Sports-related brain injury in the general population: An epidemiological study

Objectives To determine the incidence, nature and severity of all sports-related brain injuries in the general population. Design Population-based epidemiological incidence study. Methods Data on all traumatic brain injury events sustained during a sports-related activity were extracted from a dataset of all new traumatic brain injury cases (both fatal and non-fatal), identified over a one-year period in the Hamilton and Waikato districts of New Zealand. Prospective and retrospective case ascertainment methods from multiple sources were used. All age groups and levels of traumatic brain injury severity were included. Details of the registering injuries and recurrent injuries sustained over the subsequent year were obtained through medical/accident records and assessment interviews with participants. Results Of 1369 incident traumatic brain injury cases, 291 were identified as being sustained during a sports-related activity (21% of all traumatic brain injuries) equating to an incidence rate of 170 per 100,000 of the general population. Recurrent injuries occurred more frequently in adults (11%) than children (5%). Of the sports-related injuries 46% were classified as mild with a high risk of complications. Injuries were most frequently sustained during rugby, cycling and equestrian activities. It was revealed that up to 19% of traumatic brain injuries were not recorded in medical notes. Conclusions Given the high incidence of new and recurrent traumatic brain injury and the high risk of complications following injury, further sport specific injury prevention strategies are urgently needed to reduce the impact of traumatic brain injury and facilitate safer engagement in sports activities. The high levels of ‘missed’ traumatic brain injuries, highlights the importance in raising awareness of traumatic brain injury during sports-related activity in the general population

Position-Dependent Urinary Retention in a Traumatic Brain Injury Patient: A Case Report

INTRODUCTION: Voiding disorders are common complication after traumatic brain injury. Usually, they are caused by neurogenic bladder although they can also occur as a result of other pathologic processes and conditions as well as side effects of medications. CASE PRESENTATION: A 62-year-old traumatic brain injury patient with position-dependent urinary retention is presented in this article. Neurogenic bladder with detrusor sphincter dyssynergia was suspected initially, with detection of multiple small bladder stones as the final cause of his urinary retention afterwards. CONCLUSION: Careful clinical, imaging, and urodynamic evaluation must be performed in traumatic brain injury patients to exclude the coexistence of two or more factors leading to urinary dysfunction in this population group

Prevention Strategies of Traumatic Brain Injury in Football Players

In this project, we study the effects of the impact angle during a helmet-to-helmet collision on stress distribution and deacceleration values of the brain tissue in efforts to reduce brain injuries for football players. The overall goal is to provide sufficient information to improve the design of helmet technology. In addition, our study will be able to inform the athletes to avoid a helmet-to-helmet collision, such that, they can be trained to shift their heads in the horizontal direction to create a “glancing blow” effect. It is suggested that by avoiding a helmet-to-helmet collision, both rotational acceleration and stress can be reduced leading to a lower probability of receiving concussions and subsequent brain injuries [1].Cockrell School of Engineerin

The Auditory Radiation in Traumatic Brain Damage: Diffusion Tensor Imaging Study

Hearing loss is a known symptom among people who suffer from traumatic brain injuries. Studies have shown that sensorineural hearing loss is the most common type of hearing loss resulting from traumatic brain injury. However, it is not well understood whether the auditory pathway is affected by traumatic brain injury. In this study, we examined the auditory radiation, using diffusion tensor imaging data and probabilistic tractography. Fifty-three veterans with traumatic brain injury and forty-four veterans without traumatic brain injury are compared. There was no significant difference in fractional anisotropy of the auditory radiation between those with and without traumatic brain injury. It is suggested that the auditory radiation is not impacted by traumatic brain injury, while sensorineural hearing loss is commonly found in individuals with traumatic brain injury

Determinants of recovery after traumatic brain injury:a neuropsychological perspective on symptoms across the severity spectrum

Annually, approximately 85.000 people in the Netherlands sustain a traumatic brain injury, also known as a concussion (mild traumatic brain injury) or a contusion (moderate to severe traumatic brain injury). There is great variation in the way people recover after a traumatic brain injury.Sandra Rakers' PhD research focused on further elucidating important factors that can influence recovery. Cognitive functions, fatigue, coping, anxiety, depression and neuroimaging measures were examined. It turned out that a slower mental pace after a more severe traumatic brain injury was associated with more cognitive effort and therefore higher mental fatigue. In contrast, in patients with a mild traumatic brain injury, fatigue symptoms were found to be strongly associated with psychological distress and reverting to passive coping strategies. Within the group of patients with a mild traumatic brain injury, different subgroups were present that differed with regard to the factors that influence recovery. The effect of executive disorders on the use of active coping strategies appeared to be limited. Furthermore, neuroimaging measures did not provide a clear explanation for clinical recovery after mild traumatic brain injury. Taken together, patients with mild traumatic brain injury and patients with moderate to severe traumatic brain injury should be approached as separate patient groups and each deserves tailored care

Decompressive Craniectomy Is Associated With Good Quality of Life Up to 10 Years After Rehabilitation From Traumatic Brain Injury

OBJECTIVES Traumatic brain injury is the number one cause of death in children and young adults and has become increasingly prevalent in the elderly. Decompressive craniectomy prevents intracranial hypertension but does not clearly improve physical outcome 6 months after traumatic brain injury. However, it has not been analyzed if decompressive craniectomy affects traumatic brain injury patients' quality of life in the long term. DESIGN Therefore, we conducted a cross-sectional study assessing health-related quality of life in traumatic brain injury patients with or without decompressive craniectomy up to 10 years after injury. SETTING Former critical care patients. PATIENTS Chronic traumatic brain injury patients having not (n = 37) or having received (n = 98) decompressive craniectomy during the acute treatment. MEASUREMENTS AND MAIN RESULTS The Quality of Life after Brain Injury questionnaire was used as outcome measure with a total score from zero to 100, representing lowest and best health-related quality of life, respectively. Health-related quality of life was compared between patients with or without decompressive craniectomy for the entire cohort, for the traumatic brain injury severity (mild, moderate, severe) measured by the initial Glasgow Coma Scale, for age and time variables (age at traumatic brain injury, age at survey, elapsed time since traumatic brain injury) using the Mann-Whitney U test. Differences were considered significant at a p value of less than 0.05.Decompressive craniectomy was necessary in all initial traumatic brain injury severity groups. Eight percent more decompressive craniectomy patients reported good health-related quality of life with a Quality of Life after Brain Injury total score greater than or equal to 60 compared with the no decompressive craniectomy patients up to 10 years after traumatic brain injury (p = 0.004). Initially, mild classified traumatic brain injury patients had a median Quality of Life after Brain Injury total score of 83 (decompressive craniectomy) versus 62 (no decompressive craniectomy) (p = 0.028). Health-related quality of life regarding physical status was better in decompressive craniectomy patients (p = 0.025). Decompressive craniectomy showed a trend toward better health-related quality of life in the 61-85-year-old reflected by median Quality of Life after Brain Injury total scores of 62 (no decompressive craniectomy) versus 79 (decompressive craniectomy) (p = 0.06). CONCLUSIONS Our results suggest that decompressive craniectomy is associated with good health-related quality of life up to 10 years after traumatic brain injury. Thus, decompressive craniectomy may have an underestimated therapeutic potential after traumatic brain injury

Structural and functional connectivity of the whole brain and subnetworks in individuals with mild traumatic brain injury:Predictors of patient prognosis

Patients with mild traumatic brain injury have a diverse clinical presentation, and the underlying pathophysiology remains poorly understood. Magnetic resonance imaging is a non-invasive technique that has been widely utilized to investigate neurobiological markers after mild traumatic brain injury. This approach has emerged as a promising tool for investigating the pathogenesis of mild traumatic brain injury. Graph theory is a quantitative method of analyzing complex networks that has been widely used to study changes in brain structure and function. However, most previous mild traumatic brain injury studies using graph theory have focused on specific populations, with limited exploration of simultaneous abnormalities in structural and functional connectivity. Given that mild traumatic brain injury is the most common type of traumatic brain injury encountered in clinical practice, further investigation of the patient characteristics and evolution of structural and functional connectivity is critical. In the present study, we explored whether abnormal structural and functional connectivity in the acute phase could serve as indicators of longitudinal changes in imaging data and cognitive function in patients with mild traumatic brain injury. In this longitudinal study, we enrolled 46 patients with mild traumatic brain injury who were assessed within 2 weeks of injury, as well as 36 healthy controls. Resting-state functional magnetic resonance imaging and diffusion-weighted imaging data were acquired for graph theoretical network analysis. In the acute phase, patients with mild traumatic brain injury demonstrated reduced structural connectivity in the dorsal attention network. More than 3 months of followup data revealed signs of recovery in structural and functional connectivity, as well as cognitive function, in 22 out of the 46 patients. Furthermore, better cognitive function was associated with more efficient networks. Finally, our data indicated that small-worldness in the acute stage could serve as a predictor of longitudinal changes in connectivity in patients with mild traumatic brain injury. These findings highlight the importance of integrating structural and functional connectivity in understanding the occurrence and evolution of mild traumatic brain injury. Additionally, exploratory analysis based on subnetworks could serve a predictive function in the prognosis of patients with mild traumatic brain injury.</p

Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial

Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial

Detection of blast-related traumatic brain injury in U.S. military personnel

BACKGROUND: Blast-related traumatic brain injuries have been common in the Iraq and Afghanistan wars, but fundamental questions about the nature of these injuries remain unanswered. METHODS: We tested the hypothesis that blast-related traumatic brain injury causes traumatic axonal injury, using diffusion tensor imaging (DTI), an advanced form of magnetic resonance imaging that is sensitive to axonal injury. The subjects were 63 U.S. military personnel who had a clinical diagnosis of mild, uncomplicated traumatic brain injury. They were evacuated from the field to the Landstuhl Regional Medical Center in Landstuhl, Germany, where they underwent DTI scanning within 90 days after the injury. All the subjects had primary blast exposure plus another, blast-related mechanism of injury (e.g., being struck by a blunt object or injured in a fall or motor vehicle crash). Controls consisted of 21 military personnel who had blast exposure and other injuries but no clinical diagnosis of traumatic brain injury. RESULTS: Abnormalities revealed on DTI were consistent with traumatic axonal injury in many of the subjects with traumatic brain injury. None had detectible intracranial injury on computed tomography. As compared with DTI scans in controls, the scans in the subjects with traumatic brain injury showed marked abnormalities in the middle cerebellar peduncles (P<0.001), in cingulum bundles (P = 0.002), and in the right orbitofrontal white matter (P = 0.007). In 18 of the 63 subjects with traumatic brain injury, a significantly greater number of abnormalities were found on DTI than would be expected by chance (P<0.001). Follow-up DTI scans in 47 subjects with traumatic brain injury 6 to 12 months after enrollment showed persistent abnormalities that were consistent with evolving injuries. CONCLUSIONS: DTI findings in U.S. military personnel support the hypothesis that blast-related mild traumatic brain injury can involve axonal injury. However, the contribution of primary blast exposure as compared with that of other types of injury could not be determined directly, since none of the subjects with traumatic brain injury had isolated primary blast injury. Furthermore, many of these subjects did not have abnormalities on DTI. Thus, traumatic brain injury remains a clinical diagnosis. (Funded by the Congressionally Directed Medical Research Program and the National Institutes of Health; ClinicalTrials.gov number, NCT00785304.

Hypopituitarism following traumatic brain injury

Traumatic brain injury (TBI) is a worldwide public health problem and an important cause of hypopituitarism. The incidence of hypopituitarism following moderate to severe TBI varies in different studies and may occur as multiple or isolated hormonal deficiencies, with gonadotrophin and growth hormone insufficiencies predominating, particularly in the acute setting. Adrenocorticotropic hormone deficiency is also common during the recovery phase. Pituitary function assessment in the acute phase post TBI is subject to multiple caveats and pitfalls due to hormonal alterations which occur as normal physiological responses to critical illness and the effects of drugs that are used in the intensive care unit. Nonetheless, assessment of the hypothalamo-pituitary-adrenal axis is of paramount importance during this period. Predictors of hypopituitarism during the acute phase of TBI remain unclear - further research is warranted.peer-reviewe