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Brain Injury, Research

The Brain Injury Rehabilitation Workbook

The Brain Injury Rehabilitation Workbook edited by Rachel Winson, Barbara A. Wilson, and Andrew Bateman.

Packed with practical tools and examples, this state-of-the-art workbook provides a holistic framework for supporting clients with acquired brain injury. Clinicians are guided to set and meet collaborative treatment goals based on a shared understanding of the strengths and needs of clients and their family members. Effective strategies are described for building skills and teaching compensatory strategies in such areas as attention, memory, executive functions, mood, and communication. Particular attention is given to facilitating the challenging process of identity change following a life-altering injury. In a large-size format for easy photocopying, the volume features 93 reproducible client handouts. Purchasers get access to a Web page where they can download and print the reproducible materials.

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Memory, Research

The Surprisingly Powerful Influence of Drawing on Memory

The Surprisingly Powerful Influence of Drawing on Memory by Myra A. Fernandes, Jeffrey D. Wammes, Melissa E. Meade. First Published August 30, 2018.

Abstract: The colloquialism “a picture is worth a thousand words” has reverberated through the decades, yet there is very little basic cognitive research assessing the merit of drawing as a mnemonic strategy. In our recent research, we explored whether drawing to-be-learned information enhanced memory and found it to be a reliable, replicable means of boosting performance. Specifically, we have shown this technique can be applied to enhance the learning of individual words and pictures as well as textbook definitions. In delineating the mechanism of action, we have shown that gains are greater from drawing than other known mnemonic techniques, such as semantic elaboration, visualization, writing, and even tracing to-be-remembered information. We propose that drawing improves memory by promoting the integration of elaborative, pictorial, and motor codes, facilitating the creation of a context-rich representation. Importantly, the simplicity of this strategy means it can be used by people with cognitive impairments to enhance memory, with preliminary findings suggesting measurable gains in performance in both normal aging individuals and patients with dementia.

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Research

Association of Concussion With the Risk of Suicide

Michael Fralick, Eric Sy, Adiba Hassan, et al. (2018). Association of Concussion With the Risk of Suicide. A Systematic Review and Meta-Analysis. JAMA Neurol. Published online November 12, 2018.

Systematic review and meta-analysis found a 2-fold higher risk of subsequent suicide among more than 700 000 patients diagnosed with concussion and/or mild TBI, compared with more than 6.2 million individuals who had not been so diagnosed. Experiencing concussion and/or mild TBI was also associated with a higher risk of suicide attempt and suicidal ideation.

These results suggest that experiencing concussion and/or mild TBI is associated with an increased risk of suicide.

https://jamanetwork.com/journals/jamaneurology/fullarticle/2712851

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Brain Injury, Consciousness, Research

Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury

Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury, Journal of Neurotrauma, September 2018, F. Hammond; J. Giacino; R. Nakase-Richardson; J. A. Haley; X. Tang.

Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI).

This study examined functional status during the first ten years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state).

The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury.

The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (>28 days post-injury or never).

Measureable functional recovery occurred throughout the 10-year period, with more than 2/3 of the sample achieving independence in mobility and self-care, and about 1/4 achieving independent cognitive function by 10 years.

Following commands prior to 28 days was associated with greater functional independence at all outcome time points.

More than half the sample achieved near-maximal recovery by 1-year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort.

The proportion of participants achieving functional independence increased between 5 and 10 years post-injury.

These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.

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Research

Glial Fibrillary Acidic Protein as a Marker for Mild Traumatic Brain Injury

What’s the science?

Millions of cases of mild traumatic brain injury occur each year. Computed tomography (CT) scans are used to detect mild traumatic brain injury, and MRI can be used to detect subtle changes in the brain like neuron axonal injury, however these are costly and time-consuming. There is a need for a blood-based biomarker that can detect milder forms of brain injury to ensure proper treatment for these patients. This week in Neurology, Ori and colleagues test whether blood-based biomarkers are associated with neuroimaging changes (on CT and MRI scans) and can successfully detect mild traumatic brain injury.

How did they do it?

Four blood-based biomarkers have previously been associated with brain changes that follow traumatic brain injury of varying severities: Tau (a neuronal injury marker), Glial Fibrillary Acidic protein, ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) and neurofilament light. The authors aimed to assess whether any of these biomarkers would be elevated in mild traumatic brain injury and whether they were also associated with subtle structural changes shown on an MRI scan (using diffusion tensor imaging). A group of 277 patients seeking care for a mild brain injury were enrolled in the study. Blood was drawn to measure plasma concentrations of biomarkers and CT and MRI scans were performed within 48 hours of the injury. A control group of 49 healthy participants (with well-matched demographics) was included for comparison.
What did they find?

Glial Fibrillary Acidic protein, Tau and Neurofilament light were all higher in patients with mild traumatic brain injury compared to controls. Glial Fibrillary Acidic protein was the best predictor of mild traumatic brain injury (diagnosis). When patients with mild brain injury were stratified into those with and without changes on their CT scans, Glial Fibrillary Acidic protein, Tau and neurofilament light concentrations were all higher in patients with detectable changes. However, Glial Fibrillary Acidic protein concentration was the only biomarker that significantly predicted trauma-related CT scan changes. Glial Fibrillary Acidic protein, Tau and Neurofilament light all predicted structural MRI changes, however Glial Fibrillary Acidic protein was the strongest predictor of structural MRI changes related to mile traumatic brain injury.

What’s the impact?

This is the first study to examine whether blood-based biomarkers can be used to detect mild traumatic brain injury. Glial Fibrillary Acidic protein concentration is a sensitive predictor of mild traumatic brain injury and is also closely associated with neuroimaging changes. CT and MRI scans are expensive and time-consuming, so having methods to detect the presence and severity of brain injury early on is important for proper and effective treatment.

Gill et al (2018). Glial fibrillary acidic protein elevations relate to neuroimaging abnormalities acutely following a mild traumatic brain injury. Neurology, Sep 12, 2018.

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Research

Neuropsychological Recovery Trajectories in Moderate to Severe Traumatic Brain Injury: Influence of Patient Characteristics and Diffuse Axonal Injury

Neuropsychological Recovery Trajectories in Moderate to Severe Traumatic Brain Injury: Influence of Patient Characteristics and Diffuse Axonal Injury

Amanda R. Rabinowitz, Tessa Hart, John Whyte, Junghoon Kim

Published online: 16 October 2017, pp. 237-246

Objectives: The goal of the present study was to elucidate the influence of demographic and neuropathological moderators on the longitudinal trajectory neuropsychological functions during the first year after moderate to severe traumatic brain injury (TBI). In addition to examining demographic moderators such as age and education, we included a measure of whole-brain diffuse axonal injury (DAI), and examined measures of processing speed (PS), executive function (EF), and verbal learning (VL) separately. Methods: Forty-six adults with moderate to severe TBI were examined at 3, 6, and 12 months post-injury. Participants underwent neuropsychological evaluation and neuroimaging including diffusion tensor imaging. Using linear mixed effects modeling, we examined longitudinal trajectories and moderating factors of cognitive outcomes separately for three domains: PS, VL, and EF. Results: VL and EF showed linear improvements, whereas PS exhibited a curvilinear trend characterized by initial improvements that plateaued or declined, depending on age. Age moderated the recovery trajectories of EF and PS. Education and DAI did not influence trajectory but were related to initial level of functioning for PS and EF in the case of DAI, and all three cognitive domains in the case of education. Conclusions: We found disparate recovery trajectories across cognitive domains. Younger age was associated with more favorable recovery of EF and PS. These findings have both clinical and theoretical implications. Future research with a larger sample followed over a longer time period is needed to further elucidate the factors that may influence cognitive change over the acute to chronic period after TBI. (JINS, 2018, 24, 237–246)

https://www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/neuropsychological-recovery-trajectories-in-moderate-to-severe-traumatic-brain-injury-influence-of-patient-characteristics-and-diffuse-axonal-injury/6F22CA4361481005F235BE84E4A89E63

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Children, Health, Research

Home Environment as a Predictor of Long-Term Executive Functioning following Early Childhood Traumatic Brain Injury

Home Environment as a Predictor of Long-Term Executive Functioning following Early Childhood Traumatic Brain Injury | Journal of International Neuropsychological Society Vol 24, issue 1, Jan 2018

This study examined the relationship of the home environment to long-term executive functioning (EF) following early childhood traumatic brain injury (TBI). Methods: Participants (N=134) were drawn from a larger parent study of 3- to 6-year-old children hospitalized for severe TBI (n=16), complicated mild/moderate TBI (n=44), or orthopedic injury (OI; n=74), recruited prospectively at four tertiary care hospitals in the United States and followed for an average of 6.8 years post-injury. Quality of the home environment, caregiver psychological distress, and general family functioning were assessed shortly after injury (i.e., early home) and again at follow-up (i.e., late home). Participants completed several performance-based measures of EF at follow-up.

Conclusions: The home environment is not a consistent predictor of long-term EF in children with early TBI and OI, but may moderate the effects of TBI on EF.

The findings suggest that interventions designed to improve the quality of stimulation in children’s home environments might reduce the long-term effects of early childhood TBI on EF.

(JINS, 2018, 24, 11–21)

https://doi.org/10.1017/S1355617717000595

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