Brain Waves: UAB Traumatic Brain Injury Model System Newsletter Volume 16 | Number 1 | Page 4

TBI INFORMATION SPOTLIGHT
Systematic Reviews
A systematic review is a formal,
organized method for compiling,
evaluating and summarizing all of the
published research evidence related
to a specific medical or health topic.
Results of a systematic review
provide the best information for
making decisions about treatment,
practice or behavior.
The Model Systems Knowledge
Translation Center (MSKTC) works
with the Traumatic Brain Injury
(TBI) Model Systems’ researchers
to conduct systematic reviews on
high priority health topics to inform
clinical practice. Together, the
MSKTC and TBI Model Systems
have done four Systematic Reviews
and another, TBI & Education, is
being developed.
Interventions for Fatigue after TBI
In general, fatigue is not having
the energy to do things. This often
includes not having the energy to go
out in the community or do normal,
everyday activities.
Many people with TBI have
post-traumatic brain injury fatigue
(PTBIF). So instead of going out in
the community and doing everyday
activities, they often spend more
time sleeping.
Sometimes PTBIF happens early
on in recovery and goes away in
time. But it can last longer. So it’s no
surprise that people with prolonged
PTBIF report a lower quality of life.
This Systematic Review was done
to see what’s known about managing
PTBIF. Here’s what was found.
1. There’s not enough evidence to
recommend or not recommend
any treatments of PTBIF.
2. Modafinil, a medication to treat
sleepiness, is not likely to be
effective for PTBIF.
3. Piracetam, a supplement used
to enhance memory, and bright
blue light may reduce PTBIF.
4. Research is needed to see if
cognitive behavioral therapy is
effective for PTBIF.
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5. Research is needed to find the
benefits of promising treatment
options, evaluate treatments for
fatigue that have been shown to
be effective in other populations,
and develop new treatment
options for PTBIF.
Interventions for Post Traumatic
Headache
Headache is one of the most
common problems after TBI. This
Systematic Review was done to:
• Find out what treatment options
have been developed for post-
traumatic headache (PTHA).
• Find out what treatment options
have been shown to be effective.
• Identify any gaps in research for
PTHA treatment options.
• Suggest areas for future
research to improve treatment
options for persons with PTHA.
Here’s what was found.
1. There’s no strong research
evidence that supports a
direction in the treatment of
PTHA.
2. The Review offered guidelines
for PTHA management based
on primary headache categories
and treatments.
3. It’s essential that well-designed
studies be done to inform
clinicians on management and
prevention of PTHA.
Screening and Brief Intervention for
Substance Misuse among Patients
with TBI
Screening and brief interventions
(SBI) are common in medical settings
like emergency departments and
trauma centers. Part 1 of an SBI is to
ask a short list of questions to find
out how severe substance use is and
identify the appropriate treatment.
Part 2 is a brief intervention (as few
as 3 minutes) to increase insight and
awareness about substance use and
provide motivation to change misuse
behaviors.
Brain injuries are often caused by
accidents that result from substance
abuse. Yet, SBI has not yet been
evaluated for persons who incur a
brain injury.
This Systematic Review was done
to see if past SBI research included
people with TBI and whether or not
their outcomes were different from
others without TBI who were seen
in medical settings like emergency
departments and trauma centers.
Here’s what was found.
1. SBI wasn’t used for patients with
more severe TBI and those who
presented with enough confusion
that they couldn’t give informed
consent.
2. Future studies are needed to find
out what prevents the use of SBI.
3. There’s a need to develop and
evaluate ways to use the SBI for
persons with neurobehavioral
impairments who would likely
benefit from brief interventions
for substance misuse.
Treatment for Depression Following
TBI
Depression is a feeling of sadness,
loss, despair or hopelessness that
doesn’t get better over time. It’s
a medical condition that’s severe
enough to hamper daily life.
Depression is common after
TBI. About 1/2 of people with TBI
experience depression within the
first year after injury, and about 2/3
experience it within 7 years.
This systematic review was done
to look treatments for depression
and recommend areas for future
research. Here’s what was found.
1. There’s been little high quality
research on depression after
TBI.
2. Serotonergic antidepressants
and cognitive behavioral therapy
seem to be the most commonly
used treatments.
3. More research is needed
to provide evidence-based
treatment recommendations for
depression following TBI.