Carrie Esopenko

Resting-state functional MRI (rsfMRI) has become a widely-deployed methodology in human neuroscience, and its application to traumatic brain injury (TBI) has produced a rapidly growing literature. Efforts to synthesize this literature are complicated by methodological heterogeneity, including differences in data cleaning, denoising, and, critically, brain parcellation, leaving the field without consensus regarding the network response to brain injury. injury. We conducted a systematic review of 219 rsfMRI studies spanning the full TBI spectrum: civilian mild TBI, sports-related head impacts, military TBI, pediatric TBI, moderate-to-severe TBI, and intimate partner violence-related brain injury. All findings are remapped to a common network atlas (Seitzman) and organized by patient population, injury phase, and network. Our primary observation is that much of the apparent inconsistency reflects meaningful variability rather than noise. Coherent patterns emerge when findings are organized this way: within-network hypoconnectivity predominates acutely in civilian mTBI, sports-related concussion shows the opposite pattern of early within-network hyperconnectivity, moderate-to-severe TBI follows a protracted trajectory from early hypoconnectivity through compensatory hyperconnectivity toward eventual normalization or permanent disconnection, and pediatric findings are shaped by sex, symptom status, and developmental stage. Across populations, the default mode and frontoparietal networks show the most consistent alterations, and graph theory studies provide a coherent temporal framework. Methodological factors, including motion mitigation (e.g., global signal regression) and analytic approach, account for a substantial portion of between-study divergence. This review concludes that rsfMRI is a viable approach for modeling systems-level plasticity after TBI and identifies key methodological priorities for the field moving forward.

Context : Clinical assessments of the cervical spine and vestibular/oculomotor systems may inform return-to-play (RTP) clearance time after concussion and inform individualized concussion prognosis. Our objective was to investigate whether cervical spine and vestibular/oculomotor clinical assessments were associated with RTP clearance time after concussion. Design : Prospective cohort study. Methods : Adolescents ages 13–18 years within 3 weeks of concussion completed assessments of symptom severity using the Post-Concussion Symptom Inventory, cervical spine proprioception (head repositioning accuracy [HRA]), and symptom provocation with vestibular/oculomotor testing (visio-vestibular exam [VVE]; assesses smooth pursuits, saccades, vestibulo-ocular reflex, and motion sensitivity). HRA was performed with eyes closed and involved patients relocating their head to a neutral starting position after right/left rotation and cervical spine flexion/extension. The mean distance (distance between center position and each self-reported center point) across 12 trials was used in analysis as the measure of HRA error. For VVE, we used the number of tests that provoked symptoms for analysis. We then monitored participants until they received RTP clearance from their physician. We used multivariable linear regression with RTP clearance time (days from concussion to RTP clearance) as the outcome, HRA error and number of positive VVE subtests as predictors, adjusting for covariates. Results : We assessed 68 participants (age = 15.8 (1.4) y, 59% female, mean = 11.0 (3.8) d of postconcussion). After adjusting for age, sex, concussion history, initial symptom severity (Post-Concussion Symptom Inventory score), and days from concussion to assessment, neither HRA error (hazard ratio = 0.89; 95% confidence interval, 0.71–1.12; P = .34) or number of positive VVE subtests (hazard ratio = 1.06; 95% confidence interval, 0.91–1.24; P = .47) were associated with RTP clearance time. Conclusions : Cervical spine proprioception and vestibular/oculomotor symptom provocation evaluated within 3 weeks of injury were not associated with RTP clearance time, potentially reflecting the complexity and multifaceted nature of RTP decisions.

We examined associations between magnetic resonance imaging (MRI)–obtained cervical spine flexor and extensor muscle fat infiltrate and muscle volume with (1) return-to-play clearance and (2) postconcussion injury incidence. Adolescents (N = 30, age = 15.8 ± 1.3 years, 60% female) underwent cervical spine MRI initially postconcussion and were monitored until return to play. After return-to-play clearance, participants underwent follow-up MRI and completed monthly injury surveys for 12 months. Cox proportional hazards regression examined associations between muscle fat infiltrate and muscle volume (1) initially postconcussion with return-to-play clearance and (2) at return-to-play with subsequent injury incidence. Adjusting for covariates, return-to-play clearance was not associated with cervical spine muscle fat infiltrate (hazard ratio [HR] = 0.99, 95% confidence interval [CI]: 0.96-1.02) or muscle volume (HR = 0.98; 95% CI: 0.96-1.01). Adjusting for covariates, postconcussion injuries were not associated with muscle fat infiltrate (HR = 0.90; 95% CI: 0.78-1.05) or muscle volume (HR = 1.01; 95% CI: 0.97-1.04). Cervical spine muscle characteristics may not be affected after concussion, or our MRIs may have occurred too early to capture postconcussion dysfunction.

Objective: The aim of the study was to characterize the experiences of intimate partner violence (IPV)-related head trauma (HT) among cisgender women. Setting: Three geographic regions across the United States. Participants: Seventy-two cisgender women aged 18 to 60 years (mean age = 39.6 years). Design: In-depth semi-structured interviews. Main Measures: Participants completed a semi-structured interview, which was audio-recorded to determine the number and mechanisms of IPV-HT injuries experienced over their lifetime. Quotes from interview transcriptions were used to illustrate how participants describe their IPV-HT episodes. Results: A total of 69/72 cisgender women reported at least 1 injury episode that involved IPV-HT. Participants reported between 1 and 9 injury episodes that involved HT during their lifetimes. Participants reported a total of 240 injury episodes, of which 186 represented a single, isolated injury, while 54 were a repetitive exposure by the same mechanism(s) of injury over time. The time over which an injury episode was repeated ranged from 1 month to 16 years (mean: 4.72 years, standard deviation: 4.70 years). The most frequent mechanisms of injury were blunt force trauma (41.7%) and strangulation (22.1%), while 22.5% of episodes involved multiple mechanisms. The most common within-person overlap of mechanisms was blunt force trauma and strangulation ( n = 21, 31%). The interview quotes demonstrated that the true frequency of IPV-HT may be unknown and/or unable to be recalled, highlighting the challenges in capturing accurate IPV-HT exposure within this population even through in-depth interviews. Conclusions: This study provides important information on the experience of HT among women with exposure to IPV. Such findings may improve our ability to characterize and understand the injuries resulting from IPV among women, which may, in turn, benefit existing tools for determining experiences of IPV-HT and probable brain injury.

Individuals who experience intimate partner violence (IPV) often report posttraumatic stress disorder (PTSD) and depressive symptoms and IPV-related head trauma (IPV-HT), which can also affect mental health. We aimed to estimate rates of IPV-HT and examine the unique associations of IPV, HT, and IPV-HT with PTSD and depression symptom severity in a community-based sample of cohabitating couples. A total of 413 participants (216 women, 1 non-binary) self-reported lifetime history of HT and physical IPV. Chi-square analyses and Fisher’s exact tests were used to compare the proportion of women and men who reported IPV-HT. Kruskal–Wallis tests with Dunn’s post-hoc testing and Bonferroni correction were used to compare symptom severity across five groups: (a) IPV-HT, (b) non-IPV-related HT (Other HT) with exposure to physical IPV (IPV-Other HT), (c) Other HT without exposure to physical IPV (No IPV-Other HT), (d) no exposure to HT with exposure to physical IPV (IPV-No HT), and (e) no exposure to HT without exposure to physical IPV (No IPV-No HT). A greater proportion of women than men reported IPV-HT from a fight or being strangled (fight: 50.0% vs. 3.6%, p < .001; Strangulation: 74.1% vs. 3.8%, p < .001). The IPV-HT and IPV-Other HT groups endorsed greater PTSD and depression symptom severity compared to all individuals with no history of physical IPV, regardless of HT exposure (IPV-No HT and IPV-Other HT groups). No differences in symptom severity between the IPV-HT and the other IPV groups (No HT and Other HT) were found. These results suggest that PTSD and depression symptom severity may be driven by experiencing physical IPV, with some exacerbation due to experiencing HT of any etiology. Future work seeking to examine the effects of IPV-HT on PTSD and depression symptom severity should consider any history of physical IPV and any additional HT exposures.

Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.

Intimate partner violence (IPV) is a significant global public health concern; one in three women and one in four men report experiencing severe physical violence, which confers high risk for IPV-related head trauma (IPV-HT). Transgender and gender-diverse (TGD) individuals are more than twice as likely to experience injuries due to physical IPV compared with their cisgender peers, yet few studies to date have assessed whether TGD individuals experience IPV-HT. Thus, the purpose of this study was to assess experiences of IPV-HT among TGD adults. TGD individuals (n = 76) completed an online survey to assess experiences of abuse from an intimate partner, IPV-HT events and brain injury (IPV-BI) using the Brain Injury Screening Questionnaire (BISQ) IPV Module, and lifetime HT events and BI sustained in military service, sports, or other civilian exposures using the BISQ-7. Experiences of abuse, total IPV, and non-IPV-related blows to the head were compared across three gender identity groups: transgender women, transgender men, and other gender-diverse adults. Proportions of TGD adults endorsing IPV-HT events and IPV-BI were compared with a sample of cisgender adults (n = 142; 50 cisgender women) participating in a longitudinal BI study. Two-thirds of participants experienced at least one form of abuse from an intimate partner. Twenty-one TGD adults reported IPV-related blows to the head with a range of 1 to 40 total blows/participant. A greater proportion of TGD adults (n = 21, 32%) and cisgender women (n = 17, 34%) endorsed IPV-HT events/BI compared with cisgender men (n = 5, 5%). IPV-HT is a gender-based issue that differentially affects gender minorities, including TGD adults. The repetitive nature of IPV-HT likely has important implications for lifetime neurological health among these individuals. Future work is needed to elucidate the time course of IPV-HT events and IPV-BI exposure in relation to changes in gender expression to inform violence prevention strategies.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15–90. The effects of dementia, mild cognitive impairment, Parkinson’s disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p < 0.001), while neither depression nor ADHD showed consistent associations with VLM scores (p > 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders.

Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date. We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership. The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD. Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.