Title: Combined cognitive and vocational interventions after mild-to-moderate traumatic brain injury: study protocol for a randomized controlled trial

Size: px
Start display at page:

Download "Title: Combined cognitive and vocational interventions after mild-to-moderate traumatic brain injury: study protocol for a randomized controlled trial"

Transcription

1 Author s response to reviews Title: Combined cognitive and vocational interventions after mild-to-moderate traumatic brain injury: study protocol for a randomized controlled trial Authors: Emilie Howe (emilie.howe@medisin.uio.no) Knut-Petter Langlo (knsela@ous-hf.no) Hans Christoffer Terjesen (Hans.Terjesen@afi.hioa.no) Cecilie Roe (cecilie.roe@medisin.uio.no) Anne-Kristine Schanke (Anne-Kristine.Schanke@sunnaas.no) Helene Søberg (h.l.soberg@medisin.uio.no) Unni Sveen (UNSVEE@ous-hf.no) Eline Aas (elinea@ous-hf.no) Heidi Enehaug (heidi.enehuag@afi.hioa.no) Daniele Alves (daniele.alves@afi.hioa.no) Pål Klethagen (Pal.Klethagen@afi.hioa.no) Kjersti Sagstad (Kjersti.Sagstad@nav.no) Christine Moen (Christine.Misje.Moen@nav.no) Karin Torsteinsbrend (Karin.Torsteinsbrend@nav.no) Anne-Margrete Linnestad (Anne-Margrethe.Linnestad@sunnaas.no) Tonje Nordenmark (tofoss@ous-hf.no) Birte Rismyhr (birte@personskadeforbundet.no) Grete Wangen (Grete.Wangen@afi.hioa.no) Juan Lu (juan.lu@vcuhealth.org) Jennie Ponsford (Jennie.Ponsford@monash.edu)

2 Elizabeth Twamley Helene Ugelstad Øystein Spjelkavik Marianne Løvstad Nada Andelic Version: 1 Date: 14 Sep 2017 Author s response to reviews: Dear Editor Thank you for the review and your comments concerning our manuscript. We find the comments very fruitful, and have tried to follow the recommendations from the reviewer, and addressed the comments in a point-by-point manner in the text below. Reviewer #1: Abstract Comment 1: 2nd paragraph - the authors describe patients on sick-leave due to "post-concussive symptoms" 2 months after injury. Given that the study includes patients with moderate TBI it is not correct to describe ongoing symptoms as "post-concussive" - this risks creating confusion with concussion, which is not a correct description after moderate TBI. Response 1: We thank the reviewer for this comment. We have based the use of post-concussive symptoms term in this population on TBI literature which indicates that the term post-concussive symptoms is not limited to use in individuals with concussion or mild TBI, but is also used to describe symptoms present in individuals with moderate and severe TBI. Silver & McAllister (1997) and Mittenberg & Strauman (2000) note that mild TBI is not synonymous with terms such as post-concussive symptoms as these can be seen after TBI of any severity. Moreover, Sigurdardottir et al., (2009) found presence of post-concussion symptoms in patients with mild, moderate and severe TBI 3 and 12 months post-injury. Thus, we prefer to use the term postconcussive symptoms to describe this cluster of TBI-related symptoms that are commonly present in patients with mild and moderate injuries in this study. Comment 2: The sentence "this will additionally be supported by work stability and work productivity over the first year following the intervention" is unclear. In what way "supported"? The English isn't quite clear here.

3 Response 2: We thank the reviewer for this comment. We have changed the wording to clarify the meaning. The sentence now reads Primary outcome measures are the proportion of participants who have returned to work at 12 months follow-up and length of time until RTW, in addition to work stability, and work productivity over the first year following the intervention. (See abstract) Comment 3: Suggest clarifying in the abstract that the study will be performed in Norway, and as such will work within Norwegian state healthcare and welfare systems. Response 3: We have added the following sentence to the methods section in the abstract: The study will be carried out in the South-Eastern region of Norway, and thereby be performed within the Norwegian welfare system. (See abstract) Introduction Comment 4: This gives a generally good overview. The authors could consider also referring to the wider literature on acquired brain injury (including but not exclusive to TBI), for example Donder-Cools et al, Brain Injury 2016, systematic review. Response 4: The following sentence has been added to the background section in the manuscript: Furthermore, a systematic review assessing effective return-to-work interventions after acquired brain injury found that involvement of patient and employer and work or workplace accommodations were among the components incorporated in the most effective interventions (reference number 19). (See page 3) Methods Comment 5: The authors should clarify their minimum criteria for assessing whether the patient has in fact suffered a mild traumatic brain injury or not. It is implied, but not absolutely clear, that all patients will have been assessed at the neurosurgical department (page 11 line 23), although it is also stated that recruitment to the study can be via general practitioners. This should be clarified. There is no real difficulty for patients with moderate TBI, but it is important to define the upper end of the spectrum for mild TBI, delineating this from trivial head trauma. For example the authors state LOC<24 hours and PTA<7 days as eligibility criteria, but do not state whether LOC and/or PTA for any minimum time was required. Referring to published criteria for mild TBI would be useful. Clarification regarding the minimum criteria for a diagnosis of mild TBI is important for generalizability. Response 5: We thank the reviewer for this comment. Most patients will have been assessed at the neurosurgical department, but this is not a prerequisite for being eligible for study inclusion. The patients may also be referred from general practitioners without having been assessed at the neurosurgical department, acknowledging that not all patients with injuries in the mild end of the TBI-spectrum are seen in a hospital immediately following their injury, but may still experience symptoms causing functional deficits and difficulty coping with work-demands in the aftermath

4 of the injury. We have clarified this in the manuscript by making the following adaptations: Participants will be recruited from the neurosurgical department at OUH and from general practitioners (GP). The study population will consist of patients with mild-to-moderate TBI, as assessed by a Glasgow Coma Scale score (GCS) of 10-15, loss of consciousness (LOC) for <24 hours and posttraumatic amnesia (PTA) for < 7 days. (See page 7) Regarding minimum criteria for a diagnosis of mild TBI, we are adhering to the definition developed by the American Congress of Rehabilitation Medicine (ACRM), reading A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following: 1) any period of loss of consciousness, 2) any loss of memory for events immediately before or after the accident, 3) any alteration in mental state at the time of the accident (eg, feeling dazed, disoriented, or confused), and 4) focal neurological deficits that may or may not be transient; but where the severity of the injury does not exceed the following: loss of consciousness for approximately 30 minutes or less; after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15; and post traumatic amnesia not greater than 24 hours. The following sentence has been added to the manuscript: Confirmation of diagnosis of mild TBI will be done through documenting that acute symptoms adhere to the American Congress of Rehabilitation Medicine`s (ACRM) definition of mild TBI (reference number30). This will either be extracted from pre-existing medical records, or established at the time of screening for study eligibility. (See page 7) Comment 6: It should be noted that the authors have chosen to combine two arguably different patient groups, i.e. those with moderate TBI and those with mild TBI. Patients with mild TBI may have a normal CT-brain and typically go home directly from the emergency room, whereas patients with moderate TBI typically have structural pathology and may spend several days as an inpatient on a surgical or neurosurgical ward. Recovery trajectories are also different, whereby some patients with moderate TBI may still be experiencing ongoing improvement at 2 months, whereas recovery is generally much quicker after mild TBI. It is at least debatable whether it is reasonable to combine these patient groups, and some discussion of this aspect should be included. Further, recent systematic reviews have shown that prognosis after mild TBI is generally good, with only a minority having persistent symptoms impairing ability to work, and where non-brain injury factors (e.g. co-morbidity, psycho-social factors) are thought frequently to contribute to persistence of symptoms. Response 6: We thank the reviewer for this comment. The study is a pragmatic RCT reflecting clinical practice and characteristics of the patients that are referred to our department. We modelled our study based on Twamley and colleagues 2014 pilot study that targeted individuals with mild and moderate TBI with persistent cognitive and post-concussive symptoms. The aim of the study was to assess the effect of the CogSMART intervention in combination with supported employment in improving post-concussive symptoms, neuropsychological performance, quality of life, functional capacity, emotional symptoms, and work participation. One of the arguments for choosing to include individuals with mild and moderate TBI was the increased likelihood of returning to competitive work, compared to individuals with severe TBI. The Compensatory Cogntive Training intervention is a development of CogSMART, and is a manualized intervention largely adapted to individuals with a history of mild TBI who experience persistent symptoms. The inclusion criteria in our study states that the patients should

5 be sick listed at the 50 % or higher level two months post-injury due to post-concussive symptoms, thereby excluding individuals who do not experience persistent symptoms and who are not in need of clinical follow-up. We chose the two-month limit to ensure a somewhat stabilized functional level. We have added the following sentences to the approaches section of the manuscript: We modelled our study based on Twamley and colleagues 2014 pilot study that targeted individuals with mild and moderate TBI with persistent cognitive and post-concussive symptoms. The aim of the study was to assess the effect of the CogSMART intervention in combination with supported employment in improving post-concussive symptoms, neuropsychological performance, quality of life, functional capacity, emotional symptoms, and work participation. (See page 4) Comment 7: Why wait 2 months after injury before beginning the intervention? It would be reasonable to wait a week, i.e. until the end of PTA, but by waiting 2 months the authors are missing the early period of neuroplasticity when rehabilitation training promoting recovery is thought to be most effective. Indeed, there is some lack of clarity regarding the intended effect of the CCT intervention which could explain why the authors have chosen to wait 2 months: According to the name ("Compensatory Cognitive Training") and description in the text (page 7 line 5), the focus is on compensatory strategy training. It is thus somewhat contradictory to state (page 7 line 13), that pilot studies show that CCT improves cognition; with compensatory strategies one would expect the patient to manage their cognitive deficits better, but compensatory strategies would not be expected to lead to any improvement in cognition per se. The distinction between interventions that enhance actual recovery and those that help the patient compensate for deficits is an important one, and more clarity is o Response 7: The majority of patients with mild TBI experience spontaneous recovery during the first few weeks following their injury, and are not in need of treatment. The spontaneous recovery tends to stabilize within 6-8 weeks and individuals who continue to experience symptoms beyond this point are at risk of chronification. Patients are typically referred to our department 6 weeks or more following the injury, when persistent symptoms affect the patients functioning to such a degree that it disrupts ability to return to work and a need for more extensive clinical follow-up is realized. The Compensatory Cognitive Training treatment focuses on psychoeducation and compensatory strategies, and targets post-concussive symptom management and cognitive symptoms. It focuses on the effect that post-concussive symptoms (such as sleep disturbance, pain, headache, fatigue, tension, and emotional symptoms) can have on cognitive symptoms and functional recovery, in addition to the effects of cognitive impairment per se. The aim is to educate the participants about this complex interrelationship, and to teach them strategies to compensate for the functional consequences of the symptoms they are experiencing. The CCT manual does not emphasize brain injury much. Rather the focus is on functional recovery, and symptom management. CCT stresses a biopsychosocial understanding where symptom occurrence and trajectories are typically due to complex interactions between biological, psychological and psycho-social factors. The following changes have been made to the section describing the CCT intervention: The intervention focuses on psychoeducation and compensatory strategy training, and targets post-concussive symptom management and cognitive symptoms. It focuses on the effect that post-concussive symptoms (such as sleep disturbance,

6 pain, fatigue, headache, tension, and emotional distress) can have on cognitive symptoms and functional recovery. The CCT intervention stresses a biopsychosocial understanding and aims to educate the participants about this complex interrelationship, and to teach them stress-reduction techniques and strategies to compensate for the functional consequences of the symptoms they are experiencing. The compensatory cognitive strategies targets prospective memory, attention and concentration, learning and memory, and executive functioning. (See page 4) We have changed the wording in the sentence pointed out by the reviewer to clarify the meaning: Pilot studies in patients with mild-to-moderate TBI have demonstrated the efficacy of CogSMART and CCT in improving emotional problems, functional capacity, quality of life, and performance on neurocognitive measures. (See page 4) Comment 8: One much debated aspect regarding mild TBI is the extent to which late symptoms are due to brain injury, rather than relating to non-specific effects of traumatic injury such as pain and stress, both of which can also contribute to symptoms including cognitive symptoms. Previous studies have controlled for these non-specific factors by including a control group with, for example, minor orthopedic injuries to the extremities without head trauma. Such a control group would strengthen the study and allow an understanding of the extent to which the intervention is brain injury specific. Response 8: We thank the reviewer for pointing this out and acknowledge the limitation presented by not including a control group which is not affected by traumatic injury. Limitations due to the grant that was provided unfortunately prevents us from implementing this. Furthermore, as noted above, we know that symptomatology will be the end result of complex processes where the brain injury as such is but one potential cause. The main aim of this study is to affect work participation through a combination of cognitive remediation and supported employment. For this purpose, a treatment as usual control group seems appropriate to us, as etiologies and causation will be comparable across groups. We have added the following sentence to study limitations: By including a control group with traumatic injury, but without head trauma, it would have been possible to identify non-specific effects of traumatic injury that may contribute to symptoms and lasting functional impairment. The grant provided unfortunately prevents us from implementing this. Furthermore, the main aim of this study is to affect work participation through a combination of cognitive remediation and supported employment. For this purpose, a treatment as usual control is appropriate, as etiologies and causation will be comparable across groups. (See page 18) Comment 9: On page 15, line 37 the abbreviations "CCI-SE" and "CG" are used, but where are the definitions of these? Do the authors mean CCT-SE (not CCI-SE) and if so is this identical to CCT (as described on pats 6 from line 56)? Please clarify. Response 9: We have changed the wording to clarify the meaning: between the CCT-SE (Compensatory Cognitive Training-Supported Employment) and CG (control group) is regarded (See page 11)

7 Comment 10: Trial status (page 23 line 39). The authors refer to a feasibility study which was scheduled to end in July, and after which they state that adjustments in the protocol may be made. Suggest incorporating these adjustments into the manuscript before publication. Response 10: The study was performed as scheduled and feasibility deemed overall satisfactory. No adjustments were made to the intervention protocol. We have made the following changes to the manuscript: A feasibility study including six patients has been performed and concluded in July The results of this are under preparation for publication. No major changes to the protocol were made as a result of the feasibility study. Recruitment and randomization of participants for the main study commenced in July 2017, and will end when we have enrolled the estimated sample size, (approximately in November/December 2018). (See page 19) The revisions are indicated in track changes to ease identification. Thank you for the opportunity to revise the manuscript and for considering it for publication in Trials. We look forward to hearing from you. Best regards Emilie Isager Howe Corresponding author

Mild Traumatic Brain Injury (mtbi): An Occupational Dilemma

Mild Traumatic Brain Injury (mtbi): An Occupational Dilemma Mild Traumatic Brain Injury (mtbi): An Occupational Dilemma William H. Cann, MD MPH Occupational Medicine Trainee Occupational Medicine Trainee University of Washington Disclosures None This presentation

More information

Kristine Burkman, Ph.D. Staff Psychologist San Francisco VA Medical Center

Kristine Burkman, Ph.D. Staff Psychologist San Francisco VA Medical Center Kristine Burkman, Ph.D. Staff Psychologist San Francisco VA Medical Center ASAM Disclosure of Relevant Financial Relationships Content of Activity: ASAM Medical Scientific Conference 2013 Name Commercial

More information

CRITICALLY APPRAISED PAPER (CAP)

CRITICALLY APPRAISED PAPER (CAP) CRITICALLY APPRAISED PAPER (CAP) Twamley, E. W., Jak, A. J., Delis, D. C., Bondi, M. W., & Lohr, J. B. (2014). Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for Veterans with traumatic

More information

Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial

Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial Howe et al. Trials (2017) 18:483 DOI 10.1186/s13063-017-2218-7 STUDY PROTOCOL Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized

More information

PEDIATRIC SPORTS RELATED CONCUSSIONS

PEDIATRIC SPORTS RELATED CONCUSSIONS Anna Mazur, PhD PEDIATRIC SPORTS RELATED CONCUSSIONS Disclosure No financial interests or funding 1 Presentation Outline Prevalence Predicting recovery: Post Traumatic Amnesia and Loss of Consciousness

More information

VA/DoD Clinical Practice Guideline for the Management of Concussion/mTBI

VA/DoD Clinical Practice Guideline for the Management of Concussion/mTBI VA/DoD Clinical Practice Guideline for the Management of Concussion/mTBI Chief, Evidence-Based Practice US Army Medical Command Clinical Program Specialist Office of Performance and Quality Improvement

More information

TITLE: Improving Work Outcomes for Veterans with Traumatic Brain Injury. San Diego, CA 92161

TITLE: Improving Work Outcomes for Veterans with Traumatic Brain Injury. San Diego, CA 92161 AD AWARD NUMBER: W81XWH-08-2-0193 TITLE: Improving Work Outcomes for Veterans with Traumatic Brain Injury PRINCIPAL INVESTIGATOR: Elizabeth W. Twamley, Ph.D. CONTRACTING ORGANIZATION: Veterans Medical

More information

Handling Challenges & Changes after TBI

Handling Challenges & Changes after TBI Handling Challenges & Changes after TBI Quick Facts about Traumatic Brain Injury (TBI) The CDC reports that roughly 2.5 million Americans have a TBI each year The most common causes are: falls, motor vehicle

More information

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children September 2018

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children September 2018 Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children September 2018 Nothing to Disclose CDC Guidelines- Objective Question-

More information

Optimizing Concussion Recovery: The Role of Education and Expectancy Effects

Optimizing Concussion Recovery: The Role of Education and Expectancy Effects Rehabilitation Institute of Michigan Optimizing Concussion Recovery: The Role of Education and Expectancy Effects Robin Hanks, Ph.D., ABPP Chief of Rehabilitation Psychology and Neuropsychology Professor

More information

Effect of multidisciplinary outpatient treatment after mild traumatic brain injury

Effect of multidisciplinary outpatient treatment after mild traumatic brain injury Effect of multidisciplinary outpatient treatment after mild traumatic brain injury Dissertation for the degree of philosophiae doctor (PhD) at the University of Bergen Dissertation date: It is not only

More information

Neuropsychological Sequale of Mild Traumatic Brain Injury. Professor Magdalena Mateo. Megan Healy

Neuropsychological Sequale of Mild Traumatic Brain Injury. Professor Magdalena Mateo. Megan Healy Neuropsychological Sequale of Mild Traumatic Brain Injury Professor Magdalena Mateo Megan Healy Abstract: Studies have proven that mild traumatic brain injuries (MTBI), commonly known as concussions, can

More information

Title:Continuity of GP care is associated with lower use of complementary and alternative medical providers A population-based cross-sectional survey

Title:Continuity of GP care is associated with lower use of complementary and alternative medical providers A population-based cross-sectional survey Author's response to reviews Title:Continuity of GP care is associated with lower use of complementary and alternative medical providers A population-based cross-sectional survey Authors: Anne Helen Hansen

More information

Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only*

Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only* Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only* Name of patient/veteran: SSN: Your patient is applying to the U. S. Department

More information

Concussions and Mild Traumatic Brain Injury

Concussions and Mild Traumatic Brain Injury Concussions and Mild Traumatic Brain Injury Nancy Mann, MD, Paradigm Medical Director Fellow, American Academy of Physical Medicine and Rehabilitation Nancy Mann, MD Specializes in traumatic brain injury

More information

Mild Traumatic Brain Injury: Nosology & Pathogenesis

Mild Traumatic Brain Injury: Nosology & Pathogenesis Psychological Medicine Clinical Academic Group (CAG) Mild Traumatic Brain Injury: Nosology & Pathogenesis Mike Dilley, Lishman Unit, Maudsley Hospital michael.dilley@slam.nhs.uk A 38-year-old woman presents

More information

School of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC

School of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC School of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC Fall of a Teton How Bad is He Hurt? What REALLY happened inside Johnny s head? How common are these types of injuries? PONDER THIS What part

More information

Traumatic Brain Injury. By Laura Gomez, LCSW

Traumatic Brain Injury. By Laura Gomez, LCSW Traumatic Brain Injury By Laura Gomez, LCSW Objectives Briefly describe TBI, and its incidence, severity, and treatments Describe the VHA system of specialized TBI care for active duty and veterans Describe

More information

Brain-based disorders in children, teens, and young adults: When to know there is a problem and what to do

Brain-based disorders in children, teens, and young adults: When to know there is a problem and what to do Brain-based disorders in children, teens, and young adults: When to know there is a problem and what to do Timothy A. Fratto, Ph.D. Neuropsychology Associates of Fairfax What is Neuropsychology? The study

More information

In addition, we have asked an English-editing service to edit the text, and you will find an English-edited version of the paper submitted as well.

In addition, we have asked an English-editing service to edit the text, and you will find an English-edited version of the paper submitted as well. Author s response to reviews Title: Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH): A Norwegian Cohort Study from Admission to a Nursing Home until Death. A description of study

More information

Conceptualization of Functional Outcomes Following TBI. Ryan Stork, MD

Conceptualization of Functional Outcomes Following TBI. Ryan Stork, MD Conceptualization of Functional Outcomes Following TBI Ryan Stork, MD Conceptualization of Functional Outcomes Following Traumatic Brain Injury Ryan Stork, MD Clinical Lecturer Brain Injury Medicine &

More information

Language After Traumatic Brain Injury

Language After Traumatic Brain Injury Chapter 7 Language After Traumatic Brain Injury 10/24/05 COMD 326, Chpt. 7 1 1 10/24/05 COMD 326, Chpt. 7 2 http://www.californiaspinalinjurylawyer.com/images/tbi.jpg 2 TBI http://www.conleygriggs.com/traumatic_brain_injury.shtml

More information

TRAUMATIC BRAIN INJURY

TRAUMATIC BRAIN INJURY Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences TRAUMATIC BRAIN INJURY GARY STOBBE, MD UNIVERSITY OF WASHINGTON GENERAL DISCLOSURES The University of Washington

More information

Neuropsychology of TBI & PTSD

Neuropsychology of TBI & PTSD Neuropsychology of TBI & PTSD George S. Serna, Ph.D. Louis Stokes VA Medical Center TBI: The Signature Injury of the Iraq/Afghanistan War Veteran? 19% - 30% of OEF/OIF veterans reported some level of TBI

More information

The University of Nebraska Omaha Concussion Management Plan

The University of Nebraska Omaha Concussion Management Plan Definition: The University of Nebraska Omaha Concussion Management Plan A concussion is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to

More information

The Components of an Objective IME

The Components of an Objective IME The Components of an Objective IME Presented By: Lee H. Doppelt, PhD Brought to you by: Today s Topics Appropriate and ethical communication with IME providers IME providers standards of conduct requirement

More information

Pediatric Traumatic Brain Injury. Seth Warschausky, PhD Department of Physical Medicine and Rehabilitation University of Michigan

Pediatric Traumatic Brain Injury. Seth Warschausky, PhD Department of Physical Medicine and Rehabilitation University of Michigan Pediatric Traumatic Brain Injury Seth Warschausky, PhD Department of Physical Medicine and Rehabilitation University of Michigan Modules Module 1: Overview Module 2: Cognitive and Academic Needs Module

More information

Disclosures. Objectives 2/15/2014. Wright, Concussion Assessment, Management and Return to Sports

Disclosures. Objectives 2/15/2014. Wright, Concussion Assessment, Management and Return to Sports Concussion Assessment, Management and Return to Sports Wendy L. Wright, MS, APRN, FNP, FAANP Adult/Family Nurse Practitioner Owner Wright & Associates Family Healthcare Amherst Owner Wright & Associates

More information

Donald A. Davidoff, Ph.D., ABPDC Chief, Neuropsychology Department, McLean Hospital Assistant Professor of Psychology, Harvard Medical School

Donald A. Davidoff, Ph.D., ABPDC Chief, Neuropsychology Department, McLean Hospital Assistant Professor of Psychology, Harvard Medical School Donald A. Davidoff, Ph.D., ABPDC Chief, Neuropsychology Department, McLean Hospital Assistant Professor of Psychology, Harvard Medical School Interests: Adult/Geriatric/Forensic Neuropsychology ddavidoff@mclean.harvard.edu

More information

A Healthy Brain. An Injured Brain

A Healthy Brain. An Injured Brain A Healthy Brain Before we can understand what happens when a brain is injured, we must realize what a healthy brain is made of and what it does. The brain is enclosed inside the skull. The skull acts as

More information

Traumatic brain injury (TBI) is a major cause of mortality, cognitive and

Traumatic brain injury (TBI) is a major cause of mortality, cognitive and Disorder: Traumatic Brain Injury (TBI) Essay Title: Paediatric Traumatic Brain Injury (TBI) Title: Associate Professor Name: Cathy Surname: Catroppa Qualifications: BBSc., DipEdPsych., M.Ed.Psych., PhD

More information

Title: Development and external validation of a new PTA assessment scale

Title: Development and external validation of a new PTA assessment scale Author's response to reviews Title: Development and external validation of a new PTA assessment scale Authors: Bram Jacobs (b.jacobs@umcg.nl) Janneke van Ekert (J.Vanekert@donders.ru.nl) Lotje P.L. Vernooy

More information

What is concussion? DR MARTIN RAFTERY CHIEF MEDICAL OFFICER NOVEMBER 2016

What is concussion? DR MARTIN RAFTERY CHIEF MEDICAL OFFICER NOVEMBER 2016 What is concussion? DR MARTIN RAFTERY CHIEF MEDICAL OFFICER NOVEMBER 2016 2 WHAT IS RUGBY? Short video CONCUSSION WHY IMPORTANT? 1. Can mimic more serious intra-cranial injury 2. Can lead to persistent

More information

Head, Face, Eyes, Ears, Nose and Throat. Neurological Exam. Eye Function 12/11/2017. Oak Ridge High School Conroe, Texas

Head, Face, Eyes, Ears, Nose and Throat. Neurological Exam. Eye Function 12/11/2017. Oak Ridge High School Conroe, Texas Head, Face, Eyes, Ears, Nose and Throat Oak Ridge High School Conroe, Texas Neurological Exam Consists of Five Major Areas: 1. cerebral testing cognitive functioning 2. Cranial nerve testing 3. Cerebellar

More information

Prolonged Issues with Cognitive Function. Julie Miller, Psy.D., ABPP-CN Neuropsychologist Wallace-Kettering Neuroscience Institute

Prolonged Issues with Cognitive Function. Julie Miller, Psy.D., ABPP-CN Neuropsychologist Wallace-Kettering Neuroscience Institute Prolonged Issues with Cognitive Function Julie Miller, Psy.D., ABPP-CN Neuropsychologist Wallace-Kettering Neuroscience Institute Presentation Outline Basics of human brain development Vulnerability of

More information

Emotional Symptoms in Athletes With PCS. David Westerdahl, MD FAAFP Cleveland Clinic Florida 6/24/2012

Emotional Symptoms in Athletes With PCS. David Westerdahl, MD FAAFP Cleveland Clinic Florida 6/24/2012 Emotional Symptoms in Athletes With PCS David Westerdahl, MD FAAFP Cleveland Clinic Florida 6/24/2012 Objectives Discuss Post-Concussion symptoms and functional problems Identify pre-injury factors that

More information

Complexity and Challenges of Return to Play After a Mild Traumatic Brain Injury

Complexity and Challenges of Return to Play After a Mild Traumatic Brain Injury Complexity and Challenges of Return to Play After a Mild Traumatic Brain Injury Kristina Wilson, MD, MPH, CAQSM, FAAP Medical Director, Pediatric and Adolescent Sports Medicine and Sports Physical Thearpy

More information

Return to play after concussion(s) A set of Danish Guidelines (or not?)

Return to play after concussion(s) A set of Danish Guidelines (or not?) Morten Høgh PT MSc RISPT DipMT Sports Medicine Congress 2015 Copenhagen Return to play after concussion(s) A set of Danish Guidelines (or not?)? Symposium: Concussion in Sports This presentation 1. Danish

More information

Changes, Challenges and Solutions: Overcoming Cognitive Deficits after TBI Sarah West, Ph.D. Hollee Stamper, LCSW, CBIS

Changes, Challenges and Solutions: Overcoming Cognitive Deficits after TBI Sarah West, Ph.D. Hollee Stamper, LCSW, CBIS Changes, Challenges and Solutions: Overcoming Cognitive Deficits after TBI Sarah West, Ph.D. Hollee Stamper, LCSW, CBIS Learning Objectives 1. Be able to describe the characteristics of brain injury 2.

More information

LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore for the required texts for this class.

LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore  for the required texts for this class. LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS SPECIAL NOTE: This brief syllabus is not intended to be a legal contract. A full syllabus will be distributed to students at the first class session. TEXT AND SUPPLEMENTARY

More information

VA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI

VA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI VA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI Ernest Degenhardt Chief, Evidence-Based Practice USA Medical Command Quality Management Division Office of Evidence-Based Practice

More information

Dr Nigel S King Consultant Clinical Neuropsychologist

Dr Nigel S King Consultant Clinical Neuropsychologist Dr Nigel S King Consultant Clinical Neuropsychologist Oxford Institute of Clinical Psychology Training University of Oxford, UK nigel.king@hmc.ox.ac.uk & Community Head Injury Service Bucks Healthcare

More information

TBI and PTSD in the Post 9/11 Era: From Research to Practice

TBI and PTSD in the Post 9/11 Era: From Research to Practice TBI and PTSD in the Post 9/11 Era: From Research to Practice Nazanin Bahraini, PhD & Lisa A. Brenner, PhD, ABPP HSR&D Cyberseminar September 30, 2014 Poll Question #1 How knowledgeable are you about deployment

More information

Concussion: Not Just For Athletes

Concussion: Not Just For Athletes Concussion: Not Just For Athletes M WASIF HUSSAIN, MBBS, FRCPC (NEUROLOGY) PRACTITIONER S DAY NOVEMBER 15, 2017 Overview Background Epidemiology Definitions Clinical Picture Concussion, PCS, CTE Concussion

More information

Concussions and the Athlete Child Neurology of Tulsa Page 1 of 5

Concussions and the Athlete Child Neurology of Tulsa Page 1 of 5 Page 1 of 5 The Following information has been compiled from the American Academy of Neurology: This practice parameter is based on a background paper 1 written by James P. Kelly, MD, and Jay H. Rosenberg,

More information

Copyright 2009 ACNN 1

Copyright 2009 ACNN 1 1 The focus of this information is children who have previously been evaluated and have an established diagnosis of concussion. The information contained herein is not intended for acute concussion management.

More information

Functional Level During the First Year After Moderate and Severe Traumatic Brain Injury: Course and Predictors of Outcome

Functional Level During the First Year After Moderate and Severe Traumatic Brain Injury: Course and Predictors of Outcome Original Article Elmer ress Functional Level During the First Year After Moderate and Severe Traumatic Brain Injury: Course and Predictors of Outcome Maria Sandhaug a, b, e, Nada Andelic c, Svein A Berntsen

More information

SUMMARY DECISION NO. 1058/98. Fibromyalgia.

SUMMARY DECISION NO. 1058/98. Fibromyalgia. SUMMARY DECISION NO. 1058/98 Fibromyalgia. The worker suffered a wrist injury in 1984. The worker appealed a decision of the Appeals Officer denying entitlement for fibromyalgia. Considering the evidence

More information

PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL)

PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL) PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)

More information

Mild Brain Injury & Post-Concussion Syndrome. Patient Information Booklet. Talis Consulting Limited

Mild Brain Injury & Post-Concussion Syndrome. Patient Information Booklet. Talis Consulting Limited Mild Brain Injury & Post-Concussion Syndrome Patient Information Booklet Talis Consulting Limited What is Minor Head Injury? Minor Head Injury is one of the most common neurological conditions seen in

More information

Postdoctoral Fellowship in Neuropsychology and Intervention

Postdoctoral Fellowship in Neuropsychology and Intervention Clinical Psychology Training Programs at Brown: A Consortium of the Providence VA Medical Center, Lifespan, and Care New England Postdoctoral Fellowship Training Program Postdoctoral Fellowship Description:

More information

WakeMed Health & Hospitals

WakeMed Health & Hospitals WakeMed Health & Hospitals The Power to Heal. A Passion for Care. WakeMed Health & Hospitals Raleigh, North Carolina Traumatic Brain Injury December 4th, 2012 Laurie Leach, Ph.D., FACPN Director of Neuropsychology

More information

Davidson College Sports Medicine Concussion Management Policy

Davidson College Sports Medicine Concussion Management Policy Davidson College Sports Medicine Concussion Management Policy Davidson College practices concussion management care based on the most current research and consensus statements from noted concussion experts.

More information

Disclosure Statement. Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk.

Disclosure Statement. Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk. Disclosure Statement Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk. Head Trauma Evaluation Primary and secondary injury Disposition Sports related

More information

Pre and Post Concussion Management

Pre and Post Concussion Management Pre and Post Concussion Management Timothy A. Tolbert, Ph.D., ATC Clinical Coordinator Marshall University Athletic Training Program 1 Concussion A complex pathophysiological process affecting the brain,

More information

Title: DreamTel; Diabetes Risk Evaluation and Management Tele-monitoring Study

Title: DreamTel; Diabetes Risk Evaluation and Management Tele-monitoring Study Author's response to reviews Title: DreamTel; Diabetes Risk Evaluation and Management Tele-monitoring Study Authors: Sheldon Tobe (sheldon.tobe@sunnybrook.ca) Joan Wentworth (jwentworth@miwayawinhealth.org)

More information

Community Partnerships for Youth Concussion Care: Power of the Medical Neighborhood

Community Partnerships for Youth Concussion Care: Power of the Medical Neighborhood Community Partnerships for Youth Concussion Care: Power of the Medical Neighborhood Gerard A. Gioia, Ph.D. Pediatric Neuropsychologist Chief, Division of Pediatric Neuropsychology Director, Safe Concussion

More information

Instructional Course #34. Review of Neuropharmacology in Pediatric Brain Injury. John Pelegano MD Jilda Vargus-Adams MD, MSc Micah Baird MD

Instructional Course #34. Review of Neuropharmacology in Pediatric Brain Injury. John Pelegano MD Jilda Vargus-Adams MD, MSc Micah Baird MD Instructional Course #34 Review of Neuropharmacology in Pediatric Brain Injury John Pelegano MD Jilda Vargus-Adams MD, MSc Micah Baird MD Outline of Course 1. Introduction John Pelegano MD 2. Neuropharmocologic

More information

Army troops suffering from traumatic brain injury

Army troops suffering from traumatic brain injury Army troops suffering from traumatic brain injury Since October 2001, more than two million American troops have deployed to fight the Global War on Terror being fought in Iraq and Afghanistan. The War

More information

Wednesday 8 March Behaviours of concern following traumatic brain injury Presenters:

Wednesday 8 March Behaviours of concern following traumatic brain injury Presenters: Breakfast Club Lecture Series 2017 The Summer Foundation is proud to announce the Breakfast Club professional development lecture series on brain injury rehabilitation. These lectures, originally established

More information

Title: Socioeconomic conditions and number of pain sites in women

Title: Socioeconomic conditions and number of pain sites in women Author's response to reviews Title: Socioeconomic conditions and number of pain sites in women Authors: Finn E Skjeldestad (fisk@fhi.no) Toril Rannestad (Toril.Rannestad@hist.no) Version: 2 Date: 17 January

More information

Mild Traumatic Brain Injury: A prospective repeated measures study investigating the influence of illness perceptions and coping on clinical outcome.

Mild Traumatic Brain Injury: A prospective repeated measures study investigating the influence of illness perceptions and coping on clinical outcome. Mild Traumatic Brain Injury: A prospective repeated measures study investigating the influence of illness perceptions and coping on clinical outcome. Deborah L Snell A thesis submitted for the degree of

More information

Arizona Department of Health Services Division of Behavioral Health Services (ADHS/DBHS) Traumatic Brain Injuries

Arizona Department of Health Services Division of Behavioral Health Services (ADHS/DBHS) Traumatic Brain Injuries Arizona Department of Health Services Division of Behavioral Health Services (ADHS/DBHS) Traumatic Brain Injuries May 2011 Anatomy of the Brain Introduction The Department of Health decided to increase

More information

Mini Research Paper: Traumatic Brain Injury. Allison M McGee. Salt Lake Community College

Mini Research Paper: Traumatic Brain Injury. Allison M McGee. Salt Lake Community College Running Head: Mini Research Paper: Traumatic Brain Injury Mini Research Paper: Traumatic Brain Injury Allison M McGee Salt Lake Community College Abstract A Traumatic Brain Injury (also known as a TBI)

More information

Sports Related Concussion. Joshua T. Williams, PT, DPT, OCS, SCS, CSCS

Sports Related Concussion. Joshua T. Williams, PT, DPT, OCS, SCS, CSCS Sports Related Concussion Joshua T. Williams, PT, DPT, OCS, SCS, CSCS Concussion & Traumatic Brain Injury Glasgow Coma Scale Minimal Mild Mod Severe? Sports concussion Severe GCS 8 Moderate GCS 9-12 Mild

More information

Title: Prevalence of sexual, physical and emotional abuse in the Norwegian Mother and Child Cohort Study

Title: Prevalence of sexual, physical and emotional abuse in the Norwegian Mother and Child Cohort Study Author's response to reviews Title: Prevalence of sexual, physical and emotional abuse in the Norwegian Mother and Child Cohort Study Authors: Marie F Sorbo (marie.flem.sorbo@ntnu.no) Hilde Grimstad (hilde.grimstad@ntnu.no)

More information

Adult Neuropsychological Issues: Impact on Intellectual Functioning and Return to Work. Kenneth Perrine, Ph.D., ABPP-CN Weill Cornell Medical College

Adult Neuropsychological Issues: Impact on Intellectual Functioning and Return to Work. Kenneth Perrine, Ph.D., ABPP-CN Weill Cornell Medical College Adult Neuropsychological Issues: Impact on Intellectual Functioning and Return to Work Kenneth Perrine, Ph.D., ABPP-CN Weill Cornell Medical College Disclosures I receive compensation from the New York

More information

Post-Concussion Syndrome

Post-Concussion Syndrome Post-Concussion Syndrome By David Coppel SIGNS AND SYMPTOMS According to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-4) an individual with post-concussion disorder experiences

More information

Author s response to reviews

Author s response to reviews Author s response to reviews Title: Comprehension of confidence intervals - development and piloting of patient information materials for people with multiple sclerosis: qualitative study and pilot randomised

More information

USASOC Neurocognitive Testing and Post Injury Evaluation and Treatment Clinical Practice Guideline (CPG)

USASOC Neurocognitive Testing and Post Injury Evaluation and Treatment Clinical Practice Guideline (CPG) USASOC Neurocognitive Testing and Post Injury Evaluation and Treatment Clinical Practice Guideline (CPG) Note: The intent of this CPG is to serve as general guidance for medics and medical officers. It

More information

Assessment and Treatment of Persistent Postconcussive Symptoms in Veterans: Rethinking the Role of Concussion

Assessment and Treatment of Persistent Postconcussive Symptoms in Veterans: Rethinking the Role of Concussion Assessment and Treatment of Persistent Postconcussive Symptoms in Veterans: Rethinking the Role of Concussion Amy Jak, Ph.D. ajak@ucsd.edu INS 2018 DISCLOSURE This presentation is based on work supported,

More information

THE ESSENTIAL BRAIN INJURY GUIDE

THE ESSENTIAL BRAIN INJURY GUIDE THE ESSENTIAL BRAIN INJURY GUIDE Outcomes Section 9 Measurements & Participation Presented by: Rene Carfi, LCSW, CBIST Senior Brain Injury Specialist Brain Injury Alliance of Connecticut Contributors Kimberly

More information

Therapy Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2017 DXC Technology Company. All rights reserved.

Therapy Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2017 DXC Technology Company. All rights reserved. INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Therapy Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 9 P U B L I S H E D : A U G U S T 1, 2 0 1 7 P O L I C I E

More information

Summary of evidence-based guideline update: Evaluation and management of concussion in sports

Summary of evidence-based guideline update: Evaluation and management of concussion in sports Summary of evidence-based guideline update: Evaluation and management of concussion in sports Report of the Guideline Development Subcommittee of the American Academy of Neurology Guideline Endorsements

More information

DIMENSIONS OF POST-CONCUSSIVE SYMPTOMS IN CHILDREN WITH MILD TRAUMATIC BRAIN INJURY DISSERTATION

DIMENSIONS OF POST-CONCUSSIVE SYMPTOMS IN CHILDREN WITH MILD TRAUMATIC BRAIN INJURY DISSERTATION DIMENSIONS OF POST-CONCUSSIVE SYMPTOMS IN CHILDREN WITH MILD TRAUMATIC BRAIN INJURY DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate

More information

Use of CT in minor traumatic brain injury. Lisa Ayoub-Rodriguez, MD Bert Johansson, MD Michael Lee, MD

Use of CT in minor traumatic brain injury. Lisa Ayoub-Rodriguez, MD Bert Johansson, MD Michael Lee, MD Use of CT in minor traumatic brain injury Lisa Ayoub-Rodriguez, MD Bert Johansson, MD Michael Lee, MD No financial or other conflicts of interest Epidemiology of traumatic brain injury (TBI) Risks associated

More information

Mark J. Harary, MD Primary Care Sports Medicine St Charles Orthopedics, LLP

Mark J. Harary, MD Primary Care Sports Medicine St Charles Orthopedics, LLP Mark J. Harary, MD Primary Care Sports Medicine St Charles Orthopedics, LLP Facts, Definitions, etc Appropriate Recognition Comprehensive Management Treatment Consequences of Concussions Neurocognitive

More information

Title: Defensive coping and health-related quality of life in Chronic Kidney Disease: a cross-sectional study

Title: Defensive coping and health-related quality of life in Chronic Kidney Disease: a cross-sectional study Author's response to reviews Title: Defensive coping and health-related quality of life in Chronic Kidney Disease: a cross-sectional study Authors: Anna Kaltsouda (akalts@cc.uoi.gr) Petros Skapinakis (p.skapinakis@gmail.com)

More information

Marianne Løvstad, PhD, Clinical neuropsychologist; Sunnaas rehabilitation Hospital, Ass. Prof., Dept. of psychology, University of Oslo

Marianne Løvstad, PhD, Clinical neuropsychologist; Sunnaas rehabilitation Hospital, Ass. Prof., Dept. of psychology, University of Oslo Self-reported executive deficit in patients with neurological and neuropsychiatric conditions - symptom levels and relationship to cognition and emotional distress. Marianne Løvstad, PhD, Clinical neuropsychologist;

More information

Let s s talk about behaviour

Let s s talk about behaviour Let s s talk about behaviour Common Terms: Coma Restless Agitated Disoriented Confused Disinhibition Disrupted sleep cycle Amnestic Combative Inappropriate Vocalizing Some less accurate terminology Rude

More information

Brain Concussion: A Stealth Injury. Christine Schulman, RN, MS, CNS, CCRN Trauma & Critical Care CNS Legacy Health, Portland, Oregon Director, AACN

Brain Concussion: A Stealth Injury. Christine Schulman, RN, MS, CNS, CCRN Trauma & Critical Care CNS Legacy Health, Portland, Oregon Director, AACN Brain Concussion: A Stealth Injury Christine Schulman, RN, MS, CNS, CCRN Trauma & Critical Care CNS Legacy Health, Portland, Oregon Director, AACN Legacy Emanuel Medical Center Portland, Oregon Disclosures

More information

Cognitive Changes Workshop Outcomes

Cognitive Changes Workshop Outcomes HO 4.1 Cognitive Changes Workshop Outcomes At the end of this session, participants should be able to: define Neuropsychology and the role of the Neuropsychologist (optional) recognise normal difficulties

More information

Title: Differences between patients' and clinicians' report of sleep disturbance: A field study in mental health care in Norway.

Title: Differences between patients' and clinicians' report of sleep disturbance: A field study in mental health care in Norway. Author's response to reviews Title: Differences between patients' and clinicians' report of sleep disturbance: A field study in mental health care in Norway. Authors: Håvard Kallestad (havard.kallestad@ntnu.no)

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1820/13

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1820/13 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1820/13 BEFORE: J. P. Moore: Vice-Chair HEARING: September 18, 2013 at Kitchener Oral Post-hearing activity completed on March 20, 2014 DATE

More information

Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms. Patient Version

Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms. Patient Version Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms 3 rd Edition - for adults, +18 years of age Patient Version This guideline has been created to help with management of concussion/mild

More information

Neuropsychological assessment of children and adults with traumatic brain injury

Neuropsychological assessment of children and adults with traumatic brain injury Neuropsychological assessment of children and adults with traumatic brain injury Guidelines for the NSW Compulsory Third Party Scheme and Lifetime Care and Support Scheme 2013 Motor Accidents Authority

More information

Updates from the CDC Pediatric mtbi Guideline

Updates from the CDC Pediatric mtbi Guideline Updates from the CDC Pediatric mtbi Guideline Angela Lumba-Brown, MD Pediatric mtbi Workgroup Lead, Centers for Disease Control & Prevention Co-Director, Stanford Concussion and Brain Performance Center

More information

Author's response to reviews

Author's response to reviews Author's response to reviews Title: Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control.

More information

Carleton College Concussion Safety Protocol

Carleton College Concussion Safety Protocol Carleton College Introduction Carleton College is committed to ensuring the health and safety of its student-athletes. To this end, and in accordance with NCAA legislation [Division III Constitution 3.2.4.16],

More information

Author s response to reviews

Author s response to reviews Author s response to reviews Title: Evaluation of the Effectiveness of Music Therapy in Improving the Quality of Life of Palliative Care Patients: a Randomised Controlled Pilot and Feasibility Study Authors:

More information

Determining causation of traumatic versus preexisting. conditions. David Fisher, Ph.D., ABPP, LP Chairman of the Board PsyBar, LLC

Determining causation of traumatic versus preexisting. conditions. David Fisher, Ph.D., ABPP, LP Chairman of the Board PsyBar, LLC Determining causation of traumatic versus preexisting psychological conditions David Fisher, Ph.D., ABPP, LP Chairman of the Board PsyBar, LLC 952 285 9000 Part 1: First steps to determine causation Information

More information

THE ATHLETE S GUIDE TO CONCUSSION MANAGEMENT

THE ATHLETE S GUIDE TO CONCUSSION MANAGEMENT THE ATHLETE S GUIDE TO CONCUSSION MANAGEMENT THE ATHLETE S GUIDE TO CONCUSSION MANAGEMENT Table of Contents Introduction...3 What is a Concussion?...4 How Do I Know If I Have a Concussion?...4 Concussion

More information

Title: Quality of life in childhood epilepsy with lateralized focus

Title: Quality of life in childhood epilepsy with lateralized focus Author's response to reviews Title: Quality of life in childhood epilepsy with lateralized focus Authors: Krystyna A. Mathiak (krystyna.mathiak@psych.uw.edu.pl) Malgorzata Luba (malgosia.luba@gmail.com)

More information

PROPOSAL FOR MULTI-INSTITUTIONAL IMPLEMENTATION OF THE BRAIN INJURY GUIDELINES

PROPOSAL FOR MULTI-INSTITUTIONAL IMPLEMENTATION OF THE BRAIN INJURY GUIDELINES PROPOSAL FOR MULTI-INSTITUTIONAL IMPLEMENTATION OF THE BRAIN INJURY GUIDELINES INTRODUCTION: Traumatic Brain Injury (TBI) is an important clinical entity in acute care surgery without well-defined guidelines

More information

Assessment and Treatment of Persistent Postconcussive Symptoms in Veterans: Rethinking the Role of Concussion. Amy Jak, Ph.D.

Assessment and Treatment of Persistent Postconcussive Symptoms in Veterans: Rethinking the Role of Concussion. Amy Jak, Ph.D. Assessment and Treatment of Persistent Postconcussive Symptoms in Veterans: Rethinking the Role of Concussion Amy Jak, Ph.D. ajak@ucsd.edu INS 2018 DISCLOSURE This presentation is based on work supported,

More information

ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR PERSISTING DISABILITY AFTER MILD TRAUMATIC BRAIN INJURY

ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR PERSISTING DISABILITY AFTER MILD TRAUMATIC BRAIN INJURY From the Department of Clinical Sciences, Danderyd Hospital Division of Rehabilitation Medicine Karolinska Institutet, Stockholm, Sweden ASSESSMENT AND MANAGEMENT OF PATIENTS AT RISK FOR PERSISTING DISABILITY

More information

IF IN DOUBT, SIT THEM OUT.

IF IN DOUBT, SIT THEM OUT. IF IN DOUBT, SIT THEM OUT. Scottish Sports Concussion Guidance: grassroots sport and general public 2018 version. Adapted from the Berlin 5th International concussion consensus statement 2016. Contents

More information

PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL)

PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL) PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)

More information

The Extended Glasgow Coma Scale and Mtbi

The Extended Glasgow Coma Scale and Mtbi The Extended Glasgow Coma Scale and Mtbi Michael J. Slater Slater Vecchio, Vancouver, B.C. December, 2001 Introduction In cases where a lawyer is attempting to prove that a plaintiff has suffered a mild

More information