Search Our Scientific Publications & Authors

J Neurotrauma 2021 May 10. Epub 2021 May 10.

Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

In this prospective cohort study, we investigated associations between acute diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) metrics and persistent post-concussion symptoms (PPCS) 3 months after mild traumatic brain injury (mTBI). Adult patients with mTBI ( = 176) and community controls ( = 78) underwent 3 Tesla magnetic resonance imaging (MRI) within 72 h post-injury, estimation of cognitive reserve at 2 weeks, and PPCS assessment at 3 months. Eight DTI and DKI metrics were examined with Tract-Based Spatial Statistics. Read More

Rev Med Chil 2020 Dec;148(12):1796-1805

Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. Read More

Med Sci (Basel) 2021 Mar 25;9(2). Epub 2021 Mar 25.

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15232, USA.

Neuroelectric measures derived from human magnetoencephalographic (MEG) recordings hold promise as aides to diagnosis and treatment monitoring and targeting for chronic sequelae of traumatic brain injury (TBI). This study tests novel MEG-derived regional brain measures of tonic neuroelectric activation for long-term test-retest reliability and sensitivity to symptoms. Resting state MEG recordings were obtained from a normative cohort, Cambridge Centre for Ageing and Neuroscience (CamCAN), baseline: = 619; 16-month follow-up: = 253) and a chronic symptomatic TBI cohort, Targeted Evaluation, Action and Monitoring of Traumatic Brain Injury (TEAM-TBI), baseline: = 64; 6-month follow-up: = 39). Read More

Can J Neurol Sci 2021 Mar 26:1-9. Epub 2021 Mar 26.

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Objective: To assess demographic, clinical, and injury characteristics associated with health-related quality of life (HRQOL) in adults with persistent post-concussion symptoms (PPCS).

Methods: Adults with PPCS presenting to a specialized brain injury clinic completed demographic, injury, and clinical outcome questionnaires at the initial clinic assessment. Clinical outcome measures were collected including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and the Fatigue Severity Scale (FSS). Read More

Ann Acad Med Singap 2021 02;50(2):119-125

Department of Paediatrics, KK Women and Children's Hospital, Singapore.

Introduction: Head injuries occur commonly in children and can lead to concussion injuries. We aim to describe the epidemiology of head injuries among school-going children and identify predictors of brain concussions in Singapore.

Methods: This is a retrospective study of children 7-16 years old who presented to the Emergency Department (ED) of KK Women's and Children's Hospital in Singapore with minor head injury between June 2017 and August 2018. Read More

Injury 2021 May 9;52(5):1227-1233. Epub 2021 Mar 9.

Faculty of Welfare and Health Sciences, University of Haifa, Abba Khoushy Ave 199, Haifa, Israel. Electronic address:

Background And Aim: Although post-motor vehicle collision (MVC) pain and symptoms are largely convergent among those with mild traumatic brain injury (mTBI) and whiplash associated disorder (WAD), and patients oftentimes report initial neck and head complaints, the clinical picture of mTBI and WAD has been primarily studied as separate conditions which may result in an incomplete clinical picture. As such, this study was conducted to explore the role of pain and post-traumatic psychological features in explaining both head and neck-related symptom variability in a cohort of post-collision patients. This is with the goal of disentangling if contributory factors are uniquely related to each diagnosis, or are shared between the two. Read More

Front Neurol 2021 23;12:614648. Epub 2021 Feb 23.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.

Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. Read More

Expert Rev Neurother 2021 Apr 26;21(4):475-490. Epub 2021 Apr 26.

Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

Introduction: Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients. Read More

J Clin Med 2021 Feb 17;10(4). Epub 2021 Feb 17.

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.

Little is known about post-concussion-like symptoms in the general injury population and the association of these symptoms with outcome after injury. This study aimed to assess the prevalence of post-concussion-like symptoms in a general injury population and describe the association between post-concussion syndrome (PCS) and health-related quality of life (HRQL), health care use, and return to work. In this longitudinal study of a cohort of injury patients, data were collected 6 and 12 months after their Emergency Department visit. Read More

J Neurosurg Pediatr 2021 Feb 26:1-10. Epub 2021 Feb 26.

1Department of Neurosurgery, University Hospital Heidelberg, Germany.

Objective: The aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment.

Methods: Patients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13-15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. Read More

JAMA Netw Open 2021 02 1;4(2):e210207. Epub 2021 Feb 1.

Seattle Children's Research Institute, Center for Child Health, Behavior and Development, University of Washington, Seattle.

Importance: Despite the high level of impairment for adolescents with persistent postconcussive symptoms, few studies have tested whether such problems can be remediated.

Objective: To examine whether collaborative care treatment is associated with improvements in postconcussive, quality of life, anxiety, and depressive symptoms over 1 year, compared with usual care.

Design, Setting, And Participants: The Collaborative Care Model for Treatment of Persistent Symptoms After Concussion Among Youth II Trial was a randomized clinical trial conducted from March 2017 to May 2020 with follow-up assessments at 3, 6, and 12 months. Read More

SAGE Open Med Case Rep 2021 21;9:2050313X20952224. Epub 2021 Jan 21.

Registered Occupational Therapist, CranioSacral Therapy-Diplomat, Special Therapies, Inc., Waukesha, WI, USA.

This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Read More

Ann Emerg Med 2021 03;77(3):327-337

Department of Emergency Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.

Study Objective: We measure the effect of video discharge instructions on postconcussion symptoms in patients with mild traumatic brain injury in the emergency department.

Methods: A multicenter randomized controlled trial was conducted in which patients with mild traumatic brain injury were randomly assigned to either intervention (verbal, written, and video discharge information) or control (verbal and written discharge information only). All patients were interviewed 1 week and 3 months from randomization. Read More

Int J Sports Phys Ther 2021 Feb 1;16(1):248-258. Epub 2021 Feb 1.

Department of Physical Therapy, Mercer University, Atlanta, GA, USA.

Background And Purpose: Less than half of patients discharged from the emergency department post-concussion receive patient education or follow-up care, and 10-20% of individuals will develop symptoms that last longer than six months. Current research on interventions for post-concussion syndrome (PCS) shows inconsistent results, and recommendations for effective physical therapy treatment for patients with chronic PCS are lacking. The purpose of this case report is to highlight a successful, multi-system approach to physical therapy examination and treatment of a patient with chronic PCS. Read More

Int J Sports Phys Ther 2021 Feb 1;16(1):12-20. Epub 2021 Feb 1.

Park City Hospital, Intermountain Healthcare.

Background: After concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged.

Purpose: This study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy. Read More

Br J Neurosurg 2021 Feb 10:1-6. Epub 2021 Feb 10.

Clinic of Neurosurgery, University Clinical Center of Kosovo, Prishtina, Kosovo.

Introduction: Among children who sustain mild traumatic brain injury (mTBI), 10-30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7-10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients. Read More

Sports Health 2021 Feb 2:1941738120970515. Epub 2021 Feb 2.

Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Read More

J Int Neuropsychol Soc 2021 Jan 29:1-12. Epub 2021 Jan 29.

Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Objective: Despite consensus that personality influences mild traumatic brain injury (mTBI) recovery, it has been underexamined. We evaluated the extent to which diverse personality and psychiatric symptom dimensions predict mTBI recovery.

Methods: This prospective cohort study involved psychological assessments of hospital patients with mTBI (n = 75; median = 2 days post-injury, range = 0-12 days) and orthopedic trauma controls (OTC; n = 79) who were used for comparison in mediation modeling. Read More

J Rehabil Med 2021 Feb 5;53(2):jrm00149. Epub 2021 Feb 5.

Department of Clinical Science, Karolinska Institutet, 18288 Stockholm, Sweden. E-mail:

Objective: To determine the effectiveness of specialized rehabilitation in adults with prolonged symptoms, or risk of prolonged symptoms, following mild traumatic brain injury.

Data Sources: Randomized controlled trials or non-randomized controlled studies published between 1 Jan 2000 and 10 Mar 2019 in Cochrane Controlled Register of Trials, PubMed, EMBASE, CINAHL or PsycINFO. Meta-analyses were performed for studies of similar interventions when identical or comparable outcomes were reported. Read More

Trauma Surg Acute Care Open 2021 7;6(1):e000608. Epub 2021 Jan 7.

Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA.

Recent military conflicts in Iraq and Afghanistan have resulted in the significant increase in blast-related traumatic brain injury (TBI), leading to increased Department of Defense interest in its potential long-term effects ranging from the mildest head injuries termed subconcussive trauma to the most debilitating termed chronic traumatic encephalopathy (CTE). Most patients with mild TBI will recover quickly while others report persistent symptoms called postconcussive syndrome. Repeated concussive and subconcussive head injuries result in neurodegenerative conditions that may hinder the injured for years. Read More

J Can Chiropr Assoc 2020 Dec;64(3):214-226

Canadian Memorial Chiropractic College.

This case series describes the multi-modal treatment plans delivered by two chiropractic sports specialists for the management of post-concussive symptoms (PCS). Three concussion cases are presented each with different mechanisms of injury (two sportrelated and one non-sport-related) and each within a different stage of recovery (acute, sub-acute, and chronic). Treatment plans included patient education, sub-symptom threshold exercise, soft-tissue therapy, spinal manipulation, and cervical spine as well as visual/vestibular rehabilitation exercises. Read More

JAMA Neurol 2021 May;78(5):596-608

Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: Mild traumatic brain injury (TBI) is experienced by 55.9 million people globally each year. The symptoms of mild TBI are diverse and sometimes long-lasting, requiring frequent use of pharmacological interventions to mitigate them. Read More

Brain Inj 2021 Jan 16;35(1):103-113. Epub 2021 Jan 16.

Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.

:The most widely used proxies of cognitive complaint after mTBI are post-concussion syndrome (PCS) symptom checklists, which do not have a clear relationship with cognition. This study investigated whether an mTBI-specific cognitive complaint measure would have clearer associations with objective cognition than a widely used PCS symptom checklist.:An observational design was used. Read More

Front Hum Neurosci 2020 11;14:598208. Epub 2020 Dec 11.

School of Psychological Science, University of Western Australia, Perth, WA, Australia.

Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Read More

Percept Mot Skills 2021 Apr 24;128(2):714-730. Epub 2020 Dec 24.

Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States.

Recent research findings have strongly suggested that sport-related concussion (SRC) increases risk for subsequent injury of any type, as well as a potential for long-term adverse effects on neurological and psychological well-being. The primary purpose of this study was to explore the reliability and discriminatory power of clinical testing procedures for detecting persisting effects of SRC. We used a cross-sectional study design to assess both self-reported symptoms commonly associated with post-concussion syndrome, and the effects of mental or physical activity on metrics derived from a smartphone app designed to test perceptual-motor responses. Read More

J Clin Nurs 2021 Mar 2;30(5-6):793-802. Epub 2021 Jan 2.

Stanford Children's Hospital, Palo Alto, CA, USA.

Background And Purpose: The Centers for Disease Control and Prevention estimates that 3.8 million concussions occur in the United States each year. Concussion symptoms can negatively impact the academic performance of adolescents after they return to school. Read More

Brain Sci 2020 Dec 17;10(12). Epub 2020 Dec 17.

Department of Neurology, Carrick Institute, Cape Canaveral, FL 32920, USA.

Balance control systems involve complex systems directing muscle activity to prevent internal and external influences that destabilize posture, especially when body positions change. The computerized dynamic posturography stability score has been established to be the most repeatable posturographic measure using variations of the modified Clinical Test of Sensory Integration in Balance (mCTSIB). However, the mCTSIB is a standard group of tests relying largely on eyes-open and -closed standing positions with the head in a neutral position, associated with probability of missing postural instabilities associated with head positions off the neutral plane. Read More

Sci Rep 2020 12 15;10(1):21982. Epub 2020 Dec 15.

Rehabilitation Sciences Institute, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.

Concussions are associated with a range of cognitive, neuropsychological and behavioral sequelae that, at times, persist beyond typical recovery times and are referred to as postconcussion syndrome (PCS). There is growing support that concussion can disrupt network-based connectivity post-injury. To date, a significant knowledge gap remains regarding the sex-specific impact of concussion on resting state functional connectivity (rs-FC). Read More

Brain Inj 2021 Jan 10;35(1):48-58. Epub 2020 Dec 10.

Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.

: To investigate the feasibility, tolerability, and efficacy of twice-daily, low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (DLPFC) in the reduction of chronic post-concussion symptoms (PCS) in patients who have suffered a mild traumatic brain injury (mTBI).: 15 patients with mTBI received 30 sessions of twice-daily LF rTMS (1 Hz) over the right DLPFC. Post-concussion symptoms, pain, disability, fatigue, apathy, agitation, and mood were assessed by a psychiatrist pre- and post-treatment. Read More

Clin Neuropsychol 2020 Dec 9:1-40. Epub 2020 Dec 9.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, MassGeneral Hospital for ChildrenTM Sports Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA.

This study examined factor models for the Post-Concussion Symptom Scale (PCSS) at baseline and after suspected sport-related concussion, and measurement invariance from pre-injury to post-injury assessments and across age, gender, and health history groups (e.g., attention-deficit/hyperactivity disorder, psychiatric history). Read More