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Poster 52 Prediction of the Functional Impact of Headache After Traumatic Brain Injury: A Longitudinal Cohort Analysis
PM&R
injury, psychological symptoms measured by Beck Depression Inventory at 6-, 12-, and 24-months and Impact of Event Scale at 6- and 12-months post-injury, as well as neurobehavioral measures assessed by the Neurobehavioral Functioning Inventory at 6- and 12-months post-injury. Group comparisons and multiple linear regression models were used for statistical analyses. Results: Twenty three (47.9%) had no sleep complaint at either 6- or 12-months post-injury or resolved sleep complaint at 12-months (“without persistent SC” group); twenty five (52.1%) maintained sleep complaint from 6- to 12-months or reported sleep complaint at 12-months post-injury (“with persistent SC” group). Significant psychological patterns were identified in those with persistent SC, i.e. worse post-traumatic stress (PTS) symptoms, especially avoidance, at 12-months (P⬍.05) and worse depression at 12-months (P⬍.001) and 24-months (P⬍.05) post-injury. The Without Persistent SC group had slight improvement in PTS symptoms and depression from 6 to 12 months post-injury. Other demographic, premorbid and periinjury characteristics, as well as neurobehavioral measures did not significantly differentiate the two groups. Conclusions: Worse PTS symptoms at 12-months and/or worse depression at 12- and 24-months after brain injury are highly associated with sleep complaint at 12 months. The observed psychological patterns associated with persistent sleep complaint in brain injury patients have important research and clinical implications that deserve further study. Poster 52 Prediction of the Functional Impact of Headache After Traumatic Brain Injury: A Longitudinal Cohort Analysis. William C. Walker, MD (Virginia Commonwealth University, School of Medicine, Richmond, VA, United States); Jessica M. Ketchum, PhD; Jennifer H. Marwitz, MA; Amber R. Wilk, MS. Disclosures: W. C. Walker, No Disclosures. Objective: Measure the functional impact of headache (HA) after moderate-severe traumatic brain injury (TBI), determine predictors, and assess for change over time. Design: Multicenter longitudinal cohort study. Setting: Subjects were enrolled during acute inpatient rehabilitation hospitalization following TBI. Participants: 450 participants with moderate-severe TBI consecutively enrolled at 7 participating TBI Model Systems (TBIMS) centers. Inclusion criteria were the same as for the TBIMS. Interventions: n/a. Main Outcome Measures:: Functional impact was a 5-level ordinal measure of the degree that HA interfered with activities of daily living (ADL). Results: Data was analyzed using a generalized linear mixed effects model. Sex was the only variable that showed a significant effect of change in ADL limitations from HA over time. At 3 months after TBI sex was not related to outcome, at 6 months there was a nonsignificant trend toward more HA related ADL impairment in females, whereas at 12 months females were significantly more likely to have HA related ADL impairment (odds ratio 2.64 (P⬍.05, CI ⫽ 1.33, 5.24)). Multiple factors, including skull/facial fractures, penetrating TBI, female gender, and pre-injury HA, were significantly
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associated with ADL impairment from HA at various time points. However, severity of injury as measured by PTA duration was not predictive of outcome at any time point. Conclusions: These results corroborate past studies in showing that HA after TBI is both unrelated to severity of injury, and is more of a “problem” for females compared to males. Additionally, the current study showed that the influence sex had on ADL limitation from HA changed over time. At early time-points females and males were equally susceptible to having HA that limited ADLs. However, females become increasingly more susceptible to having HA that limits ADLs as the first post-injury year progresses. Poster 43 Repeated Blasts Induce Deterioration of Rats Cognitive and Locomotor Function. Oscar U. Scremin, MD, PhD (VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States); Mulugeta Million, DVM, PhD; Keith M. Norman; Margareth Roch, Ch.Eng.; James J. Schultz, PhD; A.M.Erika Scremin, MD. Disclosures: O. U. Scremin, No Disclosures. Objective: To determine if repeated blast exposure induces alterations of learning, memory and gait in an animal model of blastinduced brain injury. Design: Prospective, randomized. Setting:: Basic science laboratory. Participants: Sprague-Dawley male rats. Interventions: Two groups of 10 rats each were exposed to mild to moderate blasts (172-207 kPascals) (bTBI) while under isoflurane anesthesia or a CONTROL condition (anesthesia but no blast). Variables were measured after each of three successive bTBI or CONTROL events spaced by two weeks. Main Outcome Measures: Learning and memory were assessed with the Morris water maze (WM) and gait by computerized analysis of rats walking on a glass plate, including maximal and mean area, width, length, angle and intensity of paw impressions on the walking surface recorded on video, swing speed, stride length, duty cycle, and base of support. Statistical significance of differences between CONTROL and mTBI variable means was determined by ANOVA followed by Tukey-Kramer tests with significance set at P⬍.05. Results: After the first blast, mTBI animals took significantly longer time to reach the target in the WM test (Mean⫾SE, seconds: bTBI⫽36.7⫾1.9, CONTROL⫽27.4⫾1.9, P⬍.001). Both groups improved their performance with each successive WM trainingtesting following an event, but the difference between groups was maintained after the third event (bTBI⫽12.3⫾0.6, CONTROL⫽ 9.0⫾0.5, P⬍.001). Locomotor testing indicated no significant changes between groups after the first blast. After the second blast, bTBI animals had significantly lower means of areas, length and width of hindpaws impressions only. In contrast, following the third blast, bTBI animals showed marked decreases in front and hind paws impression parameters and duty cycle as well as swing speed and base of support of hindpaws. Conclusions: This model reproduces impairments of veterans exposed to multiple explosions and could be used to test treatments for bTBI.
injury, psychological symptoms measured by Beck Depression Inventory at 6-, 12-, and 24-months and Impact of Event Scale at 6- and 12-months post-injury, as well as neurobehavioral measures assessed by the Neurobehavioral Functioning Inventory at 6- and 12-months post-injury. Group comparisons and multiple linear regression models were used for statistical analyses. Results: Twenty three (47.9%) had no sleep complaint at either 6- or 12-months post-injury or resolved sleep complaint at 12-months (“without persistent SC” group); twenty five (52.1%) maintained sleep complaint from 6- to 12-months or reported sleep complaint at 12-months post-injury (“with persistent SC” group). Significant psychological patterns were identified in those with persistent SC, i.e. worse post-traumatic stress (PTS) symptoms, especially avoidance, at 12-months (P⬍.05) and worse depression at 12-months (P⬍.001) and 24-months (P⬍.05) post-injury. The Without Persistent SC group had slight improvement in PTS symptoms and depression from 6 to 12 months post-injury. Other demographic, premorbid and periinjury characteristics, as well as neurobehavioral measures did not significantly differentiate the two groups. Conclusions: Worse PTS symptoms at 12-months and/or worse depression at 12- and 24-months after brain injury are highly associated with sleep complaint at 12 months. The observed psychological patterns associated with persistent sleep complaint in brain injury patients have important research and clinical implications that deserve further study. Poster 52 Prediction of the Functional Impact of Headache After Traumatic Brain Injury: A Longitudinal Cohort Analysis. William C. Walker, MD (Virginia Commonwealth University, School of Medicine, Richmond, VA, United States); Jessica M. Ketchum, PhD; Jennifer H. Marwitz, MA; Amber R. Wilk, MS. Disclosures: W. C. Walker, No Disclosures. Objective: Measure the functional impact of headache (HA) after moderate-severe traumatic brain injury (TBI), determine predictors, and assess for change over time. Design: Multicenter longitudinal cohort study. Setting: Subjects were enrolled during acute inpatient rehabilitation hospitalization following TBI. Participants: 450 participants with moderate-severe TBI consecutively enrolled at 7 participating TBI Model Systems (TBIMS) centers. Inclusion criteria were the same as for the TBIMS. Interventions: n/a. Main Outcome Measures:: Functional impact was a 5-level ordinal measure of the degree that HA interfered with activities of daily living (ADL). Results: Data was analyzed using a generalized linear mixed effects model. Sex was the only variable that showed a significant effect of change in ADL limitations from HA over time. At 3 months after TBI sex was not related to outcome, at 6 months there was a nonsignificant trend toward more HA related ADL impairment in females, whereas at 12 months females were significantly more likely to have HA related ADL impairment (odds ratio 2.64 (P⬍.05, CI ⫽ 1.33, 5.24)). Multiple factors, including skull/facial fractures, penetrating TBI, female gender, and pre-injury HA, were significantly
Vol. 4, Iss. 10S, 2012
S185
associated with ADL impairment from HA at various time points. However, severity of injury as measured by PTA duration was not predictive of outcome at any time point. Conclusions: These results corroborate past studies in showing that HA after TBI is both unrelated to severity of injury, and is more of a “problem” for females compared to males. Additionally, the current study showed that the influence sex had on ADL limitation from HA changed over time. At early time-points females and males were equally susceptible to having HA that limited ADLs. However, females become increasingly more susceptible to having HA that limits ADLs as the first post-injury year progresses. Poster 43 Repeated Blasts Induce Deterioration of Rats Cognitive and Locomotor Function. Oscar U. Scremin, MD, PhD (VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States); Mulugeta Million, DVM, PhD; Keith M. Norman; Margareth Roch, Ch.Eng.; James J. Schultz, PhD; A.M.Erika Scremin, MD. Disclosures: O. U. Scremin, No Disclosures. Objective: To determine if repeated blast exposure induces alterations of learning, memory and gait in an animal model of blastinduced brain injury. Design: Prospective, randomized. Setting:: Basic science laboratory. Participants: Sprague-Dawley male rats. Interventions: Two groups of 10 rats each were exposed to mild to moderate blasts (172-207 kPascals) (bTBI) while under isoflurane anesthesia or a CONTROL condition (anesthesia but no blast). Variables were measured after each of three successive bTBI or CONTROL events spaced by two weeks. Main Outcome Measures: Learning and memory were assessed with the Morris water maze (WM) and gait by computerized analysis of rats walking on a glass plate, including maximal and mean area, width, length, angle and intensity of paw impressions on the walking surface recorded on video, swing speed, stride length, duty cycle, and base of support. Statistical significance of differences between CONTROL and mTBI variable means was determined by ANOVA followed by Tukey-Kramer tests with significance set at P⬍.05. Results: After the first blast, mTBI animals took significantly longer time to reach the target in the WM test (Mean⫾SE, seconds: bTBI⫽36.7⫾1.9, CONTROL⫽27.4⫾1.9, P⬍.001). Both groups improved their performance with each successive WM trainingtesting following an event, but the difference between groups was maintained after the third event (bTBI⫽12.3⫾0.6, CONTROL⫽ 9.0⫾0.5, P⬍.001). Locomotor testing indicated no significant changes between groups after the first blast. After the second blast, bTBI animals had significantly lower means of areas, length and width of hindpaws impressions only. In contrast, following the third blast, bTBI animals showed marked decreases in front and hind paws impression parameters and duty cycle as well as swing speed and base of support of hindpaws. Conclusions: This model reproduces impairments of veterans exposed to multiple explosions and could be used to test treatments for bTBI.