Spinal Cord Injury and Co-Occurring Traumatic Brain Injury: Assessment and Incidence

Macciocchi, Stephen N.; Seel, Ronald T.; Thompson, Nicole; Byams, Rashida; Bowman, Brock

doi:10.1016/j.apmr.2007.11.055

Cited by 122 publications

(92 citation statements)

References 27 publications

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“…This frequency is similar to multicenter retrospective figures from the SCI model systems reported in 1995 (28.2%) [10] but lower than figures from a prospective study in a single SCI model system reported in 2008 (60%) [4]. We believe that the higher frequency found in the prospective research study is attributable to more accurate screening and documentation of associated injuries at the time of the SCI and that more consistent screening and documentation of associated injuries, particularly TBI, is required in clinical practice, as discussed later.…”

Section: Discussionsupporting

confidence: 47%

“…Some studies have found cervical SCI to be associated with greater rates of concurrent TBI [4,9]. Our results did not show significant differences in the frequency of TBI between the groups of patients with tetraplegia or paraplegia ( Table 1).…”

Section: Discussioncontrasting

confidence: 32%

“…Fortunately, adequate admission time is standard practice in the VA. It is possible that our finding that 50 percent of Veterans who experienced traumatic SCI in the last 10 yr are currently being recorded as having a concurrent TBI is still an underestimate, so there may still be a significant number of Veterans in whom TBI has not been diagnosed as suggested by the recent study in civilians [4]. It is critically important to avoid missing the diagnosis of TBI in Veterans (and others) if appropriate rehabilitation and follow-up care is to be provided.…”

Section: Improved Awarenessmentioning

confidence: 64%

“…Patients with paraplegia and co-occurring severe TBI have been shown to have worse motor outcomes and longer acute rehabilitation lengths of stay than those with paraplegia and no TBI [3]. There is, however, a wide range of estimates of the prevalence of such a dual diagnosis [4].…”

Section: Introductionmentioning

confidence: 99%

“…The Spinal Cord Injury Model Systems reported retrospectively in 1995 that 28.2 percent of patients with SCI had at least a mild TBI with loss of consciousness and 11.5 percent had a TBI severe enough to demonstrate cognitive or behavioral changes [10]. A more recent prospective study of a sample of 198 patients with SCI in a single large SCI model system estimated that 60 percent had TBI [4]. There may be several reasons for uncertainty about the prevalence of TBI in patients with SCI.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic brain injury in U.S. Veterans with traumatic spinal cord injury

et al. 2015

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Abstract-Patients with both a spinal cord injury (SCI) and traumatic brain injury (TBI) are often very difficult to manage and can strain the resources of clinical units specialized in treating either diagnosis. However, a wide range of estimates exists on the extent of this problem. The aim of this study was to describe the scope of the problem in a well-defined population attending a comprehensive SCI unit. Electronic medical records of all patients with SCI being followed by the SCI unit in a U.S. Veterans' hospital were searched to identify those with concurrent TBI. The data were analyzed for age, sex, cause of injury, level and completeness of SCI, cognitive impairment, relationship with Active Duty military, and date of injury. Of 409 Veterans with a traumatic SCI, 99 (24.2%) were identified as having had a concurrent TBI. The occurrence did not appear to be closely related to military conflict. Reports of TBI were much more common in the last 20 yr than in previous decades. Documentation of TBI in patients with SCI was inconsistent. Improved screening and documentation could identify all patients with this dual diagnosis and facilitate appropriate management.

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Section: Discussionsupporting

confidence: 47%

Section: Discussioncontrasting

confidence: 32%

Section: Improved Awarenessmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Traumatic brain injury in U.S. Veterans with traumatic spinal cord injury

et al. 2015

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Venlafaxine Extended-Release for Depression Following Spinal Cord Injury

et al. 2015

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IMPORTANCE Depression is prevalent and associated with negative outcomes in individuals with spinal cord injury (SCI). Antidepressants are used routinely to treat depression, yet no placebo-controlled trials have been published in this population to our knowledge. OBJECTIVE To determine the efficacy and tolerability of venlafaxine hydrochloride extended-release (XR) for major depressive disorder (MDD) or dysthymic disorder in persons with chronic SCI. DESIGN, SETTING, AND PARTICIPANTS Multisite, randomized (1:1), double-blind, placebo-controlled Project to Improve Symptoms and Mood After SCI (PRISMS) trial. All research staff conducting screening, intervention, and outcome procedures were blinded to randomization status. We screened 2536 patients from outpatient clinics at 6 SCI treatment centers in the United States and randomized 133 participants into the trial. Participants were 18 to 64 years old and at least 1 month after SCI, with MDD or dysthymic disorder. Seventy-four percent of participants were male, and participants were on average 40 years old and 11 years after SCI. Forty-seven percent had cervical injuries, 53.4% had American Spinal Injury Association injury severity A (complete injury) SCI, 24.1% had at least 2 prior MDD episodes, and 99.2% had current MDD. Common comorbidities included chronic pain (93.9%), significant anxiety (57.1%), and history of substance dependence (44.4%). INTERVENTIONS Twelve-week trial of venlafaxine XR vs placebo using a flexible-dose algorithm. MAIN OUTCOMES AND MEASURES The Hamilton Depression Rating Scale (HAM-D 17-item version and Maier subscale, which focuses on core depression symptoms and excludes somatic symptoms) over 12 weeks. RESULTS Mixed-effects models revealed a significant difference between the venlafaxine XR and placebo groups in improvement on the Maier subscale from baseline to 12 weeks (treatment effect, 1.6; 95% CI, 0.3-2.9; P = .02) but not on the HAM-D 17-item version (treatment effect, 1.0; 95% CI, −1.4 to 3.4; P = .42). Participants receiving venlafaxine XR reported significantly less SCI-related disability on the Sheehan Disability Scale at 12 weeks compared with placebo (treatment effect, 4.7; 95% CI, 1.5-7.8; P = .005). Blurred vision was the only significantly more common new or worsening adverse effect in the venlafaxine XR group compared with the placebo group over 12 weeks. CONCLUSIONS AND RELEVANCE Venlafaxine XR was well tolerated by most patients and an effective antidepressant for decreasing core symptoms of depression and improving SCI-related disability. Further research is needed to determine the optimal treatment and measurement approaches for depression in chronic SCI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00592384

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Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Nightingale

Lim

Sachdeva

et al. 2019

PM&R

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Background: Following spinal cord injury (SCI), up to 64% of individuals experience cognitive deficit. However, the reliability of commonly used neuropsychological tests is currently unknown in this population. Objectives: To evaluate the test-retest reliability of cognitive measures in individuals with SCI. Design: Cross-sectional study. Setting: Vancouver General Hospital. Participants: Individuals with a chronic (>2 years) SCI (n = 22). Methods: Across three visits (separated by~16 days), 22 participants with chronic SCI completed a neuropsychological battery evaluating memory (Rey Auditory-Verbal Learning Test [RAVLT]), attention/concentration/psychomotor speed (Digit Span Task, Stroop Test), and executive function (Trail Making Test A&B, Symbol Digit Modalities Test, Controlled Oral Word Association Test). Coefficients of variation (CV intra ) and intraclass correlation coefficients (ICCs) were calculated to determine the reliability of each test between visits. Linear regressions were performed to assess the associations between variability (CV intra ) and participant characteristics, such as age or highest education level attained. Repeated-measures, one-way analysis of variance (ANOVA) was conducted to determine any significant practice effects, and smallest real differences (SRDs) were calculated. Main Outcome Measurements: Repeated scores on aforementioned neuropsychological tests. Results: ICCs ranged from 0.77 to 0.93, with the exception of RAVLT recognition score (ICC = 0.27). Age showed a moderate association with CV intra in RAVLT interference recall scores (r = 0.43, P = .047), but was not a confounding factor for other measures. Education was not associated with CV intra . Significant practice effects were noted for most of the cognitive tests assessed. Conclusions: Other than the RAVLTrecognition score, these cognitive measures demonstrated good-to-excellent reliability. Although this is encouraging, test-retest variability should be considered when interpreting the efficacy of various cognitive training strategies to mitigate cognitive decline in this population. Thus, the SRD values presented herein will allow researchers and clinicians to identify "true" changes in cognitive function with repeated testing.

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Spinal Cord Injury and Co-Occurring Traumatic Brain Injury: Assessment and Incidence

Cited by 122 publications

References 27 publications

Traumatic brain injury in U.S. Veterans with traumatic spinal cord injury

Traumatic brain injury in U.S. Veterans with traumatic spinal cord injury

Venlafaxine Extended-Release for Depression Following Spinal Cord Injury

Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

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