Objective To determine the reliability of the KINARM robot in assessing sensorimotor and neurocog... more Objective To determine the reliability of the KINARM robot in assessing sensorimotor and neurocognitive function in athletes. Design Test-retest reliability. Setting Sport Medicine Clinic. Participants Thirty-nine randomly selected athletes (mean age: 18±3 years) over 2011–2012 and 2014–2015 seasons. Outcome measures Sixty-three parameters from five robotic tasks (Visually Guided Reaching, Position Matching, Object Hit, Object Hit and Avoid, and Trail Making B) characterising sensorimotor and neurocognitive function. Each athlete was tested three times, with an average of 43±27 days between baseline (BL) and first retest (R1), and 306±32 days between R1 and second retest (R2). Reliability was assessed by intra-class correlation coefficients (ICCs) between BL and R1, and R1 and R2. Change in task performance between assessments was also evaluated with multivariate analysis of variance (MANOVA) and post-hoc comparisons within specific task parameters. Main results ICCs ranged from −0....
ABSTRACT "MQ-87224." Thesis (M.Sc.)--University of Calgary, Dept. of Cardiovasc... more ABSTRACT "MQ-87224." Thesis (M.Sc.)--University of Calgary, Dept. of Cardiovascular/Respiratory Sciences, 2003. Includes bibliographical references. Microfiche.
BACKGROUND: Increasing evidence suggests autonomic nervous system (ANS) dysfunction may occur fol... more BACKGROUND: Increasing evidence suggests autonomic nervous system (ANS) dysfunction may occur following mild traumatic brain injury (mTBI). Measures of heart rate, heart rate variability, blood pressure and baroreceptor sensitivity can be used to evaluate ANS dysfunction following mTBI. OBJECTIVE: Summarize the evidence for ANS dysfunction in adults following mTBI. METHODS: A search of Embase, MEDLINE, Cochrane Central Register, PsycINFO, CINAHL and SPORTDiscus databases was conducted. Search topics included: mTBI and ANS. Identified abstracts were independently reviewed by 2 reviewers followed by full text screening. Risk of bias was assessed using a modified SIGN checklist. A structured synthesis was performed. RESULTS: Thirty-nine studies (combined 1,467 participants diagnosed with mTBI) evaluating ANS function were included. ANS function was evaluated under various conditions including: rest, during exertion, cold pressor test, Valsalva maneuver, using face cooling and eyeball p...
A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus ve... more A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus vehicle traffic accident. Post injury, he began to experience symptoms including light-headedness, spatial disorientation, nausea, fatigue and prominent dizziness brought on by postural change, physical activity or eye movements. Symptoms of dizziness persisted for over 5 years, despite numerous extensive and rigorous vestibular and vision therapy regimens. All investigations suggested normal peripheral and central vestibular functioning. The patient underwent 10 sessions of repetitive transcranial magnetic stimulation (rTMS) treatment, with stimulation of the left dorsolateral prefrontal cortex at 70% of resting motor threshold and a frequency of 10 Hz. Dizziness symptom severity and frequency were reduced by greater than 50% at 3 months post treatment, with a clinically significant reduction of dizziness disability from 40 to 21 points on the Dizziness Handicap Inventory. We propose rTMS as a safe, effective and cost-effective treatment option for patients who experience persistent post-traumatic dizziness secondary to mTBI.
Supplemental Material, sj-docx-5-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magneti... more Supplemental Material, sj-docx-5-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau by Alexander McGirr, Daniel J Devoe, Amelie Raedler, Chantel T Debert, Zahinoor Ismail and Marcelo T Berlim in The Canadian Journal of Psychiatry
Supplemental Material, sj-pdf-1-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic... more Supplemental Material, sj-pdf-1-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau by Alexander McGirr, Daniel J Devoe, Amelie Raedler, Chantel T Debert, Zahinoor Ismail and Marcelo T Berlim in The Canadian Journal of Psychiatry
Supplemental Material, sj-docx-2-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magneti... more Supplemental Material, sj-docx-2-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau by Alexander McGirr, Daniel J Devoe, Amelie Raedler, Chantel T Debert, Zahinoor Ismail and Marcelo T Berlim in The Canadian Journal of Psychiatry
Background: The identification of factors associated with clinical recovery in youth after sports... more Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered sy...
Pituitary dysfunction, specifically growth hormone (GH) deficiency, can occur following traumatic... more Pituitary dysfunction, specifically growth hormone (GH) deficiency, can occur following traumatic brain injury. Our objective was to characterize the prevalence of GH deficiency (GHD) testing and response to recombinant human GH (rhGH) treatment in adults with persistent symptoms following mild traumatic brain injury (mTBI) referred for assessment of pituitary dysfunction. A retrospective chart review was conducted of patients seen at an outpatient brain injury clinic with a diagnosis of mTBI and persistent post-concussive symptoms who were referred to endocrinology. Clinical assessments of symptoms were collected. Investigations and results of GHD were collected, including initiation of rhGH treatment and treatment response. Of the 253 patients seen in both brain injury and endocrinology clinics, 97 with mTBI were referred for investigation of pituitary dysfunction and 73 (75%) had dynamic testing for assessment of GHD. Of the 26 individuals diagnosed with GHD, 23 (88%) started rhG...
Over 27 million individuals are affected every year worldwide with central nervous system (CNS) i... more Over 27 million individuals are affected every year worldwide with central nervous system (CNS) injuries. These injuries include but are not limited to traumatic brain injury (TBI) and spinal cord injury (SCI). CNS injuries remain a significant public health concern which demands reliable tools for rapid, on-sight, on-field, and point-of-care diagnostic (POC) solutions. To address these challenges, we developed a low-cost, open-source, hand-held, portable, and POC detection technology, termed as MicroDrop (μDrop), which can simultaneously detect up to eight target biomolecules and display results in both analog and digital formats. The data acquired is stored wirelessly in a cloud server for further investigation and statistical analysis. Multiplexing capability of μDrop and immuno-biosensors detects and quantifies Cleaved-Tau Protein (C-Tau) and Neuron-Filament (NFL) proteins in the blood of TBI patients. Immuno-biosensors rapidly sense the two target proteins in less than 30 min, ...
Background Analysis of fluid metabolites has the potential to provide insight into the neuropatho... more Background Analysis of fluid metabolites has the potential to provide insight into the neuropathophysiology of injury in patients with traumatic brain injury (TBI). Objective Using a 1H nuclear magnetic resonance (NMR)-based quantitative metabolic profiling approach, this study determined (1) if urinary metabolites change during recovery in patients with mild to severe TBI; (2) whether changes in urinary metabolites correlate to injury severity; (3) whether biological pathway analysis reflects mechanisms that mediate neural damage/repair throughout TBI recovery. Methods Urine samples were collected within 7 days and at 6-months post-injury in male participants (n = 8) with mild-severe TBI. Samples were analyzed with NMR-based quantitative spectroscopy for metabolomic profiles and analyzed with multivariate statistical and machine learning-based analyses. Results Lower levels of homovanillate (R = −0.74, p ≤ 0.001), L-methionine (R = −0.78, p < 0.001), and thymine (R = −0.85, p < 0.001) negatively correlated to injury severity. Pathway analysis revealed purine metabolism to be a primary pathway (p < 0.01) impacted by TBI. Conclusion This study provides pilot data to support the use of urinary metabolites in clinical practice to better interpret biochemical changes underlying TBI severity and recovery. The discovery of urinary metabolites as biomarkers may assist in objective and rapid identification of TBI severity and prognosis. Thus, 1H NMR metabolomics has the potential to facilitate the adaptation of treatment programs that are personalized to the patient’s needs.
Objective: Millions of sport-related concussions (SRC) occur annually in North America, and curre... more Objective: Millions of sport-related concussions (SRC) occur annually in North America, and current diagnosis of concussion is based largely on clinical evaluations. The objective of this study was to determine whether urinary metabolites are significantly altered post-SRC compared to pre-injury.Setting: Outpatient sports medicine clinic.Participants: Twenty-six male youth sport participants.Methods: Urine was analyzed pre-injury and after SRC by 1H NMR spectroscopy. Data were analyzed using multivariate statistics, pairwise t-test, and metabolic pathway analysis. Variable importance analysis based on random variable combination (VIAVC) was applied to the entire data set and resulted in a panel of 18 features. Partial least square discriminant analysis was performed exploring the separation between pre-injury and post-SRC groups. Pathway topography analysis was completed to identify biological pathway involvement. Spearman correlations provide support for the relationships between s...
Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment modality... more Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment modality for Post-traumatic stress disorder (PTSD). Several targets and stimulation parameters have been investigated, and while previous meta-analyses have suggested that rTMS is efficacious, these have pooled different stimulation parameters and targets, and the relative efficacy of each is unknown. Methods: We therefore performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) by searching MEDLINE, EMBASE, CENTRAL, and PsycINFO and retaining RCTs with at least 5 individuals per arm and clinician-rated PTSD symptoms (PROSPERO CRD42019134984). We adhered to PRISMA guidelines, and 2 independent reviewers screened studies for eligibility and extracted the primary outcome of clinician-rated PTSD symptoms. Dropouts were extracted as a proxy for acceptability. Random effects pairwise meta-analyses and a network meta-analysis were performed. Results: We synthesize...
OBJECTIVE Evaluate physical activity (PA) and sedentary behavior and their associations with symp... more OBJECTIVE Evaluate physical activity (PA) and sedentary behavior and their associations with symptom and quality of life outcomes in adults with persistent post-concussive symptoms (PPCS) following mild traumatic brain injury (mTBI). DESIGN Cross-sectional cohort study. SETTING Outpatient brain injury clinic. PARTICIPANTS Consecutive sample of adults (n=180) with a diagnosis of mTBI and PPCS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES PA and sedentary behavior were assessed using the Godin Leisure-Time Exercise Questionnaire and Rapid Assessment Disuse Index, respectively. Participants were dichotomized according to whether they completed 150 minutes of moderate-to-vigorous PA per week, based on Canadian guidelines. Post-injury moderate-to-vigorous PA was also analyzed as a continuous variable. RESULTS Prior to injury, 85% of participants reported meeting PA guidelines, compared to 28% post-injury. Individuals meeting PA guidelines post-injury reported higher quality of life (η2p=0.130, p<0.001) and lower scores on measures of functional impact of headache (η2p=0.065, p=0.009), fatigue (η2p=0.080, p=0.004), depression (η2p=0.085, p=0.001) and anxiety (η2p=0.046, p=0.031), compared to those not meeting guidelines. Sedentary behavior post-injury was negatively correlated with quality of life (rs(127)= -0.252, p=0.004) and positively correlated with symptom burden (rs(167)=0.227, p=0.003), fatigue (rs(127)=0.288, p=0.001), depression (rs(174)=0.319, p<0.001) and anxiety (rs(127)=0.180, p=0.042). CONCLUSIONS PA was significantly decreased in individuals with PPCS compared to pre-injury levels. Meeting PA guidelines post-injury was associated with better clinical outcomes, suggesting that returning individuals to PA should be considered in the treatment of this patient population.
Supplemental Digital Content is Available in the Text. Objective: Fear avoidance behavior after a... more Supplemental Digital Content is Available in the Text. Objective: Fear avoidance behavior after a concussion or mild traumatic brain injury (mTBI) is associated with a number of adverse outcomes, such as higher symptom burden, emotional distress, and disability. The Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) is a recently developed and validated self-report measure of fear avoidance after mTBI. The objective of this study was to derive clinical normative data for the FAB-TBI. To determine whether demographic stratification was necessary and to further support clinical interpretation, we also explored associations between fear avoidance behavior and demographic and injury variables. Setting: Five concussion clinics in Canada. Participants: Adults who sustained an mTBI (N = 563). Design: Cross-sectional. Main Measures: Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) and measures of postconcussion symptom burden (Rivermead Postconcussion Symptoms Questionnaire, Sport Concussion Assessment Tool-5) at clinic intake. Results: Generalized linear modeling revealed that females reported more fear avoidance than males (95% CI = 0.66 to 2.75), indicating that FAB-TBI normative data should be stratified by sex. Differences between recruitment sites on FAB-TBI scores were reduced but not eliminated by controlling for potential confounds. Loss of consciousness (95% CI =0.61 to 2.76) and higher postconcussion symptom burden (95% CI = 0.79 to 1.03) were also associated with higher FAB-TBI scores, but time since injury was not (95% = CI −0.4 to 0.03). Tables to convert FAB-TBI raw scores to Rasch scores to percentiles are presented. Conclusion: These findings support clinical interpretation of the FAB-TBI and further study of fear avoidance after mTBI.
Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Po... more Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Post-traumatic headaches (PTH) are a common sequalae of TBI and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain, but have a short duration of effect. Platelet rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this study is to evaluate the pain response of a single perineural PRP injection in the treatment of post-traumatic GON.Methods: Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: 1) autologous PRP injection 2) steroid/anesthetic injection (standard care) or 3) placebo injection with normal saline. Injections will be performed to the greater occipital n...
Objective To determine the reliability of the KINARM robot in assessing sensorimotor and neurocog... more Objective To determine the reliability of the KINARM robot in assessing sensorimotor and neurocognitive function in athletes. Design Test-retest reliability. Setting Sport Medicine Clinic. Participants Thirty-nine randomly selected athletes (mean age: 18±3 years) over 2011–2012 and 2014–2015 seasons. Outcome measures Sixty-three parameters from five robotic tasks (Visually Guided Reaching, Position Matching, Object Hit, Object Hit and Avoid, and Trail Making B) characterising sensorimotor and neurocognitive function. Each athlete was tested three times, with an average of 43±27 days between baseline (BL) and first retest (R1), and 306±32 days between R1 and second retest (R2). Reliability was assessed by intra-class correlation coefficients (ICCs) between BL and R1, and R1 and R2. Change in task performance between assessments was also evaluated with multivariate analysis of variance (MANOVA) and post-hoc comparisons within specific task parameters. Main results ICCs ranged from −0....
ABSTRACT &quot;MQ-87224.&quot; Thesis (M.Sc.)--University of Calgary, Dept. of Cardiovasc... more ABSTRACT &quot;MQ-87224.&quot; Thesis (M.Sc.)--University of Calgary, Dept. of Cardiovascular/Respiratory Sciences, 2003. Includes bibliographical references. Microfiche.
BACKGROUND: Increasing evidence suggests autonomic nervous system (ANS) dysfunction may occur fol... more BACKGROUND: Increasing evidence suggests autonomic nervous system (ANS) dysfunction may occur following mild traumatic brain injury (mTBI). Measures of heart rate, heart rate variability, blood pressure and baroreceptor sensitivity can be used to evaluate ANS dysfunction following mTBI. OBJECTIVE: Summarize the evidence for ANS dysfunction in adults following mTBI. METHODS: A search of Embase, MEDLINE, Cochrane Central Register, PsycINFO, CINAHL and SPORTDiscus databases was conducted. Search topics included: mTBI and ANS. Identified abstracts were independently reviewed by 2 reviewers followed by full text screening. Risk of bias was assessed using a modified SIGN checklist. A structured synthesis was performed. RESULTS: Thirty-nine studies (combined 1,467 participants diagnosed with mTBI) evaluating ANS function were included. ANS function was evaluated under various conditions including: rest, during exertion, cold pressor test, Valsalva maneuver, using face cooling and eyeball p...
A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus ve... more A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus vehicle traffic accident. Post injury, he began to experience symptoms including light-headedness, spatial disorientation, nausea, fatigue and prominent dizziness brought on by postural change, physical activity or eye movements. Symptoms of dizziness persisted for over 5 years, despite numerous extensive and rigorous vestibular and vision therapy regimens. All investigations suggested normal peripheral and central vestibular functioning. The patient underwent 10 sessions of repetitive transcranial magnetic stimulation (rTMS) treatment, with stimulation of the left dorsolateral prefrontal cortex at 70% of resting motor threshold and a frequency of 10 Hz. Dizziness symptom severity and frequency were reduced by greater than 50% at 3 months post treatment, with a clinically significant reduction of dizziness disability from 40 to 21 points on the Dizziness Handicap Inventory. We propose rTMS as a safe, effective and cost-effective treatment option for patients who experience persistent post-traumatic dizziness secondary to mTBI.
Supplemental Material, sj-docx-5-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magneti... more Supplemental Material, sj-docx-5-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau by Alexander McGirr, Daniel J Devoe, Amelie Raedler, Chantel T Debert, Zahinoor Ismail and Marcelo T Berlim in The Canadian Journal of Psychiatry
Supplemental Material, sj-pdf-1-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic... more Supplemental Material, sj-pdf-1-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau by Alexander McGirr, Daniel J Devoe, Amelie Raedler, Chantel T Debert, Zahinoor Ismail and Marcelo T Berlim in The Canadian Journal of Psychiatry
Supplemental Material, sj-docx-2-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magneti... more Supplemental Material, sj-docx-2-cpa-10.1177_0706743720982432 for Repetitive Transcranial Magnetic Stimulation for the Treatment of Post-traumatic Stress Disorder: A Systematic Review and Network Meta-analysis: La Stimulation Magnétique Transcrânienne Répétitive Pour le Traitement du Trouble de Stress Post-Traumatique : Une Revue Systématique et une Méta-Analyse en Réseau by Alexander McGirr, Daniel J Devoe, Amelie Raedler, Chantel T Debert, Zahinoor Ismail and Marcelo T Berlim in The Canadian Journal of Psychiatry
Background: The identification of factors associated with clinical recovery in youth after sports... more Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered sy...
Pituitary dysfunction, specifically growth hormone (GH) deficiency, can occur following traumatic... more Pituitary dysfunction, specifically growth hormone (GH) deficiency, can occur following traumatic brain injury. Our objective was to characterize the prevalence of GH deficiency (GHD) testing and response to recombinant human GH (rhGH) treatment in adults with persistent symptoms following mild traumatic brain injury (mTBI) referred for assessment of pituitary dysfunction. A retrospective chart review was conducted of patients seen at an outpatient brain injury clinic with a diagnosis of mTBI and persistent post-concussive symptoms who were referred to endocrinology. Clinical assessments of symptoms were collected. Investigations and results of GHD were collected, including initiation of rhGH treatment and treatment response. Of the 253 patients seen in both brain injury and endocrinology clinics, 97 with mTBI were referred for investigation of pituitary dysfunction and 73 (75%) had dynamic testing for assessment of GHD. Of the 26 individuals diagnosed with GHD, 23 (88%) started rhG...
Over 27 million individuals are affected every year worldwide with central nervous system (CNS) i... more Over 27 million individuals are affected every year worldwide with central nervous system (CNS) injuries. These injuries include but are not limited to traumatic brain injury (TBI) and spinal cord injury (SCI). CNS injuries remain a significant public health concern which demands reliable tools for rapid, on-sight, on-field, and point-of-care diagnostic (POC) solutions. To address these challenges, we developed a low-cost, open-source, hand-held, portable, and POC detection technology, termed as MicroDrop (μDrop), which can simultaneously detect up to eight target biomolecules and display results in both analog and digital formats. The data acquired is stored wirelessly in a cloud server for further investigation and statistical analysis. Multiplexing capability of μDrop and immuno-biosensors detects and quantifies Cleaved-Tau Protein (C-Tau) and Neuron-Filament (NFL) proteins in the blood of TBI patients. Immuno-biosensors rapidly sense the two target proteins in less than 30 min, ...
Background Analysis of fluid metabolites has the potential to provide insight into the neuropatho... more Background Analysis of fluid metabolites has the potential to provide insight into the neuropathophysiology of injury in patients with traumatic brain injury (TBI). Objective Using a 1H nuclear magnetic resonance (NMR)-based quantitative metabolic profiling approach, this study determined (1) if urinary metabolites change during recovery in patients with mild to severe TBI; (2) whether changes in urinary metabolites correlate to injury severity; (3) whether biological pathway analysis reflects mechanisms that mediate neural damage/repair throughout TBI recovery. Methods Urine samples were collected within 7 days and at 6-months post-injury in male participants (n = 8) with mild-severe TBI. Samples were analyzed with NMR-based quantitative spectroscopy for metabolomic profiles and analyzed with multivariate statistical and machine learning-based analyses. Results Lower levels of homovanillate (R = −0.74, p ≤ 0.001), L-methionine (R = −0.78, p < 0.001), and thymine (R = −0.85, p < 0.001) negatively correlated to injury severity. Pathway analysis revealed purine metabolism to be a primary pathway (p < 0.01) impacted by TBI. Conclusion This study provides pilot data to support the use of urinary metabolites in clinical practice to better interpret biochemical changes underlying TBI severity and recovery. The discovery of urinary metabolites as biomarkers may assist in objective and rapid identification of TBI severity and prognosis. Thus, 1H NMR metabolomics has the potential to facilitate the adaptation of treatment programs that are personalized to the patient’s needs.
Objective: Millions of sport-related concussions (SRC) occur annually in North America, and curre... more Objective: Millions of sport-related concussions (SRC) occur annually in North America, and current diagnosis of concussion is based largely on clinical evaluations. The objective of this study was to determine whether urinary metabolites are significantly altered post-SRC compared to pre-injury.Setting: Outpatient sports medicine clinic.Participants: Twenty-six male youth sport participants.Methods: Urine was analyzed pre-injury and after SRC by 1H NMR spectroscopy. Data were analyzed using multivariate statistics, pairwise t-test, and metabolic pathway analysis. Variable importance analysis based on random variable combination (VIAVC) was applied to the entire data set and resulted in a panel of 18 features. Partial least square discriminant analysis was performed exploring the separation between pre-injury and post-SRC groups. Pathway topography analysis was completed to identify biological pathway involvement. Spearman correlations provide support for the relationships between s...
Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment modality... more Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment modality for Post-traumatic stress disorder (PTSD). Several targets and stimulation parameters have been investigated, and while previous meta-analyses have suggested that rTMS is efficacious, these have pooled different stimulation parameters and targets, and the relative efficacy of each is unknown. Methods: We therefore performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) by searching MEDLINE, EMBASE, CENTRAL, and PsycINFO and retaining RCTs with at least 5 individuals per arm and clinician-rated PTSD symptoms (PROSPERO CRD42019134984). We adhered to PRISMA guidelines, and 2 independent reviewers screened studies for eligibility and extracted the primary outcome of clinician-rated PTSD symptoms. Dropouts were extracted as a proxy for acceptability. Random effects pairwise meta-analyses and a network meta-analysis were performed. Results: We synthesize...
OBJECTIVE Evaluate physical activity (PA) and sedentary behavior and their associations with symp... more OBJECTIVE Evaluate physical activity (PA) and sedentary behavior and their associations with symptom and quality of life outcomes in adults with persistent post-concussive symptoms (PPCS) following mild traumatic brain injury (mTBI). DESIGN Cross-sectional cohort study. SETTING Outpatient brain injury clinic. PARTICIPANTS Consecutive sample of adults (n=180) with a diagnosis of mTBI and PPCS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES PA and sedentary behavior were assessed using the Godin Leisure-Time Exercise Questionnaire and Rapid Assessment Disuse Index, respectively. Participants were dichotomized according to whether they completed 150 minutes of moderate-to-vigorous PA per week, based on Canadian guidelines. Post-injury moderate-to-vigorous PA was also analyzed as a continuous variable. RESULTS Prior to injury, 85% of participants reported meeting PA guidelines, compared to 28% post-injury. Individuals meeting PA guidelines post-injury reported higher quality of life (η2p=0.130, p<0.001) and lower scores on measures of functional impact of headache (η2p=0.065, p=0.009), fatigue (η2p=0.080, p=0.004), depression (η2p=0.085, p=0.001) and anxiety (η2p=0.046, p=0.031), compared to those not meeting guidelines. Sedentary behavior post-injury was negatively correlated with quality of life (rs(127)= -0.252, p=0.004) and positively correlated with symptom burden (rs(167)=0.227, p=0.003), fatigue (rs(127)=0.288, p=0.001), depression (rs(174)=0.319, p<0.001) and anxiety (rs(127)=0.180, p=0.042). CONCLUSIONS PA was significantly decreased in individuals with PPCS compared to pre-injury levels. Meeting PA guidelines post-injury was associated with better clinical outcomes, suggesting that returning individuals to PA should be considered in the treatment of this patient population.
Supplemental Digital Content is Available in the Text. Objective: Fear avoidance behavior after a... more Supplemental Digital Content is Available in the Text. Objective: Fear avoidance behavior after a concussion or mild traumatic brain injury (mTBI) is associated with a number of adverse outcomes, such as higher symptom burden, emotional distress, and disability. The Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) is a recently developed and validated self-report measure of fear avoidance after mTBI. The objective of this study was to derive clinical normative data for the FAB-TBI. To determine whether demographic stratification was necessary and to further support clinical interpretation, we also explored associations between fear avoidance behavior and demographic and injury variables. Setting: Five concussion clinics in Canada. Participants: Adults who sustained an mTBI (N = 563). Design: Cross-sectional. Main Measures: Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire (FAB-TBI) and measures of postconcussion symptom burden (Rivermead Postconcussion Symptoms Questionnaire, Sport Concussion Assessment Tool-5) at clinic intake. Results: Generalized linear modeling revealed that females reported more fear avoidance than males (95% CI = 0.66 to 2.75), indicating that FAB-TBI normative data should be stratified by sex. Differences between recruitment sites on FAB-TBI scores were reduced but not eliminated by controlling for potential confounds. Loss of consciousness (95% CI =0.61 to 2.76) and higher postconcussion symptom burden (95% CI = 0.79 to 1.03) were also associated with higher FAB-TBI scores, but time since injury was not (95% = CI −0.4 to 0.03). Tables to convert FAB-TBI raw scores to Rasch scores to percentiles are presented. Conclusion: These findings support clinical interpretation of the FAB-TBI and further study of fear avoidance after mTBI.
Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Po... more Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Post-traumatic headaches (PTH) are a common sequalae of TBI and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain, but have a short duration of effect. Platelet rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this study is to evaluate the pain response of a single perineural PRP injection in the treatment of post-traumatic GON.Methods: Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: 1) autologous PRP injection 2) steroid/anesthetic injection (standard care) or 3) placebo injection with normal saline. Injections will be performed to the greater occipital n...
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