Mild Traumatic Brain Injury Literature Review and Proposed Changes To Classification

Krainin, Benjamin M; Forsten, Robert D.; Kotwal, Russ S; Lutz, Robert H.; Guskiewicz, Kevin M.

doi:10.55460/d7hh-zgpk

Cited by 23 publications

(2 citation statements)

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“…Exposure. The selection of TI >7 days as the cut-off point was informed by a previous review on mild traumatic brain injury [34] and to mitigate the impact of the early physiological impact of acute trauma on HRV [17][18][19][20]. Studies with participants of traumatic brain injury, spinal cord, depression, and post-traumatic stress disorder were excluded [26,[35][36][37].…”

Section: Eligibility Criteriamentioning

confidence: 99%

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

et al. 2023

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Heart rate variability (HRV) is a non-invasive measure of autonomic function. The relationship between unselected long-term traumatic injury (TI) and HRV has not been investigated. This systematic review examines the impact of non-acute TI (>7 days post-injury) on standard HRV indices in adults. Four electronic databases (CINAHL, Medline, Scopus, and Web of Science) were searched. The quality of studies, risk of bias (RoB), and quality of evidence (QoE) were assessed using Axis, RoBANS and GRADE, respectively. Using the random-effects model, mean difference (MD) for root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN), and standardized mean difference (SMD) for Low-frequency (LF): High-Frequency (HF) were pooled in RevMan guided by the heterogeneity score (I2). 2152 records were screened followed by full-text retrieval of 72 studies. 31 studies were assessed on the inclusion and exclusion criteria. Only four studies met the inclusion criteria. Three studies demonstrated a high RoB (mean RoBANS score 14.5±3.31) with a low QoE. TI was associated with a significantly higher resting heart rate. Meta-analysis of three cross-sectional studies demonstrated a statistically significant reduction in RMSSD (MD -8.45ms, 95%CI-12.78, -4.12, p<0.0001) and SDNN (MD -9.93ms, 95%CI-14.82, -5.03, p<0.0001) (low QoE) in participants with TI relative to the uninjured control. The pooled analysis of four studies showed a higher LF: HF ratio among injured versus uninjured (SMD 0.20, 95%CI 0.01–0.39, p<0.04) (very low QoE). Albeit low QoE, non-acute TI is associated with attenuated HRV indicating autonomic imbalance. The findings might explain greater cardiovascular risk following TI. Trial registration PROSPERO registration number: CRD: CRD42021298530.

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Section: Eligibility Criteriamentioning

confidence: 99%

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

et al. 2023

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“…A CONCUSSION INJURY is an injury to the head, neck, or face,1 and the recovery process is categorized in 3 stages: acute (1-7 days), subacute (8-89 days), and chronic (≥90 days) 2. Postconcussion symptoms can be divided into 4 domains: somatic, emotional, cognitive, and sleep.…”

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confidence: 99%

Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study

Ludwig,

Rippee,

D’Silva

et al. 2024

Journal of Head Trauma Rehabilitation

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Objective: Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms. Setting: This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom). Participants: Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses. Design: This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks. Main Measures: The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling. Results: There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms. Conclusions: CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.

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An Empirical Review of Treatment and Rehabilitation Approaches Used in the Acute, Sub-Acute, and Chronic Phases of Recovery Following Sports-Related Concussion

Elbin

Schatz

Lowder

et al. 2014

Curr Treat Options Neurol

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Several treatment and rehabilitation approaches for sport-related concussion have been mentioned in recent consensus and position statements. These options range from the more conservative behavioral management approaches to aggressive pharmacological and therapeutic interventions. Moreover, clinical decision-making for sport-related concussion changes as symptoms and impairments persist throughout recovery. The current article provides an empirical review of proposed treatment and rehabilitation options for sport-related concussion during the acute, subacute, and chronic phases of injury.

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Mild Traumatic Brain Injury Literature Review and Proposed Changes To Classification

Cited by 23 publications

References 0 publications

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study

An Empirical Review of Treatment and Rehabilitation Approaches Used in the Acute, Sub-Acute, and Chronic Phases of Recovery Following Sports-Related Concussion

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