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633 KiB

Open AccessFeature PaperArticle

Autonomic Dysfunction after Mild Traumatic Brain Injury

by Dmitry Esterov and Brian D. Greenwald

Brain Sci. 2017, 7(8), 100; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7080100 - 11 Aug 2017

Cited by 111 | Viewed by 18931

A mild traumatic brain injury (mTBI) is a complex pathophysiologic process that has a systemic effect on the body aside from solely an impairment in cognitive function. Dysfunction of the autonomic nervous system (ANS) has been found to induce abnormalities in organ systems [...] Read more.

A mild traumatic brain injury (mTBI) is a complex pathophysiologic process that has a systemic effect on the body aside from solely an impairment in cognitive function. Dysfunction of the autonomic nervous system (ANS) has been found to induce abnormalities in organ systems throughout the body, and may contribute to cardiovascular dysregulation and increased mortality. Autonomic dysfunction, also known as dysautonomia, has been studied in moderate and severe TBI, and has emerged as a major contributing factor in the symptomatology in mTBI as well. Analysis of the ANS has been studied through changes in heart rate variability (HRV), pupillary dynamics, eye pressure, and arterial pulse wave in those with mild TBI. Graded exercise testing has been studied as both a method of diagnosis and as a means of recovery in those with mild TBI, especially in those with persistent symptoms. Given the studies showing persistence of autonomic dysfunction after symptomatic resolution of concussions, further research is needed to establish return to play protocols. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessArticle

A Novel Computer Oculomotor Rehabilitation (COR) Program for Mild Traumatic Brain Injury (mTBI)

by Kenneth J. Ciuffreda, Naveen K. Yadav, Preethi Thiagarajan and Diana P. Ludlam

Brain Sci. 2017, 7(8), 99; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7080099 - 09 Aug 2017

Cited by 5 | Viewed by 5476

Abstract

Individuals with traumatic brain injury (TBI) manifest a wide range of visual dysfunctions. One of the most prevalent involves the oculomotor system, which includes version, vergence, and accommodation. However, until recently, there has been no comprehensive, computer-based program for remediation of these oculomotor [...] Read more.

Individuals with traumatic brain injury (TBI) manifest a wide range of visual dysfunctions. One of the most prevalent involves the oculomotor system, which includes version, vergence, and accommodation. However, until recently, there has been no comprehensive, computer-based program for remediation of these oculomotor deficits. We present such an oculomotor rehabilitation program that has been tested in a clinical trial in patients having TBI with a high degree of success based on before-and-after objective system recordings, performance measures, and related visual symptomotology. The basic program components include a versatile stimulus package incorporating the attentional paradigm of rapid serial visual presentation (RSVP), the ability to add a visual and/or auditory distractor to the training to increase difficulty level (“task loading”), automated assessment of RSVP errors, and automated assessment of visual performance over the training period. Program limitations and future directions are also considered. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessArticle

Multiple Mild Traumatic Brain Injuries Are Associated with Increased Rates of Health Symptoms and Gulf War Illness in a Cohort of 1990–1991 Gulf War Veterans

by Megan K. Yee, Patricia A. Janulewicz, Daniel R. Seichepine, Kimberly A. Sullivan, Susan P. Proctor and Maxine H. Krengel

Brain Sci. 2017, 7(7), 79; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7070079 - 09 Jul 2017

Cited by 30 | Viewed by 5814

Abstract

Recent research demonstrated a relation between traumatic brain injury (TBI), health symptoms and diagnosis of Gulf War Illness (GWI) in Gulf War Veterans, but no study has examined the impact of multiple mild TBIs (mTBIs). A total of 229 male Gulf War Veterans [...] Read more.

Recent research demonstrated a relation between traumatic brain injury (TBI), health symptoms and diagnosis of Gulf War Illness (GWI) in Gulf War Veterans, but no study has examined the impact of multiple mild TBIs (mTBIs). A total of 229 male Gulf War Veterans from the Ft Devens Cohort were categorized by a number of mTBIs reported. One-way ANOVA and chi-square test of independence were used to test for differences in total reported health symptoms and diagnosis of chronic multisymptom illness (CMI) or Kansas GWI criteria, two of the most common case definitions of GWI. A total of 72 veterans reported no mTBIs (31.4%), 26 reported one mTBI (11.4%), 25 reported two mTBIs (10.9%), and 106 veterans reported sustaining three or more mTBIs (46.3%). Veterans reporting two or more mTBIs (p < 0.01) or three or more mTBIs (p < 0.001) endorsed significantly higher rates of health symptoms than Veterans reporting no mTBIs. Significantly higher rates of CMI (p = 0.035) and Kansas GWI criteria (p < 0.001) were seen in the three or more mTBI group. Results suggest two mTBIs increase risk of health symptoms, but three mTBIs may be the threshold needed to sustain chronic symptom reporting needed for a formal diagnosis. These findings highlight the importance of implementing policies and procedures monitoring head injuries in military personnel. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessArticle

Validation of Acoustic Wave Induced Traumatic Brain Injury in Rats

by Sean Berman, Toni L. Uhlendorf, David K. Mills, Elliot B. Lander, Mark H. Berman and Randy W. Cohen

Brain Sci. 2017, 7(6), 59; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7060059 - 02 Jun 2017

Cited by 3 | Viewed by 5490

Abstract

Background: This study looked to validate the acoustic wave technology of the Storz-D-Actor that inflicted a consistent closed-head, traumatic brain injury (TBI) in rats. We studied a range of single pulse pressures administered to the rats and observed the resulting decline in motor [...] Read more.

Background: This study looked to validate the acoustic wave technology of the Storz-D-Actor that inflicted a consistent closed-head, traumatic brain injury (TBI) in rats. We studied a range of single pulse pressures administered to the rats and observed the resulting decline in motor skills and memory. Histology was observed to measure and confirm the injury insult. Methods: Four different acoustic wave pressures were studied using a single pulse: 0, 3.4, 4.2 and 5.0 bar (n = 10 rats per treatment group). The pulse was administered to the left frontal cortex. Rotarod tests were used to monitor the rats’ motor skills while the water maze test was used to monitor memory deficits. The rats were then sacrificed ten days post-treatment for histological analysis of TBI infarct size. Results: The behavioral tests showed that acoustic wave technology administered an effective insult causing significant decreases in motor abilities and memory. Histology showed dose-dependent damage to the cortex infarct areas only. Conclusions: This study illustrates that the Storz D-Actor effectively induces a repeatable TBI infarct, avoiding the invasive procedure of a craniotomy often used in TBI research. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Review

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Open AccessReview

A Review of Chronic Pain and Cognitive, Mood, and Motor Dysfunction Following Mild Traumatic Brain Injury: Complex, Comorbid, and/or Overlapping Conditions?

by Ramesh Grandhi, Samon Tavakoli, Catherine Ortega and Maureen J. Simmonds

Brain Sci. 2017, 7(12), 160; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7120160 - 06 Dec 2017

Cited by 36 | Viewed by 7087

Abstract

Mild traumatic brain injury (mTBI) is commonly encountered in clinical practice. While the cognitive ramifications of mTBI are frequently described in the literature, the impact of mTBI on emotional, sensory, and motor function is not as commonly discussed. Chronic pain is a phenomenon [...] Read more.

Mild traumatic brain injury (mTBI) is commonly encountered in clinical practice. While the cognitive ramifications of mTBI are frequently described in the literature, the impact of mTBI on emotional, sensory, and motor function is not as commonly discussed. Chronic pain is a phenomenon more prevalent among patients with mTBI compared to those with moderate or severe traumatic brain injury. Chronic pain can become a primary disorder of the central nervous system (CNS) expressed as widespread pain, and cognitive, mood, and movement dysfunction. Shared mechanisms across chronic pain conditions can account for how pain is generated and maintained in the CNS, irrespective of the underlying structural pathology. Herein, we review the impact of mTBI on cognitive, emotional, sensory, and motor domains, and the role of pain as an important confounding variable in patient recovery and dysfunction following mTBI. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessReview

Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

by Carolyn Prince and Maya E. Bruhns

Brain Sci. 2017, 7(8), 105; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7080105 - 17 Aug 2017

Cited by 136 | Viewed by 17074

Abstract

Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide [...] Read more.

Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessReview

Binasal Occlusion (BNO), Visual Motion Sensitivity (VMS), and the Visually-Evoked Potential (VEP) in mild Traumatic Brain Injury and Traumatic Brain Injury (mTBI/TBI)

by Kenneth J. Ciuffreda, Naveen K. Yadav and Diana P. Ludlam

Brain Sci. 2017, 7(8), 98; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7080098 - 09 Aug 2017

Cited by 11 | Viewed by 9361

Abstract

The diagnosis and treatment of the possible visual sequelae in those with traumatic brain injury (TBI) represents an important area of health care in this special population. One of their most prevalent yet elusive visual symptoms is visual motion sensitivity (VMS). In this [...] Read more.

The diagnosis and treatment of the possible visual sequelae in those with traumatic brain injury (TBI) represents an important area of health care in this special population. One of their most prevalent yet elusive visual symptoms is visual motion sensitivity (VMS). In this review, we present the basic VMS phenomenon and its related symptoms, clinical studies in the area, clinical research investigations using the visual-evoked potential (VEP) as a cortical probe, and possible mechanisms and related neurophysiology that may underlie VMS. Lastly, therapeutic interventions are briefly described, as well as future directions for clinical research and patient care in those with VMS and TBI. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessReview

Coagulopathy in the Setting of Mild Traumatic Brain Injury: Truths and Consequences

by Joseph P. Herbert, Andrew R. Guillotte, Richard D. Hammer and N. Scott Litofsky

Brain Sci. 2017, 7(7), 92; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7070092 - 22 Jul 2017

Cited by 25 | Viewed by 6720

Abstract

Mild traumatic brain injury (mTBI) is a common, although poorly-defined clinical entity. Despite its initially mild presentation, patients with mTBI can rapidly deteriorate, often due to significant expansion of intracranial hemorrhage. TBI-associated coagulopathy is the topic of significant clinical and basic science research. [...] Read more.

Mild traumatic brain injury (mTBI) is a common, although poorly-defined clinical entity. Despite its initially mild presentation, patients with mTBI can rapidly deteriorate, often due to significant expansion of intracranial hemorrhage. TBI-associated coagulopathy is the topic of significant clinical and basic science research. Unlike trauma-induced coagulopathy (TIC), TBI-associated coagulopathy does not generally follow widespread injury or global hypoperfusion, suggesting a distinct pathogenesis. Although the fundamental mechanisms of TBI-associated coagulopathy are far from clearly elucidated, several candidate molecules (tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), tissue factor (TF), and brain-derived microparticles (BDMP)) have been proposed which might explain how even minor brain injury can induce local and systemic coagulopathy. Here, we review the incidence, proposed mechanisms, and common clinical tests relevant to mTBI-associated coagulopathy and briefly summarize our own institutional experience in addition to identifying areas for further research. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessReview

Mini Review of Controlled Cortical Impact: A Well-Suited Device for Concussion Research

by Nicole Osier and C. Edward Dixon

Brain Sci. 2017, 7(7), 88; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7070088 - 20 Jul 2017

Cited by 13 | Viewed by 5808

Abstract

Mild traumatic brain injury (mTBI) is increasingly recognized as a significant public health problem which warrants additional research. Part of the effort to understand mTBI and concussion includes modeling in animals. Controlled cortical impact (CCI) is a commonly employed and well-characterized model of [...] Read more.

Mild traumatic brain injury (mTBI) is increasingly recognized as a significant public health problem which warrants additional research. Part of the effort to understand mTBI and concussion includes modeling in animals. Controlled cortical impact (CCI) is a commonly employed and well-characterized model of experimental TBI that has been utilized for three decades. Today, several commercially available pneumatic- and electromagnetic-CCI devices exist as do a variety of standard and custom injury induction tips. One of CCI’s strengths is that it can be scaled to a number of common laboratory animals. Similarly, the CCI model can be used to produce graded TBI ranging from mild to severe. At the mild end of the injury spectrum, CCI has been applied in many ways, including to study open and closed head mTBI, repeated injuries, and the long-term deficits associated with mTBI and concussion. The purpose of this mini-review is to introduce the CCI model, discuss ways the model can be applied to study mTBI and concussion, and compare CCI to alternative pre-clinical TBI models. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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Open AccessReview

Neurobehavioral Outcomes of Mild Traumatic Brain Injury: A Mini Review

by Robert Eme

Brain Sci. 2017, 7(5), 46; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci7050046 - 25 Apr 2017

Cited by 24 | Viewed by 5976

Abstract

Traumatic brain injury outcomes can be classified as acute or chronic. Acute outcomes refer to injuries that occur immediately at the time of the injury and subsequent short-term consequences. Chronic outcomes refer to adverse outcomes that are more long-term. In mild traumatic brain [...] Read more.

Traumatic brain injury outcomes can be classified as acute or chronic. Acute outcomes refer to injuries that occur immediately at the time of the injury and subsequent short-term consequences. Chronic outcomes refer to adverse outcomes that are more long-term. In mild traumatic brain injury, recovery from acute outcomes typically occurs very rapidly, i.e., within 2 weeks, with full recovery expected by 90 days. However, some 10%–15% individuals can remain symptomatic for much longer with an outcome termed post-concussive syndrome. This outcome is difficult to predict since there are very few rigorous, prospective studies of this syndrome. Full article

(This article belongs to the Special Issue Mild Traumatic Brain Injury (mTBI): Medical Treatments and Complications)

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