NeuroRehabilitation - Volume Pre-press, issue Pre-press

Authors: Ragsdale, Katie A. | Nichols, Anastacia A. | Mehta, Mansi | Maples-Keller, Jessica L. | Yasinski, Carly W. | Hyatt, Courtland S. | Watkins, Laura E. | Loucks, Laura A. | Carbone, Elizabeth | Rauch, Sheila A. M. | Rothbaum, Barbara O.

Article Type: Research Article

Abstract: BACKGROUND: The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. OBJECTIVE: This article reviews the EHVP. METHODS: The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. RESULTS: This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a …TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. CONCLUSION: Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members. Show more

Keywords: Posttraumatic stress disorder, traumatic brain injury, military psychiatry, veterans, mental health, therapy

DOI: 10.3233/NRE-230235

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-10, 2024

Authors: Hinds II, Sidney R. | Cifu, David X.

Article Type: Research Article

Abstract: BACKGROUND: Conducting mild traumatic brain injury (mTBI) longitudinal studies across multiple sites is a challenging endeavor which has been made more challenging because of COVID-19. OBJECTIVE: This article briefly describes several concerns that need to be addressed during the conduct of research to account for COVID-19’s impact. METHODS: The recent actions and steps taken by the Long-term Impact of Military-relevant Brain Injury Consortium (LIMBIC)-Chronic Effects of Neurotrauma Consortium (CENC) researchers are reviewed. RESULTS: COVID-19’s effects on the conduct of LIMBIC-CENC for the short-term and long-term were considered to ensure the study continued safely for …participants and researchers. COVID-19 may have long-lasting health and especially neurological effects which may confound the quantitative and qualitative measures of this any comparable longitudinal studies. CONCLUSION: The recognition, understanding, and preparation of COVID-19’s impact on a longitudinal military and veteran mTBI population is crucial to successfully conducting LIMBIC-CENC and similar neurological research studies. Developing a plan based on the best available information while remaining agile as new information about COVID-19 emerge, is essential. Research presented in this special issue underscores the complexity of studying long-term effects of mTBI, in a population exposed to and symptomatic from COVID-19. Show more

Keywords: Traumatic brain injury, COVID-19, military, veteran, neurotrauma, neurorehabilitation, neurodegeneration

DOI: 10.3233/NRE-230272

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-6, 2024

Authors: Olowoyo, Paul | Dhamija, Rajinder K. | Owolabi, Mayowa O.

Article Type: Review Article

Abstract: BACKGROUND: Telerehabilitation as a new subdiscipline of telehealth is the application of information technology to support and deliver rehabilitation services via two-way or multipoint interactive online telecommunication technology. This enables the therapist to optimize the timing, intensity, and duration of therapy which is often not possible within the constraints of face-to-face treatment protocols in current health systems. OBJECTIVE: To review the historical perspective and conceptual framework of telerehabilitation in neurological disorders. METHODS: A narrative review of the literature was performed for the historical perspective and a systematic review of the conceptual framework was performed using the …PRISMA guidelines on chronic neurological disorders; multiple sclerosis, spinal cord injury, stroke, Parkinson’s disease, cognitive impairment, and headaches. The search included articles from the past 20 years (2004 to 2024). RESULTS: Telerehabilitation dates back to the 1960s and early 1970s. Documented effective interventions were mostly on therapies for speech disorders. The conceptual framework consisted of three major components of telerehabilitation programmes including development, implementation, and evaluation. The COVID-19 pandemic suddenly made telerehabilitation come to the limelight because physical distancing became necessary. Out of the 110,000 articles downloaded, 43 met the inclusion criteria for review on the conceptual framework of telerehabilitation in relation to neurological disorders. The articles discussed multiple sclerosis (2), spinal cord disorders (1), stroke (17), Parkinson’s disease (15), headaches (3), and cognitive disorders (5). All articles reviewed assessed the effectiveness of telemedicine except for the articles on multiple sclerosis and spinal cord disorders which examined the interphase between the technology and the end users. CONCLUSION: The future of telerehabilitation looks promising with the subsequent integration of innovative tools and applications. This will require the adaption of technology, continuous capacity building, education, and training of healthcare professionals to ensure that they are adequately equipped with the necessary skills to provide quality virtual reality rehabilitation care. Show more

Keywords: Telerehabilitation, historical perspectives, conceptual framework

DOI: 10.3233/NRE-240079

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-13, 2024

Authors: Barnett, Nathan | Ljubic, Milica | Chung, Joyce | Capizzi, Allison

Article Type: Research Article

Abstract: BACKGROUND: U.S. Special Operations Forces (SOF) are at increased risk of multiple mild traumatic brain injury (mmTBI). Testosterone was prescribed for several participants in a VA program designed to address sequelae of mmTBI for SOF. OBJECTIVE: To determine testosterone prevalence in the Palo Alto VA Intensive Evaluation and Treatment Program (IETP) and observe for association between testosterone and neurobehavioral outcomes. METHODS: A retrospective cohort study included patients in the Palo Alto VA IETP. Sociodemographic data, testosterone blood levels, and neurobehavioral outcomes were collected from medical records. RESULTS: 55 IETP participants were included: six were …testosterone users; the rest were classified as non-users. Testosterone use in this population is 11%, higher than reported national averages in the U.S. Of the 6 testosterone users, 2 (33%) had a formal diagnosis of hypogonadism prior to initiation of testosterone. Neurobehavioral outcome scores between testosterone users and non-users failed to show statistically significant differences, except for the PROMIS pain score, which was higher in the testosterone user population. CONCLUSION: The current study did not find an association between mmTBI, testosterone use, or testosterone level and neurobehavioral outcomes. This study highlights a need to further examine the relationship between hypogonadism, mmTBI, SOF culture around testosterone, and the effects of testosterone use in this population. Show more

Keywords: Traumatic brain injury, TBI, neuroendocrine dysfunction, hypogonadism, multiple mild traumatic brain injury, testosterone, special operations forces

DOI: 10.3233/NRE-230291

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-9, 2024

Authors: Ho, Dan P. | Andersen, Michael | Hammer, Daniel

Article Type: Research Article

Abstract: BACKGROUND: Mandibular reconstruction has historically been challenging due to the complex, highly functional, and esthetic nature of the anatomy. The most common etiologies of these defects requiring resection include trauma, benign tumors, and malignant pathology. Mandibular defects have been treated with little consideration for neural reconstruction, leaving patient’s orally incompetent with associated social stigma. Although recent advances in reconstructive techniques improve oral rehabilitation, immediate inferior alveolar nerve (IAN) reconstruction has not been widely adapted. OBJECTIVE: Here-in we seek to discuss the innovations of neural reconstruction of large segment mandibular defects and associated IAN defects and present an example …case performed at Naval Medical Center San Diego (NMCSD). METHODS: Pertinent literature discussing maxillofacial reconstruction and nerve repair using autogenous nerve harvest and allograft was queried from available online resources. RESULTS: Six patients have received immediate reconstruction of the IAN using processed nerve allograft over the past three years. All obtained sensation to S3 within six months of surgery. CONCLUSION: IAN repair using nerve allografts in conjunction with free flap reconstruction for large mandibular defects is a viable treatment and should be the new paradigm in maxillofacial reconstruction as it provides substantial quantifiable and qualitative improvements in social, functional, and esthetic outcomes of care. Show more

Keywords: Fibula free flap, inferior alveolar nerve, jaw-in-a-day, maxillofacial reconstruction, nerve allograft

DOI: 10.3233/NRE-230253

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-9, 2024

Authors: Miller, Austin R. | Martindale, Sarah L. | Rowland, Jared A. | Walton, Samuel | Talmy, Tomer | Walker, William C.

Article Type: Review Article

Abstract: BACKGROUND: A significant factor for the high prevalence of traumatic brain injury (TBI) among U.S. service members is their exposure to explosive munitions leading to blast-related TBI. Our understanding of the specific clinical effects of mild TBI having a component of blast mechanism remains limited compared to pure blunt mechanisms. OBJECTIVE: The purpose of this review is to provide a synopsis of clinical research findings on the long-term effects of blast-related mild TBI derived to date from the Long-Term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC). METHODS: Publications on blast-related …mild TBI from LIMBIC-CENC and the LIMBIC-CENC prospective longitudinal study (PLS) cohort were reviewed and their findings summarized. Findings from the broader literature on blast-related mild TBI that evaluate similar outcomes are additionally reviewed for a perspective on the state of the literature. RESULTS: The most consistent and compelling evidence for long-term effects of blast-related TBI is for poorer psychological health, greater healthcare utilization and disability levels, neuroimaging impacts on brain structure and function, and greater headache impact on daily life. To date, evidence for chronic cognitive performance deficits from blast-related mild TBI is limited, but futher research including crucial longitudinal data is needed. CONCLUSION: Commentary is provided on: how LIMBIC-CENC findings assimilate with the broader literature; ongoing research gaps alongside future research needs and priorities; how the scientific community can utilize the LIMBIC-CENC database for independent or collaborative research; and how the evidence from the clinical research should be assimilated into clinical practice. Show more

Keywords: Traumatic brain injury, mild traumatic brain injury, concussion, blast injuries, military medicine, veterans health, outcome studies

DOI: 10.3233/NRE-230268

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-17, 2024

Authors: Gano, Amanda | Gold, Joanne | Remigio-Baker, Rosemay A. | Monti, Katrina

Article Type: Research Article

Abstract: BACKGROUND: Concussion, also known as mild traumatic brain injury (mTBI), is a condition with unique ties to military service. Service members (SMs) are inherently at a higher risk for concussive injuries due to the intense physical training environment and combat operational tempo required to serve. The Traumatic Brain Injury Center of Excellence (TBICoE) is the US Department of Defense authority on this condition and provides a thorough approach to management of concussion and associated symptom sequela. OBJECTIVES: This article seeks to review the TBICoE approach to the management and rehabilitation of military SMs with mTBI, and highlight resources …available to military medical providers. METHODS: The authors reviewed evidence and TBICoE resources to provide this comprehensive overview of the TBICoE approach to management and rehabilitation of concussion in military SMs. RESULTS: A progressive return to activity protocol in conjunction with symptom-guided management of common post-concussive sequelae, including headache, vestibular and oculomotor issues, sleep dysfunction, cognitive rehabilitation, and behavioral health comorbidities are essential for concussion management in the acute, post-acute and chronic phases of injury. CONCLUSION: The TBICoE approach to the rehabilitation of military SMs is comprehensive, and includes initial management with a stepwise return to duty protocol and an objective return to duty screening. The mainstays of treatment for SMs with post-acute and chronic post-concussion symptoms are headache management, vestibular and oculomotor rehabilitation, sleep interventions, cognitive rehabilitation, and early intervention for behavioral health comorbidities. These evidence-based strategies may be applied in the treatment of SMs in the US and internationally. Show more

Keywords: Traumatic brain injury, concussion, military, rehabilitation, service members, veterans

DOI: 10.3233/NRE-230269

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-10, 2024

Authors: Landvater, Jeremy | Kim, Sharon | Caswell, Keenan | Kwon, Caroline | Odafe, Emamoke | Roe, Grace | Tripathi, Ananya | Vukovics, Christian | Wang, Johnathan | Ryan, Keith | Cocozza, Victoria | Brock, Matthew | Tchopev, Zahari | Tonkin, Brionn | Capaldi, Vincent | Collen, Jacob | Creamer, Jennifer | Irfan, Muna | Wickwire, Emerson | Williams, Scott | Werner Jr., J. Kent

Article Type: Review Article

Abstract: BACKGROUND: Traumatic brain injury (TBI) is a hallmark of wartime injury and is related to numerous sleep wake disorders (SWD), which persist long term in veterans. Current knowledge gaps in pathophysiology have hindered advances in diagnosis and treatment. OBJECTIVE: We reviewed TBI SWD pathophysiology, comorbidities, diagnosis and treatment that have emerged over the past two decades. METHODS: We conducted a literature review of English language publications evaluating sleep disorders (obstructive sleep apnea, insomnia, hypersomnia, parasomnias, restless legs syndrome and periodic limb movement disorder) and TBI published since 2000. We excluded studies that were not specifically evaluating …TBI populations. RESULTS: Highlighted areas of interest and knowledge gaps were identified in TBI pathophysiology and mechanisms of sleep disruption, a comparison of TBI SWD and post-traumatic stress disorder SWD. The role of TBI and glymphatic biomarkers and management strategies for TBI SWD will also be discussed. CONCLUSION: Our understanding of the pathophysiologic underpinnings of TBI and sleep health, particularly at the basic science level, is limited. Developing an understanding of biomarkers, neuroimaging, and mixed-methods research in comorbid TBI SWD holds the greatest promise to advance our ability to diagnose and monitor response to therapy in this vulnerable population. Show more

Keywords: Traumatic brain injury, sleep, military, veteran, post traumatic stress disorder, sleep wake disorder, neuroinflammation

DOI: 10.3233/NRE-230380

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-26, 2024

Authors: Springer, Shauna | Whitmer, Paul | Steinlin, Morgan | Gray, Lindsey | Blankfield, Jason

Article Type: Review Article

Abstract: BACKGROUND: For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE: This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB’s safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS: The current …body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS: Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION: SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress. Show more

Keywords: Stellate ganglion block, SGB, post-traumatic stress disorder, PTSD, combat stress disorder, nerve block, military health, veterans health

DOI: 10.3233/NRE-230236

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-12, 2024

Authors: Engin, Onur | Kızılırmak Karataş, Ayşe Sezgi | Taşpınar, Betül | Taşpınar, Ferruh

Article Type: Research Article

Abstract: BACKGROUND: YouTube has emerged as an important source for obtaining information regarding health issues. OBJECTIVE: The study aimed to assess the reliability and quality of facial paralysis exercise videos that are accessible on the YouTube platform. METHODS: The investigation was carried out on Youtube, utilizing the keyword “facial paralysis exercises”. We listed the first 100 videos based on relevancy. The quality and reliability of the videos were assessed using DISCERN, the Journal of the American Medical Association (JAMA) Benchmark Criteria, the Global Quality Scale (GQS), and the Video Power Index (VPI). RESULTS: Out of …100 studies, we excluded 52 and included the remaining 48. The scores we obtained for the videos were as follows: DISCERN Quality (2.92±0.91), DISCERN Total (39.16±6.75), JAMA (2.09±0.55), and GQS (3.00±0.89). Our study also revealed that videos uploaded by healthcare professionals had significantly higher DISCERN total, JAMA and VPI scores compared to those uploaded by non-healthcare professionals (p  = 0.018, 0.001 and 0.023, respectively). Additionally, we observed a positive and statistically significant correlation between the DISCERN quality score, total score, JAMA, and video features. CONCLUSION: The facial paralysis exercise videos were determined to be of medium to low quality. Higher-quality videos need to be produced. Show more

Keywords: Bell’s palsy, exercise, facial paralysis, information sources, internet, neurological rehabilitation, rehabilitation

DOI: 10.3233/NRE-240027

Citation: NeuroRehabilitation, vol. Pre-press, no. Pre-press, pp. 1-8, 2024