Practice Patterns in Pharmacological and Non-Pharmacological Therapies for Children with Mild Traumatic Brain Injury: A Survey of 15 Canadian and United States Centers

Mannix, Rebekah; Zemek, Roger; Yeates, Keith Owen; Arbogast, Kristy B.; Atabaki, Shireen M.; Badawy, Mohamed; Beauchamp, Miriam H.; Beer, Darcy; Bin, Steven S.; Burstein, Brett; Craig, William; Corwin, Daniel J.; Doan, Quynh; Ellis, Michael J.; Freedman, Stephen B.; Gagnon, Isabelle; Gravel, Jocelyn; Leddy, John J.; Lumba‐Brown, Angela; Master, Christina L.; Mayer, Andrew R.; Park, Grace; Penque, Michelle; Rhine, Tara; Russell, Kelly; Schneider, Kathryn; Bell, Michael J.; Wisniewski, Steven R.

doi:10.1089/neu.2018.6290

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…Cerebral edema can lead to increased intracranial pressure (ICP), which disrupts brain perfusion and results in long-term disabilities or even death. While many pharmacological and non-pharmacological interventions exist to treat severe TBIs, guidelines and effective interventions for mild TBI are lacking [11], notably in pediatrics [12]. Interventions such as decompressive craniectomies, cerebrospinal fluid drainage, and mannitol reduce ICP, increase cerebral perfusion, and improve outcome [13,14].…”

Section: Introductionmentioning

confidence: 99%

Role of innate inflammation in traumatic brain injury

et al. 2021

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Traumatic brain injury is one of the leading causes of morbidity and mortality throughout the world. Its increasing incidence, in addition to its fundamental role in the development of neurodegenerative disease, proves especially concerning. Despite extensive preclinical and clinical studies, researchers have yet to identify a safe and effective neuroprotective strategy. Following brain trauma, secondary injury from molecular, metabolic, and cellular changes causes progressive cerebral tissue damage. Chronic neuroinflammation following traumatic brain injuries is a key player in the development of secondary injury. Targeting this phenomenon for development of effective neuroprotective therapies holds promise. This strategy warrants a concrete understanding of complex neuroinflammatory mechanisms. In this review, we discuss pathophysiological mechanisms such as the innate immune response, glial activation, blood-brain barrier disruption, activation of immune mediators, as well as biological markers of traumatic brain injury. We then review existing and emerging pharmacological therapies that target neuroinflammation to improve functional outcome.

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Section: Introductionmentioning

confidence: 99%

Role of innate inflammation in traumatic brain injury

et al. 2021

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“…36 Other targeted therapies toward posttraumatic headache are based on contributors to headache provocation and include exercise, cervical physical therapy, and vestibular therapy. 37…”

Section: Discussionmentioning

confidence: 99%

Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion

Alsalaheen

Almeida

et al. 2021

Clinical Journal of Sport Medicine

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Objective:To examine the factor structure of the Sport Concussion Assessment Tool-5 (SCAT5) symptom scale in adolescents on their initial presentation to a concussion clinic within the typical recovery period after concussion (ie, <30 days). We hypothesize that the SCAT5 symptoms represent various clinically meaningful groups. A secondary purpose was to examine the effects of sex on the factor structure of the SCAT5 symptom scale.Study Design:Retrospective cross-sectional analysis.Setting:Tertiary, institutional.Patients:Nine hundred eighty-one adolescents (45% women) aged between 13 and 18 years.Independent Variables:Adolescents completed the SCAT5 symptom scale.Main Outcome Measures:The factor structure of SCAT5 examined using a principal axis factor analysis.Results:A 5-factor structure model explained 61% of the variance in symptoms. These 5 factors are identified as Energy (17%), Mental Health (13%), Migrainous (13%), Cognitive (9%), and Vestibulo-Ocular (9%). A similar 5-factor model emerged for each sex, and the proportion of variance in symptoms explained by the 5-factor model was comparable between the sexes.Conclusions:The findings of this report indicate that the SCAT5 symptoms aggregated into 5 delineated factors, and these factors were largely consistent across the sexes. The delineation of symptoms into 5 factors provides preliminary validation for the presence of different concussion phenotypes. Confirmatory factor analysis is warranted to examine the applicability and clinical utility of the use of the 5-factor structure in a clinical setting.

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“…Subconcussive pathology, despite the disease being poorly understood overall, is also well reported, with CTE being perhaps the most notable long-term sequala TBI makes it difficult to study, an issue further exacerbated by the limited availability of high-quality evaluation tools particularly for those with mild injuries [96,101]. Furthermore, there are a lack of evidence-based guidelines related to when occupational therapy should be employed in the post-TBI recovery process, leading to inconsistent referral patterns, and which techniques should be utilized, though practice recommendations have been previously published amidst these limitations (Clinical Practice Guidance: Occupational Therapy and Physical Therapy for Mild Traumatic Brain Injury, 2009) [95, [102][103][104][105]. Recent studies, including a survey of clinicians caring for pediatric mild TBI patients, have identified that occupational therapy is routinely utilized for only a minority of patients who may benefit from it following mild TBI [103,105].…”

Section: Learningmentioning

confidence: 99%

“…Furthermore, there are a lack of evidence-based guidelines related to when occupational therapy should be employed in the post-TBI recovery process, leading to inconsistent referral patterns, and which techniques should be utilized, though practice recommendations have been previously published amidst these limitations (Clinical Practice Guidance: Occupational Therapy and Physical Therapy for Mild Traumatic Brain Injury, 2009) [95, [102][103][104][105]. Recent studies, including a survey of clinicians caring for pediatric mild TBI patients, have identified that occupational therapy is routinely utilized for only a minority of patients who may benefit from it following mild TBI [103,105]. Another study contextualized this trend by identifying that utilization may be disparate with respect to geographic and/or socioeconomic factors [106].…”

Section: Learningmentioning

confidence: 99%

Subconcussion, Concussion, and Cognitive Decline: The Impact of Sports Related Collisions

Dioso¹,

Cerillo²,

Azab³

et al. 2022

J Med Res Surg

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Subconcussion can cause long-term consequences for patients. Increasing understanding of what causes the injury and how it can be assessed is important. This paper focuses on the pathophysiology, epidemiology, and assessment tools. Specific emphasis is placed on early diagnosis to implement treatment. Current research is targeting improved pharmaceutic and biomechanic innovations. Enhanced understanding of subconcussion will improve outcomes for patients and allow clinicians to implement treatments earlier.

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Practice Patterns in Pharmacological and Non-Pharmacological Therapies for Children with Mild Traumatic Brain Injury: A Survey of 15 Canadian and United States Centers

Cited by 15 publications

References 35 publications

Role of innate inflammation in traumatic brain injury

Role of innate inflammation in traumatic brain injury

Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion

Subconcussion, Concussion, and Cognitive Decline: The Impact of Sports Related Collisions

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