Relationships and Evidence-Based Theoretical Perspectives on Persisting Symptoms and Functional Impairment Among Mild Traumatic Brain Injury and Behavioral Health Conditions

Abstract

The purpose of this study is to characterize and describe the relationships between symptoms and functional impairment following mild traumatic brain injury (mTBI) and behavioral health conditions (BHCs) in order to inform evidence-based theories on why symptoms and functional impairments persist in some individuals but not others. This is a retrospective, multi-site, cross-sectional study utilizing data collected from a total of 289 Operation Iraqi Freedom/Operation Enduring Freedom Veterans who were classified into diagnostic groups using the symptom attribution and classification algorithm and the VA clinical reminder and comprehensive traumatic brain injury evaluation. The Neurobehavioral Symptom Inventory was used to assess mTBI symptom number and severity. The World Health Organization Disability Assessment Schedule 2.0 was used to assess functional impairment. Symptom profiles differed between diagnostic groups irrespective of symptom attribution method used. Veterans with both mTBI and BHCs and those with BHCs alone had consistently greater number of symptoms and more severe symptoms relative to no symptom and symptoms resolved groups. Symptom number and severity were significantly associated with functional impairment. Both symptom number and functional impairment were significantly associated with the number of mTBI exposures. Together, these results informed evidence-based theories on understanding why symptoms and functional impairment persist among some OEF/OIF Veterans.

Cutting to the Pathophysiology Chase: Translating Cutting-Edge Neuroscience to Rehabilitation Practice in Sports-Related Concussion Management

“…41,78,91 With increased injuries, there is risk for greater symptom severity and functional impairment. 45,87,110 Exposure to subclinical repetitive head trauma incurred during sports participation (eg, soccer heading) may also influence concussion risk and recovery. Brain changes may reflect pathways through which repeated subthreshold head trauma increases vulnerability to concussion and protracted recovery.…”

Preliminary Report: Localized Cerebral Blood Flow Mediates the Relationship between Progesterone and Perceived Stress Symptoms among Female Collegiate Club Athletes after Mild Traumatic Brain Injury

“…Concussion is a form of mild traumatic brain injury (mTBI) that accounts for the majority of the 300,000 sports-related brain injuries among high school and college athletes in the United States each year 1 . Prior concussions can lead to increased risk to subsequent concussions [2][3][4] and repetitive head impacts, whether resulting in a clinically diagnosable concussion or not, can lead to cumulative functional deficits [5][6][7] .…”

Neuropsychological Performance and Functional Capacity Following Mild Traumatic Brain Injury in Veterans

“…Both PTSD and depressive symptoms, when considered independently or when they co-occur with a history of mTBI, are associated with functional impairments across several psychosocial domains (eg, social, work) 12–14. Similarly, TBI characteristics independently contribute to functional impairments, beyond the contributions of these psychiatric factors 14,15…”

“…11 Both PTSD and depressive symptoms, when considered independently or when they co-occur with a history of mTBI, are associated with functional impairments across several psychosocial domains (eg, social, work). [12][13][14] Similarly, TBI characteristics independently contribute to functional impairments, beyond the contributions of these psychiatric factors. 14,15 Growing evidence supports a relationship between greater neuropsychological deficits and worse functional outcomes in individuals with a history of mild to moderate TBI.…”

“…[12][13][14] Similarly, TBI characteristics independently contribute to functional impairments, beyond the contributions of these psychiatric factors. 14,15 Growing evidence supports a relationship between greater neuropsychological deficits and worse functional outcomes in individuals with a history of mild to moderate TBI. For instance, better objective executive functioning, verbal fluency, and planning abilities are associated with better functional outcomes such as return to work, higher wages earned, and ability to complete instrumental activities of daily living postinjury.…”