Publications by authors named "Alice Theadom"

110 Publications

Impact and predictors of quality of life in adults diagnosed with a genetic muscle disorder: a nationwide population-based study.

Qual Life Res 2021 Nov 27. Epub 2021 Nov 27.

Neurology Department, Auckland City Hospital, Auckland, New Zealand.

Objectives: To determine the impact of genetic muscle disorders and identify the sociodemographic, illness, and symptom factors influencing quality of life.

Methods: Adults (aged 16-90 years) with a confirmed clinical or molecular diagnosis of a genetic muscle disorder identified as part of a nationwide prevalence study were invited to complete an assessment of the impact of their condition. Quality of life was measured using the World Health Organization Quality of Life questionnaire. Impact was measured via the prevalence of symptoms and comparisons of quality of life against New Zealand norms. Multivariate regression models were used to identify the most significant predictors of quality of life domains.

Results: 490/596 participants completed the assessment (82.2% consent rate). Quality of life was lower than the general population on physical (t = 9.37 p < 0.0001, d = 0.54) social (t = 2.27 p = 0.02, d = 0.13) and environmental domains (t = 2.28 p = 0.02, d = 0.13), although effect sizes were small. No difference was found on the psychological domain (t = - 1.17 p = 0.24, d = 0.07). Multivariate regression models (predicting 42%-64% of the variance) revealed personal factors (younger age, being in employment and in a relationship), symptoms (lower pain, fatigue, and sleep difficulties), physical health (no need for ventilation support, fewer activity limitations and no comorbidities), and psychosocial factors (lower depression, anxiety, behavioural dyscontrol and higher self-efficacy, satisfaction with health care and social support) contributed to improved quality of life.

Conclusions: A range of factors influence the quality of life in adults diagnosed with a genetic muscle disorder and some may serve as targets for multi-faceted intervention.
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http://dx.doi.org/10.1007/s11136-021-03046-2DOI Listing
November 2021

Mental Health and Wellbeing of Retired Elite and Amateur Rugby Players and Non-contact Athletes and Associations with Sports-Related Concussion: The UK Rugby Health Project.

Sports Med 2021 Nov 18. Epub 2021 Nov 18.

Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK.

Background: Concerns have intensified over the health and wellbeing of rugby union and league players, and, in particular, about the longer-term effects of concussion. The purpose of this study was to investigate whether there were differences in mental health, sleep and alcohol use between retired elite and amateur rugby code players and non-contact athletes, and to explore associations with sports-related concussion.

Methods: 189 retired elite (ER, n = 83) and amateur (AR, n = 106) rugby code players (rugby union n = 145; rugby league n = 44) and 65 former non-contact athletes (NC) were recruited to the UK Rugby Health Project between 2016 and 2018. Details on sports participation and concussion history were obtained by questionnaire, which also included questions on mental health, anger, sleep, mood, alcohol use, social connections and retirement from injury. Data were compared between sports groups (ER, AR and NC), between exposure of three or more or five or more concussions and for years in sport.

Results: ER reported more concussions than AR (5.9 ± 6.3 vs. 3.7 ± 6.3, p = 0.022) and NC (0.4 ± 1.0, p < 0.001). ER had a higher overall negative mental health score (indicating poor mental health) than AR (10.4 ± 6.3 vs. 7.4 ± 6.5, d = 0.47, p = 0.003) and NC (7.1 ± 4.8, d = 0.57, p = 0.006) and a lower overall positive score (indicating good mental health) than NC (8.9 ± 4.1 vs. 10.7 ± 3.4, d = 0.46, p = 0.021). Negative scores were highest and positive scores lowest in those reporting three or more concussions (d = 0.36, p = 0.008; d = 0.28, p = 0.040, respectively) or five or more concussions (d = 0.56, p < 0.001; d = 0.325, p = 0.035, respectively). Reported symptoms for sleep disruption were more prevalent in ER than NC, and in former athletes with three or more concussions (d = 0.41-0.605, p < 0.05). There were no significant differences in alcohol score (p = 0.733). Global anger score and covert anger expression was higher in former athletes with five or more concussions (d = 0.32, p = 0.035; d = 0.37, p = 0.016). AR reported greater attachment to friends than NC (d = 0.46, p = 0.033) and 20% of ER reported that they would not turn to anyone if they had a problem or felt upset about anything.

Conclusion: There was a significantly higher prevalence of adverse mental health and sleep disruption in ER and in former athletes who reported a higher number of concussions. Anger and irritability were more prevalent in former athletes with a history of five or more concussions. Strategies are needed to address mental health and sleep disturbance in elite rugby code athletes, who are also less likely to seek help should they need it. Further research is needed to elucidate causation, and the neurobiological connection between concussion, sub-concussions and longer-term psychological health and wellbeing.
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http://dx.doi.org/10.1007/s40279-021-01594-8DOI Listing
November 2021

Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury.

J Psychosom Res 2021 Dec 3;151:110664. Epub 2021 Nov 3.

TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand.

Background: Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS.

Method: Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury).

Results: A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS.

Conclusions: Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.
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http://dx.doi.org/10.1016/j.jpsychores.2021.110664DOI Listing
December 2021

Feasibility of administering the WAIS-IV using a home-based telehealth videoconferencing model.

Clin Neuropsychol 2021 Oct 14:1-13. Epub 2021 Oct 14.

TBI Network, Auckland University of Technology, Auckland, New Zealand.

Use of telehealth to deliver neuropsychological services has proven to be a feasible approach, however, there is limited research which has examined the reliability of home-based assessment models using a comprehensive intelligence test. The aim of this study was to examine the reliability and feasibility of a home-based videoconferencing administration of the Wechsler Adult Intelligence Scales-4 Edition (WAIS-IV).

Thirty healthy participants (aged 18-40 years) completed the WAIS-IV both in-person and via home-based videoconferencing utilizing a randomized counter-balanced methodology to attempt to control for an order effect. Paper record forms for Coding/Symbol Search and Blocks were sent and returned via tamper proof courier packs. Participants completed an online survey of their experiences of TNP following completion of their assessments. Group mean comparisons, intra class correlation coefficients (ICCs) and Bland-Altman measures of bias were calculated.

Findings from both modalities were highly concordant across all WAIS-IV subtests and indices, with all ICCs rated as "excellent," (≥0.9). There were no significant mean group differences and no evidence of proportional bias. The majority of participants were very satisfied with the use of videoconferencing as an application for cognitive assessment and high levels of participant compliance were observed.

In this non-clinical cohort home-based videoconference administration of the WAIS-IV was feasible, reliable and acceptable. TNP may offer an alternative for those consumers where there are challenges in accessing a face-to-face service delivery model, thereby improving equity, and enabling continuation of service delivery. Future research is needed with a larger and more ethnically diverse clinical population.
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http://dx.doi.org/10.1080/13854046.2021.1985172DOI Listing
October 2021

The role of psychological flexibility in recovery following mild traumatic brain injury.

Rehabil Psychol 2021 Nov 30;66(4):479-490. Epub 2021 Sep 30.

School of Psychology.

Purpose and Objective: Psychological distress is known to contribute to recovery following mild traumatic brain injury (mTBI) and there is a need to understand the mechanisms that contribute to this relationship. The present study examined psychological flexibility, as a hypothesized psychological mechanism, in 169 treatment-seeking adults with mTBI. Research Method/Design: Participants completed self-report measures of postconcussion symptoms, psychological distress (anxiety, stress, and depression) and functional status within four weeks of entry to an mTBI outpatient clinic. A general measure (Acceptance and Action Questionnaire), as well as a context-specific (Acceptance and Action Questionnaire-Acquired Brain Injury) measure of psychological flexibility were administered. Results: Simple linear regression analysis showed that psychological flexibility made a significant contribution to the prediction of postconcussion symptoms and functional status. A series of multiple mediation analyses also found that psychological flexibility had a significant indirect effect on the relationships between psychological distress and postconcussion symptoms, and functional status. The context-specific, rather than the general measure of psychological flexibility, was consistently shown to contribute to these findings. Conclusions/Implications: These results suggest that psychological flexibility is a psychological mechanism that contributes to recovery outcomes in individuals with mTBI and could therefore be an important treatment target in mTBI interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000406DOI Listing
November 2021

Rasch analysis of the Brain Injury Screening Tool (BIST) in mild traumatic brain injury.

BMC Neurol 2021 Sep 29;21(1):376. Epub 2021 Sep 29.

TBI Network, Auckland University of Technology, Auckland, New Zealand.

Objective: To evaluate the psychometric properties of the Brain Injury Screening Tool (BIST) symptom scale in a sample of people with a mild Traumatic Brain Injury (mTBI) through Rasch analysis, and to obtain an interval level measurement score for potential clinical use.

Materials And Methods: Data were obtained from 114 adults aged over 16 years, who had experienced at least one mTBI in the past 10 years. Participants were recruited via social media, concussion clinics and sports organisations over a 4-month period between May and September 2020. Participants were asked to compete the symptom scale of the BIST tool via an anonymous online questionnaire. Internal construct validity, dimensionality, person separation index, and differential item functioning of the BIST were examined with Rasch analysis.

Results: BIST in its original form produced a satisfactory item-trait interaction, and good reliability, but was found to be multi-dimensional. Rasch analysis of the full scale with three domains as subtests resulted in acceptable model fit (χ(6) =3.8, p >  0.05), with good reliability (Person Separation Index = 0.84), and uni-dimensionality. Differential Item Functioning (DIF) analysis displayed no significant DIF effects for sex or age revealing that people responded consistently and similarly to the individual BIST items based on severity of symptom burden.

Conclusions: The 15-item symptom scale of the BIST tool is a psychometrically sound measure of symptom burden following mTBI. The findings provide support for use of both total and sub scale scores for clinical use. Ordinal to interval score conversions are recommended for use when using the scores for research purposes in mTBI.
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http://dx.doi.org/10.1186/s12883-021-02410-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479917PMC
September 2021

Preliminary Evidence for the Clinical Utility of Tactile Somatosensory Assessments of Sport-Related mTBI.

Sports Med Open 2021 Aug 9;7(1):56. Epub 2021 Aug 9.

Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand.

Objectives: To evaluate the clinical utility of tactile somatosensory assessments to assist clinicians in diagnosing sport-related mild traumatic brain injury (SR-mTBI), classifying recovery trajectory based on performance at initial clinical assessment, and determining if neurophysiological recovery coincided with clinical recovery.

Research Design: Prospective cohort study with normative controls.

Methods: At admission (n = 79) and discharge (n = 45/79), SR-mTBI patients completed the SCAT-5 symptom scale, along with the following three components from the Cortical Metrics Brain Gauge somatosensory assessment (BG-SA): temporal order judgement (TOJ), TOJ with confounding condition (TOJc), and duration discrimination (DUR). To assist SR-mTBI diagnosis on admission, BG-SA performance was used in logistic regression to discriminate cases belonging to the SR-mTBI sample or a healthy reference sample (pooled BG-SA data for healthy participants in previous studies). Decision trees evaluated how accurately BG-SA performance classified SR-mTBI recovery trajectories.

Results: BG-SA TOJ, TOJc, and DUR poorly discriminated between cases belonging to the SR-mTBI sample or a healthy reference sample (0.54-0.70 AUC, 47.46-64.71 PPV, 48.48-61.11 NPV). The BG-SA evaluated did not accurately classify SR-mTBI recovery trajectories (> 14-day resolution 48%, ≤14-day resolution 54%, lost to referral/follow-up 45%). Mann-Whitney U tests revealed differences in BG-SA TOJc performance between SR-mTBI participants and the healthy reference sample at initial clinical assessment and at clinical recovery (p < 0.05).

Conclusions: BG-SA TOJ, TOJc, and DUR appear to have limited clinical utility to assist clinicians with diagnosing SR-mTBI or predicting recovery trajectories under ecologically valid conditions. Neurophysiological abnormalities persisted beyond clinical recovery given abnormal BG-SA TOJc performance observed when SR-mTBI patients achieved clinical recovery.
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http://dx.doi.org/10.1186/s40798-021-00340-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353035PMC
August 2021

Parent and Teacher-Reported Child Outcomes Seven Years After Mild Traumatic Brain Injury: A Nested Case Control Study.

Front Neurol 2021 23;12:683661. Epub 2021 Jul 23.

School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.

Increasing evidence suggests potential lifetime effects following mild traumatic brain injury (TBI) in childhood. Few studies have examined medium-term outcomes among hospitalized and non-hospitalized samples. Study aims were to describe children's behavioral and emotional adjustment, executive function (EF), quality of life, and participation at 7-years following mild TBI using parents' and teachers' reports. Nested case control study of 86 children (68% male, mean age at assessment = 11.27 years; range 7-17 years) who sustained a mild TBI 7-years previously, identified from a prospective, population-based study. They were compared to 69 children free from TBI (61% male, mean age at assessment = 11.12 years; range 5-17 years). In addition to parent-reported socio-demographic details, parents (mild TBI = 86, non-TBI = 69) completed age-appropriate standardized questionnaires about children's health-related quality of life, behavioral and emotional adjustment, EF, and social participation. Parents own mood was assessed using the Hospital Anxiety and Depression Scale. Teachers (mild TBI = 53, non-TBI = 42) completed questionnaires about children's behavioral and emotional adjustment, and EF. Parent reports showed median group-level scores for cases were statistically significantly greater than controls for emotional symptoms, conduct problems, hyperactivity/inattention, total behavioral difficulties, inhibitory control, shifting, planning/organizing, and Global Executive Composite (total) EF difficulties (-values 0.001-0.029). Parent reports of child quality of life and social participation were similar, as were teacher reports of child behavioral and emotional adjustment, and EF ( > 0.05). When examining clinical cut-offs, compared to controls, cases had a higher risk of parent-reported total EF difficulties (odds ratio = 3.00) and, to a lesser extent, total behavior problems (odds ratio = 2.51). As a group, children with a history of mild TBI may be at elevated risk for clinically significant everyday EF difficulties in the medium-term compared to non-TBI controls, as judged by their parents. Further multi-informant longitudinal research is required, following larger samples. Aspects requiring particular attention include pre-injury characteristics, such as sleep disturbances and comorbidities (e.g., headaches), that may act as potential confounders influencing the association between mild TBI and child behavioral problems.
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http://dx.doi.org/10.3389/fneur.2021.683661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342814PMC
July 2021

Psychological flexibility in mild traumatic brain injury: an evaluation of measures.

Brain Inj 2021 07 1;35(9):1103-1111. Epub 2021 Aug 1.

University of Otago Wellington, University of Otago, Newtown, Wellington.

Primary Objective: In this study, we examined the psychometric properties of measures of psychological flexibility in a mild traumatic brain injury (mTBI) sample.

Method And Procedures: Adults who sustained a mTBI (n = 112) completed the Acceptance and Action Questionnaire - Acquired Brain Injury reactive avoidance subscale (AAQ-ABI (RA). Exploratory factor analysis and Rasch analysis were conducted to evaluate the facture structure, dimensionality, and differential item functioning. Construct validity was determined by correlating the AAQ-ABI (RA) with the Acceptance and Action Questionnaire-Revised (AAQ-II) and Fear Avoidance after Traumatic Brain Injury (FAB-TBI).

Main Outcome And Results: The AAQ-ABI (RA) was found to have strong internal consistency (Cronbach's α = 0.87). Consistent with previous findings, the AAQ-ABI (RA) had one distinct factor. Fit to the unidimensional Rasch model was adequate ( (18) = 22.5, = .21) with no evidence of differential item functioning across person factors examined. The AAQ-ABI (RA) also had expected relationships with theoretically relevant constructs.

Conclusions: The AAQ-ABI (RA) appears to be a psychometrically sound measure of psychological flexibility in mTBI.
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http://dx.doi.org/10.1080/02699052.2021.1959062DOI Listing
July 2021

Stroke survivors' expectations and post-intervention perceptions of mindfulness training: A qualitative study.

Neuropsychol Rehabil 2021 Jul 19:1-23. Epub 2021 Jul 19.

Auckland University of Technology, Auckland, New Zealand.

Depression and anxiety are common sequelae of stroke, occurring in at least one-third of patients. This study evaluated the acceptability and feasibility of providing mindfulness training (MT) to stroke survivors with the aim of reducing depression and anxiety. Following a six-week one-on-one MT course, 17 participants were interviewed. The median age of participants was 71, and 10 participants were male. This paper focuses on participants' expectations of the MT and their views about its impact on their everyday lives. Conventional content analysis was used for coding and analysis. A single theme, was captured in relation to expectations of MT, and four themes provided information relating to participants' perceived impact of the course: , , , and .Most participants knew little about mindfulness before the MT and did not have specific goals in mind when volunteering to take part. The findings suggest that most participants considered MT beneficial through reducing stress and giving them additional skills to cope with their everyday lives. A tailored mindfulness intervention may be a useful adjunct to other rehabilitation therapies for stroke survivors.
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http://dx.doi.org/10.1080/09602011.2021.1950777DOI Listing
July 2021

Coping in Children and Adolescents with a Genetic Muscle Disorder -Findings from a Population-Based Study.

J Neuromuscul Dis 2021 ;8(6):1069-1078

National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.

Background: The impacts of genetic muscle disorders on quality of life in affected children are well-documented. However, few studies have investigated children's coping strategies and relationships between coping and quality of life.

Objectives: To determine coping strategy use, efficacy, and associations with quality of life in children with a genetic muscle disorder.

Methods: Forty-eight children (6-15 years, 58% male) with a genetic muscle disorder were identified as part of a national prevalence study. Children completed the Kidcope in response to a specific stressor (doctors visits) and the Pediatric Quality of Life Inventory Neuromuscular Module.

Results: 'Wishful thinking' (75%, 36/48) and 'cognitive restructuring' (71%, 34/48) were the most frequently used coping strategies. 'Self-criticism' (12%, 6/48), and 'blaming others' and 'resignation' (both 19%, 9/48) were the least used strategies. Coping strategy use did not differ across age and sex groups (p's from 0.08 to 1.00). Positive coping strategies tended to be more effective (medians ranged from 2.00 to 2.75) than negative strategies (medians ranged from 1.38 to 2.50). Using a greater number of different types of positive (F(4, 46) = 5.79, p = 0.001) and/or negative (F(4, 44) = 5.64, p 0.001) coping strategies was linked to poorer health-related quality of life.

Conclusion: We conclude that children with genetic muscle disorders use a wide range of positive and/or negative coping strategies in response to stressors associated with a doctor visit and may benefit from greater support to improve health-related quality of life. Findings support the value of routine screening of children's coping to identify those who would benefit from support.
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http://dx.doi.org/10.3233/JND-200564DOI Listing
January 2021

An intervention to improve coping strategies in adult male prisoners with a history of traumatic brain injury: A pilot randomised clinical trial.

Clin Rehabil 2021 Aug 11;35(8):1185-1195. Epub 2021 Mar 11.

Department of Psychology, School of Clinical Sciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.

Objective: To determine whether a psychological intervention improves coping, post-concussion symptoms and decreases in-prison infractions in adult males with a history of traumatic brain injury.

Design: A single centre, randomised, wait-list, pilot study.

Setting: A high security prison in New Zealand.

Subjects: Fifty-five adult male participants who had experienced at least one traumatic brain injury in their lifetime (mean age 37.29 +/-9.81 years).

Intervention: A manualised ten session, in-person, group based combined Cognitive Behavioural Therapy /Mindfulness Based Stress Reduction intervention versus wait list control.

Main Measures: The Negative Affect Repair Questionnaire and Rivermead Post-concussion Symptom Questionnaire were completed at baseline, post-intervention (five weeks) and at 12 week follow up. In-prison misconduct charges and negative file notes were reviewed for the previous five weeks at each assessment time point.

Results: There was an improvement in the use of calming and distraction strategies in the intervention group from baseline ( = 17.38, SD = 3.57) to post-intervention ( = 18.67, SD = 3.84) and 12-week follow up ( = 18.13, SD = 2.63). Participants in the intervention group had significantly higher negative affect repair on the calming and distractive strategies subscale following completion of the intervention, compared to wait-list controls ( = 4.69,  = 0.04) with a moderate effect size (η = 0.11). Improvements in use of calming and distractive strategies was not sustained at the twelve-week follow-up ( = 0.87,  = 0.36). There was no-significant improvement on other negative affect subscales or for post-concussion symptoms or decrease in-prison infractions.

Conclusion: A manualised psychological intervention may have the potential to facilitate the development of positive coping strategies in prisoners with a history of traumatic brain injury.
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http://dx.doi.org/10.1177/0269215521998535DOI Listing
August 2021

Sensitivity to Noise Following a Mild Traumatic Brain Injury: A Longitudinal Study.

J Head Trauma Rehabil 2021 Sep-Oct 01;36(5):E289-E301

Department of Psychology, Auckland University of Technology, Auckland, New Zealand (Drs Shepherd, Landon, and Theadom); and Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland (Drs Heinonen-Guzejev and Heikkilä).

Objective: To describe changes in the prevalence and clinical correlates of noise sensitivity (NS) in mild traumatic brain injury (mTBI) across a 12-month period and to determine whether NS at an early stage of recovery has predictive value for later postconcussive symptoms.

Setting: A mixed urban and rural region of New Zealand.

Participants: Data for 341 adults (201 males, 140 females; age range from 16 to 91 years) were extracted from a 1-year TBI incidence, and outcomes study was conducted in New Zealand.

Design: Secondary analysis of data from a community-based, longitudinal population study of an mTBI incidence cohort collected within 1 week of injury (baseline) and at 1, 6, and 12 months postinjury.

Main Measures: Measures at baseline (within 2 weeks of the injury) and 1, 6, and 12 months included the Rivermead Post-concussion Symptoms Questionnaire and its NS item, the Hospital Depression and Anxiety Scale, and the computerized CNS-Vital Signs neurocognitive test.

Results: NS progressively declined postinjury, from 45% at baseline to 28% at 12 months. In turn, NS showed itself as a significant predictor of future postconcussive symptoms.

Conclusion: Taken together with previous research, the findings of the current study indicate that NS may have clinical utility in flagging vulnerability to persistent postconcussive symptoms.
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http://dx.doi.org/10.1097/HTR.0000000000000645DOI Listing
October 2021

The Brain Injury Screening Tool (BIST): Tool development, factor structure and validity.

PLoS One 2021 4;16(2):e0246512. Epub 2021 Feb 4.

TBI Network, Auckland University of Technology, Auckland, New Zealand.

Currently health care pathways (the combination and order of services that a patient receives to manage their injury) following a mild traumatic brain injury vary considerably. Some clinicians lack confidence in injury recognition, management and knowing when to refer. A clinical expert group developed the Brain Injury Screening Tool (BIST) to provide guidance on health care pathways based on clinical indicators of poor recovery. The tool aims to facilitate access to specialist services (if required) to improve longer term prognosis. The tool was developed using a three-step process including: 1) domain mapping; 2) item development and 3) item testing and review. An online retrospective survey of 114 adults (>16 years) who had experienced a mild brain injury in the past 10 years was used to determine the initial psychometric properties of the 15-item symptom scale of the BIST. Participants were randomised to complete the BIST and one of two existing symptom scales; the Rivermead Post-concussion Symptom Questionnaire (RPQ) or the Sports Concussion Assessment Test (SCAT-5) symptom scale to determine concurrent validity. Participant responses to the BIST symptom scale items were used to determine scale reliability using Cronbach's alpha. A principal components analysis explored the underlying factor structure. Spearman's correlation coefficients determined concurrent validity with the RPQ and SCAT-5 symptom scales. The 15 items were found to require a reading age of 6-8 years old using readability statistics. High concurrent validity was shown against the RPQ (r = 0.91) and SCAT-5 (r = 0.90). The BIST total symptom scale (α = 0.94) and the three factors identified demonstrated excellent internal consistency: physical/emotional (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80). This study provides evidence to support the utility, internal consistency, factor structure and concurrent validity of the BIST. Further research is warranted to determine the utility of the BIST scoring criteria and responsiveness to change in patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246512PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861451PMC
August 2021

Psychosocial functioning at 4-years after pediatric mild traumatic brain injury.

Brain Inj 2021 03 4;35(4):416-425. Epub 2021 Feb 4.

School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.

: Behavioral and emotional difficulties are reported following pediatric mild traumatic brain injury (TBI). But few studies have used a broad conceptual approach to examine children's long-term psychosocial outcomes. This study examines children's psychosocial outcomes at 4-years after mild TBI and associated factors. Parents of 93 children (<16 years) with mild TBI completed subscales of age-appropriate versions of the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function, the Pediatric Quality of Life Inventory, and the Adolescent Scale of Participation questionnaire at 4-years post-injury. Mean group-level scores were statistically significantly higher for hyperactivity/inattention and lower for emotional functioning than published norms. Levels of participation were greater compared to those observed in normative samples. More than 19% met published criteria for clinically significant hyperactivity/inattention, emotional functioning problems, peer relationship problems, and social functioning difficulties. Lower family socio-economic status and greater parental anxiety and depression were associated with overall psychosocial difficulties. Findings indicate that as a group, children with mild TBI are characterized by elevated rates of behavioral, emotional, and social difficulties at 4-years post-injury. Parent mental health may be an untapped opportunity to support children's psychosocial development following mild TBI, with replication required in larger samples.
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http://dx.doi.org/10.1080/02699052.2021.1878553DOI Listing
March 2021

Nutritional interventions to improve neurophysiological impairments following traumatic brain injury: A systematic review.

J Neurosci Res 2021 02 26;99(2):573-603. Epub 2020 Oct 26.

Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.

Traumatic brain injury (TBI) accounts for significant global health burden. Effects of TBI can become chronic even following mild injury. There is a need to develop effective therapies to attenuate the damaging effects of TBI and improve recovery outcomes. This literature review using a priori criteria (PROSPERO; CRD42018100623) summarized 43 studies between January 1998 and July 2019 that investigated nutritional interventions (NUT) delivered with the objective of altering neurophysiological (NP) outcomes following TBI. Risk of bias was assessed for included studies, and NP outcomes recorded. The systematic search resulted in 43 of 3,748 identified studies met inclusion criteria. No studies evaluated the effect of a NUT on NP outcomes of TBI in humans. Biomarkers of morphological changes and apoptosis, oxidative stress, and plasticity, neurogenesis, and neurotransmission were the most evaluated NP outcomes across the 43 studies that used 2,897 animals. The risk of bias was unclear in all reviewed studies due to poorly detailed methodology sections. Taking these limitations into account, anti-oxidants, branched chain amino acids, and ω-3 polyunsaturated fatty acids have shown the most promising pre-clinical results for altering NP outcomes following TBI. Refinement of pre-clinical methodologies used to evaluate effects of interventions on secondary damage of TBI would improve the likelihood of translation to clinical populations.
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http://dx.doi.org/10.1002/jnr.24746DOI Listing
February 2021

Psychological flexibility: A psychological mechanism that contributes to persistent symptoms following mild traumatic brain injury?

Med Hypotheses 2020 Oct 30;143:110141. Epub 2020 Jul 30.

Proactive Rehab, Wakefield Specialist Centre, Florence Street, Wellington 6021, New Zealand.

Persistent symptoms following a mild traumatic brain injury (mTBI) can have profound implications on all aspects of an individual's functioning. Psychological factors have a significant role in contributing to the development of persistent post-concussion symptoms and predicting outcomes. Biopsychosocial explanations have therefore been applied to prognostic models of mTBI. What is not evident in the literature to date is an understanding of the psychological mechanisms that may be important in mediating the various psychological factors in these models. The construct of psychological flexibility holds promise in this regard. Psychological flexibility is the ability to act in alignment with values in the presence of inner discomfort such as pain and distress. It is hypothesised that psychological flexibility has a significant role in the development and maintenance of persistent symptoms following mild traumatic brain injury. The rationale that forms the basis of this hypothesis is as follows: a relationship exists between psychological flexibility and pre-injury psychological risk factors; psychological flexibility is vulnerable to the pathophysiology associated with mTBI; post-injury psychological and neuropsychological factors exacerbate and maintain psychological inflexibility; and psychological flexibility underlies psychological responses to mTBI that contribute to unfavourable outcomes. A discussion of the literature that pertains to each of these points is presented. Based on this hypothesis, we conclude, that there is rationale to empirically explore the role of psychological flexibility in mTBI and its relationship to outcomes. This may also lead to evaluation of specific interventions that target this psychological mechanism in mTBI, such as Acceptance and Commitment Therapy, and improve outcomes for this population.
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http://dx.doi.org/10.1016/j.mehy.2020.110141DOI Listing
October 2020

Knowledge, attitudes, and behavior toward concussion in adult cyclists.

Brain Inj 2020 07 20;34(9):1175-1182. Epub 2020 Jul 20.

TBI Network, Auckland University of Technology , Auckland, New Zealand.

Objective: To determine knowledge, attitudes, and behavior toward concussion in cyclists and to identify predictors of concussion knowledge.

Methods: Cycling organizations sent members a web link to online information about the study and a questionnaire. Anyone aged >16 years, living in New Zealand and engaged in a cycling activity was invited to participate. The 36-item questionnaire included sociodemographics, knowledge about concussion, helmet use, and personal concussion history. Data were collected between 15/05/19 and 30/06/19. A multiple linear regression model identified factors associated with levels of concussion knowledge.

Results: The questionnaire was completed by 672 participants aged between 16 and 82 years (x̄ = 48.6 years). Knowledge of concussion was high. However, knowledge that helmets are not able to prevent concussion was low and time to return to sport after injury was variable. Knowledge did not always translate to seeking of medical attention or replacement of helmet behavior. Younger age and having sustained at least one prior concussion were associated with higher levels of concussion knowledge F(df = 3) = 8.81, < .001.

Conclusions: Knowledge and attitudes toward concussion were positive. However, knowledge gaps and discrepancies between attitudes and behavior were identified. Consistent, clear messages are needed around return to sport timeframes.
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http://dx.doi.org/10.1080/02699052.2020.1793386DOI Listing
July 2020

Cumulative Sport-Related Injuries and Longer Term Impact in Retired Male Elite- and Amateur-Level Rugby Code Athletes and Non-contact Athletes: A Retrospective Study.

Sports Med 2020 Nov;50(11):2051-2061

National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand.

Background: Rugby union and rugby league are popular team contact sports, but they bring a high risk of injury. Although previous studies have reported injury occurrence across one or several seasons, none have explored the total number of injuries sustained across an entire career. As the first to do so, the aim of this study was to report on cumulative injuries and their perceived long-term impact in retired rugby code athletes compared to athletes from non-contact sports.

Methods: One hundred and eighty-nine former rugby code athletes (rugby union n = 145; rugby league n = 44) and 65 former non-contact athletes were recruited to the UK Rugby Health Project between September 2016 and December 2018. Details on sports participation, sports injuries and concussion history, sports injury-related surgeries, and previous and current health were obtained from a validated, online self-report questionnaire.

Results: Former elite rugby code athletes (n = 83) reported more total injuries per player (median 39, IQR 35) than former amateur rugby code athletes (n = 106; median 23, IQR 30; p = 0.014) and non-contact sports athletes (n = 65; median 7.5, IQR 15; p < 0.001). Concussion was the most frequently reported injury for the elite and amateur rugby code groups, followed by upper/lower back and knee ligament injuries. These injuries also presented with the highest recurrence. Rugby code groups reported a higher continued impact of previous concussion, neck injuries, shoulder dislocation, ACL tears, and knee ligament injuries (p = 0.003-0.045). The reported prevalence of osteoarthritis was more than twofold greater in the elite rugby code group than in non-contact athletes (51% v 22%, p < 0.001). The prevalence of back pain and/or severe and regular joint pain was high across all groups (47-80%), particularly the elite rugby code group. The total number of joint injuries and sport injury-related surgeries was higher in those who reported current osteoarthritis and current severe and regular joint pain (p < 0.001-p = 0.028).

Conclusion: Across multiple injury types, past participation in rugby union and rugby league, particularly at elite level, is associated with a high cumulative injury load and a continued impact of previous injuries post-retirement. Given the high number of reported concussions (and their recurrence) and associations between previous injuries during a player's career and current musculoskeletal conditions, efforts should be prioritized to reduce the occurrence and recurrence of injuries in rugby codes at all levels of the sport. Strategies should also be developed for supporting the specific physical health needs of rugby code athletes post-retirement.
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http://dx.doi.org/10.1007/s40279-020-01310-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575474PMC
November 2020

Concussion knowledge, attitudes and behaviour in equestrian athletes.

J Sci Med Sport 2020 Nov 17;23(11):1055-1061. Epub 2020 May 17.

Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand; TBI Network, School of Clinical Sciences, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand.

Objective: To determine knowledge, attitudes and behaviour towards concussion in adult equestrian athletes.

Design: Nationwide, cross-sectional, questionnaire.

Methods: Participants were recruited via advertisements circulated through social media, community presentations and equestrian organisations. Participants were sent a web link to an online questionnaire previously designed for high school athletes and modified to ensure relevance to equestrian activities. The percentage of correct responses per item and a total knowledge score were calculated. Differences in concussion knowledge by age, sex, level of experience and previous history of concussion were explored using t-tests, 95% confidence intervals (CI) and effect sizes.

Results: The questionnaire was completed by 1486 participants (Mean age=39.1±15.4). Knowledge of what concussion was, how to recognise it and key symptoms (except poor sleep) was high (>80%). In contrast, awareness of guidelines was moderate (56%) and inability of helmets to prevent concussion was low (12%). Significantly higher levels of knowledge of concussion were identified in females compared with males (t=-6.55 p<0.001, 95%CI=-3.26 to -1.75). The majority (87%) of participants reported that a helmet should be replaced after a fall, yet 46% reported re-using a helmet following a hit to the head.

Conclusions: Knowledge of and attitudes towards concussion were positive. However, there were knowledge gaps and discrepancies between some attitudes and behaviour on some aspects of concussion. Targeted campaigns to promote awareness of concussion and improve recognition and onward management are needed. Education related to equestrian activities such as helmet use and injury mechanisms is needed to change behaviour and minimise the risk of injury.
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http://dx.doi.org/10.1016/j.jsams.2020.05.008DOI Listing
November 2020

Incidence of Sports-Related Traumatic Brain Injury of All Severities: A Systematic Review.

Neuroepidemiology 2020 14;54(2):192-199. Epub 2020 Jan 14.

National Institute for Stroke and Applied Neuroscience, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand.

Introduction: Whilst there are many benefits to participating in sports and recreational activities, there is also a risk of injury including sports-related traumatic brain injury -(SR-TBI). To inform injury prevention initiatives, it is important to explore the burden of SR-TBI at the population level. This review aimed to estimate the incidence of SR-TBI in the general population across injury severities.

Methods: Systematic search of electronic databases using keywords from 1965 until June 2019 facilitated by hand searches of reference lists. Original research reporting on the incidence of SR-TBI, capturing people of all ages in a well-defined population area was included. Studies were excluded if they focused on a specific sport(s) or population group. All studies were required to be published in the English language. Quality of studies was determined as poor, moderate or good based on the standards of reporting of neurological disorders criteria. Data on year(s) of data collection, diagnostic criterion, case ascertainment sources, population denominator and incidence per 100,000 and by age, sex, injury severity and sport were extracted by 2 authors independently using a standard data extraction form.

Results: Following review of 11 studies meeting the inclusion criteria, the incidence of SR-TBI within hospital-based studies ranged between 3.5 and 31.5 per 100,000. One community-based study using multiple case ascertainment sources identified a higher incidence of 170 per 100,000. SR-TBI accounted for 1.2-30.3% of all TBIs. One study provided incidence data across a 5-year period suggesting an increasing trend in incidence over time. Males were more at risk than females (66.1-75.6%), and adolescents and young adults had the highest incidence of SR-TBI.

Conclusion: The primary objective of this review was to provide a summary of descriptive data on SR-TBI epidemiology at the population level. SR-TBI represented up to one-third of all causes of TBI. Trends in incidence by age and sport were challenging to determine due to lack of consistency in reporting as well as the small number of studies overall. Undertaking injury surveillance at all levels of TBI will assist with understanding the nature, mechanism of and surrounding events where injuries occur in sport.
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http://dx.doi.org/10.1159/000505424DOI Listing
February 2021

Predicting Sport-related mTBI Symptom Resolution Trajectory Using Initial Clinical Assessment Findings: A Retrospective Cohort Study.

Sports Med 2020 Jun;50(6):1191-1202

Faculty of Health and Environmental Science, National Institute of Stroke and Applied Neuroscience (NISAN), Auckland University of Technology, Auckland, New Zealand.

Objectives: To identify which aspects of initial clinical assessment for sport-related mild traumatic brain injury (SR-mTBI) predict whether an athlete achieves symptom resolution within 14 days of the injury.

Research Design: Retrospective cohort study using prospectively collected data.

Methods: Clinical assessment data were collected from 568 patients diagnosed with SR-mTBI at a single medical clinic between February 2017 and December 2018. Demographic data, medical history, SCAT-5 testing, and physician notes were included in the data set. Data were processed and analysed to identify a shortlist of predictor variables to develop a logistic regression model to discriminate between SR-mTBI symptom resolution that occurred in ≤ 14-days or > 14-days. The data were randomly divided into model development and validation subsamples. The top 15 models were analysed to determine the predictor variables to be included in the final logistic regression model. The final model was then applied to the validation subsample.

Results: Half of the athlete participants in this study experienced > 14-day symptom resolution. The final logistic regression model included sex, symptom reporting at initial assessment and presentation with a physiological predominant symptom cluster. The model accounted for 0.90 and 0.85 of the area under the curve and predicted recovery trajectory with 81% and 76% accuracy for the training and validation subsamples, respectively.

Conclusions: Being female, reporting a higher Positive Symptom Total at initial assessment, and being less likely to have a physiological predominant symptom cluster at initial assessment predicted > 14 versus ≤ 14-day SR-mTBI symptom resolution with a high level of accuracy.
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http://dx.doi.org/10.1007/s40279-019-01240-4DOI Listing
June 2020

The association between health-related quality of life and noise or light sensitivity in survivors of a mild traumatic brain injury.

Qual Life Res 2020 Mar 30;29(3):665-672. Epub 2019 Oct 30.

Department of Psychology, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.

Purpose: Sensory impairment is a common aftereffect of mild traumatic brain injury (TBI); however, their influence upon treatment outcomes and quality of life has yet to be investigated. This study sought to determine the effects of noise and light sensitivity upon the quality of life of individuals diagnosed with a TBI.

Methods: A cross-sectional adult sample obtained from a longitudinal study (n = 293) provided measures of light and noise sensitivity and quality of life 12 months post injury. Sensitivities were taken from the Rivermead Post-concussion Symptoms Questionnaire, while quality of life was estimated using the Short-Form 36 health survey (SF-36).

Results: Approximately 42% of participants reported ongoing difficulties with noise and light sensitivity. Additionally, those reporting sensory difficulties also reported lower SF-36 domain and composite scores compared to those reporting no such symptoms. After controlling for known co-factors, hierarchical multiple regression analyses indicated that the combination of light and noise sensitivity explained between 8 and 35% of the variance in SF-36 scores.

Conclusions: Light and noise sensitivity appear to degrade the quality of life of those with a mild TBI. Our findings challenge contemporary rehabilitation practices that tend to sideline sensory complaints and instead focus on the remediation of acute TBI symptoms.
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http://dx.doi.org/10.1007/s11136-019-02346-yDOI Listing
March 2020

Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies.

N Z Med J 2019 09 20;132(1502):40-54. Epub 2019 Sep 20.

National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland, on behalf of the BIONIC and ARCOS-IV study groups.

Aims: Traumatic Brain Injury (TBI) and stroke are the main causes of acquired brain injury. The differences in demographic profiles of stroke and TBI suggest that high-quality epidemiological studies of the two be compared. This study examined incidence of stroke and TBI by age and ethnicity in New Zealand.

Methods: Incidence rates are presented by age and ethnicity from two New Zealand population-based epidemiological studies (Brain Injury Outcomes New Zealand In the Community (BIONIC); and Auckland Regional Outcomes of Stroke Studies (ARCOS-IV)).

Results: Males and females had similar stroke risk, while males had 2x relative risk of mild TBI and 3x the relative risk of moderate/severe TBI compared to females. More TBI cases (35.6%) were identified through non-medical sources compared to stroke (3%). Incidence of TBI was greater than 5 times that of stroke. New Zealand European/Pākehā had the highest TBI incidence when less than 5 years of age, while Māori had the highest incidence after five years of age. For stroke, Pacific people and Māori had higher incidences until 75-84 years, after which Europeans had higher incidence.

Conclusions: Differences in TBI and stroke incidence suggest targeting prevention very differently for the two groups. Incidence profiles suggest TBI is much more common; and a need to target males and those of Māori ethnicity for TBI prevention.
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September 2019

Associations between brain drawings following mild traumatic brain injury and negative illness perceptions and post-concussion symptoms at 4 years.

J Health Psychol 2019 09 1;24(10):1448-1458. Epub 2017 Mar 1.

1 Auckland University of Technology, New Zealand.

Characteristics of patient's drawings have been linked to short-term health-related outcomes across a range of health conditions. This study examined associations between brain drawings at 1 month and illness perceptions and post-concussion symptoms at 4 years in 92 adults following mild traumatic brain injury. Greater damage depicted at 1 month was correlated with perceived greater impact on life, duration of injury, symptoms of brain injury, emotional consequences and late-onset post-concussion symptoms. Results indicate that brain drawings shortly after traumatic brain injury offer a simple and insightful tool that may help to identify those who need additional support to improve long-term outcomes.
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http://dx.doi.org/10.1177/1359105317695430DOI Listing
September 2019

Prevalence of Charcot-Marie-Tooth disease across the lifespan: a population-based epidemiological study.

BMJ Open 2019 06 14;9(6):e029240. Epub 2019 Jun 14.

Auckland City Hospital, Auckland, New Zealand.

Objectives: This population-based study aimed to determine age-standardised prevalence of Charcot-Marie-Tooth disease (CMT) across the lifespan using multiple case ascertainment sources.

Design: Point-prevalence epidemiological study in the Auckland Region of New Zealand (NZ).

Setting: Multiple case ascertainment sources including primary care centres, hospital services, neuromuscular disease registry, community-based organisations and self-referral were used to identify potentially eligible participants.

Participants: Adults (≥16 years, n=207, 87.7%) and children (<16 years, n=29, 12.3%) with a confirmed clinical or molecular diagnosis of CMT, hereditary sensory neuropathy, hereditary motor neuropathy or hereditary neuropathy with liability to pressure palsies who resided in the Auckland Region of NZ on 1 June 2016.

Primary Outcome: Prevalence per 100 000 persons with 95% CIs by subtype, age and sex were calculated and standardised to the world population.

Results: Age-standardised point prevalence of all CMT cases was 15.7 per 100 000 (95% CI 11.6 to 21.0). Highest prevalence was identified in those aged 50-64 years 25.2 per 100 000 (95% CI 19.4 to 32.6). Males had a higher prevalence (16.6 per 100 000, 95% CI 10.9 to 25.2) than females (14.6 per 100 000, 95% CI 9.6 to 22.4). Prevalence of CMT1A was 6.9 per 100 000 (95% CI 5.6 to 8.4). The majority (93.2%) of cases were identified through medical records, with 6.8% of cases uniquely identified through community sources.

Conclusions: A small but significant proportion of people with CMT are not connected to healthcare services. Epidemiological studies using medical records alone to identify cases may risk underestimating prevalence. Further studies using population-based methods and reporting age-standardised prevalence are needed to improve global understanding of the epidemiology of CMT.
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http://dx.doi.org/10.1136/bmjopen-2019-029240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585838PMC
June 2019

Longitudinal patterns of behavior, cognition, and quality of life after mild traumatic brain injury in children: BIONIC study findings.

Brain Inj 2019 23;33(7):884-893. Epub 2019 Apr 23.

e BIONIC Study Group members listed below.

: Research following mild traumatic brain injury (mTBI) during childhood predominantly examines recovery up to 12 months post-injury. : To determine children's longer-term (4 years) patterns and predictors of recovery. : Parents of 196 children (aged 1-15 years) completed the Behaviour Assessment System for Children and Pediatric Quality of Life Inventory at baseline, 1, 6, 12, and 48 months post-injury. Children aged ≥8 years at each assessment completed a computerized neurocognitive testing battery. At 1 month, parents completed the Hospital Anxiety and Depression Scale. Multilevel modeling accounted for repeated measures. : Children had significantly fewer child behavior problems, better adaptability, and improved quality of life after 12 months. Concurrent improvements in overall neurocognitive function were no longer significant once adjusted for age, gender, and socio-economic status. From 12 to 48 months, quality of life reduced significantly while child behavior and neurocognition plateaued. Child behavior problems and worse quality of life were associated with parental anxiety and lower socio-economic satus. : Children's recovery in the year following mTBI appears to plateau from 12 to 48 months, with a concomitant reduction in quality of life. Identification and treatment of parent mental health issues may reduce the exacerbation of negative child outcomes following mTBI.
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http://dx.doi.org/10.1080/02699052.2019.1606445DOI Listing
April 2020

Clinical correlates of noise sensitivity in patients with acute TBI.

Brain Inj 2019 21;33(8):1050-1058. Epub 2019 Apr 21.

a Department of Psychology , Auckland University of Technology , Auckland , New Zealand.

: The impact of noise sensitivity (NS) on the daily functioning of people who have experienced a traumatic brain injury (mTBI) is an understudied area, particularly following mTBI. The primary objective of this cross-sectional study was to investigate clinical markers of NS in a sample of New Zealand adults following mTBI. : Cross-sectional study. : A community-based sample of 151 adults who had experienced a brain injury in the last two weeks completed assessments estimating cognitive functioning, postconcussion symptoms (including NS), and affective state. : Over half the sample (59%) reported some degree of NS. Exploratory statistical analyses indicated that NS was associated with being female, living in a rural area, number of previous brain injuries, cognitive flexibility scores, reaction time, perceptions of recovery, anxiety, and depression. Regression analyses revealed that anxiety was the dominant correlate of NS (B = .120, < .001, 95% CI [0.069, 1.71]). : As the first study to explore the correlates of NS following mild TBI, the findings have important clinical and research implications. The present findings suggest that treatment approaches targeting anxiety may be effective in reducing NS in people who have experienced a brain injury. Moreover, evidence is presented suggesting that NS is unlikely to reflect malingering, and should be treated as a genuine somatic symptom of brain injury.
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http://dx.doi.org/10.1080/02699052.2019.1606443DOI Listing
July 2020

Social cognition four years after mild-TBI: An age-matched prospective longitudinal cohort study.

Neuropsychology 2019 May 28;33(4):560-567. Epub 2019 Mar 28.

National Institute for Stroke and Applied Neuroscience, Auckland University of Technology.

Objective: To assess longer-term social cognition after mild traumatic brain injury (mTBI) and to identify the sociodemographic and acute factors (mood, cognitive functioning, and symptoms) influencing social cognition.

Method: Data were extracted for 121 adults who experienced a mTBI and completed the Emotion Evaluation and Social Inference Enriched tests of The Awareness of Social Inference Test (TASIT) 4 years postinjury. To identify early indicators of outcome, responses to the Hospital Anxiety and Depression Scale, Rivermead Post-Concussion Symptom Questionnaire, and CNS Vital Signs neurocognitive assessment conducted 1 month postinjury were also extracted. Social cognition scores were compared to age-matched TASIT norms (N = 121).

Results: The mTBI group was significantly less able to interpret what people say and intend than norms, although the effect sizes were small (d = 0.43). There were 24.8% of people 4 years postmTBI and 9.9% of norms who experienced at least mild impairment in social inference. There were no significant differences between the mTBI group and norms for emotion evaluation. Poorer social inference 4 years after mTBI was significantly associated with lower cognitive flexibility and executive function (F = 2.57, df = 13,26, p = .02). Group differences remained after controlling for cognitive functioning (F = 104.59 df = 1,58, p = .001.

Conclusions: These novel results suggest that adults postmTBI may experience social inference difficulties 4 years post-TBI that are not completely explained by cognitive difficulties. Further research is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000516DOI Listing
May 2019
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