Traumatic Brain Injury: A Review of Practice Management and Recent Advances

Department of Physical Medicine and Rehabilitation, University of Missouri-Columbia, DC046.00, One Hospital Drive, Columbia, MO 65212, USA.
Physical Medicine and Rehabilitation Clinics of North America (Impact Factor: 0.93). 12/2007; 18(4):681-710, vi. DOI: 10.1016/j.pmr.2007.06.005
Source: PubMed


This review of traumatic brain injury encompasses its impact on society, pathophysiology, and rehabilitative management. Topics include mild traumatic brain injury, outcomes, prognosis, cognitive rehabilitation, behavioral management, and neurologic and medical complications. Emphasis is placed on clinically relevant topics that have had recent developments or have been historically difficult to treat. Neurologic complications discussed include seizure, balance, visual dysfunction, and spasticity. Medical complications discussed include neuroendocrine and pain issues.

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    • "Mild TBI is associated with a host of symptoms and signs: headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes (including posttraumatic stress disorder (PTSD) and depression ), and problems with memory, concentration, and attention (Chen and D'Esposito, 2010;Gerber and Schraa, 1995;Ghajar, 2000;Kushner, 1998;McAllister, 2011;McDowell et al., 1997). It is unknown why a percentage of mTBI individuals (~10–15% of adults, and up to 40% of children) (Crooks et al., 2007;Dikmen et al., 1986;McCrea et al., 2009;Thornhill et al., 2000) continue to manifest symptoms at the chronic stage. Conventional structural imaging scans are typically normal. "
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    ABSTRACT: We report on the results of a multimodal imaging study involving behavioral assessments, evoked and resting-state BOLD fMRI, and DTI in chronic mTBI subjects. We found that larger task-evoked BOLD activity in the MT+/LO region in extra-striate visual cortex correlated with mTBI and PTSD symptoms, especially light sensitivity. Moreover, higher FA values near the left optic radiation (OR) were associated with both light sensitivity and higher BOLD activity in the MT+/LO region. The MT+/LO region was localized as a region of abnormal functional connectivity with central white matter regions previously found to have abnormal physiological signals during visual eye movement tracking (Astafiev et al., 2015). We conclude that mTBI symptoms and light sensitivity may be related to excessive responsiveness of visual cortex to sensory stimuli. This abnormal sensitivity may be related to chronic remodeling of white matter visual pathways acutely injured.
    Full-text · Article · Jan 2016 · Clinical neuroimaging
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    • "Approximately 7.8 million persons live in Europe with some level of disability caused by TBI [1] [2]. Impairment, activity limitations and participation restrictions are ubiquitous and very important consequences of moderate and severe TBI [3] [4] [5]. "
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    ABSTRACT: To identify the most frequently used outcome measurement instruments reported in clinical studies on TBI and to provide a content comparison in the framework of the International Classification of Functioning, Disability and Health (ICF). A systematic literature review of clinical studies in TBI was performed using Medline, EMBASE and PsychINFO. The items of the measurement instruments present in more than 20% of the studies were linked to the ICF language. 193 papers fulfilled the eligibility criteria. The frequency analysis identified six instruments: Functional Independence Measure (50%), Glasgow Outcome Scale (34%), Disability Rating Scale (32%), Wechsler Adult Intelligence Scale (29%), Trail Making Test (26%) and Community Integration Questionnaire (22%). The analysed instruments focus on different aspects of body functions (especially DRS, WAIS and TMT) and aspects of activities and participation in life (especially CIQ and FIM). Inter-researcher agreement for the ICF linking process was 0.83. Translating the items of different measurement instruments into the ICF language provides a practical tool to facilitate content comparisons among different outcome measures. The comparison can assist clinical researchers to integrate information acquired from different studies and different tools.
    Full-text · Article · Jan 2012 · Clinical neurology and neurosurgery
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    • "Research should be strongly supported with a focus on rehabilitation programmes assessment, assessment of long-term community reintegration and outcomes in terms of activity and participation, as well as long-term outcome into adulthood, using specific and sensitive ecological outcome measures (Crooks et al. 2007; Engberg 2007). "
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    ABSTRACT: Acquired brain injury (ABI) is a leading cause of death and lifelong acquired disability in children and remains a significant public health issue. Deficits may only become fully apparent when developmental demands increase and once cognitive processes are expected to be fully developed. It is therefore necessary to provide organized long-term follow-up for children post ABI. Despite these recommendations, it has been shown that only a small proportion of children received specialized rehabilitation and adequate follow-up after ABI. The aims are: (i) to describe a comprehensive model of care devoted to children with acquired brain injuries; and (ii) to provide descriptive data analysing the characteristics of children followed up, the type/amount of services provided and general outcomes. PROGRAMME DESCRIPTION: The programme features an in- and outpatient rehabilitation facility, where multidisciplinary rehabilitation and specialized schooling are provided. The ultimate goal of the programme is to promote each child's successful reintegration in school and in the community. Adequate preparation of discharge is essential, long-term follow-up is organized, and an outreach programme has been developed to deal with the complex delayed psychosocial issues. Overall outcome, as measured by the Glasgow Outcome Scale, improved dramatically between admission (3.3; SD = 0.45) and discharge (2.15; SD = 0.74). Most of the children were discharged home with an adequate personalized plan for ongoing rehabilitation and school adaptations. Analysis of the outreach programme underlines the more challenging issues arising in late adolescence-early adulthood. Given the specificities of childhood ABI, long-term specific care must be organized and co-ordinated, regardless of injury severity.
    Preview · Article · Jun 2009 · Child Care Health and Development
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