Awareness Of Traumatic Brain Injury Research Articles

Community resource facilitation use by ethnic minority groups with traumatic brain injury in the Midwestern United States

ABSTRACT Objective This study surveyed the use of community-based resource facilitation (RF) services by ethnic minority survivors of traumatic brain injury (TBI) living in the Midwestern United States. Method Past records of RF use by survivors of TBI were reviewed. Demographics and patterns of RF use across 3 ethnic groups were documented. Reported barriers to community integration related to ethnic identity were identified using Chi-square test of independence. Results Ethnic minority survivors were less likely to use RF services than white survivors. Caucasian women and men utilized RF services at similar rates, whereas more African American men and Latina women used RF services. Caucasians received information about RF from a greater variety of sources than ethnic minority survivors. Ethnic identity was significantly associated with greater reported needs for TBI awareness. Conclusions A pattern of differential RF use by survivors from ethnic minority groups was noted, suggesting potential socio-cultural influences on help-seeking behavior after TBI. These factors should be considered to develop more accessible and equitable strategies of RF service referral and support. Future investigations of cultural perspectives of TBI and injury-related services may improve understanding of the likelihood and necessity of community-based RF service use by diverse populations.

The role and importance of helmet use in the prevention of traumatic brain injury – a literature review

Protective helmets are used in a wide range of professional, sport and recreational activities. They undoubtedly play a very important role in the prevention of head injuries, including traumatic brain injury. There is no doubt that they improve user safety. The main aim of the following paper is to analyse recent publications and studies describing to what extent a helmet can protect against traumatic brain injury and its consequences. Traumatic brain injury is the disruption of brain function or the presence of any other pathology in the brain caused by physical force. There are many head injuries worldwide that result in traumatic brain injury. The effects of these accidents can be reduced by using safety helmets. Statistics quite clearly show that helmets realistically reduce the number of traumatic brain injuries, as well as their consequences. Injuries sustained by people who wore a helmet on their head at the time of the accident were less severe, gave less serious complications and were also less likely to be fatal compared to injuries acquired when a helmet was not worn on the head. The wearing of helmets has been made compulsory in many places and this has had a significant impact on the decrease in the incidence of severe brain injuries. The use of protective helmets is correlated with milder and less frequent head injuries and fewer complications of these injuries. Public awareness of traumatic brain injury is still low. Although the benefits of wearing helmets are widely known, there are still many people who do not use this method of head injury prevention. Awareness campaigns, notification systems or other innovative methods are just a few of the many ways in which attempts are made to draw the public’s attention to the need to wear a helmet during activities with a higher risk of head injury.

What Happens Next? Traumatic Brain Injury in the Community.

Traumatic brain injury (TBI) continues to substantially impact the lives of millions of people around the world annually. Community-based prevention and support of TBI are particularly challenging and underresearched aspects of TBI management. Ongoing cognitive, emotional, and other effects of TBI are not immediately obvious in community settings such as schools, workplaces, sporting clubs, aged care facilities, and support agencies providing homelessness or domestic violence support. This is compounded by a lack of guidance and support materials designed for nonmedical settings. Connectivity Australia, a not-for-profit organization promoting TBI awareness, research, and support, responded to this need by conducting a national survey and series of roundtables to deepen understanding of TBI awareness, challenges, and support needs across the community. The 48 survey respondents and 22 roundtable participants represented Australian departments of health; correctional services; homelessness and housing; Aboriginal and Torres Strait Islander health; community, school, and professional sports; allied healthcare and rehabilitation providers; insurance; and work health and safety. Three key themes were identified: Accessible, nationally consistent plain-language guidelines ; Building research literacy ; and Knowing your role in TBI identification and management . This commentary briefly describes these themes and their implications based on a publicly available full report detailing the study findings ( www.connectivity.org.au/resources-for-researchers/connectivity-research ).

A 'Network of Understanding and Compassion': A Qualitative Study of Survivor Perspectives on Unmet Needs After Traumatic Brain Injury (TBI) in Regional Communities.

This qualitative study aimed to identify the service and support needs of people with a recent history of traumatic brain injury (TBI) living in the community. A postal survey was sent to 662 people 6-18 months after hospital admission for a mild-to-severe TBI. The survey included an open-ended item ('wish-basket') for collecting ideas about important unmet needs. Responses from 53 individuals were coded and processed using thematic analysis. Five themes (n = 39) were identified, three of which were related to personal needs. These personal wishes were about being symptom-free, independent and emotionally supported by, and connected to, loved ones. The remaining themes were about the wished-for changes to the health system and society, such as wishing for health care continuity (as opposed to being abandoned), and for greater understanding and support by society. There is scope to improve the services and support for people living with TBI in the community. This includes reconsidering the way that discharge occurs, addressing the personal needs that remain when living in the community and promoting greater social awareness of TBI to counteract disadvantage.

Repetitive Low-Level Blast Exposure Improves Behavioral Deficits and Chronically Lowers Aβ42 in an Alzheimer Disease Transgenic Mouse Model.

Public awareness of traumatic brain injury (TBI) in the military increased recently because of the conflicts in Iraq and Afghanistan where blast injury was the most common mechanism of injury. Besides overt injuries, concerns also exist over the potential adverse consequences of subclinical blast exposures, which are common for many service members. A TBI is a risk factor for the later development of neurodegenerative diseases, including Alzheimer disease (AD)-like disorders. Studies of acute TBI in humans and animals have suggested that increased processing of the amyloid precursor protein (APP) toward the amyloid beta protein (Aβ) may explain the epidemiological associations with AD. In a previous study, however, we found in both rat and mouse models of blast overpressure exposure that rather than increasing, rodent brain Aβ42 levels were decreased after acute blast exposure. Here we subjected APP/presenilin 1 transgenic mice (APP/PS1 Tg) to an extended sequence of repetitive low-level blast exposures (34.5 kPa) administered three times per week over eight weeks. If initiated at 20 weeks of age, these repetitive exposures, which were designed to mimic human subclinical blast exposures, reduced anxiety and improved cognition as well as social interactions in APP/PS1 Tg mice, returning many behavioral parameters in APP/PS1 Tg mice to levels of non-transgenic wild type mice. Repetitive low-level blast exposure was less effective at improving behavioral deficits in APP/PS1 Tg mice when begun at 36 weeks of age. While amyloid plaque loads were unchanged, Aβ 42 levels and Aβ oligomers were reduced in the brain of mice exposed to repetitive low-level blast exposures initiated at 20 weeks of age, although levels did not directly correlate with behavioral parameters in individual animals. These results have implications for understanding the nature of blast effects on the brain and their relationship to human neurodegenerative diseases.

Exploring Traumatic Brain Injuries and Aggressive Antisocial Behaviors in Young Male Violent Offenders.

Background: Traumatic brain injury (TBI) is a major cause of disabilities and mortality worldwide, with higher prevalence in offender populations than in the general population. Previous research has strongly advocated increased awareness of TBI in offender populations. The aim of this study was to explore the prevalence and characteristics of TBI, and to investigate associations and interactions between TBI, aggressive antisocial behaviors, general intellectual functioning, and substance use disorders (SUD) in a well-characterized group of young violent offenders.Methods: The study investigated a cohort (n = 269) of 18 to 25-year-old male violent offenders in Sweden. Data on TBI (files + self-report), aggressive antisocial behaviors (Life History of Aggression), SUD (clinical interviews), and general intellectual functioning (General Ability Index, Wechsler Adult Intelligence Scales Third Edition) were collected between 2010 and 2012. Parametric (Student's t-test) and non-parametric (Mann-Whitney U-test, Spearman's rho, χ2, Kruskal Wallis test) inferential statistics were applied and effect sizes reported.Results: TBI, both with and without loss of consciousness, was common, with 77.5% of the offenders reporting having suffered at least one TBI during their lifetime. TBI was associated with an increased occurrence of aggressive antisocial behaviors and SUD, and offenders with both TBI and SUD evidenced the largest amount of aggressive antisocial behaviors. No clinically meaningful associations were found between TBI and general intelligence. Effect sizes were in the small to medium range.Conclusions: Our study confirms an increased prevalence of TBI among young violent offenders compared to the general population, as well as associations between TBI, aggressive antisocial behaviors, and SUD. However, it provides no information on the severity of the TBI, nor on the causality of the demonstrated associations. Nevertheless, TBI, and possible related deficits, need to be considered in the assessment and treatment of young violent offenders.

Battered and Brain Injured: Assessing Knowledge of Traumatic Brain Injury Among Intimate Partner Violence Service Providers.

Background: Traumatic brain injury (TBI) as a result of intimate partner violence (IPV) is a significant health concern; yet, little is known about the intersection between the two. Existing research is scarce, limiting the ability of health care providers to develop effective supports. This pilot project surveyed the IPV support community in Toronto, Canada to understand the degree of existing TBI-specific knowledge and relevant services available among these service providers and to seek to bridge the divide between research and practice by developing a national knowledge-to-practice network to support brain-injured women survivors of IPV.Materials and Methods: In phase 1, 68 agencies providing IPV support services were invited to complete an anonymous online survey. In phase 2, 22 stakeholders attended a workshop held to disseminate existing knowledge, develop a national knowledge-to-practice network, and determine next steps in research and practice.Results: The results highlighted a general lack of TBI awareness and understanding among IPV service providers. In addition, participants stated that frontline workers and women survivors of IPV alike do not recognize signs or symptoms of TBI. Recommendations addressing research gaps, professional and public education, and service development were identified and are discussed herein.Conclusions: The identified lack of TBI knowledge among IPV service providers highlights the immediate need to increase education among management and frontline workers. Further investigation identifying best practices for knowledge transfer are suggested. The development of a national strategy addressing education, research, and funding is critical for successful uptake and integration of TBI-sensitive services within the IPV sector.

The long journey towards uniform epidemiological monitoring of TBI around the globe

Reliable epidemiological data and improved awareness of traumatic brain injury (TBI) are both essential to fully understand the scale and socioeconomic burden of this condition, including our ability to plan and implement prevention measures, and to allocate health-care resources. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar Although accomplishing these tasks, at first glance, might be considered straightforward, reality has proven the contrary. To date, all attempts to harmonise data collection and analyses across Europe and USA still confirm wide variation and discrepancies in reported incidence and mortality. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar , 2 Li M Zhao Z Yu G Zhang J Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol & Neurosci. 2016; 1: 1007 Google Scholar , 3 Majdan M Plancikova D Brazinova A et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016; 1: e76-e83 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar These differences are mostly attributable to methodological diversity, including differences in case ascertainment, non-standardised definitions of TBI, and variations in hospital admission policies. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar , 2 Li M Zhao Z Yu G Zhang J Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol & Neurosci. 2016; 1: 1007 Google Scholar , 3 Majdan M Plancikova D Brazinova A et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016; 1: e76-e83 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar Moreover, robust data for many parts of the world, particularly for low-to-middle-income countries (LMICs) where TBI is likely to occur much more frequently, are almost entirely absent. Traumatic brain injury in ChinaChina has more patients with traumatic brain injury (TBI) than most other countries in the world, making this condition a major public health concern. Population-based mortality of TBI in China is estimated to be approximately 13 cases per 100 000 people, which is similar to the rates reported in other countries. The implementation of various measures, such as safety legislation for road traffic, establishment of specialised neurosurgical intensive care units, and the development of evidence-based guidelines, have contributed to advancing prevention and care of patients with TBI in China. Full-Text PDF

Experiences of Violence and Head Injury Among Women and Transgender Women Sex Workers

Women and transgender women sex workers have similar experiences of housing instability, childhood trauma, and victimization to populations with high rates of traumatic brain injury (TBI), such as people experiencing homelessness and incarceration; yet, there is little research on TBI among sex workers. We conducted a mixed method study using qualitative interviews and the Ohio State University TBI Identification Method to understand experiences of violence and head injury with 10 participants recruited from Elizabeth Fry Toronto. Head injuries which resulted in loss of consciousness, or a change in conscious state, a report of feeling dazed or a gap in memory, were classified as traumatic brain injuries. All other injuries to the head which did not meet these criteria were classified as head injuries. Ninety percent of participants reported at least one lifetime TBI, and all participants reported at least one head injury related to violence in sex work. Findings indicate the need to educate sex workers on the seriousness of head injuries and the importance of treatment. Participants spoke of widespread stigma and discrimination as barriers to care, which may be mitigated by enhanced training with an anti-oppressive framework in the health care sector and in law enforcement. Participants felt that peer support workers could best deliver education and create awareness of TBI among people involved in sex work. The magnitude of violence and TBI in this population indicates the need for future research to determine actual prevalence of TBI and appropriate screening tools combined with educational programs.

Hashtag #TBI: A content and network data analysis of tweets about Traumatic Brain Injury

ABSTRACTObjective: The aims of this study were to: (a) determine how Twitter is used by people with traumatic brain injury (TBI) and TBI organisations, (b) analyse the Twitter networks and content of tweets tagged with TBI-related hashtags, and (c) identify any challenges people with TBI encounter in using Twitter.Research Design: Mixed methods in a Twitter hashtag study.Methods: Mixed methods in a Twitter hashtag study. Tweets tagged with TBI-related hashtags were harvested from the Twitter website over a one-month period in 2016 and analysed qualitatively and quantitatively.Results: The sample of 29,199 tweets included tweets sent by 893 @users, 219 of whom had a brain injury. Twitter was used to: (a) discuss health issues, (b) raise awareness of TBI, (c) talk about life after TBI, (d) talk about sport and concussion, and (e) communicate inspirational messages.Conclusions: Twitter is an important platform for research and knowledge translation on TBI, and for hearing the voices of people with TBI as they express their personal views and stories of living with TBI and become more visible and influential in Twitter communities. TBI clinicians could use these narratives of people with TBI in Twitter to develop more effective and personally meaningful rehabilitation goals.

Beyond academic performance: Practice implications for working with students following traumatic brain injury

Purpose: Speech-language pathologists (SLPs) have a key role in supporting educational participation for secondary and tertiary students with traumatic brain injury (TBI). This article aims to (i) explore issues identified by students with TBI that affect educational participation beyond their academic performance, (ii) offer a framework based on research evidence to guide the practice of SLPs and (iii) explore strategies that may expand the traditional roles of SLPs to support students beyond academic performance.Method: Data were drawn from an earlier qualitative research project in which three adolescent males were interviewed about their experiences of returning to education after severe TBI. Interviews were recorded, transcribed verbatim and analysed using a grounded theory approach.Result: Six themes were identified that had a substantial impact beyond academic performance: poor community awareness of TBI, the invisible nature of TBI, getting back to everyday life, planning to return to education, being accepted and adjusting to long-term changes. Incorporating these factors, a clinical framework is put forward to guide SLPs in developing strategies for promoting positive educational participation.Conclusion: By considering factors beyond academic performance and addressing these in intervention, SLPs may significantly improve the overall educational success and wellbeing of students living with TBI.

Adult sports-related traumatic brain injury in United States trauma centers.

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use-particularly in equestrian and roller sports-are critical elements for decreasing sports-related TBI events in adults.

Emerging subspecialties in neurology: neurorehabilitation.

Since the initial Emerging Subspecialties article on neurorehabilitation was published in 2008,1 much has changed in the world and in medical practice. Veterans, athletes, and concussion patients have increased our awareness of traumatic brain injury (TBI) and neurorehabilitation has sought to optimize clinical outcomes by improving research.2 For interested trainees, there is now subspecialty certification in brain injury available, which had its inaugural examination in 2014. TBI care pathways are needed to provide the best evidence-based care and assist with managing populations in the changing landscape of health care reimbursement. This article highlights the past, present, and future of neurorehabilitation.

Neuroendocrine Disturbances after Brain Damage: An Important and Often Undiagnosed Disorder.

Traumatic brain injury (TBI) is a common and significant public health problem all over the world. Until recently, TBI has been recognized as an uncommon cause of hypopituitarism. The studies conducted during the last 15 years revealed that TBI is a serious cause of hypopituitarism. Although the underlying pathophysiology has not yet been fully clarified, new data indicate that genetic predisposition, autoimmunity and neuroinflammatory changes may play a role in the development of hypopituitarism. Combative sports, including boxing and kickboxing, both of which are characterized by chronic repetitive head trauma, have been shown as new causes of neuroendocrine abnormalities, mainly hypopituitarism, for the first time during the last 10 years. Most patients with TBI-induced pituitary dysfunction remain undiagnosed and untreated because of the non-specific and subtle clinical manifestations of hypopituitarism. Replacement of the deficient hormones, of which GH is the commonest hormone lost, may not only reverse the clinical manifestations and neurocognitive dysfunction, but may also help posttraumatic disabled patients resistant to classical treatment who have undiagnosed hypopituitarism and GH deficiency in particular. Therefore, early diagnosis, which depends on the awareness of TBI as a cause of neuroendocrine abnormalities among the medical community, is crucially important.

Caring for patients with closed traumatic brain injury in rural settings.

The Centers for Disease Control and Prevention (CDC) has acknowledged closed traumatic brain injuries (cTBIs), a form of traumatic brain injury (TBI), as being a major public health matter in the United States. Statistical analysis, as well as public health data, has suggested that there are approximately 1,300 cases of cTBI per year in the United States alone. The standard of care for patients with a cTBI is to undergo diagnostic imaging, most commonly computerized tomography, which is considered to be a luxury and seldom exists in rural clinics. Despite increasing TBI awareness and publicity, healthcare providers, including advanced practice registered nurses, have yet to have a full understanding of the severity of damages that can result from a cTBI. The purpose of this article is to provide an understanding of cTBI and concise clinical best practice guidelines that will aid healthcare providers in rural settings to properly diagnose, treat, and provide education for patients with cTBIs.

Development of electrochemical methods to enzymatically detect traumatic brain injury biomarkers.

As awareness of traumatic brain injury (TBI) increases, the need to detect mild forms and distinguish between the different severities of TBI becomes more apparent. The goal of this work is to develop a point-of-care sensor to detect whole blood biomarkers for rapid and sensitive diagnosis of TBI severity. Presented herein is the enzymatic detection of norepinephrine through the use of immobilization chemistry and impedance techniques. Sustained elevation of norepinephrine concentrations in the blood has been correlated to negative long-term outcomes in TBI cases, often resulting in permanent cognitive or physical deficits. Novel analysis techniques have been used to identify an optimal binding frequency (371.1 Hz) of norepinephrine to the immobilized enzyme on a gold disk electrode. This form of analysis yielded a logarithmic fit characterized by exceptional responsivity (20.89 Ω/pg mL(-1)), reproducibility (R(2)=0.96), and lower limit of detection (98 pg/mL) first in purified samples, then in rabbit whole blood solutions. Once the optimal binding frequency was determined, the preliminary use of an impedance-time technique was attempted in this work. This technique more closely resembles the amperometric detection method used in commercial self-monitoring blood glucose meters, allowing for continuous or instantaneous measurement of blood borne biomarkers without compromising sensitivity. Future directions include exploration of simultaneous multi-marker detection with the impedance-time technique and experimentation with novel mesoporous materials to filter large blood components.

Traumatic brain injury and cognitive impairment in men who are homeless

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

Sports-related brain injury in the general population: An epidemiological study

To determine the incidence, nature and severity of all sports-related brain injuries in the general population. Population-based epidemiological incidence study. Data on all traumatic brain injury events sustained during a sports-related activity were extracted from a dataset of all new traumatic brain injury cases (both fatal and non-fatal), identified over a one-year period in the Hamilton and Waikato districts of New Zealand. Prospective and retrospective case ascertainment methods from multiple sources were used. All age groups and levels of traumatic brain injury severity were included. Details of the registering injuries and recurrent injuries sustained over the subsequent year were obtained through medical/accident records and assessment interviews with participants. Of 1369 incident traumatic brain injury cases, 291 were identified as being sustained during a sports-related activity (21% of all traumatic brain injuries) equating to an incidence rate of 170 per 100,000 of the general population. Recurrent injuries occurred more frequently in adults (11%) than children (5%). Of the sports-related injuries 46% were classified as mild with a high risk of complications. Injuries were most frequently sustained during rugby, cycling and equestrian activities. It was revealed that up to 19% of traumatic brain injuries were not recorded in medical notes. Given the high incidence of new and recurrent traumatic brain injury and the high risk of complications following injury, further sport specific injury prevention strategies are urgently needed to reduce the impact of traumatic brain injury and facilitate safer engagement in sports activities. The high levels of 'missed' traumatic brain injuries, highlights the importance in raising awareness of traumatic brain injury during sports-related activity in the general population.

Epidemiological Shifts in Elderly Traumatic Brain Injury: 18-Year Trends in Pennsylvania

Older adults tend to have poorer outcomes compared to younger adults following moderate-to-severe traumatic brain injury (TBI). Currently, there is a need for research focusing on how elderly TBI has changed as the U.S. population shifts. This study provides a statewide account of moderate-to-severe TBI in regard to injury-related variables and incidence rates in the elderly. Data from Pennsylvania accredited trauma centers collected in the Pennsylvania Trauma Outcome Study between 1992 and 2009 were used in the current study. Incidence rates for TBI were calculated using U.S. Census Bureau estimates for individuals aged 65-90 years (separated into three subgroups: ages 65-73, 74-82, and 83-90 years). In addition, we focused on describing the following injury-related variables: mechanism of injury, injury severity, hospital length of stay, and functional status at discharge. The results indicate that the incidence of elderly TBI has approximately doubled in the past 18 years, and that the increase in elderly TBI is greatest for individuals between the ages of 83 and 90. Furthermore, this age group had the poorest outcomes following TBI. Prevention and awareness of TBI in the elderly is imperative in reducing the likelihood of injury and disability. Continued statewide work is needed to demonstrate trends in elderly TBI nationwide to further add to the knowledge base used for prevention and rehabilitation work.

Traumatic Brain Injury and Its Neuropsychiatric Sequelae in War Veterans

The post-September 11, 2001 wars in and around Afghanistan and Iraq have increased awareness of traumatic brain injury (TBI), particularly blast-induced mild TBI. This article provides an overview of TBI and its neuropsychiatric sequelae in U.S. war veterans who participated in the current operations in and around Afghanistan and Iraq, with particular emphasis on blast-related mild TBI. Psychiatric disorders, particularly posttraumatic stress disorder, pain, and sensory impairments are prevalent in war veterans with TBI. Research is needed to more definitively characterize the epidemiology of TBI-related functional difficulties, the effects of blasts compared with other mechanisms of injury, recovery trajectories, and treatment outcomes in this population.