Traumatic Brain Injury Individuals Research Articles

Non-pharmacological interventions for sleep disruptions and fatigue after traumatic brain injury: a scoping review.

The aim of this study was to conduct a scoping review to determine the nature, variety, and volume of empirical evidence on nonpharmacological interventions for sleep disturbances with potential implications for fatigue in adults sustaining a traumatic brain injury (TBI). A systematic literature search was conducted across four databases to identify primary studies testing a single non-pharmacological intervention or a combination of non-pharmacological interventions for sleep disturbances and fatigue in community-dwelling adults with TBI. Sixteen studies were reviewed addressing six non-pharmacological interventions for sleep disruptions and fatigue after TBI including light therapy, cognitive-behavioral therapy, warm footbath application, shiatsu, and sleep hygiene protocol. Non-pharmacological interventions involving light or cognitive-behavioral therapy were reported in 75% of the studies. Actigraphy-based estimation of total sleep time and subjective level of fatigue were frequent outcomes. While this scoping review has utility in describing existing non-pharmacological approaches to manage sleep and fatigue after TBI, the findings suggest that interventions are often developed without considering TBI individuals' source of motivation and the need for support in self-administration. Future studies may achieve greater sustainability by considering the evolving needs of TBI patients and their families and the drivers and barriers that might influence non-pharmacological intervention use at home.

Improved comprehension of irony and indirect requests following a severe traumatic brain injury: two case studies

ABSTRACT Background Following a traumatic brain injury (TBI), people frequently have difficulty understanding nonliteral language, including irony and indirect requests. Despite the handicap that these disorders can represent in daily life, they are rarely treated clinically, and remediation studies are scarce. Aims The present study thus aimed to evaluate the effectiveness of an explicit metapragmatic therapy targeting nonliteral language comprehension and taking into account cognitive processes likely to underlie this comprehension (i.e., contextual processing, theory of mind, and executive functions). Methods & Procedure This study was registered on the ClinicalTrials.gov system (ID: NCT04708561) before participant recruitment. Two adults with severe TBI took part in the study. An ABA design with multiple baselines was used to assess the evolution of treated and non-treated written literal and nonliteral story comprehension, as well as ecological tasks and tasks assessing the cognitive processes of interest (theory of mind and executive functions). An interview was also conducted at the end of treatment to assess participant satisfaction. Outcomes & results Therapy resulted in significant improvement in treated items, with one-month maintenance of gains and generalisation to untreated items in both participants. The generalisation to a working memory task was also observed in one participant. Finally, participant satisfaction with the treatment was high. Conclusions & implications Our study demonstrated for the first time the potential of a therapy targeting irony and indirect request comprehension in TBI individuals. Clinically, it offers concrete therapeutic avenues and fills a critical gap in the TBI population’s evidence for the remediation of nonliteral language comprehension.

Towards PPG-based anger detection for emotion regulation

BackgroundAnger dyscontrol is a common issue after traumatic brain injury (TBI). With the growth of wearable physiological sensors, there is new potential to facilitate the rehabilitation of such anger in the context of daily life. This potential, however, depends on how well physiological markers can distinguish changing emotional states and for such markers to generalize to real-world settings. Our study explores how wearable photoplethysmography (PPG), one of the most widely available physiological sensors, could be used detect anger within a heterogeneous population.MethodsThis study collected the TRIEP (Toronto Rehabilitation Institute Emotion-Physiology) dataset, which comprised of 32 individuals (10 TBI), exposed to a variety of elicitation material (film, pictures, self-statements, personal recall), over two day sessions. This complex dataset allowed for exploration into how the emotion-PPG relationship varied over changes in individuals, endogenous/exogenous drivers of emotion, and day-to-day differences. A multi-stage analysis was conducted looking at: (1) times-series visual clustering, (2) discriminative time-interval features of anger, and (3) out-of-sample anger classification.ResultsCharacteristics of PPG are largely dominated by inter-subject (between individuals) differences first, then intra-subject (day-to-day) changes, before differentiation into emotion. Both TBI and non-TBI individuals showed evidence of linear separable features that could differentiate anger from non-anger classes within time-interval analysis. However, what is more challenging is that these separable features for anger have various degrees of stability across individuals and days.ConclusionThis work highlights how there are contextual, non-stationary challenges to the emotion-physiology relationship that must be accounted for before emotion regulation technology can perform in real-world scenarios. It also affirms the need for a larger breadth of emotional sampling when building classification models.

Multi-site, multi-country randomized clinical trial of an acute traumatic brain injury caregiver transition assistance program in Latin America.

Individuals with traumatic brain injury (TBI) in Latin America experience high levels of disability and extremely poor functional outcomes, and their informal caregivers play a key role in their rehabilitation and care. To improve TBI rehabilitation through stronger informal caregiving, this study developed and evaluated an evidence-based and culturally appropriate Transition Assistance Program (TAP) for informal caregivers of individuals with TBI in Latin America, specifically targeting the time period before and after the transition from hospital to home. A sample of 89 people with a new TBI and their primary informal caregiver (n = 178) was recruited from two hospitals in Mexico City, Mexico, and in Cali, Colombia. Caregivers were randomly assigned to either the TAP group or to a control group receiving the standard care provided by the hospital. Caregivers completed measures of depression and burden, and individuals with TBI completed measures of depression and self-perceived burden on caregivers before hospital discharge and at 2- and 4-month follow ups. Caregivers in the TAP group reported significantly lower burden than those in the control group and marginally lower depression. Individuals with TBI whose caregivers had been in the TAP group reported significantly lower depression than those whose caregivers had been in the control group, and a non-significant but lower self-perceived burden on their caregivers. The results suggest that the TAP has strong potential to benefit both TBI caregivers and individuals with TBI during the transition from acute TBI hospitalization to home in Latin America, generally showing small-or medium-sized effects on key outcomes.

The Underlying Mechanisms in the Association Between Traumatic Brain Injury in Childhood and Conduct Disorder Symptoms in Late Adolescence

The present study examined i) the direct association between traumatic brain injury (TBI) in childhood and conduct disorder symptoms in adolescence, ii) whether this effect is mediated by impulsivity and/or callous unemotional traits (CU traits), and iii) whether these indirect effects are moderated by childhood family adversity and adolescent substance use. Utilising data from the Avon Longitudinal Study of Parents and Children (ALSPAC), participants with head injury information up to 12 years (4.5 years, 5.4 years, 6.5 years, 8.6 years, 11.7 years) were identified and categorised into a TBI (n = 409), orthopaedic injury (n = 1469) or non-injury group (n = 5685). Psychosocial factors such as impulsivity at 13 years, CU traits at 13 years, childhood family adversity (between birth to 4 years) and substance use at 14 years were collated for moderated mediation analyses. Conduct disorder symptoms were assessed at 16 years of age. TBI and conduct disorder symptoms were positively associated, and this association was mediated by impulsivity but not CU traits. The indirect effects were higher in magnitude for individuals with higher levels of childhood family adversity. Adolescent substance use was not found to moderate the indirect effects between TBI and conduct disorder symptoms. These results were specific to TBI individuals, and not in participants with orthopaedic injury and no reported injuries. Targeting impulsivity and early family adversity may alleviate the risk of conduct disorder symptoms following TBI in childhood. These findings have important implications for informing neuro-rehabilitative and preventative measures in clinical and community settings.

Long-term follow-up of neurodegenerative phenomenon in severe traumatic brain injury using MRI.

Traumatic brain injury (TBI) lesions are known to evolve over time, but the duration and consequences of cerebral remodelling are unclear. Degenerative mechanisms occurring in the chronic phase after TBI could constitute "tertiary" lesions related to the neurological outcome. The objective of this prospective study of severe TBI was to longitudinally evaluate the volume of white and grey matter structures and white matter integrity with 2 time-point multimodal MRI. Longitudinal MRI follow-up was obtained for 11 healthy controls (HCs) and 22 individuals with TBI (mean [SD] 60 [15] months after injury) along with neuropsychological assessments. TBI individuals were classified in the "favourable" recovery group (Glasgow Outcome Scale Extended [GOSE] 6-8) and "unfavourable" recovery group (GOSE 3-5) at 5 years. Variation in brain volumes (3D T1-weighted image) and white matter integrity (diffusion tensor imaging [DTI]) were quantitatively assessed over time and used to predict neurological outcome. TBI individuals showed a marked decrease in volumes of whole white matter (median -11.4% [interquartile range -5.8; -14.6]; p<0.001) and deep grey nuclear structures (-17.1% [-10.6; -20.5]; p<0.001). HCs did not show any significant change over the same time period. Median volumetric loss in several brain regions was higher with GOSE 3-5 than 6-8. These lesions were associated with lower fractional anisotropy and higher mean diffusivity at baseline. Volumetric variations were positively correlated with normalized fractional anisotropy and negatively with normalized mean diffusivity at baseline and follow-up. A computed predictive model with baseline DTI showed good accuracy to predict neurological outcome (area under the receiver operating characteristic curve 0.82 [95% confidence interval 0.81-0.83]) CONCLUSIONS: We characterised the striking atrophy of deep brain structures after severe TBI. DTI imaging in the subacute phase can predict the occurrence and localization of these tertiary lesions as well as long-term neurological outcome. ClinicalTrials.gov: NCT00577954. Registered on October 2006.

Cortical and Subcortical Alterations and Clinical Correlates after Traumatic Brain Injury.

Background: Traumatic brain injury (TBI) often results in persistent cognitive impairment and psychiatric symptoms, while lesion location and severity are not consistent with its clinical complaints. Previous studies found cognitive deficits and psychiatric disorders following TBI are considered to be associated with prefrontal and medial temporal lobe lesions, however, the location and extent of contusions often cannot fully explain the patient′s impairments. Thus, we try to find the structural changes of gray matter (GM) and white matter (WM), clarify their correlation with psychiatric symptoms and memory following TBI, and determine the brain regions that primary correlate with clinical measurements. Methods: Overall, 32 TBI individuals and 23 healthy controls were recruited in the study. Cognitive impairment and psychiatric symptoms were examined by Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and Wechsler Memory Scale-Chinese Revision (WMS-CR). All MRI data were scanned using a Siemens Prisma 3.0 Tesla MRI system. T1 MRI data and diffusion tensor imaging (DTI) data were processed to analyze GM volume and WM microstructure separately. Results: In the present study, TBI patients underwent widespread decrease of GM volume in both cortical and subcortical regions. Among these regions, four brain areas including the left inferior temporal gyrus and medial temporal lobe, supplementary motor area, thalamus, and anterior cingulate cortex (ACC) were highly implicated in the post-traumatic cognitive impairment and psychiatric complaints. TBI patients also underwent changes of WM microstructure, involving decreased fractional anisotropy (FA) value in widespread WM tracts and increased mean diffusivity (MD) value in the forceps minor. The changes of WM microstructure were significantly correlated with the decrease of GM volume. Conclusions: TBI causes widespread cortical and subcortical alterations including a reduction in GM volume and change in WM microstructure related to clinical manifestation. Lesions in temporal lobe may lead to more serious cognitive and emotional dysfunction, which should attract our high clinical attention.

Effects of Computerized Biofeedback-based Balance Intervention on the Muscle Coactivation Patterns during Dynamic Postural Control in Traumatic Brain Injury.

Balance Dysfunction (BDF) is a severe conse-quence of Traumatic Brain Injury (TBI) that significantly increases the falls risk. However, the neuromuscular mecha-nisms of the BDF are not adequately researched. Therefore, in this study, our objective was to investigate the effects of a Computerized Biofeedback-based Balance Intervention (CBBI) on the muscle coactivation patterns in a group of TBI participants. This study presents the findings from 13 TBI individuals randomized into the Intervention group (TBI - INT, N=6) and Control group (TBI-CTL, N=7). Using a computerized posturography platform (Neurocom Balance Master) during baseline and follow-up assessment visits, the participant's pos-tural response to anterior-posterior balance perturbations were recorded in a multimodal setup including electroencephalogra-phy (EEG), electromyography (EMG), and the platform sway in terms of center of pressure (COP). The muscle responses were recorded from lower-limb muscles, including tibialis an-terior (TA) and gastrocnemius (GAST), whose coactivation was computed using a metric called Co-Contraction Index (CCI). Clinical outcome measures such as Berg Balance Scale (BBS), 10 Meter Walk Test (10MWT), and Timed Up-and-Go (TUG) tests were used to evaluate functional balance and mobility. The comparison of CCI values across time points (baseline and follow-up) revealed a significant decrease (p<0.01) in the TBI-INT group but not TBI-CTL. The intervention-related changes in CCI correlated with the changes in BBS score (from baseline to follow-up). These preliminary findings demonstrate that the CBBI training may help postural stability by facilitating the coactivation between muscles involved in postural control. Clinical relevance- The current knowledge of changes in the neuromuscular response to balance perturbation in TBI is limited. Our study opens the possibility of using the muscle CCI metric to evaluate the muscle response in individuals with impaired balance.

Inflammatory Biomarkers of Traumatic Brain Injury.

Traumatic brain injury (TBI) has a complex pathology in which the initial injury releases damage associated proteins that exacerbate the neuroinflammatory response during the chronic secondary injury period. One of the major pathological players in the inflammatory response after TBI is the inflammasome. Increased levels of inflammasome proteins during the acute phase after TBI are associated with worse functional outcomes. Previous studies reveal that the level of inflammasome proteins in biological fluids may be used as promising new biomarkers for the determination of TBI functional outcomes. In this study, we provide further evidence that inflammatory cytokines and inflammasome proteins in serum may be used to determine injury severity and predict pathological outcomes. In this study, we analyzed blood serum from TBI patients and respective controls utilizing Simple Plex inflammasome and V-PLEX inflammatory cytokine assays. We performed statistical analyses to determine which proteins were significantly elevated in TBI individuals. The receiver operating characteristics (ROC) were determined to obtain the area under the curve (AUC) to establish the potential fit as a biomarker. Potential biomarkers were then compared to documented patient Glasgow coma scale scores via a correlation matrix and a multivariate linear regression to determine how respective biomarkers are related to the injury severity and pathological outcome. Inflammasome proteins and inflammatory cytokines were elevated after TBI, and the apoptosis-associated speck like protein containing a caspase recruitment domain (ASC), interleukin (IL)-18, tumor necrosis factor (TNF)-α, IL-4 and IL-6 were the most reliable biomarkers. Additionally, levels of these proteins were correlated with known clinical indicators of pathological outcome, such as the Glasgow coma scale (GCS). Our results show that inflammatory cytokines and inflammasome proteins are promising biomarkers for determining pathological outcomes after TBI. Additionally, levels of biomarkers could potentially be utilized to determine a patient’s injury severity and subsequent pathological outcome. These findings show that inflammation-associated proteins in the blood are reliable biomarkers of injury severity that can also be used to assess the functional outcomes of TBI patients.

Systematic Review on the Association of a Traumatic Brain Injury (TBI) and Development of Alzheimer's Disease (AD)

<h3>Objective(s)</h3> The purpose of this systematic review was to examine the association of a traumatic brain injury and development of Alzheimers. <h3>Data Sources</h3> This review was conducted using the following databases: Taylor & Francis, Science Direct, Google Scholar, and ProQuest Central. Inclusion criteria consisted of peer-reviewed articles published in English between the years of 1999-2017. Keywords for the search included Alzheimer's Disease, dementia, traumatic brain injury, and TBI. A total number of 26 articles were reviewed, and 5 articles were retained. <h3>Study Selection</h3> Literature Review. <h3>Data Extraction</h3> Independent extraction by multiple observers. <h3>Data Synthesis</h3> Articles reviewed demonstrate consistency in the association between increased risk for AD and history of head trauma, specifically early onset when TBIs are experienced at an older age. Additionally, sustaining a TBI at an older age increases the risk of rapid progression and functional impairment following onset of AD. Overall, studies analyzed report TBI as a possible precipitating factor of AD. Research suggests the mechanisms involved in TBI and Apoe4 may be linked to AD pathology, specifically, Aβ plaques. Furthermore, these plaques are more prevalent at a younger age in cognitively intact individuals with Apoe4 genetic predispositions when compared to non-carriers. Of note, plaques identified in TBI individuals resemble those found in early stages of AD. <h3>Conclusions</h3> Research indicated that although a scarcity of research exists on factors that may influence AD progression, helpful information such as history of TBI and its recency may be useful tools. This may also assist in predicting prognosis and in identifying severity of disability. Risk factors include higher rates of functional decline in AD, specifically for individuals where TBI occurred relatively close to the onset of AD. Further research should be conducted to evaluate possible preclinical features of AD, such as the predisposition to falls resulting in head trauma, to identify potential alternative explanations and possible pathological overlap between AD and TBI. <h3>Author(s) Disclosures</h3> N/A.

Prophylactic Activation of Shh Signaling Attenuates TBI-Induced Seizures in Zebrafish by Modulating Glutamate Excitotoxicity through Eaat2a.

Approximately 2 million individuals experience a traumatic brain injury (TBI) every year in the United States. Secondary injury begins within minutes after TBI, with alterations in cellular function and chemical signaling that contribute to excitotoxicity. Post-traumatic seizures (PTS) are experienced in an increasing number of TBI individuals that also display resistance to traditional anti-seizure medications (ASMs). Sonic hedgehog (Shh) is a signaling pathway that is upregulated following central nervous system damage in zebrafish and aids injury-induced regeneration. Using a modified Marmarou weight drop on adult zebrafish, we examined PTS following TBI and Shh modulation. We found that inhibiting Shh signaling by cyclopamine significantly increased PTS in TBI fish, prolonged the timeframe PTS was observed, and decreased survival across all TBI severities. Shh-inhibited TBI fish failed to respond to traditional ASMs, but were attenuated when treated with CNQX, which blocks ionotropic glutamate receptors. We found that the Smoothened agonist, purmorphamine, increased Eaat2a expression in undamaged brains compared to untreated controls, and purmorphamine treatment reduced glutamate excitotoxicity following TBI. Similarly, purmorphamine reduced PTS, edema, and cognitive deficits in TBI fish, while these pathologies were increased and/or prolonged in cyclopamine-treated TBI fish. However, the increased severity of TBI phenotypes with cyclopamine was reduced by cotreating fish with ceftriaxone, which induces Eaat2a expression. Collectively, these data suggest that Shh signaling induces Eaat2a expression and plays a role in regulating TBI-induced glutamate excitotoxicity and TBI sequelae.

Elevated serum and urine levels of progranulin (PGRN) as a predictor of microglia activation in the early phase of traumatic brain injury: a further link with the development of neurodegenerative diseases.

Traumatic brain injury (TBI) is afrequent finding during forensic autopsies and neuropathological examinations in medico-legal practices. Despite the unprecedented attention currently focused on TBI pathogenesis, there is aneed to improve its diagnostics through the use of novel biomarkers to facilitate detection, treatment, and prognosis. Recently, growth factor progranulin (PGRN) has attracted significant attention because of its neurotrophic and anti-inflammatory activities. The role of PGRN in TBI has not been widely discussed, although PGRN-related neuroinflammatory and neurodegenerative phenomena have been described. The aim of this study was to identify PGRN concentration levels in biofluids and examine PGRN and CD68 protein expression in brain tissue using immunohistochemical staining in individuals with fatal TBI in its early phase. The study was performed using cases (n = 30) of fatal head injury and control cases (n = 30) of sudden death. The serum and urine were collected within ~24 h after death and compared using the ELISA test, where brain specimens were stained with anti-PGRN and anti-CD68 antibodies. In our study, we observed elevated concentration levels of PGRN in the serum and urine of TBI individuals in the early phase of TBI. These changes were accompanied by increased expression of PGRN in the frontal cortex (1st-3rd layers), in which anti-CD68 immunostaining revealed disseminated cortical microglia activation. The possible implementation of performing such assays offers anovel and interesting tool for investigation and research regarding TBI diagnosis and pathogenesis. Furthermore, the above-mentioned surrogate biofluid assays may be useful in clinical prognosis and risk calculation of non-fatal cases of TBI, considering the development of neurodegenerative conditions of TBI individuals.

A Systematic Review of Cognitive Functioning After Traumatic Brain Injury in Individuals Aged 10-30 Years.

Given the importance of the period of life from 10 to 30 years in terms of cognitive development and education, combined with the high incidence of traumatic brain injury (TBI) during this period, and limited consensus as to the pattern and degree of cognitive impairment post TBI during this period, we conducted a systematic review to investigate cognitive performance across a range of domains among individuals between the ages of 10 and 30 years who had sustained a TBI. We searched five databases and identified 799 unique records; 52 met our inclusion criteria. These studies reported cognitive function for intelligence, attention, memory, processing speed, and executive function. The majority of the studies reported significant effects, suggesting that TBI is associated with cognitive impairments in these domains. Nine of the studies used physiological tests (EEG and fMRI), the outcomes of which supported behaviorally demonstrated cognitive deficits. In the studies we reviewed, individuals aged 10-30 years who had experienced a TBI performed worse than healthy controls on cognitive function measures-specifically for attention, memory, processing speed, and executive function. In the studies that subjected the individuals with TBI to EEG and fMRI, atypical activation in associated brain regions was demonstrated while the individuals were undergoing cognitive tasks. However, caution should be taken when interpreting the overall results due to the high risk of bias across the majority of the studies. The broader implications of reduced cognitive performance after TBI across this age range are yet to be fully understood.

Neurofilament light chain level in traumatic brain injury: A system review and meta-analysis.

Background:Neurofilament light (NfL) level was obviously increased in traumatic brain injury (TBI) individuals. But, no comprehensive meta-analysis has ever been conducted to assess the diagnostic performance of NfL. This study aims to evaluate the relationship between NfL level and TBI through a meta-analysis.Methods:Studies were selected from Pubmed, Web of science, Embase, Google Scholar, PMC and Chinese National Knowledge Infrastructure (CNKI), and the Chinese Biomedical Literature Database (CBM) through inclusion and exclusion criteria. The standard mean difference (SMD) and 95% confidence interval (CI) were calculated using the random-effect model or fixed-effect model to assess the association between NfL level and TBI. Subgroup analysis according to sample collection time, sample type and detection method was performed. The influence analysis and publication bias was also conducted. All analyses were performed using the RevMan 5.3 and Stata 12 software.Results:A total of 9 studies were included. Results indicated that TBI individuals had a higher NfL expression level compared with the non-TBI individuals (SMD = 2.48, 95% CI = 1.52–3.43, I2 = 96%, P < .01). Similar NfL increasing was also observed in Caucasian population, 0–48 hour and 6–10 days sample collection time, as well as cerebrospinal fluid (CSF), serum, plasma sample subgroup analysis. Moreover, the NfL increasing still existed no matter the NfL expression level was detected by ELISA or Simoa assay.Conclusion:NfL expression level was increased in TBI individuals, which indicated that NfL could be a potential biomarker in the diagnosis of TBI and other neurodegenerative diseases.

Assessment of Health Related Quality of Life in Post Traumatic Brain Injury

Traumatic brain injury (TBI) occurs as a result of an outside force, e.g. a blow to the head in a fall or traffic accident, and is a major cause of death and disability all over the world, especially in children and young adults.Objective: To determine the Assessment of health related quality of life in post traumatic brain injury. Methods:It was the cross-sectional observational study. Data was collected by 40 TBI patients on basis of inclusion and exclusion criteria. Quality of life after traumatic brain injury questionnaire was used in this study to see the QoL in post TBI patients.Results: In general males were more affected then females and main reason of TBI was motor bike. The quality of life much affected in feeling, physical work and social relationship. The QoL didn’t depend upon time since injury but depend on severity of injury. Conclusion: Physical work issue was the fundamental predictive factor of hundered personal satisfaction of TBI individuals perhaps, there was no relationship among impairment and QoL. This change of QOL has clinical implications and features the need of more endeavors to improve the rehabilitation interventions.

The experiences and perceptions of employers and caregivers of individuals with mild-moderate traumatic brain injury in returning to work.

Traumatic brain injury (TBI) has contributed significantly to the burden of health care in many countries. The scarcity of resources in the public sector available for rehabilitation has caused many families to take responsibility for the care and rehabilitation of their family members who sustain a TBI. The roles of employers and caregivers in facilitating the return to work (RTW) process of individuals who sustained a TBI, is now commonly acknowledged. The aim of this study was to explore the perceptions and experiences of employers and caregivers of individuals with mild to moderate traumatic brain injury who are returning to work after completing a vocational rehabilitation program (VR), using the Model of Occupational Self-Efficacy (MOOSE). A qualitative research design was used to explore the experiences and perceptions of caregivers and employers of ten individuals who sustained a mild to moderate brain injury. Semi-structured interviews were completed and data analyzed according to thematic analysis. Five themes emerged: Themes one and two describe the employers' and caregivers' experiences and perceptions that hinder the RTW process. Theme three relates to the enabling aspects that the employers and caregivers, as well as the TBI individuals concerned, derive from engaging in the VR process. Themes four and five present the coping strategies that aid the employers and caregivers in playing an ongoing role in the RTW process. All ethical principles with regard to confidentiality, anonymity and informed consent were adhered to in the study. Occupational therapists (OT) using the MOOSE should regard employers and caregivers as key role players during therapy. Employers should have a better understanding of TBI and allow for sick leave to be granted to individuals with TBI during the rehabilitation process. Caregivers would benefit from establishing a support network for themselves, and by connecting with employers of the individuals with TBI in order to understand the their work environment.

The Abbreviated Westmead Post-traumatic Amnesia Scale: A procedure to identify post-traumatic amnesia after mild traumatic brain injury

This article describes the Abbreviated Westmead Post-traumatic Amnesia Scale (A-WPTAS), a measure that extends the Glasgow Coma Scale (GCS) with three picture cards to measure amnesia. The A-WPTAS has been shown to identify individuals with an optimal GCS score of 15/15 who are in PTA. The scale is more sensitive than the GCS alone and improves identification of mild traumatic brain injury in individuals presenting to an Emergency Department with a suspected closed head injury.

Behaviours of concern following moderate to severe traumatic brain injury in individuals living in the community

ABSTRACTPrimary Objective: Behaviours of Concern (BoC) following traumatic brain injury (TBI) have a significant negative impact on the daily functioning and quality of life for the individual and their family. However, there has been limited research examining the nature and severity of BoC beyond the acute recovery period, including the perspective of the individual with TBI as well as close others (COs).Methods and Procedure: Eighty-nine individuals with predominantly severe TBI, at a mean of 11.4 years’ post-injury, were identified through a no-fault accident compensation system database. Structured interviews were completed with 65 individuals with TBI, and 62 COs. Current BoC were documented using the Overt Behaviour Scale (OBS).Main Outcomes and Results: 70.5% of participants exhibited BoC on the OBS, with an average of 3 behaviours. Verbal aggression and socially inappropriate behaviour were the most common BoC. Self-report of behaviour change was endorsed by 81% of the sample. There was generally poor concordance between the perspectives of the individual with the TBI and their CO.Conclusion: Severe BoC, across multiple behaviour types, may be evident many years following predominantly severe TBI. There is a need to provide long-term behaviour support for these individuals.

Communicative-pragmatic disorders in traumatic brain injury: The role of theory of mind and executive functions

Previous research has shown that communicative-pragmatic ability, as well as executive functions (EF) and Theory of Mind (ToM), may be impaired in individuals with traumatic brain injury (TBI). However, the role of such cognitive deficits in explaining communicative-pragmatic difficulty in TBI has still not been fully investigated. The study examined the relationship between EF (working memory, planning and flexibility) and ToM and communicative-pragmatic impairment in patients with TBI. 30 individuals with TBI and 30 healthy controls were assessed using the Assessment Battery of Communication (ABaCo), and a set of cognitive, EF and ToM, tasks. The results showed that TBI participants performed poorly in comprehension and production tasks in the ABaCo, using both linguistic and extralinguistic means of expression, and that they were impaired in EF and ToM abilities. Cognitive difficulties were able to predict the pragmatic performance of TBI individuals, with both executive functions and ToM contributing to explaining patients’ scores on the ABaCo.

CHANGES OF INTERLEUKINS IN PATIENTS WITH NOSOCOMIAL PNEUMONIA AGAINST A BACKGROUND OF TRAUMATIC BRAIN INJURY: ROLE IN THE DIAGNOSIS AND MONITORING OF DISEASE

Introduction. Nosocomial pneumonia (NP) is the second leading frequency and mortality among nosocomial infections. NP is a frequent complication of severe traumatic brain injury (TBI). The difficulty in diagnosis and monitoring of disease NP on the background of TBI is that the usual signs NP "masked" manifestations of the underlying disease. The aim of our study was to improve the diagnosis and assess the effectiveness of the treatment of nosocomial pneumonia with clarithromycin by studying of serum interleukins in patients with nosocomial pneumonia on the background of traumatic brain injury. Materials and methods. We determined levels of TNFα, IL-4, IL-6, IL-8, IL-10. We examined 45 patients with isolated TBI, 44 patients with NP (standard treatment scheme), 49 patients with NP, each therapy with clarithromycin. The control group was 33 relatively healthy people. Conclusions. The study revealed a significant increase in the concentration of interleukin TNFα, IL-6, IL-8, IL-10 in the serum of patients with NP on the background of TBI compared with patients with isolated TBI and healthy individuals. Our study found significantly lower concentrations of interleukin TNFα, IL-6, IL-8, IL-10 in the serum of patients after treatment with the addition of clarithromycin compared with patients with standard therapy.