Journal of Head Trauma Rehabilitation最新文献

{"title":"Behavioral Activation With Remote Technology for Emotional Distress Following Moderate-Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial.","authors":"Tessa Hart, Amanda Rabinowitz, Monica Vaccaro, Joshua Banks, Inna Chervoneva","doi":"10.1097/HTR.0000000000001072","DOIUrl":"10.1097/HTR.0000000000001072","url":null,"abstract":"<p><strong>Objective: </strong>Examine effects of 8-week Behavioral Activation (BA)-based treatment on emotional distress in moderate-severe traumatic brain injury (msTBI).</p><p><strong>Setting: </strong>Single TBI rehabilitation center.</p><p><strong>Participants: </strong>Sixty community-dwelling persons with msTBI sustained ≥6 months prior, with at least mild depression and/or anxiety but no suicidal ideation/ psychiatric instability.</p><p><strong>Design: </strong>Randomized controlled trial comparing 2 treatments: the BAT condition delivered in 8 sessions of BA (6 face-to-face, 2 phone) with ecological momentary assessment (EMA) and text reminders for increased activity; the INT condition, shown in a previous trial to be highly credible and mildly efficacious, used 1 face-to-face session plus 8 weeks of text reminders framed as implementation intentions for increased activity.</p><p><strong>Main measures: </strong>Global Severity Index of Brief Symptom Inventory-18 (BSI-18 GSI; primary outcome); secondary outcome measures of hypothesized BA mechanisms (environmental reward, activation); participation; and quality of life assessed at baseline, post-treatment, 2-month follow-up; Patient Global Impression of Change (PGIC) measured post-treatment.</p><p><strong>Results: </strong>Primary analysis revealed that BAT participants with higher baseline emotional distress had significantly greater improvement in distress (primary outcome) compared to INT participants at post-treatment; this response was attenuated at follow-up. Across distress levels, both measures of BA mechanism showed superior response to BAT at post-treatment and at follow-up. Other secondary outcomes did not differ significantly by treatment, although there was a trend for BAT participants to show more improved health-related quality of life. BAT participants reported significantly greater degree of meaningful change post-treatment (PGIC).</p><p><strong>Conclusions: </strong>Findings support a growing body of research suggesting that structured, theoretically based approaches to increasing activity linked to personal values can have substantial beneficial impact for many persons with chronic msTBI and emotional distress. Promising future directions include adapting the BAT treatment to remote delivery to improve its potential reach.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159560","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":"Video-Based Analysis of Suspected Concussions in Slap Fighting: Incidence and Characteristics.","authors":"Yavuz Lima, Ogün Köyağasıoğlu, Kerry Peek, Levend Karaçoban","doi":"10.1097/HTR.0000000000001071","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001071","url":null,"abstract":"<p><strong>Objective: </strong>Despite the high frequency of head impacts in slap fighting, little is known about suspected concussions in this sport. This study examined the frequency and characteristics of observable signs of suspected concussions in slap fighting among male athletes.</p><p><strong>Setting: </strong>Video-based analysis.</p><p><strong>Participants: </strong>Athletes who participated in official male power slap matches from January 1, 2023 to June 31, 2024.</p><p><strong>Design: </strong>Video footage of all official male power slap matches during the study period was retrospectively analyzed by 3 sports medicine specialists experienced in sports injuries.</p><p><strong>Main measures: </strong>The frequency, total number, and types of observable signs of suspected concussion, and whether the fight continued after signs of suspected concussion were observed.</p><p><strong>Results: </strong>A total of 115 fights (97.5%) during the study period were available for video review. Of these, 40 (38.4%) resulted in knockouts and 21 (18.3%) in technical knockouts. Observable signs of suspected concussion were observed in 79.1% of fights, averaging 1.41 concussion signs per fight, and 0.31 per slap. Forty-eight (52.7%) of the fights with signs of suspected concussion continued following observed concussion signs.</p><p><strong>Conclusion: </strong>The frequency, early identification, and management of suspected concussions in slap fighting should be prioritized, with further studies combining clinical assessments strongly recommended.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159592","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 Dyad Approach to Understanding Intimate Partner and Family Distress as Risk Factors for Poor Warfighter Brain Health Following Mild Traumatic Brain Injury in Military Couples.","authors":"Tracey A Brickell, Brian J Ivins, Megan M Wright, Jamie K Sullivan, Samantha M Baschenis, Kelly C Gillow, Louis M French, Rael T Lange","doi":"10.1097/HTR.0000000000001060","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001060","url":null,"abstract":"<p><strong>Objective: </strong>Using a dyadic approach with military couples, the current study examined family risk factors for chronic neurobehavioral symptoms in service members and veterans (SMVs) following a mild traumatic brain injury (MTBI).</p><p><strong>Setting: </strong>Military Treatment Facility.</p><p><strong>Participants: </strong>SMV (n = 122) and intimate partner (IPs, n = 122) dyads (N = 244).</p><p><strong>Design: </strong>Prospective cohort.</p><p><strong>Main measures: </strong>SMVs completed seven neurobehavioral outcome measures. Their intimate partners completed 12 health-related quality of life (HRQOL) risk factor measures. Both members of the dyad completed three family relationships risk factor measures.</p><p><strong>Results: </strong>The number of neurobehavioral measures that were clinically elevated (≥60 T) were summed and used to classify SMVs into three outcome groups: (1) None/Few Symptoms [0-1 elevated scores]; (2) Several Symptoms [2-3 elevated scores]; and (3) Many Symptoms [4-7 elevated scores]. SMVs in the Many Symptoms group had significantly higher scores on nine family risk factor measures compared to the None/Few Symptoms group, and seven family risk factor measures compared to the Several Symptoms group. The Several Symptoms group had higher scores on one risk factor measure compared to the None/Few Symptoms group. The largest effect sizes were found for the SMV family relationships risk factor measures. SMVs were 4.2 to 13.0 times more likely to have poor neurobehavioral outcomes when they had negative versus positive family relationships.</p><p><strong>Conclusion: </strong>An important and unique addition to the literature was the finding that a range of risk factors in the SMV's family environment were strongly associated with clinically elevated chronic neurobehavioral symptoms following an MTBI. The establishment of the Family Wellness Program within the Defense Intrepid Network will open the door for family wellness to have a long-term place in military TBI treatment programs as a holistic, family-centered interdisciplinary model of care for warfighter brain health and return to duty following a TBI, and healthy, resilient, and military ready families.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110958","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 Qualitative Study of Collegiate Student-Athlete Experiences of Recovery After Concussion.","authors":"Bernadette A D'Alonzo, Andrea L C Schneider, Anthony Erz, Christina L Master, Ian J Barnett, Roy H Hamilton, Douglas J Wiebe, Julia E Szymczak","doi":"10.1097/HTR.0000000000001067","DOIUrl":"10.1097/HTR.0000000000001067","url":null,"abstract":"<p><strong>Objective: </strong>Social and cultural dynamics surrounding expectations of athletes may influence recovery after sport-related concussion. Qualitative investigations narrowly focus on reporting, or specific age groups or sports. We explore how collegiate student-athletes experience concussion recovery; manage diagnosis, symptoms, and return-to-academics and return-to-play decision-making.</p><p><strong>Setting: </strong>Collegiate athletics at a large, private Division 1 University in Philadelphia, PA.</p><p><strong>Participants: </strong>Twenty-two varsity student-athletes who sustained a diagnosed sport-related concussion within 1 year from start of data collection (October 1, 2022) and progressed through the return-to-play protocol, inclusive of recently graduated alumni.</p><p><strong>Design: </strong>Qualitative interview study.</p><p><strong>Main measures: </strong>We conducted semi-structured interviews between October 2022 and May 2023 about how experience with concussion(s) shaped their perception of risk, reporting, recovery, and that of stakeholders (teammates, coaches, athletic trainers, family members). We analyzed interview data using the framework analysis method and created a post-injury-recovery-return model to summarize participant experiences in the context of these key moments over time.</p><p><strong>Results: </strong>Twenty-two student-athletes (women, 59.1%; White, 77.3%; 27.3% Sophomore year) representing 15 sports teams participated. The majority of respondents experienced at least 1 concussion prior to their varsity athletics concussion. Respondents reflected on 4 key moments in their experience recovering from a concussion: (1) immediately post-diagnosis, (2) during recovery, (3) decision-making about sport and academic return, and (4) return to sports and academics. We identified the importance of managing expectations, previous concussions, and emotions on recovery and return-to-academics and sport decision-making. We also found experiences were shaped by the social environment and key actors.</p><p><strong>Conclusions: </strong>Our findings indicate that experiences after concussion are influenced by factors including expectations for recovery, managing symptoms, and navigating decision-making, and by relationships and the social environment. Findings have implications for the way concussion is managed, and the design and application of new treatment and management guidelines for concussion. Future targeted work should investigate ways to explore and measure these factors.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Sex, Fatigue, and Post-Concussion Symptoms Differs Between Those With Mild Traumatic Brain Injury Versus Trauma Control and Healthy Control Participants.","authors":"Jacqueline F I Anderson, Amy S Jordan","doi":"10.1097/HTR.0000000000001066","DOIUrl":"10.1097/HTR.0000000000001066","url":null,"abstract":"<p><strong>Objective: </strong>Sex, fatigue and subjective sleep disruption have been shown to be associated with poor subjective recovery after mild traumatic brain injury (mTBI). This study aimed to determine whether the relationship between these factors and post-concussion symptom (PCS) reporting are unique to individuals who have incurred an mTBI. Setting, Participants, Design and Main Measures: In this observational study, a group of 208 pre-morbidly healthy adults was assessed with measures of fatigue (Multi-dimensional Fatigue Inventory), subjective sleep disturbance (Pittsburgh Sleep Quality Index), depression (Inventory of Depressive Symptomatology) and anxiety (Beck Anxiety Inventory) symptomatology, and PCS endorsement (Rivermead Post-Concussion Symptoms Questionnaire).</p><p><strong>Results: </strong>Individuals who were admitted to hospital approximately 8-weeks prior with systemic traumatic injury and mTBI (mTBI; n = 86) and with systemic traumatic injury without head injury (TC; n = 46) had equivalent and elevated levels of fatigue, subjective sleep disturbance and PCS endorsement relative to a healthy community-based control sample (HC; n = 76). Female sex ( P = .028) and an elevated sense of general tiredness ( P = .037) independently explained significant variance in global PCS endorsement in the mTBI group, but sex did not independently explain variance in PCS reporting in either control group. Psychological status was the only variable that independently explained variance in PCS reporting in all groups.</p><p><strong>Conclusions: </strong>This study indicates that the vulnerability of females to report elevated PCS in the post-acute period after traumatic injury is specific to those who have incurred a concomitant mTBI. Further, only some subcomponents of fatigue independently explain variance in PCS reporting, with the groups showing variability in these associations. Further work is needed to understand whether it is the \"biological\" and/or \"socio-environmental\" aspect of being female that increases the risk of higher PCS endorsement after mTBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093956","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":"Somatic Symptom Disorder After Mild Traumatic Brain Injury.","authors":"Noah D Silverberg, Mathilde Rioux, Ana Mikolić, David L Perez, Matthew J Burke, Andrew Howard","doi":"10.1097/HTR.0000000000001068","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001068","url":null,"abstract":"<p><strong>Objective: </strong>Mild traumatic brain injury (mTBI) may be a common precipitant of Somatic Symptom Disorder (SSD). This study examined the prevalence, correlates, predictors, and functional impact of SSD after mTBI.</p><p><strong>Setting: </strong>Follow up of patients recruited from emergency departments and urgent care centers.</p><p><strong>Participants: </strong>Adults with mTBI (N = 476).</p><p><strong>Design: </strong>Secondary analysis of a clinical trial (Clinicaltrials.gov NCT04704037).</p><p><strong>Main measures: </strong>Early illness beliefs (Illness Perceptions Questionnaire-Revised; IPQ-R) were assessed ~2 weeks after mTBI and outcomes were assessed at 6 months post-injury, including SSD symptoms (Somatic Symptom Disorder-B Criteria Scale; SSD-12), post-concussion symptoms (Rivermead Post Concussion Symptoms Questionnaire; RPQ), disability (World Health Organization Disability Assessment Schedule; WHODAS), and psychiatric diagnoses (MINI Neuropsychiatric Inventory). SSD diagnosis was operationalized as having persistent symptoms and SSD-12 ≥ 16 (≥23 in sensitivity analyses).</p><p><strong>Results: </strong>15-27% of the sample met criteria for SSD at 6 months post-injury. Participants with SSD reported more pain and post-concussion symptoms, and were more likely to have comorbid Major Depressive Disorder (OR = 9.1, 95% CI = 5.3, 16.2) and at least 1 anxiety disorder (OR = 5.6, 95% CI = 3.6-8.8) compared to those without SSD. Early illness beliefs, specifically that mTBI has serious life consequences (OR = 1.2, 95% CI = 1.1-1.3) and causes distress (OR = 1.1, 95% CI = 1.0-1.2), were associated with later SSD. SSD symptoms contributed to prediction of global functional disability (WHODAS) over and above post-concussion symptom severity (RPQ; ΔDeviance = 0.22, P < .001).</p><p><strong>Conclusions: </strong>SSD after mTBI is associated with an increased burden of symptoms, comorbidity, and disability. Early identification of at-risk patients appears feasible. SSD may be a useful framework for conceptualizing poor outcome from mTBI in patients with prominent psychological distress and guiding rehabilitation.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093955","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":"Boys Versus Girls Youth Sports Participation Risk for Mild Traumatic Brain Injury and Behavioral, Physical Health, and Neurocognitive Outcomes.","authors":"Wenjing Meng, Florin Vaida, Emily L Dennis, Elisabeth A Wilde, Joanna Jacobus, Xia Yang, Michael Cheng, Emily A Troyer, Everett L Delfel, Tracy Abildskov, John R Hesselink, Erin D Bigler, Jeffrey E Max","doi":"10.1097/HTR.0000000000001065","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001065","url":null,"abstract":"<p><strong>Objective: </strong>Investigate sex-related differences in mild traumatic brain injury (mTBI) risks due to sports among children aged 9 to 10 years and examine whether the benefits of sports participation, specifically in behavioral, neurocognitive, and psychiatric health, differ between boys and girls.</p><p><strong>Setting: </strong>The Adolescent Brain Cognitive Development study involves 21 sites across the United States. The data were collected through comprehensive evaluations including neuroimaging, cognitive tests, mental health evaluations, family and environmental factors, and genetic data.</p><p><strong>Participants: </strong>The study enrolled a cohort of 11 878 children ages 9 to 10 from years 2016 to 2018. A total of 11 055 children at baseline were analyzed.</p><p><strong>Design: </strong>The study is a cross-sectional analysis of the baseline data from an ongoing longitudinal cohort study.</p><p><strong>Main measures: </strong>Our primary outcome was children's lifetime mTBI (yes/no), with exposure as participation in 23 sports (yes/no). Confounders included age, race, parental income, parental education, internalizing and externalizing behaviors.</p><p><strong>Results: </strong>Among 11 055 children (5295 girls and 5760 boys) with complete data, 85% (n = 9423) had participated in sports. Among them, the risk of mTBI was higher among boys who played tennis versus girls who played tennis, with an adjusted odds ratio (aOR) = 2.353 (95% confidence interval [CI]: 1.072, 5.606), P = .032; the risk of mTBI was lower among boys who participated in swimming/water polo versus girls who participated in swimming/water polo, aOR = 0.618 (95% CI: 0.399, 0.955), P = .030.</p><p><strong>Conclusion: </strong>The association between sports participation and mTBI risks differs by sex for certain sports. Compared to girls, boys had a higher mTBI risk in tennis but a lower mTBI risk in swimming/water polo. This indicates that implementing sex-specific strategies to mitigate mTBI risks in sports participation could be beneficial.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996626","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":"Characterizing Intimate Partner Violence-Related Head Trauma in Community-Recruited Women.","authors":"Carrie Esopenko, Divya Jain, Amelia J Hicks, Emily Carter, Ella Carlsson, Andrew Cwiek, Katherine Dorman, Adriana P Méndez-Fernández, Emma N Read, Elizabeth Rebuck, Philine Rojczyk, Carmen Velez, Inga K Koerte, Alexander P Lin, David F Tate, Frank G Hillary, Elisabeth A Wilde, Amy D Marshall","doi":"10.1097/HTR.0000000000001062","DOIUrl":"10.1097/HTR.0000000000001062","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to characterize the experiences of intimate partner violence (IPV)-related head trauma (HT) among cisgender women.</p><p><strong>Setting: </strong>Three geographic regions across the United States.</p><p><strong>Participants: </strong>Seventy-two cisgender women aged 18 to 60 years (mean age = 39.6 years).</p><p><strong>Design: </strong>In-depth semi-structured interviews.</p><p><strong>Main measures: </strong>Participants completed a semi-structured interview, which was audio-recorded to determine the number and mechanisms of IPV-HT injuries experienced over their lifetime. Quotes from interview transcriptions were used to illustrate how participants describe their IPV-HT episodes.</p><p><strong>Results: </strong>A total of 69/72 cisgender women reported at least 1 injury episode that involved IPV-HT. Participants reported between 1 and 9 injury episodes that involved HT during their lifetimes. Participants reported a total of 240 injury episodes, of which 186 represented a single, isolated injury, while 54 were a repetitive exposure by the same mechanism(s) of injury over time. The time over which an injury episode was repeated ranged from 1 month to 16 years (mean: 4.72 years, standard deviation: 4.70 years). The most frequent mechanisms of injury were blunt force trauma (41.7%) and strangulation (22.1%), while 22.5% of episodes involved multiple mechanisms. The most common within-person overlap of mechanisms was blunt force trauma and strangulation (n = 21, 31%). The interview quotes demonstrated that the true frequency of IPV-HT may be unknown and/or unable to be recalled, highlighting the challenges in capturing accurate IPV-HT exposure within this population even through in-depth interviews.</p><p><strong>Conclusions: </strong>This study provides important information on the experience of HT among women with exposure to IPV. Such findings may improve our ability to characterize and understand the injuries resulting from IPV among women, which may, in turn, benefit existing tools for determining experiences of IPV-HT and probable brain injury.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983478","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":"Internalized Disability Stigma Among People Living With Chronic Traumatic Brain Injury.","authors":"Umesh M Venkatesan, Shannon B Juengst, Lauren Krasucki, McKenzie Buszkiewic","doi":"10.1097/HTR.0000000000001063","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001063","url":null,"abstract":"<p><strong>Objective: </strong>Qualitative evidence suggests that disability stigma is an important concept in the lived experiences of individuals with traumatic brain injury (TBI). However, there have been no studies in this population specifically evaluating internalized disability stigma. We sought to characterize variability in levels of internalized stigma and examine the applicability of the \"why try\" effect (reduced self-efficacy and life goal attainment as consequences of internalized stigma) to people living with chronic TBI.</p><p><strong>Setting: </strong>Outpatient research laboratory.</p><p><strong>Participants: </strong>Eighty-four adults with chronic TBI (1.4-22.6 years post-injury).</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Main measures: </strong>Items were adapted from the Internalized Stigma of Mental Illness questionnaire to capture disability-related internalized stigma and perceived discrimination. Primary outcome measures included societal participation and self-efficacy for TBI symptom management, which were assessed using validated instruments (Participation Assessment with Recombined Tools-Objective and TBI Self-Efficacy Scale, respectively).</p><p><strong>Results: </strong>Raw and residualized (adjusted for perceived discrimination) internalized stigma scores were normally distributed. Individuals who reported internalized stigma at levels greater than predicted by their perceived discrimination tended to have more recent injuries (d = .60) and poorer processing speed (d = .50) compared to those reporting relatively lower internalized stigma. Higher internalized stigma was associated with lower self-efficacy, which, in turn, was associated with lower societal participation (indirect effect = - .26, 95% CI = [-.50, - .09]), independent of mental health symptoms.</p><p><strong>Conclusions: </strong>Findings provide preliminary support for clinically meaningful variability in internalized stigma among people with TBI, and for the applicability of the \"why try\" model to this population. Further theory-informed research could stimulate the development of behavioral health interventions for reducing stigma internalization and its harmful effects on post-injury psychosocial functioning.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024959","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":"Identifying the Influence of Lung-Related Injuries and Other Factors on Delirium in Traumatic Brain Injury Patients: A National Analysis.","authors":"Jordan Shin, Jeffry Nahmias, Patrick Chen, Jefferson Chen, Michael Lekawa, Lily Nguyen, Areg Grigorian","doi":"10.1097/HTR.0000000000000992","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000992","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a known risk factor for delirium, a condition associated with prolonged hospitalization and cognitive deterioration. Although the relationship between TBI and delirium is established, the influence of traumatic lung injuries on delirium development is less understood. Respiratory disorders can significantly influence the central nervous system, with sequelae such as hypoxia and hypercapnia causing neurologic dysfunction. Therefore, we hypothesized that TBI patients suffering lung-associated conditions, stemming either from traumatic lung injury (TLI) or subsequent pulmonary surgery will be associated with an increased risk of developing delirium.</p><p><strong>Methods: </strong>The 2021 Trauma Quality Improvement Program database was queried for patients with TBI, excluding those with pre-existing dementia. TBI patients developing delirium were compared to those without delirium. A multivariable logistic regression analysis was performed to determine pulmonary and neurogenic-associated risk factors for delirium.</p><p><strong>Results: </strong>Among 155,252 TBI patients, 3244 (2.1%) developed delirium. Delirium-afflicted patients showed elevated rates of TLI (25.0% vs 13.3%, p < .001), severe head trauma (51.4% vs 37.8%, p < .001), sepsis (3.1% vs 0.5%, p < .001) and more commonly underwent pulmonary operations (21.8% vs 6.6%, p < .001). The strongest associated risk factors for delirium included unplanned intubation (OR 2.79, CI 2.47-3.16, p < .001), pulmonary surgery (OR 1.47, CI 1.32-1.63, p < .001), COPD (OR 1.52, CI 1.34-1.72, p < .001), TLI (OR 1.25, CI 1.14-1.38, p < .001), and severe head injury (OR 1.12, CI 1.04-1.22, p = .003).</p><p><strong>Conclusion: </strong>Delirium affects approximately 2% of the national TBI population. Our study reveals an influence of lung-related conditions for delirium onset. These results emphasize the intimate relationship of the brain and pulmonary system. Future prospective studies are needed to validate these findings as they may impact TBI management and outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996867","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}