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Background: Population-based data regarding the associations between prior concussion or brain injury symptoms/diagnosis and mental/social well-being is lacking for U.S. children., Methods: Associations between prior concussion or brain injury symptoms/diagnosis (reported by parents of children ages 5-17 from the 2020 National Health Interview Survey) and current mental/social well-being were determined in multivariable models., Results: Amongst 2020 US children, 8.7% and 5.3% had previous symptoms and diagnosis of concussion/brain injury, respectively. 23% of children with symptoms were never checked for a concussion/brain injury, with younger children at higher risk of not getting checked after symptomatic head trauma. Prior concussion or brain injury symptoms/diagnosis was associated with a higher likelihood of current depressive symptoms (odds ratio [OR] = 1.60; 95% CI = 1.21-2.14; p  < 0.001), anxiety (OR = 2.07; 95% CI = 1.52-2.82; p  < 0.001), difficulty making friends (OR = 1.57; 95% = 1.06-2.33; p  = 0.03), use of medications for mental/social/behavioral issues (OR = 1.69; CI = 1.21-2.36; p  = 0.002), and mental health therapy/counseling (OR = 1.52; 95% CI = 1.13-2.04; p  = 0.006)., Conclusion: U.S. children with prior concussion or brain injury symptoms/diagnosis have a higher rate of mental and social disturbances and a more frequent need for mental health services. Nearly one-quarter of children with significant symptoms after head trauma are never checked for a concussion/brain injury; routine concussion evaluation after head trauma should be emphasized especially in younger children.

Background: The evaluation of functional cognition is a central concern in clinical practice. However, there are few standardized or validated tools, and many of them take too long, requiring screening tests., Aims: To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury. Moreover, to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes., Materials and Methods: A cross-sectional design was applied following the guidelines of the STROBE checklist. A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers. A cognitive screening test and daily living activity tests were implemented, such as ACLS-5, MoCA, Barthel, and FIM+FAM. Data were analyzed using non-parametric methods. In addition, a structural analysis and simple regression models were performed., Results: Eighty patients with chronic acquired brain injury, with a mean age of 52, were recruited. All tests are significantly related to the ACLS-5 score, a moderate effect size for MoCA (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50)., Conclusions: ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion.

Primary Objective: To examine the convergent validity of the Test of Effort (TOE), a performance validity test (PVT) currently under development that employs a two-subtest (one verbal, one visual), forced-choice recognition memory format., Research Design: A descriptive, correlational design was employed to describe performance on the TOE and examine the convergent validity between the TOE and comparison measures., Methods and Procedures: A sample of 53 individuals with chronic acquired brain injury (ABI) were administered the TOE and three well-validated PVTs (Reliable Digit Span [RDS], Test of Memory Malingering [TOMM] and Dot Counting Test [DCT])., Main Outcomes and Results: The TOE appeared more difficult than it actually was, suggesting adequate face validity. Medium-to-large correlations were observed between the TOE and established PVTs, suggesting good convergent validity. Provisional cutoff scores are offered based on performance of a subgroup of participants with "sufficient effort.", Conclusions: Overall, the TOE shows promise as a PVT measure for clinical use. Future studies with larger and more diverse samples are needed to more fully determine the psychometric characteristics of the TOE.

Objective: To explore the changes in amplitude-integrated electroencephalography (aEEG), neuron-specific enolase (NSE), and S100B in neonates with brain injury induced by neonatal hyperbilirubinemia (NHB)., Methods: 67 neonates with brain injury induced by NHB admitted to our hospital from March 2016 to October 2018 were included in a brain injury group (BIG), and 82 neonates with NHB but without brain injury in our hospital during the same period were included in a non-BIG. The two groups were compared regarding the rates of normal and abnormal aEEG results., Results: The proportion of normal aEEG results in the BIG was significantly lower than that in the non-BIG, and the proportion of moderately and severely abnormal aEEG results in the BIG were both significantly higher than those in the non-BIG. The BIG showed significantly higher NSE and S100B levels than those of the non-BIG. The ROC curve for predicting prognosis showed that the AUC of aEEG, NSE, S100B, and the combined detection are 0.780, 0.754, 0.743, 0.788. The AUC > 0.700 indicated a good predictive value for the prognosis., Conclusion: The combination of aEEG, NSE, and S100B has good value in diagnosing injury induced by NHB and can predict prognosis moderately well.

OBJECTIVE : Early identification of neonates at risk of neurological impairment is particularly important for the bedside clinician. Clinical value of S100b and neuron-specific enolase in neonates has not been yet established. We investigated their kinetics and possible early clinical utility in neonatal encephalopathy (NE). STUDY DESIGN : 36 full-term neonates (13 with moderate/severe encephalopathy, 11 with mild encephalopathy, 12 controls) were enrolled and studied prospectively. Serum S100b and neuron-specific enolase (NSE) were measured serially on days(d) 1, 3, 9 and 18 of life. Brain MRI and long-term neurodevelopmental outcome were also assessed. RESULT : Neonates with moderate/severe encephalopathy had significantly increased S100b (d1) and NSE levels (d1, d3, d9) compared to controls. Neuron-specific enolase significantly correlated with the degree of encephalopathy, and a cutoff of 38.8 μg/l (d1) accurately predicted moderate/severe encephalopathy. S100b (d1) cutoff points of 1.6 μg/l and 11.4 μg/l prognosticated severe encephalopathy and death/cerebral palsy, respectively. Both biomarkers correlated well with neuroimaging and Bayley-III scores. CONCLUSION : Combined clinical, laboratory, imaging and neurodevelopmental data indicate that serum S100b and NSE can be useful biomarkers for the diagnosis and prognosis of neonatal brain injury, providing useful information to the bedside clinician.

Introduction : Neurodynamic intervention is used in the treatment of patients with Acquired Brain Injury as a method to inhibit the spasticity or reduce the sensory impairment. Purpose of the study : Assess and compare bilateral median nerve mechanosensitivity and its relationship with physical and functional status in patients with hemiparesis or upper limb paresis after ABI. Materials and Methods : Volunteer Patients from the Brain Injury Rehabilitation Unit of the Hospital Universitario Central de Asturias were evaluated for six months. Taking into account inclusion and exclusion criteria, from the 98 original patients having treatment in the Unit included, only 32 were admitted to the final study. The assessment protocol incorporated as main outcomes: bilateral mechanosensitivity of the median nerve (sensory responses, structural differentiation and maximum range of movement in Upper Limb Neurodynamic Test 1) and as secondary outcomes: hypertonia, sensory impairment, upper limb motor function and Activities of Daily Living performance. Results : Significant differences were found when comparing the bilateral maximum range of movement in Upper Limb Neurodynamic Test 1. No relationship was found between the results of the neurodynamic test of the affected upper limb and the secondary outcomes. Conclusions : Mechanosensitivity disturbance observed in the affected upper limb may benefit from neurodynamic treatment.

Background: Although elevated serum levels of visinin-like protein 1 (VILIP-1), a neuron-specific calcium sensor protein, are associated with ischaemic stroke, only a single study has evaluated VILIP-1 as a biomarker of traumatic brain injury (TBI). The current proof-of-concept study was designed to determine whether serum VILIP-1 levels increase post-injury in a well-characterized rat unilateral cortical contusion model., Methods: Lateral flow devices (LFDs) rapidly (< 20 min) detected trace serum levels (pg/mL) of VILIP-1 in a small input sample volume (10 µL). Temporal profiles of serum levels at baseline and post-injury were measured in male Sprague Dawley rats subjected to very mild-, mild unilateral-cortical contusion, or naïve surgery and in male Sprague Dawley rats following a diffuse TBI or sham surgery., Results: Mean serum levels were significantly elevated by 0.5 h post-injury and remained so throughout the temporal profile compared with baseline in very mild and mild unilateral contusions but not in naïve surgeries. Serum levels were also elevated in a small cohort of animals subjected to a diffuse TBI injury., Conclusions: Overall, the current study demonstrates that the novel LFD is a reliable and rapid point-of-care diagnostic for the detection and quantification of serum levels of UB-VILIP-1 in a clinically relevant time frame.

Primary Objective: This study aimed to create a specific questionnaire (Parent Experiences Questionnaire) about early experiences, service involvement, and needs of children and parents following neonatal brain injury that could be used to inform clinical care and needed interventions., Research Design and Methods: A mixed-method design was utilized, engaging in both qualitative and quantitative methods across three phases. Phase 1 employed participatory design involving 12 parent and clinician participants in semi-structured interviews to address main topics, item importance, and overall impressions of the questionnaire. In phase 2, the questionnaire was piloted by 32 parents. Post hoc revisions added four questions to address current parent and child therapeutic needs in phase 3., Main Outcomes and Results: The final questionnaire yielded 24 items addressing topics of early communication between parent and clinicians, early intervention services, efficacy, and barriers in optimizing the child's development and parents' experience. The questionnaire was reviewed positively by a group of parents in phase 2 and demonstrated good acceptance, online feasibility, stability, and association with current parental mental health and child development., Conclusions: This investigation offers a valuable new questionnaire to inform clinical care regarding discussions with parents about neonatal brain injury, evaluate the perceived efficacy of early intervention services, and guide relevant future intervention efforts.

Background: A long-term follow-up study comparing children after anoxic brain injury (AnBI) with those after traumatic brain injury (TBI) was conducted, and prognostic factors were mapped., Methods: A prospective historical study following long-term functional outcome after childhood brain injury was conducted in two phases. The first phase included patients suffering from moderate-severe TBI. The second phase assessed children after AnBI, and the results were compared. Functional outcome was recorded and factors influencing prognosis were outlined., Results: On admission vegetative state (VS) was twice as prevalent in the AnBI subgroup. Approximately 90% of children with TBI and 60% of patients with AnBI gained independency in activities of daily living (ADL) and mobility. Long-term positive outcome, i.e., return to school and open-market employment, were higher in patients with TBI when compared with AnBI (61% and 48.1%, respectively). Significant outcome-predicting factors were VS at admission to rehabilitation, length of loss of consciousness (LOC) up to 11 days and functional independence measure (FIM) score at admission and discharge. Aetiology was not found to be a predicting factor., Conclusions: Duration of unconsciousness is the main long-term negative prognostic outcome factor. Anoxic brain damage, associated with longer periods of unconsciousness also heralds a less favourable outcome.

Primary Objective: 1) To explore family members' lived experiences of driving disruption at early and later stages of the recovery continuum following acquired brain injury (ABI). 2) To describe health-related quality of life of family members of individuals with ABI who are experiencing driving disruption., Research Design: Mixed methods phenomenological research approach., Methods and Procedures: Semi-structured interviews and health-related quality of life questionnaires were conducted with 15 family members of individuals with ABI (early group: 1-12 months post-injury, n = 6; later group: >1 year post-injury, n = 9)., Results: Two main themes were identified: Different for everyone: how driving disruption affects families, and Making it harder: context of driving disruption. The challenges of driving disruption were reported more frequently and with a more intense focus by family members who were caring for their relative for more than 1 year post-injury. This group also reported higher caregiver strain and poorer health-related quality of life. Reduced satisfaction with life, poor mental health and affected family functioning were reported by both groups., Conclusions: Driving disruption impacts on family members and has long-lasting consequences. It is important for clinicians to work with family members to manage these challenges even years after ABI and consider individual contextual factors.

Objective: People with brain injury often experience significant challenges to social and community engagement following injury. The purpose of this study was to investigate factors impacting social integration for adults with brain injury using the International Classification and Functioning, Disability and Health (ICF) as a conceptual model., Methods: Adults with brain injury (n = 103) recruited through two US state brain injury associations participated in a survey study. Hierarchical regression analysis was used to examine the predictive impact of components of the ICF model on social integration outcomes. Specifically, demographic (age, gender, SES), disability (severity of functional limitations), personal (disability acceptance, social self-efficacy) and environmental (neighbourhood climate, stigma, social support network) factors were entered as four conceptual groups of predictors to examine the incremental contribution of the variance in social integration explained by each set., Results: As hypothesized, the inclusion of each block of predictors significantly improved the model. The overall regression model explained 41% of the variance in social integration. Specifically, SES (β = 0.25), severity of functional limitations (β = 0.29) and social support network (β = 0.29) emerged as the strongest independent predictors., Conclusion: Findings from this study highlight the importance of adopting a biopsychosocial approach to understanding social integration for people with brain injury.

Background: After 30 years of characterisation and implementation, fluid percussion injury (FPI) is firmly recognised as one of the best-characterised reproducible and clinically relevant models of TBI, encompassing concussion through diffuse axonal injury (DAI). Depending on the specific injury parameters (e.g. injury site, mechanical force), FPI can model diffuse TBI with or without a focal component and may be designated as mild-to-severe according to the chosen mechanical forces and resulting acute neurological responses. Among FPI models, midline FPI may best represent clinical diffuse TBI, because of the acute behavioural deficits, the transition to late-onset behavioural morbidities and the absence of gross histopathology., Review: The goal here was to review acute and chronic physiological and behavioural deficits and morbidities associated with diffuse TBI induced by midline FPI. In the absence of neurodegenerative sequelae associated with focal injury, there is a need for biomarkers in the diagnostic, prognostic, predictive and therapeutic approaches to evaluate outcomes from TBI., Conclusions: The current literature suggests that midline FPI offers a clinically-relevant, validated model of diffuse TBI to investigators wishing to evaluate novel therapeutic strategies in the treatment of TBI and the utility of biomarkers in the delivery of healthcare to patients with brain injury., Competing Interests: Declaration of Interest: The authors report no conflicts of interest. Sources of funding include: U.S. Department of Health and Human Services, National Institutes of Health grants R21 NS072611, RO1 NS-065052, and Science Foundation Arizona, Bisgrove Scholar Fellowship.

Primary Objective: To characterize paediatric concussion knowledge and the management practices of school-based speech-language pathologists (SLPs) in the US to establish a baseline upon which changes in SLP training, knowledge and best practices can be measured., Research Design: A survey was developed to assess current knowledge and management of paediatric concussion allowing for comparison to previous and future surveys on SLP knowledge and practice in other areas of brain injury., Methods and Procedures: One thousand surveys were distributed to school-based SLPs from 10 states. Two hundred and eighty SLPs from Minnesota, Wisconsin, New York, Massachusetts, Georgia, Florida, Texas, Tennessee, California and Arizona responded to the survey., Main Outcomes and Results: Compared to previous survey results, SLPs from the current sample indicate an increase in general brain injury training, but confidence in providing clinical services to brain-injured students remains low. SLPs have a mix of accurate and inaccurate concussion knowledge and uncertainty about their role in concussion management., Conclusions: Findings suggest that increasing communication with other school personnel about concussion, increased training in paediatric TBI and concussion improved access to appropriate assessments tools and implementation of long-term concussion management will improve service delivery to school-aged children with concussion.

Objective: Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease associated with repetitive brain trauma (RBT). Initially described in boxers, CTE has now been found in other contact sport athletes with a history of RBT. In recent years, there has been tremendous media attention regarding CTE, primarily because of the deaths of high profile American football players who were found to have CTE upon neuropathological examination. However, the study of CTE remains in its infancy. This review focuses on research from the Centre for the Study of Traumatic Encephalopathy (CSTE) at Boston University., Methods: This study reviews the formation of the CSTE, major CSTE publications and current ongoing research projects at the CSTE., Results: The neuropathology of CTE has been well-described. Current research focuses on: methods of diagnosing the disease during life (including the development of biomarkers), examination of CTE risk factors (including genetic susceptibility and head impact exposure variables); description of the clinical presentation of CTE; development of research diagnostic criteria for Traumatic Encephalopathy Syndrome; and assessment of mechanism and pathogenesis., Conclusions: Current research at the BU CSTE is aimed at increasing understanding of the long-term consequences of repetitive head impacts and attempting to begin to answer several of the unanswered questions regarding CTE.

Objective: To introduce a set of revised guidelines for the management of mild traumatic brain injury (mTBI) and persistent symptoms following concussive injuries., Quality of Evidence: The Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms were made available in March 2011 based on literature and information up to 2008. A search for new clinical practice guidelines addressing mTBI and a systematic review of the literature evaluating treatment of persistent symptoms was conducted. Healthcare professionals representing a range of disciplines from Canada and abroad attended a consensus conference to revise the original guidelines in light of new evidence., Main Message: A modified Delphi process was used to create 96 recommendations addressing the diagnosis and management of mTBI and persistent symptoms, including post-traumatic headache, sleep disturbances, mental health disorders, cognitive difficulties, vestibular and vision dysfunction, fatigue and return to activity/work/school. Numerous resources, tools and treatment algorithms were also included to aid implementation of the recommendations., Conclusion: The revised clinical practice guideline reflects the most current evidence and is recommended for use by clinicians who provide care to people who experience PPCS following mTBI.

Background: Fall is a common mechanism of injury (MOI) in young children and an important risk factor for traumatic brain injury (TBI). Most children who fall have a minor head injury (MHI), defined as a blunt head trauma that occurred in a patient who is conscious and responsive., Objective: To seek a possible association between MOI and injury severity., Methods: A single centre cohort study was conducted. Data were collected on patients aged 0-2 years with MHI. Clinically-significant TBI (csTBI), defined as head injury resulting in death, intubation or neurosurgery, was the primary outcome measure. Traumatic finding on CT scan (TFCT) was the secondary outcome measure., Results: Five hundred and ninety-five patients were analysed. Eight types of falls were identified: from ground-level, down stairs, from a bed, from a changing table, from furniture, from adult-hold, from a playground-device and from a stroller/baby-carriage. One patient (0.16%) had csTBI. Thirty-one (5.2%) underwent CT scans, TFCT was diagnosed in 17 (2.8%) patients; 10 (1.7%) linear skull-fractures, two (0.3%) depressed skull-fractures and five (0.8%) intracranial haemorrhages. Regression analysis did not reveal a statistically significant association between any of the MOI and the presence of TFCT., Conclusions: The risk for csTBI was low and no association was found between MOI and injury severity.

Primary Objective: To investigate longitudinal diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) changes in white and grey matter in patients with mild traumatic brain injury (mTBI)., Research Design: A prospective case-control study., Methods and Procedures: DKI data was obtained from 24 patients with mTBI along with cognitive assessments within 10 days, 1 month and 6 months post-injury and compared with age-matched control (n¼ 24). Fractional anisotropy (FA), mean diffusivity (MD), radial diffusion (l(r)), mean kurtosis (MK) and radial kurtosis (Kr) were extracted from the thalamus, internal capsule and corpus callosum., Main Outcomes and Results: Results demonstrate reduced Kr and MK in the anterior internal capsule in patients with mTBI across the three visits, and reduced MK in the posterior internal capsule during the 10 day time point. Correlations were observed between the change in MK or Kr between 1–6 months and the improvements in cognition between the 1 and 6 month visits in the thalamus, internal capsule and corpus callosum., Conclusions: These data demonstrate that DKI may be sensitive in tracking pathophysiological changes associated with mTBI and may provide additional information to conventional DTI parameters in evaluating longitudinal changes following TBI.

Objective: This study explored using the FIT as a measure of performance validity among veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI)., Background: The Rey Fifteen-Item Memory Test (FIT) is a performance validity measure criticized for poor sensitivity., Methods: Two hundred and fifty-seven veterans completed the FIT and Wechsler Adult Intelligence Scale, Fourth Edition, Digit Span (DS); 109 of whom completed the Test of Memory Malingering (TOMM). FIT cut-offs of <9, <8 and stricter cut-offs were examined using DS and/or TOMM as criterion performance validity measures., Results: Only four participants scored below the standard cut score of 9 on the FIT. Among the 13 veterans failing both criterion tests, only two scored below 9 on the FIT. Regardless of which FIT cut-off was used, the FIT had poor diagnostic accuracy., Conclusion: Despite its popularity, the FIT is not supported as an appropriate measure of performance validity in veterans undergoing evaluation for possible mTBI. Therefore, inferences regarding neuropsychological data reliability with adequate statistical certainty require use of other measures of performance validity with greater sensitivity.

Primary Objective: To evaluate the psychometric properties of two adapted versions of the interpersonal communication competence scale (ICCS) that were applied to people with acquired brain injury (ABI). Construct validity was tested for both new scales and a factor extraction was performed on the proxy-rating version aiming to establish if it revealed meaningful constructs., Methods: ICCS was translated from English to Danish language, pilot tested and slightly modified for use as a self-rating scale with people with ABI. A relative/staff version of the scale was also constructed for testing. Participants with medium-to-severe ABI self-rated their interpersonal communication skills using the modified ICCS. Cronbach Alpha test was performed on both scales followed by a correlation analysis., Results: Seventeen participants with medium-to-severe ABI and staff and relatives (n = 37) were involved in testing the ICCS-staff/relative rating and ICCS-self-rating. The ICCS-Staff/Relative showed an overall Cronbach alpha of α = 0.774 and the ICCS-Self-rating α = 0.675. A factor extraction of the ICCS-Staff/Relative revealed six meaningful sub-groups that corresponded well with the original ICCS. There was a low but significant correlation between the ratings performed by the two staff members most familiar with the participants (r = 0.280, p = 0.04)., Conclusions: The ICCS-Staff/Relative revealed a good overall internal consistency, whereas the ICCS-Self-rating revealed acceptable internal consistency. The factor analysis of the proxy-rating revealed six meaningful sub-groups of interpersonal communication competencies.

Primary Objective: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran's Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology., Research Design: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given)., Methods and Procedures: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation., Main Outcomes and Results: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms., Conclusions: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation.

Aim: To evaluate the reliability, validity and responsiveness of the High-level Mobility Assessment Tool (HiMAT) in children and adolescents with traumatic brain injury (TBI) and to compare the mobility skills of children with TBI to those of healthy peers., Method: The mobility skills of 52 children with moderate and severe TBI (36 males; mean age = 12 years, range = 6-17) were assessed using the HiMAT and the Pediatric Evaluation of Disability Inventory (PEDI). Inter-rater reliability, re-test reliability and responsiveness of the HiMAT were evaluated in sub-groups by comparing results scored at several time-points. The HiMAT scores of children with TBI were compared with those of a healthy comparative cohort., Results: The HiMAT demonstrated excellent inter-rater reliability (ICC = 0.93), re-test reliability (ICC = 0.98) and responsiveness to change (p = 0.002). The PEDI demonstrated a ceiling effect in mobility assessment of ambulant children with TBI. The HiMAT scores of children with TBI were lower than those of their healthy peers (p < 0.001)., Interpretation: The HiMAT is a reliable, valid and sensitive measure of high-level mobility skills following childhood TBI. The high-level mobility skills of children with TBI are less proficient than their peers.

Primary Objective: The present paper systematically reviews studies using transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) to assess cortical excitability, intra-cortical inhibition/facilitation and synaptic plasticity following mild traumatic brain injury (mTBI)., Methods: Articles using TMS over M1 in patients with mTBI or sport-related concussion indexed in PubMed and published between 1998 and September 2014 were included in the present review., Main Outcomes and Results: From the 17 articles that matched search criteria, results from various TMS paradigms were summarized and divided in three main areas of interest: motor cortical excitability/facilitation, motor cortical inhibition and cortical plasticity. Although studies suggest a trend of abnormal intra-cortical inhibition following mTBI, no clear and specific pattern emerges from the surveyed data., Conclusions: At this time and with the possible exception of intra-cortical inhibitory measures, TMS cannot reliably detect changes in M1 excitability in individuals with mTBI or a concussion at both the acute and chronic stages of injury. This may be explained by the small number of studies and large variety of stimulation parameters. Additional longitudinal and multimodal studies are needed to better understand the nature of the excitability changes that may occur within M1 following mTBI.

Background: Traumatic brain injury (TBI) is classified into mild, moderate and severe, based on the Glasgow Coma Score (GCS). However, TBI patients are often influenced by ethanol, which in itself can attenuate the level of consciousness. This study investigated the effect of ethanol on the GCS group classification in TBI patients., Methods: The Oslo University Hospital trauma database was searched for all patients admitted with a head injury where the blood ethanol concentration (BEC) had been measured (n = 1004). The effect of BEC on GCS groups was analysed using multivariate ordinal logistic regression., Results: This study identified 546, 142 and 316 patients in the mild, moderate and severe groups, respectively. Increasing BEC by 1 g kg(-1) and pre-hospital intubation had OR = 1.34 and 16.34 for being in a more severe GCS group, respectively. Increasing head abbreviated injury scale (head-AIS) was significantly associated with being in a more severe GCS group. The modelled probability of detecting a head-AIS of 4 or 5 in a patient with BEC of 2.0 g kg(-1) was 20%, 38% and 65% in the mild, moderate and severe groups, respectively., Conclusions: Increasing BEC was associated with increasing odds of being in a more severe GCS group. However, because the modelled probability of significant brain injury was high in patients with high levels of BEC, a reduced level of consciousness in intoxicated patients mandates further radiological investigations.

Introduction: Conventionally, a Glasgow Coma Scale (GCS) score of 13-15 defines mild traumatic brain injury (mTBI). The aim of this study was to identify the factors that predict progression on repeat head computed tomography (RHCT) and neurosurgical intervention (NSI) in patients categorized as mild TBI with intracranial injury (intracranial haemorrhage and/or skull fracture)., Methods: This study performed a retrospective chart review of all patients with traumatic brain injury who presented to a level 1 trauma centre. Patients with blunt TBI, an intracranial injury and admission GCS of 13-15 without anti-platelet and anti-coagulation therapy were included. The outcome measures were: progression on RHCT and need for neurosurgical intervention (craniotomy and/or craniectomy)., Results: A total of 1800 patients were reviewed, of which 876 patients were included. One hundred and fifteen (13.1%) patients had progression on RHCT scan. Progression on RHCT was 8-times more likely in patients with subdural haemorrhage ≥10 mm, 5-times more likely with epidural haemorrhage ≥10 mm and 3-times more likely with base deficit ≥4. Forty-seven patients underwent a neurosurgical intervention. Patients with displaced skull fracture were 10-times more likely and patients with base deficit >4 were 21-times more likely to have a neurosurgical intervention., Conclusion: In patients with intracranial injury, a mild GCS score (GCS 13-15) in patients with an intracranial injury does not preclude progression on repeat head CT and the need for a neurosurgical intervention. Base deficit greater than four and displaced skull fracture are the greatest predictors for neurosurgical intervention in patients with mild TBI and an intracranial injury.

Primary Objective: To identify if demographics, clinical and computed tomographic (CT) characteristics at first presentation and S100B concentrations at 3 and 6 hours after mild traumatic brain injury (MTBI) predict the development of post-concussion syndrome (PCS) after 1 month., Research Design and Methods: All consecutive MTBI patients (Glasgow Coma Scale [GCS] score 13-15) admitted to the Emergency Department aged older than 15 were included in this prospective, observational study. Outcome was assessed using a Rivermead Post-Concussion Symptoms Questionnaire to identify the patients with and without PCS 1 month after the injury., Main Outcomes and Results: A total of 176 patients with isolated MTBI were included in the study. After multivariate analysis of the demographics, clinical variables, and CT abnormalities, headache (OR = 2.09, 95% CI = 1.04-4.21, p = 0.038), seizure (OR = 5.64, 95% CI = 1.55-20.54, p = 0.009), the presence of subarachnoid haemorrhage on CT (OR = 3.67, 95% CI = 1.46-9.24, p = 0.006) and 6-hour S100B concentration (OR = 2.22, 95% CI = 1.15-4.28, p = 0.017) were independently significant predictors of the outcome., Conclusions: Outcome prediction using baseline characteristics (post-traumatic headache and seizure), CT and laboratory findings (6-hour S100B) were valuable factors for identification of the individual MTBI patient at risk for developing PCS 1 month after the injury.

Primary Objective: The purpose of this study was to examine the relationship between resilience and symptom reporting following mild traumatic brain injury (mTBI). It was hypothesized that, as resilience increases, self-reported symptoms would decrease., Research Design: Cross-sectional design., Methods and Procedures: Participants were 142 US military service members who sustained a mTBI, divided into three resilience groups based on participants' responses on the Response to Stressful Experiences Scale: Moderate (n = 42); High (n = 51); and Very High (n = 49). Participants completed the Neurobehavioral Symptom Inventory (NSI) and PTSD Checklist-Civilian Version (PCL-C) within 12 months following injury., Main Outcomes and Results: There were significant main effects for the NSI total score, cognitive cluster and affective cluster, as well as for the PCL-C total score, avoidance cluster and hyperarousal cluster. Pairwise comparisons revealed that there was a negative relationship between resilience and self-reported symptoms overall. Specifically, participants with higher resilience reported fewer post-concussion and PTSD-related symptoms than participants with lower levels of resilience., Conclusions: These findings underscore the important role that resilience plays in symptom expression in military service members with mTBI and suggest that research on targeted interventions to increase resilience in the acute phase following injury is indicated.

Primary Objective: To investigate the influence of the diagnostic terms 'concussion' and 'mild traumatic brain injury' (mTBI) on contact-sport players' injury perceptions and expected symptoms from a sport-related mTBI. It was hypothesized that contact-sport players would hold more negative injury perceptions and expect greater symptom disturbance from a sport-related injury that was diagnosed as an 'mTBI' compared to 'concussion' or an undiagnosed injury., Methods and Procedures: One hundred and twenty-two contact-sport players were randomly allocated to one of three conditions in which they read a sport-related mTBI vignette that varied only according to whether the person depicted in the vignette was diagnosed with concussion (n = 40), mTBI (n = 41) or received no diagnosis (control condition; n = 41). After reading the vignette, participants rated their injury perceptions (perceived undesirability, chronicity and consequences) and expectations of post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD) symptoms 6 months post-injury., Main Outcomes: There were no significant differences in contact-sport players' injury perceptions or symptom expectations from a sport-related mTBI when it was diagnosed as an mTBI, concussion or when no diagnosis was given., Conclusions: Diagnostic terminology does not appear to have a potent influence on symptom expectation and injury perceptions in contact-sport players.

Objectives: To determine if domains included in popular measurement systems (e.g. the Peds QL™) reflect the adolescent survivor of a brain injury's sense of QoL and explore this relationship in reference to an emerging model of wellbeing in the adolescent with TBI., Methods: Mixed methods; adolescent QoL assessed using the PedsQL™ self-report and a semi-structured interview created by the lead author. Adolescent self-report was compared to adolescent narratives., Results: Ten adolescents participated. Adolescent PedsQL™ total was within normal limits. Adolescents reported that changes identified by the PedsQL were not important and did not impact on their sense of QoL. The importance on social components of QoL-as opposed to cognitive-provide additional support of the emerging model of wellbeing in adolescents with TBI., Conclusions: The PedsQL can identify changes post-TBI, but fails to consider whether these changes are relevant to the adolescent. Alternate methods of exploring QoL-which emphasize the interaction of social networks and friendships, should be considered to avoid an oblique view of QoL outcomes after TBI.

Background: Intracranial hypertension (ICH) and hyperthermia are common after traumatic brain injury (TBI) and associated with worse neurological outcomes. This study sets out to determine the combined power of temperature and intracranial pressure (ICP) for predicting neurologic outcomes and prolonged length of stay (LOS) following severe TBI., Methods: High resolution (every 6 seconds) temperature and ICP data were collected in adults with severe TBI from 2008-2010. Temperatures were plotted against concurrent ICP and divided based on breakpoints (Temperature: <36, 36-38.5 or >38.5 °C, ICP: <20, 20-30 or >30 mmHg). The percentage of time spent in each section, as well as several pooled unfavourable conditions (hyperthermia ± ICH), were then evaluated for predictive value for ICU-LOS > 7 days and short-term (<6 months) vs. long-term (>6 months) dichotomized neurologic outcomes., Results: Fifty patients were included for analysis with severe TBI. Evaluation of the area under the operating receiver curve (AUC) showed significant periods of fever and high ICP (<30 mmHg) had a strong association with poor long-term neurological outcomes (Day 3, AUC = 0.71, p = 0.04) and were higher than either condition alone. ICU-LOS > 7 days was increased when hyperthermia and/or ICH remained uncontrolled by Day 5 (AUC = 0.82, p = 0.02)., Summary: Hyperthermia combined with ICH were shown to be significant prognostic indicators of future poor neurologic outcomes in patients with severe traumatic brain injury.

Primary Objective: The aim of this study is to assess if laser evoked potentials (LEPs) examination should be considered as an objective evidence of potential or residual pain perception capacity in vegetative (VS) and minimally conscious state (MCS) patients and if it could be a feasible methodology in order to differentiate these two clinical entities., Research Design: This is a cross-sectional observational study focusing on the role of LEP examination, which is an easy and objective neurophysiological approach of the nociceptive system., Methods and Procedures: Thirteen VS and 10 MCS patients were enrolled. All subjects were evaluated clinically by using validated behavioural scales and underwent to upper and lower limbs LEP recording., Main Outcomes and Results: Intra-group LEPs analysis in VS patients highlighted significant differences for N2P2 latency (p = 0.036) and amplitude (p = 0.018). Inter-group LEPs analysis showed significant differences in post-anoxic condition for N2P2 latency (p = 0.034), amplitude (p = 0.034) and a trend in N2P2 latency in brain trauma (p = 0.07). Interestingly, correlation analysis showed a significant relationship between N2P2 amplitude and Coma Recovery Scale-Revised scoring in the post-traumatic VS (r = 0.823, p = 0.044)., Conclusions: The findings lead to detection of potential markers of conscious pain perception in patients with DOC, with important impact on therapeutic and rehabilitative management, and provide new information that may allow a better differential diagnosis.

Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI)., Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated., Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others., Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.

Primary Objective: People with the dual diagnosis of acquired brain injury and mental illness (ABI/MI) are vulnerable to a range of negative life experiences, which has received limited attention in the literature. The objective of the project described in this paper was to identify and describe these experiences in order to distinguish barriers and facilitators to successful rehabilitation and recovery., Research Design: The project used qualitative methodologies., Methods and Procedures: The 15 participants were eight people with ABI/MI, two family members and five support workers. Nineteen interviews were conducted. Analysis of these interviews produced a set of five key themes, with each theme elaborated by a set of descriptive issues., Main Outcomes and Results: The five themes were loss, personal development, occupation, family and services. The experiences of people with ABI/MI were strongly negative. They faced more barriers than facilitators to recovery. Current policies and practices were inadequate., Conclusions: Enhanced stakeholder collaboration and co-ordination and a more individualized, long-term perspective on the needs of people with ABI/MI are recommended to guide future policy and practice. Future research on quality-of-life, wellbeing, community inclusion and participation in ordinary life was recommended.

Background: This study was undertaken to identify factors that influence follow-up for patients with mild traumatic brain injury (MTBI)., Methods: One hundred and ninety-nine consecutive inpatients diagnosed with MTBI at a Trauma Centre (or TC) were monitored for establishment of care with a brain injury specialist after discharge. Bivariate statistics were calculated to determine subject characteristics impacting the decision to pursue TBI-related specialty care., Results: One hundred and nineteen patients (59.8%) followed up with the TC for routine post-injury care. Patients who followed up were older (age >40: OR = 2.48, p = 0.01, 95% CI = 1.03-8.96) and had longer hospital lengths of stay (LOS > 3 days: OR = 2.99, p < 0.001, 95% CI = 1.33-7.67). Upon follow-up, providers identified 20 patients (16.8%) with persistent neurologic symptoms, seven (3.5%) of whom saw a brain injury specialist. Lack of insurance significantly decreased the likelihood of follow-up with the TC and/or establishment of care with a TBI specialist. (OR = 0.76, p = 0.01, 95% CI = 0.62-0.95)., Conclusions: Being insured was strongly predictive for follow-up at the TC and for establishing with a brain injury specialist post-MTBI. The TC post-injury visit identified MTBI patients with persistent symptoms, suggesting post-acute TC follow-up is an important venue for MTBI sequelae screening and referral.

Primary Objective: To summarize the literature on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) and their co-morbidity, focusing on diagnosis, clinical symptoms and treatment issues relevant to the clinician., Research Design: Review of the literature., Methods and Procedures: Pubmed searches were performed using the terms post-traumatic stress disorder, traumatic brain injury, sleep, cognitive, depression, anxiety, treatment and combinations of these terms. Those articles relevant to the objective were included., Main Outcomes and Results: This study presents pathophysiological, neuroimaging and clinical data on co-morbid PTSD and TBI. It reviews associated conditions, emphasizing the impact of cognitive and sleep problems. It summarizes the emerging literature on treatment effectiveness for co-morbid PTSD and TBI, including psychotherapy, pharmacotherapy and cognitive rehabilitation., Conclusions: Both PTSD and TBI commonly occur in the general population, both share some pathophysiological characteristics and both are associated with cognitive impairment and sleep disruption. PTSD and TBI present with a number of overlapping symptoms, which can lead to over-diagnosis or misdiagnosis. Both conditions are associated with co-morbidities important in diagnosis and treatment planning. More research is needed to elucidate what treatments are effective in PTSD and TBI co-morbidity and on factors predictive of treatment success.

Background: This review discusses the advantages of transcranial magnetic stimulation combined with high-density electroencephalography (TMS-hdEEG) over other current techniques of brain imaging., Methods and Results: Its application was reviewed, focusing particularly on disorders of consciousness, in the perspective of recent theories of consciousness. Assessment of non-communicative patients with disorders of consciousness remains a clinical challenge and objective measures of the level of consciousness are still needed. Current theories suggest that a key requirement for consciousness is the brain's capacity to rapidly integrate information across different specialized cortical areas. TMS-EEG allows the stimulation of any given cortical area and the recording of the immediate electrical cortical response. This technique has recently been successfully employed to measure changes in brain complexity under physiological, pharmacological and pathological conditions., Conclusions: This suggests that TMS-EEG is a reliable tool to discriminate between conscious and unconscious patients at the single subject level. Future works are needed to validate and implement this technique as a clinical tool.

Background: To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount., Review: This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a 'passing' SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed., Conclusions: Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.

Background: Traumatic brain injury is one of the main causes of smell disorders. The degree of olfactory loss may vary and depend on the severity, nature and location of injury within the olfactory system. The diagnosis of disorders of the sense of smell is based on medical history and clinical data supported by psychophysical tests of smell, electrophysiological and neuroimaging measures., Methods: This study reports three single clinical cases of post-traumatic anosmia evaluated by Sniffin' Sticks Test, Olfactory Event-Related Potential and Magnetic Resonance Imaging examinations., Results: The Olfactory Event-Related Potential findings confirmed the presence of functional olfactory impairment in all three post-traumatic patients showing a good correlation with results of the psychophysical testing. In particular, Sniffin' Sticks Test and OERPs allowed to demonstrate the functional nature of post-traumatic olfactory loss, while the MRI identified the location and extent of injury compatible with the olfactory disorder., Conclusions: OERPs may have a good clinical application in objective diagnosis of post-traumatic anosmia, especially when the neuroradiological examination does not show lesions compatible with olfactory loss.

Objective: To examine the validity of using International Classification of Diseases (ICD) diagnosis codes from United States Department of Veterans Affairs (VA) data to describe prevalence of traumatic brain injury (TBI) among military veterans., Methods: VA clinicians complete a standardized TBI evaluation to determine whether veterans' deployment exposures resulted in TBI. Clinician-confirmed cases and non-cases of TBI were used as recorded on the evaluation as the criterion standard against which to evaluate three series of TBI-related ICD diagnosis codes in national VA datasets. Focusing on codes used within VA, measures of validity were calculated and correlates of discordance examined, including patient characteristics, region and time. Secondarily, it was examined whether TBI codes can differentiate mild from more severe TBI cases., Results: Of 49 962 veterans with completed TBI evaluations, 29 534 (59%) received clinician-confirmed TBI diagnoses. Sensitivity of the VA series of codes was 70%, specificity was 82% and concordance was 75%. Concordance varied by region, but not by patient characteristics or time. Codes were not useful for distinguishing mild TBI., Conclusion: Estimates of TBI prevalence in military veterans are important for national programme development and resource distribution. Estimates derived from ICD diagnosis codes in administrative data should take potential misclassification into account.

Background: Aggressive behaviour is a frequent legacy of traumatic brain injury (TBI) and a major obstacle to psychosocial recovery. Aggression can take many forms and there is currently no uniform method of assessment that distinguishes aggressive sub-types in a way that can assist decisions for treatment., Review: This paper attempts to provide a framework that will help distinguish two primary sub-types of aggression following TBI, impulsive and episodic aggression, based on their most prominent clinical characteristics. It is hoped that, by providing a description of the phenomenology associated with each form of aggression, together with an explanation of the probable neuropathology underpinning each sub-type, the clinical classification of these two forms of aggression will improve, leading to a commensurate improvement in the choice of treatment interventions, resulting in better psychosocial outcomes.

Objective: The influence of blood alcohol level (BAL) on outcome remains unclear. This study investigated the relationships between BAL, type and number of diffuse axonal injury (DAI), intraventricular bleeding (IVB) and 6-month outcome., Methods: This study reviewed 419 patients with isolated blunt traumatic brain injury. First, it compared clinical and radiological characteristics between patients with good recovery and disability. Second, it compared BAL among DAI lesions. Third, it evaluated the correlation between the BAL and severity of IVB, number of DAI and corpus callosum injury lesions., Results: Regardless of BAL, older age, male gender, severe Glasgow Coma Scale score (<9), abnormal pupil, IVB and lesion on genu of corpus callosum were significantly related to disability. There were no significant differences between the BAL and lesions of DAI. Simple regression analysis revealed that there were no significant correlation between BAL and severity of IVB, number of DAI and corpus callosum injury lesions., Conclusions: Acute alcohol intoxication was not associated with type and number of DAI lesion, IVB and disability. This study suggested that a specific type of traumatic lesion, specifically lesion on genu of corpus callosum and IVB, might be more vital for outcome.

Objective: The aims of this national study were to (1) examine the extent of job burnout among VA Polytrauma team members engaged in the diagnosis and treatment of traumatic brain injury (TBI); and (2) identify their coping strategies for dealing with job-related stress., Design: A cross-sectional sample of 233 VA Polytrauma team members completed the Maslach Burnout Inventory (MBI) and identified strategies for coping with work stress as part of an online survey., Results: VA Polytrauma team members experience moderate levels of emotional exhaustion, but low levels of depersonalization and high levels of personal accomplishment. Moreover, 24% of participants reported high levels of emotional exhaustion, which may be a precursor to job burnout. Participants who reported caring for veterans with TBI ≥50% of their time experienced higher levels of emotional exhaustion than those who spent <50% of their time (p ≤ 0.001). Five major thematic categories related to coping strategies emerged from the data: (1) connecting with others, (2) promoting a healthy lifestyle, (3) pursuing outside interests, (4) managing work environment and (5) maintaining positive thinking., Conclusion: Polytrauma team members caring for Veterans with TBI may be at risk for job burnout.

Background: In a patient-oriented healthcare system, the integration of the functional status of the patient from the perspective of different professionals is understandable by the use of the International Classification of Functioning, Disability and Health., Objective: A formal decision-making and consensus process is presented to develop the first version of the International Classification on Functioning, Disability and Health (ICF) Core Sets for Traumatic Brain Injury., Method: A panel with the results from preparatory studies that included a literature review, a qualitative study, empirical data collection and an expert survey, was presented. A consensus conference was held in Barcelona, March 2010 and 23 professionals attended representing nine countries., Results: The preparatory studies identified 183 eligible categories. After the voting process, 139 constituted the Comprehensive Core Sets for TBI and 23 the Brief Core Sets for TBI., Conclusions: The consensus conference led to the integration of evidence and expert opinion based on the ICF. The adoption of the ICF Core Sets for TBI provides a basic international standard for the multidisciplinary assessment of a TBI patient's functioning.

Objective: To identify if concussive symptoms occur with greater frequency among military personnel with multiple lifetime TBIs and if a history of TBI increases risk for subsequent TBI., Patients: One hundred and sixty-one military personnel referred to a TBI clinic for evaluation and treatment of suspected head injury at a military clinic in Iraq., Methods: Military patients completed standardized self-report measures of concussion, depression and post-traumatic stress symptoms; clinical interview; and physical examination. Group comparisons were made according to number of lifetime TBIs and logistic regression was utilized to determine the association of past TBIs on current TBI., Results: Patients with one or more previous TBIs were more likely to report concussion symptoms immediately following a recent injury and during the evaluation. Although differences between single and multiple TBI groups were observed, these did not reach the level of statistical significance. A history of any TBI increased the likelihood of current TBI diagnosis, but this relationship was no longer significant when adjusting for injury mechanism, depression and post-traumatic stress symptoms., Conclusion: Among deployed military personnel, the relationship of previous TBI with recent TBI and concussive symptoms may be largely explained by the presence of psychological symptoms.

Background: Bilateral traumatic basal ganglia haematoma is an extremely rare event in traumatic brain injuries, with only five reported cases. The presumed mechanism is due to shearing forces leading to haemorrhage from the lenticulostriate or anterior choroidal artery. The prognosis appears to be dependent on the extent and severity of underlying brain injury., Case Study: A case of a 38 year old fully conscious male, who presented with bilateral basal ganglia haematoma and extradural haematoma, is presented and the relevant literature is briefly reviewed.

Unlabelled: BACKGROUND AND PRIMARY OBJECTIVE: In recent years, the Montreal Cognitive Assessment (MoCA) has been developed to assess patients with ischemic stroke. However, it has not been validated for use on traumatic brain injury patients with intracranial haemorrhage (tICH). The aim was to evaluate the psychometric properties of the MoCA (MoCA) in such patients., Research Design and Method: A cross-sectional observational study was carried out on 40 controls and 48 tICH patients recruited in Hong Kong. Concurrent validity was assessed by a comprehensive battery of neuropsychological tests and the Mini-Mental State Examination (MMSE). Criterion validity was assessed by the differentiation of tICH patients from controls., Main Outcome and Results: In tICH patients, cognitive z-scores (β = 0.579; p < 0.001) and MMSE (β = 0.366, p = 0.012) significantly correlated with performance in the MoCA after adjustment for age, gender and total score for the Geriatric Depressive Scale. For the differentiation of tICH patients from controls, analysis of receiver operating characteristics curves in the MoCA revealed an optimal balance of sensitivity and specificity at 25/26 with an area under the curve of 0.704 (p = 0.001). MoCA is applicable to and significantly correlated with excellent neurological outcomes in tICH patients., Conclusions: MoCA is a useful and psychometrically valid tool for the assessment of gross cognitive function in tICH patients.

Objective: To obtain normative data using a French translation of the BNI Screen for Higher Cerebral Functions (BNIS) administered to French-speaking individuals., Methods: Recruitment and administration of the BNIS to a convenience sample of 167 French-speaking individuals between the ages of 15-84 years., Results: Mean BNIS total score for a French sample was within 1 point of what was observed in the original standardization study using 200 English-speaking controls. Age and education correlated significantly with BNIS scores in a manner reported by other studies., Conclusion: The French translation of the BNIS appears to be a reliable method of assessing higher cerebral functioning in French-speaking individuals.

Background: VHA screens for traumatic brain injury (TBI) among patients formerly deployed to Afghanistan or Iraq, referring those who screen positive for a Comprehensive TBI Evaluation (CTBIE)., Methods: To assess the programme, rates were calculated of positive screens for potential TBI in the population of patients screened in VHA between October 2007 through March 2009. Rates were derived of TBI confirmed by comprehensive evaluations from October 2008 through July 2009. Patient characteristics were obtained from Department of Defense and VHA administrative data., Results: In the study population, 21.6% screened positive for potential TBI and 54.6% of these had electronic records of a CTBIE. Of those with CTBIE records, evaluators confirmed TBI in 57.7%, yielding a best estimate that 6.8% of all those screened were confirmed to have TBI. Three quarters of all screened patients and virtually all those evaluated (whether TBI was confirmed or not) had VHA care the following year., Conclusions: VHA's TBI screening process is inclusive and has utility in referring patients with current symptoms to appropriate care. More than 90% of those evaluated received further VHA care and confirmatory evaluations were associated with significantly higher average utilization. Generalizability is limited to those who seek VHA healthcare.