Post-severe Traumatic Brain Injury Research Articles

The effects of hyperbaric oxygen therapy on neuroprotection and recovery after brain resuscitation

Objective Analyze the impact of hyperbaric oxygen therapy on neuroprotection and recovery post severe traumatic brain injury (sTBI) resuscitation. Methods Retrospective analysis of clinical data from 83 sTBI patients admitted between January 2022 to January 2024. Patients were divided into control (n = 41) and observation (n = 42) groups based on treatment received. Control received standard therapy, while the observation group received hyperbaric oxygen therapy. Effects on clinical outcomes, neuroinjury markers (S100β, GFAP, UCH-L1, NSE), neurotrophic factors (NGF, BDNF), neurological function indicators (NIHSS, CSS), and adverse reactions were compared. Results The observation group showed a higher total effective rate (80.95%) compared to control (60.98%) (p < 0.05). Neuroinjury markers decreased post-treatment in both groups, with the observation group lower (p < 0.05). NGF and BDNF levels increased post-treatment in both groups, with the observation group higher (p < 0.05). NIHSS and CSS scores decreased post-treatment in both groups, with the observation group lower (p < 0.05). No significant difference in adverse reactions between groups (p > 0.05). Conclusion Hyperbaric oxygen therapy effectively treats sTBI by improving brain resuscitation success, reducing neuroinjury factors, enhancing neurotrophic factors, and promoting neurological function recovery, without increasing adverse reaction risk.

Alterations of oligodendrocyte progenitor cells (OPCs) with survival time in humans following high impact brain trauma

BackgroundAs there is a lack of comprehensive literature regarding the molecular environment of the human brain emphasizing on oligodendrocyte progenitor cells (OPCs) following high impact brain trauma. The protagonist of OPCs post severe traumatic brain injury (sTBI) provides a significant thrust towards estimating time elapsed since trauma as well as developing novel therapeutic approaches. The present study was carried out to study post trauma alterations pertaining to myelin sheath and oligodendrocyte response with survival time. Materials and methodsIn the present study, victims (both male and female) of sTBI (n = 64) were recruited and contrasted with age and gender matched controls (n = 12). Post mortem brain samples from corpus callosum and grey white matter interface were collected during autopsy examination. Extent of myelin degradation and response of OPC markers Olig-2 and PDGFR-α were evaluated using immunohistochemistry and qRT-PCR. STATA 14.0 statistical software was used for data analysis with P-value<0.05 considered statistically significant. ResultsTimewise qualitative correlation with extent of demyelination performed using LFB-PAS/IHC-MBP, IHC Olig-2 and mRNA expression revealed tendency towards remyelination in both corpus callosum and grey white matter interface. Number of Olig-2 positive cells was significantly higher in sTBI group as compared to control group (P-value: 0.0001). Moreover, mRNA expression studies of Olig-2 showed significant upregulation in sTBI patients. mRNA expression of Olig-2 and PDGFR-α in sTBI patients showed significant variation with respect to survival time (p value:0.0001). ConclusionDetailed assessment of post TBI changes implementing various immunohistochemical and molecular techniques shall potentially reveal intriguing and important inferences in medicolegal practices and neurotherapeutics.

Clinical and rehabilitative considerations in a complex case of spastic tetraplegia, mixed aphasia, secondary encephalopathy – post severe traumatic brain injury with hemorrhagic and is-chemic lesions – with favorable late evolution and post-symptomatic status after SARS-COV-2 infection

The traumatic brain injury remains a current research topic considering the severity and the in-creased incidence of this pathology. Both physical and neuro-psychological sequelae require a complex rehabilitation program. Material and methods. We describe the evolution of a 20-year-old case, victim of a severe traumatic brain injury due to physical aggression, with spastic te-traplegia, extended ischemia in the left cerebral hemisphere, mixed aphasia, post-traumatic en-cephalopathy, left eyelid ptosis, right paresis of nerve III, post remitted status of left subdural hematoma, post remitted status of right fronto-parietal subarachnoid hemorrhage, severe joint stiffness (right elbow and fist, bilateral hips and knees), cachexia and SARS-COV-2 infection. In our clinic the patient followed medical, complex kinetotherapeutic treatments and was functio-nally assessed using the following scales: modified Ashworth, Penn Spasm Frequency Scale ( Penn), Life Quality Assessment ( QOL ), Montreal Cognitive Assessment ( MoCA ), FAC Interna-tional Scale, Glasgow Outcome Scale-Extended (GOS-E), modified Rankin scale (mRS ). Results. During the hospitalization, the patient presented a favorable late evolution with a great impro-vement of motor and neurological deficit, aphasia in remision, improvement of eyelid ptosis and joint stiffness, fact also confirmed by the increasing scores from the evaluated scales. Con-clusions. Consequently in traumatic brain injury the proper medication, personalized rehabilita-tion program, ergotherapy, speech therapy, a great deal of involvement and documentation of current information is required to improve the patient's quality of life. Keywords: traumatic brain injury, neuro-rehabilitation program, spastic tetraplegia

Sex Differences in Experimental Traumatic Brain Injury‐induced Epileptogenesis

Traumatic brain injury (TBI) is a complex condition that affects millions of people worldwide. TBI has both immediate and long-term pathological consequences, and individual cases are graded as minor, moderate, or severe based on the Glasgow Coma Scale. Among the numerous factors that influence prognosis, gender is perhaps the most notable because of hormonal factors. It has been shown that progesterone, a female steroid hormone with reproductive and neuroactive effects, has improved motor function and mortality rates in patients post-severe TBI. In this study, we sought to investigate the sex differences in progression of spontaneous recurrent seizures and long-term inflammation after TBI. We used a controlled cortical-hippocampal impact (CCI) model of severe TBI in adult male and cycling female mice. They were monitored by 24/7 by video-EEG recording g for 4 months through a recording electrode placed in the contralateral hippocampus. Behavioral and motor analyses were assessed over a 4-month period and tests consisted of beam-walk, neuroscore, rotarod, elevated plus maze, and novel object recognition. Brains were post-fixed for immunohistochemistry and analyzed for astrogliosis (GFAP+) and microgliosis (IBA1+). Epileptic seizures were identified in both the male and female mice, though incidence and frequency were significantly lower in the female cohort with CCI. Reactive gliosis and astrocyte activated persisted through 4 months post-TBI, indicating a chronic inflammatory response. Additionally, female mice displayed significantly improved functional and sensory-motor performance compared to age-matched males. Hormones impacts many aspects of TBI including clinical manifestations, recovery outcomes, and quality of life. Our results characterize striking sex differences in TBI-induced epileptogenesis and its associated comorbidities which has implications to develop sex-specific treatments and improve prognosis.

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3-4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<-1 DS) or low IGF-1 (<-2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5-10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4-6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study.

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3-4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<-1 DS) or low IGF-1 (<-2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5-10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4-6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

Variation in Candidate Traumatic Brain Injury Biomarker Genes Are Associated with Gross Neurological Outcomes after Severe Traumatic Brain Injury.

Diagnostic and prognostic biomarkers of traumatic brain injury (TBI) are actively being pursued; potential candidates include glial fibrillary acid protein (GFAP), S100 calcium-binding protein B (S100B), and ubiquitin C-terminal hydrolase L1 (UCHL1), two of which the United States Food and Drug Administration (FDA) recently approved for marketing of blood tests for adult concussion. The relationship between biomarker-encoding genes and TBI outcomes remains unknown. This pilot study explores variation in 18 single nucleotide polymorphisms (SNPs) in biomarker-encoding genes as predictors of neurological outcome in a population of adults with severe TBI. Participants (n = 305) were assessed using the Glasgow Outcome Scale (GOS) at 3, 6, 12, and 24 months post-injury. Multivariate logistical regression was used to calculate the odds ratio (OR) and determine the odds of having a lower score on the GOS ( = 1-2 vs. 3-5) based on variant allele presence, while controlling for confounders. Possession of the variant allele of one S100B SNP (rs1051169) was associated with higher scores on the GOS at 3 months (OR = 0.39; p = 0.04), 6 months (OR = 0.34; p = 0.02), 12 months (OR = 0.32; p = 0.02), and 24 months (OR = 0.30; p = 0.02) post-severe TBI. The relationship among these polymorphisms, protein levels, and biomarker utility, merits examination. These findings represent a novel contribution to the evidence that can inform future studies aimed at enhancing interpretation of biomarker data, identifying novel biomarkers, and ultimately harnessing this information to improve clinical outcomes and personalize care.

Group-Based Trajectory Analysis of Emotional Symptoms Among Survivors After Severe Traumatic Brain Injury.

Depressive symptoms and anxiety are fairly common emotional outcomes after severe traumatic brain injury (TBI). Life satisfaction is a main factor in the general construct of subjective well-being. However, there is limited literature available on the interrelationship between emotional outcomes and life satisfaction post-severe TBI over time. The purpose of this study was to characterize distinct patterns of change in depressive symptoms, anxiety, and life satisfaction over 24 months after severe TBI and evaluate the interrelationship of different trajectory groups among them as well as associated subject characteristics. This prospective study used longitudinal data collected from the University of Pittsburgh Brain Trauma Research Center from survivors of severe TBI (N = 129). In addition to demographic and injury-related data, depressive symptoms, anxiety, and life satisfaction were collected at 3, 6, 12, and 24 months postinjury. A group-based trajectory model was performed to identify distinct longitudinal patterns of depressive symptoms, anxiety, and life satisfaction. The interrelationships of distinct trajectory groups were examined using χ tests. A multivariate logistic regression model was used to examine the predictors of different emotional symptom trajectories. The group-based trajectory model identified 2 distinct patterns of each of 3 outcomes: constantly low and constantly high depressive symptoms group (70.4% vs 29.6%), constantly low and constantly high anxiety group (69.1% vs 30.9%), and low-decreasing and high-stable life satisfaction groups (56.3% vs 43.7%). A strong pairwise association was observed between trajectory group membership for depressive symptoms and anxiety (P < .0001), depressive symptoms and life satisfaction (P < .0001), and anxiety and life satisfaction (P < .001). Subjects with increased severe injury were more likely to belong to the high-stable depressive symptoms group, while there were no significant associations between age, gender, race, education, marriage status and distinct depressive symptoms, anxiety, and life satisfaction trajectory groups. A group-based trajectory model revealed patterns of emotional symptoms that have not been fully explored among survivors of severe TBI. There appear to be distinct trajectory patterns for depressive symptoms, anxiety, and life satisfaction, respectively. There was strong interrelationship among emotional symptoms. The findings add to our understanding of psychosocial outcomes experienced over time after severe TBI.

Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI

BackgroundMotion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations.MethodsA single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data.ResultsDynamic balance, characterized by the DGI, increased during the intervention phase χ2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = < .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase.ConclusionsUse of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population.Trial registrationClinicaltrial.gov ID - NCT02889289

Predictors of functional and professional outcomes in patients with severe traumatic brain injury

To determine factors influencing long-term functional and professional outcomes in patients post severe traumatic brain injury (STBI). A descriptive analytical transversal and cross-sectional study involving patients with STBI dated more than 1 year and managed in rehabilitation department on an outpatient basis. Described parameters were: coma duration, post-traumatic amnesia duration (PTA), duration of hospitalization in intensive care unit, rehabilitation delay management, brain imaging findings, motor impairment, neuropsychological impairment assessed with Neurobehavioral Rating Scale-Revised (NRS-R), functional outcomes assessed with Functional Independence Measure (FIM) and disability assessed with Glasgow Outcome Scale (GOS). Three years post-STBI, motor impairment was severe in 34% of cases. Neuropsychological impairments were common: memory disorders (89.6%), attention-deficit disorder (81.2%), irritability (64.6%). Dependency in activities of daily living according to FIM was severe and total in 44% of cases and disability was severe in 44% of cases according to GOS. Factors significantly associated with bad functional outcomes (FIM and GOS) were: coma duration ( P : 0.014), PTA ( P < 0.001) and hospitalization duration ( P < 0,001). We noticed that patients with brain injuries, such as cerebral contusion; cerebral oedema and subarachnoid hemorrhage have a poor recovery. The vocational reintegration rate was at 22%. Patients who failed to return to work had mainly severe motor impairment and an altered FIM or GOS. APT duration and the length of hospitalization in intensive care unit were correlated to return to work. It is important to determine and to understand factors influencing patient's prognosis after severe traumatic brain injury allowing us to improve functional and professional outcomes of this population. The current study confirmed the impact of APT and coma duration on functional recovery and professional activities resumption.

Acute Treatment of an Atypical Benign Paroxysmal Positional Vertigo Variant Postsevere Traumatic Brain Injury

Background and Purpose: The differential diagnosis and treatment of peripheral vestibular disorders in persons with traumatic brain injury presents a complex set of challenges. In the acute rehabilitation setting, orthopedic and medical restrictions, agitation, and/or the inability of the patient to verbalize current symptoms present barriers to many traditional means of assessment and intervention. The purpose of this article is to present a case report of 2 patients successfully treated in the acute inpatient rehabilitation setting postsevere traumatic brain injury with an atypical variant of horizontal canal benign paroxysmal positional vertigo in which both examination and intervention modifications were required in a novel context when applied to this patient population. Case Description: Two patients were consulted to have a vestibular rehabilitation examination performed given interdisciplinary reports of nystagmus and in 1 case significant emesis associated with bed mobility. Both patients presented as Rancho Los Amigos classification 3 to 4, were nonverbal, and presented with multiple comorbidities. Intervention: Both patients were treated for apogeotropic horizontal canal benign paroxysmal positional vertigo using a sequence of bedside canalith repositioning maneuvers safely and efficiently accommodating the clinical brain injury presentation. Outcomes: Both patients demonstrated complete remission of horizontal nystagmus and remission of associated emesis in the 1 case allowing for increased interdisciplinary rehabilitation participation. Discussion: This case report illustrates how application of recent scientific and clinical evidence may be applied within the early acute brain injury population. Vestibular rehabilitation may be an important component to acute neurological rehabilitation posttraumatic brain injury, even when the patient cannot actively verbalize symptoms. In these cases, the clinician must then use a collaborative approach as well as a clinical decision-making model on the basis of an understanding of the neurological underpinning of eye movements and nystagmus.

Outcome one year post severe traumatic brain injury: About a Tunisian population

The main objective of this study was to investigate the epidemiological characteristics, functional and socio-professional outcome of a population of individuals one year after a severe traumatic brain injury (TBI). The following parameters were analysed: profession, mechanism of trauma, period of care in rehabilitation, initial GCS, imaging results, nature of neuro-orthopedic sequelae, cognitive disorders, and functional level assessed by the FIM (Functional Independence Measure). The handicap was evaluated by the Glasgow outcome scale (GOS). The socio-professional status after TBI (lifestyle, occupation and education) was also investigated. The average age of the 50 patients included in the study was 28.1 ± 15.3 years, mostly male (76%). Length of stay in functional rehabilitation averaged 8.7 ± 14.7 months. All patients included in this study were socially active before the accident and lived with their family. Only 7 patients had returned to work and only 8 patients had resumed their schooling. Problems with memory, executive functions and thinking were reported in 42% of cases. The behavioural troubles (frontal syndrome and emotional problem health) were noted in 40% of cases. The average value of the FIM was 84.1 ± 29. According to the GOS, 30% of patients had a good recovery, and 2 patients remained in persistent vegetative state. Our study population is relatively young and predominantly male. Rehabilitation management takes place very late and the rate of socio-professional reintegration is very low. These findings highlight the importance of providing coordinated medical rehabilitation and intensive care unit to promote social outcomes after severe TBI.

A novel, ultrasensitive assay for tau: potential for assessing traumatic brain injury in tissues and biofluids.

Traumatic brain injury (TBI) is a cause of death and disability and can lead to tauopathy-related dementia at an early age. Pathologically, TBI results in axonal injury that is coupled to tau hyperphosphorylation, leading to microtubule instability and tau-mediated neurodegeneration. This suggests that the forms of this protein might serve as neuroinjury-related biomarkers for diagnosis of injury severity and prognosis of the neurological damage prior to clinical expression. We initially determined whether we could detect tau in body fluids using a highly sensitive assay. We used a novel immunoassay, enhanced immunoassay using multi-arrayed fiberoptics (EIMAF) either alone or in combination with rolling circle amplification (a-EIMAF) for the detection of total (T) and phosphorylated (P) tau proteins from brains and biofluids (blood, CSF) of rodents following controlled cortical impact (CCI) and human patients post severe TBI (sTBI). This assay technology for tau is the most sensitive to date with a detection limit of approximately 100 ag/mL for either T-tau and P-tau. In the rodent models, T-tau and P-tau levels in brain and blood increased following CCI during the acute phase and remained high during the chronic phase (30 d). In human CSF samples, T-tau and P-tau increased during the sampling period (5-6 d). T-tau and P-tau in human serum rose during the acute phase and decreased during the chronic stage but was still detectable beyond six months post sTBI. Thus, EIMAF has the potential for assessing both the severity of the proximal injury and the prognosis using easily accessible samples.

Etioloy and potential mechanism of cerebral infarction post severe traumatic brain injury

Objective To investigate the clinical characteristics,risk factors and potential mechanism of cerebral infarction post severe traumatic brain injury(TBI).Method Clinical records of 24 patients suffering cerebral infarction and 46 patients without cerebral infarction after severe TBI were reviewed retrospectively.Results patients with cerebral infarction got a survival rate at 58％,lower than patients without cerebral infarction (83％).The maximal body temperature (38.1 ± 0.8) ℃ in the first 24hrs,incidence of coagulating dysfunction (75％) and middle cerebral artery spasm(75％) were much higher in infarction group than the non-infarction group (P ＜ 0.05).Conclusion Cerebral infarction exerts a tremendous influence on the prognosis of severe TBI.Cerebral vessel spasm,devastation and compression of the vessel structure are the high risk factors for cerebral infarction after severe TBI. Key words: Brain trauma; Brain infarction; Cerebral vasospasm; High risk factors

Role of S100B protein in urine and serum as an early predictor of mortality after severe traumatic brain injury in adults

S100B is a calcium-binding protein released into the blood from astroglial cells due to brain injury. Some authors have described a correlation between S100B serum concentration and severity of brain damage. There is not much information about the accuracy of urinary S100B for predicting outcome after severe traumatic brain injury (TBI). 55 patients with severe TBI were included in the study. Blood and urine samples were drawn to determine S100B levels on admission and on the subsequent 24, 48, 72 and 96h. S100B concentrations (serum and urine) were significantly higher in patients who were dead a month after the accident compared to survivors. ROC-analysis showed that S100B at 24h post-severe TBI is a useful tool for predicting mortality (serum: AUC 0.958, urine: AUC 0.778). The best cut-offs for S100B were 0.461μg/L and 0.025μg/L (serum and urine respectively), with a sensitivity of 90% for both measurements and a specificity of 88.4% (serum) and 62.8% (urine). We can state that the determination of S100B levels both in urine and serum acts as a sensitive and an effective biomarker for the early prediction of mortality after severe TBI.

The effect of variable gait modes on walking parameters among children post severe traumatic brain injury and typically developed controls

The goal of the present study was to assess the effect of various walking modes on dynamic gait characteristics and to evaluate the possible differences in the adaptation reactions between children post severe traumatic brain injury (TBI) and typically developed (TD) controls. Thirteen children post severe TBI, mean of 3.5 years post trauma, independent walkers, with a walking velocity > 1.1 m/sec, and 15 TD controls participated in this study. Ages were 7-13 years. Gait speed, step time and length and step time and length variability were assessed by an electronic walkway. The children completed three cycles on the walkway for each of the following situations: comfortable walking, walking as fast as possible, as slow as possible and walking on a straight line. Despite a similar walking performance while walking at a "regular" speed, children post severe TBI exhibit a significantly reduced range of walking speeds (73-154 cm/sec), about half, as compared to TD children (54-193 cm/sec) across the study assignments. In addition, while "walking on a straight line" children post TBI walk slower, with increased step variability as compared to their peers. Children post severe traumatic brain injury may achieve independent walking at a comparable rate to typically developed controls; however their impairments will be exacerbated as the demands increase. Since a variety of walking speeds is crucial for independent daily living at any age and for children in particular, and since adequate balance is an inherent element of walking, these issues need repeated assessments and the children should receive appropriate treatment.

Effect of concurrent cognitive tasks on gait features among children post-severe traumatic brain injury and typically-developed controls

Aim: To investigate and compare the influence of concurrent cognitive tasks on gait characteristics in children post-traumatic brain injury (TBI) and typically-developed (TD) controls.Methods: Fifteen children post-TBI (aged 9.5 ± 2.2 years) and 15 TD controls (aged 9.9 ± 1.3 years) were included in the study. The children were asked to walk under three conditions: (1) walking at a self-selected speed, (2) walking at a self-selected speed while memorizing and recalling a series of three random numbers and (3) walking at a self-selected speed while listening and identifying commonly experienced sounds. Gait parameters include walking speed, step time and length and step time and length variability as measured with the GAITRite® system.Results: Introduction of a concurrent task led to decreased walking speed and step length and increased step time and step length variability in both groups, but with a significantly prominent effect in children post-TBI. The results also showed that the effect of a concurrent cognitive task on walking depended on the complexity level of the task.Conclusion: When children were asked to perform an additional task while they were walking, this had a negative effect on their gait. One may deduce from these results that control of the rhythmic stepping mechanism at a self-selected walking speed in children is dependant to an extent on their ability to focus attention on their gait. In children post-TBI who usually have an attention deficit anyway, this ability is severely disturbed.

Poster 169: Attention Processing Training and Theory of Mind Performance: Results From a Pilot Study

Objective: To determine whether a structured treatment program, designed to improve attention, could improve Theory of Mind (ToM) performance in individuals with traumatic brain injury (TBI). Design: Principles of single subject experimental design provided the basis for this study. Setting: Outpatient clinic setting. Patient: A 24-year-old man who was 9 months postsevere TBI. Intervention: A modified version of the Attention Processing Training (APT-1) program. Main Outcome Measures: Baseline assessments of ToM (first and second order belief cartoons) and attention (Paced Auditory Serial Addition Test) were given pretraining, during each of the 5 weeks of structured intervention (Attention Processing Training), and posttraining.

Understanding the role of communication in maintaining and forming friendships following traumatic brain injury

Primary objective: To describe and analyse how two adults with traumatic brain injury (TBI) construct meaning about their communication and its impact upon friendships. This information was sought with a view to understanding whether these adults perceived a link between their post-TBI communication and their experience of friendship; and, in addition, which aspects of their communication, if any, emerged as being important in this scenario.Research design: A qualitative approach based on Grounded Theory.Methods and procedures: Purposive sampling of two participants living in the community at a minimum of 2 years post-severe TBI was utilized. Data was collected via in-depth semi-structured interviews. Transcripts were analysed for categories and themes.Outcomes and results: Three major themes were evident: (1) The experience of friendship following TBI, (2) Changes to conversational skill and (3) Opening up to others. Communication change was important in the experience of friendships in so much as difficulties with conversational skill impacted on participation levels and self-disclosure. Participants identified aspects of communication associated with difficulties when interacting with friends and peers.Conclusions: Participants’ stories illustrate the need to address post-TBI communication difficulties within social contexts. Further research addressing communication difficulties that impact on friendships specific to gender, age and time post-injury is warranted.

Heart rate and heart rate variability at rest and during exercise in boys who suffered a severe traumatic brain injury and typically-developed controls

Objectives: To measure heart rate (HR) and heart rate variability (HRV) at rest and during exercise in children with post-severe traumatic brain injury as compared to age-matched typically-developed controls.Design: Comparative study.Setting: Out-patient rehabilitation department.Participants: Twelve boys post-severe traumatic brain injury (TBI) (aged 7–13 years) and 18 typically-developed (TD) boys matched for age.Interventions: HR and HRV were determined at rest and at a steady functional walking rate on the treadmill.Main outcome measures: HR and HRV parameters include: time domain parameters: standard deviation of the R-R interval, square root of the mean squared differences of successive R-R differences at rest and during steady-state exercise.Results: Children post-TBI demonstrated higher mean HR values at rest (TBI 91.8 ± 7.0 beats per minute vs 72.0 ± 7.1 beats per minute in controls, p < 0.05) and during exercise (TBI 123.4 ± 15.5 beats per minute vs 113.0 ± 9.1 beats per minute in controls, p < 0.05). At rest, the time domain measures of HRV were significantly lower in the TBI group (p < 0.05). Time domain mean values decreased significantly during exercise only among the TD children.Conclusions: The findings of this study suggest that among children post-severe TBI, the cardiac autonomic mechanism is less efficient at rest and less adaptive to exercise and activity as compared to TD children.