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Driving Difficulties and Adaptive Strategies: The Perception of Individuals Having Sustained a Mild Traumatic Brain Injury  [PDF]
Carolina Bottari,Marie-Pierre Lamothe,Nadia Gosselin,Isabelle Gélinas,Alain Ptito
Rehabilitation Research and Practice , 2012, DOI: 10.1155/2012/837301
Abstract: Introduction. After a mild traumatic brain injury (mTBI), individuals quickly resume driving. However, relatively little is known about the impact of mTBI on driving ability and, notably, on the perceived influence of postconcussive symptoms on driving. Hence, the objective of this study was to document the perception of driving abilities in individuals with mTBI. Method. Twenty-seven drivers with mTBI were interviewed to document their perception regarding their driving abilities. Both driving-related difficulties and compensatory strategies used to increase driving safety were documented. A mixed quantitative and qualitative analysis of the data was completed. Results. 93% of participants reported at least one difficulty perceived as having an impact on everyday activities. Most frequently named problems affecting driving were fatigue and reduced concentration. In addition, 74% of participants had adapted their driving or developed strategies to compensate for driving difficulties. Discussion/Conclusion. Postconcussive symptoms have repercussions on driving ability. However, people with mTBI tend to be aware of their difficulties and develop, over time, adaptive strategies. Preventive measures are thus warranted to increase health care professionals' awareness of the potential consequences of mTBI on driving ability and to promote guidelines for the safe resumption of driving after injury. 1. Introduction Mild traumatic brain injury (mTBI) is a major public health problem disproportionately affecting young adults [1]. Incidence in the United States is about 600 per 100,000 population, though many do not seek medical care, and only 25% are admitted to hospital [1]. It is estimated that up to 25% of individuals presenting to the emergency department with mTBI have persisting postconcussive symptoms at 6 months following injury [2], such as headaches, fatigue, concentration deficits, delayed information processing, and vision and memory problems. Despite these problems, individuals generally resume driving shortly after their mTBI. However, very few studies have examined the potential consequences of mTBI on driving ability to promote positive strategies and guidelines for the safe resumption of driving after injury. In the present study, this issue will be investigated by obtaining the perspective of individuals who have sustained a mTBI in order to explore and describe the problems they experience in relation to driving, and the strategies they utilize to ensure safety when driving. Driving is a complex, cognitively demanding activity [3]. It requires
Preclinical care of children with traumatic brain injury (TBI)
Sefrin, Peter,Brandt, Michael,Kredel, Markus
GMS German Medical Science , 2004,
Abstract: The fact that injuries caused by accidents are the most common cause of death in children and adolescents in Germany gave rise to the study, which mainly deals with traffic accidents in this group. 200,221 records of emergency-service physicians in Bavaria which cover the period 1995-1999 were analysed with respect to the importance of traumatic brain injury (TBI) in children and adolescents (n = 721 - representing 45.8% of traffic injuries in this age group). The highest incidence of TBI was in summer (34.3%) and in the evening between 16.00 and 18.00 (23.7%). The time taken between accident and arrival of the emergency services was 8.8 ± 3.1 minutes. The preclinical phase lasted 19.3 ± 5.8 minutes. The probability of having an accident with TBI increases with age, the maximum being in the age-range 7 - 14 years (61.6%). Boys (63.2%) were almost twice as susceptible to injury as girls. 36.8% of all cases had no noticeable neurological disorder, 71.1% resulted in a Glasgow Coma Scale (GCS) score of 15. Only 6.3% had most severe neurological disorders, resulting in a GCS score of 3 - 5. Circulation parameters in the form of adapted hypotension were abnormal in only 3.4%, 21.9% of the children had a bradycardia and in 12.3% the blood oxygen saturation fell below 94%. The most frequent intervention was the laying of an i.v. line for infusions. 8.6% of the patients were intubated to allow for ventilation with oxygen. Analgesics were given in 16.7% of the cases. In 84.7% of all cases, the condition was stable and in only 3.3% was a severe deterioration to be observed. The assessments were made using both the National Advisory Committee for Aeronautics (NACA) and Glasgow Coma Scales (GCS). Discrepancies occurred, as a NACA scale of I - III and a GCS score of < 9 was reported in 4.9% of cases. In contrast a NACA scale of IV - VI was reported with a GCS score of 15 in 30% of all cases. TBI symptoms in children are less obvious than in adults, which leads to an age-dependent restriction in implementing therapeutic measures. If these restrictions are a result of misinterpretation of the situation or due to a lack of practice in the preclinical phase, then further training and education of the physicians involved in emergency service work are necessary.
Assessment of Social Participation in Three Measurement Times in Children with Traumatic Brain Injuries (TBI) Based on Parental Perceptions  [PDF]
Patrick Fougeyrollas, Céline Lepage, Lucie Boissière, Isabelle Deaudelin, Louis Doré
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.24021
Abstract: Purpose: The aim of this study was to measure social participation in children with traumatic brain injuries (TBI) on their parental perceptions, retrospectively for the pre-injury period, at the beginning of rehabilitation and one year after return to school. Methods: This study was conducted among 17 children aged 5 to 17 years old with moderate or severe TBI and their parents. Social participation was assessed using the LIFE-H for Children (1.0). Results: A significant decrease (p ≤ 0.001) in the level of accomplishment of life habits was found for all categories between the measurements taken pre-injury and at the beginning of rehabilitation. Significant differences (p ≤ 0.002) related to the increase in the life habit accomplishment scores were also found between measurements taken at the beginning of rehabilitation and one year after return to school. Conclusion: TBI significantly affected the accomplishment of life habits of the participants compared to their pre-injury level. The assessment of social participation at various times provides a report on the client’s progress and allows clinicians to update his or her intervention plan, to plan follow-ups or to end the intervention. This knowledge must be considered by anyone involved in helping these children to achieve their greatest social participation.
Scale and pattern of atrophy in the chronic stages of moderate-severe TBI  [PDF]
Robin E. A. Green,Jerome J. Maller,Mark Bayley,Joanna Glazer,David J. Mikulis
Frontiers in Human Neuroscience , 2014, DOI: 10.3389/fnhum.2014.00067
Abstract: Background: Moderate-severe traumatic brain injury (TBI) is increasingly being understood as a progressive disorder, with growing evidence of reduced brain volume and white matter (WM) integrity as well as lesion expansion in the chronic phases of injury. The scale of these losses has yet to be investigated, and pattern of change across structures has received limited attention.
Pivotal Role of Anterior Cingulate Cortex in Working Memory after Traumatic Brain Injury in Youth  [PDF]
Fabienne Cazalis,Christopher Giza,Robert F. Asarnow
Frontiers in Neurology , 2011, DOI: 10.3389/fneur.2010.00158
Abstract: In this fMRI study, the functions of the anterior cingulate cortex (ACC) were studied in a group of adolescents who had sustained a moderate to severe traumatic brain injury (TBI). A spatial working memory task with varying working memory loads, representing experimental conditions of increasing difficulty, was administered. In a cross-sectional comparison between the patients and a matched control group, patients performed worse than Controls, showing longer reaction times and lower response accuracy on the spatial working memory task. Brain imaging findings suggest a possible double-dissociation: activity of the ACC in the TBI group, but not in the Control group, was associated with task difficulty; conversely, activity of the left sensorimotor cortex (lSMC) in the Control group, but not in the TBI group, was correlated with task difficulty. In addition to the main cross-sectional study, a longitudinal study of a group of adolescent patients with moderate to severe TBI was done using fMRI and the same spatial working memory task. The patient group was studied at two time-points: one time-point during the post-acute phase and one time-point 12 months later, during the chronic phase. Results indicated that patients’ behavioral performance improved over time, suggesting cognitive recovery. Brain imaging findings suggest that, over this 12-month period, patients recruited less of the ACC and more of the lSMC in response to increasing task difficulty. The role of ACC in executive functions following a moderate to severe brain injury in adolescence is discussed within the context of conflicting models of the ACC functions in the existing literature.
Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury
Angela Colantonio, Jocelyn E Harris, Graham Ratcliff, Susan Chase, Kristina Ellis
BMC Neurology , 2010, DOI: 10.1186/1471-2377-10-102
Abstract: This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis.Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning.This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.According to the Center for Disease Control and Prevention, 1.7 million Americans sustain a traumatic brain injury (TBI) each year [1]. Advances in medical technology and care have led to increasing numbers of individuals surviving TBI and requiring ongoing community services to facilitate their return to everyday activities [2-4]. The majority of research to date is predominantly focused on male participants likely due to males having a higher incidence of TBI than women. Information regarding the effect of TBI on women's health is limited. Further, it is known that women with disability lack sufficient medical care compared to women without a disability [5]. The examination of health outcomes based on gender may reflect important differences post TBI and help inform health service decision-makers.There is a growing bo
Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)  [PDF]
Alfred Mansour, Renee Lajiness-O’Neill
Psychology (PSYCH) , 2015, DOI: 10.4236/psych.2015.64033
Abstract: Much has been gained in our understanding of the psychopathology, assessment, and treatment of TBI. Still lacking is the breadth and depth that an integrative and multi-disciplinary approach to TBI portends. While there is a greater awareness of a need for such a systems-based approach as evidenced by the number of professional organizations and government agencies recently advocating a need for standardization in the collection data in TBI, the application of multi-dimensional approach, and the development novel strategies to deliver prevention, assessment and treatment to large, diverse populations, we are still in the early stages in making this important shift. In the nearer term, there are clinical assessment and interventional programs that can be developed and empirically validated to bring us closer to this integrative, multi-disciplinary ideal. The following review calls for a universal diagnostic classification system for TBI, integration of pathophysiology and pharmacological and rehabilitative therapies, development of treatments addressing disorders comorbid with TBI, and the delivery of assessment and treatment services to large underserved populations.
Apolipoprotein E polymorphism and outcome after mild to moderate traumatic brain injury: A study of patient population in India  [cached]
Pruthi Nupur,Chandramouli B,Kuttappa Thelma,Rao Shobini
Neurology India , 2010,
Abstract: Background: The nature and extent of recovery after traumatic brain injury (TBI) is heterogeneous. Apolipoprotein E (APOE) plays a major role in repair of cell membrane and growth of neurites following injury to cells. Studies done on the western population have shown that the APOE e4 genotype is associated with poor survival following neurotrauma. Aim: To explore the association of APOE polymorphism and outcome following TBI in a patient population from a tertiary care hospital exclusive for neurological diseases in south India. Patients and Methods: Ninety eight patients who sustained mild to moderate TBI (computed tomography (CT) scan brain showing traumatic parenchymal contusions) were the subjects of the study and the study period was from November 2003 to December 2008. APOE polymorphism status was determined by PCR technique using venous blood. Patients were assessed on follow-up with a battery of four neuropsychological tests as well as Glasgow outcome scale. Results: Of the 98 patients, 20 (20%) patients had at least one APOE e4 allele. A follow-up of minimum six months was available for 73 patients. None of the12 patients who had at least one APOE e4 allele had a poor outcome at six-month follow-up whereas 11(18%) patients without an APOE e4 allele had a poor outcome (Fisher′s Exact test, P=0.192). On the neuropsychological tests, performance of patients with APOE e4 allele did not differ significantly from those without these alleles. Conclusion: This study does not support the current contention that the presence of APOE e4 allele should have a significant negative effect on the outcome after TBI.
Chemical Blocking of Zinc Ions in CNS Increases Neuronal Damage Following Traumatic Brain Injury (TBI) in Mice  [PDF]
Peter Doering,Meredin Stoltenberg,Milena Penkowa,J?rgen Rungby,Agnete Larsen,Gorm Danscher
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0010131
Abstract: Traumatic brain injury (TBI) is one of the leading causes of disability and death among young people. Although much is already known about secondary brain damage the full range of brain tissue responses to TBI remains to be elucidated. A population of neurons located in cerebral areas associated with higher cognitive functions harbours a vesicular zinc pool co-localized with glutamate. This zinc enriched pool of synaptic vesicles has been hypothesized to take part in the injurious signalling cascade that follows pathological conditions such as seizures, ischemia and traumatic brain injury. Pathological release of excess zinc ions from pre-synaptic vesicles has been suggested to mediate cell damage/death to postsynaptic neurons.
Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders  [PDF]
David O. Keyser,Scott A. Wylie
Frontiers in Neurology , 2013, DOI: 10.3389/fneur.2013.00091
Abstract: Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant’s clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.
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