Journal of neurotrauma
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Journal of neurotrauma · Dec 2020
Comparative StudySensory reweighting for upright stance in soccer players: A comparison of high and low exposure to soccer heading.
The purpose of this study was to compare sensory reweighting for upright stance between soccer players who report higher soccer heading exposure to those who report lower soccer heading exposure. Thirty participants completed a self-reported questionnaire to estimate the number of soccer headers experienced over the previous year and were divided into "low exposure" and "high exposure" groups based on their responses. Sensory reweighting for upright stance was assessed by simultaneously perturbing visual, vestibular, and proprioceptive systems. ⋯ Without vibration, COM 95% area (F = 5.861, p = 0.022*, partial η2 = 0.173), velocity (F = 14.198, p = 0.001, partial η2 = 0.336), and total power (F = 13.491, p = 0.001, partial η2 = 0.325) for the "high exposure" group were higher than for the "low exposure" group, and postural sway lagged the vestibular stimulus in the "high exposure" group rather than leading it as in the "low exposure" group (F = 4.765, p = 0.038, partial η2 = 0.145). There were no differences in sensory reweighting and no differences in COM gain/phase between groups. These findings lend empirical evidence to a detrimental effect of soccer heading exposure on balance control during upright stance.
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Journal of neurotrauma · Dec 2020
ReviewLOW-VALUE CLINICAL PRACTICES IN ADULT TRAUMATIC BRAIN INJURY: AN UMBRELLA REVIEW.
Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last 3 decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. ⋯ For the following practices, effect estimates were consistently close to the null: computed tomography (CT) in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality, and most included studies had a high risk of bias.
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Journal of neurotrauma · Dec 2020
Sliding Scoring of the Glasgow Outcome Scale - Extended (GOS-E) as Primary Outcome in Traumatic Brain Injury Trials.
The Glasgow Outcome Scale-Extended (GOS-E), an ordinal scale measuring global outcome, is used commonly as the primary outcome measure in clinical trials of traumatic brain injury. Analysis is often based on a dichotomization and thus has inherent statistical limitations, including loss of information related to the collapse of adjacent categories. A fixed dichotomization defines favorable outcome consistently for all subjects, whereas a sliding dichotomy tailors the definition of favorable outcome according to baseline prognosis/severity. ⋯ Two examples show the corresponding potential for improved power. A sliding score approach allows for quantification of the magnitude of change while still accounting for prognosis. Scientific advantages include increased power and an intuitive interpretation.
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Journal of neurotrauma · Dec 2020
Is the fear-avoidance model also relevant for chronic disability after traumatic brain injury?
Previous studies convincingly suggest that the biopsychosocial fear-avoidance model (FAM) may be of added value in understanding chronic disability after traumatic brain injury (TBI). In this model, persistent symptoms occur as a result of catastrophizing and fear-avoidance regarding initial symptoms, leading to depression, reduced mental activity, and greater disability in daily functioning. This study examined the FAM in a large English-speaking TBI sample. ⋯ The separate regression analyses for depression, fewer mental activities, and disability revealed "fear-avoidance thoughts" as the only consistent variable. In conclusion, this study shows the association of the FAM with chronic disability after TBI, which has implications for assessment and future management of the FAM in TBI in English-speaking countries. Longitudinal studies are warranted to further investigate and refine the model.
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Journal of neurotrauma · Dec 2020
Repetitive mild traumatic brain injuries in mice during adolescence cause sexually dimorphic behavioural deficits and neuroinflammatory dynamics.
Adolescent brain injuries have devastating impacts on lifelong health given that adolescence is a critical period for brain development. Adolescents are susceptible to mild traumatic brain injuries (mTBIs) acquired from collisions in contact sports, which are often sustained in a repetitive nature (repetitive mild traumatic brain injuries; RmTBIs), and cause compounding, sexually dimorphic neurological deficits. Neuroinflammation accompanies RmTBIs and may be a central driving force for chronic neurological decline. ⋯ Flow cytometric quantification of neuroinflammatory responses revealed time- and sex-dependent infiltration of peripheral macrophages and T cells and male-specific decreases in microglia number. Using immunohistochemistry, we report specific microglia density decreases in male mice in the motor cortex and thalamus. We show novel neuroinflammatory responses after adolescent brain injuries that expands the current understanding of RmTBI pathophysiology in this critical neurodevelopmental period.