Effects of music production on cortical plasticity within cognitive rehabilitation of patients with mild traumatic brain injury.

OBJECTIVE: We explored the effects of playing the piano on patients with cognitive impairment after mild traumatic brain injury (mTBI) and, addressed the question if this approach would stimulate neural networks in re-routing neural connections and link up cortical circuits that had been functional inhibited due to disruption of brain tissue. Functional neuroimaging scans (fMRI) and neuropsychological tests were performed pre-post intervention. METHOD: Three groups participated, one mTBI group (n = 7), two groups of healthy participants, one with music training (n = 11), one baseline group without music (n = 12). The music groups participated in 8 weeks music-supported intervention. RESULTS: The patient group revealed training-related neuroplasticity in the orbitofrontal cortex. fMRI results fit well with outcome from neuropsychological tests with significant enhancement of cognitive performance in the music groups. Ninety per cent of mTBI group returned to work post intervention. CONCLUSION: Here, for the first time, we demonstrated behavioural improvements and functional brain changes after 8 weeks of playing piano on patients with mTBI having attention, memory and social interaction problems. We present evidence for a causal relationship between musical training and reorganisation of neural networks promoting enhanced cognitive performance. These results add a novel music-supported intervention within rehabilitation of patients with cognitive deficits following mTBI.

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study.

OBJECTIVE: To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at-risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. DESIGN: Randomised controlled trial. PATIENTS: One hundred fifty-one patients, 16-56 years. METHODS: Multidisciplinary outpatient rehabilitation with individual contacts and a psycho-educational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after the multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient's impressions of change and psychological distress. RESULTS: Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p = 0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p = 0.041). No group differences were observed for disability (p = 0.193), patients impression of change (p = 0.285) or psychological distress (p = 0.716). CONCLUSION: The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms. Additional studies should focus on which factors exhibit a direct impact on return-to-work.

Missing a follow-up after mild traumatic brain injury--does it matter?

OBJECTIVE: This study sought to identify potential differing clinical characteristics between patients with a mild traumatic brain injury (MTBI) who attended a planned follow-up session and not. This study investigated whether clinical characteristics and attendance for a planned follow-up service 2-months after injury could be related to return-to-work (RTW) 1-year later. METHOD: Prospective cohort study of 343 patients with MTBI admitted consecutively to the Department of Neurosurgery in 2009-2011. Demographic and clinical data were obtained from the hospital files and data about sick leave from The Norwegian Labour and Welfare Service. Patients were categorized into two groups according to their attendance. RESULTS: One hundred and sixty-one (67%) patients attended (AG) and 80 (33%) did not (NAG) attend their follow-up appointments. The AG had significantly more frequently intracranial pathology on CT scan, had consumed less alcohol and were older. Logistic regression showed that follow-up attendance (OR = 16.89) and sick leave before injury (OR = 9.70) are unfavourably related to RTW at 12-months. Skull fracture and cause of injury had no influence of the outcome. CONCLUSION: Not attending the follow-up has a favourable outcome after MBTI, indicating that these patients have a reduced need for medical and rehabilitation support for their brain injury.

Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review.

OBJECTIVE: To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury. DATA SOURCE: We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies. DATA EXTRACTION: Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs. DATA SYNTHESIS: Four studies with a total number of 409 subjects, all with traumatic brain-associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low. CONCLUSIONS: No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation.

Predictors for Psychological Distress 2 Months After Mild Traumatic Brain Injury.

Objective: To predict psychological distress at 2 months for patients with mild traumatic brain injury. Method: A prospective cohort study of 162 patients with mild traumatic brain injury (MTBI) admitted consecutively to an outpatient clinic at Haukeland University Hospital, Norway. Demographic data were obtained from Statistics Norway and injury characteristics were obtained from the hospital records. Sick leave data from the last year before the injury were obtained from The Norwegian Labor and Welfare Service. Self-report questionnaires were used to obtain history about earlier disease and symptom profiles. The Hospital Anxiety and Depression Scale (HAD) detecting states of depression and anxiety were used as the dependent variable in a stepwise linear regression. Pre-injury factors and injury-related factors were examined as potential predictors for HAD. Results: In the first steps we observed a significant association between HAD at 2 months and education, whiplash associated disorder (WAD), and earlier sick listed with a psychiatric diagnosis. In the final step there was an association only between HAD and self-reported anxiety and WAD. There were no associations between HAD and injury-characteristics like severity at Glasgow Coma Scale or intracranial injury. Conclusion: Patients with low education, earlier psychiatric diagnosis, self-reported earlier anxiety and WAD were more likely to develop a psychological distress after a MTBI. These findings should be taken into consideration when treating patients with MTBI.

Predictors for Return to Work in Subjects with Mild Traumatic Brain Injury.

Objective. To predict return to work (RTW) at 12 months for patients who either were sick-listed or were at risk to be sick-listed with persistent postconcussion symptoms (PCS) at six to eight weeks after injury. Method. A prospective cohort study of 151 patients with mild traumatic brain injury (MTBI) admitted consecutively to outpatient clinics at two University Hospitals in Norway. The study was conducted as part of a randomised clinical trial. Injury characteristics were obtained from the medical records. Sick leave data from one year before to one year after MTBI were obtained from the Norwegian Labour and Welfare Service. Self-report questionnaires were used to obtain demographic and symptom profiles. Results. We observed a significant negative association between RTW at 12 months and psychological distress, global functioning, and being sick-listed at two months after MTBI, as well as having been sick-listed the last year before injury. Conclusion. Psychological distress, global functioning postinjury, and the sick leave trajectory of the subjects were negative predictors for RTW. These findings should be taken into consideration when evaluating future vocational rehabilitation models.