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Available from: Keith D Cicerone, Jun 01, 2015
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    • "Importantly, higher scores on the NSI are indicative of more severe post-concussive symptomatology. The NSI total score represents the sum of severity ratings of 22 symptoms, and cluster scores (i.e., vestibular, somatic, cognitive , and affective) were derived per Merterko et al. (2012). Recently, Vanderploeg et al. (2015) validated the 4-factor model in military TBI populations. "
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    ABSTRACT: We investigated associations between DTI indices of three brainstem white matter tracts, traumatic brain injury (TBI) injury characteristics, and postconcussive symptomatology (PCS) in a well-characterized sample of veterans with history of mild to moderate TBI (mTBI). 58 military veterans (mTBI: n = 38, mean age = 33.2, mean time since injury = 90.9 months; military controls [MC]; n = 20; mean age = 29.4) were administered 3T DTI scans as well as a comprehensive neuropsychiatric evaluation including evaluation of TBI injury characteristics and PCS symptoms (e.g., negative mood, dizziness, balance and coordination difficulties). Tractography was employed by seeding ROIs along 3 brainstem white matter tracts (i.e., medial lemniscus-central tegmentum tract [ML-CTT]; corticospinal tracts [CST], and pontine tegmentum [PT]), and mean DTI values were derived from fractional anisotropic (FA) maps. Results showed that there were no significant difference in FA between the MC and TBI groups across the 3 regions of interest; however, among the TBI group, CST FA was significantly negatively associated with LOC duration. Additionally, lower FA of certain tracts-most especially the PT-was significantly associated with increased PCS symptoms (i.e., more severe vestibular symptoms, poorer physical functioning, and greater levels of fatigue), even after adjusting for PTSD symptoms. Our findings show that, in our sample of veterans with mTBI, tractography-based DTI indices of brainstem white matter tracts of interest are related to the presence and severity of PCS symptoms. Findings are promising as they show linkages between brainstem white matter integrity and injury severity (LOC), and they raise the possibility that the pontine tegmentum in particular may be a useful marker of PCS symptoms. Collectively, these data point to important neurobiological substrates of the chronic and complex constellation of symptoms following the 'signature injury' of our combat-exposed veterans.
    Brain Imaging and Behavior 08/2015; 9(3). DOI:10.1007/s11682-015-9432-2 · 4.60 Impact Factor
    • "The dependent measure for this study is a measure of postconcussion symptom complaints, the Neurobehavioral Symptom Inventory (NSI; Cicerone & Kalmar, 1995). The NSI is a 22-item postconcussive symptom questionnaire on which patients are asked to rate each symptom on a scale of 0–4 (None, Mild, Moderate, Severe, and Very Severe) with four different types of symptoms: affective, somatosensory, vestibular, and cognitive (Meterko et al., 2012). Higher scores indicate greater levels of postconcussive symptoms. "
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    ABSTRACT: The purpose of this study was to examine the relationship between postconcussion symptom complaint (PCS) severity and positive coping factors (knowledge, self-efficacy, and attributions) in a sample of individuals who have sustained a mild TBI, above and beyond the demographic and psychiatric predictors that have been most commonly examined. Ninety-one people with a history of reported mild TBI were surveyed. Hierarchical regression analyses revealed that demographic variables and psychiatric symptom severity predicted PCS severity. Consistent with our hypotheses, knowledge, self-efficacy, and attributions, when taken together, made an independent and significant contribution to prediction of PCS severity (21% of additional variance). The most potent factor was attribution, or the extent to which one attributes symptoms to mild TBI versus other causes. Those who attribute their symptoms to TBI are more likely to report greater symptom severity overall. Taken together, knowledge, self-efficacy, and attributions contribute independently to PCS severity. Additional research is needed to determine if these factors are amenable to intervention.
    The Clinical Neuropsychologist 03/2013; 27(3). DOI:10.1080/13854046.2013.774438 · 1.72 Impact Factor
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    ABSTRACT: The U.S. Veterans Health Administration established the Polytrauma System of Care (PSC) in response to the growing need for Traumatic Brain Injury (TBI) and polytrauma rehabilitation services for our returning war heroes. The unique and complex patterns of injuries sustained during the conflicts in Iraq and Afghanistan have resulted in significant physical, cognitive, and psychological impairments which require an extraordinary level of specialized training and skill provided by the PSC interdisciplinary team. The PSC offers a holistic, coordinated, and comprehensive continuum of polytrauma/brain injury rehabilitation. These services range from intensive inpatient rehabilitation to residential and outpatient programs designed to address all facets of combat injury. These services are available to Veterans and service members across the nation and have been involved in the direct care of tens of thousands of combat injured personnel. This article provides an overview of services and new initiatives created by the PSC to provide the best care for our Veterans and service members.
    09/2013; 1(3). DOI:10.1007/s40141-013-0023-0
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