Cognition and return to work after mild/moderate traumatic brain injury: A systematic review

Mani, Karthik; Cater, Bryan; Hudlikar, Akshay N.

doi:10.3233/wor-172597

Cited by 68 publications

(36 citation statements)

References 54 publications

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“…Looking more specifically at productivity loss, Silverberg et al (13) found that residual symptoms and comorbid psychiatric conditions were predictors, and regarding long-term outcomes, Theadom et al (11) reported that cognitive complaints at 1 month post-injury were predictive of work limitations 4 years post-injury. A recent systematic review supports the role of cognition in predicting and facilitating RTW (17). Thus, a range of factors, including demographic, physical, cognitive, and emotional as well as environmental and societal, may impact the course of employment outcomes after mTBI in a complex interaction, which is yet unclear.…”

Section: Introductionmentioning

confidence: 90%

Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning

Cour

Rasmussen

Foged³

et al. 2019

Front. Neurol.

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Persisting post-concussive symptoms are challenging to treat and may delay return-to-work (RTW). The aims of this study were to describe a multidisciplinary and holistic vocational rehabilitation (VR) program for individuals with mild traumatic brain injury (mTBI) and to explore course and predictors of employment outcome during VR. The VR program was described using the Standard Operating Procedures (SOPs) framework. Further, a retrospective, cohort study on individuals with mTBI receiving VR was conducted based on clinical records ( n = 32; 22% males; mean age 43.2 years; 1.2 years since injury on average). The primary outcome was difference in hours at work per week from pre- to post-VR, and the secondary outcome was change in a three-level RTW-status. Time since injury, age, sex, and loss of consciousness were investigated as predictors of the outcomes. The VR intervention is individually tailored and targets patients' individual needs. Thus, it may combine a variety of methods based on a biopsychosocial theoretical model. During VR, hours at work, 17.0 ± 2.2, p < 0.001, and RTW-status, OR = 14.0, p < 0.001, improved significantly with 97% having returned to work after VR. Shorter length of time since injury and male sex were identified as predictors of a greater gain of working hours. Time since injury was the strongest predictor; double the time was associated with a reduction in effect by 4.2 ± 1.4 h after adjusting for working hours at start of VR. In sum, these results suggest that individuals facing persistent problems following mTBI may still improve employment outcomes and RTW after receiving this multidisciplinary and holistic VR intervention, even years after injury. While results are preliminary and subject to bias due to the lack of a control group, this study warrants further research into employment outcomes and VR following mTBI, including who may benefit the most from treatment.

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Section: Introductionmentioning

confidence: 90%

Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning

Cour

Rasmussen

Foged³

et al. 2019

Front. Neurol.

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“…Traumatic brain injury (TBI) causes damaging neurological impairments leading to disability and morbidity. TBI affects young and old, with young victims creating a substantial negative impact to families and wider society with years of lost productivity and an increasing burden on healthcare systems [1,2]. Such is its prevalence that its economic cost to the US is $56 billion a year [3].…”

Section: Introductionmentioning

confidence: 99%

Differential Expression of Circulating Inflammatory Proteins Following Sport-Related Traumatic Brain Injury

Begum¹,

Reddy

Yakoub

et al. 2020

IJMS

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Sport-related traumatic brain injury (TBI) elicits a multifaceted inflammatory response leading to brain injury and morbidity. This response could be a predictive tool for the progression of TBI and to stratify the injury of which mild TBI is most prevalent. Therefore, we examined the differential expression of serum inflammatory markers overtime and identified novel markers in repetitively concussed athletes. Neuropsychological assessment by Wechsler Adult Intelligence Scale (WAIS) and Immediate Post Concussion Assessment and Cognitive Test (ImPACT) was performed on rugby players and serum was taken from healthy, concussed and repetitively concussed athletes. Serum was also obtained <1 week and >1 week after trauma and analyzed for 92 inflammatory protein markers. Fibroblast growth factor 21 (FGF21) and interleukin-7 (IL-7) differentiated repetitively concussed athletes. Macrophage chemotactic protein-1 (MCP-1), tumor necrosis factor superfamily member 14 (TNFSF14) were significantly reduced >1 week and chemokine (C-X3-C motif) ligand 1 (CX3CL1) upregulated <1 week after injury. FGF21 and MCP-1 negatively correlated with symptoms and their severity. We have identified dynamic changes in the inflammatory response overtime and in different classes of concussion correlating with disease progression. This data supports the use of inflammatory biomarkers as predictors of symptom development due to secondary complications of sport-related mTBI. mTBI can be defined as head trauma resulting in either memory loss or altered neurological function up to a day following the traumatic ictus or loss of consciousness for under 30 min [5]. A large proportion of mTBI consists of sport-related concussive (SRC) injury with up to 3.8 million cases reported in the United States annually [6]. There is also a greater risk of these athletes experiencing repetitive concussions which has been associated with the development of neurodegenerative diseases such as Parkinson's, Alzheimer's, and chronic traumatic encephalopathy (CTE) [6][7][8][9][10][11][12][13][14][15]. Neurocognitive tests have been developed to diagnose concussion. However, these assessments are expensive, subject to bias due to lack of appropriate baselines and have not yet demonstrated efficacy as prognostic tools [16][17][18].Difficulties in developing tools for the prediction of progressive pathology in TBI are confounded by the variability in the anatomical location, extent of the mechanical injury to the brain, as well as the multitude of biological response mechanisms involved. TBI is broadly characterized by 2 phases [19,20]. Immediately after impact, the primary phase is associated with shearing and tearing of neural and vascular brain structures and enhanced permeability of the blood-brain barrier. Within minutes start the secondary phase, where danger-associated molecular pattern (DAMPs) molecules are released from damaged cells which stimulate the Toll-like receptor (TLR) [21]. Cytokines and chemokines are also released leading to the recruitment of microglia a...

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“…Cognitive deficits are common after TBI and have consistently been linked to negative employment outcome (15,22,23). Cognitive skills such as learning new tasks, and social interaction at the workplace are crucial for job performance.…”

Section: Introductionmentioning

confidence: 99%

“…Cognitive skills such as learning new tasks, and social interaction at the workplace are crucial for job performance. A literature review by Mani and colleagues (22) found that executive functioning, attention, memory, and verbal skills were predictive of RTW post-TBI. The review also found evidence for the efficacy of cognitive rehabilitation in facilitating RTW.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up

et al. 2020

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Cognition and return to work after mild/moderate traumatic brain injury: A systematic review

Cited by 68 publications

References 54 publications

Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning

Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning

Differential Expression of Circulating Inflammatory Proteins Following Sport-Related Traumatic Brain Injury

Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up

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