Brain Injury Screening Research Articles

Dynamic motor tracking is sensitive to subacute mTBI.

Effective screening for mild traumatic brain injury (mTBI) is critical to accurate diagnosis, intervention, and improving outcomes. However, detecting mTBI using conventional clinical techniques is difficult, time intensive, and subject to observer bias. We examine the use of a simple visuomotor tracking task as a screening tool for mTBI. Thirty participants, 16 with clinically diagnosed mTBI (mean time since injury: 36.4±20.9days (95% confidence interval); median=20days) were asked to squeeze a hand dynamometer and vary their grip force to match a visual, variable target force for 3min. We found that controls outperformed individuals with mTBI; participants with mTBI moved with increased variability, as quantified by the standard deviation of the tracking error. We modeled participants' feedback response-how participants changed their grip force in response to errors in position and velocity-and used model parameters to classify mTBI with a sensitivity of 87% and a specificity of 93%, higher than several standard clinical scales. Our findings suggest that visuomotor tracking could be an effective supplement to conventional assessment tools to screen for mTBI and track mTBI symptoms during recovery.

Screening for Remote History of Mild Traumatic Brain Injury in VHA: A Critical Literature Review.

The authors reviewed the existing literature on the Veterans Health Administration's (VHA's) traumatic brain injury (TBI) screening and evaluation program to provide a qualitative synthesis and critical review of results focusing on the psychometric properties of the screen. All studies of the VHA's screening and evaluation process were reviewed, both those involving primary data collection and those relying upon VHA data. Diagnostic statistics were summarized and also recalculated on the basis of a positive screening rate of 20%, the observed rate within the VHA, and an estimated population prevalence of TBI of 15% within the Department of Veterans Affairs (VHA). The TBI screen within the VHA is administered to nearly every eligible patient. The majority of clinical presentations are deemed to be due to mental health and/or a combination of mental health and TBI factors. The screen has good internal consistency, variable test-retest reliability, and questionable validity, with poor agreement between the TBI screen and criterion standards overall. Studies based on nonrepresentative samples reported high sensitivity. Assuming the VHA's TBI screening rate of 20% in a hypothetical sample, sensitivity is poor (the screen misses 30%-60% of TBI cases). However, specificity remains adequate. Studies based on samples with high rates of TBI reported much higher positive predictive values (and slightly lower negative predictive values) than those observed when a hypothetical TBI prevalence of 15% was used. Questions remain about the validity of the TBI screen. Future research should address the utility of screening for TBI.

Responses to Traumatic Brain Injury Screening Questions and Suicide Attempts among Those Seeking Veterans Health Administration Mental Health Services.

Psychometrically sound screening tools available to aid in the identification of lifetime history of traumatic brain injury (TBI) are limited. As such, the Traumatic Brain Injury-4 (TBI-4) was developed and implemented in a Veterans Health Administration (VHA) mental health clinic. To provide information regarding both the predictive validity and clinical utility of the TBI-4, the relationship between screening results and future suicide attempts was evaluated. The aim of this study was to determine whether a positive screen on the TBI-4 was associated with increased risk for suicide attempt within 1-year post screening. The TBI-4 was administered to 1,097 Veterans at the time of mental health intake. Follow-up data regarding suicide attempts for the year post-mental health intake were obtained from suicide behavior reports (SBRs) in Veteran electronic medical records (EMRs). Fisher's exact tests were used to determine the proportion of suicide attempts by TBI-4 status. In the year post TBI-4 screening, significantly more Veterans who screened positive had a documented suicide attempt as compared to those who screened negative (p = 0.003). Those with a positive TBI screen at mental health intake had a higher proportion of SBRs than those who screened negative for TBI. Findings provided further psychometric support for the TBI-4. Moreover, results suggest the inclusion of this screen could prove to be helpful in identifying those who may be at risk for future suicide attempt within 1-year post screening.

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans.

The Department of Veterans Affairs traumatic brain injury (TBI) screening program is intended to detect and expedite treatment for TBI and postconcussive symptoms. Between April 14, 2007, and May 31, 2012, of 66,089 Iraq and Afghanistan Veterans who screened positive on first-level TBI screening and later completed comprehensive TBI evaluation that includes the Neurobehavioral Symptoms Inventory, 72% reported moderate to very severe cognitive impairment (problems with attention, concentration, memory, etc.) that interfered with daily activities. This included 42% who were found not to have sustained combat-related mild TBI (mTBI). In contrast, 70.0% received a posttraumatic stress disorder (PTSD) diagnosis and 45.8% received a depression diagnosis. Compared with Veterans without mTBI, PTSD, or depression diagnoses, the lowest risk for self-reported cognitive impairment was in Veterans with confirmed mTBI only; a greater risk was found in those with PTSD diagnoses, with the greatest risk in Veterans with PTSD, depression, and confirmed mTBI, suggesting only a weakly additive effect of mTBI. These findings suggest that Veterans with multiple mental health comorbidities, not just those with TBI, report moderate to very severe cognitive impairment. Mental health treatment for conditions such as PTSD and depression (with or without TBI) may result in improvements in cognitive functioning and/or include assessment and support for Veterans experiencing cognitive problems.

The Veterans Health Administration’s traumatic brain injury clinical reminder screen and evaluation: Practice patterns

The goals of this study were to describe clinical practice patterns associated with the Veterans Health Administration's (VHA's) Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and determine whether practice patterns vary by patient, provider, or facility characteristics. Veterans (N = 614) who had initial healthcare visits between 2008, and 2011 and who had previously completed the VHA's traumatic brain injury (TBI) screen and subsequent CTBIE were drawn from a national database. Participants were primarily male (95%) with a mean age of 29.8 yr (standard deviation = 8). Chart reviews were conducted on a random sample of charts with completed CTBIEs from 21 sites. Using a cross-sectional design, patient- and facility-specific variables were investigated as potential predictors of practice variation. During the study period, 79% of patients in this national sample were screened within 1 d of their initial healthcare visit and 65% were evaluated via CTBIE within 30 d of screening. Provider and participant characteristics were generally not associated with timeliness. The CTBIE was completed by individuals versus teams at comparable rates. Much of what occurred during the evaluation, beyond TBI-specific procedures, were medical assessments, such as review of medications and other substances.

Current Suicidal Ideation Among Treatment-Engaged Active-Duty Soldiers and Marines

We examined suicidal ideation among 399 active-duty Soldiers and Marines engaged in mental health treatment. Using a generalized linear model (GLM) controlling for demographic and military factors, depression, and positive traumatic brain injury (TBI) screen, we confirmed our hypothesis that self-report measures of current post-traumatic stress disorder (PTSD) symptoms uniquely predicted suicidal ideation. The association between PTSD severity and suicidal ideation was moderated by gender, with women at higher risk as PTSD severity increased. Female Soldiers and Marines with high levels of PTSD should receive additional monitoring and intervention. Self-report measures may aid with risk assessment and identify symptom-related distress associated with suicide risk.

Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) Clinical Interview and the VA TBI Screen

Mild traumatic brain injury is the signature injury of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), yet its identification and diagnosis is controversial and fraught with challenges. In 2007, the Department of Veterans Affairs (VA) implemented a policy requiring traumatic brain injury (TBI) screening on all individuals returning from deployment in the OEF/OIF/OND theaters of operation that lead to the rapid and widespread use of the VA TBI screen. The Boston Assessment of TBI-Lifetime (BAT-L) is the first validated, postcombat semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span, including prior to, during, and post-military service. Community-dwelling convenience sample of 179 OEF/OIF/OND veterans. BAT-L, VA TBI screen. Based on BAT-L diagnosis of military TBI, the VA TBI screen demonstrated similar sensitivity (0.85) and specificity (0.82) when administered by research staff. When BAT-L diagnosis was compared with historical clinician-administered VA TBI screen in a subset of participants, sensitivity was reduced. The specificity of the research-administered VA TBI screen was more than adequate. The sensitivity of the VA TBI screen, although relatively high, suggests that it does not oversample or "catch all" possible military TBIs. Traumatic brain injuries identified by the BAT-L, but not identified by the VA TBI screen, were predominantly noncombat military injuries. There is potential concern regarding the validity and reliability of the clinician administered VA TBI screen, as we found poor correspondence between it and the BAT-L, as well as low interrater reliability between the clinician-administered and research-administered screen.

Method of assessment and symptom reporting in veterans with mild traumatic brain injury

Objectives: We hypothesized that in a sample of veterans (1) frequency and consistency of post-concussive symptom endorsement would differ across assessment methods (detailed physician interview, brief screening interview, or self-report questionnaire checklist) and (2) that participants would endorse more symptoms on the self-report checklist than the screening interview or the physician interview. Methods: To assess the presence and severity of post-concussive symptoms, veterans and current military service members were recruited via newspaper advertisement for a research project to assess history of traumatic brain injury. Participants underwent evaluation, including a brief screening interview (the Rehabilitation Institute of Chicago Military Traumatic Brain Injury Screening Instrument), a detailed physician interview, and completion of a self-report questionnaire (the Rivermead Post-concussion Questionnaire). Results: Symptom reporting significantly differed across assessment methods for headaches [Q(2) = 65.45, p < .001], dizziness [Q(2) = 52.55, p < .001], and nausea [Q(2) = 58.58, p < .001]. Symptoms were most likely to be reported in a brief screening interview followed by the self-report questionnaire, followed by a physician interview. Consistency of symptom reporting also differed: reporting of dizziness was more discordant across assessment methods than reporting of nausea or headaches. Discussion: Our findings support our first hypothesis, but provided only partial support for our second hypothesis. That is, the data confirm that differences exist in post-concussion symptom reporting based on data gathering technique and type of symptom. Yet, contrary to our expectations, participants endorsed more symptoms during a brief screening interview than on a self-report questionnaire. These findings may have implications for optimizing assessment of complaints after concussion, especially within a veteran population.

Examining the influence of mild traumatic brain injury and posttraumatic stress disorder on alcohol use disorder in OEF/OIF veterans.

Examine (1) impact of mild traumatic brain injury (mTBI) on posttraumatic stress disorder (PTSD) symptoms, (2) frequency of alcohol use disorder in male and female combat Veterans, and (3) influence of PTSD and mTBI on alcohol use disorder. A retrospective medical-record review extracted the following data for Operation Enduring Freedom/Operation Iraqi Freedom Veterans (N = 1,278) who completed a semi-structured mental health evaluation: alcohol use disorder diagnoses, PTSD symptom criteria, and Brief Traumatic Brain Injury Screen. Logistic regressions tested if PTSD and mTBI predicted which Veterans had an alcohol use disorder diagnosis. Veterans with mTBI had more re-experiencing, avoidance, and hyperarousal symptoms than Veterans without mTBI. Men and women differed regarding alcohol use. For men, PTSD predicted alcohol use diagnosis while mTBI did not. For women, neither mTBI nor PTSD predicted alcohol use diagnosis. Findings from this study can inform treatment providers by alerting them to the possibility of subthreshold PTSD in Veterans with mTBI. Providers may begin PTSD treatments or consider targeting hyperarousal symptoms early in treatment to reduce distress. PTSD is also uniquely associated with alcohol use disorder in male Veterans, while more research on predictors of alcohol use disorder is needed for female Veterans.

Cerebral Ischemia in Adults with Sickle Cell Disease after First Stroke

IntroductionPeople with sickle cell disease (SCD) have a greatly increased risk of silent cerebral infarct (SCI) and ischemic and hemorrhagic stroke compared with the general population. A prospective cohort study of pediatric patients with SCD after first stroke demonstrated recurrent brain injury (SCI and stroke) in 45% of the participants (median follow-up of 5.5 years) despite regular transfusions to maintain a hemoglobin S concentration less than 30%. The rate of recurrent brain injury in adults with SCD with a history of stroke has not been described.MethodsThis retrospective cohort study identified patients with SCD treated at Johns Hopkins Hospital who were at least 15 years old with a history of ischemic or hemorrhagic stroke and at least 2 MRIs of the brain available for interpretation. Two neuroradiologists interpreted and completed a data extraction form for each MRI and, when available, MR angiography. The form included the type of lesion, the number of lesions, the progression of the lesion from previous MRIs, and the presence or absence of cerebral vasculopathy by vessel. Clinical and demographic data were extracted from paper and electronic medical records. All data were entered into Microsoft Access and verified for accuracy. We used Stata Intercooled 12® to calculate descriptive statistics and rates and 95% confidence intervals by exact methods.ResultsWe identified 24 patients (50% male) with a median age of 20 years (IQR 13, 24) at the baseline imaging and 23 (IQR 21, 30) at the time of the most recent imaging. Twenty had sickle cell anemia (HbSS) and 4 had hemoglobin SC disease. At baseline, 23 (96%) had evidence of cerebral ischemic lesions with a median of 8 (IQR 4, 10) lesions and 4 (16%) had global atrophy. Two participants had acute intraparenchymal hemorrhage and one prior hemorrhage with hemosiderin deposition in the brain parenchyma. Of the 20 with interpretable MR angiography, 15 (75%) had cerebral vasculopathy. Median follow-up was 3.3 years (IQR 1.9, 8.7) with a median of 2.5 MRIs obtained during follow-up (IQR 1.5, 4). We identified recurrent ischemic brain injury in 13 (54%) of participants with 17 new SCIs (3 also had enlargement of existing lesions) and 5 overt strokes. The rate of recurrent brain injury was 18 per hundred person-years (95% CI 12, 28). The rate was lower (15 per 100 person-years) in those with cerebral vasculopathy compared with those without cerebral vasculopathy (40 per 100 person-years), but this difference was not statistically significant (p=0.12). The rate of new SCI was 14 (95% CI 8.3, 23) and the rate of recurrent ischemic stroke was 4.2 per 100 person-years (95% CI 1.4, 9.8). No participants had new hemorrhagic strokes.DiscussionPeople with SCD and a history of stroke have high rates of recurrent brain ischemia as adolescents and adults. The proportion in this study with recurrent ischemic events was similar to that seen in children and adolescents despite a substantially shorter period of follow-up. This may be secondary to differences in the treatment of adults with SCD and stroke (perhaps lower rates of chronic transfusion therapy), ascertainment bias (adolescents and adults with concerning symptoms for recurrent stroke may be more likely to have follow-up MRIs of the brain), or a continued high rate of recurrent ischemia in this population. Given the high rate of ischemia, regular screening for brain injury should be considered in adults with SCD and a history of stroke. DisclosuresNo relevant conflicts of interest to declare.

Deployment-related mild traumatic brain injury, mental health problems, and post-concussive symptoms in Canadian Armed Forces personnel.

BackgroundUp to 20% of US military personnel deployed to Iraq or Afghanistan experience mild traumatic brain injury (mTBI) while deployed; up to one-third will experience persistent post-concussive symptoms (PCS). The objective of this study was to examine the epidemiology of deployment-related mTBI and its relationship to PCS and mental health problems (MHPs) in Canadian Armed Forces (CAF) personnel.MethodsParticipants were 16153 personnel who underwent post-deployment screening (median =136 days after return) following deployment in support of the mission in Afghanistan from 2009 – 2012. The screening questionnaire assessed mTBI and other injuries while deployed, using the Brief Traumatic Brain Injury Screening Tool. Current MHPs and PCS were assessed using items from the Patient Health Questionnaire, the Patient Checklist for PTSD, and the Cognitive Failures Questionnaire. Log-binomial regression explored the association of mTBI, other injuries, and MHPs with PCS, using the presence of 3 or more of 7 PCS as the outcome. Results are expressed as adjusted prevalence ratios (PR).ResultsmTBI while deployed was reported in 843 respondents (5.2%). Less severe forms of mTBI (associated only with having been dazed or confused or having “seen stars”) predominated. Blast was reported as a mechanism of injury in half of those with mTBI. Multiple PCS were present in 21% of those with less severe forms of mTBI and in 27% of those with more severe forms of mTBI (i.e., mTBI associated with loss of consciousness or post-traumatic amnesia). After adjustment for confounding, mTBI had no statistically significant association with PCS relative to non-TBI injury. In contrast, MHPs had a strong association with reporting 3 or more PCS (adjusted prevalence ratio (PR) =7.77).ConclusionDeployment-related mTBI prevalence was lower than in many US reports; most of those who had had mTBI were free of multiple PCS. PCS was strongly associated with MHPs but not with mTBI. Careful assessment of MHPs is essential in personnel with a history of combat-related mTBI and PCS.

Screening for traumatic brain injury: findings and public health implications.

To provide an overview of a series of projects that used a structured self-report screening tool in diverse settings and samples to screen for lifetime history of traumatic brain injury (TBI). Diverse community settings. Homeless persons (n = 111), individuals with HIV seeking vocational rehabilitation (n = 173), youth in the juvenile justice system (n = 271), public schoolchildren (n = 174), substance users (n = 845), intercollegiate athletes (n = 90), and other community-based samples (n = 396). Cross-sectional. Brain Injury Screening Questionnaire. Screening using the Brain Injury Screening Questionnaire finds that 27% to 54% of those in high-risk populations report a history of TBI with chronic symptoms. Associations between TBI and social, academic, or other problems are evident in several studies. In non-high-risk community samples, 9% to 12% of individuals report TBI with chronic symptoms. Systematic TBI screening can be implemented efficiently and inexpensively in a variety of settings. Lifetime TBI history data gathered using a structured self-report instrument can augment existing estimates of the prevalence of TBI, both as an acute event and as a chronic condition. Identification of individuals with TBI can facilitate primary prevention efforts, such as reducing risk for reinjury in high-risk groups, and provide access to appropriate interventions that can reduce the personal and societal costs of TBI (tertiary prevention).

The association between neuropsychological performance and self-reported traumatic brain injury in a sample of adult male prisoners in the UK

This study employed a correlational and group comparison design to investigate whether self-report of traumatic brain injury (TBI) in a sample of male prisoners screened using the Brain Injury Screening Index (BISI) was associated with impaired cognitive performance on standardised questionnaires and neuropsychological tests. A total of 139 male prisoners who reported having suffered a TBI in the BISI were interviewed, and completed further questionnaires and neuropsychological assessments. Their results were compared to 50 prisoners who had no reported history of TBI. The results of the screening questionnaire correlated with responses in a follow-up interview, with self-report questionnaires of neurobehavioural disorder (.31 to .50) and neuropsychological measures (−.24 to −.45). The “TBI Index”, an indicator summarising the number and severity of self-reported injuries in a single score, also correlated well with scores on formal neuropsychological tests (–.20 to –.42). Self-report of traumatic brain injury among prisoners is consistently associated with measurable neuropsychological and neurobehavioural disability. The implications of these findings for current practice in identifying and referring individuals to specialist services are considered.

The Relationship between Sleep Architecture and Symptoms of Sleep Disturbance in Individuals with Traumatic Brain Injury

Objective: To measure sleep architecture in individuals with TBI and determine its relationship with self-reported sleep quality, fatigue, and daytime sleepiness. Design: Participants: completed self-report measures and underwent two nights of in-laboratory nocturnal polysomnography. Setting: General community. Participants: 46 individuals with mild to severe TBI. Inclusion criteria included age between 18 years to 65 years and a documented TBI as a result of a blow to the head with a loss of consciousness or period of being dazed and confused (e.g., EMS report, hospital record, physician record, or a positive screen on the Brain Injury Screening Questionnaire). Participants: were required to be at least one year post injury (SD Z 13.33 years, range 1.17 years e 56.33 years), English-speaking, and have at least a sixth-grade reading level. No use of Modafinil, amphetamines or soporific medications (e.g., zolpidem, zolpidem MR, eszopiclone, zaleplon, sedating antidepressants, melatonin, valerian root, Benedryl, Ramelteon or chloral hydrate) was allowed 72 hours prior to polysomnography. Use of medications known to cause hypersomnolence (e.g. barbiturates, benzodiazepines, opiates) was not allowed for seven days prior to study. Exclusion criteria included active hepatic or renal failure (which may lead to hypersomnia), active substance abuse disorder, prior or current psychotic disorder, pre-existing neurological disorder or a brain injury with an etiology other than trauma, untreated hypothyroidism and any medical condition or reason that, in the investigator’s opinion, might make the participant unsuitable to participate. All participants were recruited through flyer postings in the Mount Sinai Medical Center and through healthcare provider referrals. The study was approved by the institutional review board of Icahn School of Medicine at Mount Sinai. Informed consent was obtained prior to screening to determine whether or not they met inclusion/exclusion criteria. Interventions: Not applicable. Main Outcome Measure(s): The measures included self-report measures of sleep quality (Pittsburgh Sleep Quality Index; PSQI), fatigue (Multidimensional Assessment of Fatigue; MAF), daytime sleepiness (Epworth Sleepiness Scale; ESS), and nocturnal polysomnography (NPSG) from which sleep efficiency, sleep onset latency, REM latency, wake time after sleep onset, and percentage of stage 1, 2, 3, and REM 4 sleep were extracted. Results: Pearson product-moment correlation coefficients were used to analyze the association between responses on self-report questionnaires. Hierarchical linear regression was used to analyze the association between NPSG sleep parameters and self-report questionnaires, adjusting for age, sex, body mass index, sleep apnea, and TBI severity. Poor sleep quality as measured by the PSQI was associated with fatigue as measured by the MAF. Poor sleep quality was associated with poor sleep efficiency, short duration of stage 2 sleep, and long duration of rapid eye movement sleep. There was a weak association between high levels of fatigue and poor sleep efficiency. Daytime sleepiness as assessed was not associated with any NPSG sleep parameters. Conclusions: In this sample of TBI survivors, those who reported poor sleep quality evidenced shorter time spent in stage 2 sleep compared to those who reported better sleep quality. These findings suggest that disruptions in stage 2 sleep might underlie the symptoms of sleep disturbance experienced following TBI.

Traumatic brain injury among men in an urban homeless shelter: observational study of rates and mechanisms of injury.

Little empiric research has investigated the interrelationship between homelessness and traumatic brain injury. The objectives of this study were to determine the rate, mechanisms and associated outcomes of traumatic brain injury among men in an urban homeless shelter. We recruited participants from an urban men's shelter in Toronto, Ontario. Researchers administered the Brain Injury Screening Questionnaire, a semistructured interview screening tool for brain injury. Demographic information and detailed histories of brain injuries were obtained. Participants with positive and negative screening results were compared, and the rates and mechanisms of injury were analyzed by age group. A total of 111 men (mean age 54.2 ± standard deviation 11.5 yr; range 27-81 yr) participated. Nearly half (50 [45%]) of the respondents had a positive screening result for traumatic brain injury. Of these, 73% (35/48) reported experiencing their first injury before adulthood (<18 yr), and 87% (40/46) reported a first injury before the onset of homelessness. Among those with a positive screening result, 33 (66%) reported sustaining at least one traumatic brain injury by assault, 22 (44%) by sports or another recreational activity, 21 (42%) by motor vehicle collision and 21 (42%) by a fall. A positive screening result was significantly associated with a lifetime history of arrest or mental illness and a parental history of substance abuse. Multiple mechanisms contributed to high rates of traumatic brain injury within a sample of homeless men. Assault was the most common mechanism, with sports and recreation, motor vehicle collisions and falls also being reported frequently by the participants. Injury commonly predated the onset of homelessness, with most participants experiencing their first injury in childhood. Additional research is needed to understand the complex interactions among homelessness, traumatic brain injury, mental illness and substance use.

Traumatic brain injury and cognitive impairment in men who are homeless

Purpose: To examine cognitive performance among a sample of men in a residential unit of an urban homeless shelter and to compare cognitive performance between those with and without a history of traumatic brain injury (TBI). Methods: An exploratory, quantitative study of participants recruited through convenience sampling. Participants were screened for TBI using the Brain Injury Screening Questionnaire, and cognitive function using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Data were analyzed to examine associations between TBI status and cognitive performance. Results: Thirty-four participants were recruited for the study: n = 12 with a positive and n = 22 with a negative screen for TBI. Both groups performed below norms in all cognitive domains measured by the RBANS. Those with a positive screen for TBI performed significantly worse on attention tasks than those with a negative screen for TBI (p = 0.026). RBANS scores were not associated with either mental health or substance abuse status. Conclusions: A history of TBI was associated with generally poorer cognitive performance in the study sample. An improved awareness of TBI and cognitive dysfunction among service providers and routine TBI screening could improve treatment and service delivery for this population.Implications for RehabilitationThe prevalence of traumatic brain injury among homeless populations is greater than that observed in the general population.Validated screening measures are available to screen for a history of traumatic brain injury among individuals who are homeless.A history of traumatic brain injury among adult men in a long-term residential unit of a homeless shelter was associated with poorer performance on the attention domain of a validated cognitive screening measure.

Traumatic brain injury and PTSD screening efforts evaluated using latent class analysis.

To empirically identify latent classes of service members according to persistent postconcussive symptom patterns and to characterize the identified classes relative to other postdeployment variables including posttraumatic stress disorder (PTSD) and mild traumatic brain injury (TBI) screening results. Such comparisons may directly inform policy regarding these routine assessments and translate to improved treatment decisions. Self-report data were obtained for 12,581 combat-exposed male U.S. Navy and Marine Corps personnel who returned from deployment in 2008-2009 and completed a Post-Deployment Health Assessment (PDHA) and an associated Post-Deployment Health Reassessment (PDHRA). Persistent postconcussive symptoms indicated on the PDHRA were used as manifest variables in a latent class analysis yielding 4 distinct classes: systemic, cognitive/behavioral, comorbid, and nonpresenting. Although the nonpresenting class endorsed few or no postconcussive symptoms, the systemic and cognitive/behavioral classes displayed elevated likelihoods of neurological and mental health symptoms, respectively. Members of the comorbid class had an increased probability of reporting a wide range of symptoms across both domains. Characterization of identified classes suggested that class membership may indicate the presence or absence of persistent conditions resulting from head injury and/or mental health issues. Under this assumption, estimated class membership probabilities implied a rate of probable neurological injury among this sample to be 17.9%, whereas the standard assessments aimed at identifying repercussions of mild TBI reported a positive screening rate of only 13.1%. Findings suggest that the routinely administered PDHA and PDHRA appear to underestimate the true prevalence of service members experiencing postdeployment health problems. Supplemental items or an alternative screening algorithm incorporating persistent postconcussive symptoms may enable identification of additional cases requiring treatment following return from deployment.

The Rehabilitation Institute of Chicago Military Traumatic Brain Injury Screening Instrument

Traumatic brain injury (TBI) is referred to as the signature injury of the wars in Iraq and Afghanistan. Given the prevalence of TBI in military personnel, there is a need for validated instruments tailored to accurately screen for TBI in this population. Three hundred service members or veterans underwent a novel screen and a comprehensive diagnostic assessment to identify the occurrence of TBI and/or the presence of posttraumatic stress disorder. Negative predictive value, positive predictive value, sensitivity, and specificity were calculated. This screening tool for TBI yielded sensitivity of 96%, specificity of 64%, negative predictive value of 95%, and positive predictive value of 69%. The Rehabilitation Institute of Chicago Military Traumatic Brain Injury Screening Instrument has a high negative predictive value and high sensitivity for TBI. This tool identifies individuals likely to have sustained a TBI. Moreover, it detects those who are likely not to have sustained such an injury and can be reassured in this regard. Because such distinction can be made with a high degree of accuracy in rapid and cost-effective fashion, it represents an important contribution to the armamentarium of TBI screening tools.

Elevated Movement Path Tortuosity in Voluntary Outdoor Ambulation in Community-Dwelling Veterans With a History of Traumatic Brain Injury

In comparison to veterans without a history of traumatic brain injury (TBI), we hypothesized that veterans with past TBI would have slower walking speed and more path tortuosity, TBI symptoms, problems with spatial orientation, and poorer executive function. Community nonclinical. Seventeen males (mean age of 37.2 years) reporting prior TBI and 20 non-TBI (mean age of 42.9 years). The number of years separating date of discharge and testing was 10.8 and 15.4 for the TBI and non-TBI groups, respectively. Small 2 groups without random assignment. Brief Traumatic Brain Injury Screen, Trail Making Test-B, Clock Drawing Test, walking speed, and distance and path tortuosity in 30 minutes of voluntary outdoor walking wearing a small Global Positioning Systems recorder. Those with TBI reported 4 Brief Traumatic Brain Injury Screen symptoms versus 0.4 for controls (F = 49.1; df = 1,35; P < .001) but did not differ on Trail Making Test-B or the Clock Drawing Test. Veterans with TBI walked shorter distances, 2.33 km versus 2.84 km (F = 4.8; df = 1,35; P < .05), and had greater path tortuosity (fractal D of 1.22 vs 1.15; F = 3.5; df = 1,35; P < .05) but did not differ on travel speed or time spent walking. Traumatic brain injury has persistent symptomatic effects and significantly affects ambulation and spatial orientation years after the event. These findings corroborate and extend observations linking cognitive impairment and ambulation.

Deployment-related mild traumatic brain injury, mental health problems, and post-concussive symptoms in Canadian armed forces personnel

Up to 20% of US military personnel deployed to Iraq or Afghanistan experience mild traumatic brain injury (mTBI) while deployed; up to one-third will experience persistent post-concussive symptoms (PCS). The objective of this study was to examine the epidemiology of deployment-related mTBI and its relationship to PCS and mental health problems (MHPs) in Canadian Armed Forces (CAF) personnel. Participants were 16153 personnel who underwent post-deployment screening (median =136 days after return) following deployment in support of the mission in Afghanistan from 2009 - 2012. The screening questionnaire assessed mTBI and other injuries while deployed, using the Brief Traumatic Brain Injury Screening Tool. Current MHPs and PCS were assessed using items from the Patient Health Questionnaire, the Patient Checklist for PTSD, and the Cognitive Failures Questionnaire. Log-binomial regression explored the association of mTBI, other injuries, and MHPs with PCS, using the presence of 3 or more of 7 PCS as the outcome. Results are expressed as adjusted prevalence ratios (PR). mTBI while deployed was reported in 843 respondents (5.2%). Less severe forms of mTBI (associated only with having been dazed or confused or having "seen stars") predominated. Blast was reported as a mechanism of injury in half of those with mTBI. Multiple PCS were present in 21% of those with less severe forms of mTBI and in 27% of those with more severe forms of mTBI (i.e., mTBI associated with loss of consciousness or post-traumatic amnesia). After adjustment for confounding, mTBI had no statistically significant association with PCS relative to non-TBI injury. In contrast, MHPs had a strong association with reporting 3 or more PCS (adjusted prevalence ratio (PR) =7.77). Deployment-related mTBI prevalence was lower than in many US reports; most of those who had had mTBI were free of multiple PCS. PCS was strongly associated with MHPs but not with mTBI. Careful assessment of MHPs is essential in personnel with a history of combat-related mTBI and PCS.