Traumatic Brain Injury Population Research Articles

Rehabilitation of Executive Function in Pediatric Traumatic Brain Injury (REPeaT): Outcomes of a pilot randomized controlled trial.

To evaluate the effectiveness of Cogmed Working Memory Training (Cogmed) in improving working memory (WM) and decision making (DM) in childhood traumatic brain injury (TBI), and any associated increases in functional outcomes such as academic achievement in mathematics, behavior, social skills, and quality of life. A randomized controlled trial of the Cogmed (RM version) intervention for children with TBI. A total of 69 children post-TBI were screened for WM impairments, of which 31 eligible participants (Mage: 10.6 years; male n = 21) were recruited and randomized to either the treatment group (Cogmed, n = 16) or the active-control group (Lexia Reading Core5, n = 15). Both groups completed computerized training for 5 weeks with clinician support via an online video platform. Immediately posttraining and at 6 months follow-up, primary (WM and DM) and secondary functional outcomes were assessed. Immediately postintervention, significant improvement was found in one primary outcome (WM verbal component) for the Cogmed group, but this was not maintained at the 6 months follow-up. No immediate improvements or maintenance gains (small effect sizes) in other primary outcomes of visuospatial WM or DM were reported in the Cogmed group. No other significant group differences were detected for other functional outcomes. Despite the limited benefits observed in this small randomized controlled trial, it will be beneficial to investigate Cogmed's efficacy in a case-series methodology, to further determine its effectiveness in a pediatric TBI population. Furthermore, a cautious approach in clinical implementation of Cogmed is advised. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluation of activities and instrumental activities of daily living and correlated factors of traumatic brain injury patients in Vietnam

Traumatic brain injury (TBI) is among the leading causes of death in Vietnam. Survivors of TBI suffer from functional and cognitive deficits. Understanding that Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are crucial in measuring the treatment and health-related quality of life among patients with TBI. This study aims to evaluate ADLs and IADLs among the TBI population in Vietnam and determine the correlated factors to these two indices. A cross-sectional study was conducted on 212 patients with TBI in Vietnam from February to September 2020. ADLs and IADLs scales were applied. Depression, quality of sleep, and social support scales were used. Multivariate Tobit regression was adopted to identify factors associated with ADLs and IADLs. Patients who received first aid had higher ADLs scores than those who had not, by a statistical difference with a p value = 0.04. The mean ADLs score was 5.4 (SD = 1.4). The mean score of IADLs was 7.3 (SD = 1.7). Female patients (Mean = 7.6, SD = 1.1) performed better in IADLs than male patients (Mean = 7.1, SD = 1.9). Both ADLs and IADLs were affected strongly by depression and Injury Severity scores (p < 0.01), whereas IADLs were significantly correlated to caregiver types and quality of sleep (p < 0.01). Family support was observed as a negatively correlated factor to IADLs. Findings from the study provided evidence for authorities to adjust the health strategies among patients with TBI. Proper prehospital care, a basic low-cost hospital care model, and mental health counseling services should be considered when developing health interventions in Vietnam.

Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study.

Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.

784 Effects of Optimal Versus Suboptimal Median Household Income on the Operative Traumatic Brain Injury Population: A Propensity Score-matched Analysis

INTRODUCTION: Median household income is a useful metric for healthcare disparity assessment. New England holds a highly diverse, densely populated metropolitan area with one of the highest living wages in the US. To our knowledge, there is no published data on the effects of optimal vs. suboptimal median household income on the operative traumatic brain injury (TBI) patients. METHODS: Demographic, clinical and outcome data of operative TBI patients between 2015 and 2021 were collected and stratified based on optimal (80 000$ or more) and suboptimal (less than 80 000$) median residential household income. 1:1 tight caliper (0.01) propensity score matching was performed to balance the groups for comparative analysis. RESULTS: From the initial 91 patients in the optimal and 102 patients in the suboptimal income groups, 62 patients were included in each group after propensity matching. There were significantly more ethnic minority patients in the suboptimal as compared to the optimal income group (66.1% and 35.7%, respectively; p=0.002). Optimal income group patients presented as transfers from other hospitals significantly more frequently than the suboptimal group (52.5% and 30.7%, respectively; p = 0.02). There were no significant differences in post-operative Glasgow coma scale scores (p = 0.15), modified Rankin scale scores at discharge (p = 0.92) and upon follow-up (p = 0.1), mortality (p &gt; 0.999) or disposition destination distribution (p = 0.3). CONCLUSIONS: While the suboptimal income group is significantly more ethnically diverse, optimal versus suboptimal median household income does not seem to affect TBI outcomes and disposition. Optimal income group patients are more frequently presenting as transfers from other facilities indicating fair high-level care at a specialized high safety-net burden trauma center adapted to an ethnically diverse population.

Utilizing ultra-early continuous physiologic data to develop automated measures of clinical severity in a traumatic brain injury population

Determination of prognosis in the triage process after traumatic brain injury (TBI) is difficult to achieve. Current severity measures like the Trauma and injury severity score (TRISS) and revised trauma score (RTS) rely on additional information from the Glasgow Coma Scale (GCS) and the Injury Severity Score (ISS) which may be inaccurate or delayed, limiting their usefulness in the rapid triage setting. We hypothesized that machine learning based estimations of GCS and ISS obtained through modeling of continuous vital sign features could be used to rapidly derive an automated RTS and TRISS. We derived variables from electrocardiograms (ECG), photoplethysmography (PPG), and blood pressure using continuous data obtained in the first 15 min of admission to build machine learning models of GCS and ISS (ML-GCS and ML-ISS). We compared the TRISS and RTS using ML-ISS and ML-GCS and its value using the actual ISS and GCS in predicting in-hospital mortality. Models were tested in TBI with systemic injury (head abbreviated injury scale (AIS) ≥ 1), and isolated TBI (head AIS ≥ 1 and other AIS ≤ 1). The area under the receiver operating characteristic curve (AUROC) was used to evaluate model performance. A total of 21,077 cases (2009–2015) were in the training set. 6057 cases from 2016 to 2017 were used for testing, with 472 (7.8%) severe TBI (GCS 3–8), 223 (3.7%) moderate TBI (GCS 9–12), and 5913 (88.5%) mild TBI (GCS 13–15). In the TBI with systemic injury group, ML-TRISS had similar AUROC (0.963) to TRISS (0.965) in predicting mortality. ML-RTS had AUROC (0.823) and RTS had AUROC 0.928. In the isolated TBI group, ML-TRISS had AUROC 0.977, and TRISS had AUROC 0.983. ML-RTS had AUROC 0.790 and RTS had AUROC 0.957. Estimation of ISS and GCS from machine learning based modeling of vital sign features can be utilized to provide accurate assessments of the RTS and TRISS in a population of TBI patients. Automation of these scores could be utilized to enhance triage and resource allocation during the ultra-early phase of resuscitation.

Reference Values for the German Version of the Quality of Life after Brain Injury in Children and Adolescents (QOLIBRI-KID/ADO) from a General Population Sample.

Assessment of health-related quality of life (HRQoL) after pediatric traumatic brain injury (TBI) has been limited in children and adolescents due to a lack of disease-specific instruments. To fill this gap, the Quality of Life after Traumatic Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) Questionnaire was developed for the German-speaking population. Reference values from a comparable general population are essential for comprehending the impact of TBI on health and well-being. This study examines the validity of the German QOLIBRI-KID/ADO in a general pediatric population in Germany and provides reference values for use in clinical practice. Overall, 1997 children and adolescents aged 8-17 years from the general population and 300 from the TBI population participated in this study. The questionnaire was tested for reliability and validity. A measurement invariance (MI) approach was used to assess the comparability of the HRQoL construct between both samples. Reference values were determined by percentile-based stratification according to factors that significantly influenced HRQoL in regression analyses. The QOLIBRI-KID/ADO demonstrated strong psychometric properties. The HRQoL construct was measured largely equivalently in both samples, and reference values could be provided. The QOLIBRI-KID/ADO was considered reliable and valid for assessing HRQoL in a general German-speaking pediatric population, allowing for clinically meaningful comparisons between general and TBI populations.

Identifying the Cerebral Physiologic Response to Aerobic Exercise Following Concussion: A Scoping Review.

The purpose of this study was to identify the cerebral physiologic response to aerobic exercise in individuals with a symptomatic concussion, highlighting available knowledge and knowledge gaps in the literature. A systematic scoping review was conducted and reported in keeping with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. A search of EMBASE, MEDLINE, SCOPUS, BIOSIS, and Cochrane libraries was conducted on June 15, 2023 (from database inception). An online systematic/scoping review management system was used to remove duplicates, and the remaining articles were screened for inclusion by 2 researchers. Inclusion criteria required articles to be original research published in peer-reviewed journals. Additionally, studies were required to have an aerobic exercise component, include a measure of cerebral physiology during a bout of aerobic exercise, exclude moderate and/or severe traumatic brain injury (TBI) populations, and be in the English language. Both human and animal studies were included, with participants of any age who were diagnosed with a mild TBI/concussion only (ie, Glasgow Coma Scale score ≥ 13). Studies could be of any design as long as a measure of cerebral physiologic response to a bout of aerobic exercise was included. The search resulted in 1773 articles to be screened and data from 3 eligible studies were extracted. There are currently too few studies investigating the cerebral physiologic response to aerobic exercise following concussion or mild TBI to draw definitive conclusions. Further research on this topic is necessary since understanding the cerebral physiologic response to aerobic exercise in the concussion and mild TBI populations could assist in optimizing exercise-based treatment prescription and identifying other targeted therapies.

Transcranial Photobiomodulation and Chronic Traumatic Brain Injury

Traumatic brain injury (TBI) is a common cause of neurologic morbidity for which few effective therapies exist, especially during the chronic stage. A potential therapy for chronic TBI is transcranial photobiomodulation (tPBM). tPBM is a noninvasive neuromodulation technique that uses light to stimulate the cortex and increase blood flow and metabolism while also enhancing cognition and improving affect. There has been much work focusing on the efficacy of tPBM in acute TBI in small animals, but much less work has focused on chronic TBI. Patients with chronic TBI manifest microvascular injury, which may serve as a modifiable treatment target for tPBM. There is a need to study and improve tPBM, as the currently implemented protocols targeting microvascular injury have been relatively unsuccessful. This review includes 16 studies, which concluded that after tPBM application, there were improvements in neuropsychological outcomes in addition to increases in cerebral blood flow. However, these conclusions are confounded by differing tPBM parameters, small sample sizes, and heterogenous TBI populations. While these results are encouraging, there is a need to further understand the therapeutic potential of tPBM in chronic TBI.

Edema progression in proximity to traumatic microbleeds: Evolution of cytotoxic and vasogenic edema on serial MRI

IntroductionAlthough cerebral edema is common following traumatic brain injury (TBI), its formation and progression are poorly understood. This is especially true for the mild TBI population, who rarely undergo magnetic resonance imaging (MRI) studies, which can pick up subtle structural details not visualized on computed tomography, in the first few days after injury. This study aimed to visually classify and quantitatively measure edema progression in relation to traumatic microbleeds (TMBs) in a cohort of primarily mild TBI patients up to 30 days after injury. Researchers hypothesized that hypointense lesions on Apparent Diffusion Coefficient (ADC) detected acutely after injury would evolve into hyperintense Fluid Attenuated Inversion Recover (FLAIR) lesions. MethodsThis study analyzed the progression of cerebral edema after acute injury using multimodal MRI to classify TMBs as potential edema-related biomarkers. ADC and FLAIR MRI were utilized for edema classification at three different timepoints: ≤48 h, ∼1 week, and 30 days after injury. Hypointense lesions on ADC (ADC+) suggested the presence of cytotoxic edema while hyperintense lesions on FLAIR (FLAIR+) suggested vasogenic edema. Signal intensity Ratio (SIR) calculations were made using ADC and FLAIR to quantitatively confirm edema progression. ResultsOur results indicated the presence of ADC+ lesions ≤48 h and ∼1 week were associated with FLAIR + lesions at ∼1 week and 30 days, respectively, suggesting some progression of cytotoxic edema to vasogenic edema over time. Ten out of 15 FLAIR + lesions at 30 days (67%) were ADC+ ≤48 h. However, ADC + lesions ≤48 h were not associated with FLAIR + lesions at 30 days; 10 out of 25 (40%) ADC + lesions ≤48 h were FLAIR + at 30 days, which could indicate that some lesions resolved or were not visualized due to associated atrophy or tissue necrosis. Quantitative analysis confirmed the visual progression of some TMB lesions from ADC + to FLAIR+. FLAIR SIRs at ∼1 week were significantly higher when lesions were ADC+ ≤48 h (1.22 [1.08–1.32] vs 1.03 [0.97–1.11], p = 0.002). ConclusionAwareness of how cerebral edema can evolve in proximity to TMBs acutely after injury may facilitate identification and monitoring of patients with traumatic cerebrovascular injury and assist in development of novel therapeutic strategies.

Incidence and Risk Model of Post-Traumatic Hydrocephalus in Patients with Traumatic Brain Injury

ObjectivePost traumatic hydrocephalus (PTH) is a complication following traumatic brain injury (TBI). Early diagnosis and treatment are essential to improving outcomes. We report the incidence and risk factors of PTH in a large TBI population while considering death as a competing risk. MethodsWe conducted a retrospective cohort study on consecutive TBI patients with radiographic intracranial abnormalities admitted to our academic medical center from 2009 to 2015. We assessed patient demographics, perioperative data, and in-hospital data as risk factors for PTH using survival analysis with death as a competing risk. ResultsAmong 7,473 patients, the overall incidence of PTH requiring shunt surgery was 0.94%. The adjusted cumulative incidence was 0.99%. The all-cause cumulative hazard for death was 32.6%, which was considered a competing risk during analysis. Craniectomy (HR 11.53, p<0.001, 95% CI 5.57-223.85), venous sinus injury (HR 4.13, p=0.01, 95% CI 1.53-11.16), and age ≤5 (p<0.001) were significant risk factors for PTH. Glasgow Coma Score (GCS) >13 was protective against shunt placement (HR 0.50, p=0.04, 95% CI 0.26-0.97). Shunt surgery occurred after hospital discharge in 60% of patients. ConclusionsWe describe the incidence and risk factors for PTH in a large TBI population. Most cases of PTH were diagnosed after hospital discharge, suggesting that close follow-up and multi-disciplinary diagnostic vigilance for PTH are needed to prevent morbidity and disability.

Exercise as a behavioral approach to improve mood in persons with traumatic brain injury.

Mood disturbance is a common, long-term, negative consequence of traumatic brain injury (TBI) that is insufficiently addressed by most traditional treatment modalities. A large body of evidence supports the efficacy of exercise training (ET) to broadly improve mood, as measured most often by the Profile of Mood States (POMS). However, this behavioral approach is not used nearly enough in the TBI population, and when it is, mood is rarely measured. This scoping review will evaluate the use of POMS as a mood measure in TBI research and to establish a rationale for using ET as a behavioral approach to broadly improve mood in persons with TBI.

Digital participation in traumatic brain injury: scoping review about assessment tools for computer-mediated communication

BackgroundIndividuals with chronic traumatic brain injury (TBI) are often affected by communication disorders which might have an impact on their social participation. Due to possible cognitive and communicative disabilities, as well as impairments of social cognitive skills, individuals with TBI have been observed to exhibit difficulties in maintaining and establishing social relationships, resulting in a greater risk of social isolation. This applies to both in-person as well as computer-mediated communication (CMC), which is considered an integral part of everyday life. Research on digital participation in the TBI population has focused on the possible challenges and barriers, but also on the benefits of CMC for social interactions. Guidelines from professional societies recommend questionnaires and checklists for assessing restrictions of communicative participation (e.g., ASHA, INCOG). However, there is no overview of whether the available instruments can capture digital aspects of participation or social media use in TBI.AimIn this scoping review, following the PRISMA criteria, we aimed to provide an overview over currently available instruments that help assess CMC use as a measure of digital participation in the TBI population.MethodThe databases Web of Science Core Collection, Ovid, PsycInfo and Psyndex were screened for publications between the years 2013 and 2023 with relevant search terms referring to social participation, assessment tools, CMC and the target group, in order to find suitable tools to assess digital participation in individuals with TBI. In a multistage selection process following the PRISMA criteria, the instruments found were examined in terms of items that assess digital participation. The outcome of the review is an overview of the status quo of potentially available instruments that capture aspects of CMC.ResultsFollowing a screening on title/abstract and full-text level, a total of 10 studies could be identified that present assessment tools that evaluate CMC use as a measure of digital participation in the TBI population. Said studies were analyzed and compared in terms of content according to the selected parameters.ConclusionDigital participation is an important aspect of everyday lives for individuals with TBI. Therefore, CMC should be an integral part of rehabilitation. The existing appropriate questionnaires uncovered in the current study should therefore be applied routinely to detect impairments in CMC and digital participation. Overall, however, there is still a great need for research in the field of CMC, both regarding methods for measuring digital participation disorders as well as resources.Systematic Review Registrationhttps://www.germanistik.uni-muenchen.de/forschung/proj_gl/review_participation_tbi.pdf.

Fitness-to-drive after adult civilian traumatic brain injury: protocol for a systematic review and meta-analysis.

Traumatic brain injury (TBI) poses significant challenges for assessing fitness-to-drive (FTD) and determining the appropriate timing for return-to-driving (RTD) in civilian adults. This systematic review and meta-analysis protocol is designed to offer a comprehensive assessment of RTD timelines post-TBI, examining the effects of injury severity as well as demographic and clinical factors that influence driving capabilities. In response to gaps identified in previous literature-namely, the absence of recent systematic search strategies and thorough quality assessments-this study employs rigorous methodologies for literature search, data extraction, and evaluation of study quality. Our approach aims to provide reliable estimates and detailed analyses of subgroups within the TBI population. The findings aim to support clinical decision-making, inform RTD readiness, and potentially impact policy and driving assessment protocols. Ultimately, this review seeks to contribute to public safety measures, reduce traffic-related harm, and improve life outcomes for individuals recovering from TBI, thereby filling a vital research niche in neurotrauma rehabilitation.

Addressing caregiver needs of brain injury survivors through telehealth: A pilot qualitative study

AbstractObjectiveThis study sought to identify effective means for delivering services to address the unique needs of caregivers for traumatic brain injury (TBI) survivors.BackgroundCaregivers for TBI survivors face unique and intense challenges, including deep isolation. When these caregivers fail to thrive, the entire family system suffers.MethodEmploying a pilot study utilizing qualitative methods, we explored the effectiveness of an intervention piloting telehealth counseling to address some of the unique caregiving challenges for the TBI survivor's caregiver. We conducted two focus groups of four participants to obtain qualitative data.ResultsQualitative analysis identified key themes: isolation, boundary issues, challenges of therapy, and the benefits of telehealth counseling.ConclusionsResults indicate an improvement in overall functioning of caregivers when accessing telehealth services.ImplicationsOn a micro level, results demonstrate that telehealth services can help TBI caregivers prevent boundary enmeshment. On a macro level, results have implications for increased investment and resources for those who serve the TBI population through an online format as well as proposed best practices for the method of service delivery.

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.

74 Construct Validity for the Automatized Sequencing Test (AST) in Hispanic/Latino and Bilingual Youth

Objective:Adequate effort by examinees during neurocognitive testing is a prerequisite to valid interpretation of test results. Utilizing performance validity tests (PVTs) is strongly recommended within pediatric mild Traumatic Brain Injury (mTBI) populations. PVTs have historically been created based on majority-white and monolingual groups; investigating their validity in additional patient populations remains essential. The Automatized Sequencing Task (AST) was developed as a brief validity measure within mTBI youth (Kirkwood, et.al., 2014). This study aimed to examine the clinical utility of the AST among youth identifying as Hispanic/Latino and/or bilingual within a mTBI clinical sample.Participants and Methods:Participants ages 8-17 (N=103, M age=14.08, SD=2.2, 51.5% male, 42.7% Hispanic/Latino, 23.6% bilingual) were drawn from an outpatient mTBI/concussion program within the past 2.6 years. Median time of evaluation since injury was 3.7 weeks. Eligibility criteria included: 1) evaluated for a mTBI (GCS . 13) and 2) 8 through 17 years of age. Language status included English only and English-Spanish bilingual youth. Of the bilingual youth, 95% were considered English dominant. Youth were timed while reciting four well-learned (i.e., automatized) sequences as rapidly as possible: 1) the alphabet, 2) counting from 1-20, 3) the days of the week, and 4) the months of the year. Pass rates for the AST were examined using chi-square tests to compare performance based on ethnic/cultural identity (Hispanic vs Non-Hispanic), language status, age (children 8-12; teens 13-17), and gender.Results:In the clinical sample, 11.7% (n=12) could not complete AST months; 75% of non-completers were Hispanic/Latino. Participants who identified as Hispanic/Latino compared to Non-Hispanic/Latino participants were significantly more likely to fail the 4-item AST, χ2(1) =4.3, p&lt;.05. The odds of failing the 4-item AST was 2.3 times higher if patients identified as Hispanic/Latino. Further, patients identifying as bilingual were even more likely to fail the 4-item AST, χ2(1) =4.5, p&lt;.05. The odds of failing the 4-item AST was 3.0 times higher if patients were bilingual. There were no ethnicity or bilingual group differences in AST failure when examining performance on the 3-item AST. Neither age nor gender were a significant predictor of failure on the 3-item or 4-item AST.Conclusions:Results suggest that the month item on the AST does not function consistently across Hispanic/Latino and bilingual youth. It cannot be presumed to be ‘automatic’ as a significant number of Hispanic/Latino and/or bilingual patients were unable to complete the month item, but with otherwise intact performance on the first three items. Administering only the first three items on the AST appears to be a more culturally sensitive alternative given the increased odds of 4-item failure in Hispanic/Latino and bilingual youth. Additional research is needed to explore the predictive validity of the AST as a PVT in varying ethnic, culturally, linguistically, and socioeconomically diverse mTBI pediatric populations.

Utility of the material community deprivation index as a metric to identify at-risk children for severe traumatic brain injury

OBJECTIVE Pediatric traumatic brain injury (TBI) is a significant cause of morbidity and mortality with lasting effects including neurological deficits and psychological comorbidities. Recent studies have shown that social determinants of health are key factors that impact clinical outcomes in other pediatric traumatic injuries, suggesting that these health disparities may have a significant impact on patients sustaining TBI as well. The purpose of this study was to retrospectively review a cohort of pediatric patients diagnosed with TBI and elucidate the relationships among socioeconomic deprivation, patient-specific demographics, and morbidity and mortality. METHODS The authors conducted a retrospective cross-sectional analysis of pediatric patients (≤ 18 years of age) treated for TBI at a level I pediatric trauma center between 2016 and 2020. Patients with concussion-related injuries without intracranial findings and those with nonaccidental trauma were excluded from the study. In addition to evaluating basic patient demographics, the authors geocoded patient addresses to allow identification of the patient’s home census tract using the material community deprivation index (MCDI). The MCDI is a unique composite index score created by the combination of six census variables and ranges from 0 to 1 in severity. RESULTS Of the 513 patients included in this study, 71 (13.8%) were diagnosed with severe TBI, 28 (5.5%) with moderate TBI, and 414 (80.7%) with mild TBI. Patients in quartile 4 (MCDI ≥ 0.45) were at a significantly higher risk of having a severe TBI than patients in quartile 1 (OR 2.29, 95% CI 1.1–4.71; p = 0.02). Black patients were more likely to have a firearm-related TBI (OR 3.74, 95% CI 2.01–8.7; p = 0.018) than non-Black patients. Patients who lived in a neighborhood with a lower MCDI were significantly more likely to be discharged home than those who lived in an area with a higher MCDI (OR 2.78, 95% CI 7.90–32.93; p &lt; 0.001). CONCLUSIONS This study demonstrated that inequities continue to exist within the pediatric TBI population and that the MCDI is a valuable tool to identify at-risk subpopulations. More specifically, patients who lived in a neighborhood with a higher MCDI were at higher risk of sustaining a severe TBI. By partnering with communities, families, and policymakers, healthcare providers could serve as advocates for these patients and work to minimize the social disparities that continue to exist.

Modified Brain Injury Guidelines for preinjury anticoagulation in traumatic brain injury: An opportunity to reduce health care resource utilization.

The Brain Injury Guidelines (BIG) stratify patients by traumatic brain injury (TBI) severity to provide management recommendations to reduce health care resource burden but mandates that patients on anticoagulation (AC) are allocated to the most severe tertile (BIG 3). We sought to analyze TBI patients on AC therapy using a modified BIG model to determine if this population can offer further opportunity for safe reductions in health care resource utilization. Patients 55 years or older on AC with traumatic intracranial hemorrhage (ICH) from two centers were retrospectively stratified into BIG 1 to 3 risk groups using modified BIG criteria excluding AC as a criterion. Intracranial hemorrhage progression, neurosurgical intervention (NSI), death, and worsened discharge status were compared. A total of 221 patients were included, with 23%, 29%, and 48% classified as BIG 1, BIG 2, and BIG 3, respectively. The BIG 3 cohort had a higher rate of AC reversal agents administered (66%) compared with the BIG 1 (40%) and BIG 2 (54%) cohorts ( p < 0.01), as well as ICH progression discovered on repeat head computed tomography (56% vs. 38% vs. 26%, respectively; p < 0.001). No patients in the BIG 1 and 2 cohorts required NSI. No patients in BIG 1 and 3% of patients in BIG 2 died secondary to the ICH. In the BIG 3 cohort, 16% of patients required NSI and 26% died. Brain Injury Guidelines 3 patients had 15 times the odds of mortality compared with BIG 1 patients ( p < 0.01). The AC population had higher rates of ICH progression than the BIG literature, but this did not lead to more NSI or mortality in the lower tertiles of our modified BIG protocol. If the modified BIG used the original tertile management on our population, then NS consultation may have been reduced by up to 52%. These modified criteria may be a safe opportunity for further health care resource and cost savings in the TBI population. Prognostic and Epidemiological; Level IV.

O069 Links between sleep outcomes and lifestyle factors in young adults who sustained traumatic brain injury in childhood

Abstract Objective We investigated the relationships between subjective and objective sleep and lifestyle factors (i.e., nap duration, screentime, chronotype, use of tobacco, alcohol, caffeine, and medications) in young adults who sustained traumatic brain injury (TBI) in childhood. Methods We report cross-sectional data collected at 20 years post-childhood TBI, as part of a prospective study. Participants included 54 young adults with TBI (Mean age, 27.7years) who were assessed at 20 years postinjury (mild (n = 14), moderate (n = 27), and severe (n = 13) TBI) and 13 healthy controls (Mean age, 26.0 years). The Pittsburgh Sleep Quality Index and actigraphy were used to assess sleep outcomes, and lifestyle factors were assessed with study-designed measures. Results Results showed that poor subjective sleep quality was significantly associated with evening chronotype (p &amp;lt; 0.001) and tobacco use (p &amp;lt; 0.001), while being a parent (p = 0.038) and alcohol use (p = 0.035) were significantly associated with poorer objective sleep efficiency in the TBI group. Discussion These preliminary findings highlight interesting associations between poor sleep quality and lifestyle factors in young adults who sustained TBI in childhood, and indicate the need to further explore these relationships in this TBI population to inform on potential avenues for sleep interventions.

Towards efficient, ecological assessment of interaction: A scoping review of co-constructed communication.

The complexity of communication presents challenges for clinical assessment, outcome measurement and intervention for people with acquired brain injury. For the purposes of assessment or treatment, this complexity is usually managed by isolating specific linguistic functions or speech acts from the interactional context. Separating linguistic functions from their interactional context can lead to discourse being viewed as a static entity comprised of discrete features, rather than as a dynamic process of co-constructing meaning. The ecological validity of discourse assessments which rely on the deconstruction of linguistic functions is unclear. Previous studies have reported assessment tasks that preserve some of the dialogic features of communication, but as yet, these tasks have not been identified as a distinct genre of assessment. We suggest the term 'co-constructed communication' to describe tasks which are specifically designed to capture the dynamic, jointly produced nature of communication within a replicable assessment task. To identify and summarize how co-constructed communication has been assessed with individuals with non-progressive acquired communication disability regarding task design, measures and psychometric robustness. A scoping review methodology was used to identity relevant studies. Systematic database searches were conducted on studies published before July 2021. Studies in the yield were assessed against eligibility criteria, with 37 studies identified as eligible for inclusion. This is the first time that co-constructed communication has been defined as a genre of discourse assessment for stroke and traumatic brain injury populations. Co-constructed communication has been assessed for 144 individuals with aphasia and 111 with cognitive-communication disability. Five categories of co-constructed communication tasks were identified, ranging in complexity. Variability exists in how these assessment tasks are labelled and measured. Assessment measures require further psychometric profiling, specifically regarding test-retest reliability and validity. Co-constructed communication is a discourse genre which offers researchers and clinicians a replicable method to assess language and communication in an experimentally rigorous way, within an ecologically valid context, bridging the gap between experimental and ecological assessment approaches. What is already known on this subject Standardized assessments of language skills and monologue offer reliable, replicable ways to measure language. However, isolating language from an interactional context fundamentally changes the behaviour under study. This raises questions about the ecological validity of the measures we routinely use to determine diagnoses, guide treatment planning and measure the success of treatment. What this study adds to the existing knowledge This review highlights studies that conceptualize, and often quantify, interaction by combining experimental rigour and aspects of everyday dialogue. This is the first time this genre of discourse assessment has been identified. We propose the term 'co-constructed communication' to describe this genre and provide an operational definition for the term. What are the practical and clinical implications of this study? Co-constructed communication assessment tasks require refinement, particularly regarding aspects of psychometric robustness. In the future, these tasks offer pragmatic, meaningful ways to capture the effect and impact of aphasia and cognitive-communication disability within interaction.