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1.
Phys Ther Sport ; 48: 101-108, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33406456

RESUMO

OBJECTIVE: The purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. DESIGN: Cross-sectional survey. SETTING: Data were collected using an online survey instrument. PARTICIPANTS: Three hundred and nine adult combat sport athletes. MAIN OUTCOME MEASURES: Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. RESULTS: A history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of 'high' total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting 'high' total symptoms and symptoms severity scores. CONCLUSION: Athletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.


Assuntos
Boxe/lesões , Concussão Encefálica/diagnóstico , Artes Marciais/lesões , Adulto , Concussão Encefálica/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Lesões do Pescoço/complicações , Lesões do Pescoço/diagnóstico , Cervicalgia/etiologia , Autorrelato , Inquéritos e Questionários
2.
Clin Sports Med ; 40(1): 147-158, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187605

RESUMO

Pediatric patients with concussions have different needs than adults throughout the recovery process. Adolescents, in particular, may take longer to recover from concussion than adults. Initially, relative rest from academic and physical activities is recommended for 24 to 48 hours to allow symptoms to abate. After this time period, physicians should guide the return to activity and return to school process in a staged fashion using published guidelines. Further concussion research in pediatric patients, particularly those younger than high-school age, is needed to advance the management of this special population.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Esportes Juvenis/lesões , Adolescente , Adulto , Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Criança , Terapia por Exercício , Humanos , Aprendizagem , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/terapia , Volta ao Esporte , Fatores de Tempo
3.
JAMA Netw Open ; 3(12): e2030824, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351088

RESUMO

Importance: Mild traumatic brain injury (TBI) may predispose individuals to progressive neurodegeneration. Objective: To identify evidence of neurodegeneration through longitudinal evaluation of changes in retinal layer thickness using optical coherence tomography in veterans with a history of mild TBI. Design, Setting, and Participants: This longitudinal cohort study evaluated veterans who were receiving services at the Minneapolis Veterans Affairs Health Care System. Symptomatic or mild TBI was diagnosed according to the Mayo TBI Severity Classification System. Participants in the age-matched control group had no history of TBI. Participants with any history or evidence of retinal or optic nerve disease that could affect retinal thickness were excluded. Data analysis was performed from July 2019 to February 2020. Exposures: The presence and severity of mild TBI were determined through consensus review of self-report responses during the Minnesota Blast Exposure Screening Tool semistructured interview. Main Outcomes and Measures: Change over time of retinal nerve fiber layer (RNFL) thickness. Results: A total of 139 veterans (117 men [84%]; mean [SD] age, 49.9 [11.1] years) were included in the study, 69 in the TBI group and 70 in the control group. Veterans with mild TBI showed significantly greater RNFL thinning compared with controls (mean [SE] RNFL slope, -1.47 [0.24] µm/y vs -0.31 [0.32] µm/y; F1,122 = 8.42; P = .004; Cohen d = 0.52). Functionally, veterans with mild TBI showed greater declines in visual field mean deviation (mean [SE] slope, -0.09 [0.14] dB/y vs 0.46 [0.23] dB/y; F1,122 = 4.08; P = .046; Cohen d = 0.36) and pattern standard deviation (mean [SE] slope, 0.09 [0.06] dB/y vs -0.10 [0.07] dB/y; F1,122 = 4.78; P = .03; Cohen d = 0.39) and high spatial frequency (12 cycles/degree) contrast sensitivity compared with controls. Cognitively, there was a significantly greater decrease in the number of errors over time during the Groton Maze Learning Test (GMLT) in controls compared with veterans with mild TBI (mean [SE] slope, -9.30 [1.48] errors/y vs -5.23 [1.24] errors/y; F1,127 = 4.43; P = .04; Cohen d = 0.37). RNFL tissue loss was significantly correlated with both worsening performance on the GMLT over time (Spearman ρ = -0.20; P = .03) and mild TBI severity (Spearman ρ = -0.25; P = .006). The more severe the mild TBI (larger Minnesota Blast Exposure Screening Tool severity score), the faster the reduction in RNFL thickness (ie, the more negative the slope) across time. Conclusions and Relevance: This cohort study found longitudinal evidence for significant, progressive neural degeneration over time in veterans with mild TBI, as indicated by greater RNFL tissue loss in patients with mild TBI vs controls, as well as measures of function. These results suggest that these longitudinal measures may be useful biomarkers of neurodegeneration. Changes in this biomarker may provide early detection of subsequent cognitive and functional deficits that may impact veterans' independence and need for care.


Assuntos
Concussão Encefálica , Cognição , Doenças Neurodegenerativas , Testes Neuropsicológicos/estatística & dados numéricos , Tomografia de Coerência Óptica/métodos , Testes de Campo Visual , Concussão Encefálica/complicações , Concussão Encefálica/fisiopatologia , Doença Crônica , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/psicologia , Estados Unidos/epidemiologia , Saúde dos Veteranos/estatística & dados numéricos , Testes de Campo Visual/métodos , Testes de Campo Visual/estatística & dados numéricos
4.
Medicine (Baltimore) ; 99(38): e22305, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957391

RESUMO

RATIONALE: A developmental venous anomaly (DVA) is the most common intracranial congenital anomaly and is mostly asymptomatic. Thrombosis rarely develops in a DVA due to hypercoagulation. We report a case of ischemic stroke in the area of a DVA after minor head trauma in a patient with DVA and without a predisposition thrombosis. PATIENT CONCERNS: A healthy 17-year-old male was admitted to the emergency room due to left hemiparesis, which was caused by a ball hitting the right side of his head during a soccer game. DIAGNOSIS: Brain magnetic resonance (MR) susceptibility-weighted image showed several small veins draining to the central vein in the area from the right posterior putamen to the periventricular white matter. INTERVENTIONS: We diagnosed the patient with an ischemic stroke associated with a DVA and administered antiplatelet agents. The patient's autoantibodies (including antiphospholipid antibody) and factors of blood coagulation were normal. OUTCOMES: The left hemiparesis of the patient worsened by the second day of admission. Moreover, high signal intensity was observed in the DVA region of the diffusion weighted image of brain MR. The patient's symptoms gradually improved afterward, and left hemiparesis recovered fully 3 weeks after the onset. LESSONS: DVAs may predispose to ischemic stroke due to thrombosis and hypercoagulation, although it is rare. It is necessary to consider the possibility of ischemic stroke due to minor head trauma, even without factors causing hypercoagulation.


Assuntos
Concussão Encefálica/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Concussão Encefálica/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Imagem de Difusão por Ressonância Magnética , Humanos , Angiografia por Ressonância Magnética , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Futebol/lesões , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico
5.
Cogn Behav Neurol ; 33(3): 208-217, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889953

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a known risk factor for neurodegenerative dementias such as Alzheimer disease (AD); however, the potential risk of mild cases of TBI, such as concussions, remains unclear. OBJECTIVE: To explore whether a small sample of retired professional athletes with a diagnosis of mild cognitive impairment (MCI)-the prodromal stage of AD-and a history of multiple mild TBIs exhibit greater neuropsychological impairment than age-matched nonathletes with MCI and no history of TBI. METHOD: Ten retired National Football League players diagnosed with MCI and reporting multiple mild TBIs, and 10 nonathletes, also diagnosed with MCI but with no history of TBI, completed a standard neurologic examination and neuropsychological testing. Independent samples t tests were conducted to examine differences in neuropsychological performance between the two groups. RESULTS: The retired athletes with a history of mild TBI obtained generally similar scores to the nonathlete controls on measures of verbal learning and memory, verbal fluency, and processing speed. However, the retired athletes scored lower than the controls on tests of confrontation naming and speeded visual attention. CONCLUSION: Retired athletes with MCI and a history of mild TBI demonstrated similar neuropsychological profiles as nonathlete controls despite lower scores on measures of confrontation naming and speeded visual attention. These findings suggest that a history of multiple mild TBIs does not significantly alter the overall neuropsychological profile of individuals with MCI; confirmation of this will require longitudinal research with larger sample sizes.


Assuntos
Concussão Encefálica/complicações , Lesões Encefálicas Traumáticas/complicações , Disfunção Cognitiva/etiologia , Futebol Americano/lesões , Testes Neuropsicológicos/normas , Aposentadoria/psicologia , Idoso , Idoso de 80 Anos ou mais , Atletas/psicologia , Feminino , Futebol Americano/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
6.
PLoS One ; 15(8): e0232862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810143

RESUMO

Cognitive impairments can be a significant problem after a traumatic brain injury (TBI), which affects millions worldwide each year. There is a need for establish reproducible cognitive assays in rodents to better understand disease mechanisms and to develop therapeutic interventions towards treating TBI-induced impairments. Our goal was to validate and standardize the radial arm water maze (RAWM) test as an assay to screen for cognitive impairments caused by TBI. RAWM is a visuo-spatial learning test, originally designed for use with rats, and later adapted for mice. The present study investigates whether test procedures, such us the presence of extra-maze cues influences learning and memory performance. C57BL/6 mice were tested in an 8-arm RAWM using a four-day protocol. We demonstrated that two days of training, exposing the mice to extra-maze cues and a visible platform, influenced learning and memory performance. Mice that did not receive training performed poorer compared to mice trained. To further validate our RAWM protocol, we used scopolamine. We, also, demonstrated that a single mild closed head injury (CHI) caused deficits in this task at two weeks post-CHI. Our data supported the use of 7 trials per day and a spaced training protocol as key factor to unmask memory impairment following CHI. Here, we provide a detailed standard operating procedure for RAWM test, which can be applied to a variety of mouse models including neurodegenerative diseases and pathology, as well as when pharmacological approaches are used.


Assuntos
Concussão Encefálica/psicologia , Aprendizagem em Labirinto , Animais , Concussão Encefálica/complicações , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Sinais (Psicologia) , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Testes de Memória e Aprendizagem , Camundongos , Camundongos Endogâmicos C57BL , Antagonistas Muscarínicos/farmacologia , Testes Neuropsicológicos , Escopolamina/farmacologia
7.
Am Surg ; 86(8): 991-995, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757761

RESUMO

BACKGROUND: The modified brain injury guidelines (mBIG) provide an algorithm for surgeons to manage some mild traumatic brain injury (TBI) with intracranial hemorrhage (ICH) without neurosurgical consultation or repeat imaging. Currently, antiplatelet use among patients with any ICH classifies a patient at the highest level, mBIG 3. This study assesses the risk of clinical progression among patients taking antiplatelet medications with mild TBI with ICH. METHODS: A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, and outcome data were collected for each patient. Patients taking antiplatelet agents were reclassified as if they were not taking these medications. Patients who would have met criteria for a lower classification (mBIG 1 or 2) without antiplatelet agents were designated mBIG 3 Antiplatelet and compared with all other mBIG 1 and 2 patients. RESULTS: 736 patients met the inclusion criteria. 158 patients were taking antiplatelet medications and 53 were reclassified as mBIG 3 Antiplatelet. When comparing mBIG 3 Antiplatelet to the 226 patients originally classified as mBIG 1 and 2, mBIG 3 Antiplatelet patients were more likely to undergo repeat head computed tomography (98.1% vs 76.6%; P < .001) and neurosurgical consultation (94.2% vs 76.5%; P < .001) but had no significant differences in outcomes. No mBIG 3 Antiplatelet patients had a worsening examination or needed operative intervention. DISCUSSION: This data suggests that antiplatelet medication use should not automatically classify a patient as mBIG 3. Adoption of this strategy would better utilize resources and avoid unnecessary costs without sacrificing care.


Assuntos
Concussão Encefálica/complicações , Tomada de Decisão Clínica/métodos , Hemorragia Intracraniana Traumática/etiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Índices de Gravidade do Trauma , Algoritmos , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Feminino , Humanos , Hemorragia Intracraniana Traumática/diagnóstico , Hemorragia Intracraniana Traumática/terapia , Masculino , Guias de Prática Clínica como Assunto , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
8.
BMC Neurol ; 20(1): 315, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847526

RESUMO

BACKGROUND: Acute neck pain (ANP) has recently been demonstrated to be a predictor of persistent posttraumatic complaints after mild traumatic brain injury (mTBI). The aim of this study was to determine specific characteristics of patients with ANP following mTBI, their posttraumatic complaints and relationship with functional outcome. METHODS: Data from a prospective follow-up study of 922 mTBI patients admitted to the emergency department (ED) in three level-one trauma centres were analysed. Patients were divided into two groups: 156 ANP patients and 766 no acute neck pain (nANP) patients. Posttraumatic complaints were evaluated 2 weeks and 6 months post-injury using standardized questionnaires and functional outcome was evaluated at 6 months with the Glasgow Outcome Scale Extended (GOSE). RESULTS: ANP patients were more often female (p < 0.01), younger (38 vs. 47 years, p < 0.01) with more associated acute symptoms at the ED (p < 0.05) compared to nANP patients. More motor vehicle accidents (12% vs. 6%, p = 0.01) and less head wounds (58% vs. 73%, p < 0.01) in ANP patients indicated 'high-energy low-impact' trauma mechanisms. ANP patients showed more posttraumatic complaints 2 weeks and 6 months post-injury (p < 0.05) and more often incomplete recovery (GOSE < 8) was present after 6 months (56% vs. 40%, p = 0.01). CONCLUSIONS: MTBI patients with acute neck pain at the ED constitute a distinct group within the mTBI spectrum with specific injury and demographic characteristics. Early identification of this at risk group already at the ED might allow specific and timely treatment to avoid development of incomplete recovery.


Assuntos
Concussão Encefálica/complicações , Serviço Hospitalar de Emergência , Cervicalgia/etiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
9.
Clin J Sport Med ; 30(4): 412-415, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32644320

RESUMO

OBJECTIVE: Report the clinical findings and outcomes among pediatric patients diagnosed with benign paroxysmal positional vertigo (BPPV) after sports-related concussion (SRC). DESIGN: Retrospective case series. SETTING: Multidisciplinary pediatric concussion program. PATIENTS: Patients younger than 19 years with a sport or recreation activity-related concussion referred for comprehensive vestibular physiotherapy assessment. MAIN OUTCOME MEASURE: Symptom resolution after targeted particle repositioning (PR). RESULTS: During the study period, 115 pediatric SRC patients underwent vestibular physiotherapy assessment including 12 (10.4%) who were diagnosed with BPPV. Unilateral posterior semicircular canal (SCC) BPPV was diagnosed in 8/12 (75%) patients, and unilateral anterior SCC BPPV diagnosed in 4/12 (25%) patients. Benign paroxysmal positional vertigo was successfully treated in all patients with a mean of 1.58 targeted PR maneuvers (range = 1-4). CONCLUSIONS: Comprehensive management of pediatric SRC requires a multidisciplinary approach to address the heterogeneous pathophysiology of persistent postconcussion symptoms. Pediatric SRC patients with coexisting BPPV should be considered for targeted PR.


Assuntos
Vertigem Posicional Paroxística Benigna/etiologia , Concussão Encefálica/complicações , Esportes Juvenis/lesões , Adolescente , Traumatismos em Atletas/complicações , Traumatismos em Atletas/fisiopatologia , Vertigem Posicional Paroxística Benigna/terapia , Concussão Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Estudos Retrospectivos
10.
J Headache Pain ; 21(1): 90, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664898

RESUMO

BACKGROUND: According to the International Classification of Headache Disorders 3, post-traumatic headache (PTH) attributed to traumatic brain injury (TBI) is a secondary headache reported to have developed within 7 days from head injury, regaining consciousness following the head injury, or discontinuation of medication(s) impairing the ability to sense or report headache following the head injury. It is one of the most common secondary headache disorders, and it is defined as persistent when it lasts more than 3 months. MAIN BODY: Currently, due to the high prevalence of this disorder, several preclinical studies have been conducted using different animal models of mild TBI to reproduce conditions that engender PTH. Despite representing a simplification of a complex disorder and displaying different limitations concerning the human condition, animal models are still a mainstay to study in vivo the mechanisms of PTH and have provided valuable insight into the pathophysiology and possible treatment strategies. Different models reproduce different types of trauma and have been ideated in order to ensure maximal proximity to the human condition and optimal experimental reproducibility. CONCLUSION: At present, despite its high prevalence, PTH is not entirely understood, and the differential contribution of pathophysiological mechanisms, also observed in other conditions like migraine, has to be clarified. Although facing limitations, animal models are needed to improve understanding of PTH. The knowledge of currently available models is necessary to all researchers who want to investigate PTH and contribute to unravel its mechanisms.


Assuntos
Concussão Encefálica/fisiopatologia , Modelos Animais de Doenças , Transtornos de Enxaqueca/fisiopatologia , Cefaleia Pós-Traumática/fisiopatologia , Animais , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Cefaleia Pós-Traumática/diagnóstico , Cefaleia Pós-Traumática/etiologia , Prevalência , Reprodutibilidade dos Testes
11.
NeuroRehabilitation ; 47(1): 65-77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675426

RESUMO

BACKGROUND: The Neurobehavioral Symptom Inventory (NSI-22) is a validated self-report measure designed to assess neurobehavioral symptoms (NBS) after mild TBI (MTBI). Psychological and behavioral factors have been shown to be predictors of persistent NBS reporting in veterans; however, there is still a gap in knowledge about these associations in a civilian population presenting for treatment. OBJECTIVE: This study seeks to identify the predictors of increased NBS reporting on the NSI-22 in a treatment-seeking population with MTBI. METHODS: Analysis of 80 treatment seeking participants admitted to an interdisciplinary outpatient rehabilitation program with a diagnosis of MTBI. NSI-22 was used to measure NBS reporting. Predictor variables identified by univariate analysis were entered into a multivariable regression model, which was adjusted for demographic variables. RESULTS: Higher NSI-22 scores correlated with increased level of depressive complaints (PHQ-9), higher disability (M2PI), lower satisfaction with life (SWLS), prior MTBI, fewer years of education, absence of motor vehicle collision (MVC), and unemployment at time of assessment. When those variables were used in a multivariable linear regression model, PHQ-9, M2PI, years of education, and absence of MVC remained statistically significant. CONCLUSION: Psychological factors and level of societal participation predicted increased NBS as compared with injury severity and time since injury.


Assuntos
Concussão Encefálica/psicologia , Depressão/epidemiologia , Autorrelato/estatística & dados numéricos , Adulto , Concussão Encefálica/complicações , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Participação Social , Veteranos/psicologia
12.
J Headache Pain ; 21(1): 62, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493206

RESUMO

BACKGROUND: Calcitonin gene-related peptide (CGRP) has recently been implicated in the pathogenesis of post-traumatic headache (PTH), which raises the prospect for therapeutic use of monoclonal antibodies targeting CGRP or its receptor. Therefore, we decided to assess the efficacy, tolerability, and safety of erenumab for prevention of persistent PTH attributed to mild traumatic brain injury. METHODS: A single-center, non-randomized, single-arm, open-label study of erenumab for adults aged 18-65 years with persistent PTH. Patients were assigned to receive 140-mg erenumab monthly by two subcutaneous 1-mL injections, given every 4 weeks for 12 weeks. The primary outcome measure was the mean change in number of monthly headache days of moderate to severe intensity from baseline (4-week pretreatment period) to week 9 through 12. Tolerability and safety endpoints were adverse events (i.e. number and type). RESULTS: Eighty-nine of 100 patients completed the open-label trial. At baseline, the mean monthly number of headache days of moderate to severe intensity was 15.7. By week 9 through 12, the number was reduced by 2.8 days. The most common adverse events were constipation (n = 30) and injection-site reactions (n = 15). Of 100 patients who received at least one dose of erenumab, two patients discontinued the treatment regimen due to adverse events. CONCLUSIONS: Among patients with persistent PTH, erenumab resulted in a lower frequency of moderate to severe headache days in this 12-week open-label trial. In addition, erenumab was well-tolerated as discontinuations due to adverse events were low. Placebo-controlled randomized clinical trials are needed to adequately evaluate the efficacy and safety of erenumab in patients with persistent PTH. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT03974360. Registered on April 17, 2019 - Retrospectively registered.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Concussão Encefálica/diagnóstico , Concussão Encefálica/tratamento farmacológico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Cefaleia Pós-Traumática/diagnóstico , Cefaleia Pós-Traumática/tratamento farmacológico , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Concussão Encefálica/complicações , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Cefaleia Pós-Traumática/etiologia , Resultado do Tratamento , Adulto Jovem
13.
Clin Rehabil ; 34(5): 688-697, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366207

RESUMO

OBJECTIVE: To investigate whether the 'Brains Ahead! Intervention for children and adolescents with mild traumatic brain injury' was implemented as intended. In addition, involvement in and satisfaction with the intervention among patients, caregivers and professionals delivering the intervention were studied. DESIGN: Mixed methods, prospective study. PARTICIPANTS: Children with mild traumatic brain injury and their caregivers, allocated to the intervention group of the randomized controlled trial in the 'Brains Ahead!' study, and the two professionals providing the intervention. INTERVENTION: The intervention consists of a standardized and individualized psychoeducational session with written take-home information, and follow-up telephone call(s). MAIN MEASURES: Registration forms, evaluation questionnaires for patients and caregivers and semi-structured interviews for professionals. DATA ANALYSIS: Qualitative data were categorized based on content. Quantitative data were reported as descriptive statistics. RESULTS: Fifty-five patients and caregivers out of 60 study-participants attended both sessions. All elements of the intervention were delivered to 53 study-participants. Evaluation questionnaires were completed by 21 of the 31 patients aged 12 years and older, and by 41 caregivers. Overall, the sessions were considered useful by 19 patients, 40 caregivers and both professionals. Reassurance, creating a better understanding and recognition of symptoms were rated as important aspects. On a scale from 1 to 10, the intervention was rated by children, caregivers and professionals with 7.6 (SD 1.2), 8.1 (SD .9) and 8.0 (SD .0), respectively. CONCLUSION: The 'Brains Ahead!' intervention was largely implemented as intended and the process evaluation revealed that it is considered feasible according to patients, caregivers and professionals.


Assuntos
Terapia Comportamental/métodos , Concussão Encefálica/reabilitação , Educação de Pacientes como Assunto/métodos , Adolescente , Concussão Encefálica/complicações , Concussão Encefálica/psicologia , Cuidadores , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Países Baixos , Satisfação do Paciente , Avaliação de Processos em Cuidados de Saúde , Estudos Prospectivos
14.
Dev Neuropsychol ; 45(3): 110-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32419513

RESUMO

Increased focus on sports-related concussion (SRC) in football in the media, and mandatory concussion education for parents of youth sport athletes, may result in parental concern that youth athletes will experience long-term effects from concussion. We sought to identify beliefs about long-term effects of concussion in parents of youth soccer athletes. Four hundred and eleven parents from soccer leagues in three states completed a survey assessing parents' perceptions and knowledge of long-term effects of SRC. Nearly all youth soccer parents surveyed (96.5%) believe there are long-term effects from SRCs, 76% reported concern their child would sustain a concussion, and 71% had talked with their child about concussion symptoms/reporting. Parents ranked tackle football as having the highest risk for concussion, followed by soccer, ice hockey, cheerleading, and lacrosse. Parents of children that had previously sustained a concussion were 8.3x more likely to be concerned their child would sustain a concussion, and parents with a personal history of concussion were 2x more likely to consider not allowing their child to participate in youth sports. There are wide-spread beliefs among youth soccer parents regarding long-term effects of SRCs, and concerns their children will sustain concussions while participating in youth sports.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Pais/psicologia , Futebol/fisiologia , Criança , Feminino , Humanos , Masculino , Inquéritos e Questionários
15.
Neurology ; 94(23): e2412-e2423, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32461282

RESUMO

OBJECTIVE: To measure exosomal and plasma levels of candidate blood biomarkers in veterans with history of mild traumatic brain injury (mTBI) and test their relationship with chronic symptoms. METHODS: Exosomal and plasma levels of neurofilament light (NfL) chain, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and vascular endothelial growth factor (VEGF) were measured using an ultrasensitive assay in a cohort of 195 veterans, enrolled in the Chronic Effects of Neurotrauma Consortium Longitudinal Study. We examined relationships between candidate biomarkers and symptoms of postconcussive syndrome (PCS), posttraumatic stress disorder (PTSD), and depression. Biomarker levels were compared among those with no traumatic brain injury (TBI) (controls), 1-2 mTBIs, and repetitive (3 or more) mTBIs. RESULTS: Elevated exosomal and plasma levels of NfL were associated with repetitive mTBIs and with chronic PCS, PTSD, and depression symptoms. Plasma TNF-α levels correlated with PCS and PTSD symptoms. The total number of mTBIs correlated with exosomal and plasma NfL levels and plasma IL-6. Increased number of years since the most recent TBI correlated with higher exosomal NfL and lower plasma IL-6 levels, while increased number of years since first TBI correlated with higher levels of exosomal and plasma NfL, as well as plasma TNF-α and VEGF. CONCLUSION: Repetitive mTBIs are associated with elevated exosomal and plasma levels of NfL, even years following these injuries, with the greatest elevations in those with chronic PCS, PTSD, and depression symptoms. Our results suggest a possible neuroinflammatory and axonal disruptive basis for symptoms that persist years after mTBI, especially repetitive.


Assuntos
Concussão Encefálica/sangue , Exossomos/química , Proteínas de Neurofilamentos/sangue , Saúde dos Veteranos , Veteranos , Adulto , Biomarcadores , Traumatismos por Explosões/sangue , Traumatismos por Explosões/complicações , Concussão Encefálica/complicações , Estudos Transversais , Depressão/sangue , Depressão/etiologia , Feminino , Seguimentos , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Concussão/sangue , Síndrome Pós-Concussão/etiologia , Prognóstico , Degeneração Retrógrada , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/sangue , Transtornos de Estresse Pós-Traumáticos/etiologia , Fator de Necrose Tumoral alfa/análise , Fator A de Crescimento do Endotélio Vascular/sangue , Guerra
16.
Neuropsychology ; 34(5): 560-568, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32271043

RESUMO

OBJECTIVE: To investigate (a) whether self-reported cognitive symptoms after mild traumatic brain injury (MTBI) are associated with cognitive test performances, and (b) whether improvement in self-reported symptoms from 2 weeks to 3 months after MTBI is associated with improvement in cognitive test performances. METHOD: Patients with MTBI (n = 135), aged 16-59, who initially presented to the emergency department, completed the Rivermead Post Concussion Symptoms Questionnaire (RPQ), the Brief Symptom Inventory 18, and cognitive tests (i.e., Controlled Oral Word Association, Coding, Rey Auditory Verbal Learning, and Trail Making test) at 2 weeks and 3 months after MTBI. Using Spearman's rank correlations (ρ), associations were examined between self-report measures and cognitive test performances at each time point and between change scores (i.e., 3-month score minus 2-week score) on each outcome. RESULTS: At 3 months, 27% reported cognitive symptoms to some extent. At both assessments, greater severity of RPQ cognitive symptoms was very weakly associated with worse cognitive test performances (2-week ρ range = -0.19 to -0.01; 3-month ρ range = -0.20 to -0.10). RPQ cognitive symptoms were, however, strongly related to greater somatic and emotional symptoms. Change in self-reported cognitive symptoms from 2 weeks to 3 months was not associated with change in cognitive test performance. In contrast, change in self-reported cognitive symptoms was strongly associated with change in emotional (ρ = 0.58) and somatic symptoms (ρ = 0.57). CONCLUSIONS: These findings indicate that improvements in subjective cognitive symptoms after MTBI co-occur with improvements on other subjective metrics, but are not related to improvements in objectively measured cognitive functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Concussão Encefálica/psicologia , Cognição/fisiologia , Emoções/fisiologia , Síndrome Pós-Concussão/psicologia , Adolescente , Adulto , Concussão Encefálica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Síndrome Pós-Concussão/diagnóstico , Autorrelato , Inquéritos e Questionários , Adulto Jovem
17.
J Clin Neurosci ; 76: 126-133, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32299773

RESUMO

OBJECTIVE: The clinical epidemiology of organ outcomes in pediatric traumatic brain injury (TBI) has not been examined. We describe associated markers of cerebral, cardiac and renal injury after pediatric TBI. DESIGN: Prospective observational study. PATIENTS: Children 0-18 years who were hospitalized with TBI. MEASUREMENTS: Measures of myocardial (at least one elevated plasma troponin [cTnI] ≥ 0.4 ng/ml) and multiorgan (hemodynamic variables, cerebral perfusion, and renal) function were examined within the first ten days of hospital admission and within 24 h of each other. MAIN RESULTS: Data from 28 children who were 11[IQR 10.3] years, male (64.3%), with isolated TBI (67.9%), injury severity score (ISS) 25[10], and admission Glasgow coma score (GCS) 11[9] were examined. Overall, 50% (14 children) had elevated cTnI, including those with isolated TBI (57.9%; 11/19), polytrauma (33.3%; 3/9), mild TBI (57.1% 8/14), and severe TBI (42.9%; 6/11). Elevated cTnI occurred within the first six days of admission and across all age groups, in both sexes, and regardless of TBI lesion type, GCS, and ISS. Age-adjusted admission tachycardia was associated with cTnI elevation (AUC 0.82; p < 0.001). Reduced urine output occurred more commonly in patients with isolated TBI (27.3% elevated cTnI vs. 0% normal cTnI). CONCLUSIONS: Myocardial injury commonly occurs during the first six days after pediatric TBI irrespective of injury severity, age, sex, TBI lesion type, or polytrauma. Age-adjusted tachycardia may be a clinical indicator of myocardial injury, and elevated troponin may be associated with cardio-cerebro-renal dysfunction.


Assuntos
Escala de Coma de Glasgow , Escala de Gravidade do Ferimento , Taquicardia/complicações , Adolescente , Biomarcadores/sangue , Concussão Encefálica/sangue , Concussão Encefálica/complicações , Lesões Encefálicas Traumáticas/sangue , Síndrome Cardiorrenal , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Rim/lesões , Masculino , Escores de Disfunção Orgânica , Estudos Prospectivos , Taquicardia/etiologia , Troponina I/sangue
18.
J Headache Pain ; 21(1): 33, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295535

RESUMO

BACKGROUND: Close associations between insomnia with other clinical factors have been identified in migraine, but there have been few studies investigating associations between insomnia and clinical factors in patients with persistent post-traumatic headache (PPTH). The study objective was to contrast the severity of insomnia symptoms in PPTH, migraine, and healthy controls, and to identify factors associated with insomnia in patients with PPTH vs. migraine. METHODS: In this cross-sectional cohort study, 57 individuals with PPTH attributed to mild traumatic brain injury, 39 with migraine, and 39 healthy controls were included. Participants completed a detailed headache characteristics questionnaire, the Migraine Disability Assessment Scale (MIDAS), Insomnia Severity Index (ISI), Hyperacusis Questionnaire (HQ), Allodynia Symptom Checklist, Photosensitivity Assessment Questionnaire, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Post-Traumatic Stress Disorder (PTSD) checklist, Ray Auditory Verbal Learning Test, and the Trail Making Test A and B to assess headache characteristics, disability, insomnia symptoms, sensory hypersensitivities, and neuropsychological factors. Fisher's test and one-way ANOVA or Tukey's Honest Significant Difference were used to assess group differences of categorical and continuous data. Stepwise linear regression analyses were conducted to identify clinical variables associated with insomnia symptoms. RESULTS: Those with PPTH had significantly higher ISI scores (16.7 ± 6.6) compared to migraine patients (11.3 ± 6.4) and healthy controls (4.1 ± 4.8) (p <  0.001). For those with PPTH, insomnia severity was most strongly correlated with the BDI (Spearman's rho (ρ) = 0.634, p <  0.01), followed by Trait Anxiety (ρ = 0.522, p <  0.01), PTSD (ρ = 0.505, p <  0.01), HQ (ρ = 0.469, p <  0.01), State Anxiety (ρ = 0.437, p <  0.01), and MIDAS scores (ρ = 0.364, p <  0.01). According to linear regression models, BDI, headache intensity, and hyperacusis scores were significantly positively associated with insomnia severity in those with PPTH, while only delayed memory recall was negatively associated with insomnia severity in those with migraine. CONCLUSIONS: Insomnia symptoms were more severe in those with PPTH compared to migraine and healthy control cohorts. Depression, headache intensity, and hyperacusis were associated with insomnia in individuals with PPTH. Future studies should determine the bidirectional impact of treating insomnia and its associated symptoms.


Assuntos
Concussão Encefálica/complicações , Transtornos de Enxaqueca/complicações , Cefaleia Pós-Traumática/complicações , Distúrbios do Início e da Manutenção do Sono/complicações , Adulto , Concussão Encefálica/fisiopatologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Testes Neuropsicológicos , Cefaleia Pós-Traumática/fisiopatologia , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Inquéritos e Questionários
19.
Clin Pediatr (Phila) ; 59(6): 580-587, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32297793

RESUMO

This study examined the relationship between postconcussive symptom domain and school attendance. Retrospective chart review was completed for 88 children aged 6 to 18 years who were evaluated within 30 days postinjury. Hierarchical multiple regression was used to assess the association of physical, cognitive, emotional, and sleep symptoms with extent of school attendance. A subgroup multiple regression analysis was conducted to evaluate whether age affected the relationship of symptoms to school attendance. After controlling for demographic variables and total number of symptoms, a higher number of postconcussive sleep symptoms strongly predicted less school attendance. Specifically, older children (≥14 years old) with more sleep symptoms demonstrated less school attendance. For children presenting for specialty care after concussion, sleep symptoms are unfavorably associated with return to school. Future work aimed at optimizing sleep regulation following concussion may assist with early reengagement in school as recommended by current concussion management guidelines.


Assuntos
Absenteísmo , Concussão Encefálica/complicações , Transtornos do Sono-Vigília/etiologia , Adolescente , Fatores Etários , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Instituições Acadêmicas , Sono
20.
J Orthop Sports Phys Ther ; 50(4): CPG1-CPG73, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32241234

RESUMO

Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therapy management of concussion and its associated impairments. Further, many of these guidance documents have targeted specific populations in specific care contexts. The primary purpose of this CPG is to provide a set of evidence-based recommendations for physical therapist management of the wide spectrum of patients who have experienced a concussive event. J Orthop Sports Phys Ther 2020;50(4):CPG1-CPG73. doi:10.2519/jospt.2020.0301.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Modalidades de Fisioterapia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Medicina Baseada em Evidências , Humanos , Educação de Pacientes como Assunto
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