Brain injury最新文献

{"title":"Immediate vs delayed concussion reporting: role of concussion knowledge, attitudes, and symptoms.","authors":"Thomas A Buckley, Scott W Passalugo, Caitlin A Gallo, Barry Bodt, Kelsey M Evans, Barry A Munkasy","doi":"10.1080/02699052.2026.2696033","DOIUrl":"10.1080/02699052.2026.2696033","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to identify if concussion knowledge and attitude scores differed between collegiate student-athletes with immediate or delayed concussion reporting.</p><p><strong>Methods: </strong>There were 67 student-athletes who were divided into 'Immediate' (<i>N</i> = 35) and 'Delayed' (<i>N</i> = 32) reporting of non-obvious concussions. Participants completed the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) questionnaire, which is composed of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. Groups were compared with a pooled two-sample t test, and a binary logistic regression was performed with three predictors (CKI, CAI, Symptoms).</p><p><strong>Results: </strong>There were no group differences for CKI Score (Immediate: 20.2 ± 2.9 vs Delayed: 19.8 ± 2.5; t(65) = 0.68, <i>p</i> = 0.501, d = 0.17), but the Delayed group had a significantly higher CAI score (Immediate: 51.9 ± 6.8 vs Delayed: 55.8 ± 9.1, t(65) = -2.00, <i>p</i> = 0.050, d = -0.49). Higher CKI (OR: 1.31, 95% CI [1.03, 1.75]) and Symptoms (OR: 1.05, 95% CI [1.00, 1.09]) increased the unit odds of Immediate report, but higher (safer) CAI had lower unit odds of Immediate report (OR: 0.89, 95% CI [0.79, 0.98]).</p><p><strong>Conclusion: </strong>Concussion reporting remains a complex process which likely includes intrinsic (i.e. knowledge and attitude) factors, non-modifiable factors (e.g. symptoms), and environmental factors which challenges sports medicine clinician's ability to increase athlete's self-report of potential concussions.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"927-934"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between growth hormone deficiency and quality of life after traumatic brain injury: a case-control study.","authors":"Mason Nelson, Ramzi Badra, Brooke Scardina, Varun Mishra, Taylor P van Doren, Melissa Martinez, Justin L Weppner","doi":"10.1080/02699052.2026.2702961","DOIUrl":"10.1080/02699052.2026.2702961","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) is a leading cause of long-term disability. Post-traumatic hypopituitarism, particularly growth hormone deficiency (GHD), is an increasingly recognized yet frequently underdiagnosed sequela of moderate-to-severe TBI (msTBI). This study aimed to determine whether untreated GHD is associated with reduced quality of life (QOL) in adults with chronic msTBI.</p><p><strong>Design: </strong>Prospective case-control study of 138 adults with chronic msTBI: 69 with GHD and 69 matched controls without GHD. QOL was measured using the Quality of Life after Brain Injury questionnaire. GHD was diagnosed by glucagon stimulation testing at least 1 year after injury.</p><p><strong>Results: </strong>Demographic characteristics were similar between groups. Cases with GHD reported lower QOL in the Emotions domain than controls (21.4 vs 24.7, corrected <i>p</i> = 0.021), including worse energy, self-esteem, self-perception, and future outlook. The overall Feelings domain was not significantly different in matched analysis, but anxious feelings and sadness/depression were worse in the GHD group. In multivariable mixed-effects regression, absence of GHD was associated with better overall QOL (β = 0.46, <i>p</i> = 0.0016), and model-estimated QOL differed significantly in the Emotion and Feelings domains.</p><p><strong>Conclusions: </strong>Untreated GHD after chronic msTBI is associated with poorer emotional well-being and lower overall QOL, supporting consideration of endocrine evaluation in this population.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"976-984"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of adverse childhood experiences on functional recovery following traumatic brain injury-related rehabilitation in veterans.","authors":"Naomi Bennett, Shane W Adams, Joyce S Chung, Jennifer Terry, Shaliza Shorey, Daniel B Herrick, Maria Bederson, Odette A Harris","doi":"10.1080/02699052.2026.2697350","DOIUrl":"10.1080/02699052.2026.2697350","url":null,"abstract":"<p><strong>Introduction: </strong>Adverse childhood experiences (ACEs) and childhood social determinants of health (SDOH) are associated with poorer health outcomes in adults, but their impact on rehabilitation and functional outcomes post-traumatic brain injury (TBI) is unclear.</p><p><strong>Objective: </strong>To examine the potential impact of ACEs/SDOH on symptom and functional outcomes following TBI-related rehabilitation in veterans.</p><p><strong>Methods: </strong>Participants included 140 veterans enrolled in Veterans Affairs (VA) polytrauma rehabilitation programs between 2010-2024 who completed supplemental assessment of ACEs, SDOH, and other childhood trauma.</p><p><strong>Results: </strong>Participants with more ACEs had significantly lower Functional Independence Measure (FIM) Total and Motor score improvements from admission to discharge. SDOH and other childhood trauma were also significantly correlated with lower FIM Motor score improvements. When controlling for hospitalization length, more ACEs were associated with lower FIM Motor score improvements (<i>β</i> = -.245, <i>p</i> = 0.02) and marginally associated with lower FIM Total score improvements (<i>β</i> = -.205, <i>p</i> = 0.06) following TBI-related rehabilitation.</p><p><strong>Conclusions: </strong>Higher ACEs were associated with less FIM Motor function improvement following TBI-related rehabilitation in veterans. ACEs may be associated with differences in functional motor outcomes in veterans following TBI, contributing to heterogeneous rehabilitation outcomes. Systematic integration of potential childhood adversities into rehabilitation may optimize outcomes for veterans who have been disproportionately affected.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"967-975"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Memory alterations over a football season are dependent on athlete position-type and prior concussion history.","authors":"Owen Griffith, Alexa E Walter, Jon Kelly, Michael Gay, Wayne Sebastianelli, Linda Papa, S M Slobounov","doi":"10.1080/02699052.2026.2683513","DOIUrl":"10.1080/02699052.2026.2683513","url":null,"abstract":"<p><strong>Objective: </strong>Lifetime accumulation of subconcussive head trauma has been linked to neurodegenerative processes, however it is only recently that measurable alterations in brain function after short bouts of repetitive head impacts have been acknowledged. The primary aim of this study was to compare changes in memory function between American Football athletes exposed to repetitive head impacts and non-contact athletes over the course of a single collegiate athletics season, including changes driven by specific athlete position-type and medical history of previous concussion.</p><p><strong>Methods: </strong>Collegiate Football and Track and Field athletes completed a functional memory battery, measuring spatial memory, immediate memory, concentration and delayed recall at 1-14 days prior to their athletic season, and again 1-14 days following the end of the season. Rate of change in all memory domains were calculated, and group comparisons were made between sports. Position-type (Speed and Non-Speed for Football) and concussion history were included in analyses as covariates.</p><p><strong>Results: </strong>Track and Field athletes performed better than Football athletes in all memory measures at both time points, and significantly better in preseason concentration (z = 2.643, <i>p</i> = 0.008), preseason delayed recall (z = 3.253, <i>p</i> = 0.001), and postseason delayed recall (z = 2.396, <i>p</i> = 0.017). Track and Field athletes scored significantly higher in postseason spatial memory (z = 7.691, <i>p</i> = 0.007). Football athletes demonstrated a significantly better rate of change in concentration than Track and Field athletes (z = -2.138, <i>p</i> = 0.032), which was shown via pairwise comparisons to be driven by a significant difference between Track and Field athletes and Football speed position athletes (H(z)=7.678, <i>p</i> = 0.022). Football athletes of non-speed positions, compared to speed positions and track and field athletes, had significant decreases in rate of change scores in delayed recall with concussion history included as a covariate (H(z = -2.355, <i>p</i> = 0.023).</p><p><strong>Conclusion: </strong>Football athletes had lower scores overall in all memory domains compared to Track and Field athletes. Memory changes after acute exposure to repetitive head impacts may be dependent upon factors such athlete positional requirements and concussion history. These findings add to clinical understanding of how athletes may be differentially affected by repetitive head impacts.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"886-895"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond exercise: a scoping review of heart rate variability in cognitive and emotional paradigms following adult concussion.","authors":"Laura E Boylan, Ben Ginsberg, Jessie R Oldham, Gisela Chelimsky, Raouf Gharbo, Jennifer B Weggen, Thomas Chelimsky, William B Walker, James B Burch","doi":"10.1080/02699052.2026.2704928","DOIUrl":"10.1080/02699052.2026.2704928","url":null,"abstract":"<p><strong>Background: </strong>Concussions often result in psychophysiological symptoms that reflect disruptions in brain-body systems, yet objective biomarkers remain limited. Heart rate variability (HRV) has emerged as a promising biomarker of autonomic adaptability and rehabilitation, including as an index of physiological recovery following concussion. However, concussion literature has predominantly emphasized HRV responses to physiological stressors, rather than psychological tasks that engage impaired domains such as attention, emotion regulation, and executive function.</p><p><strong>Objectives: </strong>We systematically mapped the use of HRV during emotional and cognitive paradigms in adult concussion populations clarifying rationales for its application, the stimuli and measures employed, and state of science.</p><p><strong>Results: </strong>We identified 6,791 records, four meeting inclusion criteria. Paradigms included emotional film clips and cognitive tasks, with HRV indices spanning time-, frequency-, and nonlinear domains. Across studies, individuals with concussion demonstrated altered autonomic flexibility compared to control subjects, including blunted modulation, atypical valence-related responses, and compensatory increases in vagal activity. Methodological heterogeneity limited cross-study comparability.</p><p><strong>Conclusion: </strong>This review highlights a critical evidence gap regarding HRV measurement in psychological contexts after adult concussion. Standardized HRV protocols, diverse samples, and longitudinal designs are needed to clarify recovery trajectories and further assess the value of HRV as a recovery biomarker after concussion.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"935-944"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stacking machine learning model for risk stratification of acute respiratory distress syndrome after traumatic brain injury: a multicenter retrospective study.","authors":"Yixi Wang, Zhu Xuanle, Wenzhe Li, Qiuyuan Huang, Jian Cui, Yan Li, Yuqian Li","doi":"10.1080/02699052.2026.2683517","DOIUrl":"10.1080/02699052.2026.2683517","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) is a severe complication after traumatic brain injury (TBI), and early risk stratification may facilitate timely preventive interventions and improve clinical outcomes.</p><p><strong>Methods: </strong>Model development used the MIMIC-IV v3.1 database with external validation in a cohort from the First Affiliated Hospital of Xinjiang Medical University. Candidate variables recorded within 24 hours of ICU admission were sequentially screened by univariable analysis, Boruta, and ElasticNet to identify predictors for model training. Eleven machine-learning algorithms were trained and integrated into a stacking ensemble optimized through hyperparameter tuning and five-fold cross-validation. Performance was evaluated using discrimination, calibration, decision-analytic metrics, and standard classification measures, with SHAP used for model interpretation.</p><p><strong>Results: </strong>The development cohort included 985 patients (280 ARDS) and the external validation cohort 184 patients (67 ARDS). The stacking ensemble demonstrated stable discrimination across training, internal test, and external validation cohorts (AUC 0.948, 0.926, and 0.912; AP 0.950, 0.828, and 0.863), with good calibration and favorable decision-analytic performance. SHAP analysis identified global severity, hemodynamic instability, neurologic dysfunction, and metabolic disturbances as major contributors.</p><p><strong>Conclusion: </strong>The stacking model showed good performance and interpretability, suggesting potential utility for ARDS risk stratification in critically ill TBI patients.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"896-909"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The true costs of data management in the era of data sharing mandates.","authors":"Abel Torres-Espin, Jessica L Nielson, Bridget E Hawkins, Stefania Mondello, Maryann E Martone, David W Nelson, Ari Ercole, Ewout W Steyerberg, David X Cifu, Mary Jo Pugh, Amma A Agyemang, Clara E Dismuke-Greer, David K Menon, Véronique De Keyser, Andrew I R Maas, Mary Vassar, Amy J Markowitz, Geoffrey T Manley, Adam R Ferguson","doi":"10.1080/02699052.2026.2695303","DOIUrl":"10.1080/02699052.2026.2695303","url":null,"abstract":"<p><strong>Introduction: </strong>United States (US) and European Union (EU) funders mandate data sharing, joining publishers with deposition requirements. Although funders require data sharing and curation plans be included in grant budgets, costs are difficult to forecast and there is pressing need for guidance.</p><p><strong>Methods: </strong>We estimated costs of data maintenance, ongoing curation, and consultation for shared data from several major US and EU initiatives, providing benchmarks to help researchers, clinicians, administrators, and governmental agencies better forecast hidden costs of biomedical data sharing.</p><p><strong>Results: </strong>We observe that costs to prepare, deposit, and share data in dynamic, federated environments, may subsume approximately 20% of a traditional operational research budget. The value of sharing these data for secondary analyses and validation/replication is substantial, but difficult to precisely estimate. One estimate suggests that the return on investment of specialized repositories ranges from 2700% to 6500%, measured by the initial cost to acquire their data holdings.</p><p><strong>Conclusions: </strong>Academic cultivation and advancement across the range of professionals and their diverse data acquisition, curation, and maintenance skillsets is essential. Close partnership between research community stakeholders paired with government mandates and funding to support data management and sharing standards can facilitate accurate and efficient translation of knowledge into clinical practice.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"919-926"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 social parameters and life satisfaction and functional outcomes: a systematic review and meta-analysis.","authors":"Chuxi Pan, Urooba Shaikh, Thaisa Tylinski Sant'Ana, Hyejun Kim, Rachel Spouge, Tatyana Mollayeva","doi":"10.1080/02699052.2026.2694091","DOIUrl":"10.1080/02699052.2026.2694091","url":null,"abstract":"<p><strong>Purpose: </strong>Association between social determinants of health (SDoH) and functional outcomes and life satisfaction after traumatic brain injury (TBI) has not been systematically analyzed, constituting a knowledge gap.</p><p><strong>Material and methods: </strong>We searched six databases on August 15, 2025, for observational studies reporting associations between SDoH and functional outcomes or life satisfaction. We applied PROGRESS-Plus framework to analyze data. We conducted meta-analysis and visualized results for certainty assessment.</p><p><strong>Results: </strong>We included 31 studies of excellent and good quality involving 101,239 adults with TBI (85% male/men, mean age 38.8 ± 17.1 years). Education, social capital, and occupation were the most commonly examined SDoH. Meta-analysis revealed significant gender/sex differences in the Functional Independence Measure (FIM) Total, Cognitive, and Motor scores (standardized mean difference, SMD 0.13 [0.09, 0.16]; -0.16 [-0.32, -0.01]; 0.20 [0.07. 0.33], respectively); and Glasgow Outcome Scale Extended (GOS-E) scores (SMD 0.35 [0.05, 0.66]). No significant gender/sex effect was observed for life satisfaction (SMD 0.23 [-0.09, 0.55]). Moderate certainty suggests links between race/ethnicity and social capital with GOS/GOS-E; and education and age with employment. All other findings were low or very low in certainty.</p><p><strong>Conclusion: </strong>Evidence on SDoH is essential for advancing our understanding of functional outcomes and life satisfaction after TBI. PROSPERO: CRD42024547456.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"825-856"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vestibular neuromodulation for chronic insomnia after traumatic brain injury: a case series.","authors":"Jason P Caffrey, Darlene D Makulski","doi":"10.1080/02699052.2026.2702959","DOIUrl":"10.1080/02699052.2026.2702959","url":null,"abstract":"<p><strong>Objective: </strong>Sleep dysfunction is common after traumatic brain injury (TBI) and can be difficult to manage due to medication side effects and complex neuropsychiatric comorbidities. Noninvasive electrical vestibular system stimulation (VSS) is an emerging neuromodulation therapy that has demonstrated benefit for primary chronic insomnia in adults without known brain injury, but has not been described for chronic insomnia in individuals with TBI.</p><p><strong>Results: </strong>We present a retrospective case series of 5 adult veterans with chronic TBI and moderate-to-severe insomnia (Insomnia Severity Index [ISI] ≥15) who were treated with nightly home VSS. All patients reported subjective improvement in sleep at 3 to 8 week follow-up. ISI score decreased from 25.0 ± 2.5 (mean ± SD) at baseline to 7.2 ± 4.7 at follow-up, representing a reduction of 17.8 ± 6.6 points. Each patient demonstrated a clinically meaningful reduction in ISI (≥6-point reduction). Some individuals reported reductions in nightmares and improvements in daytime alertness.</p><p><strong>Conclusions: </strong>In this case series, VSS use was associated with clinically meaningful reductions in chronic insomnia severity in veterans with chronic TBI.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"1007-1011"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employment outcomes of comprehensive vocational rehabilitation after traumatic brain injury.","authors":"Marina Downing, Pamela Ross, Dean McKenzie, Jennie Ponsford","doi":"10.1080/02699052.2026.2680667","DOIUrl":"10.1080/02699052.2026.2680667","url":null,"abstract":"<p><strong>Purpose: </strong>Vocational rehabilitation (VR) is important to maximize return-to-work (RTW) outcomes for individuals with traumatic brain injury (TBI). However, long-term outcomes from early provision of such services are limited, including impact on rates of RTW and whether pre-injury hours and duties are achieved. Furthermore, factors contributing to successful RTW following VR provided early and embedded within the rehabilitation team have not been thoroughly examined.</p><p><strong>Materials and methods: </strong>RTW outcome data were extracted from clinical records of patients employed pre-injury who completed a comprehensive VR program.</p><p><strong>Results: </strong>There were 99 participants (mean age 38.88 years; 75.8% male), one who completed two separate RTW trials. Of these, 92% returned to their previous employer, but 51% returned to modified duties, 50% needed strategies to compensate for cognitive/physical changes, 45% worked reduced hours, and 25% returned to modified duties, reduced hours and used compensatory strategies. Factors influencing RTW included age, injury severity and time from injury to commencement of RTW program. On average, 14 vocational therapy hours were required per RTW program.</p><p><strong>Conclusion: </strong>With specialist RTW support, successful RTW can be achieved, but can be a lengthy process, particularly if physical/spinal cord injuries are also present and modifications to hours/duties are frequently required.</p>","PeriodicalId":9082,"journal":{"name":"Brain injury","volume":" ","pages":"864-873"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}