Rehabilitation Of Traumatic Brain Injury Patients Research Articles

Traumatic Brain Injury and Neuromodulation Techniques in Rehabilitation: A Scoping Review.

Traumatic Brain Injury (TBI) is a condition in which an external force, usually a violent blow to the head, causes functional impairment in the brain. Neuromodulation techniques are thought to restore altered function in the brain, resulting in improved function and reduced symptoms. Brain stimulation can alter the firing of neurons, boost synaptic strength, alter neurotransmitters and excitotoxicity, and modify the connections in their neural networks. All these are potential effects on brain activity. Accordingly, this is a promising therapy for TBI. These techniques are flexible because they can target different brain areas and vary in frequency and amplitude. This review aims to investigate the recent literature about neuromodulation techniques used in the rehabilitation of TBI patients. The identification of studies was made possible by conducting online searches on PubMed, Web of Science, Cochrane, Embase, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF (JEP3S). We have found that neuromodulation techniques can improve the rehabilitation process for TBI patients in several ways. Transcranial Magnetic Stimulation (TMS) can improve cognitive functions such as recall ability, neural substrates, and overall improved performance on neuropsychological tests. Repetitive TMS has the potential to increase neural connections in many TBI patients but not in all patients, such as those with chronic diffuse axonal damage. This review has demonstrated that neuromodulation techniques are promising instruments in the rehabilitation field, including those affected by TBI. The efficacy of neuromodulation can have a significant impact on their lives and improve functional outcomes for TBI patients.

Atypical within-session motor procedural learning after traumatic brain injury but well-preserved between-session procedural memory consolidation

Using the finger-to-thumb opposition sequence (FOS) learning task several stages of procedural learning have been defined in healthy subjects, nevertheless, in patients with traumatic brain Injury (TBI) they remain obscure. Given the importance of skill acquisition in the rehabilitation of TBI patients, optimization of theory-based training protocols is vital to fulfill their potential for long-term plasticity. The aim of this study was to characterize motor skill acquisition in TBI patients using the FOS paradigm in comparison with healthy subjects. Ten TBI patients (trained TBI), 11 healthy participants were trained using a multi-session protocol: a single session was afforded in the first week of the study, and 4 daily sessions during the second. Performance speed and accuracy were tested before and after each session. Retention was tested one month later. Ten TBI patients (control TBI) had no FOS training and were tested only at the beginning and after 6 weeks. The phases of skill learning found in healthy adults (acquisition, between-session consolidation gains and long-term retention) were identified in TBI patients. However, their time-course of learning was atypical. The trained TBI demonstrated significantly larger speed increase compared with the TBI controls with no speed-accuracy tradeoff. During the second week, while training daily, the rate of improvement of the trained TBI group was significantly slower compared with the healthy controls, due to within-sessions losses in speed found only in this group. The data presented allows for improved characterization of neurobehavioral constraints on motor learning after TBI and enable caregivers to optimize treatment protocols.

Prevalence of hypothalamo pituitary dysfunction in patients of traumatic brain injury.

Background:Traumatic brain injury (TBI) is common in young soldiers of armed forces leading to significant morbidity and mortality. We studied the prevalence of hypopituitarism following TBI and its association with trauma severity.Materials and Methods:We conducted a 12-month prospective study of 56 TBI patients for the presence of hormonal dysfunction. Hormonal parameters were estimated during the early phase (0–10 days posttraumatically) and after 6 and 12 months. Dynamic testing was done when required, and the results were analyzed by appropriate statistical methods.Results:Hormonal dysfunction was seen in 39 of the 56 (70%) patients at initial assessment. Persisting pituitary deficiencies are seen in 7 and 8 patients at the end of 6 months and 12 months, respectively. Hypogonadotropic hypogonadism, hypothyroidism, and growth hormone deficiency are the most common diagnoses. Initial severe TBI and plurihormonal involvement predicted the long-term hypopituitarism.Conclusion:Early hypopituitarism was common in severe TBI, but recovers in majority. Evaluation for the occult pituitary dysfunction is required during the rehabilitation of TBI patients.

Traumatic axonal injury of the medial lemniscus pathway in a patient with traumatic brain injury: validation by diffusion tensor tractography.

Traumatic axonal injury of the medial lemniscus pathway in a patient with traumatic brain injury: validation by diffusion tensor tractography.

Rhythmic exercises in rehabilitation of TBI patients: A case report

Patients who have sustained traumatic brain injury (TBI) often present with a multiplicity of dysfunctions making rehabilitation challenging. Patients who have taken part in studies of rehabilitation exercises that incorporated monotonous timed auditory cues (using a metronome) following cerebrovascular events demonstrated improvement in gait and motor functions. The purpose of this case report is to describe the efficacy of Rhythmic Exercises with Auditory Cues (REAC) to improve functions in a patient, years after their traumatic brain injury. A single case report of a 24-year-old female patient, nine years post hemispherectomy following TBI that resulted in right hemiparesis. The patient was taught to perform REAC exercises at home. These exercises were designed to activate the body while Alternating hands and feet Bilaterally with Cross-midline movements for a short Duration while synchronizing the movements with a metronome as a Rhythm regulator. Outcome measurements included gait and functional assessment and cognitive and psychological instrument scores that were compared pre and post treatment. Clinical improvement was observed in the patient's gait pattern with reduced hip hiking motion and increased cadence. There was a decrease in spasticity in the right arm and leg with some isolated volitional movements of the hand and fingers returning. She also regained sensation in her right arm and leg. Cognitive improvement was demonstrated by increased IQ scores from 78 to 94.

Perceived social support and locus of control after a traumatic brain injury (TBI)

Research design: The aim of the study was to investigate the social rehabilitation related to the perceived social support and the locus of control (LC) of patients with traumatic brain injury (TBI).Methods and procedures: A group of 46 patients 3–5 years after injury was evaluated. For the social rehabilitation, patients were categorized as ‘high rehabilitation’ or ‘low rehabilitation’ as regards vocational rehabilitation. Low rehabilitation patients should confirm the idea of an external locus of control more than high rehabilitation patients.Main outcomes and results: As far as perceived social support is concerned, both groups reported a poor level of social support, although the patients considered as high rehabilitation exhibited greater satisfaction in terms of social support. When one considers LC, patients with TBI were associated with a weaker internal LC than non-patients with TBI. In patients exhibiting a high level of rehabilitation, the LC was less frequently attributed to ‘chance’ or ‘powerful others’. Patients with a low level of rehabilitation explained their difficulties in terms of external factors.Conclusions: It is therefore necessary to take rehabilitation, perceived high-quality social support and low external LC into account if one is to improve the rehabilitation of TBI patients.

Neuroendocrine dysfunction in the acute phase of traumatic brain injury.

Pituitary hormone abnormalities have been reported in up to 50% of survivors of traumatic brain injury (TBI) who were investigated several months or longer following the event. The frequency of pituitary dysfunction in the early post-TBI period is unknown. To evaluate the prevalence of anterior and posterior pituitary dysfunction in the early phase following TBI. Fifty consecutive patients admitted to the neurosurgical unit with severe or moderate TBI [initial Glasgow Coma Scale (GCS) score 3-13], and 31 matched healthy control volunteers were studied. The glucagon stimulation test (GST) was performed at a median of 12 days (range 7-20) following TBI. Baseline thyroid function, PRL, IGF-1, gonadotrophins, testosterone or oestradiol, plasma sodium, plasma and urine osmolalities or the standard observed water deprivation test were performed. The control subjects underwent the GST for GH and cortisol responses; other parameters were compared to locally derived reference ranges. Control data indicated that peak serum GH of > 5 ng/ml and cortisol > 450 nmol/l following glucagon stimulation should be taken as normal. Nine TBI patients (18%) had GH response < 5 ng/ml (12 mU/l). Eight patients (16%) had peak cortisol responses < 450 nmol/l. Compared to controls, basal cortisol values were significantly lower in patients with subnormal cortisol responses to glucagon and significantly higher in patients with normal cortisol responses (P < 0.05). GH and cortisol deficiencies were unrelated to patient age, BMI, initial GCS or IGF-1 values (P > 0.05). Forty patients (80%) had gonadotrophin deficiency, with low sex steroid concentrations, which was unrelated to the presence of hyperprolactinaemia. In males there was a positive correlation between serum testosterone concentration and GCS (r = 0.32, P = 0.04). One patient had TSH deficiency. Hyperprolactinaemia was present in 26 patients (52%) and serum PRL levels correlated negatively with the GCS score (r =-0.36, P = 0.011). Thirteen patients (26%) had cranial diabetes insipidus (DI) and seven (14%) had syndrome of inappropriate ADH secretion. Our data show that post-traumatic neuroendocrine abnormalities occur early and with high frequency, which may have significant implications for recovery and rehabilitation of TBI patients.

Physicians' preferences and expectations in traumatic brain injury rehabilitation-results of a case-based questionnaire survey

Purpose : Analysis of medical decisions in the differential allocation of traumatic brain injury (TBI) rehabilitation programmes. Method : Medical specialists routinely involved in the treatment and rehabilitation of TBI patients from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Insurance of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic survey, in which they had to give their opinions on the individually optimal rehabilitation setting and therapies and probable outcome on the basis of case vignettes. These specialists are crucial for decision-making in rehabilitation resource allocation. Results : Both allocation and prognosis depended mainly on patient characteristics. In a mixed logistic regression model, which takes into account that: (a) patient and physician characteristics may influence each other; and (b) that expert assessments might be correlated, setting preferences were related to chronicity and degree of motor and cognitive impairment, but also to the institutional background of the reviewer. Neuropsychological therapy dominated intervention recommendations, followed by physio- and occupational therapy. A comparatively great demand of psychotherapy and medicosocial assessment was recognized. Preferred rehabilitation setting did not influence the physicians' subjective prognosis. Older, chronic and motorically impaired patients were considered to profit less from rehabilitation. Physician characteristics and recommendations of either rehabilitation setting or therapies did not influence prognostic expectations.

The current status and problems of rehabilitation for TBI (traumatic brain injury) patients in Japan.

Recently, traumatic brain injury (TBI) is one of the major topics of rehabilitation medicine. In the USA, a nationwide research project has already been underway since 1987. However, interest in the rehabilitation of TBI patients became a matter of concern in Japan from the 1990s. TBI patients do not only have physical impairments, but also impairments of higher cortical functions such as cognitive impairment and abnormal behavior, so both physical and cognitive rehabilitation are very important for TBI patients. The purpose of this paper is to report on the current status of and problems with TBI rehabilitation in Japan, and also to introduce a new TBI evaluation system that we originally developed in Japan.