INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #56 The Compounding Effect of Repetitive Head Impacts in Traumatic Brain Injury Survivors on Risky Behaviors and Self-Directed Harm Ariel Pruyser, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States Holly Carrington, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States Lisa Bura, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States Emily Blunt, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States Nicola de Souza, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States Kristen Dams-O’Connor, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult) Keyword 1: traumatic brain injury Keyword 2: executive functions Keyword 3: aggression Objective: Traumatic brain injury (TBI) and repetitive head impact (RHI) are both independently associated with risk-taking behaviors and suicidal ideation. Many individuals with TBI also have a history of RHI exposure that has traditionally been ignored in TBI research. We investigated the associations of RHI exposure with risk-taking behaviors and self-directed harm among individuals with TBI. We hypothesized that individuals with both TBI and RHI exposure (RHI+) would demonstrate greater aggression, impulsivity, substance use, and self-directed harm compared to those with TBI only (RHI-). Participants and Methods: Data were collected from 182 participants (M age=53.1, SD±14.1 years; 69.2% male; 86.7% White) enrolled in the Late Effects of TBI (LE-TBI) project. Eligible participants had sustained at least one complicated mild, moderate, or severe TBI and were at least 1-year post-TBI. Participants completed the Brain Injury Screening Questionnaire (BISQ), a structured assessment of lifetime history of head trauma exposure and duration of exposure to high-risk RHI activities/experiences. We defined substantial RHI according to the National Institute of Neurological Disorders and Stroke traumatic encephalopathy syndrome (TES) criteria which stipulates ≥5y exposure to contact sports, military service, or domestic violence. Risk-taking behaviors and self-directed harm were measured using: (1) the Brown Goodwin Aggression Scale to assess the frequency of lifetime and current aggressive behaviors; we dichotomized responses to distinguish current endorsement of any aggression versus no aggression, (2) the Barratt Impulsiveness Scale-11 to assess impulsive behavior, (3) the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to characterize the level of risk (low, moderate, high) associated with substance use, and (4) a single-item query regarding whether the participant ever thought about or attempted self-harm before and after their most severe TBI. Results: Of 182 participants, 82 (45.1%) met criteria for substantial RHI exposure. Lifetime aggression did not significantly differ between RHI+ (Median [IQR]=5.5[2.8-14.2]) and RHI- (Median [IQR]=6.0[2.5-12.0]) participants (Two-sample Wilcoxon Test, W=3064.5, p=.48). A significantly lower proportion of RHI+ participants (29.3%) reported any current aggression compared to RHI- participants (46.2%; Fisher’s Exact Test, p=.035). The endorsement of most substance use in the sample was low, however, a subset met criteria for moderate-risk use of cannabis (30.2%), tobacco (25.8%), alcohol (5.5%), cocaine (5.5%), and £3% for other substances; substance use risk level did not differ across RHI+ and RHI- groups (p>.05). No significant group differences were found in impulsive behaviors (RHI+: M=68.8, SD± 9.3; RHI-: M=67.4, SD± 7.2; t(164)=-1.06, p=.29) or reported thoughts of or attempted self-harm before or (Fisher’s Exact Test, p’s>.05). Conclusions: Contrary to our hypothesis, we found that substantial exposure to RHI in individuals living with TBI is not associated with higher engagement in risk-taking behaviors or self-directed harm. Clinical phenotypes of symptomatic chronic TBI overlap with core clinical features of TES, and current findings suggest RHI may not confer substantial incremental risk in the context of chronic TBI. Potential protective factors in the RHI+ group warrant additional research, and implications of RHI for other functional domains (e.g., cognitive and motor function) should be investigated.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #56

The Compounding Effect of Repetitive Head Impacts in Traumatic Brain Injury Survivors on Risky Behaviors and Self-Directed Harm

Ariel Pruyser, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
Holly Carrington, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
Lisa Bura, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
Emily Blunt, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
Nicola de Souza, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
Kristen Dams-O’Connor, Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: traumatic brain injury
Keyword 2: executive functions
Keyword 3: aggression

Objective:

Traumatic brain injury (TBI) and repetitive head impact (RHI) are both independently associated with risk-taking behaviors and suicidal ideation. Many individuals with TBI also have a history of RHI exposure that has traditionally been ignored in TBI research. We investigated the associations of RHI exposure with risk-taking behaviors and self-directed harm among individuals with TBI. We hypothesized that individuals with both TBI and RHI exposure (RHI+) would demonstrate greater aggression, impulsivity, substance use, and self-directed harm compared to those with TBI only (RHI-).

Participants and Methods:

Data were collected from 182 participants (M age=53.1, SD±14.1 years; 69.2% male; 86.7% White) enrolled in the Late Effects of TBI (LE-TBI) project. Eligible participants had sustained at least one complicated mild, moderate, or severe TBI and were at least 1-year post-TBI. Participants completed the Brain Injury Screening Questionnaire (BISQ), a structured assessment of lifetime history of head trauma exposure and duration of exposure to high-risk RHI activities/experiences. We defined substantial RHI according to the National Institute of Neurological Disorders and Stroke traumatic encephalopathy syndrome (TES) criteria which stipulates ≥5y exposure to contact sports, military service, or domestic violence. Risk-taking behaviors and self-directed harm were measured using: (1) the Brown Goodwin Aggression Scale to assess the frequency of lifetime and current aggressive behaviors; we dichotomized responses to distinguish current endorsement of any aggression versus no aggression, (2) the Barratt Impulsiveness Scale-11 to assess impulsive behavior, (3) the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to characterize the level of risk (low, moderate, high) associated with substance use, and (4) a single-item query regarding whether the participant ever thought about or attempted self-harm before and after their most severe TBI.

Results:

Of 182 participants, 82 (45.1%) met criteria for substantial RHI exposure. Lifetime aggression did not significantly differ between RHI+ (Median [IQR]=5.5[2.8-14.2]) and RHI- (Median [IQR]=6.0[2.5-12.0]) participants (Two-sample Wilcoxon Test, W=3064.5, p=.48). A significantly lower proportion of RHI+ participants (29.3%) reported any current aggression compared to RHI- participants (46.2%; Fisher’s Exact Test, p=.035). The endorsement of most substance use in the sample was low, however, a subset met criteria for moderate-risk use of cannabis (30.2%), tobacco (25.8%), alcohol (5.5%), cocaine (5.5%), and £3% for other substances; substance use risk level did not differ across RHI+ and RHI- groups (p>.05). No significant group differences were found in impulsive behaviors (RHI+: M=68.8, SD± 9.3; RHI-: M=67.4, SD± 7.2; t(164)=-1.06, p=.29) or reported thoughts of or attempted self-harm before or (Fisher’s Exact Test, p’s>.05).

Conclusions:

Contrary to our hypothesis, we found that substantial exposure to RHI in individuals living with TBI is not associated with higher engagement in risk-taking behaviors or self-directed harm. Clinical phenotypes of symptomatic chronic TBI overlap with core clinical features of TES, and current findings suggest RHI may not confer substantial incremental risk in the context of chronic TBI. Potential protective factors in the RHI+ group warrant additional research, and implications of RHI for other functional domains (e.g., cognitive and motor function) should be investigated.