Persistent problems after traumatic brain injury: The need for long-term follow-up and coordinated care

Lew, Henry L.; Poole, John H.; Guillory, Sylvia; Salerno, Rose Marie; Leskin, Gregory A.; Sigford, Barbara

doi:10.1682/jrrd.2006.05.0054

Cited by 72 publications

(57 citation statements)

References 5 publications

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“…When entered into the same model simultaneously along with other factors, each remained a significant predictor, with mTBI history the most robust. PTSD and depression have been well documented in OIF/OEF veterans [6,23,[48][49][59][60][61][62][63][64][65][66][67]. This is a notable finding because other studies have found diminished effects of TBI when PTSD and depressive symptom severity were taken into account [6,62].…”

Section: Discussionmentioning

confidence: 97%

“…Because of the degree of symptom overlap between TBI and psychiatric disorders [46,61,[63][64]66,[76][77][78][79][80], clinicians evaluating TBI also should determine whether mental health conditions are present to decide on the best course of treatment [6,62]. Patients with MSI may benefit from a team-based approach to care [63][64][77][78].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with MSI may benefit from a team-based approach to care [63][64][77][78]. As discussed elsewhere [7], the VA CTBIE process and NSI-22 allow clinicians, at a glance, to survey symptoms that patients endorse as being disruptive to their daily functioning, obtain a better history of the nature of the problem(s), and decide what type of follow-up care is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

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Abstract-With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

Self Cite

View full text Add to dashboard Cite

show abstract

“…One of the most disruptive symptoms experienced by TBI patients who survive their injuries are persistent memory deficits. [1][2][3] These deficits include declarative memory and working memory dysfunction that are caused by damage to the hippocampus. [4][5][6][7][8][9][10][11] Problems with memory can interfere with post-TBI recovery, rehabilitation, and living an independent life.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Eukaryotic Initiation Factor 2 Alpha Phosphatase Reduces Tissue Damage and Improves Learning and Memory after Experimental Traumatic Brain Injury

Dash

Hylin

Hood

et al. 2015

Journal of Neurotrauma

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Patients who survive traumatic brain injury (TBI) are often faced with persistent memory deficits. The hippocampus, a structure critical for learning and memory, is vulnerable to TBI and its dysfunction has been linked to memory impairments. Protein kinase RNA-like ER kinase regulates protein synthesis (by phosphorylation of eukaryotic initiation factor 2 alpha [eIF2a]) in response to endoplasmic reticulum (ER) stressors, such as increases in calcium levels, oxidative damage, and energy/glucose depletion, all of which have been implicated in TBI pathophysiology. Exposure of cells to guanabenz has been shown to increase eIF2a phosphorylation and reduce ER stress. Using a rodent model of TBI, we present experimental results that indicate that postinjury administration of 5.0 mg/kg of guanabenz reduced cortical contusion volume and decreased hippocampal cell damage. Moreover, guanabenz treatment attenuated TBI-associated motor, vestibulomotor, recognition memory, and spatial learning and memory dysfunction. Interestingly, when the initiation of treatment was delayed by 24 h, or the dose reduced to 0.5 mg/kg, some of these beneficial effects were still observed. Taken together, these findings further support the involvement of ER stress signaling in TBI pathophysiology and indicate that guanabenz may have translational utility.

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“…In particular, the conflicts in Iraq and Afghanistan have resulted in a new generation of combat survivors who frequently have complex physical injuries and emotional trauma [3][4][5][6]. The Department of Veterans Affairs (VA) healthcare system has often been acknowledged for its exemplary care of veterans.…”

Section: Introductionmentioning

confidence: 99%

Military and VA telemedicine systems for patients with traumatic brain injury

Lew

Poole²,

Vanderploeg³

et al. 2007

JRRD

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143

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Abstract-The conflicts in Iraq andAfghanistan have resulted in a new generation of combat survivors with complex physical injuries and emotional trauma. This article reports the initial implementation of the Polytrauma Network Site (PNS) clinic, which is a key component of the Department of Veterans Affairs (VA) Polytrauma System of Care and serves military personnel returning from combat. The PNS clinic in Palo Alto, California, is described to demonstrate the VA healthcare system's evolving effort to meet the clinical needs of this population. We summarize the following features of this interdisciplinary program: (1) sequential assessment, from initial traumatic brain injury screening throughout our catchment area to evaluation by the PNS clinic team, and (2) clinical evaluation results for the first 62 clinic patients. In summary, this population shows a high prevalence of postconcussion symptoms, posttraumatic stress, poor cognitive performance, head and back pain, auditory and visual symptoms, and problems with dizziness or balance. An anonymous patient feedback survey, which we used to fine-tune the clinic process, reflected high satisfaction with this new program. We hope that the lessons learned at one site will enhance the identification and treatment of veterans with polytrauma across the country.

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Persistent problems after traumatic brain injury: The need for long-term follow-up and coordinated care

Cited by 72 publications

References 5 publications

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Inhibition of Eukaryotic Initiation Factor 2 Alpha Phosphatase Reduces Tissue Damage and Improves Learning and Memory after Experimental Traumatic Brain Injury

Military and VA telemedicine systems for patients with traumatic brain injury

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