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New Perspectives in Rehabilitation after Traumatic Brain Injury

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Brain Injury".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 39389

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Special Issue Editors

Prof. Dr. Nada Andelic

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Leading Guest Editor

1. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
2. Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, 0373 Oslo, Norway
Interests: traumatic brain injury; rehabilitation; functional outcomes; health care services; unmet rehabilitation; healthcare needs
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Cecilie Røe

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Co-Guest Editor

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
Interests: traumatic brain injury; musculoskeletal disorders; pain; rehabilitation; health care services

Prof. Dr. Eirik Helseth

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Co-Guest Editor

1. Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Interests: traumatic brain injury; neurosurgery; elderly; antithrombotics; functional outcome; cervical spine injury

Dr. Emilie Isager Howe

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Assistant Guest Editor

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
Interests: traumatic brain injury; rehabilitation; cognition; functional outcomes; randomized controlled trials
Special Issues, Collections and Topics in MDPI journals

Dr. Marit Vindal Forslund

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Assistant Guest Editor

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
Interests: traumatic brain injury; rehabilitation; functional outcomes; health-related quality of life; healthcare service provision and needs; randomized controlled trials
Special Issues, Collections and Topics in MDPI journals

Dr. Torgeir Hellstrøm

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Assistant Guest Editor

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
Interests: traumatic brain injury; rehabilitation; prediction; functional outcomes; neuroimaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There has been increased focus on the evaluation of the scientific knowledge base within the field of traumatic brain injury (TBI) rehabilitation. TBI rehabilitation comprises several phases, from acute medical care to post-acute care in rehabilitation facilities and chronic care in the community. Rehabilitation is a multidisciplinary effort that covers the full spectrum of medical neuroscience, cognitive neuroscience, pharmacology, brain imaging, and assistive and smart technology. A future challenge is to integrate these areas to guide TBI rehabilitation into extensive research and clinical practice. The use of smart technologies and improved brain imaging techniques has an important future in the rehabilitation of patients with cognitive difficulties and disabilities. There is also the need for broad international collaboration to establish large multinational clinical trials in order to define effective service provision and to reach consensus on the best evidence-based practice of TBI rehabilitation. With this Special Issue, we hope to encourage submissions that discuss ongoing knowledge gaps and controversies, and focus on new perspectives regarding the rehabilitation and management of TBI.

Prof. Dr. Nada Andelic
Prof. Dr. Cecilie Røe
Prof. Dr. Eirik Helseth
Dr. Emilie Isager Howe
Dr. Marit Vindal Forslund
Dr. Torgeir Hellstrøm
Guest Editors

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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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

Traumatic brain injury
Rehabilitation
Biomarkers
Imaging and smart technology
New treatments
Clinical trials

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11 pages, 1545 KiB

Open AccessArticle

Cortical and Subcortical Alterations and Clinical Correlates after Traumatic Brain Injury

by Qiang Xue, Linbo Wang, Yuanyu Zhao, Wusong Tong, Jiancun Wang, Gaoyi Li, Wei Cheng, Liang Gao and Yan Dong

J. Clin. Med. 2022, 11(15), 4421; https://doi.org/10.3390/jcm11154421 - 29 Jul 2022

Cited by 6 | Viewed by 1845

Abstract

Background: Traumatic brain injury (TBI) often results in persistent cognitive impairment and psychiatric symptoms, while lesion location and severity are not consistent with its clinical complaints. Previous studies found cognitive deficits and psychiatric disorders following TBI are considered to be associated with prefrontal and medial temporal lobe lesions, however, the location and extent of contusions often cannot fully explain the patient′s impairments. Thus, we try to find the structural changes of gray matter (GM) and white matter (WM), clarify their correlation with psychiatric symptoms and memory following TBI, and determine the brain regions that primary correlate with clinical measurements. Methods: Overall, 32 TBI individuals and 23 healthy controls were recruited in the study. Cognitive impairment and psychiatric symptoms were examined by Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and Wechsler Memory Scale-Chinese Revision (WMS-CR). All MRI data were scanned using a Siemens Prisma 3.0 Tesla MRI system. T1 MRI data and diffusion tensor imaging (DTI) data were processed to analyze GM volume and WM microstructure separately. Results: In the present study, TBI patients underwent widespread decrease of GM volume in both cortical and subcortical regions. Among these regions, four brain areas including the left inferior temporal gyrus and medial temporal lobe, supplementary motor area, thalamus, and anterior cingulate cortex (ACC) were highly implicated in the post-traumatic cognitive impairment and psychiatric complaints. TBI patients also underwent changes of WM microstructure, involving decreased fractional anisotropy (FA) value in widespread WM tracts and increased mean diffusivity (MD) value in the forceps minor. The changes of WM microstructure were significantly correlated with the decrease of GM volume. Conclusions: TBI causes widespread cortical and subcortical alterations including a reduction in GM volume and change in WM microstructure related to clinical manifestation. Lesions in temporal lobe may lead to more serious cognitive and emotional dysfunction, which should attract our high clinical attention. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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18 pages, 721 KiB

Open AccessArticle

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

by Elinor E. Fraser, Marina G. Downing, Kerrie Haines, Linda Bennett, John Olver and Jennie L. Ponsford

J. Clin. Med. 2022, 11(12), 3525; https://doi.org/10.3390/jcm11123525 - 19 Jun 2022

Cited by 5 | Viewed by 2350

Abstract

There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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23 pages, 1659 KiB

Open AccessArticle

Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI)

by Ingvil Laberg Holthe, Nina Rohrer-Baumgartner, Edel J. Svendsen, Solveig Lægreid Hauger, Marit Vindal Forslund, Ida M. H. Borgen, Hege Prag Øra, Ingerid Kleffelgård, Anine Pernille Strand-Saugnes, Jens Egeland, Cecilie Røe, Shari L. Wade and Marianne Løvstad

J. Clin. Med. 2022, 11(9), 2564; https://doi.org/10.3390/jcm11092564 - 3 May 2022

Cited by 13 | Viewed by 2814

Abstract

The current study is a feasibility study of a randomized controlled trial (RCT): the Child in Context Intervention (CICI). The CICI study is an individualized, goal-oriented and home-based intervention conducted mainly through videoconference. It targets children with ongoing challenges (physical, cognitive, behavioral, social and/or psychological) after acquired brain injury (ABI) and their families at least one year post injury. The CICI feasibility study included six children aged 11–16 years with verified ABI-diagnosis, their families and their schools. The aim was to evaluate the feasibility of the intervention components, child and parent perceptions of usefulness and relevance of the intervention as well as the assessment protocol through a priori defined criteria. Overall, the families and therapists rated the intervention as feasible and acceptable, including the videoconference treatment delivery. However, the burden of assessment was too high. The SMART-goal approach was rated as useful, and goal attainment was high. The parents’ ratings of acceptability of the intervention were somewhat higher than the children’s. In conclusion, the CICI protocol proved feasible and acceptable to families, schools and therapists. The assessment burden was reduced, and adjustments in primary outcomes were made for the definitive RCT. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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13 pages, 1854 KiB

Open AccessArticle

Abnormal Dorsal Caudate Activation Mediated Impaired Cognitive Flexibility in Mild Traumatic Brain Injury

by Hui Xu, Xiuping Zhang and Guanghui Bai

J. Clin. Med. 2022, 11(9), 2484; https://doi.org/10.3390/jcm11092484 - 28 Apr 2022

Cited by 5 | Viewed by 1997

Abstract

Background: Mild traumatic brain injury (mTBI) is an important but less recognized public health concern. Previous studies have demonstrated that patients with mTBI have impaired executive function, which disrupts the performance of daily activities. Few studies have investigated neural mechanisms of cognitive flexibility in mTBI patients using objective tools such as the psychological experiment paradigm. Here, we aimed to examine neural correlates of cognitive flexibility in mTBI. Methods: Sixteen mTBI patients and seventeen matched healthy controls (HCs) underwent functional MRI during a rule-based task-switching experimental paradigm. Linear models were used to obtain within-group activation maps and areas of differential activation between the groups. In addition, we conducted mediation analyses to evaluate the indirect effect of abnormal dorsal caudate activation on the association between information processing speed and cognitive flexibility in mTBI. Results: mTBI patients exhibited significantly longer reaction time in the task switching (TS) condition compared to HCs, reflecting impaired cognitive flexibility. In addition, the patients showed reduced activation in the dorsal caudate (dCau), anterior cingulate cortex, and other frontal regions during the TS condition. Mediation analysis revealed that the reduced dCau activation had a significant effect on the relationship between information processing speed and cognitive flexibility in mTBI. Conclusions: Abnormal dorsal caudate activation in mTBI mediates impaired cognitive flexibility, which indicated dorsal caudate might be playing a vital role in the cognitive flexibility of mTBI patients. These findings highlight an alternative target for clinical interventions for the improvement of cognitive functions in mTBI. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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10 pages, 655 KiB

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Age Moderates the Effect of Injury Severity on Functional Trajectories in Traumatic Brain Injury: A Study Using the NIDILRR Traumatic Brain Injury Model Systems National Dataset

by Laraine Winter, Janell L. Mensinger, Helene J. Moriarty, Keith M. Robinson, Michelle McKay and Benjamin E. Leiby

J. Clin. Med. 2022, 11(9), 2477; https://doi.org/10.3390/jcm11092477 - 28 Apr 2022

Cited by 5 | Viewed by 2078

Abstract

Age is a risk factor for a host of poor outcomes following traumatic brain injury (TBI), with some evidence suggesting that age is also a source of excess disability. We tested the extent to which age moderates the effect of injury severity on functional trajectories over 15 years post injury. Data from 11,442 participants from the 2020 National Institute of Disability and Independent Living Rehabiitation Research (NIDILRR) Traumatic Brain Injury Model Systems (TBIMS) National Dataset were analyzed using linear mixed effects models. Injury severity was operationally defined using a composite of Glasgow Coma Scale scores, structural imaging findings, and the number of days with post-trauma amnesia. Functioning was measured using the Glasgow Outcomes Scale-Extended. Age at injury was the hypothesized moderator. Race, ethnicity, sex, education, and marital status served as covariates. The results showed a significant confounder-adjusted effect of injury severity and age of injury on the linear slope in functioning. The age effect was strongest for those with mild TBI. Thus, the effects of injury severity on functional trajectory were found to be moderated by age. To optimize outcomes, TBI rehabilitation should be developed specifically for older patients. Age should also be a major focus in TBI research. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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12 pages, 1182 KiB

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Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial

by Aleksi J. Sihvonen, Sini-Tuuli Siponkoski, Noelia Martínez-Molina, Sari Laitinen, Milla Holma, Mirja Ahlfors, Linda Kuusela, Johanna Pekkola, Sanna Koskinen and Teppo Särkämö

J. Clin. Med. 2022, 11(8), 2184; https://doi.org/10.3390/jcm11082184 - 14 Apr 2022

Cited by 11 | Viewed by 5099

Abstract

Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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11 pages, 378 KiB

Open AccessArticle

Cognitive Reserve, Early Cognitive Screening, and Relationship to Long-Term Outcome after Severe Traumatic Brain Injury

by Natascha Ekdahl, Alison K. Godbolt, Catharina Nygren Deboussard, Marianne Lannsjö, Britt-Marie Stålnacke, Maud Stenberg, Trandur Ulfarsson and Marika C. Möller

J. Clin. Med. 2022, 11(7), 2046; https://doi.org/10.3390/jcm11072046 - 6 Apr 2022

Cited by 3 | Viewed by 2059

Abstract

The objective was to investigate the relationship between early global cognitive functioning using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and cognitive flexibility (Trail Making Test (TMT), TMT B-A), with long-term outcome assessed by the Mayo-Portland Adaptability Index (MPAI-4) in severe traumatic brain injury (sTBI) controlling for the influence of cognitive reserve, age, and injury severity. Of 114 patients aged 18–65 with acute Glasgow Coma Scale 3–8, 41 patients were able to complete (BNIS) at 3 months after injury and MPAI-4 5–8 years after injury. Of these, 33 patients also completed TMT at 3 months. Global cognition and cognitive flexibility correlated significantly with long-term outcome measured with MPAI-4 total score (r_BNIS = 0.315; r_TMT = 0.355). Global cognition correlated significantly with the participation subscale (r = 0.388), while cognitive flexibility correlated with the adjustment (r = 0.364) and ability (r = 0.364) subscales. Adjusting for cognitive reserve and acute injury severity did not alter these relationships. The effect size for education on BNIS and TMT scores was large (d ≈ 0.85). Early screenings with BNIS and TMT are related to long-term outcome after sTBI and seem to measure complementary aspects of outcome. As early as 3 months after sTBI, educational level influences the scores on neuropsychological screening instruments. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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19 pages, 789 KiB

Open AccessArticle

Impact of Somatic Vulnerability, Psychosocial Robustness and Injury-Related Factors on Fatigue following Traumatic Brain Injury—A Cross-Sectional Study

by Daniel Løke, Nada Andelic, Eirik Helseth, Olav Vassend, Stein Andersson, Jennie L. Ponsford, Cathrine Tverdal, Cathrine Brunborg and Marianne Løvstad

J. Clin. Med. 2022, 11(6), 1733; https://doi.org/10.3390/jcm11061733 - 21 Mar 2022

Cited by 3 | Viewed by 3057

Abstract

Fatigue is a common symptom after traumatic brain injuries (TBI) and a crucial target of rehabilitation. The subjective and multifactorial nature of fatigue necessitates a biopsychosocial approach in understanding the mechanisms involved in its development. The aim of this study is to provide a comprehensive exploration of factors relevant to identification and rehabilitation of fatigue following TBI. Ninety-six patients with TBI and confirmed intracranial injuries were assessed on average 200 days post-injury with regard to injury-related factors, several patient-reported outcome measures (PROMS) of fatigue, neuropsychological measures, and PROMS of implicated biopsychosocial mechanisms. Factor analytic approaches yielded three underlying factors, termed Psychosocial Robustness, Somatic Vulnerability and Injury Severity. All three dimensions were significantly associated with fatigue in multiple regression analyses and explained 44.2% of variance in fatigue. Post hoc analyses examined univariate contributions of the associations between the factors and fatigue to illuminate the relative contributions of each biopsychosocial variable. Implications for clinical practice and future research are discussed. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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17 pages, 464 KiB

Open AccessArticle

Health and Well-Being of Persons of Working Age up to Seven Years after Severe Traumatic Brain Injury in Northern Sweden: A Mixed Method Study

by Maud Stenberg, Britt-Marie Stålnacke and Britt-Inger Saveman

J. Clin. Med. 2022, 11(5), 1306; https://doi.org/10.3390/jcm11051306 - 27 Feb 2022

Cited by 2 | Viewed by 1652

Abstract

Purpose: To explore the health and well-being of persons seven years after severe traumatic brain injury (STBI). Material and methods: Follow-up of 21 persons 1 and 7 years after STBI using surveys for functional outcome, anxiety/depression, health and mental fatigue. Interviews were conducted and analysed using qualitative content analysis. Convergent parallel mixed method then merged and analysed the results into an overall interpretation. Results: Good recovery, high functional outcome and overall good health were relatively unchanged between 1 and 7 years. Well-being was a result of adaptation to a recovered or changed life situation. Persons with good recovery had moved on in life. Persons with moderate disability self-estimated their health as good recovery but reported poorer well-being. For persons with severe disability, adaptation was an ongoing process and health and well-being were low. Only a few persons reported anxiety and depression. They had poorer health but nevertheless reported well-being. Persons with moderate and severe mental fatigue had low functional outcomes and overall health and none of them reported well-being. Conclusions: The life of a person who has suffered STBI is still affected to a lesser or greater degree several years after injury due to acceptance of a recovered or changed life situation. Further studies are needed on how health and well-being can be improved after STBI in the long-term perspective. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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17 pages, 1035 KiB

Open AccessArticle

Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury

by Ida M. H. Borgen, Solveig L. Hauger, Marit V. Forslund, Ingerid Kleffelgård, Cathrine Brunborg, Nada Andelic, Unni Sveen, Helene L. Søberg, Solrun Sigurdardottir, Cecilie Røe and Marianne Løvstad

J. Clin. Med. 2022, 11(4), 958; https://doi.org/10.3390/jcm11040958 - 12 Feb 2022

Cited by 8 | Viewed by 5794

Abstract

Traumatic brain injury (TBI) is a heterogeneous condition with long-term consequences for individuals and families. Goal-oriented rehabilitation is often applied, but there is scarce knowledge regarding types of goals and goal attainment. This study describes goal attainment in persons in the chronic phase of TBI who have received an individualized, SMART goal-oriented and home-based intervention, compares goal attainment in different functional domains, and examines indicators of goal attainment. Goal attainment scaling (GAS) was recorded in the intervention group (n = 59) at the final session. The goal attainment was high, with 93.3% increased goal attainment across all goals at the final session. The level of goal attainment was comparable across domains (cognitive, physical/somatic, emotional, social). Gender, anxiety symptoms, self-reported executive dysfunction, and therapy expectations were indicators of goal attainment. These results indicate a potential for the high level of goal attainment in the chronic phase of TBI. Tailoring of rehabilitation to address individual needs for home-dwelling persons with TBI in the chronic phase represents an important area of future research. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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16 pages, 1198 KiB

Open AccessArticle

Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches?

by Francesco Latini, Markus Fahlström, Fredrik Vedung, Staffan Stensson, Elna-Marie Larsson, Mark Lubberink, Yelverton Tegner, Sven Haller, Jakob Johansson, Anders Wall, Gunnar Antoni and Niklas Marklund

J. Clin. Med. 2022, 11(2), 358; https://doi.org/10.3390/jcm11020358 - 12 Jan 2022

Cited by 3 | Viewed by 2900

Abstract

Traumatic brain injury (TBI) or repeated sport-related concussions (rSRC) may lead to long-term memory impairment. Diffusion tensor imaging (DTI) is helpful to reveal global white matter damage but may underestimate focal abnormalities. We investigated the distribution of post-injury regional white matter changes after TBI and rSRC. Six patients with moderate/severe TBI, and 12 athletes with rSRC were included ≥6 months post-injury, and 10 (age-matched) healthy controls (HC) were analyzed. The Repeatable Battery for the Assessment of Neuropsychological Status was performed at the time of DTI. Major white matter pathways were tracked using q-space diffeomorphic reconstruction and analyzed for global and regional changes with a controlled false discovery rate. TBI patients displayed multiple classic white matter injuries compared with HC (p < 0.01). At the regional white matter analysis, the left frontal aslant tract, anterior thalamic radiation, and the genu of the corpus callosum displayed focal changes in both groups compared with HC but with different trends. Both TBI and rSRC displayed worse memory performance compared with HC (p < 0.05). While global analysis of DTI-based parameters did not reveal common abnormalities in TBI and rSRC, abnormalities to the fronto-thalamic network were observed in both groups using regional analysis of the white matter pathways. These results may be valuable to tailor individualized rehabilitative approaches for post-injury cognitive impairment in both TBI and rSRC patients. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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14 pages, 880 KiB

Open AccessArticle

In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation

by Cathrine Tverdal, Nada Andelic, Eirik Helseth, Cathrine Brunborg, Pål Rønning, Torgeir Hellstrøm, Cecilie Røe and Mads Aarhus

J. Clin. Med. 2021, 10(16), 3577; https://doi.org/10.3390/jcm10163577 - 14 Aug 2021

Cited by 6 | Viewed by 2574

Abstract

Previous research has demonstrated that early initiation of rehabilitation and direct care pathways improve outcomes for patients with severe traumatic brain injury (TBI). Despite this knowledge, there is a concern that a number of patients are still not included in the direct care pathway. The study aim was to provide an updated overview of discharge to rehabilitation following acute care and identify factors associated with the direct pathway. We analyzed data from the Oslo TBI Registry—Neurosurgery over a five-year period (2015–2019) and included 1724 adults with intracranial injuries. We described the patient population and applied multivariable logistic regression to investigate factors associated with the probability of entering the direct pathway. In total, 289 patients followed the direct pathway. For patients with moderate–severe TBI, the proportion increased from 22% to 35% during the study period. Significant predictors were younger age, low preinjury comorbidities, moderate–severe TBI and disability due to TBI at the time of discharge. In patients aged 18–29 years, 53% followed the direct pathway, in contrast to 10% of patients aged 65–79 years (moderate–severe TBI). This study highlights the need for further emphasis on entering the direct pathway to rehabilitation, particularly for patients aged >64 years. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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17 pages, 539 KiB

Open AccessReview

Overview of Cochrane Systematic Reviews of Rehabilitation Interventions for Persons with Traumatic Brain Injury: A Mapping Synthesis

by Vanessa M. Young, Juan R. Hill, Michele Patrini, Stefano Negrini and Chiara Arienti

J. Clin. Med. 2022, 11(10), 2691; https://doi.org/10.3390/jcm11102691 - 10 May 2022

Cited by 3 | Viewed by 2820

Abstract

Background: The World Health Organization has identified an unmet global need for rehabilitation interventions concerning 20 non-communicable diseases, traumatic brain injury included. This overview compiles and synthesizes the quality and quantity of available evidence on the effectiveness of rehabilitation interventions for traumatic brain injury from Cochrane systematic reviews (CSRs). The results will be used to develop the Package of Interventions for Rehabilitation. Methods: All CSRs on TBI tagged in the Cochrane Rehabilitation database published between August 2009 and September 2021 were included. Evidence mapping was implemented to extract study characteristics and evidence from the CSRs. Results: Six CSRs (42 studies; n = 3983) examined the effectiveness of either non-pharmacological or pharmacological interventions after TBI. Among 19 comparisons, 3% were rated as high in quality of evidence, 9% moderate, 54% low, and 34% very low. Non-pharmacological interventions with moderate quality, hospital-based cognitive rehabilitation and cognitive didactic therapy, likely produced minimal to no changes in the return-to-work rate. Anti-epileptic drugs and neuroprotective agents resulted in a minimal difference to the frequency of late seizure episodes in post-traumatic epilepsy. Conclusions: No prominent advances in treatment options were reported in any of the CSRs. The high rate of low and very low quality of evidence makes it difficult to ascertain the effectiveness of several recommended non-pharmacological interventions. Full article

(This article belongs to the Special Issue New Perspectives in Rehabilitation after Traumatic Brain Injury)

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