Recovery Timeframes Research Articles

Characterizing iconic gesture during narratives in chronic traumatic brain injury recovery

IntroductionIt is known that co-speech hand gestures increase and supplement speech in individuals with language impairment after brain injury, e.g., post-stroke aphasia. Traumatic Brain Injury (TBI) provides a unique avenue to evaluate gestures as TBI often presents with both anomia (word-finding impairments) and cognitive impairments, resulting in a cognitive-communicative disorder. However, there is a great need for evaluation of gestures in TBI during typical spontaneous speech and across the recovery trajectory (from sub-acute to chronic stages). In a large population (N = 54) of persons with moderate-severe TBI, who were examined at 3 months post-TBI whilst telling a procedural narrative (“how to make a sandwich”), we examined three aims: (1) characterize the extent to which adults with moderate-severe TBI produce iconic gestures; (2) identify the extent to which language impairment relates to iconic gesturing in TBI; and (3) characterize the extent to which iconic gesturing changes across TBI recovery.MethodsIn a subpopulation (Group 1, N = 14) who were examined at three- and 24-months (sub-acute and substantially chronic), and in a smaller subpopulation (Group 2, N = 6) who had data for five timepoints (three-, six-, nine-, 12-, and 24-months), we used paired tests to examine and characterize longitudinal changes in iconic gesturing.ResultsThe large group analysis suggested that individuals with TBI use iconic gesture during narrative, which take several different iconic forms (e.g., enacting use of an object), and that a minority employed gestures that supplemented (added to, disambiguated, or replaced) speech. The subpopulation analyses suggested that participants did not produce iconic gestures significantly differently across the 2-year recovery timeframe. Case examination of a participant with moderate-severe aphasia suggested a relationship between language impairment and gesture, with this individual producing the highest proportion of supplemental gesturing of the entire group. This finding aligns with research from the post-stroke aphasia field.DiscussionBroadly, this study significantly extends prior research on the relationship between gesturing, language, and brain injury.

Community opioid dispensing after rib fracture injuries: CODI study.

Pain from rib fractures often requires inpatient management with opioid medication. The need for ongoing opioid prescriptions following hospital discharge is poorly understood. Harms associated with long-term opioid use are generally accepted. However, a deeper understanding of current prescribing patterns in this population at-risk is required. A retrospective cohort of adult patients hospitalised in Queensland, Australia between 2014 and 2015 with rib fractures (ICD-10-AM: S22.3, S22.4, S22.5), was obtained from the Community Opioid Dispensing after Injury (CODI) study, which includes person-linked hospitalisation, mortality and community opioid dispensing data. Data were extracted 90-days prior to the index-hospitalisation and 720-days after discharge. Factors associated with long-duration (>90 days cumulatively) and increased end-dose were examined using multivariable logistic regressions, odds ratios (OR), and 95% confidence intervals (95% CI). In total, 4306 patients met the inclusion criteria, and 58.8% had opioids dispensed in the community within 30 days of hospital discharge. 23.6% had long-duration dispensing and 13.7% increased opioid end-doses. Pre-injury opioid use was most associated with long-duration (OR = 12.00, 95% CI 8.99-16.01) and increased end-dose (OR = 9.00, 95% CI 6.75-12.00). Females and older persons had higher odds of long-duration dispensing (Females OR = 1.75, 95% CI 1.38-2.22; Age 65+ OR = 1.86, 95% CI 1.32-2.61). Injury severity and presence of concurrent injuries were not statistically significantly associated with duration or dose (p > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (p < .001). Opiate prescribing following rib fractures is prolonged in older, and female patients, beyond the traditionally reported recovery time frames requiring analgesia. Previous opioid use (without dependence) is associated with long-duration opioid use and increased end-dose in rib fracture patients. These results support the need for a collaborative health system approach and individualised strategies for high-risk patients with rib fractures to reduce long-term opiate use. Level III, Prognostic/Epidemiological.

From Tissue to System: What Constitutes an Appropriate Response to Loading?

Optimal loading involves the prescription of an exercise stimulus that promotes positive tissue adaptation, restoring function in patients undergoing rehabilitation and improving performance in healthy athletes. Implicit in optimal loading is the need to monitor the response to load, but what constitutes a normal response to loading? And does it differ among tissues (e.g., muscle, tendon, bone, cartilage) and systems? In this paper, we discuss the "normal" tissue response to loading schema and demonstrate the complex interaction among training intensity, volume, and frequency, as well as the impact of these training variables on the recovery of specific tissues and systems. Although the response to training stress follows a predictable time course, the recovery of individual tissues to training load (defined herein as the readiness to receive a similar training stimulus without deleterious local and/or systemic effects) varies markedly, with as little as 30min (e.g., cartilage reformation after walking and running) or 72h or longer (e.g., eccentric exercise-induced muscle damage) required between loading sessions of similar magnitude. Hyperhydrated and reactive tendons that have undergone high stretch-shorten cycle activity benefit from a 48-h refractory period before receiving a similar training dose. In contrast, bone cells desensitize quickly to repetitive loading, with almost all mechanosensitivity lost after as few as 20 loading cycles. To optimize loading, an additional dose (≤ 60 loading cycles) of bone-centric exercise (e.g., plyometrics) can be performed following a 4-8h refractory period. Low-stress (i.e., predominantly aerobic) activity can be repeated following a short (≤ 24h) refractory period, while greater recovery is needed (≥ 72h) between repeated doses of high stress (i.e., predominantly anaerobic) activity. The response of specific tissues and systems to training load is complex; at any time, it is possible that practitioners may be optimally loading one tissue or system while suboptimally loading another. The consideration of recovery timeframes of different tissues and systems allows practitioners to determine the "normal" response to load. Importantly, we encourage practitioners to interpret training within an athlete monitoring framework that considers external and internal load, athlete-reported responses, and objective markers, to contextualize load-response data.

Evaluating the Financial Performance of Bharti Airtel: An Analysis of WACC, NPV, IRR, Profitability Index, and Payback Period

This research paper aims to conduct a comprehensive financial performance evaluation of Bharti Airtel Limited by analyzing key financial metrics including Weighted Average Cost of Capital (WACC), Net Present Value (NPV), Internal Rate of Return (IRR), Profitability Index (PI), and Payback Period. The project's financial infeasibility is highlighted by a negative Net Present Value (NPV) and a poor profitability index, indicating that the anticipated returns are insufficient to justify the initial investment. Further analysis shows the Internal Rate of Return (IRR) falling below the cost of capital, reinforcing the project's unviability. Additionally, both standard and discounted payback periods exceed ten years, demonstrating an extended timeframe for cost recovery. These findings collectively suggest that Bharti Airtel should explore alternative investment opportunities better aligned with its financial objectives.

Delayed-onset vocal cord palsy after thyroidectomy occurring despite normal initial post-operative endoscopy.

Recurrent laryngeal nerve (RLN) injury is a known complication of thyroidectomy. Most cases manifest immediately and are promptly recognized. Rarely, some patients experience delayed-onset vocal cord palsy. This can occur despite normal findings on intra-operative nerve monitoring and initial post-operative endoscopy. This can cause considerable distress for patients, and its incidence and prognosis should be recognized. We report seven patients experiencing delayed-onset RLN palsy (RLNP) after thyroidectomy. All had normal findings on pre-operative flexible nasoendoscopy (FNE), intra-operative nerve monitoring at conclusion of surgery, and initial post-operative FNE. All diagnoses of RLNP were confirmed on endoscopy. Serial FNE examinations were performed to evaluate recovery. Of seven patients (43% male, median age 65 years), the median timing of delayed-onset RLNP was 12 (range 9-35) days. RLNP was diagnosed on the unilateral side of surgery in six out of seven patients (86%). All received conservative management, including referral to voice therapy. All seven patients recovered vocal cord function after a median duration of 24 weeks (range 8-52 weeks), and six within ~6 months (28 weeks). The incidence of this complication was 0.1% (among 6607 thyroidectomies). We report the first Australian series of delayed-onset vocal cord palsy after thyroidectomy. We explore its prognosis, discussing different pathophysiological mechanisms and the timeframe for recovery compared to most other RLN injuries. This may assist recognition of a rare complication, reassure patients, and facilitate early intervention to improve a patient's quality of life.

A - 103 Exploring the Diagnostic Criteria for Alcohol-Related Dementia: a Case Study

Abstract Objective Excessive and chronic alcohol use can cause structural/functional abnormalities in the brain, including cognitive impairment (CI) (Harper, 2009). Despite these established risks, alcohol-related dementia (ARD) has received little recognition, mainly due to lack of a distinct pathophysiological profile. Through a case differential approach (concussion vs. ARD), the authors aim to clarify diagnostic criteria for ARD. Methods A 56-year-old right-handed male presented to the emergency room after fall with head strike (no loss of consciousness) with alcohol withdrawal delirium. Symptoms of cerebellar ataxia and CI of 6-month duration were noted. Past medical history was significant for alcohol use (four standard units per day), hyperlipidemia, tobacco use, and depression/anxiety. Neuroimaging revealed cerebral atrophy and chronic small vessel ischemic disease. A neuropsychological evaluation (NPE) was conducted 18 days post-fall. Results NPE revealed relative weaknesses in working memory, complex attention, and visual abstraction. Impairments were noted in visuospatial organization/planning, processing speed, basic attention, verbal fluency, and verbal memory. Motor examination was evident for intention tremor. Conclusion Brain changes associated with ARD include volume loss, altered glucose metabolism, reduced neuronal density, changes in frontal lobe function, and white matter loss. In contrast, individuals affected by concussions may encounter challenges with attention/concentration, processing speed, and working memory. Distinguishing a clear diagnostic profile for ARD is difficult due to high rates of concomitant concussion in this population. The patient’s deficits exceed those expected due to concussion alone, with an anticipated cognitive recovery timeframe of 7–14 days (Iverson, 2006). Furthermore, neuroimaging and NPE results support the diagnostic hypothesis of ARD.

Age and growth of a habitat-forming deep-sea coral Solenosmilia variabilis in the New Zealand region: implications for fisheries management

ABSTRACT One of the most widespread and abundant habitat forming deep-sea corals in the South Pacific region is Solenosmilia variabilis. The age of this species was assessed using radiocarbon content (14C) on long dead, recently dead, and live branch sections of coral reef matrix sampled from the New Zealand region. Conventional 14C colony ages (yrs BP), for the living, recently dead, and long dead samples, ranged from 803 to 1186 years (Graveyard Knolls, Chatham Rise), and 907 to 11, 694 years (Louisville Seamount Chain east of New Zealand). Overall calendar ages, ranged from 84 to 292 years, and similar linear and step-wise growth rate data were obtained. Linear growth ranged from 0.2 to 1.3 mm/yr. From a conservative estimate of matrix height of ∼20 cm, it could take hundreds of years (∼150–660) of growth for a colony of S. variabilis to attain this height, and around ∼2000 years to build a colony diameter of 1 metre. Defining the age, growth and recovery timeframes of deep-sea coral can inform risk assessments of the level of susceptibility to trawling activity and their potential to recover, as well as provide options for the considered management of deep-sea habitats.

Community-centred disaster recovery: A call to change the narrative.

This paper challenges current approaches to undertaking community-centred disaster recovery. Community-centred approaches are widely recognised as 'the gold standard' for effective recovery from disasters. Yet, they are rarely applied well enough in practice. Challenges include the 'authority' culture of command-and-control agencies, the emphasis on discrete recovery time frames, and the reluctance to relinquish centralised control. The paper focuses on people's experiences of community-centred recovery in New South Wales, Australia, which has experienced severe fires and floods since 2019. We undertook key informant interviews and an online survey to inquire into how community-centred recovery is enacted. Our work uncovered widespread dissatisfaction with current practices. The paper discusses key themes emerging from the research and ends with a call to change how community-centred recovery is framed and conducted by responding organisations, to include the underlying causes of vulnerability in recovery, to measure success differently, and to alter the narrative of who 'owns' disasters.

Evaluation of natural history communication and shared decision making for self-limiting conditions: Analysis of UK primary care consultations

ObjectiveTo analyse communication about the natural course of self-limiting illnesses, as part of shared decision-making (SDM), in general practice consultations. MethodsNatural history communication and SDM (using Observing Patient Involvement in Decision-Making (OPTION-12) and Assessing Communication about Evidence and Patient Preferences (ACEPP) items) were rated by two raters using transcripts from the UK ‘One in a Million’ database. ResultsOf 55 eligible consultations, a ‘wait and see’ option was mentioned in 27 consultations (49 %), using varying terminology, with a general recovery timeframe provided in 21. Mean OPTION-12 score (of 100) was 25.2 (SD=7.4), indicating a low level of SDM. Mean ACEPP score (out of 5) was 1.2 (SD=0.5), indicating minimal communication about the options’ benefits and harms. Recovery likelihood was quantified in only two consultations, while harms were quantified in none. ConclusionCommunication about the natural history of self-limiting illnesses was generally limited. The ‘wait and see’ approach, along with its benefits and harms, was typically not explicitly presented as an option for patients to consider. Practice ImplicationsImproving clinicians’ awareness of the importance of and skills for communicating the natural history of self-limiting illnesses, as part of SDM, may facilitate informed decision-making in managing these conditions.

Time to resolution of symptoms and recovery after mild traumatic brain injury: protocol for a systematic review and meta-analysis

IntroductionMild traumatic brain injury (mTBI) is a leading cause of morbidity and mortality, with approximately 1 out of 200 people each year sustaining an mTBI in Europe. There is a...

A rapid return to normal: temporal gene expression patterns following cold exposure in the bumble bee Bombus impatiens.

Bumble bees are common in cooler climates and many species likely experience periodic exposure to very cold temperatures, but little is known about the temporal dynamics of cold response mechanisms following chill exposure, especially how persistent effects of cold exposure may facilitate tolerance of future events. To investigate molecular processes involved in the temporal response by bumble bees to acute cold exposure, we compared mRNA transcript abundance in Bombus impatiens workers exposed to 0°C for 75 min (inducing chill coma) and control bees maintained at a constant ambient temperature (28°C). We sequenced the 3' end of mRNA transcripts (TagSeq) to quantify gene expression in thoracic tissue of bees at several time points (0, 10, 30, 120 and 720 min) following cold exposure. Significant differences from control bees were only detectable within 30 min after the treatment, with most occurring at the 10min recovery time point. Genes associated with gluconeogenesis and glycolysis were most notably upregulated, while genes related to lipid and purine metabolism were downregulated. The observed patterns of expression indicate a rapid recovery after chill coma, suggesting an acute differential transcriptional response during recovery from chill coma and return to baseline expression levels within an hour, with no long-term gene expression markers of this cold exposure. Our work highlights the functions and pathways important for acute cold recovery, provides an estimated time frame for recovery from cold exposure in bumble bees, and suggests that cold hardening may be less important for these heterothermic insects.

Cerebral and Peripheral Immune Cell Changes following Rodent Juvenile Traumatic Brain Injury.

Traumatic brain injury (TBI) is one of the leading causes of death and disability. TBI is associated with neuroinflammation, but temporal changes in immune and inflammatory signaling following TBI have not been fully elucidated. Furthermore, there have been no previous studies on changes in immune cell populations following TBI via the Closed Head Injury Model of Engineered Rotational Acceleration (CHIMERA). The current study aimed to determine the time course changes to inflammatory marker mRNA expression in the acute period following TBI in juvenile rats and to determine acute changes to brain and circulating immune cell populations. For this study, post-natal day (PND)-30 male Long Evans rats sustained a TBI or Sham TBI and were euthanized at 0, 3, 6, 12, 24, or 96 h post-injury. Prefrontal cortex and hippocampus samples were used to determine mRNA expression changes of inflammatory factors. The mRNA expression of the pro-inflammatory cytokine TNF-α was significantly elevated at 6 h post-injury in both regions evaluated. To evaluate immune cell populations, male Long Evans rats were euthanized at 48 h post-injury, and brain and blood samples were used for cell sorting by marker-specific antibodies. In the peripheral blood, there was an elevation in CD3+ total T cells, CD45R+ total B cells, and CD3+CD4+ helper T cells in the TBI subjects. However, there were no changes to natural killer cells or CD3+CD8+ cytotoxic T cell populations. In the brain, there was a reduction in CD11b/c+ monocytes/macrophages, but no changes in other immune cell populations. At 48 h post-injury, the TBI subjects also demonstrated expansion of the thymic medulla. These changes in the cerebral and blood immune cell populations and thymic medulla expansion may implicate the subacute recovery timeframe as a vulnerable window for the immune system in the pediatric population.

Resurgence in paradise: decoding the patterns of arrivals with different trip purposes in Hawaii’s post-pandemic tourism recovery

ABSTRACT This study provides a comprehensive investigation into the resurgence of Hawaii’s tourism industry following the COVID-19 pandemic, utilizing Seasonal Autoregressive Integrated Moving Average models with intervention analysis. We conducted an in-depth analysis of Hawaii’s tourism data, encompassing the volume of domestic arrivals and diverse travel purposes before and after the pandemic, subsequently estimating the recovery timeframe for each travel purpose. Enriching theoretical discourse and practical applications, this study furnishes a nuanced understanding of Hawaii’s tourism resurgence while concurrently establishing a framework for modelling, predicting, and planning tourism recovery in the face of future global crises akin to the recent pandemic.

Diagnosis of COVID-19 impact on the construction employment: Decline and recovery

The Coronavirus Disease 2019 (COVID-19) had an unprecedented impact on U.S. construction employment. The assessment of employment declines and recoveries across various construction sectors, workforce demographics, and geographic regions helps develop inclusive long-term plans to overcome the setbacks of natural hazards, such as the COVID-19 pandemic. Existing methods for quantifying the employment decline from sudden shocks do not consider trends and seasonality of construction employment under normal conditions. Hence, it is not clear whether the employment declines are due to the impact of a disaster or associated with trends and seasonal patterns of employment. The objective of this research is to develop an approach based on time series models, i.e., seasonal autoregressive integrated moving average (SARIMA) models, and cumulative sum (CUSUM) control charts to statistically quantify the impact of the COVID-19 pandemic on construction employment. Seasonal ARIMA models are developed using the pre-pandemic employment data from January 2011 to December 2019, and employment estimates under normal conditions are projected for the period from January 2020 to August 2021. CUSUM control charts are then used to detect employment declines and recovery timeframes for different construction employment. Results show declines in all construction sectors, faster recovery for women and Hispanic workers, and residential building jobs rebounding first. By August 2021, 14 states recovered construction employment, but 36 states lagged. It is anticipated that construction workforce decision-makers can benefit from this study by enhancing their understanding of the employment declines and the recovery status across industry sectors, gender, race, and geographical regions.

Who crashes their car following wrist fracture?

BackgroundWrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood. Purpose(1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture. Study DesignRetrospective cohort study. MethodsThree state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar’s tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period. ResultsData relating to 37,107 adults revealed a 3.3% (95% CI 3.0%–3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07–3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries. ConclusionsThese results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture.

Clinical recovery from concussion–return to school and sport: a systematic review and meta-analysis

ObjectiveTo define the time frames, measures used and modifying factors influencing recovery, return to school/learn (RTL) and return to sport (RTS) after sport-related concussion (SRC).DesignSystematic review and meta-analysis.Data sources8 databases...

Intensity of Cyclophosphamide-Based Bridging Therapy Before Chimeric Antigen Receptor T Cell Therapy in Myeloma

Patients receiving autologous chimeric antigen receptor T-cell (CAR-T) therapies for multiple myeloma (MM) may require bridging therapy (BT) before CAR-T infusion to maintain some level of disease control. Alkylators such as cyclophosphamide (Cy) are often used as parts of BT regimens, either in high-intensity regimens such as modified hyperCVAD or once-weekly regimens such as KCd. However, there is no consensus around the optimal BT alkylator dose intensity in MM. We performed a single-center analysis of all instances of BT before planned autologous CAR-T for MM during a 5-year period ending April 2022. We classified bridging regimens into three cohorts: (1) hyperfractionated Cy (HyperCy) with inpatient Cy every 12-24 hours or as continuous intravenous infusions, (2) less intensive Cy dosing (WeeklyCy) such as KPd or KCd, and (3) NonCy, where no alkylators were used in BT. Demographic, disease-related, and treatment-related characteristics were collected for all patients. The three BT cohorts were compared using Fisher's exact tests, Kruskal-Wallis tests, and log-rank tests where appropriate. We identified 70 discrete BT instances among 64 unique patients: 29 (41%) with HyperCy, 23 (33%) with WeeklyCy, and 18 (26%) with NonCy. Median total levels of Cy dosing during BT were 2100 mg/m2, 615 mg/m2, and 0 mg/m2 respectively. Age, number of prior lines, triple-class refractory status, presence of high-risk cytogenetics, extramedullary disease, bone marrow plasma cell burden, involved free light chain (iFLC) kinetics before collection, and other measures of disease aggressiveness were comparable between cohorts. iFLC levels rose ≥25% and ≥100 mg/L during BT (approximating progressive disease) in comparable proportions (p=0.25) between cohorts: 52% HyperCy, 39% WeeklyCy, and 28% NonCy. All BT instances without subsequent CAR-T were due to manufacturing failures. Among 61 instances of bridging followed by CAR-T, vein-to-vein times were slightly longer (p = 0.03) with HyperCy (45 days) vs WeeklyCy (39 days) and NonCy (46.5 days). Neutrophil recovery timeframes were similar between cohorts, but platelet recovery took longer with HyperCy (64 days) vs WeeklyCy (42 days) and NonCy (12 days). PFS was comparable between cohorts, but median OS was not: 15.3 months with HyperCy versus 30.0 months with WeeklyCy and not reached with NonCy. In our retrospective analysis of BT before CAR-T therapy in MM, HyperCy did not result in superior disease control than WeeklyCy despite a threefold higher dose of Cy. In contrast, HyperCy was associated with longer post-CAR-T platelet recovery and worsened OS despite comparable measurements of disease aggressiveness and tumor burden. Study limitations include our small sample size as well as confounding from gestalt markers of MM aggressiveness that might have led both to poorer outcomes as well as physicians' decisions to prescribe HyperCy. Given the rarity of objective disease responses to chemotherapy in relapsed/refractory MM, our analysis suggests that hyperfractionated Cy regimens do not outperform once-weekly Cy regimens for most patients who require BT before CAR-T therapy.

Concussed Neural Signature is Substantially Different than Fatigue Neural Signature in Non-concussed Controls

Traumatic brain injuries can result in short-lived and long-lasting neurological impairment. Identifying the correct recovery timeframe is challenging, as balance-based metrics may be negatively impacted if testing is performed soon after exercise. Thirty-two healthy controls and seventeen concussed individuals performed a series of balance challenges, including virtual reality optical flow perturbation. The control group completed a backpacking protocol to induce moderate fatigue. Concussed participants had lower spectral power in the motor cortex and central sulcus when compared to fatigued controls. Moreover, concussed participants experienced a decrease in overall theta band spectral power while fatigued controls showed an increase in theta band spectral power. This neural signature may be useful to distinguish between concussed and non-concussed fatigued participants in future assessments.

A Prospective Study of Longitudinal Risks of Cognitive Deficit for People Undergoing Glioblastoma Surgery Using a Tablet Computer Cognition Testing Battery: Towards Personalized Understanding of Risks to Cognitive Function.

Glioblastoma and the surgery to remove it pose high risks to the cognitive function of patients. Little reliable data exist about these risks, especially postoperatively before radiotherapy. We hypothesized that cognitive deficit risks detected before surgery will be exacerbated by surgery in patients with glioblastoma undergoing maximal treatment regimens. We used longitudinal electronic cognitive testing perioperatively to perform a prospective, longitudinal, observational study of 49 participants with glioblastoma undergoing surgery. Before surgery (A1), the participant risk of deficit in 5/6 cognitive domains was increased compared to normative data. Of these, the risks to Attention (OR = 31.19), Memory (OR = 97.38), and Perception (OR = 213.75) were markedly increased. These risks significantly increased in the early period after surgery (A2) when patients were discharged home or seen in the clinic to discuss histology results. For participants tested at 4-6 weeks after surgery (A3) before starting radiotherapy, there was evidence of risk reduction towards A1. The observed risks of cognitive deficit were independent of patient-specific, tumour-specific, and surgery-specific co-variates. These results reveal a timeframe of natural recovery in the first 4-6 weeks after surgery based on personalized deficit profiles for each participant. Future research in this period could investigate personalized rehabilitation tools to aid the recovery process found.

The longitudinal trajectory of discourse from the hyperacute to the chronic phase in mild to moderate poststroke aphasia recovery: A case series study.

Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs. Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24h; acute: 24-72h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia. What is already known on the subject Multi-level discourse analysis allows for in-depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi-level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post-stroke aphasia recovery. What this paper adds to existing knowledge The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work? This study suggests that multilevel discourse analysis will allow a better understanding of post-stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities.