Clinical Characteristics and Rehabilitation Results of Traumatic Brain Injury Patients Who Have Early Rehabilitation.

AIM: To examine the clinical characteristics and early rehabilitation results and to investigate the relationship between rehabilitation initiation time and rehabilitation-related outcome measurements in traumatic brain injury (TBI) patients who have early rehabilitation. MATERIAL AND METHODS: Forty-seven TBI patients who were referred for rehabilitation in the neurosurgery department were enrolled in the study retrospectively. Clinical characteristics and rehabilitation-related outcome measurements including consciousness, functional outcome, daily living activities, functional mobility, and ambulation of all patients were recorded. The paired samples t-test was used to compare data before and after rehabilitation. The relationship between rehabilitation initiation time and the other outcomes was analyzed with Pearson's correlation test. RESULTS: Most of the TBI patients were male (83%) and the severities of the trauma were mostly mild (42%). The causes of trauma were mostly falls (53%). Twenty-three (49%) of the patients underwent surgical intervention. The lengths of time between admission and consultation and between surgery and consultation were 19.82±17.9 and 14.24±15.4 days, respectively. The lengths of stay in intensive care and hospital were respectively 27.32±34.93 and 41.35±32.83 days. The rehabilitation time was 21.50±24.32 days. The before and after rehabilitation results showed that all rehabilitation-related outcome measurements improved significantly (p < 0.001). The relationship between rehabilitation initiation time and the other outcomes was statistically significant (p < 0.05). CONCLUSION: This was a descriptive study in terms of demonstrating the demographic and clinical characteristics of TBI patients who need rehabilitation in the neurosurgery department. Early rehabilitation can enhance the rehabilitation-related outcome including consciousness, functional outcome, daily living activities, functional mobility, and ambulation in TBI patients as soon as their medical condition is stable. Early rehabilitation initiation time is important for improving the rehabilitation-related outcomes.

The Effect of Riboflavin on Neurological Rehabilitation after Traumatic Brain Injury in Children.

BACKGROUND: Traumatic brain injury (TBI), which is the brain impairment and lesion caused by the external force injuring the head and the underlying brain, can cause pediatric death, disability, neurological disorders, and even lifelong disability. This study was to explore the effect of riboflavin (RF) on neurological rehabilitation and functional recovery after TBI. METHODS: The rat models of TBI were constructed by treating rats with controlled cortical impact (CCI). By treating TBI rats with RF, we investigated whether the administration of RF would affect the sensorimotor function and cognitive ability recovery through adhesive removal test, modified neurological severity score (mNSS), corner test, wire-grip test and the Morris water maze. The effects of RF on lesion volume and water content were investigated using hematoxylin and eosin (H&E) staining and wet-dry method. The Nissl staining and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) staining were used to demonstrate the effect of RF on neural apoptosis. Inflammation-related cytokines of interleukin (IL)-6, IL-1ß, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-ß1 were measured by enzyme-linked immunosorbent assay (ELISA) to evaluate the effect of RF on neuroinflammation. The impact of RF on oxidative stress was assessed by measuring malondialdehyde (MDA) content and superoxide dismutase (SOD) activity, and the platelet endothelial cell adhesion molecule-1 (CD31) staining for observing vessel density, the reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) for measuring vascular endothelial growth factor (VEGF) mRNA expression and western blot for VEGF protein expression were used for evaluated angiogenesis. RESULTS: The administration of RF could facilitate the recovery of neurological function by promoting the recovery of sensorimotor function and cognitive ability (p < 0.05). Furthermore, RF could reduce the lesion volume and water content after TBI and ameliorate neural apoptosis, neuroinflammation, and oxidative stress (p < 0.05). Finally, RF increased vessel density (p < 0.01) and VEGF levels (p < 0.01) in brain tissues after TBI, promoting angiogenesis. CONCLUSION: RF benefits neurological rehabilitation after TBI by promoting neurological function recovery, ameliorating the pathogenesis after TBI, and facilitating brain vascular remodeling. These findings provide a novel mechanism for RF treating pediatric TBI.

VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey.

Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.

Effect of Post-traumatic Amnesia Duration on Traumatic Brain Injury (TBI) First Year Hospital Costs: A Veterans Affairs Traumatic Brain Injury Model Systems Study.

OBJECTIVE: To examine the association between severity of traumatic brain injury (TBI) as measured by duration of post-traumatic amnesia (PTA) and first year hospitalization costs for service members and veterans (SMVs) treated for TBI at Polytrauma Rehabilitation Centers (PRCs) within the Veterans Health Administration (VHA). DESIGN: Multivariable models of merged datasets from the VA TBI Model Systems (VA TBIMS) national database containing TBI clinical characterization including PTA with VHA hospital cost data. SETTING: Five VA PRCs. PARTICIPANTS: VA TBIMS participants with known PTA who received inpatient rehabilitation within 1 year of their TBI at any of 5 PRCs between 2010 and 2020 (N=717). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Total, acute care, rehabilitation, intensive care unit (ICU), and surgery costs across all VA hospitals. RESULTS: A total of 717 SMVs (mean age 36.9 years, 94.1% men, 76.8% non-Hispanic White, 7.8% active duty) met inclusion criteria for the unadjusted analyses. Unadjusted mean total hospital costs in the first-year post TBI were approximately $201,214 higher for those with PTA duration ≥24 hours ($351,157) than PTA <24 hours ($149,943). In adjusted models (n=583), each additional day of PTA duration incrementally increased total ($1453), rehabilitation ($1324), ICU ($78), and surgery ($39) costs. Other significant covariates included age, acute care length of stay, Disability Rating Scale on rehabilitation admission, penetrating violent cause of injury, and drug abuse. CONCLUSIONS: This study demonstrates that PTA as a quantitative measure of TBI severity significantly affects first-year hospitalization costs of SMVs treated at PRCs. Each additional day of PTA was associated with higher total, rehabilitation, ICU, and surgery costs. Mean first year hospital costs were also found to exceed the highest budget allocation to VHA facilities for a veteran treated at a PRC. These findings have possible implications for hospital care provision for those receiving inpatient rehabilitation in VHA settings.

Preinjury Health Status of Adults With Traumatic Brain Injury: A Preliminary Matched Case-Control Study.

OBJECTIVE: To discern whether there is evidence that individuals who sustained a traumatic brain injury (TBI) had the greater odds of preexisting health conditions and/or poorer health behaviors than matched controls without TBI. SETTING: Brain Injury Inpatient Rehabilitation Unit at Mount Sinai Hospital. Midlife in the United States (MIDUS) control data were collected via random-digit-dialing phone survey. PARTICIPANTS: TBI cases were enrolled in the TBI Health Study and met at least 1 of the following 4 injury severity criteria: abnormal computed tomography scan; Glasgow Coma Scale score between 3 and 12; loss of consciousness greater than 30 minutes; or post-TBI amnesia longer than 24 hours. Sixty-two TBI cases and 171 matched MIDUS controls were included in the analyses; controls were excluded if they reported having a history of head injury. DESIGN: Matched case-control study. MAIN MEASURES: Self-reported measures of depression symptoms, chronic pain, health status, alcohol use, smoking status, abuse of controlled substances, physical activity, physical health composite score, and behavioral health composite score. RESULTS: Pre-index injury depression was nearly 4 times higher in TBI cases than in matched controls (OR= 3.98, 95% CI, 1.71-9.27; P = .001). We found no significant differences in the odds of self-reporting 3 or more medical health conditions in year prior to index injury (OR = 1.52; 95% CI, 0.82-2.81; P = .183) or reporting more risky health behaviors (OR = 1.48; 95% CI; 0.75-2.91; P = .254]) in individuals with TBI than in controls. CONCLUSION: These preliminary findings suggest that the odds of depression in the year prior to index injury far exceed those reported in matched controls. Further study in larger samples is required to better understand the relative odds of prior health problems in those who sustain a TBI, with a goal of elucidating the implications of preinjury health on post-TBI disease burden.

Actitudes sexuales de acuerdo con el nivel de severidad del trauma craneoencefálico / Sexual attitudes according to the level of severity of the cranioencephalic trauma

El objetivo de esta investigación fue analizar la actitud hacia la sexualidad en pacientes con antecedentes de trauma craneoencefálico (TCE), de acuerdo al nivel de severidad presentado. Método: se llevó a cabo un estudio de tipo descriptivo en una muestra de 126 personas, con edades comprendidas entre los 18 y 49 años, con antecedente de trauma craneoencefálico leve, moderado y severo, a quienes se les aplicó la Escala de Actitudes hacia la Sexualidad Ampliada (ATSS) y una encuesta de actitudes hacia la sexualidad. Resultados: se encontró que la mayoría de los participantes manifestaron haber sufrido cambios en su sexualidad tras el TCE, caracterizados por la disminución de la frecuencia de las relaciones y el deseo sexual, sin embargo, evidencian una actitud positiva frente a la sexualidad. Conclusiones: si bien la sexualidad es considerada importante por los participantes del estudio, no se evidenció una conducta tendiente a la erotofilia. No se encontraron diferencias significativas respecto al nivel de severidad del trauma craneoencefálico

The objective of this research was to analyze the attitude towards sexuality in patients with a history of cranioencephalic trauma (TCE), according to the level of severity presented. Method: a descriptive study was carried out in a sample of 126 people, aged between 18 and 49 years, with a history of mild, moderate, and severe head trauma, to whom the Scale of Attitudes towards Extended Sexuality -ATSS and a Survey of Attitudes towards Sexuality were applied. Results: it was found that most of the participants reported having suffered changes in their sexuality after TCE, characterized by a decrease in the frequency of relationships and sexual desire, however, they show a positive attitude towards sexuality. Conclusions: although sexuality is considered important by the study participants, there was no evidence of behavior tending to erotophilia. No significant differences were found regarding the level of severity of cranioencephalic trauma

Neuroinflammation and Hypothalamo-Pituitary Dysfunction: Focus of Traumatic Brain Injury.

The incidence of traumatic brain injury (TBI) has increased over the last years with an important impact on public health. Many preclinical and clinical studies identified multiple and heterogeneous TBI-related pathophysiological mechanisms that are responsible for functional, cognitive, and behavioral alterations. Recent evidence has suggested that post-TBI neuroinflammation is responsible for several long-term clinical consequences, including hypopituitarism. This review aims to summarize current evidence on TBI-induced neuroinflammation and its potential role in determining hypothalamic-pituitary dysfunctions.

Recent Advances in Stem Cell Therapies to Address Neuroinflammation, Stem Cell Survival, and the Need for Rehabilitative Therapies to Treat Traumatic Brain Injuries.

Traumatic brain injuries (TBIs) are a significant health problem both in the United States and worldwide with over 27 million cases being reported globally every year. TBIs can vary significantly from a mild TBI with short-term symptoms to a moderate or severe TBI that can result in long-term or life-long detrimental effects. In the case of a moderate to severe TBI, the primary injury causes immediate damage to structural tissue and cellular components. This may be followed by secondary injuries that can be the cause of chronic and debilitating neurodegenerative effects. At present, there are no standard treatments that effectively target the primary or secondary TBI injuries themselves. Current treatment strategies often focus on addressing post-injury symptoms, including the trauma itself as well as the development of cognitive, behavioral, and psychiatric impairment. Additional therapies such as pharmacological, stem cell, and rehabilitative have in some cases shown little to no improvement on their own, but when applied in combination have given encouraging results. In this review, we will abridge and discuss some of the most recent research advances in stem cell therapies, advanced engineered biomaterials used to support stem transplantation, and the role of rehabilitative therapies in TBI treatment. These research examples are intended to form a multi-tiered perspective for stem-cell therapies used to treat TBIs; stem cells and stem cell products to mitigate neuroinflammation and provide neuroprotective effects, biomaterials to support the survival, migration, and integration of transplanted stem cells, and finally rehabilitative therapies to support stem cell integration and compensatory and restorative plasticity.

Vítimas com traumatismo cranioencefálico na sala de emergência e fator associado à permanência no setor / Víctimas con traumatismo craneoencefálico en urgencias y factor asociado a permanencia en el sector / Victims with traumatic brain injury in the emergency room and factor associated with permanence in the sector

Objetivo: analisar a evolução das vítimas de traumatismo cranioencefálico contuso na sala de emergência e identificar fatores independentes para tempo de permanência nesse serviço. Método: coorte prospectiva que incluiu todas as vítimas que atenderam aos critérios de elegibilidade e foram admitidas entre julho e dezembro de 2017 em hospital referência para trauma. Foi aplicado o Rapid Emergency Medicine Score para identificar a evolução das vítimas até 6 horas após admissão e aplicadas estatísticas descritivas e análise bivariada. Resultados: entre a admissão e 2 horas, foram observadas mudanças desfavoráveis em 35,1% das vítimas, entre 2-4 horas em 13,6% e entre 4-6 horas, em 42,8%; foi observada melhora entre 27% e 28,6% da casuística. Suporte hemodinâmico foi fator independente para tempo de permanência. Conclusão: a evolução desfavorável foi mais frequente entre a admissão e 2 horas e após 4 horas. A maior permanência na sala de emergência ocorreu em vítimas com suporte hemodinâmico.

Objetivo: analizar la evolución de las víctimas de traumatismo craneoencefálico contundente en la sala de urgencias e identificar factores independientes para la duración de la estancia en este servicio. Método: cohorte prospectiva que incluyó a todas las víctimas que cumplieron con los criterios de elegibilidad y estuvieron ingresadas entre julio y diciembre de 2017 en un hospital de referencia por traumatismo. Se aplicó el Rapid Emergency Medicine Score para identificar la evolución de las víctimas hasta 6 horas después del ingreso y se aplicó estadística descriptiva y análisis bivariado. Resultados: entre el ingreso y 2 horas, se observaron cambios desfavorables en 35,1% de las víctimas, entre 2-4 horas en 13,6% y entre 4-6 horas, en 42,8%; se observó mejoría entre el 27% y el 28,6% de la muestra. El soporte hemodinámico fue un factor independiente para la duración de la estancia. Conclusión: la evolución desfavorable fue más frecuente entre el ingreso y 2 horas y después de 4 horas. La estancia más larga en la sala de urgencias ocurrió en víctimas con soporte hemodinámico.

Objective: analyzing the evolution of victims of blunt traumatic brain injury in the emergency room and identifying independent factors for length of stay in this service. Method: a prospective cohort that included all victims who met the eligibility criteria and were admitted between July and December 2017 in a reference hospital for trauma. The Rapid Emergency Medicine Score was applied to identify the evolution of the victims up to 6 hours after admission and descriptive statistics and bivariate analysis were applied. Results: between admission and 2 hours, unfavorable changes were observed in 35.1% of the victims, between 2-4 hours in 13.6% and between 4-6 hours, in 42.8%; improvement was observed between 27% and 28.6% of the sample. Hemodynamic support was an independent factor for length of stay. Conclusion: unfavorable evolution was more frequent between admission and 2 hours and after 4 hours. The longest stay in the emergency room occurred in victims with hemodynamic support.

Paroxysmal Autonomic Instability with Dystonia after Severe Traumatic Brain Injury.

Background: Paroxysmal autonomic instability with dystonia (PAID) syndrome, a subset of dysautonomia, is characterized by paroxysms of marked agitation, diaphoresis, hyperthermia, hypertension, tachycardia and tachypnea accompanied by hypertonia and extensor posturing. Case Report: We report a 52-year-old man who was severely brain injured and developed spastic tetraparesis with cognitive impairment. During his Intensive care unit stay and rehabilitation period, he presented with paroxysmal episodes of dystonic posturing accompanied by dysautonomia. Discussion: Our case raises awareness of PAID, a life-threatening condition which can mimic many others and poses significant challenges in the acute management and rehabilitation of patients. Highlights: PAID is characterized by paroxysms of marked agitation, diaphoresis, hyperthermia, hypertension, tachycardia and tachypnea accompanied by hypertonia and extensor posturing.It usually presents in patients with severe brain injury primarily due to trauma or hypoxia resulting in diffuse axonal or brainstem injury.PAID is also associated with tuberculous meningitis, interpeduncular tuberculoma, pneumococcal meningoencephalitis, intracerebral hemorrhage and paraneoplastic limbic encephalopathy.Differential diagnosis of PAID include neuroleptic malignant syndrome, malignant hyperthermia, sepsis, thyroid storm, pheochromocytoma, autonomic epileptic seizures, sepsis and impending cerebral herniation.

Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study.

BACKGROUND: Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. OBJECTIVE: Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. METHODS: Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. RESULTS: In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). CONCLUSIONS: Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

Two latent classes of diagnostic and treatment procedures among traumatic brain injury inpatients.

To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S. adults, 18-64 years, with primary diagnosis of TBI from 2004-2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression. Using 266,586 eligible records, LCA resulted in two classes of hospitalizations, namely, class I (n = 217,988) (mostly non-surgical) and class II (n = 48,598) (mostly surgical). Whereas orthopedic procedures were equally likely among latent classes, skin-related, physical medicine and rehabilitation procedures as well as behavioral health procedures were more likely among class I, and other types of procedures were more likely among class II. Class II patients were more likely to have moderate-to-severe TBI, to be admitted on weekends, to urban, medium-to-large hospitals in Midwestern, Southern or Western regions, and less likely to be > 30 years, female or non-White. Class II patients were also less likely to be discharged home and necessitated longer hospital stays and greater hospitalization charges. Surgery appears to distinguish two classes of hospitalized patients with TBI with divergent healthcare needs, informing the planning of healthcare services in this target population.

Cost-Benefit Analysis From the Payor's Perspective for Screening and Diagnosing Obstructive Sleep Apnea During Inpatient Rehabilitation for Moderate to Severe TBI.

OBJECTIVE: To describe the cost benefit of 4 different approaches to screening for sleep apnea in a cohort of participants with moderate to severe traumatic brain injury (TBI) receiving inpatient rehabilitation from the payor's perspective. DESIGN: A cost-benefit analysis of phased approaches to sleep apnea diagnosis. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Trial data from participants (N=214) were used in analyses (mean age 44±18y, 82% male, 75% white, with primarily motor vehicle-related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8±5). INTERVENTION: Not applicable. MAIN OUTCOME: Cost benefit. RESULTS: At apnea-hypopnea index (AHI) ≥15 (34%), phased modeling approaches using screening measures (Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender [STOPBANG] [-$5291], Multivariable Apnea Prediction Index MAPI [-$5262]) resulted in greater cost savings and benefit relative to the portable diagnostic approach (-$5210) and initial use of laboratory-quality polysomnography (-$5,011). Analyses at AHI≥5 (70%) revealed the initial use of portable testing (-$6323) relative to the screening models (MAPI [-$6250], STOPBANG [-$6237) and initial assessment with polysomnography (-$5977) resulted in greater savings and cost-effectiveness. CONCLUSIONS: The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.

Does hypertension at initial presentation adversely affect outcomes in pediatric traumatic brain injury?

BACKGROUND: Adults with traumatic brain injury (TBI) who present hypertensive suffer worse outcomes and increased mortality compared to normotensive patients. The purpose of this study is to determine if age-adjusted hypertension on presentation is associated with worsened outcomes in pediatric TBI. METHODS: A retrospective chart review was conducted on pediatric patients with severe TBI admitted to a single system pediatric tertiary care center. The primary outcome was mortality. Secondary outcomes included length of stay, need for neurosurgical intervention, duration of mechanical ventilation, and the need for inpatient rehabilitation. RESULTS: Of 150 patients, 70% were hypertensive and 30% were normotensive on presentation. Comparing both groups, no statistically significant differences were noted in mortality (13.3% for both groups), need for neurosurgical intervention (51.4% vs 48.8%, p = 0.776), length of stay (6 vs 8 days, p = 0.732), duration of mechanical ventilation (2 vs 3 days, p = 0.912), or inpatient rehabilitation rates (48.6% vs 48.9%, p = 0.972). In comparing just the hypertensive patients, there was a trend toward increased mortality in the 95th and 99th percentile groups at 15.8% and 14.1%, versus the 90th percentile group at 6.7% but the difference was not statistically significant (p = 0.701). CONCLUSIONS: Contrary to the adult literature, pediatric patients with severe TBI and hypertension on presentation do not appear to have worsened outcomes compared to those who are normotensive. However, a trend toward increased mortality did exist at extremes of age adjusted hypertension. Larger scale studies are needed to validate these findings. STUDY TYPE: Retrospective cohort study LEVEL OF EVIDENCE: III.

Transcranial Photobiomodulation Therapy in the Cognitive Rehabilitation of Patients with Cranioencephalic Trauma.

Objective: This research evaluated the hemodynamic conditions before and after the transcranial photobiomodulation therapy (PBMT) and investigated neurocognitive changes before and after treatment. Background: Traumatic brain injury (TBI) is the major cause of morbidity and mortality among individuals 21-60 years old and causes ∼500,000 people to be hospitalized in Brazil annually. Some survivors develop an irreversible decrease in neurological function, and the mortality rate is as high as 70% in severe cases. PBMT is an alternative to treat secondary injuries due to TBI. Methods: This multidisciplinary clinical study was carried out on 10 chronic adult patients with severe TBI, who were treated with PBMT with an optical device containing 13 sets of 4 light emitting diodes, and underwent hemodynamic transcranial Doppler and neuropsychological evaluation at three different times: pre-PBMT, post-PBMT (after a week), and late-PBMT, which occurred 3 months after the last session. The patients received PBMTs three times a week, for 6 weeks. PBMTs were performed for 18 sessions for 6 weeks and 30 min per session. Results: The results found an alteration in the cerebral blood flow (CBF) as well as a consequent increase of the cerebral oxygenation that helped to improve the cerebral function. Conclusions: The PBMT contributed to increased CBF, evidenced mainly by the increased left peak systolic velocity, which consequently increased the hemodynamic response after the PBMT and impacts on the peripheral cerebral perfusion contributing to improved cerebral function.

Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury: Trial protocol for a single-center, randomized, double-blind, and controlled clinical trial.

BACKGROUND: Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility. METHODS: This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).

Prediction of functional outcome and discharge destination in patients with traumatic brain injury after post-acute rehabilitation.

As the survival rate of traumatic brain injury increases, the burden of care for patients with traumatic brain injury is emerging as a socioeconomic issue and the discharge destination is one of the important outcome measures in the post-acute rehabilitation unit. To investigate the predictors of functional outcome and discharge destination in patients with traumatic brain injury after post-acute rehabilitation. A retrospective review was performed on 86 patients who were admitted to the rehabilitation unit between January 2010 and June 2017. Multiple regression analysis was used as a statistical method to identify the factors affecting Modified Barthel Index and discharge destination. The number of days from traumatic brain injury onset to rehabilitation unit admission (odds ratio = 0.959, P = 0.049), brain surgery for traumatic brain injury management (odds ratio = 0.160, P = 0.021), initial Glasgow Coma Scale score (odds ratio = 1.269, P = 0.022) and Mini-Mental State Examination score at admission (odds ratio = 1.245, P < 0.001) were the predictive factors for higher Modified Barthel Index after rehabilitation. Underlying vascular risk factors (odds ratio = 0.138, P = 0.015), Modified Barthel Index score after rehabilitation (odds ratio = 1.085, P < 0.001) and deductible-free insurance (odds ratio = 0.211, P = 0.032) were the predictive factors of home discharge. The functional outcome of patients with traumatic brain injury after rehabilitation was related to the severity of initial injury, cognitive function at admission and rehabilitation timing. The discharge destination after rehabilitation was related to functional outcome, insurance issues and underlying vascular risk factors.

Review of the Current Knowledge on the Role of Stem Cell Transplantation in Neurorehabilitation.

The management involving stem cell (SC) therapy along with physiotherapy offers tremendous chance for patients after spinal cord injury (SCI), traumatic brain injury (TBI), stroke, etc. However, there are still only a limited number of reports assessing the impact of stem cells (SCs) on the rehabilitation process and/or the results of the simultaneous use of SC and rehabilitation. Additionally, since there is still not enough convincing evidence about the effect of SCT on humans, e.g., in stroke, there have been no studies conducted concerning rehabilitation program formation and expected outcomes. It has been shown that bone marrow-derived mesenchymal stem cell (BMSCs) transplantation in rats combined with hyperbaric oxygen therapy (HBO) can promote the functional recovery of hind limbs after SCI. An anti-inflammatory effect has been shown. One case study showed that, after the simultaneous use of SCT and rehabilitation, an SCI patient progressed from ASIA Grade A to ASIA Grade C. Such promising data in the case of complete tetraplegia could be a breakthrough in the treatment of neurologic disorders in humans. Although SCT appears as a promising method for the treatment of neurological conditions, e.g., complete tetraplegia, much work should be done towards the development of rehabilitation protocols.

Evaluation of a 12-month lifestyle intervention by individuals with traumatic brain injury.

Weight gain and inactivity are common problems for individuals living with a traumatic brain injury (TBI). Yet, interventions to support a healthy lifestyle specific to individuals with TBI are lacking. The purpose of this study was to complete a program evaluation of a 12-month evidence-based healthy lifestyle intervention adapted for people with a TBI. Eighteen participants completed a brief interview after the yearlong intervention to determine their perceptions of the program effectiveness as well as barriers and facilitators in making lifestyle changes. Participants reported staff, tracking of dietary and activity behavior, and in-person meetings as most helpful aspects. Lack of motivation and difficulty preparing healthy meals were the primary barriers to a healthy lifestyle. Qualitative data revealed five themes that influenced healthy behaviors, including (1) self-regulation, (2) environmental resources, (3) knowledge of health behaviors, (4) TBI-related impairment and comorbidities, and (5) social support. Results suggest that future iterations of the healthy lifestyle intervention should emphasize self-regulation activities; require tracking of dietary and activity behaviors across 12 months; provide concurrent support for individual motivation issues; provide prepared meals; utilize web-based, telephonic, or hybrid approaches to delivery; further simplify the curriculum and learning tools; and include caregivers and peer accountability partners. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Traumatismo Encéfalo Craneano: re- construyendo aprendizajes / Traumatic brain injury: rebuilding learning

Las autoras, psicopedagogas rotantes en el Hospital de Rehabilitación Manuel Rocca, de la Ciudad de Buenos Aires, plantean distintos interrogantes alrededor de los pacientes que concurren al hospital, el tipo de abordaje que se propone, la posibles intervenciones de la especialidad en un hospital de rehabilitación, y en el proceso de rehabilitación de un adulto; y específicamente sobre el abordaje psicopedagógico de pacientes jóvenes y adultos con traumatismo encéfalo-craneano.