[Show abstract][Hide abstract] ABSTRACT: Correspondence of three core Trauma Symptom Inventory (TSI) posttraumatic stress disorder (PTSD) scales (Intrusive Experiences, Defensive Avoidance, and Anxious Arousal) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV) PTSD module were examined among 72 veterans with traumatic brain injury (TBI), PTSD, or both conditions. Subjects were classified into PTSD only, TBI only, or co-occurring PTSD and TBI groups based on TBI assessment and SCID-IV PTSD diagnosis. Linear regression was used to model TSI T-Scores as a function of group. Scores on all three scales significantly differed between the TBI and PTSD groups (PTSD only and co-occurring PTSD and TBI) in the expected direction. Study findings indicate that despite the potential overlap of symptoms between PTSD and TBI, the TSI appears to be a useful measure of trauma-related symptoms in veterans who may also have a TBI, particularly mild TBI. Limitations and areas for future research are discussed.
Military medicine 10/2009; 174(10):1005-9. DOI:10.7205/MILMED-D-00-9509 · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Seventy-two veterans with traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), or both participated in assessment procedures to evaluate between group differences. Half the sample was randomly selected for magnetic resonance imaging (MRI). Neurologic examinations were conducted using the Neurologic Rating Scale (NRS). Neuropsychological measures included the Paced Auditory Serial Addition Test (PASAT), Rey Auditory Verbal Learning Test (RAVLT), Conners' Continuous Performance Test II (CPT II), and Halstead Impairment Index (HII) including the Booklet Category Test (BCT). Data were analyzed using linear regression. Participants with moderate/ severe TBI were significantly more likely to have trauma-related imaging findings, and more severe TBI predicted lower scores on the NRS. No significant between-group differences were identified on the HII, PASAT, RAVLT, or CPT II. TBI group performance was significantly better on the BCT. More severe TBI predicted abnormal imaging findings and lower NRS scores. Hypothesized between-group differences on neuropsychological measures were not supported.
Military medicine 05/2009; 174(4):347-52. DOI:10.7205/MILMED-D-01-5808 · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our objective was to examine the Beck Depression Inventory-II (BDI-II) in a traumatic brain injury (TBI) sample using a receiver operating characteristic (ROC) curve to determine how well the BDI-II identifies depression. An ROC curve allows for analysis of the sensitivity and specificity of a diagnostic test using various cutoff points to determine the number of true positives, true negatives, false positives, and false negatives.
This was a secondary analysis of data gathered from an observational study. We examined BDI-II scores in a sample of 52 veterans with remote histories of TBI.
This study was completed at a Veterans Affairs (VA) Medical Center.
Participants were veterans eligible to receive VA health care services.
Outcome measures included the BDI-II and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV).
We generated an ROC curve to determine how well the BDI-II identifies depression using the SCID-IV as the criterion standard for diagnosing depression, defined here as a diagnosis of major depressive disorder. Results indicated a cutoff score of at least 19 if one has a mild TBI or at least 35 if one has a moderate or severe TBI. These scores maximize sensitivity (87%) and specificity (79%).
Clinicians working with persons with TBI can use the BDI-II to determine whether depressive symptoms warrant further assessment.
Archives of physical medicine and rehabilitation 05/2009; 90(4):652-6. DOI:10.1016/j.apmr.2008.10.028 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the incidence of ligamentous knee injuries in patients with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle collisions (PVMVC), to identify associated risk factors, and to compare rehabilitation outcomes and costs in TBI patients with and without ligamentous knee injury.
Retrospective, case control.
An academic rehabilitation hospital with a large metropolitan referral base.
Twenty-three consecutive adolescent and adult subjects admitted for acute inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996.
Five subjects (22%) were found to have a ligamentous knee injury, one with bilateral injuries. Two of these six injuries were diagnosed only after presentation to the rehabilitation setting. The most common injury was an anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial collateral ligament injury was identified in 4 of 6 injured knees. The risk of ligamentous knee injury was most closely associated with the presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no statistical difference between groups with and without ligamentous knee injuries with respect to age, gender, inpatient acute or rehabilitation length of stay, admission, discharge, or change in motor Functional Independence Measure (FIM) interval measures, or rehabilitation costs. Four of the 5 patients with ligamentous knee injuries were successfully managed nonoperatively. A case illustrating longitudinal management is presented.
TBI and ligamentous knee injuries, in particular ACL injuries, are common comorbidities after PVMVC. Physicians must maintain a high index of suspicion for ligamentous knee injuries in this population, particularly when a tibial plateau fracture is present. TBI patients with and without ligamentous knee injuries can have comparable functional outcomes when the ligament injuries are identified and appropriately managed, without incurring undue cost or length of inpatient rehabilitation.
Archives of Physical Medicine and Rehabilitation 07/1998; 79(7):805-10. DOI:10.1016/S0003-9993(98)90360-4 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Concussion in sports has caught the attention of the news media in recent years, primarily due to the high profile of certain athletes who have sustained traumatic brain injuries. Even though the management of concussion remains somewhat controversial, certain principles of neuroscience regarding mental status alterations and other symptoms resulting from concussion are well accepted by medical experts. Several authors have previously published management strategies for sports-related concussion based on their own experiences, but this article will describe the formal process of developing guidelines for the diagnosis and management of concussion in sports. The processes of literature review, evidence-based analysis, and consensus building are described. This article includes the grading scale, sideline evaluation, and management strategy adopted as a practice parameter by the American Academy of Neurology. Emphasis is placed on the need to detect mild forms of concussion through detailed observation and examination of athletes.
Journal of Head Trauma Rehabilitation 04/1998; 13(2):53-65. DOI:10.1097/00001199-199804000-00008 · 2.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Aspen Neurobehnvioml Conference was convened as a venue to consider interactions of mind and brain with regard to health and disease. The primary purpose of the conference was to provide a forum for discussion and scientific collaboration, particularly in areas marked by uncertainty and controversy, with eventual dissemination of conclusions. One of the selected topics for the inaugural session of the conference concerned the development of guidelines for evaluation and management of the vegetative and minimally conscious states. The purpose of this article is to acquaint neurorehabilitation specialists with the unique approach to consensus-based guideline development utilized at the Aspen Conference and to summarize the proceedings of the Aspen Workgroup on the Vegetative and Minimally Conscious States conducted since 1994
(C) Williams & Wilkins 1997. All Rights Reserved.
Journal of Head Trauma Rehabilitation 07/1997; 12(4). DOI:10.1097/00001199-199708000-00008 · 2.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neuroleptic medications are prescribed to millions of patients, but their use is limited by potentially irreversible extrapyramidal side effects. Haloperidol shows striking structural similarities to the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, which produces parkinsonism apparently through inhibition of NADH:ubiquinone oxidoreductase (complex I) of the mitochondrial electron transport chain. We now report that haloperidol, chlorpromazine, and thiothixene inhibit complex I in vitro in rat brain mitochondria. Clozapine, an atypical antipsychotic reported to have little or no extrapyramidal toxicity, also inhibits complex I, but at a significantly higher concentration. Neuroleptic treated patients have significant depression of platelet complex I activity similar to that seen in idiopathic Parkinson's disease. Complex I inhibition may be associated with the extrapyramidal side effects of these drugs.
Annals of Neurology 05/1993; 33(5):512-7. DOI:10.1002/ana.410330516 · 9.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.
JAMA The Journal of the American Medical Association 12/1991; 266(20):2867-9. DOI:10.1001/jama.1991.03470200079039 · 35.29 Impact Factor