Search Results (150)

Traumatic brain injury (TBI) is a leading cause of long-term neurological disability worldwide and is frequently associated with persistent impairments in consciousness, cognition, mood, and functional independence. Despite advances in acute neurocritical care, effective therapies that enhance neurological recovery remain limited. Neuromodulation has emerged as a promising strategy to augment neuroplasticity and improve recovery through both pharmacologic and non-pharmacologic approaches. This narrative review summarizes current evidence supporting pharmacologic neuromodulatory therapies, including central nervous system stimulants (methylphenidate and modafinil), dopaminergic agents (amantadine and bromocriptine), acetylcholinesterase inhibitors (donepezil and rivastigmine), and selective serotonin reuptake inhibitors (sertraline and fluoxetine). Mechanisms of action, clinical efficacy, adverse effects, and practical considerations across the acute, subacute, and chronic phases of TBI recovery are discussed. Emerging non-pharmacologic neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation, are also reviewed. Although amantadine remains the only neuromodulator supported by moderate-quality guideline recommendations for accelerating recovery in disorders of consciousness, accumulating evidence suggests that several additional pharmacologic and non-pharmacologic neuromodulation interventions may improve attention, executive function, fatigue, mood, and rehabilitation participation in carefully selected patients. However, current evidence is limited by heterogeneous study populations, small sample sizes, inconsistent outcome measures, and a paucity of long-term randomized controlled trials. Future research should prioritize adequately powered comparative studies, standardized outcome measures, biomarker-guided patient selection, and multimodal treatment strategies to optimize neurological recovery following TBI. Full article

This qualitative study incorporates caregiver perspectives to identify their (1) experiences with medical and educational supports for their children with chronic TBI following inpatient rehabilitation and across the recovery trajectory and (2) recommendations to improve service provision for young people with TBI. Nineteen caregivers of children with complicated-mild-to-severe TBI participated in semi-structured virtual interviews. Participants were from a large Midwestern U.S. city. Researchers used reflexive thematic analysis, incorporating an experiential orientation and a deductive approach. Standards for Reporting Qualitative Research guided this process. Children were an average of 5.2 years post-injury, and age at injury ranged from 2.6 to 18.0 years, providing depth of caregiver experiences discussed in interviews. Four primary themes were identified: (1) TBI leads to lasting changes in the child, (2) the healthcare environment is overwhelming, (3) TBI forces a shift in caregiver responsibilities, and (4) school challenges persist over time. Caregivers generated concrete, experience-based recommendations, highlighting the need for increased support, resources, and education in specific areas following pediatric TBI. By centering caregiver voices across recovery, this study underscores their unique expertise in identifying system-level gaps and informing the development of interventions, services, and policies that better support children with TBI and their families over time. Full article

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind–body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions. Full article

Background and Objectives: Evidence guiding rehabilitation outcomes among medically complex traumatic brain injury (TBI) populations remains limited, particularly in long-term acute care hospital (LTACH) settings. Most prior studies have focused on inpatient rehabilitation facilities, leaving a limited understanding of factors influencing recovery during LTACH rehabilitation. This study examined the association between mechanism of injury, time from injury to LTACH admission, and functional rehabilitation outcomes in adults with moderate-to-severe TBI. Materials and Methods: This retrospective observational cohort study included adults with moderate-to-severe TBI who received multidisciplinary rehabilitation in an LTACH between January 2017 and December 2024. Of 272 eligible patients, 239 met the inclusion criteria after exclusions for short length of stay, incomplete evaluations, duplicate records, death during rehabilitation, or full independence at admission. Functional improvement in mobility and activities of daily living (ADLs) was measured using CMS Section GG assessments and dichotomized as improvement versus no improvement. Logistic regression analyses examined associations between predictors and outcomes while adjusting for demographic covariates. Results: Longer time from injury to LTACH admission was associated with lower odds of functional improvement. Compared with admission within 30 days, admission at 31–60 days (OR = 0.53; 95% CI, 0.28–0.99; p = 0.045) and beyond 60 days (OR = 0.26; 95% CI, 0.10–0.69; p = 0.006) was associated with reduced odds of improvement. Mechanism of injury was not significantly associated with outcomes. Male gender was associated with higher odds of improvement (OR = 2.18; 95% CI, 1.05–4.51; p = 0.036). No significant interaction effects were identified. Conclusions: Delayed LTACH admission was associated with lower odds of functional improvement following TBI rehabilitation, independent of injury mechanism and demographic factors. These findings support the importance of timely access to postacute rehabilitation among medically complex TBI populations. Full article

Background: Many individuals with traumatic brain injuries (TBIs) exhibit oculomotor dysfunctions that impact their daily functioning. As current clinical screening tools are limited, we have created and pilot-tested the Rehabilitation Oculomotor Screening Evaluation (ROSE) previously in a small sample of people with acquired brain injuries and neurotypical participants. The current study aims to validate ROSE in persons with TBI, focusing on mild TBI (mTBI). Methods: Participants with TBI (n = 25) completed different clinical scales, including ROSE, Sensory Organization Test (SOT) for standing balance, Reintegration to Normal Living Index (RNLI), Timed Up and Go (TUG) for mobility, and a visual analogue scale for the subjective perception of visual vertigo. Neurotypical individuals (n = 24) who were age- and sex-matched completed only ROSE. Results: The group with mTBI (n = 18) had significantly higher ROSE scores compared to the neurotypical group, with a large effect size. Significant correlation was found between ROSE and RNLI scores, but not with other clinical outcomes. Conclusions: Significant between-group difference in ROSE scores and their association with RNLI scores suggest that ROSE is a valid tool in detecting oculomotor dysfunction in TBI. Future studies should continue the validation of ROSE in other TBI and neurologic populations and in larger sample sizes. Full article

Caregivers of children with traumatic brain injury (TBI) often report unmet healthcare needs following their child’s injury. The objective of this study was to survey medical and educational professionals in focus groups to respond to caregiver perceived gaps in care and service provision for children with TBI identified in a prior qualitative study. Subjects included 29 medical and educational providers. Reflexive thematic analysis of responses included inductive and deductive analysis and iterative consensus among the authors. Themes identified included (1) improving education and care in the hospital, (2) preparing families to go home, (3) improving behavioral health care, (4) navigating schools, (5) empowering caregivers with resources and (6) medical and system barriers. These solutions require implementation at the individual, hospital, and broader systemic levels. Overall, provider solutions illuminate a greater need to improve care coordination to navigate a child’s long-term medical needs and transition back to school, as well as the need to train more pediatric brain-injury-aware providers and improve policy and support systems. Full article

Background and Clinical Significance: We report on three patients with traumatic brain injury (TBI) who showed improvement of impaired consciousness and changes in the default mode network (DMN), which was demonstrated on follow-up diffusion tensor tractographies (DTTs). Case Presentation: Three TBI patients underwent comprehensive rehabilitation during their first and second evaluations. Their Coma Recovery Scale-Revised (CRS-R) scores were obtained, and DTT was performed at 98.7 ± 22.0 days (first) and subsequently at 216.0 ± 78.1 (second) after onset. Compared with the first evaluation, the CRS-R scores increased by 12, 8, and 10 points on the second evaluation of the three patients. Although not reconstructed on the results of the first DTT, the second DTT results showed reconstruction of the medial prefrontal cortex (mPFC)–posterior cingulate cortex (PCC) DMN in patients 1 and 2. Regarding the continuously reconstructed DMNs (both mPFC-PCC and mPFC–precuneus), structural thickenings were generally observed in patients 1 and 3; however, narrowing was observed on the right mPFC-PCC DMN of patient 3. On the second DTT, all fractional anisotropy values of the reconstructed DMNs increased in patients 1 and 3, whereas all mean diffusivity values of the reconstructed DMNs decreased. Except for the right mPFC-PCC DMN in patient 3, all tract volume values of the reconstructed DMNs increased on the second DTT. Conclusions: DTT demonstrated changes in the mPFC-PCC/precuneus DMN concurrent with the improvement of impaired consciousness in three patients. In conclusion, recovery of the mPFC-PCC/precuneus DMN is closely associated with improvement of impaired consciousness in TBI patients. Full article

Background: In patients with traumatic brain injury (TBI), proteins are considered the main source of energy. Previous studies have suggested that an increase in the urea-to-creatinine ratio (UCR) indicates the onset of protein catabolism. Therefore, we aimed to investigate the associations of the UCR with the functional independence measure (FIM). Methods: This single-center retrospective study included 291 patients aged 17–87 years who underwent inpatient rehabilitation within the first 6 months post-TBI. Their demographic, clinical, neuroradiological, and laboratory data (eGFR, urea, creatinine, UCR) were collected. Spearman’s correlation and hierarchical multivariate regression analyses adjusted for clinical covariates were performed. Results: The strongest significant positive correlation was found between the Glasgow Coma Scale (GCS) and FIM at admission (ρ = 0.488, p < 0.001) and between GCS and FIM at discharge (ρ = 0.340, p < 0.001). A significant negative correlation was found between the discharge UCR and FIM at discharge (ρ = −0.262, p < 0.003), as well as with the change in FIM (ρ = −0.207, p < 0.02). Patients with UCRs ≥ 80 had a significantly lower discharge FIM compared to patients with UCRs < 80 (median 27 vs. 40; p = 0.02). The significant independent predictors of discharge FIM were the nutritional route (NGT/PEG), level of consciousness, and FIM at admission. The UCR did not remain independently associated with the discharge FIM (ΔR² = 0.004, Cohen’s f² = 0.014). Conclusions: Although UCR is associated with functional outcomes measured by FIM in TBI patients, it is not an independent predictor of these outcomes but rather a biomarker of catabolic burden. Full article

Objective: Traumatic brain injury (TBI) is disproportionately prevalent in incarcerated populations, yet the potential impact on cognitive functioning remains underexplored. This study examined the relationship between TBI history and cognitive performance in a male prison population. Method: Sixty-three participants from Tongariro Prison completed a comprehensive neuropsychological assessment including measures of executive function, memory, processing speed, and perceptual reasoning, with embedded performance validity metrics. TBI history was assessed using the Ohio State University TBI Identification Method (OSU-TBI ID), premorbid function was assessed using the Speed and Capacity of Language Processing (SCOLP) Spot-the-Word task, mood was assessed using the Depression, Anxiety and Stress Scales (DASS-21), and alcohol and substance use were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Regression analyses explored the relationship between TBI history and cognitive functioning, controlling for premorbid function, mood, alcohol and substance use, and ethnicity. Results: Contrary to hypotheses, TBI frequency and severity were not associated with poorer cognitive performance in this population. However, a self-reported history of pervasive TBI—defined as repeated head impacts over a narrow time frame—was significantly associated with reduced performance on the Color–Word Interference Test (CWIT) inhibition task, indicating links to greater cognitive disinhibition. Conclusions: Findings suggest that experiencing at least one period of pervasive TBI may be associated with an impact on inhibition (but not other aspects of executive functioning) in men in prison. These results underscore the importance of nuanced TBI history assessment and highlight inhibition as a potential target for rehabilitation in incarcerated individuals exposed to repetitive head trauma. Full article

Background/Objectives: Assisted verticalization and supported upright activity are relevant components of rehabilitation in adults with severe acquired brain injury (sABI), although patient selection and implementation remain challenging. This retrospective observational study aimed primarily to describe the implementation feasibility and documented safety of GRILLO-based training in routine inpatient multidisciplinary rehabilitation, and secondarily to report exploratory pre–post functional changes. Methods: We reviewed clinical records of 34 adults screened or considered for GRILLO-based training at Centro Cardinal Ferrari KOS, Italy, between June 2022 and December 2024. GRILLO training was delivered as part of standard care and not as an experimental intervention. Functional outcomes included the Barthel Index (BI), Trunk Control Test (TCT), Tinetti Balance Scale, and Tinetti Gait subscale, extracted from routine documentation. Non-parametric descriptive analyses were used. Results: Of 34 screened patients, 4 did not meet diagnostic criteria for ABI, 5 interrupted training because of pain or poor tolerance to prolonged upright positioning, and 3 were not included because of poor compliance/motivation or an incomplete clinical pathway. The paired functional-analysis cohort comprised 22 patients: 20 (91%) completed 15 sessions and 2 (9%) completed 10 sessions. No serious device-related adverse events were documented in available clinical records, although minor adverse events were not systematically monitored. Among patients with paired observations, median BI increased from 16 to 22.5 (median change, +3; p = 0.008; n = 20), median TCT from 72 to 74 (median change, +12; p < 0.001; n = 21), and median Tinetti Balance Scale from 1 to 2 (median change, +1; p = 0.006; n = 22). Individual responses were heterogeneous and floor effects were evident, especially for balance and gait-related measures. Conclusions: In this retrospective real-world cohort, GRILLO-based training could be implemented in selected severely impaired inpatients, but feasibility may be overestimated if interrupted and non-completing cases are not considered. The non-completion cases may suggest that feasibility depends not only on initial clinical indication, but also on the appropriate timing of introduction, tolerance to prolonged upright physical effort, pain/discomfort, motivation, and behavioral engagement. The retrospective design, survivorship bias, non-systematic adverse-event monitoring, concurrent multidisciplinary rehabilitation, and absence of a comparator group preclude conclusions regarding device-specific safety or efficacy. Nevertheless, these preliminary findings support further prospective controlled studies. Full article

Background/Objectives: Sleep problems, cognitive deficits, and mood disorders are prevalent in justice-involved populations, especially among individuals with a history of traumatic brain injury (TBI), though the association between these variables remains understudied. This retrospective study examined the relationship between subjective sleepiness and mood state on neuropsychological functioning in a forensic population with self-reported TBI. Methods: Data were obtained from 419 inmates and probationers with a self-reported history of TBI using the Ohio State University Traumatic Brain Injury Identification Method and Automated Neuropsychological Assessment Metrics (ANAM). Multiple linear regression models examined associations between cognitive performance across domains (i.e., reaction time, learning, attention, processing speed, working memory, delayed memory, and inhibition) and subjective sleepiness and mood states (i.e., depression, anxiety, fatigue, restlessness, anger, happiness, and vigor) measured by self-report scales embedded in the ANAM. Results: Negative mood state was most associated with impaired performance on tests of learning, delayed memory, spatial working memory, and reaction time, as well as global neurocognitive test performance. Subjective sleepiness was predictive of poorer performance on reaction time tasks, while positive mood states were related to better performance on the same task. Regression models were statistically significant (p < 0.05), with subjective sleepiness and mood accounting for approximately 1–5% of the variance in cognitive performance. Conclusions: Subjective sleepiness and mood symptoms are significantly related to cognitive performance among justice-involved individuals with self-reported TBI. While these factors can contribute to the need for rehabilitation, they may also reduce the likelihood of successful engagement. Importantly, both sleepiness and mood are modifiable treatment targets, and adapting interventions to accommodate cognitive inefficiencies can improve engagement and overall treatment benefit. Full article

Tactical athletes, including military service members, are exposed to occupational demands that increase their risk of mild traumatic brain injury (mTBI), particularly through blast exposure, falls, collisions, and repeated sub-concussive events. Although clinical tools and progressive return-to-activity protocols support acute management, recovery may remain fragmented when physical, cognitive, psychological, and performance domains are not integrated. Military personnel require recovery models which extend beyond symptom resolution and return-to-duty clearance. Holistic performance programming offers a multidimensional framework which incorporates subject matter experts across strength and conditioning, rehabilitation, nutrition, behavioural health, cognitive performance, and human performance optimisation. This narrative review examines the role of holistic performance programming in optimising recovery from mTBI among tactical athletes, with emphasis on interdisciplinary care, structured assessment, recovery periodisation, monitoring technologies, and return-to-duty readiness. The role of embedded subject matter experts in identifying and monitoring mTBI; interdisciplinary care models which integrate clinical and performance expertise; structured recovery pathways from assessment to reintegration; and the importance of flexibility, communication, and service member engagement are examined. In addition, the review assesses the potential use of biomarkers, wearable technologies, and multi-domain assessment tools to guide individualised recovery. Holistic performance programming may bridge the gap between clinical recovery and operational readiness following mTBI. By integrating physical, cognitive, psychological, nutritional, and sleep-related strategies, this approach may reduce fragmented care and better address the complex nature of mTBI recovery. Interdisciplinary performance teams may improve early recognition, individualised rehabilitation, safer return-to-duty decisions, and long-term readiness. Future practice should prioritise standardised assessment, real-time monitoring, education, and stigma reduction. Full article

Background/Objectives: Traumatic brain injury (TBI) often results in heterogeneous recovery across cognitive and motor domains. However, the prognostic implications of motor–cognitive imbalance at the time of rehabilitation discharge remain unclear. This study investigated whether discharge patterns of motor–cognitive imbalance are associated with functional outcomes at 1- and 2-year follow-up in individuals with moderate-to-severe TBI. Methods: We conducted a retrospective cohort study using the Traumatic Brain Injury Model Systems (TBIMS) National Database. Adults discharged from inpatient rehabilitation with available Functional Independence Measure (FIM) motor and cognitive subscores were included (n = 8342). Participants were classified as cognitive-dominant, motor-dominant, or balanced based on standardized discrepancies between FIM motor and cognitive scores. Propensity score matching was performed against the balanced group, yielding a matched cohort of 1310 participants. Outcomes included the Disability Rating Scale (DRS), FIM (total and subscales), Glasgow Outcome Scale—Extended (GOSE), and Participation Assessment with Recombined Tools—Objective (PART-O) at 1 and 2 years. Results: The matched cohort included cognitive-dominant (n = 524), motor-dominant (n = 524), and balanced (n = 262) participants with good covariate balance. Compared with the balanced group, the cognitive-dominant group showed lower disability severity (DRS) at 1 year (β = −0.45; 95% CI, −0.81 to −0.09) and 2 years (β = −0.40; 95% CI, −0.78 to −0.03), and higher FIM total scores at both time points. The motor-dominant group demonstrated higher FIM motor scores but lower odds of favorable disability status (DRS ≤ 3) at 2 years (OR = 0.52; 95% CI, 0.31–0.88). GOSE and PART-O outcomes did not differ significantly across groups. Conclusions: Discharge motor–cognitive imbalance patterns were associated with modest but distinct differences in long-term disability severity and functional independence after moderate-to-severe TBI. The direction of imbalance may provide additional prognostic context beyond total functional scores and support domain-targeted post-acute rehabilitation planning. Full article

Background/Objectives: Due to their positions, professional baseball catchers are at elevated risk of concussion, which can impair visual processing. There is a need for sensitive sensorimotor monitoring tools to track concussion-related neurophysiological changes more accurately. We investigated whether oculometrics can address this need. Methods: Four Major League Baseball catchers completed an oculometric assessment shortly after suffering a concussion (Time 1) and again after completing vision rehabilitation (Time 2). The assessment produces 10 z-scored measures, including a summary score. Results: Players’ Time 1 summary score tended to be typical of a normal healthy adult (Mean = 0.07 z-scored units). On average, players improved by 1.3 z-score units from their Time 1 summary score (SD = 1.07). Exploratory analyses revealed that sensorimotor recovery was driven by smooth pursuit latency, proportion of tracking comprising smooth pursuit, and the amplitude of catch-up saccades. Conclusions: Our analysis was based on a very small sample of concussion cases, each of which was unique. Despite this limitation, our data show how oculometrics can measure improvements in visual processing following a concussion among baseball players with exceptional perceptual-motor skills. Our data highlight the risk that brain injuries in high-performing individuals go undetected due to standard-of-care tools normed to behavior from healthy control populations; for these athletes, “normal” scores cannot be interpreted as neurologically “healthy”. Full article

Background/Objectives: Mild traumatic brain injury (mTBI) is the most common subtype of traumatic brain injury, where patients experience a multitude of symptoms from headaches to memory loss and mood changes. Consequently, there are known poor prognostic factors for mTBI that can impede recovery and alter management courses. This narrative review aims to synthesize and provide a critical assessment of the current diagnostic criteria, management, and prognostic factors for mTBI to inform practice guidelines. Methods: This study adopts a patient-centered approach, focusing on treating presenting symptoms and referring patients to specialists for abnormal exam findings as needed. These findings are based on a narrative review of existing literature and the medical opinions of experts in neurology, physical medicine and rehabilitation, and pain medicine. The evidence supports that there are patient-related, injury-related, and contextual psychosocial factors that further complicate the long-term prognosis and management of mTBI. Conclusions: mTBI is defined by a set of diagnostic criteria: post-traumatic amnesia (PTA) lasting no longer than 24 h, loss of consciousness (LOC) not exceeding 30 min when present, and a Glasgow Coma Scale (GCS) score between 13 and 15. Current treatment options include prescribed rest followed by a gradual return to physical activity, medication management for symptoms with cognitive behavioral therapy, or vestibular physical therapy. Notably, several of these diagnostic criteria overlap with known poor prognostic indicators. These prognostic factors can be grouped into three categories: injury-related factors (LOC, positive imaging findings, history of prior concussions, and high symptom burden); patient-related factors (demographic characteristics and psychiatric history); and contextual psychosocial factors. Full article