Search Results (165)

Background: Intimate partner violence (IPV) is a pervasive medical concern affecting millions of people worldwide, with the majority being women. IPV is linked to a number of long-term physical and mental health consequences, including brain injuries and associated persistent post-concussion symptoms (PPCS) and post-traumatic stress disorder (PTSD). Despite the high prevalence of these conditions, there is sparse literature assessing accessible and effective therapeutic avenues specific to IPV victim-survivors. Methods: This narrative review had two aims: to identify therapeutic studies addressing PTSD and PPCS in women IPV survivors, and to provide a narrative overview of potential therapeutic categories, including psychotherapy, mindfulness and meditation, exercise, and pharmacotherapy. A comprehensive literature search was conducted using PubMed and Google Scholar. Inclusion criteria required full-text, peer-reviewed articles published in English, conducted in women with a history of IPV, reporting treatment outcomes related to PTSD or PPCS. Where no IPV-specific evidence was identified, findings from closely related populations including military veterans, athletes, and general TBI samples were narratively reviewed to inform potential therapeutic implications. Results: Nineteen studies addressing PTSD in women IPV survivors were identified, predominantly utilizing psychotherapeutic or mindfulness and meditation-based interventions. No intervention studies targeting PPCS specifically in IPV survivors were identified. Consequently, results for PPCS are largely extrapolated from adjacent populations. Although potential therapeutic avenues were narratively identified across psychotherapy, mindfulness and meditation, exercise, and pharmacotherapy, IPV-specific evidence remains limited, and validation for PTSD and PPCS in this population is needed before clinical recommendations can be made. Conclusions: While 19 studies identified promising therapeutic options for IPV-related PTSD, no IPV-specific PPCS interventions were identified, and implications for PPCS management remain largely inferential. Validation and integrated trauma-informed approaches addressing the intersection of PTSD and PPCS are needed for this understudied population. Full article

Background/Objectives: Sport-related concussion (SRC) elicits multi-systemic symptoms, including nausea, fatigue, and cognitive changes. Gastrointestinal (GI) symptoms are not well captured in current concussion assessments and may be under-recognised in clinical follow-up. GI disturbances may influence intake tolerance and day-to-day fuelling during post-SRC recovery. This study investigated the prevalence and severity of self-reported GI symptoms in Irish athletes after their most recent SRC, examined sex-based patterns, and evaluated the rationale for integrating GI symptom checks into standard concussion tools (e.g., SCAT6) and post-injury monitoring. Methods: An online survey was completed by recreational, competitive, and elite athletes who retrospectively self-reported concussion history, GI symptoms, and bowel function post-SRC and at the time of survey completion (ToSC; 0.03–216 months post-injury). The survey used the Bristol Stool Chart, Rivermead Post-Concussion Symptoms Questionnaire, and validated GI symptom measures. Descriptive statistics and chi-square tests examined timepoint- and sex-based differences. Results: A total of 106 athletes participated (55.7% female; mean age 26.4 ± 7.7 years), of whom 90.6% reported ≥1 GI symptom post-SRC, with greater severity observed for appetite loss, bloating, and abdominal discomfort. Bowel habits shifted bidirectionally for 42.5%, and 26.4% were experiencing ongoing symptoms at ToSC. Conclusions: Self-reported GI symptoms were common and appear under-recognised post-SRC. These findings support greater attention to GI symptom assessment and suggest that brief GI checks and facilitated access to nutrition advice where symptoms persist may be feasible within multidisciplinary, athlete-centred care. Prospective studies are needed to determine clinical relevance and to evaluate nutrition-related strategies. Full article

Mild traumatic brain injury (mTBI) is typically associated with transient cognitive disturbance, particularly involving attention and new learning, with most patients demonstrating full recovery within weeks. Memory impairment in uncomplicated mTBI generally reflects reversible neurometabolic dysfunction and is limited to a brief period of post-traumatic amnesia and restricted retrograde loss surrounding the injury. However, a subset of patients develop persistent and disproportionate autobiographical memory disturbance that exceeds expected neuroanatomical limits and lacks structural correlates on neuroimaging. In rare but clinically challenging cases, this presentation may resemble extensive retrograde or identity-related amnesia. This review examines functional (dissociative) amnesia emerging after mTBI and proposes that concussion may act as a gateway condition facilitating the development of Functional Cognitive Disorder (FCD) in vulnerable individuals. We differentiate expected post-traumatic memory patterns from atypical selective impairment of autobiographical retrieval and clarify how distinct memory systems—episodic, autobiographical, semantic, and procedural—are differentially affected. We expand the two-hit hypothesis by integrating contemporary neurobiological evidence. The first hit comprises concussion-induced neurometabolic disturbance, glial activation, oxidative imbalance, and transient fronto-limbic dysregulation. The second hit may involve psychological stress, identity threat, maladaptive metacognitive processes, or persistent neuroinflammatory signalling, collectively resulting in functional inhibition of autobiographical memory retrieval despite preserved memory storage. Functional amnesia is conceptualised as a severe phenotype within the spectrum of functional cognitive disorder. We introduce a structured clinician-administered interview (SIFRA) to operationalise diagnostic features and support systematic assessment. This integrative framework reconciles neurological vulnerability with functional network dysregulation and provides a coherent basis for diagnosis and multidisciplinary management of persistent memory disturbance after mTBI. 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

Advances in medical care now enable significant functional recovery after traumatic limb injuries. The return-to-duty decision-making process is highly variable and dependent on multiple factors. To retain service members (SM) post-injury, there needs to be a robust method to inform the decision-making process. The collection of outcome data and decision tree analysis has the potential to assist in the development of an efficient decision support tool. Data were combined from two previous research studies on 31 injured SMs (26 with limb salvage wearing custom dynamic ankle–foot orthoses and 5 with varying levels of lower limb amputation wearing prostheses). Forty-two factors across military, demographic, injury, and outcome measures were used to develop categorical tree models to classify return to duty after injury. The feasibility of the final pruned model was evaluated using a 10-fold cross-validation to calculate sensitivity, specificity, and misclassification rate. The overall misclassification rate for the final pruned model was 29% (9/31). The model classified participants into successful return to duty: (1) Post Concussion Symptom Scale < 20 and (2) age at time of assessment ≥34. These preliminary results suggest that decision tree modeling could be an effective approach to augmenting the return-to-duty decision-making process. Full article

Background/Objectives: Older adults are disproportionately affected by traumatic brain injuries (TBIs), representing a significant portion of TBI-related hospitalizations and deaths. The objective of this study was to evaluate the feasibility and effectiveness of BrainCheck (Braincheck, Inc., Austin, TX, USA), a digital cognitive assessment tool, in detecting acute TBI-related cognitive deficits in the context of dementia-related cognitive impairment in older adult emergency department (ED) patients. Methods: From March 2020 to November 2023, participants aged 65+ with mild TBI, as defined by the American College of Rehabilitation Medicine (ACRM) diagnostic criteria, and individuals with isolated orthopedic injuries were recruited from 14 U.S. type 1 and 2 trauma centers. After informed consent, each subject was assessed by well-validated neurocognitive tests to characterize pre- and postinjury cognitive status. The Clinical Dementia Rating (CDR) and Functional Activities Questionnaire (FAQ) were used to assess cognitive impairment, with the informant sections used to classify preinjury status. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ16) was used to assess injury-related symptoms, and the tablet-based BrainCheck Battery was tested as a diagnostic platform for injury-related deficits across several functional domains. Spearman’s correlation was used to assess BrainCheck’s internal validity and its relationship with self-reported cognitive symptoms. Technology familiarity was self-reported on a 1 (lowest) to 5 (highest) Likert scale. ROC curves evaluated the tool’s accuracy in identifying cognitive impairment associated with TBI in the context of pre-existing cognitive impairment. Results: For the 101 mTBI and 52 orthopedic trauma control patients, BrainCheck demonstrated strong internal validity, with significant correlations among its component tests, indicating its effectiveness in assessing cognitive impairment. However, low correlations with RPQ16 self-reported symptoms suggest that BrainCheck and the self-reported questionnaire assess different aspects of cognitive functions. Conclusions: While BrainCheck effectively identified cognitive impairment, the composite battery and scoring did not differentiate TBI and dementia. Technology familiarity did not affect test outcomes. BrainCheck is a useful tool for evaluating cognitive function in adults aged ≥ 65 years with and without TBI in ED settings. Full article

Repeated exposure to low-level blast overpressure (BOP) during controlled detonations is an emerging occupational health concern for military breachers and Special Operations Forces personnel, given accumulating evidence that chronic exposure may produce subtle, subclinical neurotrauma. This study derived a latent neuroinjury construct integrating three complementary domains of brain health—post-concussive symptoms, working-memory performance, and circulating biomarkers—to determine whether breachers exhibit coherent patterns of neurobiological alteration. Symptom severity was assessed using the Rivermead Post-Concussion Questionnaire (RPQ), and working memory was assessed with the N-Back task and a panel of thirteen neuroproteomic biomarkers was measured reflecting astroglial activation, neuronal and axonal injury, oxidative stress, inflammatory signaling, and neurotrophic regulation. Experienced Canadian Armed Forces breachers with extensive occupational BOP exposure were compared with unexposed controls. Bayesian latent-variable modeling provided probabilistic evidence for a chronic, subclinical neurobiological signal, with the strongest contributions arising from self-reported symptoms and smaller but consistent contributions from the biomarker domain. Working-memory performance did not load substantively on the latent factor. Several RPQ items and circulating biomarkers showed robust loadings, and the latent neuroinjury factor was elevated in breachers relative to controls (97% posterior probability). The pattern is broadly consistent with subclinical neurobiological stress in the absence of measurable cognitive impairment, suggesting early or compensated physiological alterations rather than overt dysfunction. This multidomain, biomarker-informed framework provides a mechanistically grounded and scalable approach for identifying subtle neurobiological strain in military personnel routinely exposed to repetitive low-level blast. It may offer value for risk stratification, operational health surveillance, and the longitudinal monitoring of neurobiological change in high-risk occupations. Full article

Introduction: The Diagnostic and Statistical Manual of Mental Disorders has been criticized for its reliability and validity, including for the major psychological injuries [Posttraumatic Stress Disorder (PTSD), chronic pain-related disorders, and neurocognitive disorders, pertinent for mild traumatic brain injury (MTBI)/persistent post-concussion syndrome (PPCS)]. Methods: This review article examines both the mental health/psychiatric and legal literature on the DSM-5 and its criticisms. The DSM-5 uses a polythetic approach, which leads to many complicating ways of expressing disorders (e.g., PTSD). Disorders related to chronic pain refer to somatic symptom disorders (e.g., with predominant pain), which leads to less focus on the chronic pain itself. The neurocognitive disorder diagnosis includes minor and major classifications, but excludes moderate ones. The international diagnostic system (International Classification of Diseases (ICD-11)) and alternate approaches to psychiatric nosology [the Research Domain Criteria (RDoC) and Hierarchal Taxonomy of Psychopathology (HiTOP)] do not help resolve these issues. Results: The comprehensive literature review undertaken indicates the limitations of the DSM-5 clinically and in court, especially for psychological injuries. The article includes tables and boxes that complement the text with specificities related to the issues raised. Conclusions: The article recommends supplementary diagnostic criteria for the three major psychological injuries (PTSD, chronic pain, and MTBI) for forensic use. This paper is an original contribution to improving the diagnostics/description and forensic use of the major psychological injuries: aside from the paper’s clinical contributions, these disorders/conditions are contentious in court, and their better specification in diagnosis, as attempted herein, is important to undertake forensically. Full article

Repetitive non-concussive head impacts (NCHIs) may contribute to long-term neurodegenerative conditions. However, objective, multimodal methods for monitoring acute changes in brain health biomarkers following NCHIs remain underdeveloped. In this exploratory study, we examined the effects of ten kicking and ten heading trials related to association football on linear and nonlinear measures of postural control and corticospinal inhibition. Postural control was assessed via force platform analysis in dual-stance and single-leg protocols, and corticospinal inhibition was measured using transcranial magnetic stimulation with electromyography. Large effects of condition were found for anteroposterior postural complexity (CI-AP), anteroposterior sway amplitude, mediolateral centre of pressure shift and cortical silent period (η² > 0.14). Pairwise comparisons revealed large post-heading effects, particularly in CI-AP, which decreased significantly relative to baseline (d_z = 0.71, p = 0.018) and showed a moderate negative effect relative to post-kicking testing (d_z = 0.53, p = 0.069). These findings suggest a possible reduction in postural control adaptability following exposure to ten NCHIs, consistent with patterns observed in mild traumatic brain injury. Whilst confirmatory research with larger samples is warranted, nonlinear measures of postural control complexity demonstrate promise as a sensitive biomarker for detecting acute NCHI-related changes. Full article

Background/Objectives: Headache after a traumatic brain injury (TBI) is one of the most common post-concussive symptoms and is associated with altered pain processing and elevated disability levels. Understanding physiologic correlates of nociception in individuals with persistent post-traumatic headache (pPTH) may help identify novel treatment targets for pain-related disability. The objective of this case–control study was to compare extra- and intracranial hemodynamic responses to a noxious cold pressor task (CPT) between individuals with pPTH and healthy controls (HC) using functional near-infrared spectroscopy (fNIRS). Methods: Ten individuals with pPTH were compared to ten HC with no history of TBI, persistent headache, or chronic pain. fNIRS optodes over the medial prefrontal cortex (PFC) measured extra- and intracranial peak-to-peak hemodynamic responses during tepid- (control) and cold-water (CPT) hand immersion. Evoked pain responses during the CPT were assessed with numeric pain ratings. Linear mixed effects modeling assessed the role of group and evoked pain on hemodynamic responses. Results: pPTH group membership (p = 0.031) predicted greater extracranial hemodynamic responses to the CPT, whereas intracranial PFC responses did not differ between groups. Regardless of group membership, greater increases in pain intensity during the CPT were associated with increased hemodynamic responses for the dorsomedial PFC (p = 0.031). Conclusions: Compared to controls, individuals with pPTH responded to a noxious cold stimulus with elevated systemic hemodynamic responses regulated by the autonomic nervous system. Irrespective of group, hemodynamic responses within the dmPFC were associated with evoked pain responses to the CPT and may provide a useful biomarker for individual variations in cortical pain processing for healthy and clinical populations. Full article

Background: Sport-related concussion is common in rugby union, yet female players remain underrepresented in research. This study examined seasonal changes in cerebral oxygenation, cardiac function, and concussion symptomology in adult female rugby players, and explored acute physiological responses following a single documented concussion. Methods: A total of 29 adult females (19 amateur rugby, 10 control) completed pre-, mid-, and end-season assessments. Measures included functional near-infrared spectroscopy (fNIRS) of the pre-frontal cortex, seismocardiography (SCG)-derived cardiac timing indices, and Sport Concussion Assessment Tool 6 (SCAT6). Group and time effects were analysed using general linear models and statistical parametric mapping. Typical error (TE) and its 90% confidence intervals (90% CI) were used to determine meaningful changes post-concussion. Results: Rugby players reported more SCAT6 symptoms (number: p = 0.006, η²_p = 0.23; severity: p = 0.020, η²_p = 0.17). They also had shorter systolic time (p = 0.002, η²_p = 0.19) and higher twist force values (p = 0.014, η²_p= 0.21) than controls. fNIRS revealed higher right-hemisphere oxyhaemoglobin (ΔO₂Hb) responses for both tasks (ps < 0.001, η²_p = 0.77 and η²_p = 0.80) and lower activation in specific prefrontal channels. No seasonal changes occurred in global oxygenation or frequency band activity. In the exploratory single-concussion case, symptomology, SCG twist force, ΔO₂Hb, and cardiac band power exceeded TE and its 90% CI at 5 days post-injury. Conclusions: The multimodal approach detected stable group-level physiology alongside localised cortical and cardiac differences, and acute changes following concussion. While these results highlight the potential of combined fNIRS and SCG measures to capture physiological disturbances, the small sample size and single-concussion case necessitate cautious interpretation. Further validation in larger, longitudinal cohorts is required before any biomarker utility can be inferred. Full article

Due to the highly individualised presentation of sport-related concussion (SRC), multi-domain assessments examining cognitive, migraine, vestibular, ocular, mood, sleep, and neck-related function have been suggested to assist clinicians with diagnosis, management, and rehabilitation. Normative data on such assessments for female, community players from countries outside the U.S. are needed. This study aimed to (i) describe normative data from community-level Ladies Gaelic Football players using a multi-domain assessment, and (ii) compare findings between adolescent and adult players. A total of 138 LGF players without SRC (101 adults, 37 adolescents) completed a multi-domain SRC assessment including Sport Concussion Assessment Tool 5th Edition, Concussion Clinical Profiles Screening, Vestibular/Ocular Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT^®), Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Pittsburgh Sleep Quality Index, Migraine Disability Assessment, and Neck Bournemouth Questionnaire, and neck dynamometry. Normative data were summarised using descriptive statistics, while differences in test scores between adolescents and adults were examined using parametric or non-parametric tests. While adolescents and adults scored similarly on most measures, adolescents scored worse on ImPACT^® visual–motor speed (d = 0.09) and reaction time (r = 0.52), SCAT5 concentration (V = 0.38), total modified Balance Error Scoring System (r = 0.42), and CP Screen vestibular profile (r = 0.38) (p < 0.05). This is the first study to describe and compare normative data for multidomain SRC assessments in adolescent and adult female, community athletes. Differences in some tests between adolescents and adults highlight the need for demographic-specific normative data when interpreting post-SRC assessment results. Full article

Oculomotor dysfunction identified within the first 10 days of sport-related concussion (SRC) is a risk factor for Persisting Post-Concussion Symptoms (PPCS). Oculomotor rehabilitation is the recommended treatment for oculomotor dysfunction from the subacute period onwards. However, there are delays in initiating rehabilitation due to a limited number of specialized providers and associated healthcare costs. Delays in initiating treatment are associated with worse outcomes. We performed a retrospective, quasi-experimental trial to evaluate whether providing instructions for self-guided oculomotor rehabilitation in adolescents with 3 or more abnormal oculomotor findings after SRC (Experimental Arm, n = 27, mean age = 15.50 ± 1.53 years, 63.0% male, 5.74 ± 2.43 days since injury) reduced the number of persisting impairments at 4 weeks compared to a wait-and-see approach (Standard Care Arm, n = 106, mean age = 14.98 ± 1.87 years, 59.4% male, 5.69 ± 2.78 days since injury). A small difference was seen in the incidence of neck tenderness but there were no differences between groups in symptom severity or number of abnormal oculomotor findings at initial presentation. Overall, 50 out of 106 (47.2%) participants in the Standard Care Arm had PPCS compared to 7 out of 27 (25.9%) in the Experimental Arm, which was significantly different (Chi-squared = 3.966, p = 0.046). This corresponds to an absolute risk reduction of 21.3%. Results from our pilot study suggest these treatment guidelines are feasible to incorporate into a busy outpatient practice in a cost-effective manner. Prospectively designed randomized controlled trials are warranted to validate the effectiveness of this treatment. Full article

Background/Objectives: Sports-related concussions can result in prolonged symptoms and deficiencies in stability and balance. Effective and standardized rehabilitation protocols remain limited. This case report introduces a novel balance training program using virtual reality and force plate technology to address persistent post-concussion symptoms. Methods: A 20-year-old National Collegiate Athletic Association (NCAA) Division I football player with a history of multiple concussions and balance-related symptoms completed a 10-week intervention. The program utilized a multi-axis force platform and immersive visual tasks to train vestibular, oculomotor, and proprioceptive systems. Each weekly session consisted of seven tasks progressing in difficulty, which were completed three times per session. Performance was measured by the percentage of time a digital cursor remained within task boundaries using the distribution of their center of mass. Symptom self-reports were also recorded. Results: Cumulative mean performance improved from 75.87% in the first session to 91.67% in the final session. All individual template scores increased, including those on the most complex template, which rose from 55.76% to 80.20%. The patient also reported reduced dizziness, disorientation, and improved functional balance across the 10-week period. Conclusions: This virtual-reality-based balance training program shows promise in resolving persistent post-concussion symptoms. Its objective measurement, engaging format, and ease of use suggest potential for broader application in concussion rehabilitation. Full article

Introduction: Mild traumatic brain injury (mTBI) in older adults (≥65 years) is often underestimated, despite being associated with significant morbidity. Age-related vulnerability, comorbidities, and medication use may exacerbate outcomes. This study aimed to identify predictors of brain health and functional recovery in older adults following mTBI, focusing on acute symptoms, CT imaging findings, and sociodemographic factors. Methods: We analyzed a cohort of 93 older adult patients with mTBI (GCS 13–15) who were prospectively enrolled at a tertiary neurosurgical center. All patients underwent baseline CT, structured clinical assessment, and follow-up at six months with standardized instruments (Glasgow Outcome Scale–Extended-GOSE, 12-Item Short Form Health Survey (quality-of-life measure)-SF-12, Rivermead Post-Concussion Symptoms Questionnaire-RPQ, Patient Health Questionnaire-9 (depression measure)-PHQ-9, PTSD (Post Traumatics Stress Disorder) Checklist for DSM (Diagnostic and Statistical Manual for Mental Disorders)-PCL-5, Timed up and Go Test (mobility measure-TUG test). Multivariate regression was performed to identify independent predictors of recovery. Results: At six months, 94.9% of older adults achieved functional independence (GOSE ≥ 5), though only 43% attained complete recovery (GOSE = 8). Patients with acute intracranial lesions on CT had worse physical outcomes, including slower mobility (mean TUG 17.6 vs. 16.3 s, p = 0.012). Severe acute headache independently predicted poorer recovery (lower GOSE and SF-12 PCS). Lower educational attainment correlated with worse functional and quality-of-life outcomes, consistent with reduced cognitive reserve. Psychological outcomes (PTSD and depression rates) were not associated with CT findings but were influenced by social support and sex. Prompt anticoagulation reversal in patients on anticoagulants markedly reduced hemorrhagic complications. Discussion: Older adults with mTBI generally maintain independence but experience reduced physical health and mobility compared to younger patients. Predictors of poorer outcomes include severe acute symptoms, CT-detected lesions, advanced age, and lower educational levels. Psychosocial support mitigated mental health complications. Conclusions: mTBI in older adults is not benign. Clinical, imaging, and sociodemographic factors collectively shape recovery. Early identification of high-risk patients and targeted interventions are essential to preserve brain health and independence in this growing population. Full article