Background: People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterised. This study sought to investigate the association between symptoms, resting heart rate (HR) and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery.
Methods: Prospective observational study of adults aged 18-65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest and exercise tolerance assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR.
Findings: Data from 32 participants were assessed (mean age 36.5±12.6 years, 41% female, 5.7±1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (p=0.002 and p=0.025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (p=0.001 and p=0.014 respectively), with individuals who were exercise intolerant having higher mean number of symptoms in each profile compared to those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with higher resting HR (greater than 80bpm) (p=0.048 and p=0.028 respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sport- or non-sport related), having a higher mood-related clinical profile was associated with persisting symptoms at three months post-injury (adjusted odds ratio = 2.08; 95% CI=1.11-3.90; p=0.013).
Interpretation: Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having 4 sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.

Vista Centre Brain Injury Services (VCBIS) offer clients with acquired brain injury a day program of social leisure activities with the objective of connecting them with other clients and promoting skill development to encourage self-efficacy in their community. During the COVID-19 pandemic, the VCBIS day program pivoted to virtual and hybrid programming to maintain service to clients. Program staff are now considering the future of these modes of service delivery. Evaluators conducted a needs assessment for the virtual and hybrid day program to determine whether this mode of program delivery would 1) meet clients' needs and 2) be attractive to clients in a way that promotes participation in the program. Evaluators used a mixed methods approach, including a VCBIS record review, surveys of clients (n=28), VCBIS staff (n=3) and alternative service providers (n-6), and client focus groups (n=11). Findings from the evaluation indicated that clients have a similar experience of virtual and in-person programming (i.e., similar levels of enjoyment, interest in activities, social connection, skill development), even if clients generally had a preference for one mode of service delivery over the other due to personal interests and accessibility needs. Contrasting this finding, clients generally perceived hybrid programming less favourably on most measures. Clients rated their enjoyment of hybrid activities (M=2.10, SD=.89) significantly lower than the in-person (M=4.65, SD=.67) and virtual (M=4.19, SD=.87) activities; however, there was no significant difference in enjoyment ratings for in-person and virtual participation. During focus groups, clients frequently reported that they struggled to see or hear others clearly during hybrid programming. Staff and alternative service providers echoed these sentiments in their survey responses, indicating that hybrid programming was often challenging to facilitate due to client lack of interest in the programming and technological barriers. Clients did indicate, however, that participating in hybrid programming was much preferred over missing day programming sessions or having no access to programming at all (e.g., due to weather, COVID). Based on these findings, evaluators recommend that VCBIS: 1) continue to offer a virtual day program; 2) tailor program activities to the mode of service delivery; 3) adopt a flexible approach that allows clients to join virtually in cases where a session would otherwise be missed; and, 4) implement ABI appropriate ongoing client feedback measures.

BACKGROUND: Functional Neurologic Disorder (FND), or conversion disorder, is a psychiatric disorder that has no organic basis with symptoms affecting sensory and motor function which are not consistent with known neurologic disorder or other medical diseases. Currently, the understanding of FND is largely limited and evolving. This retrospective study will increase the knowledge of how FND impacts the patient’s dysfunction in mobility and outcome of rehabilitation using Wee FIM scores.

METHOD: There were total of 36 (26 females,10 males) patients who were admitted from 2016-2022. (n=1) in 2016, (n=4) in 2017, (n=2) in 2018, (n=4) in 2019, (n=12) in 2020, (n=9) in 2021, (n=4) in 2022. Patient admitted should have a formal diagnosis by a provider from the referring facility with caregiver’s acceptance of an FND diagnosis. Patients received Wee FIM scores on functional mobility on admission and discharge. Scores were compared from admission to discharge. Patients received therapies from a multidisciplinary team; medical, nursing, physical, occupational, child life, recreational, psychology, and psychiatry. Therapies were evaluated according to their individual needs and discussed weekly during the family meeting. Their length of stay was dependent on their daily progress and patient/family cooperation.

RESULTS: Wee FIM admission scores; Unable to walk; 1 is total assistance TA (44%). 2 is maximum assistance Max A (22.2%). 3 is moderate assistance Mod A (0%). 4 is minimal contact Min A (8.3%), 5 is supervision S (8.3%). 6 is modified independence Mod I (13.8%) and (2.7 %) was 7 for Total independence (TI). Unable to negotiate stairs; TA (75%), Max A (2.7%), Mod A (0%), Min A (2.7%), Needs supervision (5.5%), Mod I (13.8%), TI (0%). Transfers from bed to chair/chair to bed; TA (8.3%), Max A (5.5%), Mod A (8.3%), Min A (5.5%), supervision (22.2%), Mod I (41.6%), TI (8.3%). Discharge scores; (2.7%) was unable to walk, a decrease from 44%. Max A, Mod A, Min A were (0%), supervision (5.5%), Mod I (52.7%), patients who walked and TI (38.8%) an increase from (2.7%). Negotiating stairs; TA (2.7%), Max A, Mod A, Min A were (0%), supervision (5.5%), Mod I (55.5%) up from 41.6%, and 7 (36.1%) significantly improved from (8.3%). For transfer: none needed assistance or supervision, (50%) each for Mod I, increased from 13.8% and TI definitely up from (0%). Length of stay were from 1 day to 44 days.

CONCLUSION: FND can be very debilitating that needs a multidisciplinary team in a rehabilitation facility to improve the patient’s functional mobility. Treatment includes: management of anxiety, depression, cognitive behavior, family, physical and occupational therapies.

Case Diagnosis
A 16-year old girl with a history of asthma, diagnosed with Wernicke-Korsakoff Syndrome following a sleeve gastrectomy.

Case Description or Program Description
The patient presented to the emergency department with acute onset generalized weakness 3 months after a cosmetic sleeve gastrectomy in Mexico. She did not undergo pre-operative screening or education. Post-operatively, she reported vomiting and poor oral intake. She took Biotin, B12, and iron supplements but received no follow up. Neurologic exam revealed nystagmus, and labs showed thiamine deficiency. MRI demonstrated hyperintensities involving bilateral medial thalami, the periaqueductal grey, and bilateral mammillary bodies, consistent with Wernicke’s Encephalopathy. She completed a course of intravenous thiamine and was transferred to acute inpatient rehabilitation on oral supplementation.

Setting
Acute Inpatient Rehabilitation

Assessment/Results
The patient showed inattention, poor motivation, and short-term memory deficits during therapy. She was diagnosed with Wernicke-Korsakoff Syndrome on neuropsychological assessment. During her rehabilitation course, she made significant improvements in strength and activities of daily living. However, she had persistent cognitive deficits that limited her progress.

Discussion (relevance)
Wernicke’s encephalopathy is an uncommon complication of gastric sleeve procedures, developing within 6 months due to thiamine deficiency. Although B12 absorption in the small intestine is preserved, patients may develop thiamine deficiency through vomiting and poor oral intake. Typical symptoms include ataxia, nystagmus, and diplopia. Many patients make a full recovery following thiamine supplementation. Here, we describe a progression from Wernicke’s Encephalopathy to Wernicke Korsakoff syndrome in the setting of poor follow up. Therapy interventions were beneficial for the patient. However, she suffered long term impairment.

Conclusions
Wernicke Korsakoff Syndrome is a permanent neurological condition that can significantly impair quality of life and functional status. With new guidelines recommending bariatric surgeries at an earlier age, it is important to ensure adequate follow up and education on nutritional supplementation and to recognize the symptoms of thiamine deficiency post-operatively.

Traumatic Brain Injuries (TBI) have been described as the "signature injury" from the Iraq and Afghanistan wars due to the high prevalence of blast exposure. In 2007, the Veterans Health Administration (VHA) implemented a national clinical guideline that required that providers screen all Veterans who served in combat operations for TBI. Then if a Veteran has a positive TBI screen, a TBI specialist should perform a comprehensive TBI evaluation (CTBIE) to determine a diagnosis and develop an individualized treatment plan. However, due to shortages in TBI specialists, some VA facilities were not able to complete CTBIEs for Veterans who screened positive.

To fill this gap, in 2016, VA Hudson Valley (HV) TBI care provider Dr. Cho reached out to a VA facility in Hawaii that needed assistance. To allow VA HV to provide virtual care for their Veterans, they developed a Telehealth Service Agreement (TSA). Using a modality called Clinical Video Telehealth (CVT), Veterans could go to the closest VA facility in Hawaii and connect virtually with a provider in HV, New York to complete a CTBIE. After providing successful gap coverage and a warm handoff to a newly hired TBI provider at the site in Hawaii, Dr. Cho used the framework to partner with other VA facilities who needed support providing TBI specialty care for their Veterans.

In 2021, VA HV was awarded funding from the VA Office of Rural Health which allowed them to form a more comprehensive Tele TBI Program - consisting of three TBI providers, two speech therapists, one psychologist and a TBI coordinator. To reduce patient drive times, reduce COVID-19 exposure, and improve access to care, the team also rolled out a new virtual care modality that allowed Veterans to connect with providers in HV from their personal devices.

To date, the program has provided TBI virtual care consults to over 1,400 Veterans at 20 VA facilities across the US and is working on expanding care to Active Duty Service Members (ADSM) at a Department of Defense site.

Since November 2022, 12% of HV Tele-TBI patients (169) were surveyed using a ten-question patient satisfaction survey. On average, patient satisfaction total scores were 4.7 out of 5.0. Of the 169 patients surveyed, 98% reported that they “felt comfortable discussing medical issues with their provider during the Telehealth visit,” 95% “would recommend tele-health to others,” and 98% said “overall, they were satisfied with the telehealth visit.”

Background: Neuroinflammation is an important feature of traumatic brain injury (TBI). However, the biological markers of TBI and their connections with cognitive, affective, and physical symptoms remain poorly understood, particularly in the 3-12-month time-period post-injury. Thus, the objective of our study was to examine the relationships between symptoms, biomarkers of neuroinflammation, and functional outcomes in TBI patients 3-12 months post-injury.

Methods: A cross-sectional study of 39 TBI patients was performed at a South Florida TBI clinic between May 2022 and June 2023. All patients were between 3-12 months post-injury during study participation. Clinical data, including initial Glasgow Coma Scale (GCS) score, pharmacological information, and patient co-morbidities, was obtained from the Electronic Health Record. Participants also completed a Sorting-Working Memory Test, Neuro-QOL Cognitive Function, Anxiety, Depression, and Sleep Disturbance inventories, a modified symptom checklist from the Brain Injury Association of Virginia, and the Disability Rating Scale (DRS) and Satisfaction with Life Scale (SWLS) as measures of physical function and quality of life, respectively. Multiple plasma biomarkers were assayed. The sample was characterized and associations between symptoms, biomarkers, and functional outcomes were examined using linear regression. Group means were calculated for outcomes and biological data, and analysis of variance (ANOVA) was used to compare between-group means.

Results: The sample consisted of 69.23% male participants, with the most common cause of TBI being motor vehicle accident (71.79%). The top 5 symptoms reported by participants included (1) memory problems, (2) difficulty concentrating, (3) easily agitated, (4) trouble focusing with background noise, and (5) having to check and recheck. Of the top 25 symptoms reported by TBI patients, nearly half (12 out of 25) were cognitive symptoms. Changes in concentrations of the biomarkers over time was assessed, and BDNF levels were found to increase (4191.38 ±275.87 pg/ml 3-6 months post-TBI, 5121.33 ±251.70 pg/ml 6-9 months post-TBI, and 5872.92 ±195.54 pg/ml 9-12 months post-TBI, p = .045), while injury severity was not associated with difference in mean concentrations. GCS category and Satisfaction with Life (SWLS) were also significant [F(1, 34) = 5.17, p = .029]. BDNF was inversely associated with cognitive battery outcomes and positively associated with time since injury. S-100β was positively associated with anxiety score, depression score and hospital length of stay; GFAP was also positively associated with anxiety score and hospital length of stay. IL-6 was inversely associated with time since injury and cognitive function.

Conclusions: Several biological markers were associated with functional outcomes during the 3-12-month post-injury period. We found S-100β, GFAP, IL-6 and BDNF to play a larger role in the TBI recovery period than other biomarkers examined. Additionally, focus on cognitive symptoms should be clinically integrated into patient care to improve TBI patient outcomes.

Objective: Provide an overview of the current state of knowledge on factors related to relationship quality and stability following stroke.

Data Sources: Cumulative Index to Nursing and Allied Health, Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relationship quality and (2) relationship stability after stroke.

Study Selection: English quantitative and qualitative studies investigating factors associated with relationship quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. Forty-four studies were included.

Data Extraction: Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the JBI Checklist for Analytical Cross-Sectional Studies and/or the CASP Checklist for Qualitative Research. Both were performed by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model.

Data Synthesis: Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (e.g., cognitive problems), activities (e.g., decrease of physical intimacy), participation (e.g., being socially active), environment (e.g., medication side effects), and personal factors (e.g., hyper-vigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (e.g., quality of pre-stroke relationship).

Conclusions: Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in few studies of suboptimal quality, explore possible associations between relationship stability and factors falling in the domains of body functions & structure, activity, and environmental factors, and explicitly explore potential positive effects of stroke on relationships.

Objectives
Examine the effect of whiplash associated disorders (WAD) on concussion outcomes among adults evaluated within 7 days of injury.

Setting
The study was carried out at the Hull-Ellis Concussion and Research Clinic (Toronto Rehabilitation Institute, Canada).

Methods
The authors analyzed patient’s clinical charts and routinely collected data from individuals that were admitted to the clinic between July 2019 and March 2020 from one-week to eight-weeks post-injury. The presence of WAD was determined by the presence of neck pain and cervical spine tenderness or restricted range of motion on physical examination by a clinic physician. Patients’ characteristics and outcomes were described according to the presence or absence of concomitant whiplash associated disorders (WAD).

Results
82 medical files were reviewed retrospectively. 19 cases were excluded due to missing data and 63 cases were included in the study. 25 (40%) patients included were deemed to have a concurrent WAD. The WAD group presented with higher symptom severity (mean of 59/132 (SD 32) versus 39/132 (SD 26) for the no WAD group) and number of symptoms (mean of 18/22 (SD 5) versus 15/22 (SD 6) for the no WAD group) on the SCAT5 on initial assessment. By the end of the follow-up (eight weeks post-injury), fewer individuals with WAD had recovered from their concussion than those without WAD (44% with WAD versus 66% without WAD).

Conclusion
Our findings show that the combination of both concussion and neck symptoms can result in an overall greater frequency and intensity of initial symptoms, and a longer duration is required for recovery of all injury-related symptoms. Recognition of cervical injury in tandem with a diagnosed concussion soon after injury may facilitate earlier referral to appropriate rehabilitation.

There is an array of educational material available to families and caregivers of severe brain injury experiencing Disorders of Consciousness (DoC). However, it is difficult to find information that is accurate and easy to navigate. Families and caregivers experience trauma along a continuum from hospital to community (Cameron and Gignac 2008). The need for caregivers to prepare for changes in role and caring for their loved one evolves over the course of recovery, but often not fully addressed by their clinical care team. This can lead to added stress, ambiguity and compound trauma for family and caregivers. The American Congress of Rehabilitation Medicine (ACRM) Brain Injury Interdisciplinary Special Interest Group: DoC Task Force, Family Education Subcommittee has developed a compendium of shared educational resources. During the last seven years, the committee engaged in an environmental scan of existing family education content from providers and websites that had information specific to DoC. We then developed a structure for delivering information that is simple, easy to read and organized in a way that that families/caregivers can find specific information across the course of recovery all located in a central, accessible location. The organization of content is separated into three sections: Body/Mind, Taking Care of Self and Resources. Focus groups and surveys were completed with 22 families and 16 professionals to validate the overall structure and included content for accuracy and health literacy. Consumer and professional survey responses were analyzed. Results of the family surveys 67-100% of respondents found content was easy to understand, descriptive and prompted end users to further engage with the additional website links embedded into the content. Professional surveys resulted in 100% of respondents approving the overall content included. The final product of family-focused DoC education will be accessible within a Treatment Hub on www.BrainLine.org. This poster will highlight the overall evolution of the project, content, the review process, partnership with BrainLine.org and the funding efforts to build the Treatment Hub and BrainLine. Our objective is to facilitate knowledge translation of this web-based resource to support further dissemination to the family end user experiencing acute and chronic DoC. Implementation to support utilization of this educational resource, by families, will be dependent on expanding knowledge and collaboration with brain injury medicine professionals across the care continuum for persons experiencing DoC.

Cameron JI, Gignac MA. "Timing It Right": a conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home. Patient Educ Couns. 2008 Mar;70(3):305-14. doi: 10.1016/j.pec.2007.10.020. Epub 2007 Dec 21. PMID: 18155388.

This is the case of a 48-year-old female with a past medical history of hypertension who presented to the emergency room with “the worst headache” of her life. She was found to have diffuse subarachnoid hemorrhage and left frontal intraparenchymal hemorrhage, requiring ventriculoperitoneal shunt placement. After the procedure, the patient complained of new-onset bilateral lower extremity paresthesias and weakness. Lab results ruled out cobalamin and folate deficiencies. Electrodiagnostic studies showed bilateral lumbosacral root dysfunction primarily affecting L5-S2. Lumbar MRI showed clumping and diffuse enhancement of cauda equina nerve roots. These findings raised concern for possible arachnoiditis. Arachnoiditis is defined as a persistent inflammation of arachnoid mater that involves membrane thickening, dural adhesions, and clumping of nerve roots. It has no well-defined epidemiology and is considered quite rare and difficult to diagnose. Potential causes for arachnoiditis range from physical or chemical irritants such as injections, surgery, infectious causes such as HIV or TB, or mechanical irritants such as subarachnoid hemorrhage. It has variable timing from the onset of injury until clinical manifestations appear and presents with varying imaging results. Clinically, patients present with an insidious onset of chronic and debilitating pain, most commonly back pain, progressing to radicular pain and sensory defects. Arachnoiditis is managed with supportive care such as physical therapy, pain medication, muscle relaxants, and neurostimulation. It often goes unrecognized and untreated because it is exceedingly rare and difficult to diagnose. Understanding the causes of arachnoiditis and detecting the signs on imaging and physical examination is important to cultivate treatment regimens for future patients. With supportive management through medication and physical therapy, our patient has shown improvement in symptoms and functionality.

Introduction:
Posttraumatic epilepsy (PTE) is a significant concern after traumatic brain injury (TBI), particularly in military contexts. This study investigated genetic risk factors associated with PTE following combat brain injury using a Gene Risk Score (GRS) approach, utilizing data from the Vietnam Veterans Head Injury Study (VHIS) cohort.

Methods:
We included 120 genotyped subjects with penetrating TBI (pTBI) and known PTE status monitored over a 35-year period. DNA samples were genotyped for 20 single nucleotide polymorphisms (SNPs) across nine genes linked to PTE in civilians with moderate-to-severe TBI (msTBI). SNPs were assessed using iPLEX Gold or TaqMan Assay, with double-masked genotype assignments. Covariate adjusted logistic regression was used to identify SNP associations with PTE. Covariates included education, post-traumatic stress disorder (PTSD), race, pre-injury intelligence (AFQI), pTBI-related surgery, loss of consciousness (LOC), and pTBI-related amnesia. A weighted gene risk score (wGRS) was then calculated for each individual based on beta-weights derived from univariate logistic regressions generated for each SNP located within individual genes, reaching a p=0.10 threshold in its association with PTE. Ridge regression was used to generate beta-weights for threshold associated SNPs located in the same gene (e.g. IL-1β). This wGRS was used in multivariate logistic regression to assess its added value, above covariates alone, in characterizing PTE risk.

Results:
Among this cohort, 44.1% experienced PTE over the 35-year follow-up period. Covariate adjusted logistic regression showed threshold associations between four SNPs (rs16944, rs1801131, rs1143634, and rs769391) and PTE status. For the IL-1β SNP rs16944, AA homozygotes had an 80% PTE rate compared to 30-40% in G-carriers. TT homozygotes for the MTHFR SNP rs1801131 had a 50% PTE rate. Heterozygotes had lower PTE incidence for the IL-1β SNP rs1143634 and for the GAD1 SNP rs769391. A higher number of risk genotypes was positively associated with greater seizure incidence; those with four risk genotypes had a >80% 35-year incidence of PTE while individuals with only one risk allele had ~30% PTE incidence. The wGRS was significantly associated with increased risk for PTE at 35 years, with an odds ratio of 3.64 (1.77-7.52); P<0.001) and enhanced the area under the receiver operating curve (AUROC) by 11% compared to covariates alone.

Discussion:
Key SNP associations—IL-1β rs16944, rs1143634, MTHFR rs1801131, GAD1 rs769391—and the GRS enhanced PTE risk assessment beyond covariate factors alone. This wGRS-based approach showcases the cumulative genetic influence on PTE susceptibility among individuals with combat pTBI.

Conclusion:
The study highlights genetic contributions to PTE risk after combat TBI. wGRS inclusion significantly improved multivariable model performance over covariates alone. Future work should consider GRS incorporation when assessing PTE risk among contemporary combat TBI populations to support early screening, prevention, and management strategies.

BACKGROUND: Acute agitation is a common complication in patients who have sustained traumatic brain injury (TBI) and can be measured using the Agitated Behavior Scale (ABS), a validated tool that drives clinical management. There is no consensus regarding use of as needed agents for pharmacologic management of acute agitation in people with TBI.

OBJECTIVES: The primary objective of this study is to assess the effectiveness of as needed trazodone on reduction of agitation as reflected by lower ABS scores in patients with TBI and to demonstrate consistency in reduction of score across various demographic factors of patients with TBI.

DESIGN: A retrospective chart review was performed of patients admitted to acute inpatient rehabilitation over a 2-year period, who had age > 18 years old and were diagnosed with TBI. Data collected included: demographic information, length of stay, number of trazodone administrations, and pre-/post-trazodone administration ABS scores. Patients were organized into subgroups based on demographic characteristics.

RESULTS: The mean change [CI] in ABS score and total percent change in ABS score for all 128 patients were 8.2 [7.6, 8.8] and 14.6% [13.6%, 15.7%], respectively. For gender, males represented 84.4% (N=108) and females 15.6% (N=20). Mean change and percent change of total ABS based on gender were as follows: males 8.1 [7.4, 8.7] and 14.4% [13.3%, 15.6%], and female 8.7 [7.0, 10.3] and 15.5% [12.5%, 18.4%]. ANOVA showed no significant variance in mean change of ABS based on gender (p=0.51). For race, white represented 52.2% (N=67), black 19.5% (N=25), other 8.6% (N=11), and patients who declined to answer 19.5% (N=25). Mean change and percent change of total ABS based on race were as follows: white 8.3 [7.6, 9.1] and 14.9% [13.5%, 16.3%], black 7.9 [6.3, 9.4] and 14.0% [11.3%, 16.8%], other 8.5 [6.7, 10.2] and 15.1% [12.0%, 18.2%], and declined to answer 8.4 [6.3, 9.6] and 14.2% [11.2%, 17.0%]. ANOVA showed no significant variance based on race (p=0.91). For mechanism of injury, falls represented 46.9% (N=60), motor vehicle collision (MVC) 32.8% (N=42), gunshot wound (GSW) 6.3% (N=8), blunt force trauma (BFT) 9.4% (N=12), and other 4.7% (N=6). Mean change and percent change of total ABS based on mechanism of injury were as follows: falls 8.4 [7.5, 9.3] and 15.0% [13.3%, 16.6%], MVC 7.5 [6.5, 8.4] and 13.4% [11.7%, 15.6%], GSW 7.2 [4.9, 9.4] and 12.8% [8.9%, 16.8%], BFT 10.0 [7.9, 12.2] and 17.9% [14.1%, 21.8%], and other 8.7 [4.8, 12.6] and 15.6% [8.6%, 22.5%]. ANOVA showed no significant variance in mean change of ABS based on mechanism of injury subgroup (p=0.20).

CONCLUSION: Use of as needed trazodone was associated with consistent reduction in ABS scores of people with TBI, independent of subgroup characteristics based on age, gender, race, and mechanism of injury.

PURPOSE: To evaluate the effectiveness of the OculoMotor and Vestibular Endurance Screening (MoVES) protocol in identifying concussed adults.

METHODS: Participants between the ages of 18 to 65 years old were recruited from the Virginia Neuro-Optometry and were referred to the clinic after a concussion diagnosis. Data were collected in the first visit following the MoVES protocol with the following seven assessments: 1) near point of convergence (NPC), 2) amplitude of accommodation for both eyes (AA),3) horizontal saccades, 4) vertical saccades, 5) vergence jumps, 6) horizontal vestibular oculomotor reflex (VOR), and 7) vertical VOR. The OculoMotor Assessment Tool (OMAT, Gulden Ophthalmics, Elkins Park, PA, USA, product number 18009) was utilized to provide eye movement targets for all assessments. Saccadic and vergence jump assessments were performed using methods described in the OMAT Normative study, and NPC/AA were performed utilizing methods described in CITT studies. VOR assessments were performed with the participant holding the larger slider of the OMAT tool at arm’s length and rotating the head horizontally or vertically while fixating on the target letters on the slider. The saccadic, vergence, and VOR movements were performed for one minute each, and the number of repetitions was counted by an operator utilizing the OMAT companion smartphone application. The OMAT smartphone app displayed the number of eye movements or head turns performed in one-minute in 15-second intervals.

RESULTS: Presented data was collected on 33 participants (6 males) with an average age of 39.1 ± 12.3 years and an average of 22.1 ± 34.0 months since injury (3 participants were seen 109, 123, and 126 months after injury). On average, the participants made 24.8, 22.5, 19.0, and 17.2 horizontal saccadic eye movements in each of the 15-second intervals. A similar trend of decreasing number of eye movements or head rotations was observed in all the movements: vertical saccades (24.0, 18.1, 15.2, 12.6), vergence jumps (15.2, 13.1, 11.4, 10.5), HVOR (25.0, 21.6, 19.3, 13.6), VVOR (24.6, 20.4, 19.2, 14.6). The average NPC break was 10.5 ± 7.9 cm with a recovery of 14.9 ± 10.6 cm. The number of eye or head movements presented by this cohort was significantly lower than that observed in normative non-concussed cohorts in previous studies.

CONCLUSIONS: These data indicate that the MoVES protocol can potentially be utilized to identify a concussive event in the adult population. Additionally, the MoVES protocol has the potential to be used as an objective quantitative tracking tool for recovery. Healthy controls show no statistical significance in the number of eye or head movements; however, concussed individuals show a consistent decrease in the number of eye or head movements in the first to last interval.

OBJECTIVE: Accessibility to accurate and comprehensive information is crucial for patients and caregivers after a traumatic brain injury (TBI). While fact sheets offer standardized information, the rise of chat-bot artificial intelligence (AI) presents an alternative source of information. This study evaluates and compares the accuracy and comprehensiveness of responses from ChatGPT-3.5 and ChatGPT-4.0, utilizing the most-viewed TBI fact sheets from the Model Systems Knowledge Translation Center (MSKTC) as the gold standard.

METHODS: Five TBI fact sheets were chosen from the MSKTC based on total views from 12/1/22-5/31/2023. Subheadings from the fact sheets were formatted into questions to simulate real-world queries. These questions were posed to both ChatGPT-3.5 and ChatGPT-4.0. Its output was compared to corresponding MSKTC fact sheet content and was scored by 3 blinded, independent graders using a 1-5 Likert scale based on accuracy, comprehensiveness and additional factual and useful information. The mode score among graders was used as the consensus score.

RESULTS: Analysis of 38 prompts demonstrated a significant difference in accuracy and comprehensiveness scores between ChatGPT-3.5 and ChatGPT-4.0 (p = 0.04). The mean ChatGPT-4 score was 3.63 (SD = 0.94), indicating its responses were generally accurate but occasionally lacked comprehensiveness. In comparison, ChatGPT-3.5 had a mean score of 3.21 (SD = 0.84), indicating its responses were mostly accurate but often missing key details present in MSKTC fact sheets. The standardized mean difference (SMD) was -0.47 (95% CI: -0.92, -0.01). Further analysis of individual spreadsheets showed that ChatGPT-4.0 outperformed ChatGPT-3.5 in regards to discussing details about the vegetative state, the relationship between memory and TBI and the relationship between headaches and TBI.

CONCLUSION: This study demonstrates the advancements in AI from ChatGPT-3.5 to ChatGPT-4.0, with the latter showing a statistically significant improvement in accuracy and comprehensiveness when providing information on traumatic brain injuries. While both versions of ChatGPT can serve as valuable tools for disseminating TBI information, ChatGPT-4.0 appears to be a more reliable source, particularly in discussing complex topics like vegetative state and memory-related issues post-TBI. However, caution is advised as occasional gaps in comprehensiveness were observed in both versions. Continued advancements in AI and regular updates based on reliable sources such as MSKTC are essential for optimal patient and caregiver support.

INTRODUCTION: Although often classified as ‘mild’ traumatic brain injuries (mTBI), concussions can have serious public health consequences, with approximately 32,000 people experiencing persisting symptoms in Ontario each year. Due to the lack of a standardized care pathway, care quality and receipt depend on social, geographic, and demographic factors. Concussion treatment in Ontario is provided through a combination of public and third party funded care, the nature of which is determined by the cause of injury. Third party funded care is accessible if injured in an insured motor vehicle collision or at the workplace, while those injured by falls typically only receive publicly or self-funded care. As a result, equity deserving groups are disproportionately affected, impacting the level of care received and recovery. There is little health equity-focused research characterizing the concussion population and their healthcare utilization.

OBJECTIVES: To 1) characterize mTBI/concussion and identify inequities related to healthcare utilization, and 2) highlight implications for subpopulations that may be disproportionately impacted.

METHODS: Individuals a formal mTBI/concussion diagnosis between 2016 to 2022 were identified using administrative databases (e.g., Discharge Abstract Database, National Ambulatory Care Reporting System, Ontario Health Insurance Plan, and National Rehabilitation Reporting System). Incidence and healthcare utilization rates (e.g., emergency department (ED) visits) were calculated.

FINDINGS: A total of 1,075,791 cases of mTBI/concussion were identified in Ontario. Of this cohort, nearly 30% of people sustained their injury through a fall, while sport-related injuries and motor vehicle collision comprised just 5% and 3% of all mTBI/concussions respectively. The incidence rate of concussion was 1.5 times higher among those with mental health comorbidities (14.07 vs 9.61 per 1000) and nearly 3 times higher among those with cognitive comorbidities (22.44 vs 7.87 per 1000). The ED visit rate during the two years post-concussion was considerably higher in people aged 65-79 (101 visits per 100 patient years (PY))) and 80+ (139.8 visits per 100 PY) compared to the overall provincial rate (79.3 visits per 100 PY). Those in rural or Northern areas, in the lowest income quintile, with pre-existing cognitive comorbidities, and who sustained their injury by falling also had considerably higher ED visit rates compared to the overall rate. The most utilized healthcare resource among people with concussion in the years following their injury was mental health-related care (95.8 per 100 PY).

CONCLUSION: Concussions occur frequently among older adults and people with mental health or cognitive comorbidities, who are all at greater risk of becoming high users of the healthcare system. Administrative data show that most concussions are caused by falls, which carries important implications, as fall-related injuries are unlikely to be covered by insurance-funded healthcare. Fall prevention efforts should be targeted toward these subgroups to decrease the burden on healthcare systems.

OBJECTIVES: Functional neurological disorder (FND) denotes neurological disorders of unknown origin that are not explained by other mental or medical disorders or structural injury to the brain. Symptoms can include motor/sensory loss, seizures, tremors, and other disturbances that affect critical areas of functioning. Traumatic brain injury (TBI) can be a precipitant, along with trauma and Post Traumatic Stress Disorder (PTSD) – both of which may serve as either predisposing or precipitating factors for FND. The prevalence rate of FND is higher among active-duty service members than the U.S. civilian population, with those presenting with a history of mood or PTSD symptoms at greater risk. Emergent findings on clinical treatment integrating cognitive, mindfulness, and compassion-based approaches for FND are promising but limited. There is no current evidence on body-oriented, somatic therapies which may holistically address the range of symptoms causing distress and/or dysfunction for adults with FND.

METHODS: A 3-week course of integrative treatment was delivered to a 33-yr old Special Operations Forces, male service member presenting with FND, TBI, PTSD, Generalized Anxiety Disorder, Adjustment Disorder with Depressed Mood, insomnia (clinically significant, in severe range), and chronic pain. The service member received 1-hour psychotherapy sessions, 3 to 4 times per week during an intensive post-acute inpatient brain injury rehabilitation program. Treatment consisted of a somatic and embodiment-based approach integrating cognitive behavioral psychotherapy for PTSD and chronic pain, psychoeducation, body-oriented interventions, mindful movement, meditation, self-compassion exercises, and homework. Repeated measures analyses examined change in pre-post outcomes on the General Anxiety Disorder-7, Patient Health Questionnaire-9, PTSD Checklist for DSM-5, Insomnia Severity Index, Neurobehavioral Symptom Inventory, and Self-Efficacy for Symptom Management Scale.

RESULTS: At post-intervention, there were significant decreases in neurobehavioral symptoms (31 points), PTSD (10 points), anxiety (5 points), and depression (11 points). A significant increase in self-efficacy was also found (30 points). There was a non-significant downward trend in insomnia severity (3 points). Feasibility and acceptability were established.

CONCLUSIONS: To our knowledge, this is the first evidence of efficacy, feasibility, and acceptability of third-wave cognitive behavioral treatment with a military service-member, as well as the first evidence for any integrated psychotherapy approach for adults addressing FND, TBI, and PTSD concurrently. Further adding to the literature, this is also the first investigation to demonstrate support for the effectiveness of an embodiment-focused, somatic approach to FND recovery. Further investigations based on experimental designs are needed to expand upon these preliminary findings. Recommendations for future studies and trauma-sensitive, somatic, and compassion-based approaches in intensive rehabilitation of FND and comorbid TBI and PTSD are provided.

INTRODUCTION: Photophobia is a common symptom in traumatic brain injury that can persist months and even years post injury. Currently, there is a lack of scientific guidance as to the best method to treat these patients.

METHODS: We did a retrospective review of patients presenting post-TBI to a neuro-optometric clinic complaining of photophobia and evaluated what types of light sources they found to be most triggering, as well as which treatment option they found to be most alleviating of their symptoms. We then used a spectrophotometer to measure the spectral irradiance and light intensity of the most common triggers (computer, phone, fluorescent lights, indoor incandescent bulbs, and outdoor sunlight), and the change in irradiance and light intensity when using different tinted lenses, reducing screen brightness, and using an anti-glare computer screen.

RESULTS: Direct sunlight has the highest spectral irradiance over 5x that of indoor lighting and electronics. Unlike sunlight, which had a widespread spectral irradiance over all wavelengths, Indoor fluorescent lights and electronics had small, specific peaks of irradiance. Indoor fluorescent light had peaks of irradiance at 435nm, 490nm, 545nm 585nm, 615nm and 710nm, and electronics on full brightness had peaks at 430nm, 450nm, 485nm, 540nm, 585nm, 615nm, 630nm and 650nm and 710nm which were very similar in wavelength but less intense than fluorescent lights. The intensity of the light outside was 60x more intense than fluorescent lights, and 600x more intense than electronics. Patients were variable in their photophobia triggers, with some noting all light sources as triggers, but the majority of patients only reported a profile of specific triggers (ex: fluorescent lights and electronics). Spectrophotometry of 10 different brands of “FL41” tinted lenses revealed that each tint had different spectral profile in reducing light emitted from the computer even though all are marketed as being effective in “blocking blue light.” Online purchased “blue blockers” that were clear with a slight yellow tint and prescription reading glasses with an anti-reflective coating had slight reduction in light transmission at 444-476nm, and 504-536nm, 556-576nm, 628 and 648nm, but the reduction was not as effective as using an anti-glare computer screen or adjusting the brightness of the computer. The most effective tints in reducing spectral irradiance peaks from fluorescent lights included certain but not all FL41 tints, 50% blue and 81% NOIR but that was not what the patient always said was subjectively their preferred tint for comfort.

CONCLUSION: Not all patients post-TBI are photophobic to the same light sources. The most cost effective solution is to turn the brightness down on devices and overhead lighting, and if that is not effective try an FL41, blue or NOIR tint if the patient requires it to return to ADLs.

Dr. Christopher Ogunsalu
Dr. Lissa Pinkney
Daniel Ogunsalu
Dr. Arif Saqui

The trigeminal neuralgia is a relatively uncommon condition which affects less than 0.5% of the general population. This condition is characterized by episodic attacks of sharp pains which is almost always unilateral in the region of the face with the fifth cranial nerve (CN V) distribution. This attack is triggered by movements of the facial muscles, cold temperature, touch and are spontaneous in nature and has ill-defined aetiology.

The purpose of this current work is to positively implicate the administration of the COVID-19 vaccine in the pathophysiology of this facial neuralgia which is not unlike Trigeminal neuralgia. It will as such be reasonable to implicate an immunologically mediated biochemical injury to the trigeminal ganglion as the pathway for the expressed pain.

Since Trigeminal neuralgia has existed in the past long before the introduction of COVID-19 vaccination, it may be reasonable that this condition is called a post-traumatic trigeminal neuropathic pain due to biochemical injury to the trigeminal ganglion sequel to an immunological pathway initiated by COVID-19 vaccine. It must as such be a distinct clinic-pathologic entity from trigeminal neuralgia.

Key words: Injury to the trigeminal ganglion; COVID-19 vaccine; Immunological pathway

To date, no definitive physical exam has emerged for identifying objective residual dysfunction following mTBI. Because the TBI spectrum involves subtle damage to a diffuse network of neuronal connectivity within the cortex, brainstem, cervical cord, and/or autonomic nervous system, abnormalities cannot always be localized to a focal lesion. Such findings are termed “soft signs,” and may be the only neurologic sequelae from an mTBI. These signs may persist chronically following an injury, latently impacting neurologic function and resilience. However, because the traditional neurologic exam is designed to detect focal lesions, it is often normal in patients affected by mTBI and therefore of limited utility in their diagnosis and management. In the absence of an objective, sensitive examination that assesses soft signs, many clinicians still commonly rely on subjective impressions to identify or exclude mTBI. This leads to diagnostic errors, false expectations about recovery, and limits the effective analysis of treatment interventions. A helpful contribution to this gap in validated assessment methods is the physical and neurologic examination of soft signs (PANESS), which was developed in 1984 as a tool for assessing developmental neurologic conditions in children. The PANESS has been shown to be more accurate at identifying subtle dysfunction after a concussion than the sports concussion assessment tool (SCAT). However, the PANESS does not incorporate newer research on mTBI (e.g., the VOMS), and is not standardized for adults. Considering this, we propose the SME, a soft sign assessment tool that complements the traditional neurologic bedside examination and is specific for concussion/mTBI. It integrates information from medical literature, academic conference presentations, and our research team’s more than 90 years of combined experience evaluating and studying mTBI patients. The SME focuses on identifying visual, motor, balance, and autonomic nervous system soft signs following an mTBI. These selected domains appear to be most vulnerable to damage following craniocervical neurotrauma. This premise is supported by studies on concussed athletes examined with the PANESS, by the work of other authors, and by our own prior and ongoing research evaluating processing speed, reaction time, vision, and hip flexor strength in mTBI patients. An abbreviated subset of the SME (the aSME) has recently shown effectiveness in capturing neurologic changes in subconcussed boxers compared to age-matched swimmers, post-activity. Our clinical experience and ongoing quantitative studies support the validity of the SME as a soft sign exam with the promise of being an effective tool for assessing and monitoring impairments acquired after neurotrauma. Our goal is to continue refining the SME to make it a standardized tool, available to all clinicians who evaluate and treat this complex patient population. Such an exam is necessary to improve diagnostic accuracy, guide treatment interventions, evaluate their efficacy, and assist in outcome prediction.

BACKGROUND: TBI (Traumatic Brain Injury) has been noted to be a chronic disease state. Uncertainty over predictors of long-term outcomes causes great distress for individuals with disabilities and their families.

OBJECTIVES: The purpose of this study was to determine the factors involved in the long-term prognosis of cognitive impairments and the long-term prognosis of each cognitive impairment.

METHODS: Long-term prognosis was defined as a state of 5 years or more from injury, and on May 23rd, 2023, we looked through articles from 1990 to May 23rd, 2023. A scoping review of the literature was conducted following the 2018 PRISMA-ScR Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Exclusion criteria were involving participants under 25 years old, not addressing CVD (Cerebrovascular Disease) and TBI, and no mention of cognitive impairments.

RESULTS: A total of 9 peer-reviewed articles were included for review. Factors involved in the long-term prognosis of cognitive impairment were that the severity of cognitive impairment was related with GOC (Glasgow Outcome Scale) and PTA (Period of Traumatic Amnesia) (n= 2), not related with the pre-injury social environment, but with pre-injury intelligence and educational level (n= 2), that there was significant improvement between 1 and 3 years after injury (n= 7), that there was no difference in cognitive ability after 5 and 10 years, and that some subjects have reduced memory and working memory after 10 to 15 years (n= 2). The 10-year group scored worse on NSI total score and TBI-QOL (Traumatic Brain Injury Quality Of Life) Cognitive Concerns-General, the TBI group had more physical and neurological complaints than the non-TBI group, and the neurocognitive characteristics of participants with fewer symptoms of psychological distress were better. They also stated that the prevalence of impairment of simple attention was low, with the majority of patients not impaired by 5 years post-injury, and that working memory impairment was still present at 5 years but improved between 6 months and 1 year post-injury. Visual perceptual impairment was shown to improve mostly between 1 and 5 years, and the majority of patients were free of impairment at 5 years. The prevalence of executive dysfunction was low, with the majority of participants showing no impairment by 5 years after injury, with significant improvement between 6 months and 5 years.

DISCUSSIONS: Predictors of cognitive impairment due to TBI were prior education level and severity of TBI, with visual perceptual function, attention recovered earlier from onset, and executive function and working memory recovery taking longer. However, the association between symptoms of emotional distress and cognitive function and the fact that TBI patients often have complaints suggest that the possibility that some subjects may experience memory and working memory deficits should be addressed.

INTRODUCTION: This case study describes the history of seizure-like events of a 17-year-old Caucasian female diagnosed with spastic quadriplegic cerebral palsy and Lennox-Gastaut syndrome, intractable, with status epilepticus. This individual was enrolled at the International Institute for the Brain (iBRAIN), which establishes and implements an individualized education program (IEP) for each student annually. The student’s 2022 educational plan included mandates of weekly physical (5 h), occupational (5 h), music (2 h individual; 1 h group), and speech-language therapy (5 h). Hearing (0.5 h), vision (3 h), and assistive technology services (1 h) are also included in the student's plan. For academic sessions, the student participated in a 6:1:1 special education classroom.

METHODS: As an academy, iBRAIN does not diagnose seizures. Rather, suspected occurrences were reported as seizure-like events. Information captured from a seizure-like event include, but not limited to, time of day, sensory stimulation and service rendered at time of the event, prior state of arousal, and vital signs during the postictal phase. Pulse rate, respiration rate, and saturated oxygen levels were taken, using an over-the-counter pulse oximeter with respiratory rate device (Item # 793251, Walgreens Boots Alliance, Inc., Deerfield, IL). Herein, we conduct statistical analyses of the reported seizure-like events, giving consideration to time of day, sensory stimulation, arousal level, and vital signs.

RESULTS: Within a 16-week period, 38 seizure-like events were reported during this student's school attendance. The observed frequency distribution of seizure-like events throughout the day was different (P < 0.05) from its expected distribution (i.e., equivalent number of occurrences throughout the day). The occurrence of seizure-like events was influenced (P < 0.05) by the type of sensory stimulation. Altogether, the highest seizure-like event occurrence was (in descending order) during a combination of sensory stimuli, feeding, visual, auditory, and movement. Notably, no seizure-like events were reported when the service sessions were primarily stretching exercises. In sessions where seizure-like events were reported, the mean pulse rate was 22 beats per minute higher (P < 0.05) than when no event was reported. Likewise, the mean number of respirations per minute was higher (P < 0.05) when seizure-like events were reported. Saturated oxygen levels did not differ statistically, when comparing sessions with the presence or absence of seizure-like events.

CONCLUSION: Understanding patterns of seizure-like events in a school setting could be used to dose or titrate educational and related service sessions. In this case, accommodation for arousal level and increased integration of muscular stretching may be indicated.

This poster aims at presenting the main goals of the Iberian Observatory for Disorders of Consciousness and what the developers intend to do to ensure the success of this international project.

The high rate of misdiagnosis for people with disorders of consciousness (DoC) is well known and widely reported in the literature. Most of these studies have been carried out in countries where there are validated tools for the assessment of DoC (Childs & Mercer, 1996; Andrews et al., 1996; Gill-Thwaites & Munday, 2004; Schnakers et al., 2009; Wang et al., 2020). The JFK Coma Recovery Scale-revised is the gold standard assessment for DoC and has already been translated and validated in many countries. However, there are still countries where there are no translated or validated assessment tools and/or where there is little knowledge among health professionals about this population. Portugal and Spain are among those countries. Thus, it became imperative to create an observatory that would help to organize research in this field and to shed a light on this spectrum of often forgotten population.

The main aim of this Observatory is to contribute to understanding the reality of DoC in Portugal and Spain, to understand the trajectory of patients' general state of health, and above all to give visibility to a spectrum of disorders that are little talked about in both countries. By creating partnerships with health institutions, medical and other health professionals’ societies, research centers, and other stakeholders it is hoped to open a path for high quality standard research.

It is also the Observatory's responsibility to promote international scientific research activities in the area, contribute to the validation of diagnostic tools in Spanish and Portuguese and share knowledge to the community through the organization of short courses as well as by providing support for undergraduate and postgraduate training in this area.

BACKGROUND: Traumatic Brain Injury (TBI) is a serious medical condition well recognized among veterans and athletes, but less is known about TBI as a consequence of physical violence, particularly domestic violence and intimate partner violence (DV/IPV). An estimated 25% of women and 10% of men in the United States experience DV/IPV during their lifetime, with 74% of individual violent events involving injury to the head, neck or face. Half of these events include strangulation causing hypoxic brain injury. Despite a recent study which found that 58% of women entering DV shelters had sustained one or more concussions from DV/IPV, survivors more often engage with mental health professionals (MHPs) for TBI symptoms such as anxiety, depression, and PTSD than with concussion experts. MHPs have an unique opportunity to recognize TBI in clients who have experienced physical violence or abuse, incorporate an understanding of brain injury into their care programs, and refer to TBI experts as appropriate.

OBJECTIVES: The primary objective is to estimate the percentage of MHPs who care for survivors of physical violence in their practice. The secondary objective is to assess among MHPs who care for survivors of physical violence their self-reported comfort and training to recognize signs and symptoms of TBI among their clients.

METHODS: A ten question anonymous online survey tool was vetted, validated, and sent to a cohort of U.S. health care professionals inclusive of MHPs affiliated with DV/IPV organizations. The 5-10 minute survey includes respondent demographics and utilizes standard Likert scales to assess self-reported experience, training and comfort in assessing TBI.

RESULTS: Of an estimated 350 surveys sent out, 102 responses were returned with 74 responses sufficiently completed for inclusion in the analysis. While 89.2% of MHPs reported that their clientele includes individuals who have experienced physical violence, only 16.2% of MHPs responded that they felt very comfortable or extremely comfortable in evaluating clients for TBI. 45.9% of MHPs reported receiving no training in TBI assessment; however, 70.2% reported that they are very interested or extremely interested in further TBI training.

CONCLUSION: While the majority of MHPs reported seeing clients who have experienced physical violence, a population with a high rate of TBI, the results of this study highlight the potential knowledge gap about TBI among MHPs. Given the disparity, it is encouraging that the majority of MHPs reported high interest in further training to recognize the signs and symptoms of brain injury among their clients, suggesting an opportunity to improve trauma-informed mental health services for survivors of DV/IPV.

INTRODUCTION: Traumatic brain injury (TBI) is a known risk factor for delirium, a condition associated with prolonged hospitalization and cognitive deterioration. Although the relationship between TBI and delirium is established, a detailed understanding of specific predictors remains limited. Respiratory disorders can significantly influence the central nervous system, with sequelae such as hypoxia, hypercapnia, and respiratory acidosis causing neurologic dysfunction. Therefore, we hypothesize that lung-associated conditions, stemming either from direct injuries or subsequent surgeries will increase the risk of developing delirium in TBI patients.

METHODS: The 2017-2021 Trauma Quality Improvement Program database was queried for patients with TBI, excluding for those with pre-existing dementia. TBI patients developing delirium were compared to those without delirium. A multivariable logistic regression analysis was performed to determine predictors of delirium.

RESULTS: Among 155,252 TBI patients, 3,244 (2.1%) developed delirium. Delirium-afflicted patients showed elevated rates of lung injury (25.0% vs 13.3%, p<0.001), severe head trauma (Abbreviated Injury Score ≥ 3) (51.4% vs 37.8%, p<0.001), sepsis complications (3.1% vs. 0.5%, p<0.001) and more commonly underwent pulmonary operations (21.8% vs. 6.6%, p<0.001). The strongest associated risk factors for delirium included functional dependence (OR 2.70, CI 2.43-3.00, p<0.001), intubation (OR 2.33, CI 2.13-2.56, p<0.001), concurrent lung injury (OR 1.21, CI 1.20-1.33, p<0.001) and pulmonary surgery (OR 1.64, CI 1.48-1.82, p<0.001).

CONCLUSION: Delirium affected approximately 2% of the national TBI population. Our analysis not only reaffirms known predictors but also emphasizes the critical influence of lung-related conditions on delirium onset. Systemic inflammatory response, frequently instigated by lung injuries, might intensify neurological issues, escalating risk of delirium. Recognizing these risk factors is crucial in refining delirium prediction, prevention, and treatment in the setting of TBI.

There is a growing body of literature aimed at understanding the assessment and management of chronic pain after moderate to severe traumatic brain injury (M/S-TBI). Multidisciplinary (MDT) pain management is accepted as gold standard for chronic pain, but there is limited evidence to guide clinicians on how to modify general pain management strategies for people with a M/S-TBI. The Be Pain Smart – Online Education Modules (BPS-OEM) are a suite of online modules, providing evidence-based training for clinicians on pain management strategies for people with a M/S-TBI. The modules have utilised optimal adult learning principles within the design to support the learning of pain management strategies and clinical decision making aligned with the BPS clinical reasoning framework. The online delivery allows for maximum accessibility to facilitate the training of clinicians across metropolitan and rural/remote regions. The aim of this study is to evaluate the feasibility and acceptability of the BPS-OEM, particularly examining clinicians’ pain beliefs, confidence and clinical practice when managing pain with people who have a M/S-TBI. A sample of allied health clinicians were recruited via advertisements through the relevant New South Wales (NSW) networks. Data was collected via an online survey with outcome measures targeting clinical practice, knowledge, confidence, pain beliefs and clinical value of the BPS-OEM. Results demonstrated improvement in clinician confidence and pain knowledge, and changes in pain beliefs to be more aligned with MDT pain management approaches. The BPS clinical reasoning framework with an online interactive clinical reasoning tool will be presented with accessibility and usability results presented. The authors will discuss how improvements in clinician confidence and pain knowledge will lead to increased capacity within existing services to assess and manage chronic pain in the TBI population. The added value of additional 6 group mentoring sessions to compliment the BPS-OEM will be reviewed. The BPS-OEM provides training and a clinical reasoning framework to assist clinicians to improve access to and the delivery of appropriate pain management services for people with a M/S-TBI.

Purpose:
Recovery times for collegiate athletes with sport-related concussion (SRC) range from 2 to 4 weeks. The stimulated blink reflex is abnormal after SRC. This study assessed the blink reflex daily from initial assessment (within 2 days of injury) to recovery and compared it with symptom recovery.

Methods:
Prospective cohort. Blink reflex (EyeStat) and Post-Concussion Symptom Scale (max=126) were assessed daily from injury to recovery. Blink reflex parameters: time to ipsilateral blink (latency), contralateral blink (differential latency), initial velocity, time to open, time to close, number of oscillations, and distance traveled (excursion). Associations over time were assessed using regression.

Results:
41 SRC (from 36 unique athletes, 20.46±1.50 y/o, 79.5% male, 0.95±1.2 days since injury) are included in analysis. Mean symptom severity at initial assessment was 25.00±17.3 and mean time to symptom resolution was 10.87±7.3 days. No significant correlation over time (i.e. p-value of interaction term of blink reflex parameter with days since injury) was observed between daily symptom severity and differential latency (p=0.097), initial velocity (p=0.150), time to open (p=0.506) and number of oscillations (p=0.228). However, a significant association was found for latency (p=0.016), time to close (p=0.017) and excursion (p=0.012). In all three of these regression models, symptom severity significantly decreased over time (p=0.013, 0.017 and 0.013, respectively) and correlated with individual blink reflex parameters throughout the recovery period (p=0.002, <0.001 and <0.001, respectively).

Conclusion:
Certain stimulated blink reflex parameters (latency, time to close and excursions) have a significant association with daily symptom reporting over time, meaning that they are abnormal when athletes report a high number of symptoms and return to baseline when athletes are asymptomatic.

Significance:
Identifying patterns on how the blink reflex changes throughout recovery and identifying those that are associated with symptom recovery can help develop algorithms that can use change in blink reflex parameters to predict symptom recovery.

BACKGROUND: SwapMyMood is an innovative mobile app designed to assist individuals with traumatic brain injury (TBI) in implementing problem-solving and emotion regulation strategies based on the clinically validated Short-Term Executive Plus (STEP) cognitive rehabilitation interventions. SwapMyMood's genesis stems from experiences of patients undergoing TBI rehabilitation who reported challenges recalling and initiating the STEP program process and strategies, particularly in stressful situations. The app was designed to provide a portable solution that electronically guides users through problem-solving and emotion regulation strategies based on the content of the STEP intervention paper manual. App development followed an iterative user-centered design process involving interviews, surveys, sit-by demonstrations, and take-home testing with participants with TBI and clinical experts, incorporating end-user feedback at every stage of design. Three previous design cycles were completed with input by twelve subject matter experts (SMEs) and 24 people with the lived experience of TBI leading up to the current iteration of the app.

OBJECTIVE: To describe usability results of the most recent of user-centered design testing of the recently launched 2023 version (v.1.0.10) of SwapMyMood. Usability testing ensures that the new version is functioning correctly and meets the needs of target users. It also helps identify opportunities for future improvement.

METHODS: The study included six military service members/veterans with persistent mild TBI (mTBI) symptoms who were participating in an intensive outpatient TBI rehabilitation program, along with four SME clinicians providing care to one or more of the participants. Two additional SMEs outside the clinical setting also provided feedback. Participants used the app in the clinic, home and community for up to two weeks and completed interviews and surveys regarding their experience with the app. Participants with TBI completed the System Usability Scale (SUS). All participants answered questions on app usefulness and desired features.

RESULTS: All testers rated the app's design and usability positively. SUS scores indicated high acceptability and usability (M=92.08). Users with mTBI reported an increase in knowledge of the app's supported strategies following take-home use. All SMEs believed the app could benefit people with TBI and that it could be useful in their own professional practice. Valuable feedback from participants suggested the need to further refine some features to enhance support for users with TBI-associated memory challenges in accessing the app's interventions.

CONCLUSION: The iterative user-centered design process for the SwapMyMood mobile app, conducted in a real-world clinical setting, has shown promising results. Users and SMEs are enthusiastic about its potential to support TBI patients in managing their symptoms and enhancing their quality of life. The valuable feedback collected from participants will guide ongoing app refinement, making it a more effective tool for both patients and professionals in the field of TBI rehabilitation.

Behavioral disturbances are some of the most pervasive and persistent phenomena that follow an acquired brain injury (Corrigan, 1985). Rehabilitation sites across the United States struggle to provide services for individuals who consistently engage in challenging behaviors (Ketzmer et. al, 2022). At Craig Hospital, in Englewood, Colorado, Physicians and Board Certified Behavior Analysts (BCBA) are integrating the science of Applied Behavior Analysis (ABA) into the acute inpatient setting. This science, based on human behavior, is reshaping and redefining how clinical staff in this early phase of recovery gain information about patient behaviors, communicate about behavioral needs, and utilize their environments to shape socially appropriate behaviors.
The interdisciplinary teams, in conjunction with the newly added BCBA positions, have created novel systems to collect individualized data around behaviors that most impact the current rehab process. Day-to-day data is facilitated by nursing staff and used by the entire interdisciplinary team to help inform decisions. Data is operationally defined using tools validated through the ABA community. Rehab teams focus on the ability to define behavior prior to trying to measure it for best results. The current site utilizes a 15-minute partial-interval time-sampling template with up to 4 operationally defined behaviors. These individualized systems are used in tandem with reliable and validated assessments such as the Agitated Behavior Scale (ABS) (Corrigan, 1985).
Communication for behavioral needs and escalated events have been a primary focus of this program. Staff have received education, feedback and debriefs for all information provided through our quality improvement system. Most importantly, physicians and BCBAs have focused heavily on creating a language around behavior that allows staff to communicate in a way that is intentional and functional. Staff have been encouraged and engaged with the opportunities to improve the way behavior management flows.
Globally, the focus has been on indicating how the environment shapes patient behavior. Utilizing the building blocks we all know - consistency and structure - ABA fills a crucial gap in rehabilitation implementation that exists within the current structure. Although many team members with insight into behavior do exist, behavior analysts uniquely carry skills that allow them to both intervene and educate on behavioral principles across activities of the day. Our talk will include the process used to determine the effectiveness of medications utilized for behavior management. We will describe how staff are able to also use daily information to determine location, interaction structure and reinforcement for patients. The purpose of the current oral presentation will be to provide clinicians with an overview of the science that they can use in any setting to better manage behavior.

In 2022, the National Association of State Head Injury Administrators (NASHIA) launched its first special interest group, NASHIA’s Collaborative on Children’s Brain Injury (NCCBI). NCCBI’s mission is to improve services and support for children with acquired brain injury. In 2014, NCCBI was formed outside of NASHIA, and in 2023, partnered with NASHIA to expand the group’s impact. NCCBI’s goals include 1) Identifying and addressing critical gaps in the continuum of services and supports, 2) Collaborating with national key partner groups to establish common language, practices, and to make policy/research recommendations, and 3) Educating, sharing information, developing tools, and resources on supports and services. NCCBI has two active working groups. The Standards of Practice workgroup is reviewing documents used across the United States to assess student history of brain injury. The Educational Policy workgroup focuses on early childhood brain injury and examining the processes to qualify for early intervention by state. The NCCBI workgroup’s findings will inform future projects to address the under-identification of children and adolescents who experience brain injury.

The three co-chairs of NCCBI, and colleagues representing school counseling and school psychology, recently submitted a commentary on eligibility determination for school-age children with traumatic brain injury (TBI). This paper explains the public-school evaluation process, including assessment considerations specific to students with TBI. A significant obstacle contributing to the under-identification of students with TBI is that many school districts require a medical statement for a TBI special education eligibility. To remedy this barrier, the authors propose using a guided credible history interview (GCHI) as an alternative to a medical statement. A GCHI is conducted by a school professional who is familiar with a TBI's physical, cognitive, emotional, and behavioral effects and symptoms can emerge over time. The person interviewed is someone with knowledge of the TBI event, such as a parent or guardian. The information provided in the GCHI can then be used by schools instead of a medical statement, increasing the likelihood of identification of students with TBI. In 2020, the state legislature in Oregon adopted the GCHI process. First-year implementation data indicates that the number of students identified under Oregon's TBI special education category increased 21%.

Future research is needed to evaluate the effectiveness of the GCHI to expand the identification of students with TBI so that they receive appropriate learning and behavior support. Students with TBI have nuanced needs that cannot be identified through clinical testing alone. NCCBI will identify and support educational policies that promote expanded use and interpretation of curriculum-based assessments and school-day observation to ensure that investigation of a student’s functional skills occurs where they are likely to show actual deficits.

Movement disorders are commonly seen clinical phenomena in patients who have suffered a moderate to severe acquired brain injury (ABI). While spasticity and ataxia are well known neurological deficits, less common types of movement disorders are encountered in our inpatient rehab program, which is the focus of this study. Early diagnosis and identification of contributing factors is key to reaching favorable functional outcomes for those patients. Here we present 6 types of clinical conditions including: (1) Parkinsonism with the etiology of ABI versus medication adverse effects. Dopamine agonists and anticholinergic agents may be beneficial for the former while discontinuation of culprit medications is important for the latter; (2) Dystonia with a similar etiology and pharmacological management as parkinsonism; (3) Tardive dyskinesia commonly seen as an adverse effect of dopamine antagonists, for which management is more challenging; (4) Tremor mimicking the symptoms of essential tremor (ET) seen after an injury to the cerebellum or brain stem, for which primidone is usually effective while some other antiepileptic drugs may worsen symptoms; (5) Palatal myoclonus seen after an injury involving the dentato-rubro-olivary pathway, for which antiepileptic medications can be trialed to alleviate symptoms; (6) Chronic post-hypoxic myoclonus which may be well managed with antiepileptic agents such as valproic acid, clonazepam and levetiracetam. We are a multidisciplinary team that specializes in adult ABI rehabilitation. Our team is comprised of physician specialists and allied health professionals including but not limited to pharmacists, physiotherapists, occupational therapists, speech-language pathologists and rehab therapists. We also have ready access to consulting specialists to assist in differential diagnosis and management planning if needed. In addition to medications, non-pharmacological interventions are essential to successfully enhance the function of ABI patients with movement disorders. Allied health teams can assist with positioning, developing strategies and utilizing assistive devices for more controlled movement, and thus creating opportunities to practice. The impact of the above-mentioned neurological conditions on functional movement patterns is assessed throughout the medication trials as the side effects of various medications can take time to develop. Multidisciplinary rehabilitation requires close collaboration among all team members to determine appropriate and effective strategies that, when implemented together, will optimize physical, communication, swallowing, and cognitive function. Continuous collaboration between allied health team members and the medical team is imperative to determine appropriate and effective pharmacological interventions (i.e. to address/manage tremor, hypertonia, movement initiation, etc.) that, in combination with evidence based therapeutic interventions, will enhance and maximize recovery for each patient experiencing movement disorders secondary to ABI.

This study examines hypoxic ischemic brain injuries in the context of cerebral palsy (CP) in India. Children with CP commonly experience issues like epilepsy, hearing loss, and feeding difficulties. These feeding problems result from communication barriers, oral-motor dysfunction, and aspiration. Despite various assessment tools for feeding issues, there's a lack of options in Indian languages. This study focuses on the complexities of hypoxic ischemic brain injuries, particularly within the context of CP. The objectives of the study are to evaluate the impact of hypoxic and ischemic brain injuries on individuals' neurological and cognitive functions and provide observational insights to enhance the scientific understanding of these injuries.

The research took place in Pune, Maharashtra, employing a cross-sectional design and convenient sampling. Marathi-translated version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was utilized, comprising 35 items. These items allowed parents to assess both their child's eating behaviors and their own feelings or strategies concerning feeding issues. The translated BPFAS was administered to parents of children diagnosed with CP. Using the Marathi-translated BPFAS, the questionnaire was structured into five categories: 'Picky Eaters,' 'General Toddler Refusal,' 'Toddler Refusal—Textured Foods,' 'General Older Children Refusal,' and 'Stallers.'

A sample was gathered from the School of Audiology and Speech Language Pathology at Bharati Vidyapeeth (deemed to be a university). Out of the initial group of 50 participants, aged between 9 months and 7 years and diagnosed with cerebral palsy (CP), two participants declined to provide consent for the study, and 21 participants were excluded due to not meeting the inclusion criteria. The inclusion criteria required parents to be native Marathi speakers and their children to be aged 9 months to 7 years with CP attributed to hypoxic ischemic encephalopathy; the rest were excluded.
A descriptive analysis calculated standard deviations and means, revealing no significant gender impact on BPFAS scores. Notably, the study identified distinct feeding challenges among children with CP who displayed milder picky eating tendencies, while younger children in the 'General Toddler Refusal' category exhibited common issues like whining and food refusal. The 'Toddler Refusal—Textured Foods' category emphasized difficulties with specific food textures, underscoring the need for tailored interventions. Additionally, the 'General Older Children Refusal' and 'Stallers' categories highlighted CP-related behaviors in food choice negotiation and eating habits. This study offers valuable insights into mealtime behavior patterns in children with CP, underscoring the significance of tailored feeding interventions.

In conclusion, this study sheds light on the multifaceted challenges faced by children with CP in India. The prevalence of CP, its associated comorbidities, and the impact on feeding and communication are important considerations. The findings highlight the pressing need for high-quality prevalence studies in India to better understand the CP landscape and its associated issues.

INTRODUCTION: Existing literature is clear that multidisciplinary treatment of persistent mTBI (concussion) symptoms is critical in improving patient outcomes. Institutions are often left to their own devices to determine how to provide this type of care in a way that is viable for providers, maximizes interdisciplinary potential, and is most helpful to patients and families. This study illustrates one model of achieving interdisciplinary care for a patient population with complex, varied, and persistent symptoms following remote mTBI. An interdisciplinary care model involving Medicine, Nursing, Neuropsychology, and Pediatric Psychology is presented using a case series to illustrate common symptom presentation, in-clinic assessment methods, and treatment recommendations. Twelve months of preliminary descriptive data is presented in this abstract, with five years of analysis available by date of presentation. Considerations related to equity, diversity, and inclusion within this population will be discussed.

METHODS: Retrospective chart review was conducted of patients experiencing persistent symptoms > six months following an mTBI who were evaluated in a pediatric mTBI multidisciplinary clinic. Patients with findings on neuroimaging were excluded. Three cases with persistent symptoms are illustrated. The interdisciplinary care model is presented with an emphasis on each discipline’s role, assessment methods, and treatment recommendations.

RESULTS: Preliminary data extraction of cases over the course of 12 months was reviewed (n = 23). The mean age of patients was 15.8 years (range: 10-21 years). Patients were primarily female (65.2%; sex assigned at birth), White (73.9%), and not Hispanic (65.2%). Mean time since injury was 22.3 months (range 6-72 months). Most common presenting symptoms included mood-related concerns (83%), headaches (78%), and cognitive complaints (65%). The majority of patients (91%) were fully cleared from a mTBI perspective following the interdisciplinary team evaluation. Mental health support was recommended for 96% of patients and 35% were referred to physical therapy. Analysis including a total of five years of data will be reviewed.

DISCUSSION: An interdisciplinary care model provides specialty evaluation and treatment across physical, cognitive, and emotional domains of functioning while decreasing overall medical utilization rates, reducing the potential for conflicting recommendations among providers, and lessening time away from school and work for patients and their families. Most importantly, interdisciplinary management provides a comprehensive treatment plan, making the path to recovery clear and achievable. It also allows for a broader focus on factors predictive of recovery, which may fall outside the scope of a single-discipline visit.

This presentation or poster will make use of case examples to demonstrate how the Rehabilitation Treatment Specification System (RTSS) provides the means of moving knowledge from rehabilitation literature to the front lines all in an effort to enhance the work being done at CONNECT. We will explore how the RTSS framework has helped build a greater understanding of the many opportunities for rehabilitation that are present at CONNECT.

For 30 years, CONNECT Communities has supported people in redesigning their lives after brain injury and stroke. CONNECT's Leading Practice Life Redesign Model includes meaningful community participation with an emphasis on social capital within a context of supported risk-taking. CONNECT originated in British Columbia and is now also located in Hamilton Ontario. In partnership with the local hospital system, Hamilton Health Sciences, people living with Acquired Brain Injury (ABI) are supported to engage in everyday activities to support their Life Redesign Plan. This requires close collaboration with professional team members, those who provide direct daily support (Life Redesign Coaches), and most importantly, the individual and their family. Being able to untangle complex everyday activities to allow for outcome measurement and maximized consistency of approach across the organization is a challenge. In 2016, The RTSS was introduced to rehabilitation Science. The RTSS provides a means of better analyzing, documenting, researching, and discussing the many components of any rehabilitation program. At CONNECT, the RTSS is providing the means of untangling the everyday to describe rehabilitation opportunities for individuals with ABI within CONNECT's Life Redesign Model.

Utilizing the RTSS, the regulated health professional coaches reviewed the existing Life Redesign Goals and Plans that guide the rehabilitation of 10 residents at CONNECT. The process revealed a new way of seeing rehabilitation. When viewed through a different lens, it was possible to better describe Life Redesign at CONNECT, in terms of the aims, targets, and ingredients of the RTSS. In turn, this created opportunities to disseminate knowledge to all involved. Ultimately, the collaboration among professionals, frontline coaches, family, and the individuals we support, has allowed for greater unity and a better understanding of the rehabilitation layered into the everyday.

The landscape of prolonged symptomatology and functional impairments following traumatic brain injury (TBI) can become perplexing and enigmatic to unravel etiologically. This constellation of TBI-induced symptoms can present curious, latent emerging symptoms which are difficult to distinguish across clinical settings. Since the specific biomechanics and aerodynamics involved in each injury scenario can vary widely, the combination of variability across individual coping styles, as coupled with personalized immune system responses, can interactively determine lingering and evolutionary injury-induced symptom sequelae. A sizeable amount of these persistent, post-morbid TBI symptom profiles may functionally overlap, and can feature multi-organ-system involvement. As an additional complication, impaired symptom awareness can amplify TBI-induced trauma and PTSD symptomatology for the injured individual, since an association to actual injury dynamics often goes underrecognized, and/or misdiagnosed, subsequently postponing essential treatment(s). When an injured individual discloses or displays curious, continuous and/or newly emerged TBI-related symptoms which are not taken seriously by others, these courageous communications may become misunderstood, dismissed, disbelieved, and underappreciated. Misinterpretation of symptom self-disclosures as being insincere, confabulated, or malingering can be difficult to cope with, especially when originating from family, friends and across other meaningful relationships. These discrediting impressions add baffling layers of burden to an individual suffering with a TBI, complicating the already challenging task of healing and recapturing pre-injury functioning. When the response of others involves questioning the authenticity of prolonged symptoms, this feedback translates atmospheric doubt, conveying non-supportive recovery expectations. This stress provocative dynamic can dilute relationship integrity, induce trauma triggers, reactivate, and amplify residual PTSD, and compound unresolved, post-morbid symptoms for the injured individual. A self-protective avoidance response of social disengagement is common, as the individual withdraws or self-isolates to minimize negative exposure impact. Essential treatment targets should encompass a thorough exploration of pre-morbid vs. post-morbid profiles, based on patient self-report, collateral input, and findings from standardized testing aimed at assessing and quantifying post-morbid functional impairment(s) and pre- vs. post-morbid discrepancies. Referral to well-informed, multidisciplinary providers who rely on evidence-based, specialized ancillary services can assist in discerning symptom persistence and its link to TBI-related events, while expediting multimodal interventions as may be warranted. A two-pronged psychotherapeutic approach should prioritize providing guidance and support in identifying and recognizing unrelenting post-morbid symptom comorbidities featuring neuropathophysiological, multi-system involvement. Secondly, evidence-informed psychoeducation should include didactic, portable coping skills which focus on tracking routine functioning across atmospheres, monitoring sleep architecture, nutrition, integrating modest exercise, budgeting energy output, mood regulation, promoting a self-healing mentality, and bolstering confidence in healing, health resilience and recovery. Restoring a sense of dignity for the TBI-injured individual by validating symptom legitimacy and launching endeavors to clinically investigate symptom etiology via referral(s) and clinical collaboration with multidisciplinary providers are essential approaches in addressing prolonged TBI-induced symptomatology.

Traumatic brain injury (TBI) is a condition that can cause oxidative stress, inflammation, and cell death in the brain. Antioxidant therapies have been studied as a potential treatment for TBI, including hydrogen treatment. Si-based agent continues generating hydrogen for more than 24 hours by the reaction with water and generates approximately 400 mL of hydrogen. However, there is no specific information available on the effectiveness of Si-based agents for TBI. This study aimed to investigate the beneficial effects of the Si-based agent for TBI in a mice model. We used the controlled cortical impact model (CCI) mice. The mice were fed a control diet or a diet containing the Si-based agent for one week before CCI. One week after CCI, the Y-maze and open-field tests were performed as behavioral tests. As a result, mice treated with Si-based agents (n=19) showed a notable increase in the spontaneous alternation values compared to the control group (n=19) (control group vs treatment group = 61.7% (51.9-69.2%) vs 74.2% (60.3-85.7%): p=0.03). However, there were no significant differences between the control group and treatment group in the open-field test (time in the inside zone; control group vs treatment group = 27.2 seconds (22.6-34.5 seconds) vs 30.1 seconds (16.8-34.2 seconds): p=0.99, total distance; control group vs treatment group = 29.1 meters (22.5-34.3 meters) vs 28.8 meters (23.1-35.8 meters)). These findings indicate that the Si-based agent is found to prevent impairment of spatial learning and memory after CCI, which should be considered as a novel hydrogen administration method for TBI.

In 2015, the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) published Best Practices in the Management of Traumatic Brain Injury which provided practice and care recommendations for patients with Traumatic Brain Injury (TBI) served by trauma centers. The purpose of the TBI Best Practice Guidelines (BPG) is to provide ACS verified trauma centers evidence and expert-based recommendations to determine best practices and quality care for TBI to support optimal long-term outcomes and recovery. These 2015 BPGs were developed by a committee consisting of neurotrauma, neurosurgery, neurocritical care and nursing experts and were endorsed by ACS and TQIP.

Since 2015, TBI research, published evidence and clinical care has evolved in multiple domains warranting a re-evaluation of the current TBI BPGs. ACS and TQIP supported an update to the 2015 publication to be congruent with current evidence and recommendations. The revised TBI Best Practice Guidelines builds on the work of the first edition from 2015. The updated 2024 TBI Best Practice Guidelines includes De Novo sections of TBI trauma care that were not included in the previous edition. Recently, ACS has been deliberate in pursuing collaboration with rehabilitation experts as the benefit of early rehabilitation improves outcomes from trauma and TBI patients and lead to the genesis of a focused rehabilitation best practice recommendation section within the new 2024 TBI BPGs as a de Novo section.

A cadre of TBI and rehabilitation experts were assembled to participate in the ACS TBI BPG committee to develop novel rehabilitation recommendations for trauma centers. Rehabilitation experts conducted in-depth review of rehabilitation literature to guide development of robust rehabilitation recommendations that would promote early initiation of rehabilitation within the ICU setting, emphasize the benefits of early rehabilitation for all severities of TBI and support the integration of rehabilitation experts into the core trauma team.

This poster will disseminate the final “key points” that summarize the evidence and expert consensus for rehabilitation best practice after TBI for trauma centers. These key points will be included in the final publication and will be available as open access in January 2024. The six finalized recommendations address rehabilitation for the spectrum of TBI severity and emphasize the importance of rehabilitation specialists as core members of the trauma team.

INTRODUCTION: Social determinants of health (SDoH) include socioeconomic and environmental factors that can influence health outcomes. SDoH are understudied in the concussion literature. Previous research suggests racial/ethnic and socioeconomic disparities in concussion care access. However, whether SDoH are associated with increased likelihood of sustaining a concussion remains unknown. The current study investigated whether SDoH are associated with parent-reported lifetime history of concussion in children and adolescents in a national sample.

METHODS: The 2021 National Survey of Children’s Health is a national survey that collects parents’ self-reported health data on their children. Data from 34,077 youth (ages 5-17) were selected with complete data on the lifetime concussion history survey question. SDoH variables of interest included: primary language spoken at home, family income, parental level of education, and current health insurance. Separate binary logistic regressions were conducted with parent-reported lifetime concussion history as the dependent variable and demographics/SDoH variables as the predictor variables. A multivariable logistic regression was conducted including all predictors in the same model to examine the independence and magnitude of their associations.

RESULTS: In the univariable logistic regressions male sex (OR = 1.4, p < .001), adolescent age (OR = 3.1, p < .001), playing a sport in the past 12 months (OR = 1.9, p < .001), and having current healthcare coverage (OR = 1.5, p < .01) were associated with significantly higher lifetime history of concussion. Hispanic/Latino ethnicity (OR = 0.69, p < .001), non-English primary language (OR = 0.23, p < .001), lower level of parental education (OR = 0.82, p < .001), living in poverty (OR = 0.63, p < .001), and identifying as Black or Asian (OR = 0.55 and 0.31, respectively, p < .001) were associated with significantly lower lifetime history of concussion. In the multivariable model, after accounting for the combined effects of all predictors, significant independent predictors of lower lifetime history of concussion were lower level of parental education (OR = 0.92, p < .05), non-English primary language (OR = 0.36, p < .001), and identifying as Black or Asian (OR = 0.54 and 0.36 respectively, p < .001).

CONCLUSIONS: Several demographic and SDoH variables were associated with lower parent-reported lifetime history of concussion in school-aged children and adolescents including younger age, female sex, Black or Asian race, and Hispanic ethnicity. Adjusting for all variables, lower parental education, not speaking English as the primary language at home, and Black or Asian race were independently associated with lower lifetime history of concussion. Lower health literacy or access to care may contribute to families being less likely to recognize symptoms of concussion or seek out medical care for such an injury.

INTRODUCTION: Previous research has suggested greater lifetime concussion history among children/adolescents with attention-deficit/hyperactivity disorder (ADHD) compared to peers without ADHD. This research has focused on youth athlete’s self-reported ADHD history, as opposed to parent-reported diagnoses, and those studies have not examined differences across broad age spans. It is unclear if ADHD severity or medication status are associated with greater lifetime history of concussion. The current study investigated the association between parent-reported ADHD, ADHD severity, and medication status with lifetime concussion history in a national sample. We hypothesized that parent-reported ADHD severity would be associated with greater parent-reported lifetime concussion history, and that this would not differ across age ranges. We also hypothesized that, among youth with ADHD, those who were taking ADHD medication and those with mild (vs. moderate/severe) ADHD would have lower lifetime concussion history.

METHODS: A sample of 33,914 children/adolescents (ages 5-17, mean = 11 years, SD = 4; 47.9% female) were selected from the 2021 National Survey of Children’s Health (those with complete data on the variables of interest). Overall, 6.2% of youth had parent-reported history of concussion (n = 2,103) and 13.4% had a history of parent-reported ADHD (n = 4,560). ADHD severity (mild or moderate/severe) and medication status (yes/no) were parent-reported for those children/adolescents who had current ADHD. A Mantel-Haenszel analysis was used to assess the associations between ADHD and lifetime concussion history across 5 age groups (5-7, 8-10, 11-13, 14-15, and 16–17-year-olds). Additional Mantel-Haenszel analyses were used to assess the associations between lifetime history of concussion and ADHD severity as well as medication status across the different age groups.

RESULTS: Youth with ADHD were more likely to have greater parent-reported history of concussion across all 5 age bands (χ²Mantel-Haenszel = 80.97, p < .001). However, odds ratios (OR) differed across age-groups (χ²Breslow-Day = 18.48, p = .001). The greatest difference was found in the 5-7-year-old age band (OR = 3.05) and ORs for older ages were smaller (8-10 OR = 1.68; 11-13 OR = 2.04; 14-15 OR = 1.62; 16-17 OR = 1.30). There were no differences in lifetime concussion history for those with mild ADHD versus moderate/severe ADHD (χ²Mantel-Haenszel = 0.02, p = .90). Similarly, there were no differences in lifetime concussion history for those taking ADHD medication versus those who were not taking medication (χ²Mantel-Haenszel = 0.78, p = .38).

CONCLUSIONS: Consistent with previous literature, youth with ADHD had greater lifetime concussion history. Contrary to our hypotheses, this difference was not consistent across ages, as differences between those with and without ADHD were larger for younger children compared to older children and adolescents. Also, among youth with ADHD, parent-reported ADHD severity and medication status were not associated with lifetime concussion history.