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Following a traumatic brain injury (TBI), people frequently have difficulty understanding nonliteral language, including irony and indirect requests. Despite the handicap that these disorders can represent in daily life, they are rarely treated clinically, and remediation studies are scarce. The present study thus aimed to evaluate the effectiveness of an explicit metapragmatic therapy targeting nonliteral language comprehension and taking into account cognitive processes likely to underlie this comprehension (i.e., contextual processing, theory of mind, and executive functions). This study was registered on the ClinicalTrials.gov system (ID: NCT04708561) before participant recruitment. Two adults with severe TBI took part in the study. An ABA design with multiple baselines was used to assess the evolution of treated and non-treated written literal and nonliteral story comprehension, as well as ecological tasks and tasks assessing the cognitive processes of interest (theory of mind and executive functions). An interview was also conducted at the end of treatment to assess participant satisfaction. Therapy resulted in significant improvement in treated items, with one-month maintenance of gains and generalisation to untreated items in both participants. The generalisation to a working memory task was also observed in one participant. Finally, participant satisfaction with the treatment was high. Our study demonstrated for the first time the potential of a therapy targeting irony and indirect request comprehension in TBI individuals. Clinically, it offers concrete therapeutic avenues and fills a critical gap in the TBI population's evidence for the remediation of nonliteral language comprehension. [ABSTRACT FROM AUTHOR]

Background: The ability to self‐advocate or have a say in one's care is integral to personalised care after acquired brain injury (ABI). This study aimed to understand what constitutes self‐advocacy and associated barriers and facilitators throughout hospital transitions and into the community. Method: Qualitative methodology was employed with semistructured interviews conducted with 12 people with ABI and 13 family members. Interviews were conducted at predischarge (in‐person or via telephone) and 4 months postdischarge (via telephone) from the brain injury rehabilitation unit of a tertiary hospital. Data were thematically analysed using a hybrid deductive–inductive approach. Results: Self‐advocacy reflects the process of reclaiming agency or people's efforts to exert influence over care decisions after ABI. Agency varies along a continuum, often beginning with impaired processing of the self or environment (loss of agency) before individuals start to understand and question their care (emerging agency) and ultimately plan and direct their ongoing and future care (striving for agency). This process may vary across individuals and contexts. Barriers to self‐advocacy for individuals with ABI include neurocognitive deficits that limit capacity and desire for control over decisions, unfamiliar and highly structured environments and lack of family support. Facilitators include neurocognitive recovery, growing desire to self‐advocate and scaffolded support from family and clinicians. Conclusion: Self‐advocacy after ABI entails a process of reclaiming agency whereby individuals seek to understand, question and direct their ongoing care. This is facilitated by neurocognitive recovery, growing capacity and desire and scaffolded supports. Research evaluating approaches for embedding self‐advocacy skills early in brain injury rehabilitation is recommended. Patient or Public Contribution: Two caregivers with lived experience of supporting a family member with ABI were involved in the design and conduct of this study and contributed to and provided feedback on the manuscript. [ABSTRACT FROM AUTHOR]

Objective Safety and efficacy data on controlled hypothermia (CH) for neonates with moderate to severe hypoxic ischemic encephalopathy has been extrapolated to a subgroup of these patients who also require extracorporeal membrane oxygenation for refractory persistent pulmonary hypertension of the newborn (PPHN). However, safety data on the concomitant use of CH and extracorporeal membrane oxygenation (ECMO) are lacking. Methods This is a single-center retrospective study of neonates ≥35 weeks' gestation with refractory PPHN who required ECMO between January 2010 and December 2020. Study groups were divided into those receiving CH/ECMO versus ECMO only. Baseline characteristics, short-term outcomes, and brain magnetic resonance imaging (MRI) data were compared. Results A total of 36 neonates who received ECMO for refractory PPHN were included. Of these, 44.4% (n = 16) received CH/ECMO and 55.6% (n = 20) received ECMO only. Bleeding complications were more common in CH/ECMO group 50% (n = 8) versus ECMO only 15% (n = 3, p = 0.023). T1 brain MRI severity scores were higher in CH/ECMO group versus ECMO only group, however, there were no statistical difference in T2 and diffusion-weighted image scores. Functional status and survival to discharge were comparable between groups. Conclusion In our cohort, neonates who received CH/ECMO had higher bleeding complications than ECMO only group with comparable functional status and survival at discharge. Key Points Safety data on the concomitant use of CH and ECMO are lacking in neonates. In our cohort, neonates who received CH/ECMO had higher bleeding complications than ECMO only group. Functional status and survival to discharge were no differences between the two groups. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI), recognized as the world's most serious public health problem, currently lacks effective treatment options. The development of the patch has great clinical significance whether it is used as a skull implant material or TBI repair. In response to this critical health challenge, a novel 3D‐printed bi‐layer cranial‐brain patch (SMB6) with dual functionality, addressing both TBI repair and skull regeneration, is developed. In the first layer, the incorporation of high concentrations of mesoporous bioactive glass nanoparticles establishes a microenvironment for bone regeneration. Meanwhile, the second layer, comprised of methacrylated silk fibroin hydrogel, provides essential mechanical support for nanocell membrane vesicles loaded with macrophage colony‐stimulating factor and interleukin‐6. This innovative design aims to interrupt the cascade of secondary brain injury. In experimental models of TBI, SMB6 demonstrates remarkable efficacy in inhibiting brain edema, exerting therapeutic effects on blood vessels, nerves, and inflammation. Additionally, promising outcomes are observed in promoting bone regeneration in skull defect models. This work not only introduces a potential therapeutic patch for TBI‐related diseases but also provides novel insights for the clinical translation of cranial patches. [ABSTRACT FROM AUTHOR]

Background/Aims: Although there are many researchers reviewing the existing evidence related to traumatic brain injury from speech-language pathologists' perspectives, there have been no attempts to review the existing research evidence in Standard Chinese to the best of the authors' knowledge. The purpose of this scoping review was to identify and synthesise the existing research evidence available in China for therapy related to individuals with traumatic brain injury within the speech-language pathologists' scope of practice. Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was conducted using databases that included articles in the Standard Chinese language. In collaboration with three therapists working in China, the data was extracted and translated into English. Results: Eight research articles met the inclusion and exclusion criteria of this review. Six studies were randomised control trials, and two studies were cohort studies. These eight studies focused on collaboration, counselling and treatment. All studies addressed cognition and two also addressed language. Conclusions: Evidence showed that treatment focusing on cognitive and language skills provided by speech-language pathologists can improve the lives of people with a traumatic brain injury living in China. More research is warranted to better understand traumatic brain injury and treatment efficacy in China. Implications for practice: Clinicians, especially those who work with individuals who affiliate themselves with the Chinese culture, can consider the current research evidence discussed in this article when working with clients with traumatic brain injury. Additionally, for researchers, future research efforts can prioritise addressing the identified gaps outlined in this study. [ABSTRACT FROM AUTHOR]

Background: To compare kidney blood flow and kidney function tests in infants with hypoxic ischemic encephalopathy (HIE), and the effects of therapeutic hypothermia (TH) during the first 7 days of life. Methods: Fifty-nine infants with HIE were prospectively evaluated. Infants with moderate-severe HIE who required TH were classified as group 1 (n = 36), infants with mild HIE were classified as group 2 (n = 23), and healthy infants were classified as group 3 (n = 60). Kidney function tests were evaluated on the sixth hour, third and seventh days of life in Group 1 and Group 2, and on the sixth hour and third day of life in group 3. Renal artery (RA) Doppler ultrasonography (dUS) was performed in all infants on the first, third, and seventh days of life. Results: Systolic and end diastolic blood flow in RA tended to increase and RA resistive index (RI) tended to decrease with time in group 1 (p = 0.0001). While end diastolic blood flow rates in RA on the third day were similar in patients with severe HIE and mild HIE, it was lower in patients with mild-moderate-severe HIE than healthy newborns. On the seventh day, all three groups had similar values (p > 0.05). Serum blood urea nitrogen (BUN), creatinine, uric acid, and cystatin C levels gradually decreased and glomerular filtration rate (GFR) gradually increased during TH in group 1 (p = 0.0001). Serum creatinine levels gradually decreased while GFR gradually increased during the study period in group 2. Conclusions: Therapeutic hypothermia seems to help restore renal blood flow and kidney functions during the neonatal adaptive period with its neuroprotective properties. [ABSTRACT FROM AUTHOR]

Objective We examine the effect of birth weight (BW) for gestational age (GA) on the temperatures reached during the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) with therapeutic hypothermia (TH). Study Design Retrospective data of 1,736 neonates with HIE who received TH were extracted from the Canadian Neonatal Network database for neonates admitted from 2010 to 2017. Neonates were stratified into three BW groups: small for GA < 10th centile, large for GA > 90th centile, and according to GA 10th to 89th centile at a given gestation using Canadian population data norms. Results There was no significant difference in the lowest temperature reached, the likelihood of overshooting temperatures < 32.5°C during TH, or the change of encephalopathy stages among the three groups. Conclusion BW for GA did not appear to influence the temperatures neonates reached during hypothermia or encephalopathy stage following TH. Key Point Therapeutic hypothermia is well tolerated irrespective of weight for age SGA infants achieved and maintained target temperature similar to AGA and LGA babies Change in the Sarnat stage after hypothermia was similar across all birth weight groups [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) occurs as a result of direct mechanical action on the brain and causes degeneration and cell death in the central nervous system. Cell transplantation has proven itself not only as an experimental method for studying structural and functional relationships, development, neuroplasticity, and regeneration in the adult central nervous system but has also recently shown optimistic results in restoring functions after traumatic brain injury. Unfortunately, TBI leads to the death of a large number of brain parenchyma, therefore, one of the promising approaches used in regenerative medicine is the use of three-dimensional biocompatible scaffolds capable of supporting the growth and integration of nerve cells at the site of injury. The biocompatibility of a biodegradable scaffold, which acts as a carrier of transplanted cells and replaces the matrix of nervous tissue during neuro transplantation, was studied on the model of experimental open brain injury in mice. The 3D biodegradable scaffold was created using micro stereolithographic techniques by combining bacterial cellulose and hyaluronic acid. In an experiment on the parameters of cognitive behavior of mice (a study of longterm conditioned reflexes and short-term memory during recognition of a new object), visualization of the integrity of brain tissue using high-field MRI (9.4 T), it was shown that transplantation of a 3D scaffold based on bacterial cellulose during reconstructive therapy of a brain tissue defect reduces cognitive deficit after injury, restores the integrity of brain tissue 5 months after injury. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Glasgow Outcome Scale Extended (GOSE) is a measure of recovery after traumatic brain injury (TBI). Public surveys rate some GOSE states as worse than death. Direct family experience caring for patients with TBI may impact views of post-TBI disability. STUDY DESIGN: We conducted a national cross-sectional computer-adaptive survey of surrogates of TBI dependents incurring injury more than 1 year earlier. Using a standard gamble approach in randomized order, surrogates evaluated preferences for post-TBI GOSE states from GOSE 2 (bedridden, unaware) to GOSE 8 (good recovery). We calculated median (interquartile range [IQR]) health utilities for each post-TBI state, ranging from -1 to 1, with 0 as reference (death = GOSE 1), and assessed sociodemographic associations using proportional odds logistic regression modeling. RESULTS: Of 515 eligible surrogates, 298 (58%) completed scenarios. Surrogates were median aged 46 (IQR 35 to 60), 54% married, with Santa Clara strength of faith 14 (10 to 18). TBI dependents had a median GOSE5 (3 to 7). Median (IQR) health utility ratings for GOSE 2, GOSE 3, and GOSE 4 were -0.06 (-0.50 to -0.01), -0.01 (-0.30 to 0.45), and 0.30 (-0.01 to 0.80), rated worse than death by 91%, 65%, and 40%, respectively. Surrogates rated GOSE 4 (daily partial help) worse than the general population. Married surrogates rated GOSE 4 higher (p < 0.01). Higher strength of faith was associated with higher utility scores across GOSE states (p = 0.034). CONCLUSIONS: In this index study of surrogate perceptions about disability after TBI, poor neurologic outcomes--vegetative, needing all-day or partial daily assistance--were perceived as worse than death by at least 1 in 3 surrogates. Surrogate perceptions differed from the unexposed public. Long-term perceptions about post-TBI disability may inform earlier, tailored shared decisionmaking after neurotrauma. [ABSTRACT FROM AUTHOR]

Patients with severe traumatic brain injuries require urgent medical attention at a hospital. We evaluated whether transporting adult patients with a severe traumatic brain injury (TBI) to a Neuroscience Centre is associated with reduced mortality. We reviewed studies published between 2010 and 2023 on severe TBI in adults (>18 years) using Medline, CINAHL, Google Scholar and Cochrane databases. We focused on mortality rates and the impact of transferring patients to a Neuroscience Centre, delays to neurosurgery and EMS triage accuracy. This review analysed seven studies consisting of 53 365 patients. When patients were directly transported to a Neuroscience Centre, no improvement in survivability was demonstrated. Subsequently, transferring patients from a local hospital to a Neuroscience Centre was significantly associated with reduced mortality in one study (adjusted odds ratio: 0.79, 95% confidence interval: 0.64–0.96), and 24‐h (relative risk [RR]: 0.31, 0.11–0.83) and 30‐day (RR: 0.66, 0.46–0.96) mortality in another. Patients directly transported to a Neuroscience Centre were more unwell than those taken to a local hospital. Subsequent transfers increased time to CT scanning and neurosurgery in several studies, although these were not statistically significant. Additionally, EMS could accurately triage. None of the included studies demonstrated statistically significant findings indicating that direct transportation to a Neuroscience Centre increased survivability for patients with severe traumatic brain injuries. Subsequent transfers from a non‐Neuroscience Centre to a Neuroscience Centre reduced mortality rates at 24 h and 30 days. Further research is required to understand the differences between direct transport and subsequent transfers to Neuroscience Centres. [ABSTRACT FROM AUTHOR]

Individuals with a brain injury often require a caregiver to live safely in a community-based setting. This role typically defaults to a woman family member. Under the auspices of a constructivist interpretive tradition that honors a desire-based approach, this study blended narrative inquiry and grounded theory to explore the lived experiences of women caring for loved ones with brain injury. Twenty women completed the semi-structured interview, electing to participate either via videoconferencing or telephone. Employing a constant comparative method, three consecutive rounds of interviews, coding, and analysis occurred. Findings revealed an overarching theme surrounding the intractable challenges and enduring triumphs of caregiving. This discovery further sub-divided into four themes. Two themes focused on traversing a fragmented system of care and managing the burden of caregiving. The remaining two entailed finding supports in family and friends and leveraging professional skillset (s) to optimize caregiving. The recommendations garnered from the women's experiences included enhanced caregiver education with follow-up post-medical care, expanding services into the community to support caregivers and their family members appropriately, and building compassionate networks of women living the caregiving experience. Consistent with a desire-based paradigm, leveraging relationships to triumph over the challenges provided this group of women a voice to promote effective care for self, loved ones, and others. [ABSTRACT FROM AUTHOR]

Background: Severe traumatic brain injury (TBI) is a leading cause of disability worldwide and cerebral protection (CP) management might determine the outcome of the patient. CP in severe TBI is to protect the brain from further insults, optimise cerebral metabolism and prevent secondary brain injury. This study aimed to analyse the short-term Glasgow Outcome Scale (GOS) at the intensive care unit (ICU) discharge and a month after ICU discharge of patients post CP and factors associated with the favourable outcome. Methods: This is a prospective cohort study from January 2021 to January 2022. The short-term outcomes of patients were evaluated upon ICU discharge and 1 month after ICU discharge using GOS. Favourable outcome was defined as GOS 4 and 5. Generalised Estimation Equation (GEE) was adopted to conduct bivariate GEE and subsequently multivariate GEE to evaluate the factors associated with favourable outcome at ICU discharge and 1 month after discharge. Results: A total of 92 patients with severe TBI with GOS of 8 and below admitted to ICU received CP management. Proportion of death is 17% at ICU discharge and 0% after 1 month of ICU discharge. Proportion of favourable outcome is 26.1% at ICU discharge and 61.1% after 1 month of ICU discharge. Among factors evaluated, age (odds ratio [OR] = 0.96; 95% CI: 0.94, 0.99; P = 0.004), duration of CP (OR = 0.41; 95% CI: 0.20, 0.84; P = 0.014) and hyperosmolar therapy (OR = 0.41; CI 95%: 0.21, 0.83; P = 0.013) had significant association. Conclusion: CP in younger age, longer duration of CP and patient not receiving hyperosmolar therapy are associated with favourable outcomes. We recommend further clinical trial to assess long term outcome of CP. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) share a collective goal of ensuring that adults with cognitive–communication disorders (CCD) due to acquired brain injuries (ABI) attain their highest possible level of participation and satisfaction in family, community, social, work and academic communications through evidence‐based interventions. While there is a considerable evidence base to support SLT cognitive–communication interventions, there are also numerous barriers to its implementation. Aims: The first aim is to describe the development of a comprehensive knowledge translation tool that synthesizes evidence‐based practice recommendations for SLT cognitive–communication interventions across the care continuum. The second aim is to critically analyse the barriers to implementation of these interventions and to explore how this knowledge translation tool might assist in overcoming these challenges. Methods & Procedures: We developed a map of 148 clinical practice recommendations extracted from 129 reviews and guidelines called the Cognitive–Communication Evidence Application for SLTs (CCEAS‐Map). The process of developing the CCEAS‐Map included: (1) examination of implementation science frameworks to inform knowledge tool creation; (2) search and synthesis of the evidence provided in reviews and guidelines that met specific criteria; (3) development of a framework to critically analyse and categorize the barriers and facilitators affecting the implementation of these clinical recommendations; (4) consultation with potential end users of the CCEAS‐Map, including 16 expert SLTs and eight persons with lived experience (PWLE), regarding the tool's construction, barriers and facilitators to implementation, and the potential of the CCEAS‐Map to address evidence–practice gaps; and (5) refining the CCEAS‐Map based on expert input. Main Contribution: To our knowledge this is the first synthesis of all available clinical recommendations for SLT cognitive–communication interventions for ABI, across all severities of injury, stages along the continuum of care, and areas of CCD practice. The paper presents a novel approach to analysing knowledge–practice gaps: drawing on implementation science tools, analysing barriers and facilitators, and collaborating with end users in designing a knowledge translation tool. Conclusions & Implications: The CCEAS‐Map provides a comprehensive synthesis of the available evidence in a format that can facilitate clinical application of the evidence, provide education for all stakeholders, serve as a basis for CCD pathway development, support researcher–clinician collaboration and encourage advocacy at the system level. As a knowledge translation tool, the CCEAS‐Map can promote the availability of SLT services and has the potential to ultimately improve the lives of those with CCD. What this paper Adds: What is already known on this subject: A great deal is known about cognitive–communication deficits incurred after ABI, including their impact on daily functioning, optimal methods for sensitive and ecologically valid assessment, and the efficacy of various speech–language therapy interventions along the care continuum. However, considerable constraints remain that interfere with the application of this evidence to daily SLT practice. A need was identified to develop a knowledge translation tool to help close these evidence–practice gaps. What this paper adds to existing knowledge: This study describes the development of the CCEAS‐Map, a critical synthesis of 129 reviews and guidelines, leading to 148 evidence‐based clinical recommendations, which can be used to guide SLT cognitive–communication practice and education, as well as clinical pathway development, and advocacy for systemic changes and other healthcare policy improvements. What are the potential or actual clinical implications of this work?: The CCEAS‐Map is a clinical knowledge translation tool designed to guide cognitive–communication interventions by linking practice recommendations directly to the current evidence. This paper also offers insights into barriers to SLT intervention across the care continuum and strategies for improving implementation of cognitive–communication best practices, to improve the lives of those living with ABI related disabilities. [ABSTRACT FROM AUTHOR]

Background: Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse‐level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech–language pathologists (SLPs) assess and treat discourse after TBI. Aims: To investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations. Methods & Procedures: This online survey consisted of 30 questions on SLPs' practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision‐making. Participants were recruited through national and international SLP professional bodies, TBI‐specific or SLP special‐interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses. Outcomes & Results: There were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self‐monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings. Conclusions & Implications: Overall, survey respondents' management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal‐based approach. Factors affecting the use of discourse in practice included client‐specific factors and needs, availability of time for transcription and analysis, and SLPs' knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision‐making for SLPs working in TBI. WHAT THIS PAPER ADDS: What is already known on this subject: Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically. What this paper adds to existing knowledge: This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents' practice was generally aligned with recommendations, featuring individualized, goal‐based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors. What are the potential or actual clinical implications of this work?: This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI‐specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice. [ABSTRACT FROM AUTHOR]

The lack of objective prognostication tools for severe traumatic brain injury (TBI) causes variability in the application of withdrawal of life-saving treatment (WLST). We aimed to determine whether WLST in persons with severe TBI is associated with known indicators of poor prognosis. This retrospective descriptive study focused on adult (18–64 years) and geriatric (≥65 years) patients with severe TBI who were admitted between August 1, 2018 and July 31, 2021 at a Level I trauma center and subsequently underwent WLST. The data collected from the Trauma Registry and electronic health records included information regarding demographic characteristics, injury severity, clinical variables, and length of hospital stay and were used to examine the indicators of poor prognosis and WLST. Among the 164 participants with TBI who met the inclusion criteria, 61.0% were geriatric, and 122 (74.4%) patients had 0 or only 1 of the poor prognostic indicators prior to WLST. The non-geriatric group had more indicators of poor prognosis than the geriatric group. Participants with fewer indicators of poor prognosis had a longer length-of-stay. In severe TBI cases, standardized prognostication tools can help guide informed WLST decisions, particularly in geriatric patients, improving care consistency. [ABSTRACT FROM AUTHOR]

Green Care therapies are defined as the engagement of a patient with the nature, exposing patients to a nature based therapeutic setting that may facilitate their recovery. Such therapies became popular at the end of the twentieth century. This therapeutic approach may include therapeutic horticulture, nature therapies, care farming, facilitated exercise, and animal-assisted therapies with farm animals (AATF). This paper describes the processes of planning and creating an AATF-based clinical intervention wherein persons with TBI interacted with ducks (in twice weekly, 1-hour groups) for 12 wk at a TBI rehabilitation facility. The discussion includes site identification, stakeholder engagement, intervention design and human and animal safety procedures. The research methods, theoretical framework, ethical consideration, and risk reduction strategies for human participants and ducks are discussed. Also, description of challenges and blueprints of possible solutions for other researchers interested in developing similar initiatives. This program will serve as a study site for examining effects of AATF-based interventions on self-efficacy, depression, and anxiety in persons with TBI. If the study suggests that AATF interventions with ducks may lead to positive changes, the proposed study will be followed with studies that include larger samples at multiple sites. Findings in this paper may contribute to the implementation science body of knowledge. Because of that, the information in this paper may benefit the researchers outside of the healthcare arena. From that perspective methods described in this paper may help to develop studies that focus on policy development, program expansion, or individual project implementation. [ABSTRACT FROM AUTHOR]

The goal of this study is to examine the effectiveness of case management services for a population of justice-involved individuals with TBI history. Two thousand three hundred and eighty-nine records from statewide behavioral health and brain injury program databases were used in two studies. Participants with a reported TBI history were more likely to have experienced trauma and to have a behavioral health diagnosis relative to incarcerated persons without TBI. Six months after release, 56.8% of participants with a history of TBI were still receiving community treatment, 27.8% were not in treatment, and 3.4% had completed treatment. There was a high attrition rate; 70% of people referred for case management failed to maintain contact. For those that did receive services, these data suggest that it prevented an escalation of psychosocial needs. There were no differences in community participation as measured by the Mayo Portland Adaptability Index's Participation Index (M2PI) scores (t24 =.497, p = 0.624) at intake and after 6 months of case management. This study confirms that case management confers a benefit to persons with TBI who are released from the criminal justice system. Further, recidivism rates for this vulnerable group were no different from the larger population of returning citizens. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs. Group-based mood and cognitive telerehabilitation is feasible for persons with chronic acquired brain injury, with high reported satisfaction. Screening for technical proficiency and providing ongoing technical support improves therapy adherence and retention. Integration of clinical care and research is feasible for delivering remote therapies to persons with brain injury. [ABSTRACT FROM AUTHOR]

Background When the newborn brain is exposed to hypoxia, as in hypoxic ischemic encephalopathy (HIE), it causes an inflammatory response. A wide variety of inflammatory markers are therefore used in the diagnosis of HIE. Objective We aimed to determine the diagnostic role of systemic inflammatory indices in infants with moderate-to-severe HIE. We have also investigated the effect of hypothermia treatment over those indices. Study Design A retrospective cohort study of infants suffering from moderate-to-severe HIE was conducted in a tertiary-level neonatal intensive care unit between September 2019 and March 2021. Systemic inflammatory indices including systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated for infants with HIE and controls at baseline, and after therapeutic hypothermia in those with HIE. Results A total of 103 infants (53 in the HIE group and 50 in the control group) were included in the study. Median gestational ages (GA) were 39 (37–40) and 38 (37–39) weeks, and median birth weights (BW) were 3,165 (2,890–3,440) and 3,045 (2,850–3,460) g in the HIE and control groups, respectively. GA, BW, mode of delivery, and gender of infants were similar between the groups. Infants in the HIE group had significantly higher NLR (p = 0.001), SII (p = 0.001), PIV (p = 0.001), and SIRI (p = 0.004) values when compared with the control group. Those indices decreased significantly after hypothermia treatment in the HIE group. Areas under curve for NLR, PLR, MLR, SII, SIRI, and PIV to predict HIE were found to be 0.808, 0.597, 0.653, 0.763, 0.686, and 0.663, respectively. Cutoff values having a good ability to predict HIE for SII and NLR were 410 and 1.12. Elevated NLR level above 1.12 was found to be an independent predictor for HIE, as revealed by multivariate analyses. No associations were found between systemic inflammatory indices and amplitude-integrated electroencephalography (aEEG) patterns, presence of seizures, and death. Conclusion Systemic inflammatory indices may represent reliable and readily available predictors of HIE risk. NLR seems to be an independent factor in diagnosing moderate-to-severe HIE. Key Points Systemic inflammatory incides are readily calculated from the peripheral blood count. NLR is an independent and valuable factor in diagnosing moderate-to-severe hypoxic-ischemic encephalopathy. Systemic inflammatory incides might be feasible for diagnosing hypoxic-ischemic encephalopathy. [ABSTRACT FROM AUTHOR]

Individuals with traumatic brain injuries (TBI) often experience executive function impairments that impact activities of daily living. Assistive technologies can help overcome these disabilities and Goal Management Training (GMT) provides an effective therapeutic approach for treating such impairments. To capture the benefits of GMT with assistive technology we developed the RehaGoal App. In this study, we investigate whether combining a modified GMT (mGMT) with the RehaGoal App is feasible in terms of study design, and preliminary evaluation of the attainment of self-defined goals. We also examine if the app produces useful metrics data, tests its usability, and gauges its potential for improving goal attainment. We used a case study design to evaluate four individuals with impairments in executive functions after TBI. They underwent an 8-week mGMT and RehaGoal App intervention to achieve a self-defined goal. To investigate the intervention's feasibility, we collected Goal Attainment Scale (GAS) scores at two-time points, neuropsychological data at study start, System Usability Scale (SUS) scores at study end, and metrics data throughout the study period. Participant retention and compliance rates were high. All participants improved on GAS. Metrics data was collected successfully and revealed different participant usage behaviours. Overall, the SUS scores of the participants indicated excellent app usability. The intervention was feasible but the study design should be modified. Preliminary evaluation of GAS, SUS, and metrics data provided useful insights on user behaviour, app usability, and its role in achieving self-defined goals. The app received overall positive participant ratings. Metric data can be useful as it can give therapists additional opportunities to gain more information about the realization of intervention tasks between the therapy sessions allowing them to use this information to adjust therapy elements. RehaGoal App in combination with a modified GMT may be able to support participants with impairment in executive functions in completing the task of daily living. The study shows that the RehaGoal App is feasible in rehabilitation for a small sample size and that it may be scaled up in the future larger randomized controlled trial. [ABSTRACT FROM AUTHOR]

To gain an understanding of current evaluation practices, post-injury recommendations, and referrals to allied healthcare professions (AHP) by first-line healthcare professionals (FHPs) providing care for people with mild traumatic brain injury (mTBI). Survey study Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers (n = 126) completed an online survey, including Likert scale and free response question relating to mTBI evaluation, management, and referral practices. FHPs surveyed reported being confident in their ability to evaluate patients with suspected mTBI, relying most heavily on patient-reported symptoms and physical signs as methods of evaluation. Most FHPs reported making recommendations to compensate for the symptoms experienced following mTBI diagnosis. In contrast, FHPs expressed challenges in the evaluation and management of symptoms associated with mTBI along with limited knowledge of and referrals to AHPs. Overall, FHPs feel confident in the diagnosis of mTBI but experience assessment and management challenges. AHPs are underutilized on mTBI management teams calling for a need for multidisciplinary collaboration on research, education, and rehabilitation efforts to optimally care for people experiencing mTBI symptoms. [ABSTRACT FROM AUTHOR]

To elucidate the sociodemographic and study factors involved in enrollment in the Traumatic Brain Injury Model System (TBIMS) database, this study examined the effect of a variety of variables on enrollment at a local TBIMS center. A sample of 654 individuals from the local TBIMS center was studied examining enrollment by age, gender, race, ethnicity, homelessness status at date of injury, history of homelessness, health insurance status, presence of social support, primary language, consenting in hospital or after discharge, and the need for an interpreter. Binary logistic regression was conducted to identify variables that predict center-based enrollment into TBIMS. Results demonstrated that older age was associated with decreasing enrollment (OR = 0.99, p = 0.01), needing an interpreter made enrollment less likely (OR = 0.33, p < 0.01), being primarily Spanish speaking predicted enrollment (OR = 3.20, p = 0.02), Hispanic ethnicity predicted enrollment (OR = 7.31, p = 0.03), and approaching individuals in the hospital predicted enrollment (OR = 6.94, p < 0.01). Here, OR denotes the odds ratio estimate from a logistic regression model and P denotes the corresponding p-value. These results can be useful in driving enrollment strategies at this center for other similar TBI research, and to contribute a representative TBI sample to the national database. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study are to evaluate the efficacy of transcranial direct current stimulation for improving disorders of consciousness and to compare efficacy of the different etiologies of disorders of consciousness. Design: Randomized controlled trials or crossover trials examining effects of transcranial direct current stimulation in patients with disorders of consciousness were searched in PubMed, Embase, Cochrane Library, and Web of Science. The sample characteristics, etiology, transcranial direct current stimulation treatment characteristics, and outcomes were extracted. Meta-analysis was performed using the RevMan software. Results: We included nine trials providing data with 331 participants and found that transcranial direct current stimulation improved the Coma Recovery Scale--Revised score of disorders of consciousness patients. We found a significant improvement of Coma Recovery Scale--Revised score in the minimally conscious state group (weighted mean difference = 0.77, 95% confidence interval = 0.30--1.23, P = 0.001), but not in the vegetative state or unresponsive wakefulness syndrome group. The effects of transcranial direct current stimulation are related to etiology, as the Coma Recovery Scale--Revised score was improved in the traumatic brain injury group (weighted mean difference = 1.18, 95% confidence interval = 0.60--1.75, P < 0.001), but not in vascular accident and anoxia groups. Conclusions: This meta-analysis revealed the evidence for positive effects of transcranial direct current stimulation on disorders of consciousness without adverse effects observed inminimally conscious state patients. In particular, transcranial direct current stimulation may be an effective treatment in rehabilitating cognitive functions in people with traumatic brain injury. [ABSTRACT FROM AUTHOR]

Hypoxic ischaemic encephalopathy (HIE) is associated with oxidative stress. A potential marker of oxidative damage is carboxyhaemoglobin (COHb) which is the product of the reaction between carbon monoxide and haemoglobin and is routinely assessed on blood gas analysis. Our objective was to test the hypothesis that higher COHb levels would be associated with worse outcomes in infants treated for HIE. A retrospective, observational study was performed of all infants who received whole body hypothermia for HIE at a tertiary neonatal intensive care unit between January 2018 and August 2021. For each participating infant, the highest COHb level per day was recorded for days one, three and five after birth. During the study period, 67 infants with a median (IQR) gestational age of 40 (38–41) weeks underwent therapeutic hypothermia for HIE. The median (IQR) COHb level on day three was higher in infants without electroencephalographic seizures (1.4 [1.1–1.4] %) compared with infants with seizures (1.1 [0.9–1.3] %, p=0.024). The median (IQR) COHb on day five was higher in infants without MRI brain abnormalities (1.4 [1.2–1.7] %) compared with infants with MRI abnormalities (1.2 [1.0–1.4] %, p=0.032). The COHb level was not significantly different between the nine infants who died compared to the infants who survived. COHb levels were higher in infants with HIE without seizures and in those with normal MRI brain examinations. We suggest that carbon monoxide has a potential protective role in HIE. [ABSTRACT FROM AUTHOR]

Agitated behaviours pose a significant challenge during early recovery following traumatic brain injury (TBI). This study aimed to gain a deeper understanding of how clinicians worldwide manage post-TBI agitation. Understanding the factors that influence how clinicians manage agitation can help inform the use of consistent and effective management strategies for reducing agitation in TBI care. Using a qualitative design, semi-structured interviews were conducted with 33 clinicians (58% female, aged 23–71 years) from 16 countries who had experience working with agitated patients. The interviews explored the approaches used to manage agitation during early TBI recovery. Interviews were analysed using thematic analysis. The central theme of the interviews was the effective management of agitation, consisting of three sub-themes: managing the safety of staff and patients, reducing triggers for agitation, and implementing behavioural principles for managing agitation. Two overarching themes influenced the effective management of agitation: clinician-related factors and systemic factors. This study highlighted key approaches for effective agitation management during early TBI recovery, as described by clinicians working with these patients worldwide. There were similarities in the strategies described, although there were many challenges that impeded the consistent implementation of such strategies in TBI care settings. Effective management of agitation during early traumatic brain injury (TBI) recovery continues to pose a significant challenge for clinicians worldwide. Healthcare services may improve the management of agitation by involving the patient's family in care delivery and implementing low-cost less-restrictive non-pharmacological interventions to reduce reliance on pharmacological interventions. Proactively addressing and removing potential sources of agitation (patient-related and environmental) may help reduce the risk of agitation occurring. The use of simple behaviour management strategies may be effective for reducing agitation, but strategies need to be implemented consistently and the approach should be flexible and tailored to the patient. Clinicians should develop an understanding of a patient's premorbid behaviours and interests to best inform the management approach. Management of agitation may be improved by increasing clinicians' agency in responding to agitated behaviours, through the provision of information and resources, ongoing training and skill development, supervision and support. [ABSTRACT FROM AUTHOR]

Cerebral organoid models in-of-themselves are considered as an alternative to research animal models. But their developmental and biological limitations currently inhibit the probability that organoids can fully replace animal models. Furthermore, these organoid limitations have, somewhat ironically, brought researchers back to the animal model via xenotransplantation, thus creating hybrids and chimeras. In addition to attempting to study and overcome cerebral organoid limitations, transplanting cerebral organoids into animal models brings an opportunity to observe behavioral changes in the animal itself. Traditional animal ethics frameworks, such as the well-known three Rs (reduce, refine, and replace), have previously addressed chimeras and xenotransplantation of tissue. But these frameworks have yet to completely assess the neural-chimeric possibilities. And while the three Rs framework was a historical landmark in animal ethics, there are identifiable gaps in the framework that require attention. The authors propose to utilize an expanded three Rs framework initially developed by David DeGrazia and Tom L. Beauchamp, known as the Six Principles (6Ps). This framework aims to expand upon the three Rs, fill in the gaps, and be a practical means for assessing animal ethical issues like that of neural-chimeras and cerebral organoid xenotransplantation. The scope of this 6Ps application will focus on two separate but recent studies, which were published in 2019 and 2020. First, they consider a study wherein cerebral organoids were grown from donors with Down syndrome and from neurotypical donors. After these organoids were grown and studied, they were then surgically implanted into mouse models to observe the physiological effects and any behavioral change in the chimera. Second, they consider a separate study wherein neurotypical human embryonic stem cell-derived cerebral organoids were grown and transplanted into mouse and macaque models. The aim was to observe if such a transplantation method would contribute to therapies for brain injury or stroke. The authors place both studies under the lens of the 6Ps framework, assess the relevant contexts of each case, and provide relevant normative conclusions. In this way, they demonstrate how the 6Ps could be applied in future cases of neural-chimeras and cerebral organoid xenotransplantation. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the feasibility, acceptability, and clinical outcome measures of BETTER (B rain Injury E ducation, T raining, and T herapy to E nhance R ecovery), a culturally tailored traumatic brain injury (TBI) transitional care intervention, among diverse younger adult patients with TBI (age 18-64) and their caregivers. Trained clinical interventionists addressed patient/family needs; established goals; coordinated post-hospital care and resources; and provided patient/family training on self- and family-management coping skills. Fifteen dyads enrolled (N = 31, 15 patients, 16 caregivers). All completed baseline data; 74.2% (n = 23; 10 patients, 13 caregivers) completed 8-week data; 83.8% (n = 26; 13 each) completed 16-week data. Approximately 38% (n = 12, 3 patients, 9 caregivers) completed acceptability data, showing positive experiences (mea n = 9.25, range 0-10; SD = 2.01). Overall and mental quality of life (QOL) scores did not differ over time but physical QOL scores did improve over time (baseline: 30.3, 8 weeks: 46.5, 16 weeks: 61.6; p = 0.0056), which was considered to be a suitable outcome measure for a future trial. BETTER is a promising intervention with implications to improve TBI care standards. Research is needed to determine efficacy in a randomized trial. [ABSTRACT FROM AUTHOR]

Introduction: Severe brain injuries can leave people in prolonged disorder of consciousness resulting in multifaceted medical, nursing, and rehabilitative needs that can be challenging for even the most experienced multidisciplinary team. The complexities of care, communication with families, and best interest decision-making about medical interventions means there is a need for ongoing training in clinical, social, ethical, and legal aspects. Methods: Using a combination of group discussions, interviews, and questionnaires with learners, this article reports an evaluation of designing and delivering an interprofessional, online work-based course to health care professionals caring for prolonged disorder of consciousness patients. Results: There were challenges for staff uptake because of COVID-19, but engaging with it increased knowledge in defining and diagnosing patients' conditions, understanding multidisciplinary team roles, communicating with families, and navigating legal and ethical issues. Course participation also enhanced critical and reflective thinking skills, provided a sense of connection to other professionals, and generated plans to improve service provision. Discussion: Online learning that enables health care professionals to engage at their own pace and also come together as an interprofessional community can provide invaluable continuing professional development and help to enhance joined up, holistic patient care. However, achieving this requires significant investment in creating research-led, multimedia, learning materials, and courses that include synchronous and asynchronous delivery to combine flexible study with the opportunity for peer networks to form. It also depends on a commitment from organizations to support staff online continuing professional development. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate anxiety, postpartum depression (PPD), and hopelessness in the mothers of newborns receiving therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE) in NICU. A total of 104 mothers and infants were analyzed as a study group with HIE (n = 52) and a control groups of non-HIE (n = 52). All the mothers completed The State-Trait Anxiety, Beck Hopelessness and Edinburgh Postpartum Depression Scales (EPDS). The EPDS scores, the rate of PPD, state-trait anxiety and hopelessness levels were similar in the two groups. In the HIE group, chest compression and persistent pulmonary hypertension in infants were associated with maternal anxiety, hopelessness, and PPD. The absence of a statistical difference between the two groups in the current study does not mean that these differences do not exist. These results demonstrate the need for further detailed studies on this subject. [ABSTRACT FROM AUTHOR]

To identify treatment provider sequences and healthcare pathway characteristics and outcomes for people with mild traumatic brain injury (mTBI) in New Zealand. Total mTBI costs and key pathway characteristics were analysed using national healthcare data (patient's injury and services provided). Graph analysis produced sequences of treatment provider types for claims with more than one appointment and healthcare outcomes (costs and time to exit pathway) were compared. Key pathway characteristics' effect on healthcare outcomes were evaluated. In two years, 55,494 accepted mTBI claims cost ACC USD$93,647,261 over four years. For claims with more than one appointment (36%), healthcare pathways had a median 49 days (IQR, 12–185). The 89 treatment provider types resulted in 3,396 different provider sequences of which 25% were General Practitioners only (GP), 13% Emergency Department to GP (ED-GP) and 5% GP to Concussion Service (GP-CS). Pathways with shorter time to exit and lower costs had correct mTBI diagnosis at initial appointment. Income maintenance comprised 52% of costs but only occurred for 20% claims. Improving healthcare pathways for people with mTBI by investing in training of providers to enable correct mTBI diagnosis could yield longer term cost savings. Interventions to reduce income maintenance costs are recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transcranial direct current stimulation (tDCS) may provide a potential therapy for cognitive deficits caused by traumatic brain injury (TBI), yet its efficacy and mechanisms of action are still uncertain. OBJECTIVE: We hypothesized that anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) would boost the influence of a cognitive training regimen in a mild-to-moderate TBI (mmTBI) sample. Cognitive enhancement was measured by examining event-related potentials (ERPs) during cognitive control tasks from pre- to post-treatment. METHODS: Thirty-four participants with mmTBI underwent ten sessions of cognitive training with active (n = 17) or sham (n = 17) anodal tDCS to the left DLPFC. ERPs were assessed during performance of an auditory oddball (3AOB), N-back, and dot pattern expectancy (DPX) task before and after treatment. RESULTS: P3b amplitudes significantly decreased from baseline to post-treatment testing, regardless of tDCS condition, in the N-back task. The active tDCS group demonstrated a significantly increased P3a amplitude in the DPX task. No statistically significant stimulation effects were seen during the 3AOB and N-back tasks. CONCLUSION: Active anodal tDCS paired with cognitive training led to increases in P3a amplitudes in the DPX, inferring increased cognitive control. P3b decreased in the N-back task demonstrating the effects of cognitive training. These dissociated P3 findings suggest separate mechanisms invoked by different neuroplasticity-inducing paradigms (stimulation versus training) in brain networks that support executive functioning. [ABSTRACT FROM AUTHOR]

According to Self-Determination Theory, the fulfillment of basic psychological needs of autonomy, competence, and relatedness plays an important role in one's motivation, engagement, and well-being. How a therapist is perceived to support or thwart these needs can impact adherence to treatment, thus influencing the effectiveness of therapeutic interventions. This alternating single-subject design explores how the physiotherapist self-reports interpersonal behaviors, how the person living with a disability (PwD) perceives the physiotherapist's supportive/thwarting interpersonal behaviors, and how the two align in the context of telerehabilitation. Five PwD and their physiotherapist completed two telerehabilitation exercise programs. The PwD completed the Interpersonal Behavior Questionnaire (IBQ) to examine how they perceived the physiotherapist interpersonal behaviors. The physiotherapist completed the Interpersonal Behavior Questionnaire-Self (IBQ-Self) to document how they self-reported these same behaviors. Descriptive statistics were used to document self-reports and perceptions of behaviors. Each PwD perceived the physiotherapist as being more supportive than thwarting. The supportive/thwarting behaviors varied across relationships. Greater alignment of the perceptions of therapist and the PwD was observed at the end of the programme when compared to baseline. Assessing how therapist support/thwart psychological needs and how these behaviors are perceived by PwD is recommended as it may influence the therapist's behavior and the PwD's adherence to future telerehabilitation exercise programs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low-titer group O whole blood (LTOWB) resuscitation is becoming common in both military and civilian settings and may represent the ideal resuscitation intervention. We sought to characterize the safety and efficacy of LTOWB resuscitation relative to blood component resuscitation. STUDY DESIGN: A prospective, multicenter, observational cohort study was performed using 7 trauma centers. Injured patients at risk of massive transfusion who required both blood transfusion and hemorrhage control procedures were enrolled. The primary outcome was 4-hour mortality. Secondary outcomes included 24-hour and 28-day mortality, achievement of hemostasis, death from exsanguination, and the incidence of unexpected survivors. RESULTS: A total of 1,051 patients in hemorrhagic shock met all enrollment criteria. The cohort was severely injured with >70% of patients requiring massive transfusion. After propensity adjustment, no significant 4-hour mortality difference across LTOWB and component patients was found (relative risk [RR] 0.90, 95% CI 0.59 to 1.39, p = 0.64). Similarly, no adjusted mortality differences were demonstrated at 24 hours or 28 days for the enrolled cohort. When patients with an elevated prehospital probability of mortality were analyzed, LTOWB resuscitation was independently associated with a 48% lower risk of 4-hour mortality (relative risk [RR] 0.52, 95% CI 0.32 to 0.87, p = 0.01) and a 30% lower risk of 28-day mortality (RR 0.70, 95% CI 0.51 to 0.96, p = 0.03). CONCLUSIONS: Early LTOWB resuscitation is safe but not independently associated with survival for the overall enrolled population. When patients were selected with an elevated probability of mortality based on prehospital injury characteristics, LTOWB was independently associated with a lower risk of mortality starting at 4 hours after arrival through 28 days after injury. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nationally, the volume of geriatric falls with intracranial hemorrhage is increasing. Our institution began observing patients with intracranial hemorrhage, Glasgow Coma Scale of 14 or greater, and no midline shift or intraventricular hemorrhage with hourly neurologic examinations outside of the ICU in a high observation trauma (HOT) protocol. We first excluded patients on anticoagulants or antiplatelets (HOT I), then included antiplatelets and warfarin (HOT II), and finally, included direct oral anticoagulants (HOT III). Our hypothesis is that HOT protocol safely reduces ICU use and creates cost savings in this patient population. STUDY DESIGN: Our institutional trauma registry was retrospectively queried for all patients on HOT protocol. Patients were stratified based on date of admission (HOT I [2008-2014], HOT II [2015-2018], and HOT III [2019-2021]), and were compared for demographics, anticoagulant use, injury characteristics, lengths of stay, incidence of neurointervention, and mortality. RESULTS: During the study period, 2,343 patients were admitted: 939 stratified to HOT I, 794 to HOT II, and 610 to HOT III. Of these patients, 331 (35%), 554 (70%), and 495 (81%) were admitted to the floor under HOT protocol, respectively. HOT protocol patients required neurointervention in 3.0%, 0.5%, and 0.4% of cases in HOT I, II, and III, respectively. Mortality among HOT protocol patients was found to be 0.6% in HOT I, 0.9% in HOT II, and 0.2% in the HOT III cohort (p = 0.33). CONCLUSIONS: Throughout the study period ICU use decreased without an increase in neurosurgical intervention or mortality, indicating the efficacy of the HOT selection criteria in identifying appropriate candidates for stepdown admission and HOT protocol. [ABSTRACT FROM AUTHOR]

The use of balance outcome measures (OM) is proposed to enhance physical therapy services and patient outcomes. Explore current practices of balance OM use and OM's role in United States physical therapists' decision-making with patient's acquired brain injury (ABI). Cross-sectional survey utilizing snowball sampling, n = 373. Survey items required ranking agreement with statements on Likert scale. Multinomial logistic regression used to determine the relationship between survey answers and participant characteristics. Ninety-three percent of therapists reported using outcome measures with patients with ABI. Those who reported not using outcome measures with patients with ABI were significantly different on setting, primary patient population, APTA section membership, and ANPT membership. All respondents who primarily treated neurologic diagnoses used outcome measure with clients with ABI, compared to 87% of respondents who worked primarily with orthopedic clients. Comfort, equipment availability, and psychometric properties were the most frequent reasons for choosing a measure. Therapist decision-making was impacted by outcome measures; this frequency was dependent on practice setting, primary patient population, and specialty certifications. Physical therapists use a low diversity of outcome measures to assess balance. Respondents rated psychometric properties as more important than past published research. This is the first study to demonstrate that outcome measures play a role for most United States PTs in decision-making in all stages of the patient management model including identification of problems, diagnosis, prognosis, intervention selection, termination of services, and discharge planning, as well justifying service delivery. [ABSTRACT FROM AUTHOR]

Despite research, national legislation, and clinical guidelines supporting transitional care, there is minimal benefit from existing transitional care interventions for racial/ethnic minorities with traumatic brain injury (TBI) discharged home from acute hospital care. Existing TBI transitional care interventions are not tailored to address the needs/preferences of patients from various racial/ethnic minority groups. The purpose of this study was to describe use of personalization to tailor a TBI transitional care intervention for various racial/ethnic groups. Following preliminary intervention manual development, a qualitative descriptive study was conducted using eight focus groups with 40 English-and Spanish-speaking participants (12 patients, 12 caregivers, and 16 providers). Three personalization-related themes emerged: 1) what is important to me, 2) finding someone to deliver the intervention who can adapt to my needs, and 3) respect over culture. Findings informed personalization strategies within our final manual. We recommend researchers who wish to use personalization to tailor interventions to consider: 1) allowing stakeholders to dictate what is most important and 2) implementing an iterative intervention development process with input from diverse stakeholders. Findings have implications for informing the development of transitional care interventions to increase the likelihood that interventions are inclusive of needs and preferences of various races/ethnicities. [ABSTRACT FROM AUTHOR]

Within the fast-growing field of regenerative medicine stem-cell therapy is well established in various hematologic and immunologic diseases and has received a recent substantial boost from the introduction of gene editing and gene transfer technologies. In neonates, for example, regenerative medicine may benefit those with congenital or acquired disease due to prematurity or perinatal hypoxia-ischemia. We compare and contrast the two main approaches – autologous vs. allogeneic – and summarize the recent advances and applications of interventional stem-cell research in perinatally acquired disorders such as intraventricular hemorrhage, hypoxia-ischemia and stroke. After discussing stem-cell sources and routes of administration, we conclude by highlighting the key opportunities and obstacles in this exciting field. [ABSTRACT FROM AUTHOR]

Describe how transcranial direct current stimulation (tDCS) was incorporated into an inpatient physiotherapy program for an adolescent with severe traumatic brain injury (TBI), detail the motor learning focus of the physiotherapy sessions, and summarize gross motor progress. This case report describes an adolescent who received 20 minutes of anodal tDCS immediately prior to 16 physiotherapy sessions over four weeks. Potential side effects were tracked pre/post tDCS. Gross motor outcomes were measured pre-intervention, post-intervention, and three months post-intervention. Physiotherapy session content was analyzed using therapist documentation and the Motor Learning Strategies Rating Instrument. The youth tolerated tDCS well. The primary side effect was itchiness under the electrodes during tDCS sessions. His mobility progressed from wheelchair use pre- 'tDCS + physiotherapy' to ambulation with a walker post-intervention. His Gross Motor Function Measure score increased 33.1% points pre/post intervention. Session tasks often had several foci (e.g., skill acquisition, strength, and balance) with task focus changing as the youth progressed. Various motor learning strategies were layered within tasks to support performance and learning. tDCS was successfully integrated into an existing inpatient physiotherapy program for an adolescent with TBI. This protocol provides a structure for implementing, monitoring, and measuring tDCS + physiotherapy in pediatric rehabilitation. [ABSTRACT FROM AUTHOR]

There has been concern about the potential sequelae of mild traumatic brain injury (mTBI) in children. This study used data from the Adolescent Brain Cognitive DevelopmentSM (ABCD) study to investigate associations between mTBI and behavior and sleep in school-aged children. Generalized additive mixed models were run to examine the association between TBI and parent-reported Child Behavior Checklist and Sleep Disturbance Scale for Children scores. mTBI with or without loss of consciousness (LOC) in 9- and 10-year old children was associated with 1) higher internalizing, externalizing and total problems and 2) greater sleep disturbance scores on the CBCL. The study also demonstrated a higher incidence of mTBI with and without LOC in boys compared to girls. This study shows a statistically significant but modest association between mTBI and behavioral and sleep changes, suggesting that in a non-clinical, sociodemographically diverse community sample of school-aged children mTBI does not result in clinically significant behavioral or psychological sequelae. [ABSTRACT FROM AUTHOR]

The PI3K/Akt/mTOR signalling pathway plays a crucial role in several biological processes, including cell proliferation, survival, and apoptosis, as well as regulates numerous signalling pathways, including JNK, NF-κB, and ERK pathways. The recent proliferation of signal transduction studies in neurological and cardiovascular diseases/injuries sheds light on Akt-dependent pathogenesis. The downregulation of the Akt signalling pathway 24 hours post-injury prevents neurogenesis and promotes the progression of severe secondary injuries, including neuroinflammation, scar formation, and neuronal and glial necrosis, following traumatic brain and spinal cord injury, suggesting designing therapeutic approaches within a 24-hour window postinjury. Similarly, the downregulation of the Akt signalling pathway in myocardial infarction lowers cardiovascular protection, limits neurovascularization, and inhibits cell survival. Following myocarditis, the Akt signalling network is upregulated, leading to aggravated inflammation, and increased myocardial damage. Also, the upregulation of the PI3K/Akt/mTOR pathway in chordoma promotes tumor progression and invasion, leading to neuronal damage and impaired physiological functions. Future therapeutics that target the aberrant expression of key players in the PI3K/Akt/mTOR signalling pathway present a promising approach to treating several neurological and cardiovascular pathologies. This narrative reviewdiscusses the role of PI3K/Akt/mTOR signalling pathway in traumatic central nervous system injuries (brain and spinal cord), cardiac injury (myocardial infarction), inflammatory disease (myocarditis), and rare neurological cancer (chordoma) along with therapeutic targets that are known to prevent worsened outcomes and promote recovery following those conditions. [ABSTRACT FROM AUTHOR]

Purpose: Teen Online Problem Solving (TOPS) is an evidence-based teletherapy program designed to promote neurocognitive, behavioral, and psychosocial recovery following brain injury through family-centered training. To date, TOPS has been primarily administered by neuropsychologists and clinical psychologists. This clinical focus article discusses a quality improvement project to adapt the TOPS training and manual for use by speech-language pathologists (SLPs) and reports feedback from SLPs following TOPS training and after delivering the program with adolescents who experienced neurological insults. Method: SLPs were invited to participate in TOPS training. Trainees were asked to complete posttraining surveys, active therapist questionnaires, and follow-up surveys directed to SLPs who had completed the intervention with at least one patient. Results: To date, a total of 38 SLPs completed TOPS training, 13 have implemented TOPS with at least one adolescent. Eight SLPs and 16 psychologists/ trainees responded to follow-up surveys to share their perspectives on the program. Perceptions of clinicians delivering the program did not differ significantly in most respects. SLPs rated the ease of understanding nonverbal communication higher than psychologists. Seven SLPs responded to an SLP-specific survey about their experiences administering TOPS, noting a range of advantages and some limitations in their open-ended responses. Conclusion: Training SLPs to deliver TOPS has the potential to increase service provision to adolescents with acquired brain injury who have cognitive communication difficulties and their families. [ABSTRACT FROM AUTHOR]

To survey social workers in the field of traumatic brain injury (TBI)/acquired brain injury (ABI) about their practice in conducting psychosocial assessments. Design: A cross-sectional quality assurance study. A cross-sectional quality assurance study. Social workers from professional social work rehabilitation networks spanning Sweden, the United Kingdom, North America, and Asia Pacific regions. Purpose-designed survey comprising closed and open items, organized into six sections and administered electronically. The 76 respondents were mainly female (65/76, 85.5%) from nine countries (majority from Australia, United States, Canada). Two-thirds of respondents were employed in outpatient/ community settings (51/76, 67.1%), with the balance working in inpatient/rehabilitation hospital settings. Over 80% of respondents conducted psychosocial assessments, with the assessments informed by a systemic focus, situating the individual within their broader family and societal networks. The top five issues identified in inpatient/rehabilitation settings were housing related needs, informed consent for treatment, caregiver support, financial issues and navigating the treatment system. In contrast, the leading issues identified in community settings related to emotional regulation, treatment resistance and compliance issues, depression, and self-esteem. Social workers assessed a broad range of psychosocial issues spanning individual, family, and environmental contextual factors. Findings will contribute to future development of a psychosocial assessment framework. [ABSTRACT FROM AUTHOR]

Early mobilization is regarded as important in patients with severe acquired brain injury. To explore the feasibility, physical and physiological responses of using a new assistive, electric standing device, Innowalk Pro (IP), that passively moves the legs in an upright position. A single-subject experimental design. A three-phase model (A1-B-A2) was chosen; A1: baseline using a standing frame, B: an intervention using IP and A2: withdrawal using a standing frame. Outcome measures: Patient's and assistive personnel's experiences with Likert scales, Modified Trunk Impairment Scale, Modified Ashworth Scale (MAS), Lidcombe Template (passive ankle dorsiflexion), duration of the training, blood pressure and heart rate. A 40-year-old female, with subarachnoid haemorrhage, perceived training in the IP as more physically exhausting than training in a standing frame, influencing the training time. However, she preferred the IP over the standing frame. Trunk control did not improve, until the withdrawal phase. A small MAS reduction in ankle plantar flexors was maintained in the A2-phase. The heart rate showed an ascending trend in A1, and a non-significant descending trend in B- and A2-phases. Blood pressure showed a flat trend line in A1 and B-phases, and a descending trend in A2. The new IP was considered a feasible and motivating intervention. Heart rate tended to decrease during IP training, while the blood pressure remained stable. Further research is needed to evaluate whether the IP should be a preferable or a supplementary assistive device for early mobilization. A new electrical standing device, Innowalk Pro, which moves the legs in upright position, was found to be feasible in early mobilisation of a patient with severe brain injury. Trained physiotherapist and assistive personnel are recommended for safe training. Physiological responses like heart rate and blood pressure remained relatively stable when training in Innowalk Pro. We question whether the leg movements when standing in Innowalk Pro, may contribute to improvement in trunk control. [ABSTRACT FROM AUTHOR]

The article discusses a multicenter, double-blind, randomized, placebo-controlled High-dose Erythropoietin for Asphyxia and Encephalopathy trial on the association between extreme blood glucose level in infants and hypoxic-ischemic encephalopathy (HIE) treatment. The study examined the association of hypoglycemia or hyperglycemia with higher rates of death and with worse neurodevelopmental impairment. It identifies the blood glucose thresholds in infants used in the study.

Background: Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. Methods: A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. Results: A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. Conclusions: This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) remains common among infants with hypothermia-treated hypoxic-ischaemic encephalopathy (HIE). Little is known about long-term kidney outcomes following hypothermia treatment. We recently reported that 21% of survivors of hypothermia-treated HIE had decreased estimated glomerular filtration rate (eGFR) based on plasma creatinine in early adolescence. Here, we assessed kidney functions more comprehensively in our population-based cohort of children born in Stockholm 2007–2009 with a history of hypothermia-treated HIE. Methods: At 10–12 years of age, we measured cystatin C (cyst C) to estimate GFR. Children with decreased cyst C eGFR also underwent iohexol clearance examination. We measured urine-albumin/creatinine ratio, blood pressure (BP) and kidney volume on magnetic resonance imaging. Fibroblast growth factor 23 (FGF 23) levels in plasma were assessed by enzyme-linked immunosorbent assay (ELISA). Outcomes were compared between children with and without a history of neonatal AKI. Results: Forty-seven children participated in the assessment. Two children (2/42) had decreased cyst C eGFR, for one of whom iohexol clearance confirmed mildly decreased GFR. One child (1/43) had Kidney Disease Improving Global Outcomes (KDIGO) category A2 albuminuria, and three (3/45) had elevated office BP. Subsequent ambulatory 24-h BP measurement confirmed high normal BP in one case only. No child had hypertension. Kidney volume and FGF 23 levels were normal in all children. There was no difference in any of the parameters between children with and without a history of neonatal AKI. Conclusion: Renal sequelae were rare in early adolescence following hypothermia-treated HIE regardless of presence or absence of neonatal AKI. [ABSTRACT FROM AUTHOR]

Objective Hypoxic–ischemic encephalopathy (HIE) in infants can have long-term adverse neurodevelopmental effects and markedly reduce quality of life. Both the initial hypoperfusion and the subsequent rapid reperfusion can cause deleterious effects in brain tissue. Cerebral blood flow (CBF) assessment in newborns with HIE can help detect abnormalities in brain perfusion to guide therapy and prognosticate patient outcomes. Study Design The review will provide an overview of the pathophysiological implications of CBF derangements in neonatal HIE, current and emerging techniques for CBF quantification, and the potential to utilize CBF as a physiologic target in managing neonates with acute HIE. Conclusion The alterations of CBF in infants during hypoxia-ischemia have been studied by using different neuroimaging techniques, including nitrous oxide and xenon clearance, transcranial Doppler ultrasonography, contrast-enhanced ultrasound, arterial spin labeling MRI, 18F-FDG positron emission tomography, near-infrared spectroscopy (NIRS), functional NIRS, and diffuse correlation spectroscopy. Consensus is lacking regarding the clinical significance of CBF estimations detected by these different modalities. Heterogeneity in the imaging modality used, regional versus global estimations of CBF, time for the scan, and variables impacting brain perfusion and cohort clinical characteristics should be considered when translating the findings described in the literature to routine practice and implementation of therapeutic interventions. Key Points Hypoxic–ischemic injury in infants can result in adverse long-term neurologic sequelae. Cerebral blood flow is a useful biomarker in neonatal hypoxic–ischemic injury. Imaging modality, variables affecting cerebral blood flow, and patient characteristics affect cerebral blood flow assessment. [ABSTRACT FROM AUTHOR]

Introduction: The management of mild traumatic brain injury has evolved through the years with an emphasis on the safe discharge of patients given current resources. In this article, we discuss key studies published in the past 12 years that have influenced the direction of complicated mild traumatic brain injury (cmTBI) management. We summarize the evidence on the utilization of the Brain Injury Guideline (BIG) algorithm. Methods: An independent literature search was conducted on the BIG, updated versions of BIG, and the prognostic studies of adult mild traumatic brain injury admissions cited by the BIG articles. Evidence resources included the search engines of PubMed, Medline, Ovid, Cochrane Library, and Google Scholar bibliographic databases of items published between 1 January 2010 and 30 December 2021. The evidence focused on BIG and its modified versions, as a potential risk assessment tool for discharging mTBI patients early. Results: Studies supporting the BIG algorithm prior to 2019 presented evidence with serious limitations to their findings. These limitations threaten their veracity and fail to support the efficacy or validation of the BIG algorithm's utilization for mTBI patient management. Conclusion: The lack of rigor in the BIG algorithm studies suggest the research is currently insufficient to support early discharge and research needs to continue on modified versions of the tool before its widespread use. [ABSTRACT FROM AUTHOR]