Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program

Dams-O’Connor, Kristen; Juengst, Shannon B.; Bogner, Jennifer; Chiaravalloti, Nancy D.; Corrigan, John; Giacino, Joseph T.; Harrison-Felix, Cynthia; Hoffman, Jeanne M.; Ketchum, Jessica M.; Marwitz, Jennifer H.; Miller, A. Cate; Nakase‐Richardson, Risa; Rabinowitz, Amanda R.; Sander, Angelle M.; Zafonte, Ross; Hammond, Flora M.

doi:10.1016/s1474-4422(23)00065-0

Cited by 51 publications

(29 citation statements)

References 104 publications

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“…3,4 Despite the great advances in emergency surgery and neurocritical care management, many TBI patients remain moderately to severely disabled at 5 years and are rehospitalized at up to 10 years postinjury. 5 Therefore, according to the current understanding, TBI should be treated as a chronic disease. 5,6 TBI interrupts the corticospinal tract (CST), which descends from the ipsilesional motor cortex to the contralesional spinal cord; this results in motor impairments that can be partially abrogated by reestablishing connections between the brain and spinal cord.…”

Section: Introductionmentioning

confidence: 99%

“…5 Therefore, according to the current understanding, TBI should be treated as a chronic disease. 5,6 TBI interrupts the corticospinal tract (CST), which descends from the ipsilesional motor cortex to the contralesional spinal cord; this results in motor impairments that can be partially abrogated by reestablishing connections between the brain and spinal cord. 7,8 Synaptic plasticity and axonal sprouting in the CST are modulated by the excitability of neurons during neuronal development.…”

Section: Introductionmentioning

confidence: 99%

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Contralesional Anodal Transcranial Direct Current Stimulation Promotes Intact Corticospinal Tract Axonal Sprouting and Functional Recovery After Traumatic Brain Injury in Mice

Chen,

Tan,

Zhang

et al. 2024

Neurorehabil Neural Repair

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Background Anodal transcranial direct current stimulation (AtDCS), a neuromodulatory technique, has been applied to treat traumatic brain injury (TBI) in patients and was reported to promote functional improvement. We evaluated the effect of contralesional AtDCS on axonal sprouting of the intact corticospinal tract (CST) and the underlying mechanism in a TBI mouse model to provide more preclinical evidence for the use of AtDCS to treat TBI. Methods TBI was induced in mice by a contusion device. Then, the mice were subjected to contralesional AtDCS 5 days per week followed by a 2-day interval for 7 weeks. After AtDCS, motor function was evaluated by the irregular ladder walking, narrow beam walking, and open field tests. CST sprouting was assessed by anterograde and retrograde labeling of corticospinal neurons (CSNs), and the effect of AtDCS was further validated by pharmacogenetic inhibition of axonal sprouting using clozapine-N-oxide (CNO). Results TBI resulted in damage to the ipsilesional cortex, while the contralesional CST remained intact. AtDCS improved the skilled motor functions of the impaired hindlimb in TBI mice by promoting CST axon sprouting, specifically from the intact hemicord to the denervated hemicord. Furthermore, electrical stimulation of CSNs significantly increased the excitability of neurons and thus activated the mechanistic target of rapamycin (mTOR) pathway. Conclusions Contralesional AtDCS improved skilled motor following TBI, partly by promoting axonal sprouting through increased neuronal activity and thus activation of the mTOR pathway.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contralesional Anodal Transcranial Direct Current Stimulation Promotes Intact Corticospinal Tract Axonal Sprouting and Functional Recovery After Traumatic Brain Injury in Mice

Chen,

Tan,

Zhang

et al. 2024

Neurorehabil Neural Repair

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“…TBI has been conceptualized as a chronic condition with consequences to health and function across the lifespan. 22,23 The cognitive and behavioral impairments common after TBI can make managing health more difficult, and these same impairments can interfere with comprehension and utilization of information provided as part of patient education. Despite this, little work has been done to examine the effects of health literacy on long-term outcomes after TBI.…”

mentioning

confidence: 99%

The Relationship of Health Literacy to Health Outcomes Among Individuals With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Pappadis,

Sander,

Juengst

et al. 2024

Journal of Head Trauma Rehabilitation

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Objective: To examine the associations between health literacy and health outcomes among individuals with traumatic brain injury (TBI) at least a year post-injury. Setting: Community following discharge from inpatient rehabilitation. Participants: A total of 205 individuals with complicated mild to severe TBI who completed a TBI Model Systems National Database follow-up interview and a web-based health literacy measure. Design: A multicenter, cross-sectional, observational study. Main Measures: The Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT), number of comorbid conditions (Medical and Mental Health Comorbidities Interview [MMHCI]), perceived physical and mental health (PROMIS Global Physical and Mental Health subscales), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Results: After controlling for sociodemographic, injury, cognition, and time post-injury, adequate health literacy was associated with higher odds of greater perceived physical health compared with participants with marginal/inadequate health literacy (odds ratio = 4.10; CI = 1.52-11.70]. Participants with inadequate/marginal health literacy had 3.50 times greater odds of depression (PHQ-9 ≥ 10) compared with those with adequate health literacy. Participants 45 years and older reported a greater number of MMHCI physical health conditions, but fewer MMHCI mental health conditions and GAD-7 anxiety symptoms compared with those who were younger. Non-Hispanic White participants and those with mild/moderate TBI were more likely to report a greater number of MMHCI mental health conditions compared with non-Hispanic Black participants or those with severe TBI. Greater time post-injury was associated with greater number of chronic physical and mental health conditions, and less odds of good-to-excellent perceived global mental health. Conclusions: Inadequate health literacy is associated with worse perceived physical health and greater depressive symptoms among adults with TBI. Greater efforts are needed to explore the mechanisms by which health literacy influences chronic disease management and mental health after TBI to improve postinjury health status and outcomes, particularly among those with limited health literacy skills.

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“…TRAUMATIC BRAIN INJURY (TBI), across all severities, can lead to a host of distressing emotional,1,2 behavioral,2,3 and cognitive1,4 symptoms that persist over time5 and present significant barriers to community participation 6,7. Therefore, it is important to recognize TBI as a chronic disease process rather than an acute event 5,8,9. Chronic TBI is defined as a lifelong health condition that begins with a single TBI or multiple blows to the head 5.…”

mentioning

confidence: 99%

Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury

Juengst,

Wright,

Vos

et al. 2024

Journal of Head Trauma Rehabilitation

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Objectives: To determine the association between self-reported emotional and cognitive symptoms and participation outcomes in chronic traumatic brain injury (TBI) and to explore the relative contribution of self-reported versus performance-based cognition to participation outcomes. Setting: Community. Participants: Community-dwelling adults (n = 135) with a lifetime history of mild to severe TBI. Design: Secondary analysis of a cross-sectional study on neurobehavioral symptoms in chronic TBI. Main Measures: Behavioral Assessment Screening Tool (BAST) (Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, Substance Abuse subscales) measured self-reported neurobehavioral symptoms; Participation Assessment with Recombined Tools (Productivity, Social Relations, and Out and About) measured self-reported participation outcomes; and Brief Test of Adult Cognition by Telephone (BTACT) measured performance-based cognition (Episodic Memory and Executive Function summary scores) in a subsample (n = 40). Results: The BAST Executive Dysfunction was significantly associated with less frequent participation and had the strongest effect on participation in all participation domains. No other BAST subscales were associated with participation, after adjusting for all subscale scores and age, with the exception of BAST Impulsivity, which was associated with more frequent Social Relationships. Exploratory analysis in the sample including the BTACT revealed that, after accounting for subjective Executive Dysfunction using the BAST, performance-based Executive Function was associated with Productivity and Working Memory was associated with Social Relations, but neither was associated with being Out and About; the BAST Executive Dysfunction remained significant in all models even after including BTACT scores. Conclusions: Self-reported Executive Dysfunction contributed to participation outcomes after mild to severe TBI in community-dwelling adults, whereas self-reported emotional and fatigue symptoms did not. Performance-based cognition measures may capture different variability in participation after injury.

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Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program

Cited by 51 publications

References 104 publications

Contralesional Anodal Transcranial Direct Current Stimulation Promotes Intact Corticospinal Tract Axonal Sprouting and Functional Recovery After Traumatic Brain Injury in Mice

Contralesional Anodal Transcranial Direct Current Stimulation Promotes Intact Corticospinal Tract Axonal Sprouting and Functional Recovery After Traumatic Brain Injury in Mice

The Relationship of Health Literacy to Health Outcomes Among Individuals With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury

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