Polytrauma associated with traumatic brain injury: Incidence, nature and impact on rehabilitation outcome

Groswasser, Zeev; Cohen, M; Blankstein, Eran

doi:10.3109/02699059009026161

Cited by 81 publications

(33 citation statements)

References 12 publications

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“…However, both groups exhibited high rates of binocular dysfunction. These findings are generally consistent with the existing literature on visual impairment/dysfunction associated with TBI [29][30][31][32][33][34][35]; however, differences in severity, mechanism of injury, assessment techniques, and other factors make comparisons difficult. On a functional level, the reading difficulties described for both the PRC and PNS populations are consistent with the visual impairment and/or visual dysfunction findings, but as previously stated, cognitive, attentional, or other factors may also contribute to these symptoms.…”

Section: Visualsupporting

confidence: 87%

Eye and visual function in traumatic brain injury

Cockerham¹,

Goodrich²,

Weichel³

et al. 2009

JRRD

142

107

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Abstract-Combat blast is an important cause of traumatic brain injury (TBI) in the Department of Veterans Affairs polytrauma population, whereas common causes of TBI in the civilian sector include motor vehicle accidents and falls. Known visual consequences of civilian TBI include compromised visual acuity, visual fields, and oculomotor function. The visual consequences of TBI related to blast remain largely unknown. Blast injury may include open globe (eye) injury, which is usually detected and managed early in the rehabilitation journey. The incidence, locations, and types of ocular damage in eyes without open globe injury after exposure to powerful blast have not been systematically studied. Initial reports and preliminary data suggest that binocular function, visual fields, and other aspects of visual function may be impaired after blast-related TBI, despite relatively normal visual acuity. Damage to the ocular tissues may occur from blunt trauma without rupture or penetration (closed globe injury). Possible areas for research are development of common taxonomy and assessment tools across services, surgical management, and outcomes for blast-related eye injury; the incidence, locations, and natural history of closed globe injury; binocular and visual function impairment; quality of life in affected servicemembers; pharmacological and visual therapies; and practice patterns for screening, management, and rehabilitation.

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Section: Visualsupporting

confidence: 87%

Eye and visual function in traumatic brain injury

Cockerham¹,

Goodrich²,

Weichel³

et al. 2009

JRRD

142

107

View full text Add to dashboard Cite

show abstract

“…In a review by Schmidt and colleagues (2005), secondary brain injury was seen at autopsy in 70-90% of all fatal head injury patients. In a 1990 study of 328 patients, those patients with multiple injuries aside from TBI had significantly less favorable outcomes than TBI alone (Groswasser et al, 1990). In a separate study, patients with extra-cranial injuries in addition to head trauma had a mortality level almost twice of those with TBI alone (TBI 11.1%, polytrauma 21.8%) (Wilson and Tyburski, 2001).…”

Section: Discussionmentioning

confidence: 98%

Systemic inflammation exacerbates behavioral and histopathological consequences of isolated traumatic brain injury in rats

Utagawa

Truettner

Dietrich

et al. 2008

Experimental Neurology

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The proinflammatory cytokine interleukin-1β (IL-1β) is induced rapidly after traumatic brain injury (TBI) and contributes to the inflammatory events that lead to neuronal loss. Although an important source of IL-1β is from the injured brain itself, in patients with multiple organ trauma (polytrauma) IL-1β is also released into the bloodstream which may potentially influence brain vulnerability. The purpose of this study was to determine the effects of systemic inflammation induced by peripheral administration of IL-1β on histopathological and behavioral outcome after moderate fluid percussion (FP) brain injury in rats. At 30 min or 24 hr after TBI, saline, 20μg/kg or 40μg/kg of IL-1β was injected (n=4-9/group) intraperitoneally (IP). Sham operated animals (n=9) received either saline or IL-1β (20 or 40 μg/kg) injections. The somatosensory tactile placing test was administered at 1, 2 and 3 days posttrauma. IL-1β treated animals showed significant placing deficits compared to vehicle-treated TBI animals. Three days after injection, contusion areas and volumes were significantly increased (p<0.05) with both IL-1β doses and at both treatment times compared to vehicle treated animals. IL-1β treated rats showed more contusion injury and hippocampal neuronal damage as well as enhanced perivascular neutrophil accumulation. Cortical IL-1r1 mRNA increased as early as 1 hr following TBI, peaking at 24 hr and remained elevated 3 days posttrauma. These data show that the posttraumatic administration of IL-1β significantly aggravates behavioral outcome and increases overall contusion volume after TBI. Increased systemic inflammatory processes, including extravasation of activated leukocytes and proinflammatory cytokines could participate in this detrimental outcome. Because peripherally circulating cytokines and other neurotoxic factors may be increased following multi-organ trauma, these findings may be important in targeting therapeutic interventions in this patient population.

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“…Symptoms were ameliorated concurrent with improvement or normalization of clinical signs. This is important information because improved oculomotor abilities and related visual-perceptual skills can hasten progress in the patient's other rehabilitative programs [52][53]. This includes cognitive therapy, for example, which requires complex visual saccadic scanning and fine detail discrimination.…”

Section: Overview Of Oculomotor Rehabilitation In Traumatic Brain Injurymentioning

confidence: 99%

Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury

Thiagarajan¹,

Ciuffreda²

2013

J Rehabil Res Dev

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Abstract-A range of dynamic and static vergence responses were evaluated in 12 individuals with mild traumatic brain injury (age: 29 +/-3 yr) having near vision symptoms. All measures were performed in a crossover design before and after oculomotor training (OMT) and placebo (P) training. Following OMT, peak velocity for both convergence and divergence increased significantly. Increased peak velocity was significantly correlated with increased clinically based vergence prism flipper rate. Steady-state response variability for convergence reduced significantly following OMT. The maximum amplitude of convergence, relative fusional amplitudes, and near stereoacuity improved significantly. In addition, symptoms reduced significantly, and visual attention improved markedly. None of the measures were found to change significantly following P training. The significant improvement in most aspects of vergence eye movements following OMT demonstrates considerable residual brain plasticity via oculomotor learning. The improved vergence affected positively on nearwork-related symptoms and visual attention.

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Polytrauma associated with traumatic brain injury: Incidence, nature and impact on rehabilitation outcome

Cited by 81 publications

References 12 publications

Eye and visual function in traumatic brain injury

Eye and visual function in traumatic brain injury

Systemic inflammation exacerbates behavioral and histopathological consequences of isolated traumatic brain injury in rats

Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury

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