures, and 12 explored both vestibular and ocular measures or explored the use of vestibulo-ocular reflex measures. Most studies explored the properties associated with balance measures, particularly the balance error scoring system. Diagnostic accuracy (sensitivity and specificity metrics) of the associated measures was the most frequently documented characteristic in the literature.</p><p><strong>Conclusion: </strong>Identification of clinical measures used to evaluate vestibular and ocular deficits postconcussion is needed to understand the evidence supporting their use in practice. Documenting the psychometric properties will allow clinicians and researchers to understand the status of the current literature and support for the use of certain measures in practice in terms of their ability to appropriately detect deficits in people with concussion when deficits are truly present.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E240-E250"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348140","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}