The effects of combat-related mild traumatic brain injury (mTBI)

Kontos, Anthony P.; Elbin, R.J.; Lutz, Robert H.; Kane, Shawn F.; Benson, P. F.; Forsten, Robert D.; Collins, Michael W.

doi:10.1097/ta.0000000000000667

Cited by 29 publications

(16 citation statements)

References 22 publications

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“…The current findings addressed previous mixed results reporting either hypo- or hyper-activation in oxygenated hemoglobin during cognitive task performance in patients with ABI 75 , 83 – 87 . Our findings in the HbO 2 -HHb pattern analyses confirmed the need for both indices in examining oxygen metabolism of patients with ABI (see Fig.…”

Section: Discussionsupporting

confidence: 82%

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High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis

Jeong

Ryu

Shin

et al. 2018

Sci Rep

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Attention deficits due to auditory distractibility are pervasive among patients with acquired brain injury (ABI). It remains unclear, however, whether attention deficits following ABI specific to auditory modality are associated with altered haemodynamic responses. Here, we examined cerebral haemodynamic changes using functional near-infrared spectroscopy combined with a topological vector-based analysis method. A total of thirty-seven participants (22 healthy adults, 15 patients with ABI) performed a melodic contour identification task (CIT) that simulates auditory distractibility. Findings demonstrated that the melodic CIT was able to detect auditory distractibility in patients with ABI. The rate-corrected score showed that the ABI group performed significantly worse than the non-ABI group in both CIT1 (target contour identification against environmental sounds) and CIT2 (target contour identification against target-like distraction). Phase-associated response intensity during the CITs was greater in the ABI group than in the non-ABI group. Moreover, there existed a significant interaction effect in the left dorsolateral prefrontal cortex (DLPFC) during CIT1 and CIT2. These findings indicated that stronger hemodynamic responses involving oxygen exchange in the left DLPFC can serve as a biomarker for evaluating and monitoring auditory distractibility, which could potentially lead to the discovery of the underlying mechanism that causes auditory attention deficits in patients with ABI.

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Section: Discussionsupporting

confidence: 82%

“…Similarly, Kontos et al . 75 and Hashimoto et al . 76 have reported large decreases or inactivation of HbO 2 in the ABI group during a series of cognitive tasks (e.g.…”

Section: Introductionmentioning

confidence: 95%

High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis

Jeong

Ryu

Shin

et al. 2018

Sci Rep

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“…Of 29,566 studies identified in the primary search of articles assessing cognitive functioning longitudinally in the TBI population, 39 met inclusion and quality criteria (Figure 1): 14 studies involved patients from acute care (23–36), seven from the rehabilitation setting (37–43), ten involved college-age athletes (44–53), four were clinical trials (54–57), two involved samples from community care settings (58, 59), and another two involved military and veteran participants (60, 61). Sample sizes ranged from 10 (35, 55) to 509 (57), and consisted of mostly males (mean 76.6%, range 38-100%) with participant age ranging from 18 (57) to >60 years (57) (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Within the 39 studies, 15 instruments were used more than once. The Mini Mental State Examination (MMSE) (54, 55), Hopkins Verbal Learning Test (HVLT) (47, 49), Paced Auditory Serial Addition Test (PASAT) (27, 48), and Rey-Osterrieth Complex Figure Test (ROCF) (36, 58) were each used twice; the California Verbal Learning Test (CVLT) (57, 58, 61) and Wechsler Memory Scale (WMS) (37, 38, 42) were used three times; the Automated Neuropsychological Assessment Metrics (ANAM) (33, 50, 51, 53) and FIM-Cog (Functional Independence Measure-Cognitive Subscale) (34, 40, 43, 56, 58) were used four and five times, respectively; the Rey Auditory Verbal Learning Test (RAVLT) (28, 37, 39, 41, 42, 59), Stroop Color Word Test (SCWT) (27, 28, 37, 49, 57, 58), and Symbol Digit Modalities Test (SDMT) (26, 39, 41, 42, 48, 49) were each used six times; the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) (31, 35, 44–46, 52, 60) and Controlled Oral Word Association Test (COWAT) (24, 25, 39, 41, 42, 49, 57, 58) were used seven and eight times, respectively. The most frequently used instruments were the Trail Making Test (TMT) (23, 24, 28, 32, 37–39, 41, 42, 48, 49, 57, 59) and the Wechsler Adult Intelligence Scale (WAIS) (23–26, 28–30, 32, 36–39, 41, 42,…”

Section: Resultsmentioning

confidence: 99%

Measuring Change Over Time: A Systematic Review of Evaluative Measures of Cognitive Functioning in Traumatic Brain Injury

et al. 2019

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Objectives: The purpose of evaluative instruments is to measure the magnitude of change in a construct of interest over time. The measurement properties of these instruments, as they relate to the instrument's ability to fulfill its purpose, determine the degree of certainty with which the results yielded can be viewed. This work systematically reviews all instruments that have been used to evaluate cognitive functioning in persons with traumatic brain injury (TBI), and critically assesses their evaluative measurement properties: construct validity, test-retest reliability, and responsiveness. Data Sources: MEDLINE, Central, EMBASE, Scopus, PsycINFO were searched from inception to December 2016 to identify longitudinal studies focused on cognitive evaluation of persons with TBI, from which instruments used for measuring cognitive functioning were abstracted. MEDLINE, instrument manuals, and citations of articles identified in the primary search were then screened for studies on measurement properties of instruments utilized at least twice within the longitudinal studies. Study Selection: All English-language, peer-reviewed studies of longitudinal design that measured cognition in adults with a TBI diagnosis over any period of time, identified in the primary search, were used to identify instruments. A secondary search was carried out to identify all studies that assessed the evaluative measurement properties of the instruments abstracted in the primary search. Data Extraction: Data on psychometric properties, cognitive domains covered and clinical utility were extracted for all instruments. Results: In total, 38 longitudinal studies from the primary search, utilizing 15 instruments, met inclusion and quality criteria. Following review of studies identified in the secondary search, it was determined that none of the instruments utilized had been assessed for all the relevant measurement properties in the TBI population. The most frequently assessed property was construct validity. Conclusions: There is insufficient evidence for the validity and reliability of instruments measuring cognitive functioning, longitudinally, in persons with TBI. Several instruments with well-defined construct validity in TBI samples warrant further assessment for test-retest reliability and responsiveness. Registration Number: www.crd.york.ac.uk/PROSPERO/ , identifier CRD42017055309.

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“…99 In addition, factors related to symptom severity have been associated with prolonged recovery including post-traumatic amnesia (PTA), 9,100 loss of consciousness (LOC), 101 on-field dizziness, 102 post-traumatic migraine, 11,103,104 acute symptom burden, 69,77,105,106 and neurocognitive impairment. 75,76 The severity of biomechanical forces and/or trauma is associated with prolonged recovery in mTBI patients in both civilian 84 and military 107 populations, however this relationship in sport and recreation populations is tenuous due to a limited number of studies and the difficulty in reliably connecting biomechanical impacts to concussion diagnosis and recovery outcomes. 108–112 The type and timing of concussion treatments (eg, educational, behavioral, ocular-motor, vestibular, physical, and pharmacological) may expedite recovery, 85,113 however if not executed properly, may unintentionally prolong recovery.…”

Section: Summary Of the Current Approach To Treating Concussionsmentioning

confidence: 99%

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

et al. 2016

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Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

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The effects of combat-related mild traumatic brain injury (mTBI)

Abstract: Epidemiologic/prognostic study, level II.

Cited by 29 publications

References 22 publications

High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis

High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis

Measuring Change Over Time: A Systematic Review of Evaluative Measures of Cognitive Functioning in Traumatic Brain Injury

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

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