The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury.

Objective: To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings.

Design: Rapid evidence reviews on 12 clinical questions and Delphi method for expert consensus.

Participants: The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists.

Return to Cycling Following Brain Injury: A Proposed Multidisciplinary Approach.

Cycling is an important form of exercise, recreation, and transportation. Following traumatic brain injury, the benefits of cycling for health, fitness, and community mobility must be considered alongside potential risk for recurrent injury. In addition to medical concerns and exercise tolerance, key domains include motor function, attention, and visuospatial and executive function, which have previously been explored with regard to driving.

Fear, Anxiety, and Return to Sport After Cycling Crashes: A Survey of Cyclists.

After cycling crashes, orthopedic and neurologic complaints are often the focus of evaluation and management. However, the trauma sustained may not be limited to physical injury; psychological issues brought on by or comorbid with the crash also warrant treatment. In this original research, we evaluated the presence of fear or anxiety after cycling crashes and examined factors associated with this mechanism of injury through a survey.

Executive dysfunction after multiple concussions is not related to cerebrovascular dysfunction.

We investigated the relation between prior concussion history and working memory (WM), self-reported cognitive symptom burden, and cerebrovascular function in adolescents and young adults (14-21 years old).We recruited 59 participants, 34 clinically diagnosed with a sports-related concussion and 25 controls. Concussed subjects were studied at baseline (within 28 days of their injury) and eight weeks after, while control subjects only had one assessment.

Cerebrovascular Neuroprotection after Acute Concussion in Adolescents.

Objective: To assess acute cerebrovascular function in concussed adolescents (14-21 years of age), whether it is related to resting cerebral hemodynamics, and whether it recovers chronically.

Methods: Cerebral vasoreactivity and autoregulation, based on middle cerebral artery blood flow velocity, was assessed in 28 concussed participants (≤14 days of injury) and 29 matched controls. The participants in the concussion group returned for an 8-week follow-up assessment.

Attention-Deficit/Hyperactivity Disorder and Outcome After Concussion: A Systematic Review.

Objective: To synthesize the literature and conduct a gap analysis on the association between attention-deficit/hyperactivity disorder (ADHD) and clinical outcome from sport-related concussion.

Method: The electronic search for this systematic review (PROSPERO ID: CRD42019128281) was conducted in February 2019 using terms related to concussion, sports/athletics, and predictors/modifiers of outcome to search the PubMed, PsycINFO, MEDLINE, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science databases. Eligible studies evaluated the association between ADHD and outcome from sport-related concussion.

Reporting of Concussion-Like Symptoms After Cycling Crashes: A Survey of Competitive and Recreational Cyclists.

Context: Cycling crashes are common among recreational and competitive riders and may result in head and bodily trauma. Information is limited regarding the signs and symptoms of head injury (HI) after cycling crashes, medical treatment, and recovery.

Objectives: To evaluate concussion-like symptom reporting after cycling crashes with or without HI in recreational and competitive cyclists and to assess crash characteristics and follow-up medical care.

Psychopharmacology of traumatic brain injury.

The pathophysiology of traumatic brain injury (TBI) can be highly variable, involving functional and/or structural damage to multiple neuroanatomical networks and neurotransmitter systems. This wide-ranging potential for physiologic injury is reflected in the diversity of neurobehavioral and neurocognitive symptoms following TBI. Here, we aim to provide a succinct, clinically relevant, up-to-date review on psychopharmacology for the most common sequelae of TBI in the postacute to chronic period.

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines.

At least 3 million Americans sustain a mild traumatic brain injury (mTBI) each year, and 1 in 5 have symptoms that persist beyond 1 month. Standards of mTBI care have evolved rapidly, with numerous expert consensus statements and clinical practice guidelines published in the last 5 years. This Special Communication synthesizes recent expert consensus statements and evidenced-based clinical practice guidelines for civilians, athletes, military, and pediatric populations for clinicians practicing outside of specialty mTBI clinics, including primary care providers.

Neurologic benefits of sports and exercise.

Traumatic brain injury (TBI) is associated with several pathophysiologic changes, including: neurostructural alterations; molecular changes with shifts in circulating neurotrophins; impaired neural metabolism; changes in cerebrovascular autoregulation, vasoreactivity, and neurovascular coupling; and alterations in functional brain connectivity. In animal models of TBI, aerobic exercise reduces neuronal injury, promotes neuronal survival, and enhances the production of neuroprotective trophic factors. However, the timing of exercise initiation is an important consideration as early exercise in the acute postinjury period may impede recovery mechanisms, although evidence for this in humans is lacking.

Using a Workshop Format for Physiatry Trainees in the Management of Acute Sports-Related Concussion.

Select residency and medical student training programs have developed and researched skill-based workshops, focusing on mastering a surgical or communication skill; however, they are less frequently studied in physiatry residency programs. Given the importance of concussion care in physiatric practice, this study sought to measure the effectiveness of a novel sports-related concussion workshop. Based on the 5th International Consensus Statement on Concussion in Sport, a 6-hr concussion workshop was developed.

Stimulant Use in the Management of Mild Traumatic Brain Injury: A Qualitative Literature Review.

Mild traumatic brain injury (mTBI) often presents with cognitive complaints including difficulty with attention and concentration. As these symptoms resemble those of ADHD, stimulants may be a potential treatment for mTBI. This review evaluates the literature on the use of stimulants for the treatment of mTBI.

Placebo Effects in Traumatic Brain Injury.

In recent years, several randomized controlled trials evaluating pharmaceutical treatments for traumatic brain injury (TBI) have failed to demonstrate efficacy over placebo, with both active and placebo arms improving at comparable rates. These findings could be viewed in opposing ways, suggesting on the one hand failure of the tested outcome, but on the other, representing evidence of robust placebo effects in TBI. In this article, we examine several of the primary psychological processes driving placebo effects (verbal suggestion, cognitive re-framing, interpersonal interactions, conditioning, therapeutic alliance, anxiety reduction) as well as placebo neurobiology (top-down cortical regulation, reward system activation, dopaminergic and serotonergic neurotransmission).

Restoration of Vision After Brain Injury Using Magnet Glasses.

Visual impairments are common after traumatic brain injury (TBI) and negatively affect quality of life. We describe a 39-year-old woman with a severe TBI who was evaluated by the inpatient optometry and vision rehabilitation service with findings of complete right homonymous hemianopia and right cranial nerve III palsy with 30-degree right exotropia (eye turn out) and complete right ptosis (eyelid will not open). The 30-degree exotropia advantageously generated 30 degrees of right visual field expansion when the right ptosis was treated with a magnetic levator prosthesis, which restores eyelid opening.

Pharmacotherapy in rehabilitation of post-acute traumatic brain injury.

There are nearly 1.8 million annual emergency room visits and over 289,000 annual hospitalizations related to traumatic brain injury (TBI). The goal of this review article is to highlight pharmacotherapies that we often use in the clinic that have been shown to benefit various sequelae of TBI.

Rehabilitation after traumatic brain injury.

Traumatic brain injury (TBI) is a growing problem in the US, with significant morbidity and economic implications. This diagnosis spans a wide breath of injuries from concussion to severe TBI. Thus, rehabilitation is equally diverse in its treatment strategies targeting those symptoms that are functionally limiting with the ultimate goal of independence and community reintegration.

Myofascial pain syndrome treatments.

Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection.