The Impact of Complementary and Integrative Medicine Following Traumatic Brain Injury: A Scoping Review.

OBJECTIVE: To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI). DATA SOURCES: MEDLINE (OvidSP), PubMed (NLM), EMBASE ( Embase.com ), CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071). DATA EXTRACTION: Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers. DATA SYNTHESIS: In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM. CONCLUSION: Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.

Aprosodia Following Focal Brain Damage: What's Right and What's Left?

PURPOSE: Hemispheric specialization for the comprehension and expression of linguistic and emotional prosody is typically attributed to the right hemisphere. This study used techniques adapted from meta-analysis to critically examine the strength of existing evidence for hemispheric lateralization of prosody following brain damage. METHOD: Twenty-one databases were searched for articles published from 1970 to 2020 addressing differences in prosody performance between groups defined by right hemisphere damage and left hemisphere damage. Hedges's g effect sizes were calculated for all possible prosody comparisons. Primary analyses summarize effects for four types: linguistic production, linguistic comprehension, emotion comprehension, and emotion production. Within each primary analysis, Hedges's g values were averaged across comparisons (usually from a single article) based on the same sample of individuals. Secondary analyses explore more specific classifications of comparisons. RESULTS: Out of the 113 articles investigating comprehension and production of emotional and linguistic prosody, 62 were deemed appropriate for data extraction, but only 21 met inclusion criteria, passed quality reviews, and provided sufficient information for analysis. Evidence from this review illustrates the heterogeneity of research methods and results from studies that have investigated aprosodia. This review provides inconsistent support for selective contribution of the two cerebral hemispheres to prosody comprehension and production; however, the strongest finding suggests that right hemisphere lesions disrupt emotional prosody comprehension more than left hemisphere lesions. CONCLUSION: This review highlights the impoverished nature of the existing literature; offers suggestions for future research; and highlights relevant clinical implications for the prognostication, evaluation, and treatment of aprosodia. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20334987.

Factors influencing recovery from mild traumatic brain injury.

PRIMARY OBJECTIVE: This study determined whether initial GCS score, head CT results, cognitive performance on IMPACT testing, or APOE genotype most effectively predicted 1-month functional outcome after mild traumatic brain injury (mTBI). This study tested the hypotheses that participants with poor performance on initial cognitive testing and those with an APOEe4 genotype would exhibit a poorer 1-month recovery after mTBI. RESEARCH DESIGN: Regression analysis determined which independent variables were most effective in predicting 1-month GOS-E or DRS score. Independent t-test procedures determined whether cognitive recovery varied across APOEe4 carriers. METHODS AND PROCEDURES: 49 participants admitted to the hospital with mTBI received cognitive evaluation within 48 hours after injury and again one month later. DNA analysis provided participant APOE genotype. MAIN OUTCOMES AND RESULTS: Results showed that no study variables significantly predicted GOS-E or DRS scores, however, differences were identified when APOE groups were compared. Participants who were noncarriers of APOEe4 had significantly slower reaction times compared to APOEe4 carriers. Participants who were homozygous APOEe4 carriers had significantly lower instances of impulsivity than noncarriers. CONCLUSIONS: Further research is needed to understand how APOE allele status and performance on initial cognitive testing may influence short-term recovery after mTBI.

A Review of the Role of Auditory Evoked Potentials in Mild Traumatic Brain Injury Assessment.

Around 75% to 90% of people who experience a traumatic brain injury (TBI) are classified as having a mild TBI (mTBI). The term mTBI is synonymous with concussion or mild head injury (MHI) and is characterized by symptoms of headache, nausea, dizziness, and blurred vision. Problems in cognitive abilities such as deficits in memory, processing speed, executive functioning, and attention are also considered symptoms of mTBI. Since these symptoms are subtle in nature and may not appear immediately following the injury, mTBI is often undetected on conventional neuropsychological tests. Current neuroimaging techniques may not be sensitive enough in identifying the array of microscopic neuroanatomical and subtle neurophysiological changes following mTBI. To this end, electrophysiological tests, such as auditory evoked potentials (AEPs), can be used as sensitive tools in tracking physiological changes underlying physical and cognitive symptoms associated with mTBI. The purpose of this review article is to examine the body of literature describing the application of AEPs in the assessment of mTBI and to explore various parameters of AEPs which may hold diagnostic value in predicting positive rehabilitative outcomes for people with mTBI.

A polymorphism in human estrogen-related receptor beta (ESRRß) predicts audiometric temporary threshold shift.

OBJECTIVE: A non-synonymous single nucleotide polymorphism (rs61742642; C to T, P386S) in the ligand-binding domain of human estrogen-related receptor beta (ESRRß) showed possible association to noise-induced hearing loss (NIHL) in our previous study. DESIGN: This study was conducted to examine the effect of the ESRRß rs61742642 T variant on temporary threshold shift (TTS). TTS was induced by 10 minutes of exposure to audiometric narrow-band noise centered at 2000 Hz. Hearing thresholds and distortion product otoacoustic emissions input output function (DP IO) at 2000, 3000, and 4000 Hz were measured before and after the noise exposure. STUDY SAMPLE: Nineteen participants with rs61742642 CT genotype and 40 participants with rs61742642 CC genotype were recruited for the study. RESULTS: Participants with the CT genotype acquired a significantly greater TTS without convincing evidence of greater DP IO temporary level shift (DPTLS) compared to participants with the CC genotype. CONCLUSION: The results indicated that the ESRRß polymorphism is associated with TTS. Future studies were recommended to explore molecular pathways leading to increased susceptibility to NIHL.

Practice Update: What Professionals Who Are Not Brain Injury Specialists Need to Know About Intimate Partner Violence-Related Traumatic Brain Injury.

There is growing recognition of the risk for traumatic brain injury (TBI) among victims and survivors of intimate partner violence (IPV). A wide range of physically abusive behaviors may lead to injuries to the head or neck and place an individual at risk for a TBI. The purpose of this article is to consolidate current research and present practical guidelines for professionals, who are not brain injury specialists, but work with clients who may have sustained a TBI in the context of IPV. Recommendations are provided for TBI risk screening, making appropriate referrals, and providing services in light of a potential TBI.

Component analysis of verbal fluency performance in younger participants with moderate-to-severe traumatic brain injury.

PRIMARY OBJECTIVE: To investigate phonemic and semantic verbal fluency performance in a group of young adult participants with and without traumatic brain injury. RESEARCH DESIGN: Group comparison. METHODS AND PROCEDURES: Twenty-five participants with moderate-to-severe TBI and 25 participants with no brain damage (NBD) were given phonemic and semantic verbal fluency tasks. Responses were analysed quantitatively and qualitatively. MAIN OUTCOMES AND RESULTS: Young participants with moderate-to-severe TBI generated significantly fewer total correct words and sub-categories for both fluency conditions when compared to controls. The total number of correct words generated on the phonemic condition and for the semantic category of animals was positively correlated with the number of category switches produced during the task. CONCLUSIONS: While young participants with moderate-to-severe TBI produced fewer total correct words on both verbal fluency conditions in comparison to controls, these differences were greater on the phonemic condition. Participants with moderate-to-severe TBI switched less frequently on both fluency tasks and produced smaller cluster sizes only on the phonemic task in comparison to controls. These results are in contrast with previous investigations that have observed greater age-related declines on semantic tasks when compared to phonemic tasks.

Treatment of metaphor interpretation deficits subsequent to traumatic brain injury.

OBJECTIVE: To improve oral interpretation of metaphors by patients with traumatic brain injury (TBI). DESIGN: Both single subject experimental design and group analysis. SETTING: Patients' homes. PARTICIPANTS: Eight adult patients with moderate to severe traumatic brain injury sustained 3 to 20 years before testing. INTERVENTION: The Metaphor Training Program consisted typically of 10 baseline sessions, 3 to 9 1-hour sessions of structured intervention, and 10 posttraining baseline sessions. Training used extensive practice with simple graphic displays to illustrate semantic associations. MAIN OUTCOME MEASURES: Quality of orally produced metaphor interpretation and accuracy of line orientation judgments served as dependent measures obtained during baseline, training, posttraining, and at a 3- to 4-month follow-up. Untrained line orientation judgments provided a control measure. RESULTS: Group data showed significant improvement in metaphor interpretation but not in line orientation. Six of 8 patients individually demonstrated significant improvement in metaphor interpretation. Gains persisted for 3 of the 6 patients at the 3- to 4-month follow-up. CONCLUSION: The Metaphor Training Program can improve cognitive-communication performance for individuals with moderate to severe traumatic brain injury. Results support the potential for treating patients' residual cognitive-linguistic deficits.

Treating Metaphor Interpretation Deficits Subsequent to Right Hemisphere Brain Damage: Preliminary Results.

PURPOSE: This investigation sought to determine whether a structured intervention focused on improving use of semantic associations could improve patients' ability to provide oral interpretations of metaphors following Right Hemisphere Damage (RHD). METHODS: Principles of single subject experimental design provided the basis for the study. Five patients received either 10 or 20 baseline assessments of oral metaphor interpretation and, as a control, assessments of line orientation skill. They then received approximately 10 one-hour sessions of structured intervention to improve oral metaphor interpretation followed by post-training assessments and a 3 month follow up. RESULTS: Patients' performances revealed evidence of good response to training as shown by patients' ability to reach criterion on all intervention tasks and by their significant improvement on oral metaphor interpretation. There was relatively little improvement on the line orientation task. DISCUSSION: The results of this study support the clinical usefulness of this new approach to treating communication deficits associated with RHD due to stroke, even years post-onset. There are, however, questions that remain unanswered. For example, additional data will be needed to gauge how a patient's severity of impairment relates to the potential for improvement, to chart the durability and scope of improvement associated with the training, and to determine the type of visuospatial ability needed for using this type of pictorial material.

Stuttering Following Acquired Brain Damage: A Review of the Literature.

Communication problems resulting from acquired brain damage are most frequently manifested as motor speech disorders such as dysarthria, syndromes of aphasia, and impairments of pragmatics. A much less common phenomenon is the onset of stuttering in adults who sustain a stroke, traumatic brain injury, or other neurologic events. When stuttering occurs in association with neuropathology, precise characterization and explanation of observed behaviors is often difficult. Among the clinical challenges presented by acquired stuttering are the problem of distinguishing this form of dysfluency from those associated with dysarthria and aphasia, and identifying the neuropathological condition(s) and brain lesion site(s) giving rise to this speech disorder. Another challenge to the precise characterization of acquired stuttering is the fact that some cases of acquired stuttering apparently have a psychological or neuropsychiatric genesis rather than a neuropathological one. In this paper we provide a review of the literature pertaining to the complicated phenomenon of acquired stuttering in adults and draw some tentative explanatory conclusions regarding this disorder.

Improved language in a chronic nonfluent aphasia patient after treatment with CPAP and TMS.

OBJECTIVE: To present pretreatment and post-treatment language data for a nonfluent aphasia patient who received 2 treatment modalities: (1) continuous positive airway pressure (CPAP) for his sleep apnea, starting 1-year poststroke; and (2) repetitive transcranial magnetic brain stimulation (TMS), starting 2 years poststroke. BACKGROUND: Language data were acquired beyond the spontaneous recovery period of 3 to 6 months poststroke onset. CPAP restores adequate oxygen flow throughout all stages of sleep, and may improve cognition. A series of slow, 1 Hz repetitive TMS treatments to suppress a posterior portion of right pars triangularis has been shown to improve phrase length and naming in chronic nonfluent aphasia. METHOD: The Boston Diagnostic Aphasia Examination and Boston Naming Test were administered pre-CPAP, and after 2 to 5 months of CPAP. These same tests were administered pre-TMS, and at 3 and 6 months post-TMS, and again 2.4 years later. RESULTS: Post-CPAP testing showed increased Phrase Length, Auditory Comprehension, and naming Animals and Tools/Implements (Boston Diagnostic Aphasia Examination). Testing at 3 and 6 months post-TMS showed significant increase in Phrase Length, Auditory Comprehension, and Boston Naming Test compared with pre-TMS. These gains were retained at 2.4 years post-TMS. CPAP use continued throughout. CONCLUSIONS: Physiologic treatment interventions may promote language recovery in chronic aphasia.

Using lexical familiarity judgments to assess verbally mediated intelligence in aphasia.

In this study, a task using forced-choice lexical familiarity judgments of irregular versus archaic words (a newly developed measure called the Lexical Orthographic Familiarity Test; LOFT) was compared to a standardized oral word-reading measure (the Wechsler Test of Adult Reading; WTAR) in a group of 35 aphasic adults and a comparison group of 125 community dwelling, nonbrain damaged adults. When compared to the comparison group, aphasics had significantly lower scores on the WTAR but not the LOFT. Although both the WTAR and LOFT were significantly correlated with education in the nonbrain-damaged group, only the LOFT was correlated with education and also with the Barona full scale IQ index in the aphasic group. Lastly, WTAR performance showed a significantly greater relationship to the severity of language disorder in the aphasic group than did the LOFT. These results have both theoretical and clinical implications for the assessment of language-disordered adults, as they indicate that patients with aphasia may retain aspects of verbally mediated intelligence, and that the LOFT may provide a better estimate of premorbid functioning in aphasia than other currently available measures.

Nature-based therapy: its potential as a complementary approach to treating communication disorders.

Nature-based therapy (NBT) has been incorporated into the practice of many medical and mental health professions. Occupational therapists, physical therapists, nurses, social workers, psychologists, and to a lesser extent, speech-language pathologists have used NBT practices as a complementary means of treating a variety of physical, emotional, and cognitive disorders. This article includes a description of NBT and the three types that comprise the practice and a review of the literature demonstrating the use of NBT in the general population and, more specifically, with individuals with neurogenic communication disorders. It concludes with a discussion of directions for future research of NBT.