Advanced Neuroimaging of Mild Traumatic Brain Injury

Mechtler, Laszlo; Shastri, Kalyan; Crutchfield, Kevin E.

doi:10.1016/j.ncl.2013.08.002

Cited by 37 publications

(26 citation statements)

References 97 publications

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“…This study also showed that the GCS was not significantly associated with white matter tract changes, as measured by diffuse tensor imaging (DTI), suggesting that advanced imaging modalities are vital to clinical tracking of disease progression and may be a more sensitive measure of outcome compared to GCS alone. Indeed, DTI coupled with functional MRI and perhaps other imaging strategies would greatly advance our understanding of the age-related mechanisms of repair and plasticity following TBI [36][37][38][39]. White matter dysregulation after childhood TBI may also affect motor recovery and social cognitive skills which are realized once the skills reach maturity [40][41][42][43].…”

Section: Age-at-injury Response To Clinical Tbimentioning

confidence: 99%

Age-Dependent Responses Following Traumatic Brain Injury

Brickler¹,

Morton²,

Hazy³

et al. 2018

Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management

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Traumatic brain injury (TBI) is a growing health concern worldwide that affects a broad range of the population. As TBI is the leading cause of disability and mortality in children, several preclinical models have been developed using rodents at a variety of different ages; however, key brain maturation events are overlooked that leave some age groups more or less vulnerable to injury. Thus, there has been a large emphasis on producing relevant animal models to elucidate molecular pathways that could be of therapeutic potential to help limit neuronal injury and improve behavioral outcome. TBI involves a host of different biochemical events, including disruption of the cerebral vasculature and breakdown of the blood-brain barrier (BBB) that exacerbates secondary injuries. A better understanding of age-related mechanism(s) underlying brain injury will aid in establishing more effective treatment strategies aimed at improving restoration and preventing further neuronal loss. This review looks at studies that focus on modeling the adolescent population and highlights the importance of individualized aged therapeutics to TBI.

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Section: Age-at-injury Response To Clinical Tbimentioning

confidence: 99%

Age-Dependent Responses Following Traumatic Brain Injury

Brickler¹,

Morton²,

Hazy³

et al. 2018

Traumatic Brain Injury - Pathobiology, Advanced Diagnostics and Acute Management

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“…We thus may underestimate the strength of the evidence. Reviews with such partial responses included: "was the search strategy comprehensive", (DTI-mTBI, n 5 [45][46][47][48]52,53,55,57,63,64,66 ), "are all of the results presented with confidence intervals", (DTI-mTBI n 5 1; 34 DSCglioma n 5 4 50-52,65 ), "does it state the study design of all included articles" (DTI-mTBI, n 5 3; 25,39,44 DSC-glioma, n 5 3 62,64 ) and "does it specify the number of subjects for all included studies" (DTI-mTBI, n 5 11; 8,25,27,28,31,34,37,38,40,42,44 DSC-glioma, n 5 8 47,50,51,57,60,61,63,64 ).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding critical appraisal worksheet grades for DTI-mTBI detection reviews, 1 review achieved Grade A, 29 8 reviews achieved Grade B 8,24,25,36,39,41,42,44 and 14 reviews achieved Grade C. 6,[26][27][28][30][31][32][33][34][35]37,38,40,43 Of the reviews of DTI-mTBI outcome prediction, three reviews achieved Grade B 25,39,41 and the remaining reviews were Grade C. 6,[26][27][28][30][31][32]37,40 Of the reviews of DSC-glioma detection, 1 review achieved Grade A, 7 1 review achieved Grade B 62 and 24 reviews achieved Grade C. 9,12,[45][46][47][48][49][50][51][52][53][54]…”

Section: Classification and Grading Of Individual Review's Overall Qumentioning

confidence: 99%

Advanced neuroimaging in the clinic: critical appraisal of the evidence base

Fink

Mogil

Lipton

2016

BJR

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The shortage of high-quality systematic reviews in the field of radiology limits evidence-based integration of imaging methods into clinical practice and may perpetuate misconceptions regarding the efficacy and appropriateness of imaging techniques for specific applications. Diffusion tensor imaging for patients with mild traumatic brain injury (DTI-mTBI) and dynamic susceptibility contrast MRI for patients with glioma (DSC-glioma) are applications of quantitative neuroimaging, which similarly detect manifestations of disease where conventional neuroimaging techniques cannot. We performed a critical appraisal of reviews, based on the current evidence-based medicine methodology, addressing the ability of DTImTBI and DSC-glioma to (a) detect brain abnormalities and/or (b) predict clinical outcomes. 23 reviews of DTI-mTBI and 26 reviews of DSC-glioma met criteria for inclusion. All reviews addressed detection of brain abnormalities, whereas 12 DTI-mTBI reviews and 22 DSC-glioma reviews addressed prediction of a clinical outcome. All reviews were assessed using a critical appraisal worksheet consisting of 19 yes/no questions. Reviews were graded according to the total number of positive responses and the 2011 Oxford Centre for evidence-based medicine levels of evidence criteria. Reviews addressing DTI-mTBI detection had moderate quality, while those addressing DSC-glioma were of low quality. Reviews addressing prediction of outcomes for both applications were of low quality. Five DTI-mTBI reviews, but only one review of DSC-glioma met criteria for classification as a meta-analysis/systematic/quantitative review. INTRODUCTIONEvidence-based medicine (EBM) principles have been widely adopted as the gold standard and even the expected basis for everyday clinical practice. However, adoption of EBM principles in radiology has greatly lagged behind other clinical specialities. 1,2 In fact, the clinical utility of less than one-third of diagnostic imaging procedures is supported by sufficient evidence; as opposed to merely experience and opinion. 2,3 According to EBM standards, systematic reviews constitute the highest level of evidence because they consolidate the evidence of multiple studies rather than relying on the results of one individual study, with its inherent biases, alone. 2,4 Optimal reviews, which adopt EBM practices, provide a comprehensive overview of primary investigations of a specific topic through systematically and comprehensively searching and critically appraising the literature. While many narrative and educational

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“…This could indicate that the uninjured group had more control of their lead foot during obstacle clearances vs. the mTBI group who had larger clearance distance. In a study based on healthy young and older adults, authors found that when individuals walked slower and with more control, they tended to step closer to the obstacle 59 . This indicates that adults had greater time to plan and execute clearance strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Although some research imaging has shown changes [54][55][56][57][58][59][60][61][62] , diagnosis and management of mTBI are based largely on the clinical presentation of the child or adolescent.…”

Section: Patho-physiology Of Mtbimentioning

confidence: 99%

Balance and mobility in clinically recovered children and adolescents after a mild traumatic brain injury

Sambasivan

Grilli

Gagnon

2015

PRM

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PURPOSE: To compare the ability of clinical balance measures to detect differences between children recovered from a mild Traumatic Brain Injury (mTBI) and healthy controls. METHODS: A cross-sectional study, with twenty-six children with mTBI and twenty-two age-matched controls was conducted. Balance was evaluated on three scales: Bruininks-Osteresky Test-second edition; Balance Error Scoring System and Community Balance and Mobility Scale, along with gait analysis of three paradigms (self-selected paced walking, obstacle crossing and tandem walking), under single and dual-task conditions, using GAITRite R walkway. Independent sample t-tests (α = 0.05) were used to identify group differences. Dual-Task Cost (DTC) was analyzed using repeated measures ANOVA and t-tests. Discriminant analysis predicted which balance measure best identified the groups. RESULTS: Children with mTBI performed worse on all balance scales (p < 0.05). Gait parameters were significantly better for the controls. There were no group differences on the motor and cognitive DTC. The Community Balance and Mobility Scale and gait parameters including velocity at obstacle crossing and parameters for tandem walking, best discriminated the groups. CONCLUSION: Clinical balance assessments may need to include static and dynamic measures, to capture possible performance difficulties. The inclusion of these measures will enhance clinical decision making and prevent premature return to physical activities in children with mTBI.

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Advanced Neuroimaging of Mild Traumatic Brain Injury

Cited by 37 publications

References 97 publications

Age-Dependent Responses Following Traumatic Brain Injury

Age-Dependent Responses Following Traumatic Brain Injury

Advanced neuroimaging in the clinic: critical appraisal of the evidence base

Balance and mobility in clinically recovered children and adolescents after a mild traumatic brain injury

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