Brain Injury (Brain Inj )

Publisher: International Association for the Study of Traumatic Brain Injury; European Brain Injury Society, Taylor & Francis


This journal covers all aspects of brain injury from basic science, neurological techniques and outcomes to vocational aspects, with studies of rehabilitation and outcome of both patients and their families. It addresses both adult and pediatric issues and it embraces issues such as family and peer relationships, effects of alcohol and drugs, communication problems and management techniques and creating new programs. Brain Injury uses case studies to illustrate different approaches to a subject, and provides a forum for the appraisal of theories which may influence future research. Brain Injury is the official journal of the International Brain Injury Association (IBIA) and the European Brain Injury Society (EBIS).

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  • Website
    Brain Injury website
  • Other titles
    Brain injury (Online), BI
  • ISSN
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  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Taylor & Francis

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    • Publisher will deposit to PMC on behalf of NIH authors.
    • STM: Science, Technology and Medicine
    • SSH: Social Science and Humanities
    • 'Taylor & Francis (Psychology Press)' is an imprint of 'Taylor & Francis'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary objective: A comparison between unitary and non-unitary views on minimal consciousness. Research design: First, unitary (all-or-none) and non-unitary (gradual or continuous) models of consciousness are defined as they have been developed in both philosophy and neurophysiology. Then, the implications of these ideas to the notion the minimally conscious state (MCS) are discussed. Methods and procedures: Review and analysis of theoretical conceptions and empirical data. Main outcome and results: Both kinds of models are compatible with the actual definitions of MCS. Although unitary views may seem to contradict the description of the MCS in ‘Neurology’ 2002, the apparent contradiction can easily be solved. Most recent data, particularly those obtained using fMRI and concerning learning, emotional responsiveness and pain and suffering, speak for non-unitary models. Conclusions: Most evidence speaks for non-unitary models of minimal consciousness. If these models are correct, patients with MCS may have, in addition to temporal fluctuations, a lower level of consciousness compared with fully conscious individuals. A still lower level could characterize patients diagnosed as unresponsive wakefulness syndrome (UWS). From this point of view, therefore, the difference between UWS and MCS is gradual rather than qualitative. However, due to methodological limitations of the available studies, the evidence for non-unitary models cannot be regarded as definite.
    Brain Injury 08/2014; 28(9).
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    ABSTRACT: Objectives: The objectives of this research were to investigate the equity of brain injury rehabilitation services to rural and remote areas of the state of New South Wales (NSW), Australia, and to describe the experience of people who access and who deliver these services. Methods: Semi-structured interviews were used to gather information from people with acquired brain injury (ABI), their families and rural and remote NSW health, rehabilitation and support services staff who worked with people with a brain injury. Data analysis was guided by an interpretative phenomenological analysis approach. Findings: Fifty-nine service providers representing 35 organizations, six people with ABI and seven family members participated in the research. Three key issues emerged from the data: (1) Limited access to appropriate brain injury rehabilitation; (2) Difficulties funding, recruiting and retaining appropriately skilled health, rehabilitation and support staff; and (3) Inadequate current services resulting in a number of unmet needs. Conclusion: Current models of practice for ABI rehabilitation are not appropriate to address the significant inequalities and gaps in available services for people with brain injury in rural and remote NSW. Alternative innovative models are needed to reduce the disparity of access and outcomes for these people.
    Brain Injury 08/2014;
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    ABSTRACT: Abstract Primary objective: Cerebral oedema is a common complication of traumatic brain injury (TBI). The use of Fluid-Attenuated Inversion Recovery (FLAIR) imaging in combination with Diffusion Weighted Imaging (DWI) has the potential to distinguish between cytotoxic and vasogenic oedema. This study hypothesized a significant relationship between cytotoxic lesion volume and outcome. Research design: This observational study reports on a convenience sample where MRI was obtained for clinical purposes. Methods and procedures: Clinical post-TBI FLAIR and DWI images were analysed. For this study, lesions were defined as primarily cytotoxic oedema if the ratio of FLAIR to DWI lesion volume was comparable, defined as a ratio <2. If the ratio of FLAIR to DWI lesion volume was ≥2, oedema was considered predominantly of vasogenic origin. Main outcomes and results: The sample consisted primarily of males with TBIs whose injury severity ranged from complicated mild to severe. Analysis revealed that both oedema types are common after TBI and both are associated with functional deficits 6 months after injury. Conclusions: Acute MRI may be useful to assess pathology at the tissue after traumatic brain injury. Clinical trials targeting cytotoxic and vasogenic mechanisms of oedema formation may benefit from using DWI and FLAIR MRI as a means to differentiate the predominant oedema type after TBI.
    Brain Injury 07/2014;
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    ABSTRACT: Abstract Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI). Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated. Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others. Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.
    Brain Injury 07/2014;
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    ABSTRACT: Abstract Purpose: This preliminary study explored differences between adults with and without traumatic brain injury (TBI) for speech processing accuracy, processing speed and effort in various conditions of interference. Methods: Ten adults with TBI and six adults without TBI participated. Speech processing was studied using sentence repetition in six listening conditions with different types of interference, including noise and two simultaneous talkers. Participants repeated sentences and rated effort. Participants also completed standardized tests of cognition, including working memory and processing speed measures. Results: Sentence repetition accuracy did not differ between groups. However, the TBI group demonstrated slower processing speed than the control group and also reported significantly greater effort in the two-talker condition. Faster processing speed was also correlated with higher accuracy in the two-talker condition. Conclusions: Results of this study show group similarities in repetition accuracy across listening conditions, but group differences in speed and effort. This preliminary finding, as well as the relationship between processing speed and repetition accuracy, suggests that it is only in the most complex listening conditions that the effects of brain injury may be detectable.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Background: Epidemiology of severe traumatic brain injury (TBI) is poorly defined in the Pacific region, including in New Caledonia. The aim of this study was to assess the incidence, causes and outcome of hospital-admitted severe TBI in the whole population of New Caledonia. Methods: A retrospective study on patients with severe TBI admitted to the only trauma centre during the 5-year period (2008-2012) was performed. The electronic patient register was searched for diagnoses of intracranial injuries to identify patients. Severe TBI was defined as a Glasgow Coma Scale Score ≤ 8 during the first 24 hours after injury. Results: The annual incidence ranged from 10/100 000 in 2010 to 15/100 000 in 2011. Road traffic accidents (n = 109; 71%), falls (n = 26; 17%) and assaults (n = 19; 12%) were causes of severe TBI. Young Melanesian adults (median age = 26 [19-36]) were the most affected. In ICU, the overall case-fatality rate was 25%. The mortality rate was the highest among victims of assaults (47%). Conclusions: The high incidence of hospital-admitted patients with severe TBI in this study combined with high in-ICU mortality rates supports the need for targeted public health action to prevent assaults and traffic road accidents in this vulnerable population.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Primary objective: To examine active inhibition of irrelevant stimuli and evaluate its neural basis using functional near infrared spectroscopy in patients with attention deficits after traumatic brain injury (TBI). Research design: Case control study. Methods and procedures: Ten patients with TBI and 10 healthy control subjects participated in this study. The Paced Auditory Serial Addition Test (PASAT) was performed with (distracting PASAT) and without (PASAT) distracting Japanese kana phonetic characters presented between each number. A block design was used. Subjects alternately performed each task three times. Main outcomes and results: Healthy controls performed better than patients with TBI on both the tasks. When performing the PASAT, healthy controls showed significant activity in every region of interest except the right lateral prefrontal cortex (PFC), but patients with TBI showed significant activity only in the left anterior PFC and left lateral PFC. When performing the distracting PASAT, the right lateral PFC was active in healthy controls, but not in patients with TBI. Conclusion: These results confirm that patients with moderate-to-severe TBI were affected by distractors that influenced order processing. It is suggested that the working memory of patients with TBI was affected by distracting stimuli, whereas that of healthy individuals was not.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Background: This study was undertaken to identify factors that influence follow-up for patients with mild traumatic brain injury (MTBI). Methods: One hundred and ninety-nine consecutive inpatients diagnosed with MTBI at a Trauma Centre (or TC) were monitored for establishment of care with a brain injury specialist after discharge. Bivariate statistics were calculated to determine subject characteristics impacting the decision to pursue TBI-related specialty care. Results: One hundred and nineteen patients (59.8%) followed up with the TC for routine post-injury care. Patients who followed up were older (age >40: OR = 2.48, p = 0.01, 95% CI = 1.03-8.96) and had longer hospital lengths of stay (LOS > 3 days: OR = 2.99, p < 0.001, 95% CI = 1.33-7.67). Upon follow-up, providers identified 20 patients (16.8%) with persistent neurologic symptoms, seven (3.5%) of whom saw a brain injury specialist. Lack of insurance significantly decreased the likelihood of follow-up with the TC and/or establishment of care with a TBI specialist. (OR = 0.76, p = 0.01, 95% CI = 0.62-0.95). Conclusions: Being insured was strongly predictive for follow-up at the TC and for establishing with a brain injury specialist post-MTBI. The TC post-injury visit identified MTBI patients with persistent symptoms, suggesting post-acute TC follow-up is an important venue for MTBI sequelae screening and referral.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Primary objective: To conduct a cross-cultural adaptation of Window to Hope (WtoH), a treatment to reduce hopelessness after traumatic brain injury (TBI), from the Australian civilian context to that of US Veterans. Research design: Three-stage mixed-methods approach. Methods: Stage 1: Consensus conference with stakeholders to revise the manual. Stage 2: Pilot study of the revised manual with US Veterans to examine acceptability, feasibility and fidelity. Stage 3: Review of results with consensus conference attendees and further revisions. Results: Stage 1: Conference attendees reached 100% consensus regarding changes made to the manual. Stage 2: Qualitative results yielded themes that suggest that participants benefitted from the intervention and that multiple factors contributed to successful implementation (Narrative Evaluation of Intervention Interview, User Feedback Survey-Modified, Post-Treatment Interviews). Therapists achieved 100% treatment fidelity. Quantitative results from the Client Satisfaction Questionnaire-8 suggest that the intervention was acceptable. Stage 3: The culturally adapted manual was finalized. Conclusions: Results of this study suggest that the revised WtoH manual is acceptable and feasible. US therapists exhibited adherence to the protocol. The three-stage methodology was successfully employed to cross-culturally adapt an intervention that is well-suited for a Phase II randomized controlled trial among US military Veterans.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Introduction: Physical activity is mandatory if patients are to remain healthy and independent after stroke. Objective: Maintenance of motor function, tone, grip strength, balance, mobility, gait, independence in personal and instrumental activities of daily living, health-related quality-of-life and an active lifestyle 4 years post-stroke. Methods: A prospective randomized controlled trial. Results: Four years post-stroke, 37 of the 75 participating persons were eligible for follow-up; 19 (54.3%) from the intensive exercise group and 18 (45%) from the regular exercise group. Both groups were performing equally well with no significant differences in total scores on the BI (p = 0.3), MAS (p = 0.4), BBS (p = 0.1), TUG (p = 0.08), 6MWT (p = 0.1), bilateral grip strength (affected hand, p = 0.8; non-affected hand, p = 0.9) nor in the items of NHP (p > 0.005). Independence in performing the IADL was 40%, while 60% had help from relatives or community-based services. Conclusion: This longitudinal study shows that persons with stroke in two groups with different exercise regimes during the first year after stroke did not differ in long-term outcomes. Both groups maintained function and had a relatively active life style 4 years after the acute incident. The results underline the importance of follow-up testing and encouragement to exercise, to motivate and sustain physical activity patterns, to maintain physical function, not only in the acute but also in the chronic phase of stroke.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Primary objective: To determine whether photosensitivity (PS) changes over time and, if so, what factors may be related to the change; furthermore, to determine whether tint density changes over time, all in mild traumatic brain injury (mTBI). Design and methods: A retrospective analysis of 62 patient records (aged 18-40 years) with mTBI and PS was conducted. All charts were obtained from the SUNY/College of Optometry clinics from 2004-2011. Results: Fifty per cent demonstrated reduced PS over time, with most occurring after year 1 post-injury (40%). Promotion of PS reduction appears to be associated with the lack of spectacle tint usage (p = 0.01) and the use of contact lenses (p = 0.03). Inhibition of PS reduction appears to be associated with tinted lenses (p = 0.06), hyperacusis (p = 0.03), dry eye (p = 0.04), migraines (p = 0.03) and loss of consciousness at the time of injury (p = 0.05). Concerning tint density changes over time, 71% (p = 0.002) maintained the same degree over time, while 27% (p = 0.002) reduced and 2% waxed and waned. Conclusion: Neural adaptation to PS appears to be a long-term process. Tint usage may act to inhibit this adaptive process, while the use of contact lenses may act to promote it. These findings may provide guidance in the clinical management of photosensitivity in the mTBI population.
    Brain Injury 06/2014;
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    ABSTRACT: Abstract Objectives: The aim of this pilot study was to identify the prevalence of traumatic brain injury (TBI) among undergraduate college students, compare common TBI symptoms reported by students with and without a history of TBI and explore how often students with and without TBI access campus services. Methods: A campus-wide email recruited participants to an online survey containing questions about their history of TBI, experience of TBI symptoms and use of services. Results: Of 201 undergraduates, 55.7% reported no history of TBI or hospitalization, 27.9% reported a history of hospitalization but not TBI and 16.4% reported a history of TBI. Significant differences were seen among groups in their experience of some physical and psychosocial symptoms such as dizziness and difficulty with relationships. Healthy and TBI groups reported significantly more symptoms than the hospitalized group, but did not differ from each other. Most participants reported using no services and there were no significant differences in the average number of symptoms experienced by those seeking vs not seeking services. Conclusions: A substantial proportion of undergraduates reported a history of TBI and the experience of symptoms that could negatively impact academic performance. Further study is needed to examine factors influencing their use of available services.
    Brain Injury 05/2014;
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    ABSTRACT: Abstract Background: Intraventricular fibrinolysis (IVF) through bilateral external ventricular drains (EVD) may provide better access of the thrombolytic agent to the intraventricular clot, potentially leading to faster clot clearance. Objective: To compare the feasibility and safety between single and bilateral EVD groups. Methods: Patients with spontaneous intraventricular haemorrhage (IVH) (Graeb score ≥ 5) were treated with IVF. The selection for placement of one or two EVDs was randomized. The average daily CSF drainage volume, the indwelling EVD time, the time for monitoring in intensive care unit (ICU), intracranial re-haemorrhage and intracranial infection, Glasgow coma score (GCS), Graeb score and the reserved IVH volume have been analysed for patients with one (group I, n = 22) or two EVDs (group II, n = 25). Results: Significant difference was found in the average daily CSF drainage volume between the two groups (85.2 (SD = 13.7) vs. 108.5 (15.9) ml). No difference was found in the indwelling EVD time, the time for monitoring in the ICU. Through repeated measurements of the variance analysis, the test for a difference in IVH volume over time was statistically significant (F = 466.981, p = 0.000) and the test for the interaction between treatment and time was also significant (F = 5.033, p = 0.002), indicating that the IVH volume decreased over time in both groups, with a sharper decrease in Group II. Intracranial re-haemorrhage and infection was not found in this study. Conclusion: The results provide some evidence to support the use of bilateral EVDs for IVF in patients with severe IVH.
    Brain Injury 05/2014;
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    ABSTRACT: Abstract Background: The goal was to compare epidemiology of hospital admissions for traumatic brain injury (TBI) in Austrian residents vs. visitors to Austria. Methods: Data on all hospital admissions due to TBI (ICD-10 codes S06.0-S06.9; years 2009-2011) was provided by the Austrian Statistical Office. Data on Austrian population and on tourism (visitor numbers, nights spent) was retrieved from . Age, sex, mechanism of injury, season and mortality was analysed for Austrian residents vs. visitors. Results: Visitors contributed 3.9% to the total population and 9.2% of all TBI cases. Incidence of hospital admissions was 292/100 000/year in Austrian residents and was 727/100 000/year in visitors. Male:female ratio was 1.39:1 in Austrian residents and 1.55:1 in visitors. Austrian cases were older than visitors' cases (mean age 41 vs. 28 years). Austrian cases were distributed evenly over the seasons, while 75% of the visitors' cases happened during winter and spring. The most frequently observed causes of TBI in Austrian residents were private accidents, while sports caused almost half of the visitors' cases. Hospital mortality was lower in visitors than in Austrian residents (0.8 vs. 2.1%). Conclusion: Sports-related TBI of visitors causes a significant workload for Austrian hospitals. Better prevention is warranted.
    Brain Injury 05/2014;
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    ABSTRACT: Abstract Background: Despite the involvement of cytokine production in neurotrauma, there is still controversy regarding cytokines levels and clinical outcome following severe traumatic brain injury (TBI). Objective: The present study was designed to investigate whether cytokine levels (of IL-1β, IL-6, IL-8, IL-10, IL-12p70 and TNF-α) are associated with primary outcome (death or survival) after severe TBI. Methods: This prospective study enrolled 24 male patients, victims of severe TBI. Venous blood samples were taken in the Intensive Care Unit (ICU) (study entry), 24 and 48 hours later. Plasma cytokine levels were assayed by flow cytometry. Results: Severe TBI was associated with a 42% mortality rate. TBI patients had a significant increase in the levels of all cytokines measured, except for IL-1β, compared to controls. Statistically significant increases in the IL-10, -8 and -6 levels were observed in the non-survivors TBI patients compared to the survivors sub-group measured in the first sample (study entry) and in the subsequent sample (24 hours later). There were no significant differences in IL-1β, TNF-α and IL-12p70 levels between survivors and non-survivors in any time sampled. Conclusions: The findings indicate that increased IL-10, -8 and -6 levels may constitute an early predictor of unfavourable outcome in severe TBI patients.
    Brain Injury 05/2014;
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    ABSTRACT: Abstarct Background: Post-operative volume of subdural fluid is considered to correlate with recurrence in chronic subdural haematoma (CSDH). Information on the applications of computer-assisted volumetric analysis in patients with CSDHs is lacking. Objective: To investigate the relationship between haematoma recurrence and longitudinal changes in subdural fluid volume using CT volumetric analysis. Methods: Fifty-four patients harbouring 64 CSDHs were studied prospectively. The association between recurrence rate and CT findings were investigated. Results: Eleven patients (20.4%) experienced post-operative recurrence. Higher pre-operative (over 120 ml) and/or pre-discharge subdural fluid volumes (over 22 ml) were significantly associated with recurrence; the probability of non-recurrence for values below these thresholds were 92.7% and 95.2%, respectively. CSDHs with larger pre-operative (over 15.1 mm) and/or residual (over 11.7 mm) widths also had significantly increased recurrence rates. Bilateral CSDHs were not found to be more likely to recur in this series. On receiver-operating characteristic curve, the areas under curve for the magnitude of changes in subdural fluid volume were greater than a single time-point measure of either width or volume of the subdural fluid cavity. Conclusions: Close imaging follow-up is important for CSDH patients for recurrence prediction. Using quantitative CT volumetric analysis, strong evidence was provided that changes in the residual fluid volume during the 'self-resolution' period can be used as significantly radiological predictors of recurrence.
    Brain Injury 05/2014;
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    ABSTRACT: Abstract Background: Endotoxin shock (ES) and its severe complications, such as brain injury, remain a handicap clinically. Therefore, it is a clinical significance of developing a new drug to treat brain damage induced by ES. Aim: The present study aimed to observe the protective effect of dexmedetomidine (Dex) on hippocampal formation in endotoxin-induced shock rats and explore its possible mechanism. Methods: High and low doses of Dex were tail intravenously administered slowly. After a 5-minute interval, lipopolysaccharide was tail intravenous injected slowly to establish the ES rats. Six hours after Dex administration, these rats were immediately sacrificed. Then, the brain water content was determined. NO amounts in homogenate, cerebrospinal fluid and serum were detected by Griess Reagent assay. nNOS mRNA in hippocampal formation was measured by RT-PCR and nNOS protein was determined by Western blotting and immunohistochemistry. Results: ES rats showed that cerebral water contents were significantly increased, NO concentrations in brain tissues, serum and cerebrospinal fluid were each obviously raised and meanwhile expressions of nNOS mRNA and its protein in hippocampal formation were notably augmented. Treatment of these rats with Dex evidently decreased cerebral water contents, NO concentrations and nNOS mRNA and its protein expressions. Conclusion: These results demonstrated that Dex exerted a brain protection on hippocampal formation through inhibition of the nNOS-NO signalling in ES rats and Dex may have a favourably therapeutic value in treating brain damage in patients with endotoxin shock.
    Brain Injury 04/2014;

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