Journal of Head Trauma Rehabilitation最新文献

{"title":"Association Between Recent Traumatic Brain Injury and Anxiety, Depression, and Binge Drinking Data From the Research and Development Survey.","authors":"Dana Waltzman, Rebecca B Naumann, Alexis B Peterson, Jill Daugherty","doi":"10.1097/HTR.0000000000001142","DOIUrl":"10.1097/HTR.0000000000001142","url":null,"abstract":"<p><strong>Objective: </strong>Research highlights a potential relationship between traumatic brain injury (TBI) and psychiatric disorders and substance use. However, the relationship between TBI and these conditions post-injury may be underestimated in many traditional research data sources (eg, health insurance claims).</p><p><strong>Setting and participants: </strong>Nationally representative data (N = 10 320) from the Research and Development Survey (RANDS).</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Main measures: </strong>Estimate the association between recent (past 12 months) TBI and anxiety, depression, and binge drinking among adults and examine whether this relationship was modified by sex.</p><p><strong>Results: </strong>An estimated 5.6% of adults reported experiencing a recent TBI. Among males, sustaining a TBI was associated with 1.6 to 2.4 times the prevalence of adverse mental health measures (anxiety [aPR = 1.61, 95% CIs = 1.11-2.34] and depression [aPR = 2.40, 95% CIs = 1.51-3.80]) compared to males without a TBI. Similarly, among females, sustaining a TBI was associated with 2.2 to 2.6 times the prevalence of anxiety (aPR = 2.19, 95% CIs = 1.66-2.90) and depression (aPR = 2.63, 95% CIs = 1.92-3.61). Results for binge drinking did not suggest a strong association with TBI for either sex; however, CIs were wide.</p><p><strong>Conclusion: </strong>These findings can help inform treatment and management plans for TBI patients, including potential screening and referral for mental health services among individuals who have experienced a TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"339-348"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856787","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":"Higher Cardiovascular Risk Factor Burden Associated With Cumulative Concussion History and Age-Related Differences.","authors":"Benjamin L Brett, Mikaela E Sullivan, Neelum T Aggarwal, Zachary Y Kerr, Avinash Chandran, J D DeFreese, Samuel Walton, Kevin M Guskiewicz, Ruben J Echemendia, William P Meehan, Michael A McCrea, Rebekah Mannix","doi":"10.1097/HTR.0000000000001140","DOIUrl":"10.1097/HTR.0000000000001140","url":null,"abstract":"<p><strong>Objective: </strong>Growing evidence suggests cardiovascular dysfunction represents 1 pathway by which recurrent concussion may lead to adverse long-term outcomes, with earlier onset increasing risk. We investigated the interaction of concussion history and age on the prevalence of cardiovascular risk factors (CRF) and the association of CRF with multidomain function across age in former professional football players.</p><p><strong>Setting: </strong>Survey-data.</p><p><strong>Participants: </strong>Former National Football League players.</p><p><strong>Design: </strong>Former players were dichotomized into older (n = 1071; > age 50-years of age) and younger (n = 902; ≤ 50 years of age) age groups. Logistic and linear regression were used to test the interaction of concussion history and age on prevalence of CRFs, and the association of cardiovascular risk factors with functional outcomes across age groups.</p><p><strong>Measures: </strong>CRFs included the following: hypertension, hyperlipidemia, diabetes, and sleep apnea. Clinical outcomes from the Patient-Reported Outcomes Measurement Information System included Depression, Anxiety, Cognitive Function, and Emotional and Behavioral Dyscontrol. Logistic and linear regression tested the interaction of concussion history and age on prevalence of CRFs, and the association of cardiovascular risk factors with functional outcomes across age groups.</p><p><strong>Results: </strong>Significant concussion history by age interactions were observed for hypertension and hyperlipidemia, ( P 's < .001), with greater number of prior concussions being associated with higher rates of diagnoses for younger former athletes only. A greater prevalence of sleep apnea with higher concussion history was observed regardless of age ( P < .001). Significant age by hypertension and hyperlipidemia interactions were observed on clinical outcomes, with higher symptom endorsement among those with CRF in younger former players ( P' s < .001).</p><p><strong>Conclusion: </strong>Given higher rates of diagnoses at earlier ages, findings support cardiovascular health as representing one pathway by which recurrent concussion may lead to adverse long-term outcomes in former contact sport athletes. A clinical preventative approach including early screening and management of CRF in those with greater history of concussion should be considered.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"e500-e512"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804645","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":"Multidimensional Preinjury Health and 6-month Outcome After Traumatic Brain Injury in Older Adults Presenting With Mainly GCS 13-15.","authors":"Roy Tzemah-Shahar, Yael Rosen Lang, Ava M Puccio, Esther L Yuh, Domenico Lombardi, Michele Diaz Nelson, John Boscardin, J Russell Huie, Kristine Yaffe, David O Okonkwo, Ramon Diaz Arrastia, Geoffrey T Manley, Raquel C Gardner","doi":"10.1097/HTR.0000000000001195","DOIUrl":"10.1097/HTR.0000000000001195","url":null,"abstract":"<p><strong>Objective: </strong>To test the accuracy of existing traumatic brain injury (TBI) outcome prediction models in older adults with TBI (oaTBI), to determine the independent association of 5 different measures of preinjury health with 6-month outcome, and to investigate whether these preinjury health measures improve outcome prediction.</p><p><strong>Setting: </strong>Two level 1 trauma centers.</p><p><strong>Participants: </strong>A total of 112 adults aged ≥65 years who underwent head computed tomography after acute TBI (95% with Glasgow Coma Scale (GCS) score 13-15, 66% with acute intracranial trauma on head CT).</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Main measures: </strong>Preinjury health was characterized using activities of daily living (ADL), Functional Activities Questionnaire (FAQ), Clinical Dementia Rating (CDR), Charlson Comorbidity Index (CCI), and Groningen Frailty Index (GFI). The primary outcome was poor recovery (Glasgow Outcome Scale-Extended <5: severe disability or death) at 6 months. We compared performance of CRASH and IMPACT models in predicting 6-month outcome. Each preinjury health measure was tested for independent association with outcome and incremental prognostic value when added to the best-performing model. Model accuracy was assessed using area under the curve (AUC).</p><p><strong>Results: </strong>Participants' mean ± SD age was 77.8 ± 7.9 years; 42% were women. The CRASH-basic model had the highest accuracy (AUC = 0.74, 95% CI = 0.64-0.83). Poor 6-month outcome was independently associated with preinjury cognitive impairment (CDR OR = 1.38, 95% CI = 1.07-1.76), impaired ADL (ADL OR = 2.45, 95% CI = 1.16-5.15), decreased cognitively mediated function (FAQ OR = 1.17, 95% CI = 1.06-1.29), and higher frailty (GFI OR = 1.30, 95% CI = 1.06-1.59), but not with comorbidities (CCI OR 1.00, 95% CI 0.76-1.32). No measure significantly improved CRASH-basic AUC (all P > 0.05).</p><p><strong>Conclusions: </strong>Among older adults with mainly mild TBI, preinjury frailty and cognitive-mediated function were independently associated with poor 6-month outcome, yet these preinjury measures did not significantly improve prediction accuracy. Instruments such as the FAQ and GFI capture clinically meaningful preinjury heterogeneity and may inform the development of more precise oaTBI prognostic models.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840469","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":"Psychological Resilience and Adolescent Sport-Related Concussion.","authors":"Nikolas O Josafatow-García, Jason B Tabor, Christina Campbell, Kristina Fraser, Jean-Michel Galarneau, Keith O Yeates, Carolyn A Emery, Chantel T Debert","doi":"10.1097/HTR.0000000000001204","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001204","url":null,"abstract":"<p><strong>Objectives: </strong>Our primary objective was to investigate the trajectory of resilience from preinjury to acutely after sport-related concussion (SRC; within 10 days of injury) and to time of return to play (RTP) in adolescents. We further sought to determine whether this trajectory differed between sexes. Secondarily, we investigated the associations between resilience and post-SRC symptom burden and length of recovery.</p><p><strong>Setting: </strong>A substudy of the multicenter pan-Canadian SHRed Concussions (Surveillance in High Schools and Community Sport to Reduce the Risk of Concussions and their Consequences) prospective cohort study.</p><p><strong>Participants: </strong>Adolescent sport participants (ages 10-18 years) who sustained a SRC.</p><p><strong>Main outcomes and measures: </strong>Assessments included the Connor-Davidson Resilience Scale-10 (CDRISC-10) and Sport Concussion Assessment Tool-5 (SCAT-5; symptom number & symptom severity) completed before injury, acutely post-SRC, and at RTP. Linear mixed effect models evaluated the difference in CDRISC-10 scores between timepoints controlling for age and sex. Linear regressions and time to event analyses evaluated the associations between CDRISC-10 scores and symptom burden and time to RTP.</p><p><strong>Results: </strong>In total, 425 adolescents (45.65% female, ages 15.82 ± 1.33) participated. Longitudinally, the sex by timepoint interaction was significant, such that CDRISC-10 scores decreased acutely post-SRC in male participants, however, not in female participants (β = -0.901, 95% CI: -1.707 to -0.094, P = .029), and scores increased at RTP in female participants, not in male participants (β = 2.794, 95% CI: 1.495-4.093, P < .001). Lower acute CDRISC-10 scores were associated with higher symptom number (β = -0.265, 95% CI: -0.428 to -0.102, P = .001), symptom severity (β = -0.916, 95% CI: -1.471 to -0.361, P = .001), and longer time to RTP (HR = 1.044, 95% CI: 1.016-1.071, P = .002) after controlling for age and sex.</p><p><strong>Conclusions and relevance: </strong>Male resilience was lower acutely post-SRC, and female resilience increased at RTP. Higher resilience acutely was associated with lower symptom burden and shorter recovery for both sexes. Our study provides evidence for resilience as a modifiable target to improve recovery after SRC in adolescents.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840517","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":"Foundation Model Forecasting of Headache Days in People With Persisting Postconcussion Symptoms.","authors":"Antonios Danelakis, Gøril Storvig, Marte Helene Bjørk, Daniela Contreras, Manjit Matharu, Parashkev Nachev, Bendik Slagsvold Winsvold, Erling Tronvik, Anker Stubberud, Alexander Olsen","doi":"10.1097/HTR.0000000000001206","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001206","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to forecast headache in individuals with persisting postconcussion symptoms using foundation machine learning (ML) models and multimodal longitudinal data.</p><p><strong>Methods: </strong>This was an ML analysis of data from the Digital Solutions for Concussion (DiSCo) study, a research project assessing the usability and feasibility of 2 mobile health apps for individuals with persisting postconcussion symptoms. The participants completed daily symptom registrations and daily biofeedback sessions measuring heart rate variability, peripheral skin temperature, and upper trapezius muscle tension. Two foundation ML models, TabPFN and longitudinal TabPFN, were recruited and evaluated to predict moderate-to-severe (at least 4 on the 11-point numeric rating scale) headache days occurring in the subsequent 24-hour window using prior physiological and symptom data. The top-performing model was further evaluated for forecasting days with fatigue, which was rated as the second to headache most bothersome symptom, within the subsequent 24-hour window. Models were trained and optimized on a train-set and evaluated on a hold-out test-set with the area under the receiver operating characteristics curve (AUC) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Twenty individuals were included in the forecasting models, with data collected over a planned 28-day registration period, yielding a total of 338 days. The most stable model, longitudinal TabPFN, achieved a test-set AUC of 0.69 (95% CI: 0.62-0.74). The conventional TabPFN model achieved an AUC of 0.68 (95% CI: 0.55-0.80). In the case of fatigue, the longitudinal TabPFN model achieved an AUC of 0.81 (95% CI: 0.75-0.86). Both physiological measurements and symptomology information seemed to be important predictors.</p><p><strong>Conclusions: </strong>Moderate-to-severe postconcussion headache days can be predicted with modest accuracy 24 hours before their occurrence from multimodal physiological and self-reported symptomatology data. Incorporating temporal dynamics using longitudinal foundation models may improve such forecasting.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794052","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":"Headache and Dizziness Provoked by Mental Imagery in Patients With Persistent Postconcussive Symptoms: A Case Series.","authors":"Yotam Yanai, Dana Gefen-Doron, Keren Sivan-Speier, Avi Ohry, Yoav Gimmon","doi":"10.1097/HTR.0000000000001201","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001201","url":null,"abstract":"<p><strong>Objective: </strong>To document and characterize headache and dizziness provocation during mental imagery of real-life symptom-provoking movements in patients with persistent postconcussive symptoms (PPCS).</p><p><strong>Setting: </strong>Outpatient rehabilitation department at Reuth Rehabilitation Hospital, Tel Aviv, Israel.</p><p><strong>Participants: </strong>Thirteen adults (7 females; mean age 34.3 ± 12.6 years) undergoing multidisciplinary rehabilitation for PPCS with functional decline after mild traumatic brain injury. All were ≥3 months postinjury, reported both headache and dizziness, and had a known real-life symptom trigger (eg, movements, activity). Patients with cognitive, linguistic, or psychiatric impairments were excluded.</p><p><strong>Design: </strong>Case series.</p><p><strong>Main measures: </strong>The primary outcome was the result of mental imagery testing of symptom-provoking movements for headache and dizziness, routinely performed as part of vestibular evaluation protocol at the facility. Secondary outcomes included demographics, medical history, clinical trajectory, imaging results, current medications, symptom questionnaires scores (Brief Pain Inventory, Dizziness Handicap Inventory), and vestibular bedside assessments findings.</p><p><strong>Results: </strong>Headache was provoked in 9 out of 13 patients (69.2%), and dizziness in 11 out of 13 patients (84.6%) during mental imagery of real-life symptom-provoking movements. Five of the 13 patients (38.5%) had oculomotor and vestibular abnormalities (eg, benign paroxysmal positional vertigo, vestibular asymmetry, oculomotor deficits). Symptom reproduction occurred regardless of vestibular pathology in 3 out of 5 cases with oculomotor or vestibular abnormalities. All patients reported additional symptoms, such as musculoskeletal pain, fatigue, and sleep disturbances.</p><p><strong>Conclusions: </strong>This case series identifies a novel clinical phenomenon in patients with PPCS, where mental imagery of symptom-provoking movements provokes headache and dizziness. These findings suggest a potential link between mental imagery and symptom exacerbation, supporting the notion that PPCS may reflect functional rather than structural mechanisms. This perspective underscores the need for further research to elucidate underlying mechanisms and explore potential therapeutic interventions.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630718","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":"Rates and Predictors of Completed Cognitive Rehabilitation Referrals Among Veterans With Traumatic Brain Injury.","authors":"Adam R Kinney, Molly E Penzenik, Jeri E Forster, Frederica O'Donnell, Nazanin H Bahraini","doi":"10.1097/HTR.0000000000001181","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001181","url":null,"abstract":"<p><strong>Objective: </strong>Among Veterans with traumatic brain injury (TBI) who received a cognitive rehabilitation referral, we sought to describe rates of referral completion (ie, Veteran attends the initial encounter). Second, we examined nonclinical factors associated with referral completion.</p><p><strong>Setting: </strong>Veterans Health Administration (VHA).</p><p><strong>Participants: </strong>Veterans with 1) clinician-confirmed TBI determined using the Comprehensive TBI Evaluation database and 2) a cognitive rehabilitation referral, determined using a validated algorithm (n = 19,923 mild TBI [mTBI]; n = 3797 moderate-severe TBI).</p><p><strong>Design: </strong>Retrospective cohort study of VHA medical record data. Modified Poisson regression was used to model the likelihood of completing a cognitive rehabilitation referral based on nonclinical predisposing (eg, age) and enabling (eg, homelessness) factors. All analyses were stratified by TBI severity (mTBI vs. moderate-severe TBI).</p><p><strong>Main measures: </strong>Completed cognitive rehabilitation referrals (no/yes), identified in the VHA electronic medical record. Cognitive rehabilitation referrals are documented as \"complete\" when the Veteran attends an initial encounter with the provider who receives the referral.</p><p><strong>Results: </strong>The proportion of Veterans who completed their cognitive rehabilitation referral was similar across severities, with 69% of Veterans with mTBI and 68% of Veterans with moderate-severe TBI completing the referral. Veterans with mTBI who were older, married, and those who identified as students/homemakers/volunteers or unemployed and not looking (vs. employed) were more likely to complete the referral. Among Veterans with moderate-severe TBI, history of homelessness was associated with a reduced likelihood of completing a cognitive rehabilitation referral.</p><p><strong>Conclusions: </strong>While most Veterans with TBI initiate cognitive rehabilitation after receipt of a referral, a notable portion do not, suggesting missed opportunities for beneficial services in this population. Furthermore, patient factors such as age, marital status, employment status, and history of homelessness were associated with referral completion. Findings lay the foundation for system-level strategies that facilitate engagement with cognitive rehabilitation among Veterans with TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604204","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 Post-Concussion Sleep Disturbances in Children and Adults: A Scoping Review.","authors":"Sarah Thompson, Bridget Moors, Gabrielle Hayduk-Costa, Jessica Trier","doi":"10.1097/HTR.0000000000001203","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001203","url":null,"abstract":"<p><strong>Objective: </strong>To provide a comprehensive summary of the existing literature that describes treatment options for post-concussion sleep disturbances in children and adults.</p><p><strong>Context: </strong>Studies have shown that 30%-70% of individuals who sustain a concussion develop a post-injury sleep disturbance. The presence of sleep disturbance contributes to prolonged recovery from concussion and poorer long-term outcomes. Thus, identifying effective treatments for post-concussion sleep disturbances is essential to reduce the burden of persisting post-concussion symptoms.</p><p><strong>Design: </strong>Scoping review.</p><p><strong>Methods: </strong>A systematic literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts, then full-text articles against the inclusion and exclusion criteria. Primary studies that investigated at least 1 treatment for post-concussion sleep disturbances were included.</p><p><strong>Results: </strong>Of the 3660 articles yielded from the initial search, 19 were included in this review. The most commonly studied intervention was CBT (n = 3), followed by blue-light therapy (n = 2), photobiomodulation (n = 2), and melatonin (n = 2). Other treatments included an educational intervention, trauma-focused psychotherapy, 2 novel forms of psychotherapy, acoustic neuromodulation, multisensory integration therapy, gabapentin, hand self-shiatsu, interdisciplinary rehabilitation, and music therapy. The most common study design was a randomized controlled trial (n = 8, 42%). Over half of the studies (n = 13, 68%) used pre-existing validated scoring tools as subjective measures of sleep. Only 4 studies were conducted exclusively in children 18 years and younger.</p><p><strong>Conclusion: </strong>This review supports current guidelines that recommend CBT as a first-line therapy for post-concussion sleep disturbances. However, higher-quality evidence is needed before other interventions should be incorporated into routine practice, particularly for children. Future research should consider the impact of other post-concussion symptoms on adherence to sleep-promoting therapies.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604179","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":"Symptomatic and Asymptomatic Benign Paroxysmal Positional Vertigo Identified During Inpatient Traumatic Brain Injury Rehabilitation.","authors":"Amelia Chiu Yi Ho, Seng Kwee Wee","doi":"10.1097/HTR.0000000000001202","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001202","url":null,"abstract":"<p><strong>Objective: </strong>To determine the incidence of benign paroxysmal positional vertigo (BPPV) among adults with traumatic brain injury (TBI) undergoing inpatient rehabilitation using routine vestibular screening independent of symptom report, and to describe clinical presentation, canal characteristics, and response to canalith repositioning maneuvers.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Inpatient rehabilitation hospital.</p><p><strong>Participants: </strong>Consecutive adults admitted for inpatient rehabilitation after TBI.</p><p><strong>Methods: </strong>Medical records were retrospectively reviewed for all patients with traumatic brain injury admitted to inpatient rehabilitation who underwent standardized vestibular assessment as part of routine screening irrespective of dizziness complaints. BPPV was diagnosed based on documented positional nystagmus consistent with Bárány Society criteria. Incidence was defined as the proportion of patients diagnosed with BPPV among those who completed routine vestibular assessment during inpatient rehabilitation. Symptom status, canal involvement, and treatment outcomes were descriptively analyzed.</p><p><strong>Results: </strong>Of 119 patients screened, 10 could not be reliably assessed and were excluded. Among 109 assessed patients, 49 were diagnosed with BPPV, yielding an incidence of 45.0% (95% CI: 35.4%-54.8%). Of the 49 patients with BPPV, 19 (38.8%) reported dizziness before vestibular assessment, 13 (26.5%) reported symptoms only during positional testing, 9 (18.4%) reported no subjective vertigo despite objective positional nystagmus, and 8 (16.3%) were unable to reliably report symptom status because of cognitive or communication impairment. Posterior canal involvement was most common (65.3%), followed by horizontal canal involvement (22.4%) and multiple-canal involvement (12.2%). Canalith repositioning maneuvers resulted in resolution in 95.9% of cases (95% CI: 86.0%-99.5%). Most patients (73.5%) resolved with a single session, 20.4% required 2 sessions, and 6.1% required 3 or more sessions (median 1 session; range 1-3).</p><p><strong>Conclusions: </strong>BPPV is a common complication of TBI during inpatient rehabilitation. Routine vestibular screening identified cases that would not have been detected through spontaneous symptom reporting alone, including individuals without subjective vertigo and those unable to reliably report symptoms.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604189","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":"Applying a Novel Diagnostic Code System to Identify Postconcussive Symptom Subgroups Among Service Members With Mild Traumatic Brain Injury.","authors":"Adam R Kinney, Treven C Pickett, Amy O Bowles, Jeri E Forster, Rachel Sayko Adams, Christine M Baugh, Thomas DeGraba, Jesus Caban, Amber Lyle, Alexandra Smith, Melinda Tung, Isabelle Wal, Lisa A Brenner","doi":"10.1097/HTR.0000000000001199","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001199","url":null,"abstract":"<p><strong>Objective: </strong>First, to describe the development of a novel postconcussive symptom (PCS) code set for identifying symptoms via medical records. Second, to apply it to a population-based cohort of service members with a history of mild traumatic brain injury (mTBI) per Military Health System (MHS) records, to identify distinct subgroups based on patterns of risk for specific PCS.</p><p><strong>Setting: </strong>MHS.</p><p><strong>Participants: </strong>Population-based sample of service members with mTBI who served in the Army, Air Force, Navy, and Marine Corps and received a diagnosis within the MHS (n = 148 293).</p><p><strong>Design: </strong>Retrospective cohort study using medical record data from the MHS spanning 2002 to 2021.</p><p><strong>Main measures: </strong>In collaboration with clinical experts, we iteratively refined a novel PCS code set comprised of ICD-9/10 codes based on Neurobehavioral Symptom Inventory categories, when possible. We used latent class analysis (LCA) with a split-sample cross-validation procedure to identify subgroups of service members with mTBI based on probability of receiving each PCS diagnosis.</p><p><strong>Results: </strong>The final PCS code set included 20 symptoms, spanning vestibular, sensory, cognitive, and mood/behavioral-related symptoms. The LCA supported 5 distinct subgroups, the most prevalent being the Minimal subgroup (59%), characterized by low probability of all PCS. The next most common class was the Headache class (16%), followed by the Mood-Behavioral (15%), Headache-Sleep (6%), and Headache-Mood-Sleep (5%) classes.</p><p><strong>Conclusions: </strong>Using a novel PCS code set leveraging routinely collected data, we identified 5 clinically meaningful and statistically distinct subgroups based on symptom patterns in a population-based cohort of service members with a history of mTBI. These subgroups provide a nuanced, person-centered understanding of symptoms among those with a history of TBI and can inform targeted interventions and policies aimed at meeting the needs of these service members. Further, findings establish a foundation for investigating risk factors and outcomes across subgroups, informing prognostication.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604181","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}