Summarized by Theresa Ebo, MA

March 2024

Traumatic brain injury (TBI) is a life-changing event that can produce anywhere from mild life functioning impairments to lasting disability. The natural course of recovery for individuals who have experienced a moderate to severe TBI (msTBI) differs from the acute to chronic phases of recovery. While the initial impairment and associated need for care may be profound, this presentation does not necessarily translate into an unfavorable long-term functional outcome. The Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study aimed to systematically monitor patients’ functional outcomes after a TBI. The patients were observed from two weeks post-injury to 12-months, during which they received inpatient or outpatient rehabilitation services. The goal of the study was to assess the frequency and extent of recovery, from two weeks to 12 months, for patients who suffered moderate to severe TBI. The study included 484 individuals who presented to a level-one trauma center within 24 hours of their injury. The cause of injury included being an occupant or pedestrian in a motor vehicle crash, motorcycle crash, fall, assault, or other reason.

The results provide a positive outlook on recovery for patients with moderate to severe TBI. While 94% of the severe TBI and 79% of the moderate TBI group reported moderate to severe disability and required assistance with the basic aspects of their everyday lives at 12 months post-injury (i.e., feeding, using the toilet, and grooming themselves), a significant portion of the participants with msTBI had major improvements in life functioning, with many regaining their independence between 2 weeks to 12 months after their injury. More specifically, half of the severe group and three-quarters of the moderate group were able to function independently at home for at least eight hours per day. By 12 months, 62 out of 79 participants who were in a vegetative state at two weeks post-injury regained consciousness and 14 regained their orientation.

The article’s findings suggest that patients with msTBI experienced significant functional improvement as early as two weeks post-injury. By the end of the study (i.e., 12 months), patients saw improvement, though variable across participants, including independence at home; ability to shop; and improved work capacity and social functioning. While many participants’ impairments persisted at 12-months post injury, this study revealed that a significant percentage of patients with grave impairment during the early stage of recovery achieved favorable outcomes months later. Thus, impairments in patients with msTBI at two weeks post injury does not necessarily translate to poor long-term recovery.

The study investigates long-term outcomes (i.e., 12 months post-injury) of patients with moderate to severe TBI. The authors acknowledged some limitations, including that the definition of a favorable outcome varies from person to person. Additionally, while the study’s measures are widely accepted in TBI outcome research, they do not reflect all aspects and variables of clinical recovery. Further, two-week outcome ratings may have been influenced by sedating medications administered to the participants at that time. Finally, the study was conducted in settings with established clinical systems of care (i.e., level 1 trauma centers), which may limit the generalizability of the results to patients who may receive care in other settings.

10.1001/jamaneurol.2021.2043

Summarized by Dr. Ally Ferber, MD

February 2024

The article talks about athletes who experience a concussion while playing sports. A concussion is a type of brain injury that can happen when the head is hit hard or moves very quickly. This impact can lead to changes in how the brain works, affecting the cells (neurons) and causing different symptoms.

The article focuses on symptoms related to the vestibular-ocular-motor (VOM) system and how they impact an athlete’s return to sports and school performance. The VOM system involves balance, vision, and movement. If this system is disrupted, it can cause issues like dizziness, nausea, blurred vision, and difficulty reading.

Testing for problems in the VOM system isn’t common yet, but the article suggests it could be helpful. Using a screening tool to identify athletes with balance, vision, and movement issues, they found that those with symptoms in this system took longer to recover, had more severe symptoms, missed more school, and needed more time overall to get better.

In summary, using the VOM screening tool in the first two weeks after a sports-related concussion might help doctors identify athletes with specific issues. This can give athletes and their families an idea of how long the recovery might take, when they can return to sports, and when they can go back to school. It also allows doctors to recommend specific exercises to help athletes heal better.

https://pubmed.ncbi.nlm.nih.gov/33896286/

Summarized by Teja Makkapati, MD

January 2024

When someone ends up in the hospital, there is a high chance they might not be getting the right amount of nutrition, especially if they have experienced a traumatic brain injury (TBI). TBIs require extra nutrients for the brain to heal properly. Studies suggest that a large number of hospitalized patients, about 20-50%, end up malnourished, however there is not much research on how this specifically affects TBI patients.

For people with TBIs , their bodies go into overdrive trying to heal the brain. This means they need more calories and protein than usual. The study “Determination of calorie and protein intake among acute and sub-acute traumatic brain injury patients” looked at the dietary habits of 50 TBI patients to see how well they were eating during their hospital stay. They looked at their daily food intake, considering things like body mass index (BMI), age, and gender in their calculations.

The results showed that the more severe the TBI, the less people ate. Even though eating improved a bit over time, it still was no’t enough to meet their calorie needs. The most common reasons for this are pain, discomfort, and emotional issues after the injury which makes individuals want to eat less.

In summary, people with TBIs are not getting the nutrition they need, and those with more severe injuries are at a higher risk of developing malnutrition. This is a population at high risk of being malnourished and more studies are needed to find ways to help these patients get the right nutrition during their hospital stay for a quicker recovery.

https://pubmed.ncbi.nlm.nih.gov/32423779/

Summarized by Dr. Hannah Park

December 2023

Poor sleep is very common after a traumatic brain injury (TBI), and it affects more than 50% of patients. These sleep disturbances can include less total time sleeping, waking up from sleep more frequently, having poor quality sleep, and not feeling well-rested after sleep. Insomnia, or difficulty falling asleep, is the most common sleep disorder seen after a TBI and affects 50-70% of patients.

The reason why sleep disturbances develop after a TBI is not fully understood, but several theories include changes in hormones that affect our sleep/wake cycle, including melatonin and orexin/hypocretin. Also, TBI patients can develop mood disorders like anxiety and depression that makes it more difficult to get good quality sleep. Melatonin is a hormone naturally produced in the brain by the pineal gland. It has been used to help treat patients with circadian rhythm disorders such as insomnia, and it has been shown to improve the quality of sleep, how long it takes to fall asleep, and reducing waking up during the night.

The Utility of Melatonin for the Treatment of Sleep Disturbance After Traumatic Brain Injury: A Scoping Review. This study from 2023 looked at other research articles studying melatonin use after TBI, and they chose 9 articles to evaluate with a total of 251 participants including adults and kids. These studies were from all around the world and included all severities of TBI, from mild to severe. For the medications, they used either melatonin, Circadin (an melatonin that is slowly released throughout the day), or Ramelton (a drug that activates melatonin receptors) at doses between 2 to 10mg, and they took these medications for 3 to 12 weeks.

8 out of the 9 studies reported positive outcomes after melatonin treatment. Overall, patients had improved sleep duration, sleep quality, and daytime alertness. Melatonin also improved some mental health symptoms (anxiety and depression), cognitive function, and memory. Patients who had worse sleep patterns before starting melatonin had better responses. There were no serious adverse events with treatment of melatonin in adults and children up to doses of 10mg.

Interestingly, the medications studied caused some TBI patients to take the same amount of time to fall asleep or even more time to fall asleep by up to 5 minutes. This is different from other studies in non-TBI patients, where the medications helped patients to fall asleep more quickly. More research needs to be done to further examine this effect of the melatonin medications.

In conclusion, sleep disturbances are commonly seen after TBI, especially mild TBI. They can last for several years after an injury and make recovery more difficult because the brain doesn’t get proper rest and time to heal. Feeling tired during the day can also make it more difficult to participate in the therapies that will help with recovery. Melatonin and its related medications can help to reduce the effects and symptoms of sleep disturbances and has been well-tolerated in adults and kids. We need to do more research comparing the efficacy of these medications with other interventions like cognitive behavioral therapy, improved sleep hygiene, and alternative medications. For now, if you have a loved one who is suffering from sleep disturbances after TBI, it is reasonable to try adding melatonin under the direction of your doctors.

https://pubmed.ncbi.nlm.nih.gov/36243124/