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Brain Sciences
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Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management

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Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neuropsychology".

Deadline for manuscript submissions: closed (30 October 2020) | Viewed by 23617

Special Issue Editor

Dr. Susanna Melkas

E-Mail Website
Guest Editor
Helsinki University Hospital, University of Helsinki, Helsinki, Finland
Interests: cerebral small vessel disease (stroke, vascular degeneration); traumatic brain injury; memory diseases; rehabilitation; Special competencies granted by The Finnish Medical Association: memory diseases, rehabilitation

Special Issue Information

Dear Colleagues,

There is increasing research interest in imaging and serum markers after mild and moderate traumatic brain injuries (TBIs). The clinical usefulness of emerging markers is under investigation. However, especially after a mild TBI, recovery is highly variable and many factors seem to play roles in recovery in addition to trauma itself, for example, preinjury factors, comorbidities and resilience.

Early intervention, including proper information and symptomatic treatment against headaches, neck pain, sleep disturbance, postural vertigo, visual disturbances and post-traumatic stress, is associated with faster recovery after a mild TBI. Timely interventions can inhibit secondary cognitive complications. However, when recovery is incomplete after a single mild TBI, differential diagnostics should be considered. The following questions should be asked: What factors have made the patient so vulnerable that the injury in question has been enough to precipitate incapability to return to normal life? How can these factors be addressed? What are the roles of the glymphatic system, sleep and physical exercise? On the other hand, it is also important to determine protective factors that are linked to favorable recovery after a moderate TBI.

This Special Issue of Brain Sciences, “Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery” aims to present a collection of studies detailing the latest research on the diagnosis, assessment, and management of, as well as the recovery from, mild and moderate TBIs. Authors are invited to submit relevant original research articles and review papers for inclusion.

Dr. Susanna Melkas
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mild traumatic brain injury
  • moderate traumatic brain injury
  • concussion
  • prognosis
  • post-traumatic stress disorder
  • post-traumatic headache
  • visual disturbances
  • sleeping disorders
  • neuropsychology

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Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

2 pages, 161 KiB  
Editorial
Can Trauma Condition Vulnerable Individuals to Develop Catatonic Symptoms?
by Jackson Hortenstine and Nagy Youssef
Brain Sci. 2020, 10(6), 354; https://doi.org/10.3390/brainsci10060354 - 8 Jun 2020
Cited by 2 | Viewed by 2481
Abstract
Limited research has been done on the risk and predisposing factors of catatonic symptoms induced by traumatic events. There seem to be two types or constructs of conditioning that predispose an individual to catatonic symptoms in response to traumatic events: external conditioning and [...] Read more.
Limited research has been done on the risk and predisposing factors of catatonic symptoms induced by traumatic events. There seem to be two types or constructs of conditioning that predispose an individual to catatonic symptoms in response to traumatic events: external conditioning and internal conditioning. Here, we review a study that found a significant correlation between the Bush–Francis Catatonia Scale and the Adverse Childhood Experience questionnaire; we also review studies of rats that were conditioned to expect an electric shock who developed catatonia-like immobility without the shock being applied. We also review the clinical case report of a previously traumatized individual. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

)

Research

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16 pages, 1981 KiB  
Article
Traumatic Brain Injury-Related Attention Deficits in Children: A Controlled Treatment Trial with Lisdexamfetamine Dimesylate (Vyvanse)
by Michael G. Tramontana, Jonathan W. Prokop, Edwin Williamson, Tara Duffie and Hayden LaFever
Brain Sci. 2021, 11(1), 117; https://doi.org/10.3390/brainsci11010117 - 16 Jan 2021
Cited by 4 | Viewed by 3776
Abstract
Attention deficits are among the most common and persistent impairments resulting from traumatic brain injury (TBI). This study was the first to examine the effects of lisdexamfetamine dimesylate (LDX, Vyvanse) in treating TBI-related attention deficits in children. It was an extension of a [...] Read more.
Attention deficits are among the most common and persistent impairments resulting from traumatic brain injury (TBI). This study was the first to examine the effects of lisdexamfetamine dimesylate (LDX, Vyvanse) in treating TBI-related attention deficits in children. It was an extension of a previous controlled trial with adults. This was a 12-week, randomized, double-blind, placebo-controlled, dose-titration, crossover trial. In addition to weekly safety monitoring, there were assessments on a broad range of neuropsychological and behavioral measures at baseline, 6-weeks, and 12-weeks. A total of 20 carefully selected children were enrolled, ranging from 10 to 16 years of age. The sample consisted of cases with mainly mild TBI (based on the known details regarding their injuries), but they had persisting attention deficits and other post-concussion symptoms lasting from 2 to 29 months by the time of enrollment. A total of 16 children completed the trial. One of the children withdrew due to a mild anxiety reaction while on LDX. There were no other adverse effects. Positive treatment results were found on both formal testing of sustained attention and in terms of parent ratings of attention, emotional status, behavioral controls, and various aspects of executive functioning. The findings also served to highlight broader insights into the nature of attention deficits and their treatment in children with TBI. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

)
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11 pages, 725 KiB  
Article
Prognosis after Mild Traumatic Brain Injury: Influence of Psychiatric Disorders
by Ivan Marinkovic, Harri Isokuortti, Antti Huovinen, Daniela Trpeska Marinkovic, Kaisa Mäki, Taina Nybo, Antti Korvenoja, Raj Rahul, Risto Vataja and Susanna Melkas
Brain Sci. 2020, 10(12), 916; https://doi.org/10.3390/brainsci10120916 - 27 Nov 2020
Cited by 6 | Viewed by 2862
Abstract
Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from [...] Read more.
Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan–Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5–19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3–14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0–8.0) compared to 8.0 (IQR 7.0–8.0, p = 0.003). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient’s return to work. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

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20 pages, 3615 KiB  
Article
Feasibility Randomized Trial for an Intensive Memory-Focused Training Program for School-Aged Children with Acquired Brain Injury
by Monica Recla, Erika Molteni, Valentina Manfredi, Filippo Arrigoni, Andrea Nordio, Susanna Galbiati, Valentina Pastore, Marc Modat and Sandra Strazzer
Brain Sci. 2020, 10(7), 430; https://doi.org/10.3390/brainsci10070430 - 7 Jul 2020
Cited by 1 | Viewed by 3079
Abstract
(1) Background: Memory deficits are common sequelae of pediatric Acquired Brain Injury (ABI). Only methods for non-focused cognitive remediation are available to the pediatric field. The aims of this feasibility trial are the description, implementation, and test of an intensive program specific to [...] Read more.
(1) Background: Memory deficits are common sequelae of pediatric Acquired Brain Injury (ABI). Only methods for non-focused cognitive remediation are available to the pediatric field. The aims of this feasibility trial are the description, implementation, and test of an intensive program specific to the training and re-adaptation of memory function in children, called Intensive Memory-Focused Training Program (IM-FTP); (2) Methods: Eleven children and adolescents with ABI (mean age at injury = 12.2 years, brain tumor survivors excluded) were clinically assessed and rehabilitated over 1-month through IM-FTP, including physio-kinesis/occupational, speech, and neuropsychology treatments. Each patient received a psychometric evaluation and a brain functional MRI at enrollment and at discharge. Ten pediatric controls with ABI (mean age at injury = 13.8 years) were clinically assessed, and rehabilitated through a standard program; (3) Results: After treatment, both groups had marked improvement in both immediate and delayed recall. IM-FTP was associated with better learning of semantically related and unrelated words, and larger improvement in immediate recall in prose memory. Imaging showed functional modification in the left frontal inferior cortex; (4) Conclusions: We described an age-independent reproducible multidisciplinary memory-focused rehabilitation protocol, which can be adapted to single patients while preserving inter-subject comparability, and is applicable up to a few months after injury. IM-FTP will now be employed in a powered clinical trial. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

)
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Review

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18 pages, 507 KiB  
Review
Assessment of Executive Function in Patients with Traumatic Brain Injury with the Wisconsin Card-Sorting Test
by Lizzette Gómez-de-Regil
Brain Sci. 2020, 10(10), 699; https://doi.org/10.3390/brainsci10100699 - 1 Oct 2020
Cited by 12 | Viewed by 4853
Abstract
This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, [...] Read more.
This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, Cochrane Library, and PsycInfo, targeted publications from 2010 to 2020, in English or Spanish. Information regarding the studies’ designs, sample features and use of the WCST scores was recorded. An initial search eliciting 387 citations was reduced to 47 relevant papers. The highest proportion of publications came from the United States of America (34.0%) and included adult patients (95.7%). Observational designs were the most frequent (85.1%), the highest proportion being cross-sectional or case series studies. The average time after the occurrence of the TBI ranged from 4 to 62 years in single case studies, and from 6 weeks up to 23.5 years in the studies with more than one patient. Four studies compared groups of patients with TBI according to the severity (mild, moderate and/or severe), and in two cases, the studies compared TBI patients with healthy controls. Randomized control trials were seven in total. The noncomputerized WCST version including 128 cards was the most frequently used (78.7%). Characterization of the clinical profile of participants was the most frequent purpose (34.0%). The WCST is a common measure of executive function in patients with TBI. Although shorter and/or computerized versions are available, the original WCST with 128 cards is still used most often. The WCST is a useful tool for research and clinical purposes, yet a common practice is to report only one or a few of the possible scores, which prevents further valid comparisons across studies. Results might be useful to professionals in the clinical and research fields to guide them in assessment planning and proper interpretation of the WCST scores. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

)
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Other

6 pages, 189 KiB  
Case Report
Improving Visual Function after Mild Traumatic Brain Injury Using a Vision Therapy Program: Case Reports
by Mona-Lisa Möller, Susanna Melkas and Jan Johansson
Brain Sci. 2020, 10(12), 947; https://doi.org/10.3390/brainsci10120947 - 7 Dec 2020
Cited by 3 | Viewed by 3337
Abstract
This case report describes the outcome of vision therapy for three patients who were referred to therapy due to visual symptoms after mild traumatic brain injury (MTBI). The criterion for inclusion was a high score (>21p) on the Convergence Insufficiency Symptom Survey (CISS) [...] Read more.
This case report describes the outcome of vision therapy for three patients who were referred to therapy due to visual symptoms after mild traumatic brain injury (MTBI). The criterion for inclusion was a high score (>21p) on the Convergence Insufficiency Symptom Survey (CISS) scale. The vision therapy program (VTP) included both face-to-face sessions and home-based tasks. Cases #1 and #2 had a substantial CISS scale evaluation improvement, and case #2 normalized the CISS scale score from 36 to 19. All patients agreed that vision therapy helped them understand their own vision and changes in their vision, which helped their overall recovery after MTBI. Rehabilitation professionals have an important role in screening for vision impairments and treating functional vision challenges after mild traumatic brain injury. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

)
8 pages, 11939 KiB  
Case Report
Changes in Diffuse Tensor Imaging and Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation in Traumatic Brain Injury with Central Pain
by Dong-Ha Kang and Gi-Wook Kim
Brain Sci. 2020, 10(12), 929; https://doi.org/10.3390/brainsci10120929 - 2 Dec 2020
Cited by 5 | Viewed by 2574
Abstract
Post-trauma chronic pain characterized by central pain is a symptom following traumatic brain injury (TBI). Studies on the effect of repetitive transcranial magnetic stimulation (rTMS) on central pain and the association between central pain and spinothalamic tract (STT) have been reported, but few [...] Read more.
Post-trauma chronic pain characterized by central pain is a symptom following traumatic brain injury (TBI). Studies on the effect of repetitive transcranial magnetic stimulation (rTMS) on central pain and the association between central pain and spinothalamic tract (STT) have been reported, but few studies have examined the effect of rTMS in patients with mild TBI with central pain through changes in diffusion tensor imaging (DTI)-based metrics of STT before and after rTMS. This case series aimed to investigate the therapeutic effect of rTMS in TBI with central pain and the changes in diffusion tensor imaging (DTI)-based metrics of the spinothalamic tract (STT) before and after rTMS. This study included four patients who complained of severe pain in the left or right side of the body below the neck area after a car accident. We performed numeric rating scale (NRS), bedside sensory examination, electrodiagnostic study, and DTI-based metrics of the STT before and after rTMS. According to the guidelines of the diagnosis and grading for neuropathic pain, all patients had neuropathic pain corresponding to “probable grade.” In all patients, rTMS was applied to the contralateral M1 cortex on the more painful side. There were no medication changes and other interventions during the rTMS. After rTMS, NRS decreased, bed sensory testing improved, and DTI-based STT metrics increased in all patients compared to before rTMS. Full article
(This article belongs to the Special Issue

Mild and Moderate Traumatic Brain Injuries: Diagnosis, Assessment Tools, Management and Factors Influencing Recovery

)
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