Progress in Concussion/Traumatic Brain Injury Science and Clinical Care Over the Last 40 Years.

This Special Communication summarizes how knowledge and clinical practice have evolved over the 40 years since the Journal of Head Trauma Rehabilitation's topical issue (volume 1, issue 2) on "Minor Head Injury." We review important insights from this 1986 issue and highlight how research since has refined our understanding of concussion/traumatic brain injury pathophysiology, recovery, and long-term effects. We also discuss shifts in terminology and outline how assessment and rehabilitation approaches have developed over time.

An Intensive Upper Extremity Program Coupled With A Wearable Device for Poststroke Rehabilitation: A Qualitative Study of the Perspectives of People With Stroke.

Objective: The Virtual Arm Boot Camp program (V-ABC) was one of the first virtually-delivered upper extremity exercise programs coupled with a novel wearable device that provided reach-to-grasp feedback for individuals with stroke. Understanding the experience of participants is critical to improve the implementation of rehabilitation interventions that embed biosensor technology within rehabilitation.

Design: A qualitative study embedded within a multi-center randomized controlled trial conducted on the CanStroke Recovery Trials Platform was used to investigate the experiences of participants poststroke with the V-ABC program.

Gender Differences in Seeking and Receiving Healthcare After Mild Traumatic Brain Injury.

Objectives: To investigate gender differences in seeking and receiving healthcare following mild traumatic brain injury (mTBI).

Setting: Participants were recruited from 6 emergency departments and 2 urgent care facilities in the Greater Vancouver Area, Canada.

Participants: 254 adults (56% women, 2% gender-diverse; aged 18-69 years) who presented to emergency department/urgent care within 72 hours after mTBI and were randomized to usual care in the parent study.

New Diagnostic Criteria for Mild Traumatic Brain Injury: Medical-Legal Considerations.

The new American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) were published in 2023. The criteria are designed to be used across clinical settings. This article discusses some medical-legal issues and implications relating to the use of the new ACRM diagnostic criteria.

Trajectories of fear avoidance behavior and recovery after mild traumatic brain injury: Findings from the Toronto Concussion Study.

Objective: Fear avoidance behavior is associated with more severe postconcussion symptoms after mild traumatic brain injury (mTBI). However, it remains unclear when after injury fear avoidance behavior becomes a barrier to recovery. This study investigated changes in early fear avoidance behavior after mTBI and its associations with postconcussion symptoms.

Avoidance and endurance coping after mild traumatic brain injury: patterns of coping and associated psychological functioning.

Purpose: According to the avoidance-endurance model of chronic pain, avoidance and endurance behaviors are distinct pathways to disability following injury. Both coping styles are associated with poor outcomes post-mild traumatic brain injury (mTBI), but whether they represent distinct pathways to disability is unclear. We assessed whether distinct patterns of avoidance and endurance coping exist post-mTBI (study 1) and examined their convergent/divergent validity in an independent sample (study 2).

Functional outcomes among the survivors of veno-venous extracorporeal membrane oxygenation during the COVID-19 pandemic: a historical cohort study.

Purpose: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly being used in patients with respiratory failure. The goal of this study was to characterize postdischarge psychological and functional outcomes of this patient population.

Methods: We conducted a historical cohort study of survivors who required VV-ECMO during the COVID-19 pandemic.

Prediction of Mental Health Complications Following Mild Traumatic Brain Injury.

Prognostic models can support prevention of mental health complications after mild traumatic brain injury (mTBI). The present study aimed to identify risk factors and develop prognostic model(s) for mental health complications following mTBI. This secondary analysis of data from a randomized controlled trial included 513 adults presenting to emergency departments/urgent care centers.

A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative.

The clinical severity of traumatic brain injury (TBI) is commonly classified according to the Glasgow Coma Scale (GCS) sum score as mild (13-15), moderate (9-12), or severe (3-8). A new approach is needed for characterising TBI more accurately. In 2022, the US National Institutes of Health-National Institute of Neurological Disorders and Stroke launched an international initiative to address this need, with a focus on the acute phase of injury.

Clinical Assessment on Days 1-14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group.

The current classification of traumatic brain injury (TBI) primarily uses the Glasgow Coma Scale (GCS) to categorize injuries as mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤8). However, this system is unsatisfactory, as it overlooks variations in injury severity, clinical needs, and prognosis. A recent report by the National Academies of Sciences, Engineering, and Medicine (USA) recommended updating the classification system, leading to a workshop in 2024 by the National Institute of Neurological Disorders and Stroke.

Somatic Symptom Disorder After Mild Traumatic Brain Injury.

Objective: Mild traumatic brain injury (mTBI) may be a common precipitant of Somatic Symptom Disorder (SSD). This study examined the prevalence, correlates, predictors, and functional impact of SSD after mTBI.

Setting: Follow up of patients recruited from emergency departments and urgent care centers.

Diffusion tensor imaging after COVID-19 infection: A systematic review.

Background: Most COVID-19 neuroimaging research focuses on clinically evident lesions occurring during the acute period after infection. Chronic effects on brain structure, especially at a microstructural level, are less well defined. Existing advanced neuroimaging studies report inconsistent differences in white matter integrity after COVID-19 infection.

Quantitative brain volume differences between COVID-19 patients and non-COVID-19 volunteers: A systematic review.

Background: The majority of COVID-19 neuroimaging literature focuses on the acute period after infection and clinically evident lesions. The chronic effects of COVID-19 on brain structure are less well defined. There are inconsistencies in the existing structural neuroimaging studies regarding differences in brain volumes after COVID-19 infection.

Patient perceptions of persistent symptoms after mild traumatic brain injury and their influence on mental health treatment-seeking: a grounded theory study.

Purpose: Mental health conditions after mild traumatic brain injury (mTBI) are common and can complicate injury outcomes, but are under-treated. According to the Common Sense Model of Self-Regulation, the way patients perceive their health conditions can influence the way they manage them, including if, when, and how they seek treatment. This study explored how individuals perceive persistent symptoms after mTBI, in order to develop a grounded theory about what motivates and demotivates them to seek mental health treatment after their injury.

Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study.

Background: Traumatic brain injury (TBI) is associated with an increased risk of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). We aimed to identify predictors and develop models for the prediction of depression and PTSD symptoms at 6 months post-TBI.

Methods: We analysed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study.

Priority Clinical Actions for Outpatient Management of Nonhospitalized Traumatic Brain Injury.

Outpatient care following nonhospitalized traumatic brain injury (TBI) is variable, and often sparse. The National Academies of Sciences, Engineering, and Medicine's 2022 report on highlighted the need to improve the consistency and quality of TBI care in the community. In response, the present study aimed to identify existing evidence-based guidance and specific clinical actions over the days to months following nonhospitalized TBI that should be prioritized for implementation in primary care.

Identifying mild traumatic brain injury in the post-acute polytrauma setting: a scoping review of diagnostic approaches and screening tools.

Objective: Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings.

Methods: By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults.

A Randomized Control Trial of a Virtually Delivered Program for Increasing Upper Limb Activity After Stroke.

BackgroundUpper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke.MethodsThis was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022.

Outcomes after Traumatic Brain Injury with and Without Computed Tomography.

Our recent improved understanding of traumatic brain injury (TBI) comes largely from cohort studies of TBI patients with indication for computed tomography (CT). Using CT head as an inclusion criterion may overestimate poor outcomes after TBI with Glasgow Coma Scale (GCS) 13-15. We aimed to compare outcomes after TBI in adults who had a head CT scan (with negative findings) versus those who had no CT when presenting to an emergency department.

Pilot feasibility randomised controlled trial of cognitive-behavioural therapy for functional cognitive disorder after concussion.

Background: Functional cognitive disorder (FCD) may be common after a concussion, and no evidence-based treatment options are available. The current study evaluated the feasibility of a novel cognitive-behavioural therapy (CBT) protocol tailored to FCD after concussion.

Methods: Participants were randomised to CBT (n=11) or the current standard of care, cognitive rehabilitation (n=13).

Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study.

Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials.