https://doi.org/10.1016/j.trsl.2022.08.014

Inflammasome activation in traumatic brain injury and Alzheimer’s disease

Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.

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Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

ABSTRACT Background The evaluation of functional cognition is a central concern in clinical practice. However, there are few standardized or validated tools, and many of them take too long, requiring screening tests. Aims To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury. Moreover, to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes. Materials and methods A cross-sectional design was applied following the guidelines of the STROBE checklist. A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers. A cognitive screening test and daily living activity tests were implemented, such as ACLS-5, MoCA, Barthel, and FIM+FAM. Data were analyzed using non-parametric methods. In addition, a structural analysis and simple regression models were performed. Results Eighty patients with chronic acquired brain injury, with a mean age of 52, were recruited. All tests are significantly related to the ACLS-5 score, a moderate effect size for MoCA (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50). Conclusions ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion.

Clinical validation of the Allen's Cognitive Level Screen in acquired brain injury

<sec> <title>BACKGROUND</title> To support the rehabilitation of adults with communication difficulty after acquired brain injury (ABI), it is internationally recommended best practice to provide formal (eg, support workers) and informal (eg, friends, family) ‘communication partners’ with communication partner training (CPT). However, ABI affects more than 135 million people globally, surpassing healthcare capacities to provide CPT. ‘interact-ABI-lity’ is a free, 2-hour, self-directed, web-based CPT program that includes education and strategies to support people with cognitive-communication disorders, aphasia, and dysarthria after ABI. It is unknown whether interact-ABI-lity can facilitate the scalability and accessibility of CPT. </sec> <sec> <title>OBJECTIVE</title> To investigate the implementation and effectiveness of interact-ABI-lity as a web-based service delivery model for CPT after ABI. </sec> <sec> <title>METHODS</title> This 12-month prospective, mixed methods, hybrid type 2 implementation-effectiveness study is theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. We documented and deployed implementation strategies coproduced with stakeholders and identified by users through formative evaluation. We prospectively observed theoretically-informed implementation outcomes through web analytics, survey data, and individual interviews incorporating think-aloud methods. Qualitative implementation data were deductively analyzed against the NASSS framework, and quantitative implementation data were analyzed descriptively. Effectiveness outcomes were obtained through custom, web-based knowledge and confidence questionnaires which were administered preintervention, postintervention, and at 3 months follow-up. </sec> <sec> <title>RESULTS</title> interact-ABI-lity received 1069 unique registrations from 29 countries. User feedback surveys (n=325) indicated high satisfaction (92% indicated interact-ABI-lity was “Extremely” or “Very” useful, and 95% rated 8-10 out of 10 likelihood of recommending it to others), with positive qualitative comments. Users also reported high usability (85% indicated interact-ABI-lity was “Very easy” or “Easy” to use). Users who were older, male, informal communication partners, had lower education levels or lower confidence communicating with people with ABI were underrepresented. Effectiveness data indicated significant improvements (p&lt;0.001) in knowledge (n=307) and confidence (n=322) communicating with people with ABI postintervention. Among follow-up participants (n=52), there was no significant difference in confidence after 3 months. Although follow-up knowledge scores declined (p&lt;0.001), they remained higher than at pretest (p&lt;0.001). </sec> <sec> <title>CONCLUSIONS</title> interact-ABI-lity is the first completely self-directed CPT program to support adults with cognitive-communication disorders, aphasia, and dysarthria after ABI. Users reported high satisfaction and usability. Communication knowledge and confidence increased postintervention but were not fully retained after 3 months. Although this may reflect the limitations of a short, self-guided format, this alternate service delivery model was scalable across organizations and internationally, with potential to address unmet community and healthcare needs. Proactive reduction of complexity across a comprehensive range of domains of implementation, particularly a multidimensional value proposition, may have facilitated interact-ABI-lity’s implementation, scalability, and sustainability. Extended implementation research beyond 12 months is required. </sec> <sec> <title>CLINICALTRIAL</title> Australia and New Zealand Clinical Trials Registry: ACTRN12621001170819, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Universal Trial Number U1111-1266-6628. </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> RR2-10.2196/31995 </sec> 

Self-Guided, Web-Based Training for Communication Partners of Adults With Acquired Brain Injury: A 12-Month Prospective, Mixed Methods, Hybrid Type 2 Implementation-Effectiveness Study of ‘interact-ABI-lity’ (Preprint)

Objective Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI. Materials and Methods The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention. Statistical Analysis Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test. Results The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved. Conclusion CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.

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Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India.

Objectives Traumatic brain injury (TBI) is associated with deficits in cognition, language, and communication along with physical and psychosocial consequences. This study aimed at evaluating the association between cognition, language, and communication in a cohort of patients with TBI in southern India using standardized language specific assessment tools. Materials and Methods The present correlational study included 30 patients with TBI of any severity, that is, mild, moderate, and severe within the postinjury period of 6 to 36 months. Comprehensive evaluation of cognition, language, and communication was done using National Institute of Mental Health and Neurosciences Neuropsychology Battery, Indian adapted versions of Western Aphasia Battery and La Trobe Communication Questionnaire (LCQ) respectively. Data Analysis Measures of descriptive statistics, that is, mean, median, percentages, and frequencies, were used. Raw scores, that is, aphasia quotient (AQ), and subdomain scores for LCQ, that is, LCQ-quality, quantity, relation, manner, and cognition, were calculated. Composite scores for the three neuropsychological domains, that is, attention and processing speed, executive function, learning and memory, were evaluated. Partial correlation was computed for identifying the association between the three variables by controlling for age, education, duration, and severity of injury. Results A significant correlation was found between AQ and measures of attention and executive functioning and all measures of LCQ except LCQ-manner. Further, a significant correlation was found between executive functioning and LCQ-total, LCQ-quantity, and LCQ cognition. No correlation was found between measures of attention and memory with communication. Conclusion A good language and executive functioning are associated with better communication abilities in patients with TBI thus emphasizing on the importance of a multidisciplinary team for the management of cognitive-communication impairments following a TBI.

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The Triad of Cognition, Language, and Communication in Traumatic Brain Injury: A Correlational Study.

https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0041-1727294.pdf

Mohammed Afsar

Papers

Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India.

The Triad of Cognition, Language, and Communication in Traumatic Brain Injury: A Correlational Study.

Neuropsychological and Linguistic Outcomes after Gunshot Injury to Cerebellum: A Case Report