Screening and outcomes of co-occurring traumatic brain injury among people with spinal cord injury: a scoping review
DOI:
https://doi.org/10.2340/jrm.v57.41897Keywords:
Traumatic brain injury, traumatic spinal cord injury, dual diagnosis, screening, rehabilitation outcomesAbstract
Objective: To map existing knowledge on screening and rehabilitation outcomes for co-occurring traumatic brain injury among people with traumatic spinal cord injury (SCI).
Methods: Articles focusing on screening and rehabilitation outcomes in participants sustaining co-occurring traumatic brain injury and traumatic spinal cord injury (all ages) were identified in Ovid, Scopus, Web of Science, CINAHL, and ProQuest Dissertations and Theses electronic databases. There were no limitations on study design, date, or geographical location. Articles were excluded if they were not available in English. Data were extracted into the Rayyan online collaboration platform and summarized descriptively.
Results: Twenty-five studies were included, with a mix of retrospective, case-control, and prospective cohort designs. Screening under-estimated traumatic brain injury incidence when approaches relied on inconsistently collected traumatic brain injury indicators, especially for mild traumatic brain injury. Rehabilitation outcomes included length of stay, functional outcomes, cognitive functioning, complication rates, and employment. Although mixed, outcomes among persons with moderate to severe co-occurring traumatic brain injury especially, appeared poorer than those with spinal cord injury alone.
Conclusions: Multivariable approaches to traumatic brain injury ascertainment and greater consistency in documenting acute traumatic brain injury indicators may improve reliability of capturing traumatic brain injury and traumatic brain injury severity among persons with traumatic spinal cord injury. Impacts of co-occurring traumatic brain injury appear greater relative to SCI alone but few studies analysed outcomes based on traumatic brain injury severity.
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References
Valbuena Valecillos A, Gater D, Alvarez G. Concomitant brain injury and spinal cord injury management strategies: a narrative review. J Per Med 2022; 12: 1108-1120.
https://doi.org/10.3390/jpm12071108 DOI: https://doi.org/10.3390/jpm12071108
New Zealand Spinal Cord Injury Registry. New Zealand Spinal Cord Injury Registry Annual Summary Report 2020 2021.
Feigin V, Theadom A, Barker-Collo S, Starkey N, McPherson K, Kahan M, et al. Incidence of traumatic brain injury in New Zealand: a population-based study. Lancet Neurol 2013; 12: 53-64.
https://doi.org/10.1016/S1474-4422(12)70262-4 DOI: https://doi.org/10.1016/S1474-4422(12)70262-4
Kushner D, Alvarez G. Dual diagnosis: traumatic brain injury with spinal cord injury. Phys Med Rehabil Clin N Am 2014; 25: 681-696.
https://doi.org/10.1016/j.pmr.2014.04.005 DOI: https://doi.org/10.1016/j.pmr.2014.04.005
Snell D, Johns J, Dunn J, Nunnerley J, Singhal B. Difficulties capturing co-occurring traumatic brain injury among people with traumatic spinal cord injury: a population-based study. Spinal Cord 2023; 61: 22-26.
https://doi.org/10.1038/s41393-022-00851-5 DOI: https://doi.org/10.1038/s41393-022-00851-5
Bombardier C, Lee D, Tan D, Barber J, Hoffman J. Comorbid Traumatic Brain Injury and Spinal Cord Injury: Screening Validity and Effect on Outcomes. Arch Phys Med Rehabil 2016; 97: 1628-1634.
https://doi.org/10.1016/j.apmr.2016.03.008 DOI: https://doi.org/10.1016/j.apmr.2016.03.008
Yang T, Yoo D, Huh S, Jang M, Shin Y, Kim S. Epidemiology and Assessment of Traumatic Spinal Cord Injury With Concomitant Brain Injury: An Observational Study in a Regional Trauma Center. Ann Rehabil Med 2023; 47: 385-392.
https://doi.org/10.5535/arm.23054 DOI: https://doi.org/10.5535/arm.23054
Macciocchi S, Seel R, Thompson N, Byams R, Bowman B. Spinal cord injury and co-occurring traumatic brain injury: Assessment and incidence. Arch Phys Med Rehabil 2008; 89: 1350-1357.
https://doi.org/10.1016/j.apmr.2007.11.055 DOI: https://doi.org/10.1016/j.apmr.2007.11.055
Kushner D. Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury. Neural Regen Res 2015;10(6):859-61.
https://doi.org/10.4103/1673-5374.158329 DOI: https://doi.org/10.4103/1673-5374.158329
Sommer J, Witkiewicz P. The therapeutic challenges of dual diagnosis: TBI/SCI. Brain Injury 2004; 18: 1297-1308.
https://doi.org/10.1080/02699050410001672288 DOI: https://doi.org/10.1080/02699050410001672288
Sharma S, Bradbury C, Mikulis D, Green R. Missed diagnosis of traumatic brain injury in patients with traumatic spinal cord injury. J Rehabil Med 2014; 46: 370-373.
https://doi.org/10.2340/16501977-1261 DOI: https://doi.org/10.2340/16501977-1261
Sachdeva R, Gao F, Chan C, Krassioukov A. Cognitive function after spinal cord injury. A systematic review. Neurology 2018; 91: 611-621.
https://doi.org/10.1212/WNL.0000000000006244 DOI: https://doi.org/10.1212/WNL.0000000000006244
Sandalic D, Craig A, Tran Y, Arora M, Pozzato I, McBain C, et al. Cognitive impairment in individuals with spinal cord injury: findings of a systematic review with robust variance and network meta-analyses. Neurology 2022; 99: E1779-E1790.
https://doi.org/10.1212/WNL.0000000000200957 DOI: https://doi.org/10.1212/WNL.0000000000200957
Macciocchi S, Seel R, Warshowsky A, Thompson N, Barlow K. Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes. Arch Phys Med Rehabil 2012; 93: 1788-1794.
https://doi.org/10.1016/j.apmr.2012.01.022 DOI: https://doi.org/10.1016/j.apmr.2012.01.022
Silverberg N, Iaccarino M, Panenka W, Iverson G, McCulloch K, Dams-O'Connor K, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil 2020; 101: 382-393.
https://doi.org/10.1016/j.apmr.2019.10.179 DOI: https://doi.org/10.1016/j.apmr.2019.10.179
Madhok D, Rodriguez R, Barber J, Temkin N, Markowitz A, Kreitzer N, et al. Outcomes in Patients With Mild Traumatic Brain Injury Without Acute Intracranial Traumatic Injury. JAMA Network Open 2022; 5: e2223245.
https://doi.org/10.1001/jamanetworkopen.2022.23245 DOI: https://doi.org/10.1001/jamanetworkopen.2022.23245
Schneider A, Huie J, Boscardin W, Nelson L, Barber J, Yaffe K, et al. Cognitive outcome 1 year after mild traumatic brain injury: results from the TRACK-TBI Study. Neurology 2022; 98: e1248-e1261.
https://doi.org/10.1212/WNL.0000000000200041 DOI: https://doi.org/10.1212/WNL.0000000000200041
Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. International Int J Soc Res 2005; 8: 19-32.
https://doi.org/10.1080/1364557032000119616 DOI: https://doi.org/10.1080/1364557032000119616
Levac D, Colquhoun H, O'Brien K. Scoping studies: advancing the methodology. Implement Sci 2010; 5: 69-78.
https://doi.org/10.1186/1748-5908-5-69 DOI: https://doi.org/10.1186/1748-5908-5-69
Peters M, Marnie C, Colquhoun H, Garritty C, Hempel S, Horsley T, et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev 2021; 10 :263-269.
https://doi.org/10.1186/s13643-021-01821-3 DOI: https://doi.org/10.1186/s13643-021-01821-3
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev 2016; 5: 210-220.
https://doi.org/10.1186/s13643-016-0384-4 DOI: https://doi.org/10.1186/s13643-016-0384-4
Sikka S, Vrooman A, Callender L, Salisbury D, Bennett M, Hamilton R, et al. Inconsistencies with screening for traumatic brain injury in spinal cord injury across the continuum of care. J. Spinal Cord Med 2017; 42: 51-56.
https://doi.org/10.1080/10790268.2017.1357105 DOI: https://doi.org/10.1080/10790268.2017.1357105
Davidoff G, Morris J, Roth E, Bleiberg J. Closed head injury in spinal cord injured patients: retrospective study of loss of consciousness and post-traumatic amnesia. Arch Phys Med Rehabil 1985; 66: 41-43.
Budisin B, Bradbury C, Sharma S, Hitzig S, Mikulis D, Craven C, et al. Traumatic brain injury in spinal cord injury: Frequency and risk factors. J Head Trauma Rehabil 2016; 31: E33-E42.
https://doi.org/10.1097/HTR.0000000000000153 DOI: https://doi.org/10.1097/HTR.0000000000000153
Creasey G, Lateva Z, Schüssler-Fiorenza Rose S, Rose J. Traumatic brain injury in U.S. Veterans with traumatic spinal cord injury. J Rehabil Res Dev 2015; 52: 669-676.
https://doi.org/10.1682/JRRD.2014.11.0291 DOI: https://doi.org/10.1682/JRRD.2014.11.0291
Tolonen A, Turkka J, Salonen O, Ahoniemi E, Alaranta H. Traumatic brain injury is under-diagnosed in patients with spinal cord injury. J Rehabil Med 2007; 39: 622-626.
https://doi.org/10.2340/16501977-0101 DOI: https://doi.org/10.2340/16501977-0101
Olson-Madden J, Homaifar B, Hostetter T, Matarazzo B, Huggins J, Forster J, et al. Validating the Traumatic Brain Injury-4 screening measure for veterans seeking mental health treatment with psychiatric inpatient and outpatient service utilization data. Arch Phys Med Rehabil 2014; 95: 925-929.
https://doi.org/10.1016/j.apmr.2014.01.008 DOI: https://doi.org/10.1016/j.apmr.2014.01.008
Jang S, Ahn S, Cho Y, Lim J, Cho I. Diffusion Tensor Tractography for Detection of Concomitant Traumatic Brain Injury in Patients With Traumatic Spinal Cord Injury. J Head Trauma Rehabil 2017; 32: E44-E49.
https://doi.org/10.1097/HTR.0000000000000300 DOI: https://doi.org/10.1097/HTR.0000000000000300
Wei C, Tharmakulasingam J, Crawley A, Kideckel D, Mikulis D, Bradbury C, et al. Use of diffusion-tensor imaging in traumatic spinal cord injury to identify concomitant traumatic brain injury. Arch Phys Med Rehabil 2008; 89: S85-S91.
https://doi.org/10.1016/j.apmr.2008.07.005 DOI: https://doi.org/10.1016/j.apmr.2008.07.005
Bradbury C, Wodchis W, Mikulis D, Pano E, Hitzig S, McGillivray C, et al. Traumatic brain injury in patients with traumatic spinal cord injury: clinical and economic consequences. Arch Phys Med Rehabil 2008; 89:S77-584.
https://doi.org/10.1016/j.apmr.2008.07.008 DOI: https://doi.org/10.1016/j.apmr.2008.07.008
de Melo Neto J, Tognola W, Spotti A, de Morais D. Analysis of patients with spinal cord trauma associated with traumatic brain injury. Coluna/Columna 2014; 13: 302-305.
https://doi.org/10.1590/S1808-18512014130400459 DOI: https://doi.org/10.1590/S1808-18512014130400459
Gober J, Shapiro L, Tiozzo E, Ramos Roldán N, Brea C, Lin K, et al. Dual diagnosis of TBI and SCI: an epidemiological study in the pediatric population. Front Neurol 2023; 27: 1241550.
https://doi.org/10.3389/fneur.2023.1241550 DOI: https://doi.org/10.3389/fneur.2023.1241550
Garlanger K, Beck L, Cheville A. Functional outcomes in patients with co-occurring traumatic brain injury and spinal cord injury from an inpatient rehabilitation facility's perspective. J Spinal Cord Med 2018; 41: 718-730.
https://doi.org/10.1080/10790268.2018.1465744 DOI: https://doi.org/10.1080/10790268.2018.1465744
Macciocchi S, Bowman B, Coker J, Apple D, Leslie D. Effect of Co-Morbid Traumatic Brain Injury on Functional Outcome of Persons with Spinal Cord Injuries. Am J Phys Med Rehabil 2004; 83: 22-26.
https://doi.org/10.1097/01.PHM.0000104661.86307.91 DOI: https://doi.org/10.1097/01.PHM.0000104661.86307.91
Nott M, Baguley I, Heriseanu R, Weber G, Middleton J, Meares S, et al. Effects of concomitant spinal cord injury and brain injury on medical and functional outcomes and community participation. Top Spinal Cord Inj Rehabil 2014; 20: 225-235.
https://doi.org/10.1310/sci2003-225 DOI: https://doi.org/10.1310/sci2003-225
Ramamurthy P, Kumar N, Osman A. Epidemiology, neurological and functional outcome of concomitant traumatic brain and spinal cord injury: An Oswestry experience. Trauma 2017; 19: 30-32.
https://doi.org/10.1177/1460408617718868 DOI: https://doi.org/10.1177/1460408617718868
Gordan W, Gerber D, David D, Adornato V, Brougham R, Gassaway J, et al. Relationship of speech-language pathology inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med 2012; 35: 565-577.
https://doi.org/10.1179/2045772312Y.0000000063 DOI: https://doi.org/10.1179/2045772312Y.0000000063
Mollayeva T, Sutton M, Escobar M, Hurst M, Colantonio A. The impact of a comorbid spinal cord injury on cognitive outcomes of male and female patients with traumatic brain injury. PM & R 2021; 13: 683 - 694.
https://doi.org/10.1002/pmrj.12456 DOI: https://doi.org/10.1002/pmrj.12456
Macciocchi S, Seel R, Thompson N. The Impact of Mild Traumatic Brain injury on cognitive functioning following co-occurring spinal cord injury. Arch Clin Neuropsychol 2013; 28: 684-691.
https://doi.org/10.1093/arclin/act049 DOI: https://doi.org/10.1093/arclin/act049
Dowler R, Harrington D, Haaland K, Swanda R, Fee F, Fiedler K. Profiles of cognitive functioning in chronic spinal cord injury and the role of moderating variables. J Int Neuropsychol Soc 1997; 3: 464-472.
https://doi.org/10.1017/S1355617797004645 DOI: https://doi.org/10.1017/S1355617797004645
Richards J, Brown L, Hagglund K, Bua G, Reeder K. Spinal Cord Injury and Concomitant Traumatic Brain Injury: Results of a Longitudinal Investigation. Am J Phys Med Rehabil 1988; 67: 211-216.
https://doi.org/10.1097/00002060-198810000-00005 DOI: https://doi.org/10.1097/00002060-198810000-00005
Madsen M, Larsen K, Madsen I, Soe H, Hansen T. Late group-based rehabilitation has no advantages compared with supervised home-exercises after total knee arthroplasty. Dan Med J 2013; 60: A4607.
Mirzaeva L, Lobzin S, Tcinzerling N, Sarana A, Gilhus N, Rekind T. Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia. Spinal Cord 2020; 58: 970-979.
https://doi.org/10.1038/s41393-020-0458-y DOI: https://doi.org/10.1038/s41393-020-0458-y
Boyle C, MT N, Baguley I, Ranka J. Contextual influences on employment of people with dual diagnosis: spinal cord injury and traumatic brain injury. Aust Occup Ther J 2014; 61: 335-343.
https://doi.org/10.1111/1440-1630.12133 DOI: https://doi.org/10.1111/1440-1630.12133
Clark J, Ozturk E, Chanfreau-Coffinier C, Merritt V. Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury. Qual Life Res 2023; 33: 229-239.
https://doi.org/10.1007/s11136-023-03518-7 DOI: https://doi.org/10.1007/s11136-023-03518-7
Hagen E, Eide G, Rekand T, Gilhus N, Gronning M. Traumatic spinal cord injury and concomitant brain injury: a cohort study. Acta Neurol Scand 2010; 122: 51-57.
https://doi.org/10.1111/j.1600-0404.2010.01376.x DOI: https://doi.org/10.1111/j.1600-0404.2010.01376.x
Zahniser E, Temkin N, Machamer J, Barber J, Manley G, Markowiz A, et al. The functional status examination in mild traumatic brain injury: a TRACK-TBI sub-study. Arch Clin Neuropsychol 2019; 34: 1165-1174.
https://doi.org/10.1093/arclin/acy103 DOI: https://doi.org/10.1093/arclin/acy103
Silverberg N, Iverson G, ACRM Brain Injury Special Interest Group Mild TBI Task Force Members et al. The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2023; 104: 1343-1355.
https://doi.org/10.1016/j.apmr.2023.03.036 DOI: https://doi.org/10.1016/j.apmr.2023.03.036
Whitney S, Sparto P. Eye Movements, Dizziness, and Mild Traumatic Brain Injury (mTBI): A Topical Review of Emerging Evidence and Screening Measures. J Neurol Phys Ther 2019; 43: S31-S36.
https://doi.org/10.1097/NPT.0000000000000272 DOI: https://doi.org/10.1097/NPT.0000000000000272
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