Ohio State University Traumatic Brain Research Articles

Neurobehavioral Symptoms in Spanish-Speaking Individuals With Subconcussive Injuries.

To examine whether exposure to high-risk events causing injury to the head or neck has an effect on neurobehavioral symptoms in the absence of an alteration of consciousness in Spanish-speakers. Web-based survey. Seven hundred forty-eight individuals from Spain and Latin America, aged 18 to 65 years, with 10 years or more of education. Thirty-nine participants failed quality checks and were excluded. Seven hundred nine participants were included in the analyses. Cross-sectional study. Subconcussive exposure was defined as endorsing exposure to one or more high-risk scenarios in the absence of any alteration of consciousness. Three injury groups were derived: No Head Injury, Subconcussive Exposure, and traumatic brain injury (TBI). The Subconcussive Exposure group was further divided into Single and Multiple Exposures. Two analyses were conducted: the effect of lifetime exposure to injury (No Head Injury, Subconcussive Exposure, TBI) on neurobehavioral symptoms; the effect of Subconcussive Exposure Frequency (No Head Injury, Single Exposure, Multiple Exposures) on neurobehavioral symptoms. Spanish Ohio State University Traumatic Brain Injury Identification Method Self-Administered-Brief (OSU TBI-ID SAB); Neurobehavioral Symptom Inventory (NSI). There was a significant effect for Injury group on the NSI partial eta-squared (ηp2 = 0.053) and a significant effect of Exposure Frequency group on the NSI (ηp2 = 0.40). Individuals with subconcussive exposures reported significantly more neurobehavioral symptoms than those with no history of head injury and significantly less symptoms than those with TBI. Individuals with multiple subconcussive exposures reported significantly more neurobehavioral symptoms than those with single and no exposure. This research expands the utility of the OSU-TBI-ID SAB as a lifetime TBI history assessment tool to one capable of evaluating subconcussive exposure dosing effects in Spanish-speakers. Such an index may facilitate establishment of subconcussive exposure prevalence rates worldwide, leading to improved understanding of the chronic effects of high-risk exposures.

22 Cognitive and Psychological Profiles of a Specialized Military Force

Objective:The Explosive Ordinance Disposal (EOD) community within the US Military is a specialized force in charge of the most fundamental aspects of the military operations in combat which include disarming and safely disposing explosive threats. EOD technicians have provided critical protection for our military and civilians exposed to improvised explosive devices (IEDs), which became the signature threat of both Afghan and Iraq wars. The nature of the job puts EOD technicians at high risk for blast exposures (from training and combat) resulting in traumatic brain injury (TBI) and sub-concussive head impact. Further, this population is exposed to high levels of combat with psychologically traumatic events. Given the groups neurological and psychological risk factors as well as their critical role in combat, we hypothesized that EOD technicians will present with increased psychological and neurobehavioral symptoms as well decreased cognitive functioning compared to other military personnel.Participants and Methods:Participants were recruited from a military hospital with at least one diagnosed mild traumatic brain injury (MTBI). Exclusion criteria included TBI greater then mild severity and invalid performance on the Rey-15. Final sample included 10 EOD and 90 other military.CognCognitive measures included Hopkins Verbal Learning Test-Reviseitive measures included Hopkins Verbal Learning Test-Revised (HVLT-R); DKEFS Color Word Condition 4 Switching (CW4), Trail Making Condition 3 Letter Sequencing (TM3) and Condition 4 Switching (TM4), and Paced Auditory Serial Addition Test (PASAT). Self-report measures included the Neurobehavioral Symptom Inventory (NSI), Key Behaviors Change Inventory (KBCI), Post-Traumatic Stress Disorder Checklist (PCL-M), Patient Health Questionnaire (PHQ), Combat Exposure Scale (CES) and Blast Exposure Threshold Survey (BETS). The Ohio State University Traumatic Brain Injury Identification Method (OSU) assessed TBI history.Results:EOD were older (EOD M=38.4, SD=4.06; Others M=33.32, SD=8.08; p=0.05), had a higher pre-morbid IQ (EOD M=110.90, SD=7.64; Other M=101.59, SD=10.55; p=0.008), more combat deployments (EOD M=5.5, SD=2.37; Others M=3.55, SD=2.98; p=0.049) and exposure to wartime atrocities (CES, p=0.003). They had greater number of MTBI (OSU EOD M=6.67, SD=3.33; Other M=3.67, SD=2.34; p=0.007), blast related MTBI (OSU-TBI EOD M=2.33, SD=1.63; Other M=0.67, SD=0.91; p<0.001), and exposure to large explosives (BETS p<0.0001). EOD reported better attention skills (KBCI Inattention, p=0.016, d=0.82; Impulsivity p=0.047, d=0.67). There was a trend for EOD to have lower neurobehavioral symptoms (NSI Total, d=0.32), post-traumatic stress (PCL d=0.39), and depression (PHQ d=0.50); however, despite the moderate effect sizes (p’s >0.05). EOD presented with significantly better scores on DKEFS TMT3 (p=0.037, d=0.70), HVLT-R-Total (p=0.001, d=1.10), HVLT-R-Delayed (p=0.03, d=0.74), and attention/executive functioning skills (PASAT p=0.001, d=1.12). DKEFTS CW4 Switching (d=0.51) and TMT4 Switching were approaching significance (d=0.61) with EOD performing better.Conclusions:As expected, the EOD sample in this study had higher number of combat deployments, greater exposure to combat atrocities (e.g., death), higher levels of exposure to large explosives, as well as a higher number of MTBI. Inconsistent with our hypotheses, despite these psychological and neurological risk factors, EOD performed better on cognitive measures of memory, attention and executive functioning. They also reported less problems with inattention and impulsivity. Results may reflect the impact of psychological and cognitive resiliency.

A - 165 A Pilot Study of an Online Screening Assessment of Lifetime Exposure to Traumatic Brain Injury (TBI).

To conduct a pilot test of the feasibility and validity of administering an online screening measure of lifetime TBI exposure (LTE) and determine associations between LTE and health status. 156 adults were recruited from the general community (Age = 18-65years; 73% women) most of whom (~70%) were at-risk for TBI, primarily from playing contact-sport (62.2%). TBI exposure was assessed using the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) short form. Health status was assessed using the Rivermead Post-concussion Symptoms Questionnaire, the Depression, Anxiety and Stress Scales, and items from the 2014 Ohio Behavioral Risk Factor Surveillance Study. All measures were administered via cross-sectional survey. Online OSU TBI-ID feasibility was high (e.g., minimal missing data/attrition). With covariates controlled (e.g., TBI risk), there were positive associations between LTE [Worst TBI, Multiple TBIs] and health status (post-concussion symptoms; p's < 0.05. Initial support was found for the feasibility and validity of the online OSU TBI-ID. The patterns of associations between online LTE measures and health status were consistent with those reported for non-online methods (e.g., interview). While validation of the online LTE record against clinical records would be ideal, this study suggests that a structured method of assessing LTE can be validly administered online.

H - 32 Elevated Neurobehavioral Symptoms Detected in Greater Lifetime Subconcussive Exposure Frequency in Spanish-Speakers.

To examine whether individuals who have had one exposure to lifetime subconcussive impacts differ from those who have had multiple subconcussive exposures or those who have never had any injury to the head or neck in their report of neurobehavioral symptoms. 458 adults from the continental U.S., Spain, and Latin America participated in an online survey that included the Ohio State University Traumatic Brain Injury Identification Method Self- Administered-Brief (OSU TBI-ID SAB), which assesses lifetime exposure to Traumatic Brain Injury, and the Neurobehavioral Symptom Inventory (NSI), a measure of symptoms commonly observed after head injury. Questions from the OSU TBI-ID SAB allow for categorization of a No Exposure group, and Single and Multiple Subconcussive Exposure groups. General linear models were fitted with NSI scores as the dependent variable and the exposure groups as the independent variable. Sex, current age, and other central nervous system compromise were covariates. A significant Group difference with small effect size was found F(2,452) = 9.3, p < 0.001, ηp2 = 0.40. The Multiple Exposure group scored significantly higher on the NSI versus the Single Exposure (p = 0.004) and No Exposure (p < 0.001) groups. The Single Exposure group did not differ significantly from the No Exposure group (p = 0.084). The Spanish OSU TBI-ID SAB is sensitive to differentiating cumulative subconcussive exposures from those with only one subconcussive exposure and those with none. These data support the feasibility of deriving a subconcussive exposure index from the OSU TBI-ID SAB, and also provide preliminary justification for inclusion of a neurobehavioral symptom measure in subconcussive research and clinical practice.

Examining the Association Between Adverse Childhood Experiences and Lifetime History of Head or Neck Injury and Concussion in Children From the United States.

Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort. This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health. There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children. The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form. The sample ( N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion. ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.

Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review.

Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.

Gender Differences in Adolescents' Affective Symptoms and Behavioral Disorders After Mild Traumatic Brain Injury.

Mild traumatic brain injuries (mTBI) are considered self-limiting and full recovery is expected. Recent studies identify deficits persisting years after mTBI. Large-scale prospective data permit testing the hypothesis that mTBI increases incidence of affective and behavioral symptoms after new, past , or new and past mTBI. The study involved secondary analyses of survey responses from the Adolescent Brain Cognitive Development (ABCD) Study. Adolescents in the ABCD Study ( n = 11 869; Wave 1, aged 9-10 years; Wave 2, aged 11-12 years) whose parents reported a new ( n = 157), past ( n = 1318), or new and past ( n = 50) mTBI on the Ohio State University Traumatic Brain Injury Identification Method short form were compared with controls who had no history of mTBI ( n = 9,667). Multivariable binary logistic regression models examined associations between a new, past, or new and past mTBI and current affective (aggression, depression, anxiety) and behavioral (somatic, thought, social, attention, attention deficit hyperactivity disorder, conduct) disorders while controlling for demographic factors and baseline symptoms. The primary measure was parental reports of psychiatric and behavioral symptoms on the Child Behavior Checklist. Girls exhibited no significant effects after a new mTBI, although a past mTBI increased anxiety (adjusted odds ratios [aOR] = 1.83, 95% confidence interval [CI: 1.15-2.90]) and attention (1.89 [1.09-3.28]) problems. Girls with new and past mTBIs reported elevated anxiety (17.90 [4.67-68.7]), aggression (7.37 [1.49-36.3]), social (9.07 [2.47-33.30]), thought (7.58 [2.24-25.60]), and conduct (6.39 [1.25-32.50]) disorders. In boys, new mTBI increased aggression (aOR = 3.83, 95% CI [1.42-10.30]), whereas past mTBI heightened anxiety (1.91 [1.42-2.95]), but new and past mTBIs had no significant effects. Adolescents are at greater risk of affective and behavioral symptoms after an mTBI. These effects differ as a function of gender and time of injury. Extended screening for mTBI history and monitoring of affective and behavioral disorders after mTBI in adolescents are warranted.

What Is the Prevalence of Intimate Partner Violence and Traumatic Brain Injury in Fracture Clinic Patients?

Individuals in violent intimate relationships are at a high risk of sustaining both orthopaedic fractures and traumatic brain injury (TBI), and the fracture clinic may be the first place that concurrent intimate partner violence (IPV) and TBI are recognized. Both IPV and TBI can affect all aspects of fracture management, but prevalence of TBI and comorbid TBI and IPV is unknown. (1) What are the previous-year and lifetime prevalence of IPV and TBI in women presenting to an outpatient orthopaedic fracture clinic? (2) What are the conditional probabilities of TBI in the presence of IPV and the reverse, to explore whether screening for one condition could effectively identify patients with the other? (3) Do patients with TBI, IPV, or both have worse neurobehavioral symptoms than patients without TBI and IPV? The study was completed in the fracture clinic at a community Level 1 trauma center in Southern Ontario from July 2018 to March 2019 and included patients seen by three orthopaedic surgeons. Inclusion criteria were self-identification as a woman, age 18 years or older, and the ability to complete forms in English without assistance from the person who brought them to the clinic (for participant safety and privacy). We invited 263 women to participate: 22 were ineligible (for example, they were patients of a surgeon who was not on the study protocol), 87 declined before hearing the topic of the study, and data from eight were excluded because the data were incomplete or lost. Complete data were obtained from 146 participants. Participants' mean age was 52 ± 16 years, and the most common diagnosis was upper or lower limb fracture. Prevalence of IPV was calculated as the number of women who answered "sometimes" or "often" to direct questions from the Woman Abuse Screening Tool, which asks about physical, emotional, and sexual abuse in the past year or person's lifetime. The prevalence of TBI was calculated as the number of women who reported at least one head or neck injury that resulted in feeling dazed or confused or in loss of consciousness lasting 30 minutes or less on the Ohio State University Traumatic Brain Injury Identification Method, a standardized procedure for eliciting lifetime history of TBI through a 3- to 5-minute structured interview. Conditional probabilities were calculated using a Bayesian analysis. Neurobehavioral symptoms were characterized using the Neurobehavioral Symptom Inventory, a standard self-report measure of everyday emotional, somatic, and cognitive complaints after TBI, with total scores compared across groups using a one-way ANOVA. Previous-year prevalence of physical IPV was 7% (10 of 146), and lifetime prevalence was 28% (41 of 146). Previous-year prevalence of TBI was 8% (12 of 146), and lifetime prevalence was 49% (72 of 146). The probability of TBI in the presence of IPV was 0.77, and probability of IPV in the presence of TBI was 0.36. Thus, screening for IPV identified proportionately more patients with TBI than screening for TBI, but the reverse was not true. Neurobehavioral Symptom Inventory scores were higher (more symptoms) in patients with TBI only (23 ± 16) than those with fractures only (12 ± 11, mean difference 11 [95% CI 8 to 18]; p < 0.001), in those with IPV only (17 ± 11) versus fractures only (mean difference 5 [95% CI -1 to -11]; p < 0.05), and in those with both TBI and IPV (25 ± 14) than with fractures only (mean difference 13 [95% CI 8 to 18]; p < 0.001) or those with IPV alone (17 ± 11, mean difference 8 [95% CI -1 to 16]; p < 0.05). Using a brief screening interview, we identified a high self-reported prevalence of TBI and IPV alone, consistent with previous studies, and a novel finding of high comorbidity of IPV and TBI. Given that the fracture clinic may be the first healthcare contact for women with IPV and TBI, especially mild TBI associated with IPV, we recommend educating frontline staff on how to identify IPV and TBI as well as implementing brief screening and referral and universal design modifications that support effective, efficient, and accurate communication patients with TBI-related cognitive and communication challenges. Level II, prognostic study.

Implementing traumatic brain injury screening in behavioral healthcare: protocol for a prospective mixed methods study

BackgroundCharacteristics of both individuals and innovations are foundational determinants to the adoption of evidenced-based practices (EBPs). However, our understanding about what drives EBP adoption is limited by few studies examining relationships among implementation determinants and implementation outcomes through theory-driven hypothesis testing. Therefore, drawing on the Theory of Planned Behavior and Diffusion of Innovations Theory, this study will disentangle relationships between provider characteristics and innovation factors on the early adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral health settings.MethodsThis study will utilize an explanatory sequential mixed methods design. In Phase I (quantitative), Time 1, we will investigate behavioral health providers (N = 200) attitudes, perceived behavioral control, subjective norms, and intentions to screen for TBI upon completion of a video module introducing the OSU TBI-ID. At Time 2, we will examine the number of TBI screens conducted over the previous month, as well as the feasibility, appropriateness, and acceptability of using the OSU TBI-ID in practice. Structural equation modeling will be used to determine whether provider characteristics predict TBI screening intentions, and whether intentions mediate actual TBI screening behaviors. We will then test whether feasibility, appropriateness, and acceptability of the OSU TBI-ID moderates the relationship between intentions and TBI screening behaviors. In Phase II (qualitative), we will develop an interview guide using results from Phase I and will conduct semi-structured interviews with providers (N = 20) to assess contextual determinants of TBI screening adoption. Qualitative data will be thematically analyzed using sensitizing concepts from the Consolidated Framework for Implementation Research and integrated with the quantitative results using a joint display.DiscussionThis mixed methods study capitalizes on two theory-driven hypotheses bridging proximal (e.g., screening intent) to distal (actual behaviors) implementation outcomes and will contextualize these results qualitatively to advance our understanding about why TBI screening adoption has failed to translate to the behavioral healthcare context. Results of this study will offer insights into what is driving TBI screening adoption so that implementation strategies can be selected with greater precision to improve the adoption, sustainment, and scale-up of TBI screening in behavioral healthcare.

Persistent posttraumatic headaches and functioning in veterans: Injury type can matter.

To characterize the relationship between head trauma types (blast injury, blunt injury, combined blast+blunt injury) with subsequent headache presentations and functioning. Posttraumatic headaches (PTHs), the most common sequelae of traumatic brain injury (TBI), are painful and disabling. More than 400,000 veterans report having experienced a TBI, and understanding the predictors of PTHs may guide treatment developments. This study used a nested-cohort design analyzing baseline data from a randomized clinical trial of cognitive behavioral therapy for PTH (N=190). Participants had PTH (from blast and/or blunt head trauma) and symptoms of posttraumatic stress disorder (PTSD). The Structured Diagnostic Interview for Headache-Revised and Ohio State University Traumatic Brain Injury Identification Method were used to phenotype headaches and head injury histories, respectively. Individuals with persistent PTHs after a combined blast and blunt head trauma were more likely (OR=3.45; 95% CI [1.41, 8.4]) to experience chronic (vs. episodic) PTHs compared with the blunt trauma only group (23/33, 70% vs. 26/65, 40%, respectively); and they were more likely (OR=2.51; 95% CI [1.07, 5.9]) to experience chronic PTH compared with the blast trauma only group (44/92, 48%). There were no differences between head injury type on headache-related disability, depression symptoms, or severity of PTSD symptoms. The combination of blast and blunt injuries was associated with headache chronicity, but not headache disability. Considering the refractory nature of chronic headaches, the potential added and synergistic effects of distinct head injuries warrant further study.

Measuring Memory Concerns Among Spanish-speakers from Spain and Latin America

<h3>Research Objectives</h3> To examine the psychometric properties of a stand-alone memory concerns scale constructed from the Patient-Reported Outcomes Measurement Information System (PROMIS) Applied Cognition-General Concerns item bank among a sample of Spanish-speakers from Spain and Latin America. <h3>Design</h3> Cross-sectional analysis. <h3>Setting</h3> Web-based survey in a general community sample. <h3>Participants</h3> 396 individuals from Spain and Latin America were recruited through social media to complete an online survey regarding lifetime history of exposure to factors associated with central nervous system compromise. The sample was 69.4% female, and ages ranged from 18 to 75 (M=33.7, SD=12.7). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> PROMIS Applied Cognition-Cognitive Concerns Scale 8-item short form v1.0 (CCS-8), Eight items from the PROMIS Applied Cognition-Cognitive Concerns item bank v1.0 dealing with memory concerns (Memory Concerns Scale; MCS), Ohio State University Traumatic Brain Injury Identification Method-Self-Administered-Brief, Other Sources of Central Nervous System (CNS) Compromise Questionnaire. <h3>Results</h3> The MCS had a high internal consistency reliability (Cronbach's alpha=0.90). An exploratory factor analysis using maximum likelihood estimation with a Promax rotation containing the items from the CCS-8 and the MCS resulted in two factors demonstrating distinctiveness of the 8 memory items (MCS) from general cognitive concerns (CCS-8). Analysis of covariance controlling for age and education, showed that individuals endorsing a history of CNS compromise scored significantly higher on the MCS than those who did not report any such history, F(1,392)=7.02, p=0.008. <h3>Conclusions</h3> As a stand-alone self-report measure, the MCS appears to measure a construct distinct from general cognitive concerns with a capacity to differentiate among individuals with and without a history of CNS compromise. <h3>Author(s) Disclosures</h3> Authors have no conflicts of interest to declare.

Brain Injury in Justice-Involved Youth: Findings and Implications for Juvenile Service Professionals

It is well-established that the prevalence of brain injury among justice-involved populations is significantly greater than that of the general population. From 2014-2018, a demonstration project was conducted in two juvenile detention centers in southeastern PA. Its core strategy was to identify youth with history of brain injury; determine their neurocognitive barriers to successful re-entry; and create release plans including connections to appropriate resources. 489 youth participated. They were screened for brain injury utilizing the Ohio State University Traumatic Brain Injury Identification Method, and those who screened positive, were assessed utilizing standardized measures of memory and executive functioning. Results indicated that 49% had history of brain injury, with an average of 2.59 injuries per youth. 62% of injuries did not involve a loss of consciousness, and two-thirds never sought treatment for their injury. A history of repetitive blows to the head was also common, and often caused by violence. 147 youth were subsequently evaluated for cognitive impairment. 57% showed evidence of significant cognitive impairment, with the most common impairments being working memory, behavioral regulation, and delayed recall of novel information. Resources included referrals to brain injury school re-entry programs, vocational rehabilitation, and medical rehabilitation.

Impact of Prior Brain Injury on Concussion Recovery in Military Personnel: Evaluation of Timing Between Concussions.

To evaluate the potential impact of timing between the current and the most recent previous concussions on symptom severity among acutely concussed active duty military Service members (SMs). Three military installations. Eighty-four SMs aged 18 to 44 years who sustained a concussion within 72 hours of enrollment. No previous concussion within 1 year preenrollment. Longitudinal study with enrollment within 72 hours of injury, and follow-up at 1 week and 1 month postinjury. Lifetime concussion history (yes/no) and recency of the latest concussion (no history, relatively more recent [1 to <6 years ago], and more remote [6+ years ago]) from the current concussion using the Ohio State University Traumatic Brain Injury Identification Method-Interview Form. Symptom severity (total and by categories: cognitive, affective, somatosensory, vestibular) at all time points using the Neurobehavioral Symptoms Inventory. Concussion history assessed as having any previous concussion was not found significantly related to symptom severity (total or by categories) following a current concussion. However, when timing between concussion was taken into account, time since previous concussion was significantly related to symptomatology, whereby those with relatively more recent previous concussion had greater total symptoms within 72 hours of injury and at 1 week postinjury (though not at 1 month) than those with more remote previous concussion (≤72 hours: difference = 15.4, 95% CI = 1.8 to 29.1; 1 week: difference = 15.2, 95% CI = 1.2 to 29.2) or no history (≤72 hours: difference = 11.6, 95% CI = 0.4 to 22.8; 1 week: difference = 13.9, 95% CI = 2.4 to 25.4). When evaluated by symptom category, this relationship was particularly important on affective and somatosensory symptoms. In recently concussed active duty SMs, the timing between the current and previous concussions may be an important factor in determining prognosis. Clinical assessment of concussion history that accounts for the timing of the most recent event may be necessary to identify patients who may require a more conservative plan of care and more gradual return to activity in the acute recovery stage.

Associations between significant head injury and persisting disability and violent crime in women in prison in Scotland, UK: a cross-sectional study

SummaryBackgroundThe prevalence of head injury is estimated to be as high as 55% in women in prison and might be a risk factor for violent offending, but evidence is equivocal. The extent of persisting disability is unknown, making decisions about service needs difficult. The UN recognises vulnerabilities in women in prison, but does not include head injury. This study aimed to investigate relationships among head injury, comorbidities, disability, and offending in women in prison.MethodsIn this cross-sectional study, women were recruited between Feb 2, 2018, and Sept 30, 2019, from four prisons across Scotland, UK: Her Majesty's Prison (HMP) Cornton Vale, Her Majesty's Young Offenders Institute Polmont, HMP Edinburgh, and HMP Greenock (detaining approximately 355 individuals at the time of recruitment). Women were included if they were aged older than 16 years, fluent in English, able to participate in face-to-face assessment and provide informed consent, and did not have a severe acute disorder of cognition or communication. Head injury, cognition, disability, mental health, and history of abuse and problematic substance use were assessed by interview. History of head injury was assessed with the Ohio State University Traumatic Brain Injury Identification method and disability was assessed with the Glasgow Outcome at Discharge Scale. Comparisons were made between women with and without a history of significant head injury.FindingsWe recruited 109 (31%) of the 355 women in these prisons. The sample was demographically representative of the approximately 400 individuals in women's prisons in Scotland. Significant head injury (SHI) was found in 85 (78%) of 109 women, of whom 34 (40%) had associated disability. Repeat head injury was reported in 71 (84%) of the 85 women with SHI and, in most cases, this resulted from domestic abuse that had occurred over many years. Women with a history of SHI were significantly more likely to have a history of violent offences than those without a history of SHI (66 [79%] of 85 women in the SHI group vs 13 [54%] of 24 women in the no-SHI group had committed a violent offence; odds ratio [OR] 3·1, 95% CI 1·2–8·1). This effect remained significant after adjusting for current factors (3·1, 1·1–9·0), including comorbidities associated with post-traumatic stress disorder, and was no longer statistically significant after adjusting for historical factors (3·3, 1·0–10·9), such as abuse as a child or adult. Women with SHI had spent longer in prison than women without SHI after adjustment for current (rate ratio 3·4, 1·3–8·4) or historical (3·5, 1·3–9·2) risk factors.InterpretationIt is recognised that women in prison are vulnerable because of histories of abuse and problematic substance use; however, history of SHI needs to be included when developing criminal justice policy, interventions to reduce mental health morbidity, and assessment and management of risk of violent offending.FundingThe Scottish Government.

Post-mTBI Pain Interference in a U.S. Military Population: A Chronic Effects of Neurotrauma Consortium Study.

Chronic pain is a significant problem for service members and veterans with mild traumatic brain injury (mTBI). While the root cause of pain is not clearly understood, comorbidities may contribute to how their pain disrupts their functional status, a construct termed "pain interference." The purpose of this study is to examine the associations between mTBI, other comorbidities, and pain interference. The sample comprised participants with mTBI(s) from The Chronic Effects of Neurotrauma Consortium multicenter observational study. Potential concussive events were identified using a modified Ohio State University traumatic brain injury (TBI) Identification interview and then further with a structured interview. Pain interference was measured with the TBI quality-of-life pain interference score, which was categorized into insignificant, moderate, and high pain interference. Comorbidities of interest included anxiety, depression, post-traumatic stress disorder, insomnia, and arthritis. Multivariable relationships were analyzed using logistic regression. The analysis sample included 346 participants with mTBI(s). In adjusted analysis, those with high pain interference were more likely to have history of ≥ 3 TBIs (odds ratio (OR) 3.1, 95% confidence interval [CI] 1.4, 6.9) and to have clinical levels of post-traumatic stress disorder (OR 5.4, 95% CI 1.9, 15.7), depression (OR 2.5, 95% CI, 1.0, 6.1), anxiety (OR 4.9, 95% CI, 2.0, 11.7), and sleep disturbances (OR 6.1, 95% CI 2.0, 19.0) versus those with insignificant pain interference. These results identify clinical features of veterans and service members with mTBI(s) who are at highest risk for pain-related disability. These findings also demonstrate the need to consider mental health and sleep problems in their pain evaluation and treatment approach.

Association of remote mild traumatic brain injury with cortical amyloid burden in clinically normal older adults.

We investigated whether clinically normal older adults with remote, mild traumatic brain injury (mTBI) show evidence of higher cortical Aβ burden. Our study included 134 clinically normal older adults (age 74.1 ± 6.8 years, 59.7% female, 85.8% white) who underwent Aβ positron emission tomography (Aβ-PET) and who completed the Ohio State University Traumatic Brain Injury Identification questionnaire. We limited participants to those reporting injuries classified as mTBI. A subset (N = 30) underwent a second Aβ-PET scan (mean 2.7years later). We examined the effect of remote mTBI on Aβ-PET burden, interactions between remote mTBI and age, sex, and APOE status, longitudinal Aβ accumulation, and the interaction between remote mTBI and Aβ burden on memory and executive functioning. Of 134 participants, 48 (36%) reported remote mTBI (0, N = 86; 1, N = 31, 2+, N = 17; mean 37 ± 23years since last mTBI). Effect size estimates were small to negligible for the association of remote mTBI with Aβ burden (p = .94, η2 < 0.01), and for all interaction analyses. Longitudinally, we found a non-statistically significant association of those with remote mTBI (N = 11) having a faster rate of Aβ accumulation (B = 0.01, p = .08) than those without (N = 19). There was no significant interaction between remote mTBI and Aβ burden on cognition. In clinically normal older adults, history of mTBI is not associated with greater cortical Aβ burden and does not interact with Aβ burden to impact cognition. Longitudinal analyses suggest remote mTBI may be associated with more rapid cortical Aβ accumulation. This finding warrants further study in larger and more diverse samples with well-characterized lifelong head trauma exposure.

Assessing lifetime exposure to traumatic brain injury among an international sample of Spanish speakers.

With structured interviews being an established method for assessing one's exposure to traumatic brain injury across their lifetime, effective assessment tools are needed to serve the large population of Spanish speakers in the U.S. and abroad. To obtain preliminary evidence of validity for a Spanish version of a web-based, structured interview designed to assess lifetime exposure to TBI. A sample of 720 Spanish-speaking individuals between the ages of 18 through 65 from the continental U.S. (34.3%), South America (30.8%), the Caribbean (12.6%), Spain (12.4%), and Mexico and Central America (9.9%) completed an online survey containing the Ohio State University Traumatic Brain Injury Identification Method (Self-Administered-Brief; OSU TBI-ID SAB), Neurobehavioral Symptom Inventory, and PROMIS Cognitive Concerns Scale. Indices of severity of worst TBI, time since most recent TBI, and multiple injuries demonstrated expected relationships with neurobehavioral symptoms such that greater symptom reporting was observed among those who had more severe injuries, more recent injuries, and multiple injuries over a period of time. Findings provide preliminary evidence of validity for three of the indices derived from OSU TBI-ID SAB among Spanish-speaking individuals. Further study is needed to assess other aspects of this instrument to pave the way for further epidemiological studies involving lifetime exposure to TBI among Spanish-speaking individuals across the U.S., Spain, and Latin America.

Identifying Frequency of Mild Traumatic Brain Injury in Firefighters.

Background: Mild traumatic brain injury (mTBI) is a nationwide problem; yet, no firefighter mTBI data are available. Methods: In this cross-sectional study, we assessed retrospective head injuries using WHO guidelines. We captured mTBI frequency and examined firefighters' symptoms (e.g., using Ohio State University Traumatic Brain Injury Identification method, Brief Traumatic Brain Injury Screen, Warrior Administered Retrospective Causality Assessment Tool). Findings: Of 1,112 firefighters contacted, 60 responses were included. Most participants were White (80%), male (90%), former athletes (75%). 62% met mTBI symptom criteria. 75% reported at least one lifetime head injury. Number of head injuries and depression symptoms were associated (r = .36, p < .05). Conclusion/application to practice: Overall, it appears most firefighters have sustained at least one lifetime mTBI. Those with multiple head injuries may be at increased risk of depression. Occupational health professionals should be aware of firefighters' mTBI risk. Further research is warranted given findings.

Linguistic and Cultural Acceptability of a Spanish Translation of the Ohio State University Traumatic Brain Injury Identification Method Among Community-Dwelling Spanish-Dominant Older Adults

ObjectiveOur objective was to (1) evaluate the linguistic and cultural acceptability of a Spanish translation of the Ohio State University traumatic brain injury identification method (OSU TBI-ID) and (2) to assess the usability and acceptability of a tablet-based version of this instrument in a cohort of Spanish-dominant older adults. SettingUniversity clinical research center and local community center. ParticipantsCommunity-dwelling Spanish-dominant adults age 50 years or older without dementia residing in the Bay Area of California (N=22). DesignCross-sectional cohort study. Main Outcome MeasuresQualitative assessment of linguistic or cultural acceptability of a Spanish translation of the OSU TBI-ID as well as usability or acceptability of a tablet-based self-administered version of this instrument. ResultsThe Spanish translation had high linguistic and cultural acceptability and was further optimized based on participant feedback. Cognitive interviews to review survey wording revealed high levels of homogeneity in the clinical definitions and synonyms given by participants—for example, results for the clinical term “Quedó Inconsciente/Pérdida (temporal) de la conciencia” (To be unconscious/[Temporary] loss of consciousness) used in the survey included “perder el conocimiento” (loss of consciousness), “knockeado” (knocked out), “No es que esté dormida, porque está inconsciente, pero su corazón está todavía palpitando” (it’s not that they’re sleeping, because they’re unconscious, but their heart is still palpitating). The tablet interface had low observer-based usability, revealing that participants with <13 years of education (n=6) had more difficulty using the tablet which could be improved with minor changes to the coding of the application and minimal in-person technology support. Acceptability of the tool was low among all but 1 participant. ConclusionThis linguistically optimized Spanish translation of the OSU TBI-ID is recommended for use as a semistructured interview among Spanish-dominant older adults. Although the tablet-based instrument may be used by interviewers as an efficient electronic case report form among older adults, further research is needed, particularly among older adults with varying levels of education, to validate this instrument as a self-administered survey.

Using the OSU TBI-ID method for screening rural, older adults: a mixed methods feasibility study

ABSTRACTObjective: To examine the feasibility of: (1) a brain injury and screening tool (Ohio State University Traumatic Brain Injury Identification Method; OSU TBI-ID) training for rural Area Agency on Aging (AAA) health professionals, and (2) implementation of the screening process. Research Design: A mixed methods design was utilized to assess several aspects of feasibility. Quantitatively, the researchers examined AAA health professionals’ scores on a brain injury misconceptions survey, descriptive statistics about the clients screened, and health professionals’ accuracy using the OSU TBI-ID. Qualitative data was collected via focus group interviews with the health professionals. Methods and Procedures: The researchers conducted brain injury education and screening tool training for AAA health professionals. Subsequently, the health professionals used the OSU TBI-ID to screen their older adult clients for brain injury. Main Outcomes and Results: AAA health professionals learned the OSU TBI-ID quickly and used the protocol correctly. The screening results established that 15% of the clients screened positive for brain injury; of those with positive screens, 87% did not have a previous brain injury diagnosis. Conclusions: The current study presents evidence of feasibility for (1) training AAA health professionals, and (2) implementation of the OSU TBI-ID to screen older adult clients.