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.

Ten eleven translocases (TETs) mediate the conversion of 5-hydroxymethyl cytosine (5-mC) to 5-hydroxymethyl cytosine (5-hmC). The TET3 isoform and 5hmC are known to be enriched in the neurons in brain. TET3 is known to promote cell survival by inducing the expression of anti-inflammatory genes. Vitamin C (ascorbate) is a potent activator of TET3. Hence, we tested the efficacy of ascorbate in curtailing secondary brain damage and promoting motor and cognitive functional recovery after traumatic brain injury (TBI) induced in adult C57BL/6 mice by controlled cortical impact (CCI). Mice were given 3 doses of 500 mg/Kg ascorbate i.p. at 5 min, 1 day and 2 days after CCI injury (n =7/cohort). Seven saline treated mice were used as control. Both cohorts of mice were subjected to motor function analysis by rotarod test (between days 5 and 28) and cognitive function analysis (between das 21 and 23) after the injury. Mice were pretrained for 3 days before each test. Mice were euthanized on day 21 and the cortical injury (lesion) volume was estimated using cresyl violet stained serial brain sections. Post-TBI motor dysfunction was significantly reduced in the ascorbate-treated cohort compared to vehicle control (p < 0.05 by 2-way repeated measures ANOVA with Sidak’s post hoc test). Ascorbate treated cohort stayed in the platform quadrant significantly longer than the vehicle control mice in the Morris water maze test (probe trial on day 24; p < 0.05 by Mann-Whitney U test). In addition, the cortical lesion volume was also significantly smaller in the ascorbate treated mice compared with the vehicle treated mice (p < 0.05 by Mann-Whitney U test). These results indicate that epigenetic modulation by ascorbate is promoter of better functional outcomes after TBI. Funded by US Veterans Administration and US NIH.

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.

INTRODUCTION: Caused by a bump, blow, or jolt to the head, a traumatic brain injury (TBI) affects how the brain works. Determining the prevalence of TBI, including concussion, in the United States is difficult. Surveillance of TBI in the United States has historically relied on healthcare administrative datasets. The most recent numbers find that about 214,000 Americans are hospitalized and 69,000 Americans die from a TBI every year. However, these numbers likely undercount the true burden of TBI as they do not include people who seek care for their injuries outside of hospital settings or people who do not seek care. An alternative approach to TBI surveillance is to make use of national self-report surveys that ask respondents to report their experience with head injuries. The Centers for Disease Control and Prevention (CDC) has recently added TBI prevalence questions to several national surveys. The objective of this presentation is to summarize CDC’s recent efforts in TBI self-reporting.

METHODS: CDC added various 12-month and lifetime TBI prevalence questions to a series of nationally representative surveys (e.g., Porter Novelli’s ConsumerStyles survey, National Health Interview Survey, Youth Risk Behavior Survey). Each survey’s questions were slightly different, and they varied by time period assessed and whether they focused on adult or youth respondents.

RESULTS: Depending on the survey methodology and question wording used, 12-month prevalence of concussion/TBI among adults ranged from 3-12% while lifetime prevalence ranged from about 21-28%. Twelve-month prevalence of concussion/TBI among children and adolescents was about 10% while lifetime prevalence ranged from 7-14%.

CONCLUSION: These results demonstrate that TBI is a common health condition in the United States, and one that is likely consistently underestimated by traditional surveillance methods, which rely on hospital-based datasets. Allowing respondents to self-report their suspected concussions and TBIs resulted in larger prevalence estimates than those captured via traditional surveillance methods. Analysis of the various surveys shows that how the questions are asked, and what terminology is used (e.g., concussion vs. mild traumatic brain injury), affects the estimate. CDC has used the data collected to better refine the questions added to the surveys to ensure the most accurate prevalence estimates are being obtained. These data can be used to optimize and standardize data collection approaches across the field of TBI surveillance.

Current systems of classifying traumatic brain injury (TBI) frequently result in limitations to care. Clinical trials that use traditional classification schemes for TBI (e.g., mild, moderate, and severe) have failed to optimally translate to effective treatment and recovery in the real world, which may inhibit the discovery of effective therapies that improve outcomes based on more granular clinical profiles. Data-driven, alternative methods of classification may stratify TBI patient subpopulations more accurately for optimal identification and treatment. Data from the Centers for Disease Control and Prevention’s pilot National Concussion Surveillance System (n = 10,130 adults) were analyzed. Respondents who self-reported a head injury in the past 12 months were retained in the analysis (n = 1,364) and were queried for injury, outcome, and clinical characteristics. To identify potential TBI phenotypes among those reporting a head injury, respondents were grouped into clusters based upon 12 TBI signs and symptoms. Gower’s dissimilarity matrix was computed due to the nature of the binary input data (i.e., presence or absence of each sign or symptom). The partitioning around medoids (PAM) algorithm was used to cluster observations. To determine the association between outcomes and phenotypes, separate logistic regressions were run using the phenotype characterized by the least severity (e.g., Phenotype A [“cluster 1”]) as the reference group. The algorithm grouped the respondents into five clusters (TBI phenotypes A-E). Each TBI phenotype demonstrated unique clinical characteristics that corresponded to specific differences in outcomes and unique demographic profiles. Phenotype C represented more clinically severe TBIs with the highest prevalence of symptoms (i.e., >50% of respondents in this cluster self-reported 11 out of the 12 signs/symptoms) and a higher association with worse outcomes when compared to individuals in Phenotype A, a group with few TBI-related signs and symptoms: medical evaluation (odds ratio [OR] = 9.4, 95% confidence interval [CI] = 5.8-15.3), symptoms that were not currently resolved or resolved in 8+ days (OR = 10.6, 95% CI = 6.2-18.1), and more likely to report at least moderate, as compared to no or slight, impacts on social (OR = 54.7, 95% CI = 22.4-133.4) and work (OR = 25.4, 95% CI = 11.2-57.2) functioning. These results demonstrate that machine learning can be used to classify patients into unique TBI phenotypes. Further research might examine the utility of such classifications in supporting clinical diagnosis and patient recovery for this complex health condition.

Individuals experiencing persistent post concussive symptoms often report visual changes as well as changes in sensory processing. This session discusses the current recommended practice for assessment and intervention of visual and sensory symptoms as they relate to functional independence. Participants will be able to define the role of occupational therapy and identify its role in the management of these symptoms and be able to identify both assessment and basic treatment techniques to apply to both visual and sensory deficits.

Individuals experiencing persistent post concussive symptoms often report visual changes as well as changes in sensory processing. This session discusses the current recommended practice for assessment and intervention of visual and sensory symptoms as they relate to functional independence. Participants will be able to define the role of occupational therapy and identify its role in the management of these symptoms and be able to identify both assessment and basic treatment techniques to apply to both visual and sensory deficits.

The BeHEALTHY investigators completed a comprehensive literature review assessed for guidelines and consensus reports on the assessment and care of individuals with chronic brain injury. The results of this review will be summarized.

Chronic brain injury is associated with specific neurological, medical and psychological conditions that may decrease an individual’s functional capacities, their ability to live successfully, return to school or vocational endeavors, affect their relationships with others, and alter an individual’s quality of life. Over the last decade, numerous clinicians and researchers have emphasized the importance toward implementing a Chronic Care Model to manage the long term and often lifelong sequelae of Brain Injury.¹ A model for service delivery was originally introduced by Masel and DeWitt ² who stressed the importance of systematic Brain Injury care that extends beyond the acute and inpatient rehabilitation phase of management. This would include proactive expectant management of the lifelong needs for patients, families and caregivers. timely and appropriate rehabilitation services, and addressing concomitant psychosocial issues such that individuals can maximize their capacities for community integration and societal participation. A formal and agreed upon standard of practice to evaluate and/or manage the complex needs of brain injury individuals and how those needs may dynamically change over time does not exist.
Aims: As part of the BeHEALTHY³ initiative, this feasibility project aligns with the goals of advancing a chronic disease management model for individuals with brain injury, their caregivers and health care providers. Following a systematic literature review, a BeHealthy working task force developed an easy to administer holistic and comprehensive intake tool for clinicians to utilize regardless of their specialty when managing the sequelae of chronic brain injury. Key concepts incorporated into the tool include:
1. A shared responsibility among the patient/family/caregivers and health care professionals emphasizing self-advocacy.
2. Promoting proactive and goal-oriented management plans aimed at meeting the dynamic and individualized needs of patients, families and caregivers.
3. Emphasize collecting relevant pre injury and post injury medical and psychosocial history including mental health.
4. Emphasize the importance of evaluating an individual’s sensory-motor, neurocognitive, behavioral, social, community integration and societal participation status.

Components of the intake tool entails a Pre-visit assessment obtaining salient demographic information, relevant injury history, past medical and surgical history, medications, allergies, past hospitalization’s, current health care providers, family, educational and social history and a functional review of systems. This pre-visit tool will prepare the clinical providers for an in-person, holistic, targeted and time efficient initial intake that can be followed by personalized components of a general medical exam, neurological exam and “problem-specific and/or targeted functional exam.” Utilizing qualitative research methods for tool validation, reproducibility, comprehensiveness and ease of use, this can equip clinicians with a systematic tool useful in developing both a short and long term integrated management plan that can serve as a foundation for lifelong management.

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.

Brain Education Strategies and Technology, Inc. (BEST) is a nonprofit organization started by Michelle Ranae Wild to share the theories she has developed over more than 30 years as a professor in Coastline Community College’s Acquired Brain Injury program to help people with acquired brain injury (ABI) retrain their brains, learn compensatory skills, and rebuild their lives. Through its unique, educational model, BEST provides people with ABI a curriculum and a community to help them continue to make progress after completing medical neurorehabilitation. BEST recognizes that ABI recovery is life-long and thus meets people at any stage of their journey.

BEST offers free webinars, multi-week workshops, facilitated discussions, and asynchronous online courses that are designed to teach people with ABI, their family members, and clinicians (1) how ABI can create physical, cognitive, behavioral, and emotional challenges and (2) practical strategies they can personalize to help them navigate those challenges. In the process, BEST provides participants with a supportive community where they can feel less isolated and learn from the experiences of others.

BEST introduces cognitive and technology topics through interactive webinars that include instruction, polls, monitored live chats, and Q&A sessions. The webinars are followed by facilitated “after hours” discussions on Zoom. These peer collaboration sessions are much-loved by BEST regulars and newcomers alike, because they reduce isolation and allow participants to feel like members of a safe, supportive community where they can share how the concepts taught in the webinar relate to their lives.

BEST workshop series address webinar topics in a more comprehensive, hands-on manner. They include a multi-week curriculum delivered through interactive, weekly Zoom sessions that feature breakout groups, whole class discussions, Q&A sessions, live chats, and the integration of technology tools as appropriate. Each session begins with an iterative review, designed to reactivate and consolidate learning from prior sessions. As with webinars, participants receive presentation slides, supplemental worksheets, and session recordings so they can engage and re-engage with the content at their own pace.

Program topics include cognitive rehabilitation, neurofatigue, executive function, self-regulation, problem solving, learning styles, communication, self-efficacy, initiation, and many more. BEST also teaches people with ABI how to use technology to compensate for ABI deficits. The BEST Suite of apps helps people organize their lives and apply the strategies they learn in BEST programs.

Data from participant evaluations indicates that BEST’s programs are indeed meeting participants’ needs. More than half have attended 6 or more BEST programs. A staggering 96% rate information they learned in the webinar as “very useful,” with 97% saying they learned something they can use in daily life.

This session will share the BEST approach to cognitive/neurorehabilitation and the feedback from participants.

There is an apparent phenomenon where Black adult and pediatric athletes face disparities within their care, treatment, and recovery from mild traumatic brain injury (mTBI), or concussion while playing their sport. Previous literature has demonstrated that Black athletes who have experienced sports-related concussions (SRC) are less likely to receive formal concussion diagnoses, and subsequent referrals to tertiary concussion care. Additionally, Black athletes have demonstrated lowered access to clinical care, concussion knowledge and symptom identification, as well as intention to report injury and overall poorer psychosocial outcomes following injury. Overall, the current body of literature has identified that race is a salient social determinant of health for general mTBI and SRC – the axis of privilege and marginalization associated with race, can impact presentation for care, receiving diagnoses, symptom reporting and tracking, and the process of recovery or return to baseline functioning. However, these empirical findings do not elucidate why nor how these various factors compound. Thus, there is a need for a framework to conceptualize and create a clear theory for how these factors compound. Particularly, there is a need to encapsulate how sociocultural experiences of power, access, and biases can impact Black athletes experiencing mTBI. The authors use Ecological Systems Theory (EST; Bronfenbrenner, 1979) to create a novel organization-systems model of identified findings and theory that demonstrate and support racial disparities within general mTBI and SRC. A comprehensive literature search was employed to identify recent (published ≤10 years) empirical studies and theoretical perspectives on racial disparities in mTBI for Black patients and athletes. Using EST as a framework, the literature review examines and organizes these findings within the context of (1) historical and sociopolitical events and systems, (2) sociocultural ideologies and policy, (3) indirect and (4) direct community and cultural factors, as well as (5) person-centered social experiences and identities (social determinants of health). Ultimately, the organizational structure provides a clear thread on how macro-level policy and perceptions, can impact micro-level clinical care and decision-making for Black athletes and their experiences with mTBI.

Background/Rationale: Participation refers to involvement in meaningful social roles, such as work or school, relationships, and leisure activities. Moderate to severe traumatic brain injury (TBI) is known to affect frequency of participation in these activities. However, participation frequency is not always equivalent to participation satisfaction. A better understanding of meaningful participation that reflects a person’s abilities and values may aid in identifying better targets for rehabilitation after TBI.

Main Objective: To determine the contribution of various dimensions of participation to satisfaction with social roles and abilities in a sample of individuals with complicated mild to severe TBI.

Methods (including design, setting, sample/patient characteristics, and measures): Secondary analysis of baseline data from participants enrolled in a longitudinal intervention trial. We used data from 127 participants [mean age=35.24; 64.6%; predominately female (64.6%) and non-Hispanic White (70.1%)] who had completed a demographic questionnaire, portions of the TBI Quality of Life Scale (TBI-QOL), and the Participation Assessment with Recombined Tools-Objective (PART-O). Results: We performed a hierarchical regression to predict satisfaction with social roles and abilities using different dimensions of participation including objective (PART-O Out-and-About, Social Relations, and Productivity scores) and subjective (TBI-QOL Ability to participate in social roles and activities, Independence, and Stigma) dimensions. PART-O scores explained 17% of the variance [R2change=.17, p<.001] in satisfaction with social roles and abilities. Ability to participate in social roles and activities and Independence explained 40% of additional variance [R2change =.40, p<.001] in satisfaction with roles and abilities. Stigma explained an additional 2.3% of the variance [R2change =.023, p=.01].

Conclusions/Future Implications: How one perceives their abilities to participate and be independent, rather than the objective frequency of participation, accounted for a larger portion of the variance in how satisfied one was with their ability to participate in social roles and activities. Investigating different dimensions of participation in this population, rather than simply frequency, may result in more meaningful participation in this population.

In an effort to identify best practices on intake process, NASHIA has recently compiled the intake assessments utilized by TBI State Partnership programs across the United States. THE FINDINGS will be presented.

BACKGROUND: Prognostic prediction models (PPMs) can estimate a pediatric patient’s risk for delayed recovery following mild traumatic brain injury (mTBI). Since 2015, literature has emerged to guide reporting and reviewing PPMs. Identifying these PPMs and critically examining them would help guide use and future research.

METHODS: This review follows the Cochrane Prognosis Methods Group process. Literature searches of Ovid Medline, Embase, Ovid PsycInfo, Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Google Scholar were conducted on November 21, 2022. Studies of pediatric patients with mTBI that used a PPM to evaluate the risk of delayed recovery were included. The prediction horizon was restricted to at least 28 days but no more than 1 year after injury. Moment of prediction was any time before the 28th day after injury. Setting was not restricted. Additional inclusion criteria included the reporting of model performance; peer-reviewed original research; published in English language; and a cohort, nested case-control, or case cohort design. The Prediction model Risk of Bias (RoB) ASsessment Tool (PROBAST) and a modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to inform PPM quality. Meta-analysis was used to aggregate parameter estimates of model performance among studies reporting the same measures for the same PPM. The remaining literature was qualitatively synthesized.

RESULTS: Searches yielded 17,433 references with 6,250 duplicates; 11,183 studies were screened, and 78 references were retrieved, with 72 studies being deemed ineligible. Six studies of 9 PPMs were included. Three PPMs demonstrated statistically significant predictive capability - the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score, the Buffalo Concussion Physical Examination (BCPE) risk for delayed recovery (RDR) score, and the model developed by Grubenhoff et al. 2014. Most used the Concussion in Sport Group consensus guidelines for mTBI diagnosis. Operational definitions of delayed recovery varied. Logistic regression was the most common modeling method. The selected predictors can be grouped into 3 domains – history, exam, and symptoms. All studies were evaluated as being at high risk of bias. Meta-analysis of the 5P model demonstrated a poor to moderate effect size (aggregate AUC 0.69) without heterogeneity; however, this result should be considered preliminary given the low number of studies. GRADE rating was highest for 5P (Moderate).

DISCUSSION: Empirical support for PPM use in this population is limited due to a high risk of bias for existing studies and predominantly Very Low GRADE quality of published PPMs. The 5P clinical risk score has the most robust evidence for use. Issues inherent to the current and varied definitions of delayed recovery following mTBI will likely limit further progress in this area of study until a consensus-based, operational definition is reached.

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.

PURPOSE: To evaluate the effectiveness of the Vision Quality of Life with Time (VisQuaL-T) survey in assessing the visual quality of life in 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 was collected on the first visit, where the participants responded to the 10 questions in the survey. The survey consisted of a list of the following activities: 1) reading for pleasure, 2) studying for a test/exam, 3) completing homework, 4) completing work in an office setting, 5) being in a crowded location, 6) tolerating habitual lighting, 7) using a smartphone/tablet, 8) playing a computer/console video game, 9) using a computer for general purposes, 10) watching a show on a large screen. Participants were asked to indicate how long it took them to experience any of the following symptoms: headache, dizziness, eye strain, double vision, floating words, blurry vision, inability to pay attention, easily distracted, or sleepy/drowsy. The possible time ratings, a novel feature of VisQuaL-T, were 0-15 min, 15-30 min, 30-45min, 60+ min, and N/A (for activities a participant does not participate in). A composite score between 0 and 3 was derived utilizing the methods in the VisQuaL-T normative manuscript by Dungan Et al. 2023.

RESULTS: Presented data was collected on 40 participants (6 males) with an average age of 39.2 ± 12.4 years and an average of 21.8 ± 33.3 months since injury (4 participants were seen 98, 109, 123, and 126 months after injury). Participants had an average composite score of 1.56 ± 0.57.

CONCLUSIONS: An average composite score of 1.56 is equivalent to approximately 20 minutes. Prior studies have shown that the general population scores an average composite score of 2.4. The utilization of time as a measurement factor has the potential to illicit more concise and quantitative data from a concussed individual. The presented instrument can potentially be more clinically relevant as questions examine how long a patient can perform a task before the onset of symptoms rather than simply reporting whether symptoms are present. This non-generalized symptom scale may potentially be a better indication of their quality of life. The VisQuaL-T can potentially indicate quality of life problems in patients after a concussive event and potentially guide clinical intervention. The survey also has the potential to be used as a recovery tracking tool.

This session will incorporate presentations by experts in brain injury medicine, neuro-optometry and physical therapy to review some critically important caveats regarding the importance of interdisciplinary holistic team assessment and management of patients following concussion. The need for symptom specific differential diagnosis and treatment of symptom generators will be emphasized. The dangers of generic diagnostic labeling in the context of assessment will also be reviewed. Physician assessment and pointers will be provided and clinical nuances to maintain awareness of in this context will be discussed including exploring the symptom overlap between concussion, whiplash and oculovestibular dysfunction. The need for assessment of oculomotor dysfunction will be elaborated on by an experienced neuro-optometrist delineating the array of symptoms that can result from impairments of this type and the complexity of the anatomical connections of the systems involved in polytrauma that can generate such impairment. All too often the role of visual dysfunction following these types of traumatic injuries is undervalued and inadequately assessed and therefore treated. Lastly, the importance of multimodal assessment and treatment of the complaint of post-traumatic headache will be reviewed in the context of the myriad potential symptom generators for this common complaint and the critical importance of comprehensive “hands-on” examinations by experienced medical, neuro-optometric and physical therapy practitioners. Post-traumatic headache treatment strategies will also be addressed.

The Predicting Persistent Post-concussive Problems in Pediatrics (5P Study) derived and validated a clinical prediction rule to stratify risk of symptom persistence following concussion; attendees of this workshop learn how to implement the 5P score into clinical practice. The session will discuss how symptoms cluster across physical, cognitive, sleep and emotional domains and how these can inform clinical phenotypes. Participants will gain a deeper understanding of how clinical phenotyping can inform personalized treatment approaches and appreciate the potential for precision medicine to optimize post-concussion recovery.

This session will equip attendees with the latest evidence-based approaches for managing mild traumatic brain injury (TBI) and concussion in children and adolescents. Participants will learn to conduct a thorough physical exam specific to concussions, recognize the prognostic factors using the 5P score to predict those at higher risk for persistent post-concussion symptoms (PPCS), and implement both pharmacological and non-pharmacological strategies to mitigate the risk of PPCS. The workshop will also introduce how to navigate the dynamic Living Guideline for Pediatric Concussion Care (PedsConcussion.com) to enable clinicians and stakeholders to integrate continuously updated best practices into care protocols. This comprehensive overview is designed to enhance clinical skills, improve patient outcomes, and refine the standard of care in pediatric mild TBI management.

It is unclear whether the assessment position of patients with Disorders of Consciousness (DoC) affects the result of Coma Recovery Scale–Revised (CRS–R). Currently, only the arousal protocol is required to facilitate patients’ engagement and accurate scoring. The study aims to investigate the impact of positioning on the CRS-R total score. This is a retrospective study analyzing a total of 1470 CRS-Rs performed on 232 patients in four different positions, i.e., lying in bed (Bed), sitting at the edge of a mat (Mat), sitting in a wheelchair (Wheelchair), and up in a standing position (Standing), in an acute inpatient rehabilitation setting. A conditional random coefficients multi-level model was used to examine the changes of CRS–R based on the position, accounting for repeated measurements within subjects and the variability introduced by different raters. The cohort contains 65.1% male, age 37.4±16.2, and includes primarily traumatic brain injury (47.0%) and hypoxic-ischemic brain injury (26.7%). Each patient underwent an average of 10.3±6.8 CRS–Rs. The mean CRS–R total score was 7.4±4.1. The average arousal protocol used was 3.0±2.1 per session. We found that the CRS–R total score was significantly associated with the assessment position. Using the Bed as reference (controlling age, gender, etiology, number of arousal protocol used, and days post-injury), patients assessed in the Mat, Wheelchair, and Standing had estimated 1.3-, 1.1-, and 1.5-point increases in the CRS–R total score, respectively (P = 0.002, 0.008, and 0.050; overall, upright vs. lying, 1.2-point increase, P = 0.003). The CRS–R total score was found significantly associated with the number of arousal protocols used. However, it was estimated that with every additional administration of the arousal protocol, the CRS–R total score decreased by 0.8-point (P < 0.001). We further identified that, using the Bed as reference, the number of arousal protocol used was not associated with the assessment position, with and without controlling the abovementioned factors. Our results demonstrated that the increased use of arousal protocols indicated lower arousal level at baseline, thus, poorer CRS–R performance. The increased use of arousal protocols did not serve to improve CRS–R performance. The assessment position appears to be more important. Patients scored significantly higher in an upright position. One point change could potentially make a diagnostic difference in the CRS–R. The finding may be related to generally improved physical and cognitive functionality in an upright body position, rather than to arousal only. The arousal protocol needs to be applied as indicated regardless of the assessment position. In conclusion, CRS–R is better to be performed in an upright position rather than a lying position in patients with DoC.