Journal of Head Trauma Rehabilitation最新文献

{"title":"Military Occupational Blast Exposure: Definition, Operationalization, and Validation of a Reproducible Risk Classification Metric.","authors":"Sarah L Martindale, Jared A Rowland, Jennifer N Belding, Megan E Amuan, Eamonn Kennedy, Huong Nguyen, Lisa A Brenner, Ian J Stewart, David X Cifu, Mary Jo Pugh","doi":"10.1097/HTR.0000000000001200","DOIUrl":"10.1097/HTR.0000000000001200","url":null,"abstract":"<p><strong>Objective: </strong>To define Military Occupational Blast Exposure (MOBE) as a standardized construct of cumulative occupational blast exposure spanning low-level blast and high-level blast, and propose reproducible MOBE risk classification groups based on military occupations when objective blast records or detailed lifetime interviews are unavailable.</p><p><strong>Setting: </strong>Data were drawn from 2 Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) studies: a retrospective cohort study and a multisite prospective longitudinal cohort.</p><p><strong>Participants: </strong>The Phenotype Study included 2 522 880 post-9/11 service members and Veterans. The Prospective Longitudinal Study (PLS) included 1666 service members and Veterans who had experienced combat.</p><p><strong>Design: </strong>The Phenotype Study was used to operationalize MOBE risk classification and characterize demographic and military correlates. PLS data were used to evaluate whether MOBE risk classification aligned with blast exposure history and blast traumatic brain injury (TBI) history.</p><p><strong>Main measures: </strong>MOBE risk classification was compared with the generalized blast exposure value (GBEV) and blast exposure category scores from the Blast Exposure Threshold Survey, as well as blast TBI history from clinical interview data.</p><p><strong>Results: </strong>The Phenotype study classified 31.1% of military occupational codes into high-risk MOBE (MOBE+). In the PLS, MOBE+ individuals were more likely than MOBE- individuals to report blast TBI history (43.7% vs. 27.0%) and exceed the GBEV threshold of 200 000 (66.0% vs. 42.2%; both P < .001). MOBE+ individuals also reported higher mean blast exposure scores across all categories, with significant differences for small arms and large explosives. Occupational-level analyses showed meaningful heterogeneity in blast exposure profiles across high-risk occupations.</p><p><strong>Conclusions: </strong>MOBE risk classification differentiated meaningful patterns of blast exposure and blast-related injury in a well-characterized cohort. Findings support MOBE as a practical, scalable, standardized approach for estimating occupational blast exposure risk and improving comparability across studies when detailed individual exposure histories are unavailable.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471043","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":"From the Sidelines to the Spotlight: Addressing the Gap in Concussion Education and Management for University-Level Performing Arts Programs Using a Delphi Study Design.","authors":"Allyssa K Memmini, Olivia Hutchison, Paola Savvidou, Jeffrey A Russell, Aaron M Sinnott, Catherine C Donahue, Marisa Hentis, Randall Dick, Jeremy Stanek, Andrea N Lasner, Tiffany K Ng, Bohuslava Jelínková, Missy L Beck, Talitha L Wimberly, Ali Woerner, Abigail Skallerud, Elodie Linck, Margaret Wiss, Kristen H Schuyten","doi":"10.1097/HTR.0000000000001197","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001197","url":null,"abstract":"<p><strong>Objective: </strong>University performing artists are an under-represented population in concussion literature. The purposes of this study were to identify (1) areas of improvement regarding concussion education and management and (2) barriers with potential solutions to improve concussion care among university performing arts departments.</p><p><strong>Setting: </strong>Electronic survey.</p><p><strong>Participants: </strong>The panel (n = 21, mean age = 41.9 ± 11.6 years; 71.4% female) included university-affiliated clinicians (n = 5), sport-related concussion researchers (n = 5), performing arts faculty/staff (n = 7), and students/alumni (n = 4) with self-reported concussion history.</p><p><strong>Design: </strong>Modified Delphi technique.</p><p><strong>Methods: </strong>During round 1, panelists responded to 4 open-ended response questions regarding concussion education topics in the performing arts, challenges returning to performance, barriers to accessing care, and strategies to support postconcussion management. Constant comparative analysis was used among the research team to generate statements for subsequent rounds of voting. In round 2, panelists anonymously rated the statements using a 9-point scale (1 = strongly disagree, 9 = strongly agree). During round 3, panelists could either uphold or modify their score after reviewing the group's averages.</p><p><strong>Main measures: </strong>Consensus was achieved if the statements earned average group scores ≥7 after round 3.</p><p><strong>Results: </strong>After the Delphi process, panelists agreed on 20 topics (60.6%) to be included in future concussion education materials, 21 statements (65.6%) regarding the challenges in returning to performance after concussion, 13 barriers (48.2%) performing arts students experience when seeking care on campus, and 23 strategies (63.9%) to improve postconcussion support.</p><p><strong>Conclusion: </strong>These recommendations may support institutional policy development to address the unique gaps in concussion preparation and management among university performing arts departments.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471090","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":"Systematic Review and Meta-Analysis of Traumatic Brain Injury in First Responders.","authors":"Katherine J Hunzinger, Kayla Riel, Carly Smith, Thomas J Beach, James A Oñate, Christopher J D'Lauro, Johna K Register-Mihalik, Ashish R Panchal, Jeffrey J Wing, Jaclyn B Caccese, Andrea L C Schneider","doi":"10.1097/HTR.0000000000001198","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001198","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a systematic review and meta-analysis of studies examining the proportion of first responders (law enforcement and corrections officers, firefighters, and emergency medical services personnel) with traumatic brain injury (TBI).</p><p><strong>Methods: </strong>This review is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was a priori registered in PROSPERO. Eligible observational and interventional studies reporting the proportion of first responders with TBI (lifetime history; job/career-related; job/training-related; event-related) were identified and data were abstracted by 2 independent reviewers (with disagreements resolved by a third reviewer) from systematic searches in 5 databases (PubMed, Embase, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Web of Science). Random-effects meta-analyses were performed when population-based denominators were available with between-study heterogeneity evaluated using I2. Risk of bias was assessed using an adapted Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Twenty-three studies met inclusion criteria, with 5 contributing data to meta-analyses. Studies were heterogeneous in the method of TBI ascertainment, with some defining TBI from self-reported validated or unvalidated survey responses and others using medical or job-related administrative data to define TBI. Furthermore, definitions and language regarding the injury were heterogeneous between studies, with some studies referring to TBI (with or without loss of consciousness) and others referring to concussion or head injury/trauma. Among law enforcement and corrections officers, the pooled prevalence of lifetime TBI was 58.8% (95% confidence interval [CI]: 48.0%-69.6%; I2 = 91.5%), and the proportion with job/career-related TBI was 17.2% (95% CI: 5.8%-28.6%; I2 = 97.2%). Firefighters were found to have high self-reported lifetime TBI prevalence (62%-77%), although data were limited. Emergency medical service data were sparse and largely restricted to administrative or event-related reports.</p><p><strong>Conclusion: </strong>Traumatic brain injury is common among first responders, but studies are heterogeneous. Standardized TBI definition, surveillance, routine screening, and longitudinal occupational health monitoring are needed to address cumulative injury risk and inform prevention and policy.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471055","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":"Brief Test of Adult Cognition by Telephone: Normative Comparison in a Diverse Traumatic Brain Injury Model Systems Sample.","authors":"Angelle M Sander, Shannon B Juengst, Robiann R Broomfield, Abdulaziz Bako, Robin Hanks, Tessa Hart, Alisha Janssen, Anthony H Lequerica, Paul B Perrin, Kelli Gary Talley","doi":"10.1097/HTR.0000000000001192","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001192","url":null,"abstract":"<p><strong>Objective: </strong>To investigate impairment rates on the Brief Test of Adult Cognition by Telephone (BTACT) domains and subtests by race/ethnicity, education, and primary language for individuals with moderate-to-severe traumatic brain injury (TBI) in the Traumatic Brain Injury Model Systems (TBIMS) national database.</p><p><strong>Setting: </strong>Secondary analysis of the TBIMS national database.</p><p><strong>Participants: </strong>A total of 2,981 adults with complicated-mild-to-severe TBI who completed all BTACT subtests at 1-year follow-up (Mage = 41.0 years; 27.1% Female; Meducation = 13.6 years; 63.5% White).</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Main measures: </strong>Brief Test of Adult Cognition by Telephone domain and subtest scores were standardized using combined Midlife Development in the US norms. Cognitive impairment was defined as scores ≤ -1.5 below the normative means. Impairment rates were compared across race/ethnicity, language of administration (Spanish versus English), and education. Logistic regression models evaluated the contribution of race/ethnicity, education, and language to impairment after controlling for variables that the normative data are stratified on (age, education, sex).</p><p><strong>Results: </strong>Participants who identified as Black, Hispanic, or multiracial were more likely to be classified as cognitively impaired on the BTACT domain scores and subtests. Individuals with ≤eighth grade education had higher impairment rates on recall and executive function measures. Spanish-language administration revealed increased odds of impairment on executive functioning tasks. Racial/ethnicity disparities in impairment persisted after adjustment for age, sex, and years of education.</p><p><strong>Conclusions: </strong>Findings indicate that BTACT normative data disproportionately classify those with lower education, racial/ethnic minority, and Spanish speakers as cognitively impaired. This can result in misinterpretation of disparities in cognitive outcomes and highlight the need for demographically representative normative data. Appropriate norms are critical for accurate assessment of cognitive outcomes and for the valid interpretation of the trajectories in diverse TBI populations.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Subjective-Objective Sleep Discrepancies Among Participants With Post-acute Moderate-to-Severe Traumatic Brain Injury Following Computerized Cognitive Behavioral Therapy for Insomnia.","authors":"Daniel J Reis, Molly J Sullan, Adam R Kinney, Susan M Mingils, Kelly A Stearns-Yoder, Lisa A Brenner","doi":"10.1097/HTR.0000000000001196","DOIUrl":"10.1097/HTR.0000000000001196","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate changes in subjective-objective sleep discrepancies among participants with insomnia and a history of moderate-to-severe traumatic brain injury (TBI) following computerized cognitive behavioral therapy for insomnia (cCBT-I).</p><p><strong>Setting: </strong>An outpatient setting at a Department of Veterans Affairs medical center.</p><p><strong>Participants: </strong>United States veterans between the ages of 18 and 60 years with current insomnia and a history of moderate-to-severe TBI ( N = 36).</p><p><strong>Design: </strong>A secondary analysis of intervention-arm data from a randomized controlled trial. Participants completed an online cCBT-I program called SleepEZ. The program was primarily self-guided, with adjunctive assistance provided by a study clinician.</p><p><strong>Main measures: </strong>Subjective sleep outcomes were measured using the Consensus Sleep Diary, which were collected nightly throughout the entire intervention. Objective sleep outcomes were measured using wrist-based actigraphy, which were collected during the initial and final weeks of the program. Subjective-objective sleep discrepancies were calculated for total sleep time (TST), sleep onset latency (SOL), waking after sleep onset (WASO), early morning awakening (EMA), and sleep efficiency. Measure agreement was estimated with Bland-Altman plots. Changes in subjective-objective sleep discrepancies were estimated through multilevel modeling.</p><p><strong>Results: </strong>Poor agreement was observed for all 4 sleep outcomes. At baseline, participants overreported SOL and EMA on sleep diaries. However, WASO was greatly underreported, resulting in higher TST values calculated using sleep diaries compared with actigraphy. Following cCBT-I, overreporting of SOL decreased and sleep efficiency discrepancies grew larger, driven by improvements in subjective, but not objective, sleep measures.</p><p><strong>Conclusion: </strong>The concurrent use of subjective and objective measures is recommended to fully capture sleep health when treating insomnia after moderate-to-severe TBI. Further research is needed to elucidate mechanisms contributing to subjective-objective sleep discrepancies-potentially including specific aspects of cognitive impairment, striatal hyperactivity, or sleep pressure homeostasis-which may inform novel targets for post-TBI insomnia treatments among those with more severe injuries.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437075","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":"Head Injuries and Mental Health in Law Enforcement and Corrections Officers: Results From a Statewide Survey.","authors":"Jaclyn B Caccese, Jeffrey J Wing, Carly R Smith, Nathan A Edwards, Thomas J Beach, Joshua Hagen, James A Onate","doi":"10.1097/HTR.0000000000001194","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001194","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the prevalence, mechanisms, and treatment of lifetime and duty-related head injuries (HIs) among law enforcement and corrections officers (LEOs), and their associations with mental health outcomes.</p><p><strong>Setting: </strong>Online survey (September 2024-March 2025).</p><p><strong>Participants: </strong>Two hundred ninety eight LEOs in Ohio (mean age = 43 ± 12 years; median 17 years of service; 18.2% military history).</p><p><strong>Design: </strong>Cross-sectional, anonymous survey.</p><p><strong>Main measures: </strong>HI history was assessed using the Ohio State University Traumatic Brain Injury (TBI) Identification Method. Mental health outcomes were assessed using the Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist-Civilian version (PCL-C), and Difficulties in Emotion Regulation Scale (DERS-16).</p><p><strong>Results: </strong>A high prevalence of HIs were reported: 64.1% of LEOs endorsed at least 1 lifetime HI and 28.3% reported at least 1 duty-related HI. Critically, these injuries were largely unaddressed, with 64.4% of lifetime HIs and 72.8% of duty-related HIs remaining undiagnosed or untreated. Common duty-related mechanisms included physical training (24.3%), fights (21.4%), falls (20.4%), blast exposure (18.5%), and vehicle incidents (15.3%). Significant mental health symptoms were prevalent, with 25.8% reporting mild, 14.2% moderate, and 7.8% moderately severe-to-severe depressive symptoms (PHQ-9); 17.4% screened positive for PTSD (PCL-C), and 14.7% reported difficulties with emotion regulation (DERS-16).</p><p><strong>Conclusions: </strong>Duty-related HIs were common, frequently untreated, and associated with adverse mental health outcomes. The absence of structured TBI recognition and return-to-duty protocols leaves LEOs vulnerable to reinjury, prolonged recovery, and reduced occupational readiness. These findings highlight the need for systematic TBI screening, occupational health supports, and implementation of tailored return-to-duty protocols to enhance recovery and improve workforce safety.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404953","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":"Unobserved Is Not Absent: Prehospital Response Intervals and Diagnostic Visibility in Mild Traumatic Brain Injury.","authors":"James English, Casey Gregor","doi":"10.1097/HTR.0000000000001193","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001193","url":null,"abstract":"<p><strong>Background: </strong>Mild traumatic brain injury diagnosis depends on observing transient neurological signs-loss of consciousness, altered mental status, and post-traumatic amnesia-that resolve within minutes. When clinical contact is delayed, these defining features may no longer be present for evaluation.</p><p><strong>Methods: </strong>We analyzed 167 082 head injury encounters from the 2024 National Emergency Medical Services Information System dataset. Using k-means clustering, we identified 3 response profiles based on call-to-patient intervals. National Emergency Medical Services Information System was used as system-level evidence regarding prehospital response interval distributions rather than for individual diagnostic adjudication. Diagnostic visibility was modeled as the probability that defining signs remained observable at first clinical contact, integrating empirically derived sign duration estimates with prehospital response interval distributions.</p><p><strong>Results: </strong>Combined diagnostic visibility declined from 0.93 in Near-Scene encounters (median 6.9 minutes) to 0.44 in Remote-Response encounters (median 19.3 minutes). Rural and frontier populations were disproportionately represented in the Remote-Response cluster, where modeling estimates indicate that in 56% of Remote-Response encounters, the probability of any observable defining sign at first clinical contact was zero. Convergent findings from the French OSCOUR emergency department database suggest that these timing constraints operate across healthcare systems.</p><p><strong>Conclusions: </strong>Diagnostic uncertainty in mild traumatic brain injury frequently reflects timing constraints rather than clinical failure. Aligning diagnostic frameworks with this reality supports structured retrospective reconstruction and addresses geographic inequities in diagnostic validity. Recognition of this constraint has direct implications for clinical guidelines, epidemiologic inference, and medicolegal interpretation.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391196","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":"A Comparative Evaluation of Two Telehealth Neurocognitive Assessments for Older Adults With and Without Traumatic Brain Injury in A Quasi-randomized Trial.","authors":"Amy M Kemp, Katy H O'Brien","doi":"10.1097/HTR.0000000000001121","DOIUrl":"10.1097/HTR.0000000000001121","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of the study was to investigate acceptable and appropriate testing modalities for older adults with and without traumatic brain injuries (TBI) and efficient service delivery models for clinicians.</p><p><strong>Setting: </strong>Two neurocognitive assessments were administered in telehealth settings to older adults with and without TBI.</p><p><strong>Participants: </strong>Forty-two older adults with no more than mild cognitive impairment, 21 with a history of TBI, and 21 without (aged 71.0 ± 4.45 years) were included. All adults with TBI were in chronic stages post-TBI (5-56 years).</p><p><strong>Design: </strong>Participants from a quasi-randomized self-management intervention study were enrolled in 2 visits. The first virtual visit included neurocognitive assessments. Assessment order was randomized, and intervention providers were blinded to the injury status.</p><p><strong>Main measures: </strong>The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) on the QInteractive platform and CNS Vital Signs (CNSVS). Both validated assessments provide a global cognitive score and subscales. Time to administer and qualitative clinical notes on participation, acceptance, and preference (patient and clinician) were also collected.</p><p><strong>Results: </strong>There was a positive correlation between RBANS and CNSVS, r = .710, P < .001, indicating that both assessments produced similar neurocognitive scores. Participants without TBI had higher global neurocognitive scores than participants with TBI across both RBANS ( t = -4.29, P = < .001) and CNSVS ( t = -2.97, P = .002). When examining subscale scores, CNSVS captured more differences in individual subscales than RBANS. The RBANS administration time (34.86 min, SD = 8.4) was longer than CNSVS (31.29 min, SD = 4.79), but did not differ across injury status (RBANS: t = 1.37, P = .179; CNSVS: t = -1.56, P = .127). Patient preference was unremarkable, and older adults were reported to participate well, but clinicians preferred CNSVS.</p><p><strong>Conclusion: </strong>Regardless of the assessment, both were acceptable and appropriate for older adults with and without TBI. However, CNSVS was preferred by clinicians and captured more differences, suggesting an increased sensitivity for evaluating neurocognition.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"277-287"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191610","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":"Examining the Sensitivity of the 2023 American Congress of Rehabilitation Medicine's Diagnostic Criteria for Mild Traumatic Brain Injury Using a Sport-Related Concussion Sample.","authors":"Avi N Albert, Anthony E Bishay, Olivia Shaffer, Kristen L Williams, Samuel Fitch, Scott L Zuckerman, Douglas P Terry","doi":"10.1097/HTR.0000000000001120","DOIUrl":"10.1097/HTR.0000000000001120","url":null,"abstract":"<p><strong>Objective: </strong>To (1) retrospectively apply the updated American Congress of Rehabilitation Medicine (ACRM) mild traumatic brain injury (mTBI) criteria to a cohort of high school athletes previously diagnosed with sport-related concussion (SRC) using prior clinical definitions, and (2) compare demographics, medical history, and recovery outcomes between those who met the full mTBI criteria versus those classified as suspected mTBI.</p><p><strong>Setting: </strong>Outpatient Specialty Concussion Clinic.</p><p><strong>Participants: </strong>In total, 181 concussed athletes aged 14 to 18 years were presented to clinic within 72 hours of injury. All were diagnosed with SRC by a certified athletic trainer or physician using the Concussion in Sport Group definition, which defines SRC as any traumatic blow to the head/body causing neurologic symptoms.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Main measures: </strong>Participants were classified as having a full or suspected mTBI based on the ACRM 2023 criteria. Full mTBIs required: (1) a plausible mechanism and either (2a) a clinical sign (eg, amnesia, loss of consciousness), or (2b) at least 2 symptoms plus a clinical examination finding. Suspected mTBIs had a plausible mechanism and at least 2 symptoms or at least 2 examination findings. Groups were compared across demographics, medical history, and recovery metrics (return-to-learn, symptom resolution, return-to-play).</p><p><strong>Results: </strong>Of the 181 patients (mean age 16.3 ± 1.3 years; 35.9% female), 114 (63.0%) met the definition for a full mTBI, whereas 67 (37.0%) had a suspected mTBI. Significant differences included higher rates of family migraine history (24.8% vs 7.7%, P = .019) and on-field evaluations (50.4% vs 38.5%, P < .001) in the full group. No significant differences in return-to-learn (median [Mdn]: 4.0 vs 3.0), symptom resolution (Mdn: 11.0 vs 12.5), or return-to-play (Mdn: 15.0 vs 14.5) were noted ( P > .05).</p><p><strong>Conclusion: </strong>Among high school athletes with SRC, most met the updated full ACRM mTBI criteria, with the rest meeting the suspected mTBI criteria. Results suggest high sensitivity for the ACRM definition for diverse concussion presentations.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"255-264"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191730","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":"Prevalence of Traumatic Brain Injury in Detained Youth: Associations With Aggression, Violent Charges, and Behavioral Infractions.","authors":"Rebecca L Griffith, Sarah Nowalis, Paula Fite, Maria Kajankova","doi":"10.1097/HTR.0000000000001139","DOIUrl":"10.1097/HTR.0000000000001139","url":null,"abstract":"<p><strong>Objective: </strong>Youth involved in the legal system have markedly higher exposure to traumatic brain injury (TBI), yet limited research has examined how TBI relates to specific behavioral outcomes in this population. This preregistered study estimated TBI prevalence in detained youth and investigated associations between TBI dimensions (severity, frequency) and aggression form (physical, verbal) and function (reactive, proactive), violent charges, and facility-recorded behavioral infractions.</p><p><strong>Setting: </strong>Two state-funded juvenile detention centers in the Midwest US.</p><p><strong>Participants: </strong>252 youth (80.95% male, ages 10-17) enrolled between 2022 and 2023.</p><p><strong>Design: </strong>Cross-sectional study of consecutively admitted youth.</p><p><strong>Main measures: </strong>TBI history was assessed via self-report, with severity indexed by loss of consciousness (LOC) duration (<30 minutes: mild; >30 minutes: moderate/severe). Youth also completed the Proactive and Reactive Aggression Questionnaire and the Buss-Perry Aggression Questionnaire, and facility records provided information on violent charges and behavioral infractions. Group differences were tested using chi-square tests, t tests, Welch's t tests, and Wilcoxon rank-sum tests, with a preregistered family-wise alpha of .01.</p><p><strong>Results: </strong>TBI prevalence was 42.06%, with 23.41% reporting multiple TBIs. Among those with TBI, 63% reported LOC, and 14 youth (13.21%) were classified as moderate/severe. Youth with any TBI reported significantly higher physical aggression (Cohen d = 0.46, P = .001). Associations with verbal aggression ( d = 0.25, P = .08) and reactive aggression ( d = 0.29, P = .02) trended in the same direction but did not meet the preregistered threshold, while proactive aggression showed no association ( r = 0.01, P = .83). No significant associations were found between TBI and violent legal charges or behavioral infractions.</p><p><strong>Conclusions: </strong>TBI is common among detained youth and is selectively associated with elevated physical aggression. Routine TBI screening at intake and interventions targeting impulse control and emotion regulation may improve outcomes for this high-risk population.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"307-316"},"PeriodicalIF":3.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708466","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}