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The attached study investigates the impact of depression and post-traumatic stress (PTS) on cognitive and oculomotor performance in service members with a history of mild traumatic brain injury (mTBI). Researchers analyzed data from 188 active-duty service members, evaluating their cognitive performance using traditional neuropsychological tests and a multimodal measure called the Bethesda Eye & Attention Measure (BEAM), which assesses visual attention through manual and saccadic eye movements. Results revealed that depression and PTS significantly impair processing speed, attention, executive functions, and memory. Participants with comorbid depression and PTS had the poorest performance across cognitive and oculomotor measures. Depression was most strongly associated with slower response times and decreased processing speed, while PTS was linked to greater variability in responses and difficulties with executive functions, including inhibition. The study highlights that traditional neuropsychological tests demonstrated larger effects of depression and PTS on cognitive performance compared to BEAM measures. However, BEAM metrics provided unique insights, particularly into the consistency of response times, which can aid in distinguishing the effects of psychiatric comorbidities. These findings underscore the importance of assessing and addressing depression and PTS in the treatment of mTBI to improve cognitive and functional outcomes. The authors emphasize that depression and PTS exacerbate the cognitive challenges associated with mTBI, complicating recovery. They advocate for tailored rehabilitation approaches that address both the neurological and psychological aspects of these conditions. Future research should expand on these findings by exploring other factors, such as chronic pain and sleep disturbances, to develop more comprehensive care strategies for individuals with mTBI. Source: Hungerford L, Agtarap S, Ettenhofer M. Impact of depression and post-traumatic stress on manual and oculomotor performance in service members with a history of mild TBI.?Brain Inj.?2023;37(8):680-688. doi:10.1080/02699052.2023.2210293.

The more tools that are available in our "TBI toolbox".....the better. The attached review highlights cryoneurolysis as a promising treatment for acute and chronic pain management. Cryoneurolysis uses extreme cold to target nerve tissue, temporarily interrupting pain signals and providing prolonged pain relief. It is increasingly being used due to advancements in portable cryoneurolysis devices and ultrasound-guided techniques. The treatment has shown effectiveness in managing acute postoperative pain for procedures like thoracotomies, mastectomies, shoulder surgeries, and total knee arthroplasty (TKA). For example, studies report that cryoneurolysis can reduce postoperative pain scores, opioid use, and hospital stays. In TKA, targeting specific sensory nerves has led to improved mobility and reduced opioid dependency. Cryoneurolysis is also gaining popularity in treating chronic conditions, such as knee osteoarthritis, temporomandibular joint disorders, phantom limb pain, and neuropathic pain. Clinical cases demonstrate significant pain reductions lasting several months, improving patients' quality of life and functional capacity. Its non-invasive nature and low side effect profile make it a safer alternative to traditional nerve blocks and opioid medications. The treatment's mechanism involves applying cold temperatures to cause reversible nerve injury, interrupting pain transmission while sparing other nerve functions. As nerves regenerate over weeks to months, repeat treatments may be required, but long-term complications are rare. Despite its potential, cryoneurolysis is underutilized in clinical practice due to limited awareness, research, and standardized protocols. More large-scale studies are needed to confirm its benefits and expand its applications. However, this technique offers a valuable, non-opioid option for pain management in both surgical and office-based settings, addressing an essential need in pain medicine. Source: Ilfeld BM, Preciado J, Trescot AM. Cryoneurolysis for acute and chronic pain management: A narrative review. Reg Anesth Pain Med. 2023;48(6):359-366. doi:10.1136/rapm-2023-104026.

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Depression and other psychological symptoms like anxiety and PTSD are some of the more common symptoms we see in our offices secondary to TBI. The attached study explored the relationship between depressive symptoms and brain connectivity in patients recovering from traumatic brain injury (TBI). Depression is a common and debilitating outcome of TBI, often linked to poorer recovery and reduced quality of life. Using advanced neuroimaging techniques, the study aimed to determine if altered resting-state functional connectivity (rs-fc) between specific brain regions is associated with depressive symptoms in TBI patients. The study analyzed data from 79 TBI patients, assessing depression levels using the Beck Depression Inventory-II (BDI-II) and examining brain connectivity through functional MRI. Results showed no significant association between depression scores and brain structure, such as gray matter volume. However, depressive symptoms were strongly correlated with altered rs-fc in key brain regions involved in emotional regulation and cognitive control. The findings revealed increased connectivity between limbic regions, such as the hippocampus and amygdala, which are involved in processing emotions and memory. This heightened connectivity may contribute to a bias toward negative emotional memories, a hallmark of depression. Conversely, decreased connectivity was observed between limbic and frontal regions, including the orbitofrontal cortex, which are critical for emotion regulation and decision-making. These patterns suggest an imbalance between emotional reactivity and cognitive control in TBI-related depression. The study highlights the role of dysfunctional brain networks in the development of depression following TBI, emphasizing the need for targeted interventions. Approaches such as cognitive-behavioral therapy or neuromodulation techniques that address these connectivity issues could improve outcomes for TBI patients. Source: Luo L, Langley C, Moreno-Lopez L, Kendrick K, Menon DK, Stamatakis EA, Sahakian BJ. Depressive symptoms following traumatic brain injury are associated with resting-state functional connectivity. Psychol Med. 2023;53(11):2698-2705. doi:10.1017/S0033291721004724.

The mission that I have for raising the standard of care for mTBI (aka concussion) across the United States impacts far more than just the medicolegal arena. The attached study investigated whether individuals with a mild traumatic brain injury (mTBI) are at increased risk of engaging in criminal behavior 10 years after the injury. Using a case-control design, researchers compared 6,606 adults with mTBI to 15,771 matched controls who had sustained orthopedic injuries but no head trauma. Participants were matched on age, gender, ethnicity, socioeconomic status, and prior criminal history. The findings showed that individuals with mTBI had significantly higher rates of violent charges and convictions compared to the control group, but not for non-violent offenses. Specifically, those with a single mTBI had slightly elevated risks, while individuals with multiple mTBIs had much higher rates of violent offenses, suggesting a cumulative effect. Men with mTBI were particularly at risk, while the link between mTBI and criminal behavior was not observed in women. This highlights potential gender differences in the effects of mTBI. The study also noted that persistent symptoms, such as difficulties with attention, emotional regulation, and coping, might contribute to increased risk. These symptoms can lead to challenges in social integration and employment, potentially fostering conditions that increase the likelihood of criminal behavior. However, the study did not account for other factors like substance abuse or mental health conditions, which could also influence outcomes. The findings emphasize the importance of early diagnosis and treatment of mTBI to reduce long-term impacts. They also underscore the need for targeted interventions, particularly for individuals with multiple mTBIs or other risk factors, to mitigate the risk of engaging in violent behavior over time. Future research should further explore these relationships and examine preventative strategies. Source: Theadom A, Meehan L, McCallum S, Pacheco G. Mild traumatic brain injury increases engagement in criminal behaviour 10 years later: A case–control study. Front Psychiatry. 2023;14:1154707. doi:10.3389/fpsyt.2023.1154707.

Did you know that just a new body system was discovered in 2012? It's hard to believe that we are still finding new parts of the human body, but it's true. The glymphatic system is the brain’s system for removing waste, and this can be impaired after traumatic brain injury (TBI). Researchers used diffusion tensor imaging (DTI) along perivascular spaces (PVS) to measure fluid movement, a process essential for clearing debris and proteins that accumulate after brain injuries. The study also measured plasma neurofilament light (NfL), a blood biomarker of brain injury severity. The study involved 37 TBI patients, scanned about five months after injury, and 13 healthy controls. Results showed that the glymphatic clearance index, measured by DTI-ALPS (Analysis along the Perivascular Spaces), was significantly reduced in TBI patients compared to controls, even after accounting for age. This suggests that TBI disrupts glymphatic function. Furthermore, lower glymphatic clearance correlated with higher NfL levels, indicating that reduced waste clearance is associated with more severe brain injury. Interestingly, the volume of PVS—measured with traditional MRI—did not differ significantly between TBI patients and controls and did not correlate with NfL levels. This suggests that DTI-ALPS is a more sensitive method for assessing clearance deficits than static imaging of PVS volume. Potential causes of impaired clearance in TBI patients include inflammation, protein deposition, and sleep disruption, as sleep is known to enhance glymphatic activity. The study highlights the importance of understanding glymphatic dysfunction in TBI recovery and its role in increasing the risk of long-term neurodegenerative conditions, such as Alzheimer’s disease. Future research could focus on interventions to improve glymphatic clearance, like promoting sleep or targeting specific molecular pathways, to enhance recovery and prevent further complications. This study underscores the potential of advanced imaging techniques to provide valuable insights into brain health and injury recovery. Source: Butler T, Zhou L, Ozsahin I, Wang XH, Garetti J, Zetterberg H, et al. Glymphatic clearance estimated using diffusion tensor imaging along perivascular spaces is reduced after traumatic brain injury and correlates with plasma neurofilament light, a biomarker of injury severity. Brain Commun. 2023;5(4):fcad134. doi:10.1093/braincomms/fcad134.

The attached study explores how concussions in adolescents can lead to emotional regulation difficulties and examines the role of neuroimaging in understanding these effects. Emotional dysregulation includes symptoms like anxiety, depression, irritability, and impulsivity, which are common after concussions. These symptoms are particularly concerning in adolescents, whose brains are still developing, making them more vulnerable to long-term emotional and behavioral issues. The researchers highlight that adolescence is a critical period for brain development, especially in areas that control emotions. When a concussion occurs, it can disrupt the brain’s normal development, particularly in the limbic system (involved in emotions) and the prefrontal cortex (responsible for decision-making and emotional regulation). This disruption may explain why adolescents are more prone to emotional difficulties after a concussion. Neuroimaging techniques, such as functional MRI (fMRI) and diffusion MRI (dMRI), are used to study the effects of concussions on the brain. These techniques help identify changes in brain connectivity and structure, which are linked to emotional dysregulation. For example, research shows that adolescents with concussions may have reduced activity in the amygdala (a key brain region for processing emotions) and abnormal connectivity between brain regions involved in emotion regulation. The study concludes that neuroimaging has the potential to improve our understanding of how concussions affect emotional regulation in adolescents. This could lead to better diagnosis, treatment, and management of concussion-related emotional issues. However, more research is needed, especially in identifying specific brain changes that predict long-term emotional problems in adolescents after a concussion. This study emphasizes the importance of early detection and intervention to address the emotional and mental health challenges that adolescents may face after a concussion. Source: Lima Santos JP, Jia-Richards M, Kontos AP, Collins MW, Versace A. Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging. Int J Environ Res Public Health. 2023;20(13):6274. doi: 10.3390/ijerph20136274.

In the last 10 years or so there has been a boom in technology designed to improve brain healing and health ranging from VR applications, therapy devices, and even mobile phone apps. The attached study evaluates a mobile app, called the Parkwood Pacing and Planning application, designed to help individuals manage symptoms after experiencing mild traumatic brain injury (mTBI). This app focuses on guiding users in pacing their activities and planning their day to avoid overexertion, which can worsen mTBI symptoms. The app was developed as part of a collaborative effort between researchers, clinicians, and mTBI patients. The goal was to create a tool that would be easy to use and improve access to rehabilitation techniques for individuals with chronic mTBI. The study conducted focus groups with both patients and clinicians to gather feedback on the app's design and effectiveness. The participants were asked to use the app, which featured activity tracking, symptom logging, and educational resources, and then share their experiences. Results from the study were generally positive. Both patients and clinicians appreciated the app's simplicity, though some suggestions for improvement were made. For example, participants wanted the app to be more adaptable to their individual needs, more concise in its instructions, and similar to apps they were already familiar with. The app’s tracking of daily activity points, symptom exacerbation, and helpful resources were noted as beneficial, but further improvements in user interface and ease of navigation were recommended. Overall, the study concluded that the app has the potential to be a useful tool in managing mTBI symptoms, but modifications to its design and functionality could further enhance its effectiveness and user satisfaction. Source: Bonn MM, Graham LJ, Marrocco S, Jeske S, Moran B, Wolfe DL. Usability evaluation of a self-management mobile application for individuals with a mild traumatic brain injury. Digit Health. 2023;9:20552076231183555. doi: 10.1177/20552076231183555.

Today we raise awareness for National Concussion Day! Let's educate ourselves on the signs and symptoms of concussions and work towards promoting a safer environment for everyone and remember that help is available. A simple checklist of concussion related symptoms is available on our website. #NationalConcussionDay #ConcussionAwareness #TBI #traumaticbraininjuryawareness #traumaticbraininjury #ethostbi ethosTBI.com

David Bowie was famous for his unique creativity and artistic vision that was far beyond his era. His stage presence was not only defined by his striking makeup and exceptional musical talent, but also by his captivating, almost haunting eyes: one piercing blue, the other a mysterious black. In a moment of intense emotion, Bowie was reportedly punched in the left eye, leading to a fingernail scratching his eyeball. This caused the muscles controlling the iris to become paralyzed. Consequently, Bowie's left pupil remained permanently dilated, resulting in his distinctive blue and black eyes. Bowie's eyes would have definitely made TBI testing more challenging, but luckily anisocoria is a pretty uncommon condition that can be quickly spotted during the first check-up and we, at Ethos, are trained to know the difference. If you or someone you know could benefit from our TBI testing, TBI rehab, or neurology evaluation, please reach out to Dr. Walker directly at 904-616-1284 or email [email protected].