Objectives: This report examined theta-band neurodynamics for potential biomarkers of brain health in athletes with concussion. Methods: Participants included college-age contact/collision athletes with (N=24) and without a history of concussion (N=16) in Study 1. Study 2 (N=10) examined changes over time in contact/collision athletes. There were two primary dependent variables: (1) theta-band phase-synchronization (e.g., functional connectivity) between medial and right-lateral electrodes; and (2) the within-subject correlation between synchronization strength on error trials and post-error reaction time (i.e., operationalization of cognitive control). Results: Head injury history was inversely related with medial-lateral connectivity. Head injury was also related to declines in a neurobehavioral measure of cognitive control (i.e., the single-trial relationship between connectivity and post-error slowing). Conclusions: Results align with a theory of connectivity-mediated cognitive control. Mild injuries undetectable by behavioral measures may still be apparent on direct measures of neural functioning. This report demonstrates that connectivity and cognitive control measures may be useful for tracking recovery from concussion. Theoretically relevant neuroscientific findings in healthy adults may have applications in patient populations, especially with regard to monitoring brain health. (JINS 2019, 25, 314–323)

Objectives: This study investigated the relationship between on-field, objective signs immediately following sport-related concussion and self-reported symptom endorsement within 1 day post injury. Methods: A retrospective case series of 237 concussed high school athletes was performed. On-field signs were evaluated immediately post injury. Self-reported symptoms (2 clusters) were collected within 1 day post injury. A two-step structural equation model and follow-up bivariate regression analyses of significant on-field signs and symptom clusters were performed. Results: Signs of immediate memory, β=0.20, p=.04, and postural instability, β=0.19, p < .01, significantly predicted a greater likelihood of endorsing the cognitive-migraine-fatigue symptom cluster within 1 day post injury. Regarding signs correlated with specific symptoms, immediate memory was associated with symptoms of trouble remembering, χ 2 =37.92, p < .001, odds ratio (OR)=3.89 (95% confidence interval (CI) [2.47, 6.13]), and concentration difficulties, χ 2 =10.84, p=.001, OR=2.13 (95% CI [1.37, 3.30]). Postural instability was associated with symptom endorsement of trouble remembering, χ 2 =12.08, p < .001, OR=1.76 (95% CI [1.29, 2.40]). Conclusions: Certain post-concussion on-field signs exhibited after injury were associated with specific symptom endorsement within 1 day post injury. Based on these associations, individualized education-based interventions and academic accommodations may help reduce unanticipated worry from parents, students, and teachers following a student-athlete’s sport-related concussion, especially in cases of delayed onset symptoms. (JINS, 2018, 24, 476–485)

Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone. (JINS, 2012, 18, 576–584)

This study examines rates of reporting of new or worse post-traumatic symptoms for patients with a broad range of injury severity at 1 month and 1 year after traumatic brain injury (TBI), as compared with those whose injury spared the head, and assesses variables related to symptom reporting at 1 year post-injury. Seven hundred thirty two TBI subjects and 120 general trauma comparison (TC) subjects provided new or worse symptom information at 1 month and/or 1 year post-injury. Symptom reporting at 1 year post-injury was compared in subgroups based on basic demographics, preexisting conditions, and severity of brain injury. The TBI group reported significantly more symptoms at 1 month and 1 year after injury than TCs (each p < .001). Although symptom endorsement declined from 1 month to 1 year, 53% of people with TBI and 24% of TC continued to report 3 or more symptoms at 1 year post-injury. Symptom reporting in the TBI group was significantly related to age, gender, preinjury alcohol abuse, pre-injury psychiatric history, and severity of TBI. Symptom reporting is common following a traumatic injury and continues to be experienced by a substantial number of TBI subjects of all severity levels at 1 year post-injury. (JINS, 2010, 16, 401–411.)

The primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3–6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent–child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes. (JINS, 2010, 16, 157–168.)

The dimensions of postconcussive symptoms (PCS) were examined in a prospective, longitudinal study of 186 8 to 15 year old children with mild traumatic brain injuries (TBI). Parents and children completed a 50-item questionnaire within 2 weeks of injury and again at 3 months after injury, rating the frequency of PCS on a 4-point scale. Common factor analysis with target rotation was used to rotate the ratings to four hypothesized dimensions, representing cognitive, somatic, emotional, and behavioral symptoms. The rotated factor matrix for baseline parent ratings was consistent with the target matrix. The rotated matrix for baseline child ratings was consistent with the target matrix for cognitive and somatic symptoms but not for emotional and behavioral symptoms. The rotated matrices for ratings obtained 3 months after injury were largely consistent with the target matrix derived from analyses of baseline ratings, except that parent ratings of behavioral symptoms did not cluster as before. Parent and child ratings of PCS following mild TBI yield consistent factors reflecting cognitive and somatic symptom dimensions, but dimensions of emotional and behavioral symptoms are less robust across time and raters. (JINS, 2009, 15, 19–30.)

The present study explores the construct and ecological validity of the Biber Cognitive Estimation Test (BCET) in a traumatic brain injury (TBI) sample. Participants completed the BCET in the course of a neuropsychological evaluation at 1–15 years after injury. BCET scores correlated moderately with other standard measures of executive functioning, and contrary to our hypotheses, at least as high with neuropsychological tests with minimal demands on executive functioning. Moreover, partialing out the portion of BCET variance not attributable to executive functioning markedly attenuated the former correlations. With respect to ecological validity, BCET scores did not predict concurrent functional status, as measured by the Disability Rating Scale. By comparison, standard measures of executive functioning strongly correlated with each other, correlated less strongly with nonexecutive functioning measures, and predicted functional status. In conclusion, unlike standard measures of executive functioning, the BCET demonstrated poor construct and ecological validity in TBI patients.(JINS, 2007, 13, 898–902.)

Although substantial information exists about factors related to who returns to work and time taken to return to work after traumatic brain injury (TBI), less is known about the stability of the work experience after the injury. One hundred sixty-five workers with complicated mild to severe traumatic brain injury were followed for 3 to 5 years postinjury. Work stability definitions included amount of time worked (amount of time worked divided by time observed postinjury) and maintenance of uninterrupted employment once a person returned to work. Amount of time worked was significantly and systematically related to brain injury severity, neuropsychological functioning at 1-month postinjury, and preinjury characteristics such as prior work stability and earnings. However, once persons returned to work, the ability to maintain uninterrupted employment was largely related to premorbid characteristics such as being older, higher income before the injury, or a preinjury job with benefits. It was also related to higher neuropsychological functioning at 1-month postinjury (reflecting the combined effects of premorbid functioning and traumatic brain injury severity), but not related to neurologic indices of severity. (JINS, 2005, 11, 807–816.)

This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17–39 years (young drivers); 515 were 40–64 years (middle-aged), and 137 aged 65–84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p<0.001) and side (p<0.05) impact crashes. The results also show that older drivers sustained more injuries to the chest (p<0.0001) and that this body region is particularly problematic. The main sources of the chest injuries were found to be the seat belt in frontal crashes and the door in side impact crashes. As the number of older car users will increase rapidly in most OECD countries in the coming decades, the results suggest that vehicle re-designs are required, including in-vehicle crashworthiness systems, to take into account older people's relatively low tolerance of crash impacts.

There are few accounts of cochlear implantation in adults with post-traumatic sensorineural hearing loss. We report our experience with multichannel implantation in three such patients.

Two patients experienced no cognitive or communication deficits as a result of their head injury. At nine months post-implant, compared with our experience of non-head-injured implantees, these patients achieved average or above average scores on audiological performance tests.

The third patient presented with cognitive, behavioural and communicative deficits. The level of improvement achieved by this patient, when lip-reading was supplemented with electrical stimulation, in both BKB sentence and connected discourse tracking (CDT) tests was comparable with that of the non-head-injured group. However, his absolute performance at nine months post-implant was well below average. Performance at 18 months on BKB sentences and environmental sound recognition showed little change, and was again well below average, however his score on CDT with lip-reading and electrical stimulation improved considerably and was similar to the average achieved by the non-head-injured group. The major difficulties experienced with this patient were increasing depression and low implant use. Considerably more time was spent in the assessment and rehabilitation of this patient and involved liaison with a number of other agencies. When considering such patients for cochlear implantation it is strongly recommended that these additional requirements are taken into account.

Paralysis of the tongue due to isolated bilateral hypoglossal nerve palsy is a rare occurrence. Due to a trauma the cause in our case may have been a traction injury to both hypoglossal nerves at the base of skull. In some cases a contributing factor may be malformation of the skull base. Most cases have a good prognosis for recovery.

Traumatic internal carotid artery aneurysm presenting with epistaxis is rare. Epistaxis often occurs after a delay of weeks to months following head injury. The present case had bouts of recurrent massive epistaxis nearly four months after head injury. Diagnosis was made after carotid angiography. Epistaxis ceased after ipsilateral carotid ligation.

Benign paroxysmal positional vertigo (BPPV) is a self-limiting condition characterized by vertigo and nystagmus induced by certain head positions. The most common causes of BPPV are post-traumatic following head injury and post-viral labyrinthitis. We present an interesting case of BPPV following an otherwise uneventful neurosurgical removal of a parietal osteoma using hammer and chisel. Caution should be exercised during such procedures as disabling vertigo can result for a considerable period of time.