Journal of neurotrauma最新文献

{"title":"Machine Learning in Traumatic Brain Injury: Dynamic Prediction from Continuous Physiological Monitoring and ICU Data.","authors":"Marcus Roland Victor Gustafsson, Tomasz Benedykt Kuliński, David Bark, Andre Wyzykowski, Elham Rostami","doi":"10.1177/08977151261486820","DOIUrl":"https://doi.org/10.1177/08977151261486820","url":null,"abstract":"<p><strong>Background: </strong>Continuous physiological monitoring in neurocritical care generates large volumes of high-frequency time-series data that remain underutilized in routine traumatic brain injury (TBI) management. Machine learning (ML) approaches applied to these data have emerged as a promising strategy for dynamic prediction of secondary brain injury and individualized clinical decision support.</p><p><strong>Methods: </strong>This narrative review summarizes current ML applications based on continuous physiological monitoring in TBI and related neurocritical care populations. A structured PubMed search supplemented by manual reference screening identified studies published through January 2026. Included studies applied ML methods to continuously acquired physiological signals such as intracranial pressure (ICP), arterial blood pressure (ABP), cerebral perfusion pressure (CPP), and related intensive care unit data.</p><p><strong>Results: </strong>Thirty-four studies were identified, of which 26 met core inclusion criteria focused on continuous physiological monitoring. The most common applications were prediction of intracranial hypertension events, mortality, and functional outcome. Fewer studies addressed arterial hypotension prediction or unsupervised clustering approaches. Recent work demonstrates a transition from static admission-based prognostic models toward dynamic prediction using continuously updated physiological data. Deep learning architectures, including recurrent neural networks and transformers, were increasingly used for high-resolution time-series analysis. However, substantial heterogeneity exists in study design, preprocessing methods, prediction targets, and validation strategies. Most studies relied on retrospective observational data and internal validation, while prospective evaluation and workflow-integrated implementation remain limited.</p><p><strong>Conclusion: </strong>ML approaches using continuous physiological monitoring show significant potential for dynamic prediction and decision support in TBI care. Future progress will depend on multicenter external validation, standardized methodological frameworks, prospective evaluation, and integration into real-time neurocritical care workflows.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261486820"},"PeriodicalIF":3.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations for Mesenchymal Stem Cell-Derived Small Extracellular Vesicle-Based Clinical Treatment of Spinal Cord Injury.","authors":"Karen L Lankford, Masahito Nakazaki, Ryosuke Hirota, Jeffery D Kocsis","doi":"10.1177/08977151261483981","DOIUrl":"https://doi.org/10.1177/08977151261483981","url":null,"abstract":"<p><p>A large body of animal studies across multiple laboratories has found that a subset of small extracellular vesicles (sEVs) derived from mesenchymal stromal cells (MSC-sEVs) referred to as exosomes can improve functional recovery after spinal cord injury (SCI). Sufficient pre-clinical data have been accumulated to consider how MSC-sEVs might be used clinically for the treatment of SCI. This review discusses: (1) the SCI patient population which may benefit from MSC-sEVs treatments, (2) potential sources of MSCs for production of clinically useful MSC-sEVs, (3) dosaging of MSC-sEVs required for therapeutic efficacy, (4) timing and method of delivery of the sEVs, (5) cell targets of MSC-sEVs and their mechanism of action, (6) possible protocols for producing clinically useful quantities of MSC-sEVs, and (7) the criteria for evaluating an MSC-sEVs treatment product. We conclude with some thoughts about potential protocols for clinical trials of MSC-sEVs treatment for SCI.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261483981"},"PeriodicalIF":3.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Younger Age of First Exposure to American Football Is Associated with Worse Informant-Reported Clinical Outcomes in Older Age Brain Donors.","authors":"Sophia B Nosek, Stephanie Gonzalez Gil, Bobak Abdolmohammadi, Rachael Layden, Christopher J Nowinski, Yorghos Tripodis, Brett M Martin, Joseph N Palmisano, Alcy Torres, Brigid C Dwyer, Doug I Katz, Lee E Goldstein, Robert C Cantu, Robert A Stern, Thor D Stein, Ann C McKee, Jesse Mez, Michael L Alosco, Daniel H Daneshvar","doi":"10.1177/08977151261424707","DOIUrl":"10.1177/08977151261424707","url":null,"abstract":"<p><p>Although the younger age of first exposure (AFE) to American football has not been associated with neurodegenerative pathology, AFE has been associated with clinical symptoms. However, the literature is mixed. We examined the association between AFE to football and clinical outcomes before and after age 60 at death, to isolate the potential role of decreased neuropathological resilience in older age. This study included 677 deceased male football players who donated their brains to the Understanding Neurologic Injury and Traumatic Encephalopathy Brain Bank. Informants completed modified scales assessing cognition, function, behavior, and neuropsychiatric features with dementia adjudicated through consensus conferences. Regressions tested the association between AFE and dementia, chronic traumatic encephalopathy (CTE) pathology, and each scale, adjusted for multiple testing. Analyses were stratified by age 60, adjusting for age at death, duration of play, and neuropathology. Most donors (mean age = 60.9, standard deviation = 19.8) played college or professional football (<i>n</i> = 509, 76%). CTE was the most prevalent neuropathology (<i>n</i> = 471, 70%). AFE was not associated with neurodegenerative disease pathology. Among those older than 60 at death, younger AFE was associated with cognitive composite score impairment (odds ratio: 0.897, 95% confidence interval [CI]: 0.814-0.988, <i>p</i> = 0.027) and worse cognitive (beta: 0.04, 95% CI: 0.01-0.069, <i>p</i> = 0.009), neurobehavioral (beta: 0.032, 95% CI: 0.002-0.062, <i>p</i> = 0.035), and neuropsychiatric (beta: 0.032, 95% CI: 0.00-0.064, <i>p</i> = 0.048) composite scores. Younger AFE was only associated with worse informant-reported clinical outcomes in older deceased football players, independent of neurodegeneration. Our findings offer a potential explanation for the mixed literature on AFE and clinical outcomes. The effects of AFE may only manifest in older adults when cognitive reserve is depleted, neuropathological resilience is reduced, or age-related vulnerabilities interact with prior head injury exposure, worsening clinical outcomes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1456-1470"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Individualized Intracranial Pressure Thresholds and Long-Term Outcomes in Moderate-to-Severe TBI: A CAHR-TBI Multicenter Study.","authors":"Kevin Y Stein, Donald Griesdale, Mypinder Sekhon, Francis Bernard, Clare Gallagher, Eric P Thelin, Rahul Raj, Marcel Aries, Logan Froese, Francois Mathieu, Andreas Kramer, Frederick A Zeiler","doi":"10.1177/08977151261481325","DOIUrl":"https://doi.org/10.1177/08977151261481325","url":null,"abstract":"<p><p>Current neurocritical care relies on fixed, population-based intracranial pressure (ICP) thresholds, which fail to account for inter-individual variability or the dynamic nature of cerebral physiology. Individualized ICP (iICP) thresholds have emerged as a potential personalized alternative but have largely relied on complete recording periods, limiting their derivation to post-hoc calculations and preventing continuous real-time estimation. Recently, a novel algorithm capable of continuously deriving iICP was developed; however, this algorithm has not yet been validated beyond a single-center cohort, and its prognostic utility remains uncertain. Therefore, the goals of this study were to externally validate the performance of this continuous iICP algorithm and to evaluate the prognostic utility of continuously derived iICP compared with current guideline-based ICP thresholds. A retrospective multicenter study was conducted using high-resolution physiologic datasets from the CAHR-TBI collaborative. iICP was derived using the recently developed continuous iICP algorithm. Algorithm performance was externally validated by assessing derivation yields and associated quality metrics and comparing with those reported in the original study that introduced the algorithm. Outcome associations were evaluated using mean hourly dose of ICP above iICP and guideline-based thresholds. Logistic regression models were used to assess and compare prognostic performance, with discrimination quantified using optimism-corrected area under the receiver operating characteristic curve and added predictive value assessed using Nagelkerke's R2. Finally, intensity-duration heatmaps were generated to characterize the relationship between iICP-based insult burden and clinical outcomes. The continuous iICP algorithm demonstrated consistent performance across parameter settings compared with the original study, supporting its external validity. Select hybrid iICP configurations, defaulting to 20 mmHg or 22 mmHg during periods where iICP could not be identified, outperformed guideline-based ICP thresholds in prognostic models. Heatmap analyses demonstrated a graded relationship between iICP-defined insult burden and outcome, with greater burden of ICP above iICP associated with poorer outcomes. Overall, iICP represents a promising adjunct to conventional guideline-based ICP management in neurocritical care. The findings of this study suggest potential clinical benefit from iICP-supplemented ICP management; however, prospective randomized controlled trials will be required to determine whether such an approach translates into meaningful improvements in patient outcomes.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"8977151261481325"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral Deficits and Cortical Network Dysfunction Following Repeated Mild Traumatic Brain Injuries.","authors":"Natalie J Pinkowski, Brandi R Hess, Johann M Pacheco, Devon S Hatcher, Myah McDonald, Adrienne N Swindle, Raycarlo Laboy Ramirez, Matthew Situ, Taha Abdeljawad, Carissa J Mehos, Andrew R Mayer, Sam McKenzie, Russell A Morton","doi":"10.1177/08977151261425217","DOIUrl":"10.1177/08977151261425217","url":null,"abstract":"<p><p>Mild traumatic brain injury (mTBI) is a prevalent health concern, with more than 2.5 million cases occurring annually in the United States. Acute signs and symptoms of mTBIs may involve physical symptoms, as well as emotional, cognitive, and sleep-related issues. The underlying mechanisms of these symptoms remain elusive. Here, we describe that repeated closed skull mTBIs in mice are associated with acute behavioral deficits. We found that optogenetic-induced spreading depolarizations (SDs) are associated with similar behavioral deficits. Using <i>in vivo</i> electrophysiology, we confirmed the depression of cortical network activity following optogenetic-induced SDs. The timing of the high-frequency activity recovery coincided with the recovery of voluntary movement. Following the depression, there was a prolonged period of increased power in low frequencies (<30 Hz). Cortical dysfunction coincided temporally with motor behavioral deficits in the neurological severity score tasks. Our study provides evidence that repeated mTBIs or SDs are associated with worse behavioral deficits.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1506-1519"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147457920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Relationship Between Self-Reported and Performance-Based Cognitive Functioning in Women Experiencing Intimate Partner Violence.","authors":"McKenna S Sakamoto, Douglas P Terry, Eve M Valera","doi":"10.1177/08977151261430297","DOIUrl":"10.1177/08977151261430297","url":null,"abstract":"<p><p>Women who experience intimate partner violence (IPV) are highly susceptible to sustaining mild traumatic and hypoxic/anoxic brain injuries (mBIs), yet the cognitive and neurobehavioral consequences of IPV-mBI remain understudied. The current study examined the relationships between self-reported cognitive functioning and IPV-related mBI scores on neuropsychological test performance in women who experienced physical IPV. Participants included 48 women recruited from women's shelters and community health programs. All participants completed a neuropsychological battery, clinical interviews, and self-report questionnaires. Performance-based cognitive functioning was assessed through normed <i>z</i>-scores from six indices of neuropsychological tests of memory, learning, and cognitive flexibility. A cognitive composite score was also generated from all six indices. Self-reported cognitive functioning was measured using the cognitive subscale of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ-Cog), and an IPV-mBI frequency and recency score was calculated using the Brain Injury Severity Assessment (BISA). RPQ-Cog scores, BISA scores, and their interaction were entered into distinct hierarchical linear regressions with neuropsychological indices as the dependent variables. All analyses controlled for sociodemographic and psychological health variables that were significantly associated with neuropsychological test performance. There was a significant main effect of self-reported cognitive functioning on tests of immediate verbal memory (<i>t(</i>43) = -2.55, <i>p</i> = 0.015, 95% confidence interval [CI] [-0.50,-0.06]) and planning and initiation (<i>t(</i>42) = -2.03, <i>p</i> = 0.049, 95% CI: [-0.17,0.00]). There was a significant main effect of the IPV-mBI severity score on a test of cognitive switching (<i>t(</i>43) = -2.27, <i>p</i> = 0.029, 95% CI: [-0.78,-0.05]) and the global cognitive composite score (<i>t(</i>43) = -2.42, <i>p</i> = 0.020, 95% CI: [-0.36,-0.03]). There were no significant interactions between the RPQ-Cog scores and BISA scores on neuropsychological test performance. We found that among women who have experienced IPV, both self-reported cognitive problems and IPV-mBI history are independently related to poorer performance on neuropsychological tests. While further research is necessary, our findings suggest that women who have experienced physical IPV and endorse cognitive neurobehavioral symptoms or a history of IPV-mBI may benefit from comprehensive neuropsychological services to guide clinical care. Our findings also attest to the importance of developing screening measures for IPV-mBI history and ongoing neurobehavioral symptoms and implementing these measures in clinical settings.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1412-1422"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Nonsurgical Critical Resuscitative Interventions on Mortality and Neurological Outcomes in Isolated Moderate-to-Severe Traumatic Brain Injury in a Resource-Limited Health System.","authors":"Chelsea Dymond, Mengli Xiao, Julia Dixon, Lani Finck, Hendrick Lategan, Adriaan Vlok, George Oosthuizen, Shaheem de Vries, Craig Wylie, Janette Verster, Jakob Gamboa, Steven G Schauer, Bradley Dengler, Nee-Kofi Mould-Millman","doi":"10.1177/08977151261427265","DOIUrl":"10.1177/08977151261427265","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) accounts for approximately 2.5 million deaths yearly, with patients living in low- and middle-income countries disproportionally affected. Nonsurgical critical resuscitation interventions (nsCRIs) studied individually have been shown to improve outcomes in moderate-to-severe TBI (msTBI) patients. This cohort study primarily assesses the relationship between timeliness of delivery of grouped nsCRIs and all-cause 7-day mortality among blunt and/or penetrating isolated msTBI patients, with secondary objectives of 3- and 30-day mortality and discharge Glasgow Coma Scale (GCS). Adult trauma patients with isolated msTBI from January 2022 to December 2024 were enrolled from facilities in a trauma referral pathway in the Western Cape of South Africa. Cohort patients were categorized into treatment subgroups of those receiving nsCRI ≤1 h or nsCRI within 1-3 h; the reference group was receiving nsCRI >3 h from injury or missed nsCRIs. Inverse probability weighted Cox proportional hazard regression was used to model mortality outcome. Subgroup and sensitivity analyses were performed. Of the 507 patients within the cohort, 68.6% of patients had blunt injuries, and one-half had severe TBI. 21.7% of all msTBI patients died within 3 days, 27.6% deceased by 7 days, and 31.2% deceased within 30 days. There was a 26% (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.56, 0.98) 7-day mortality reduction among patients who received nsCRIs ≤1 h compared with the reference group. The subgroup of blunt and blunt with penetrating injured patients showed a 21% 7-day mortality benefit (HR = 0.79, 95% CI: 0.71, 0.88) and better discharge GCS categories among patients receiving timely nsCRIs (odds ratio = 1.79; 95% CI: 1.01, 3.19). Among severe TBI patients, there was a 29% 7-day mortality reduction in the nsCRI ≤1 h compared with >3 h or missed nsCRI (HR = 0.71, 95% CI: 0.5, 1.00). While those statistically significant subgroup findings should be interpreted with caution and several subgroup analyses did not show statistical significance, there was an overall trend towards survival benefit associated with nsCRIs at either ≤1 h and/or 1-3 h. Overall, in this cohort study of msTBI patients receiving care in a resource-limited trauma system, we found that nsCRIs delivered within 3 h were associated with improved 7-day mortality and neurological outcomes at discharge.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1483-1493"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evaluation of Aeromedical Evacuation Strategies Following Traumatic Brain Injury and Severe Blood Loss.","authors":"Andrew R Mayer, Amy Lloyd, Harm J van der Horn, Ciara S Grunig, Laura Kroening, Jessica R McQuaid, Samuel Miller, Tracey V Wick, Divyasree Sasi Kumar, Kristin E Connors, Carissa J Mehos Milliken, Vadim Zotev, Koen Visser, Mandy K Pacheco, Nicholas J Michaliszyn, Jingshu Wu, Andrew P Carlson, Andrew P Gigliotti, Denis E Bragin, Harry van Goor, Kaitlyn Warren, Rebekah Mannix, Joukje van der Naalt, Rachel Kinsler","doi":"10.1177/08977151261424703","DOIUrl":"10.1177/08977151261424703","url":null,"abstract":"<p><p>Individuals experiencing severe polytrauma are typically transported to the highest level of care as soon as possible, including helicopter evacuation from remote and/or rural environments. However, several recent preclinical and clinical studies have suggested that aeromedical evacuation exacerbates central nervous system injury and inflammation, and potentially results in increased mortality, questioning the right time and conditions under which to fly. Twenty-four swine with moderate-to-severe rotational traumatic brain injury (TBI) and ∼40% blood loss were randomly assigned to standard (∼8500 feet), tactical (evasive maneuvering), or mock (stationary on ground) helicopter (U.S. Army Black Hawk; HH-60M model) evacuation 2 h post-injury, with standard recommended therapies initiated in-flight. Results indicated that tactical evacuation was associated with increased cerebral perfusion pressure and inflammation (IL-6) post-flight relative to the standard and mock evacuation profiles, even after statistically controlling for pre-flight trauma procedures. Although the overall mortality rate was ∼25%, indicating severe polytrauma, no differences in mortality were observed as a function of aeromedical evacuation scenarios. Primary biomarkers of hemorrhagic shock, traumatic brain injury, lung and kidney pathology were also negative for aeromedical evacuation effects. In summary, the medical benefits associated with immediate (i.e., within a few hours of injury) helicopter evacuation of severe polytrauma patients likely outweigh the few increased complications associated with flight, as the latter may only be present during more extreme helicopter evacuation scenarios. Additional studies are needed to address potential adjunctive therapies that can be administered pre-flight to minimize the potential adverse effects of tactical flight.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1494-1505"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patient Experience of Acute and Post-Acute Care for Mild Traumatic Brain Injury: A Qualitative Phenomenological Study Using Focus Groups.","authors":"Scott W Hamilton, Alan Hamilton, Moriah Cogan, Michael McCrea, Amy J Markowitz, David O Okonkwo, Geoffrey T Manley, Joseph T Giacino, Flora M Hammond","doi":"10.1177/08977151261425221","DOIUrl":"10.1177/08977151261425221","url":null,"abstract":"<p><p>Follow-up care for traumatic brain injury (TBI) in the United States ranges from inconsistent, at best, to non-existent most predominantly. The present study aimed to gather patient perspectives on acute and post-acute TBI care using a phenomenological approach guided by the Patient Experience Framework, Chronic Care Model, and Health Literacy Framework. Using a pre-defined, semi-structured interview guide, including four groups of 35 diverse people diagnosed by a medical provider with \"mild\" TBI within 24 months, the study qualitatively explored their patient care experience, the care they received, and the care they felt they needed. Participants were 57% male, 43% female, 59% Caucasian, 28% African American, and 13% Latino, with a mean age of 43 years (range: 24-67). Four interconnected themes emerged representing critical failure points in the patient experience continuum: (1) foundational knowledge deficits that created barriers to care engagement; (2) critical touchpoint failures in acute care that minimized injury significance; (3) care transition failures and educational inadequacy during discharge; and (4) absence of longitudinal care and support systems. Participants possessed minimal brain injury knowledge and held fatalistic beliefs about recovery. Health care interactions consistently minimized TBI significance, with the term \"concussion\" conveying insignificance. Discharge occurred when cognitive capacity was most compromised, representing failed transitions rather than effective handoffs. Follow-up care was virtually absent, leaving participants to navigate complex symptom patterns without professional guidance. Psychological trauma remained unaddressed, and community support emerged as a critical unmet need. Current TBI care delivery fails patients at multiple touchpoints across the care continuum. When interpreted through established theoretical frameworks, these failures represent systemic breakdowns requiring comprehensive solutions rather than isolated improvements. Effective TBI care requires reframing TBI, including mild TBI, as a chronic condition that may require sustained support, implementing systematic education approaches that account for cognitive impairments, providing proactive follow-up care, and addressing the full spectrum of patient experience challenges including psychological sequelae and community support needs.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1471-1482"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetitive Mild Traumatic Brain Injury Causes Neuronal Damage in the APP/PS1 Mouse Model of Alzheimer's Disease Without an Enduring Impact on Amyloid Pathology, Sleep, or Epileptiform Activity.","authors":"Jefferey Yue, Victoria Carriquiriborde, Wai Hang Cheng, Taha Yildirim, Jianjia Fan, Sean Tok, Michael L Kelly, Cheryl L Wellington, Brianne A Kent","doi":"10.1177/08977151261430301","DOIUrl":"10.1177/08977151261430301","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a known risk factor for Alzheimer's disease and related neurodegenerative diseases. Sleep disturbances and epileptiform abnormalities can appear after TBI and may contribute to the development of neuropathology. In this study, we characterized sleep, epileptiform activity, and neuropathology after repetitive mild traumatic brain injury (rmTBI) in a mouse model of Alzheimer's disease. We used the Closed Head Impact Model of Engineered Rotational Acceleration to deliver rmTBI or sham (control) treatment to 6-month-old APP/PS1 mice (<i>N</i> = 19). One month post-injury, we implanted electroencephalogram and electromyographic electrodes, recorded for 72 h, and then collected brain tissue and blood plasma. Our assessment of sleep architecture showed that time spent in vigilance state was not affected by the rmTBI 1 month post-injury; however, power spectra analysis showed a shift toward higher frequencies in the rmTBI group during non-rapid eye movement sleep. Epileptiform activity did not differ between sham and rmTBI. Compared with sham controls, the rmTBI group showed higher neurofilament light (NF-L), but not glial fibrillary acidic protein in blood plasma and no change in Aβ pathology. These results indicate sustained neurological injury in the APP/PS1 mice 1 month after rmTBI without affecting amyloid deposition in the brain. Our study suggests that rmTBI can induce neural injury without causing enduring sleep disruption, seizures, and exacerbation of amyloidosis in the APP/PS1 mouse model.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1520-1534"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}