By Ivona Berger
Earlier this spring, from March 29th to April 1st 2017, the International Brain Injury Association (IBIA) held its 12th World Congress on Brain Injury in New Orleans, Louisiana. The event brought together over 1,000 clinicians, researchers, and students working in the brain injury field. There was a strong international presence, with delegates in attendance from over 50 countries, despite the challenges imposed on non-native travellers by recent political measures in the United States. The conference was held at the Sheraton New Orleans Hotel, one block away from the centre of the French Quarter. On the first evening delegates were greeted with an extravagant display of authentic New Orleans culture. Festivities included a variety of local cuisine, live music, and celebratory purple, green, and gold Mardi Gras beads.
The conference program commenced with a keynote lecture featuring this year’s IBIA Distinguished Service Award recipient, Dr. Nathan Zasler, who presented on post-traumatic headaches. Each daily keynote lecture was followed by discipline-specific sessions and poster presentations, showcasing prominent symposia speakers and peer-reviewed papers. Work from distinguished acquired brain injury (ABI) researchers was featured. Topics pertaining to traumatic brain injury (TBI) included: cognition, neuroimaging, sports-related concussion, as well as adolescent- and paediatric-focused investigations. Additional details regarding these proceedings may be accessed at the Congress website.
As I am now a first year MSc student at the Rehabilitation Sciences Institute (University of Toronto), it was my previous undergraduate work at McMaster University that brought me to the IBIA congress. Collaborating with the CanChild Centre for Childhood Disability Research, I investigated outcomes related to pediatric concussion. Specifically, the focus of my work was exploring sleep disturbance following head injury. This area of inquiry was of great interest to me due to the prevalence and widespread negative health implications of this issue. Estimates suggest 30-70% of recently concussed individuals are affected by some form of sleep disturbance (e.g. difficulties falling and staying asleep, etc.) (1). The wide range in the reported prevalence of post-concussive sleep disturbance may be explained by the variability of self-reported measures of sleep, and the lack of questionnaires specific to the TBI population (2). This issue is especially important to assess and measure in youth, as sleep problems following concussion have been repeatedly linked to reductions in school performance. In fact, students who bank less sleep on school nights report that they are struggling in school, and that sleep loss interferes with their daytime functioning (3,4). Sleep-related questionnaires are thus useful in identifying this issue in younger populations. In turn, this can facilitate greater provision of supportive resources and interventions for sleep, potentially improving long-term symptoms and behavioural functioning among concussed individuals (5).
Considering the high impact of this field of research, I was honoured to have the opportunity to present my own findings during the Sleep and Fatigue after Brain Injury session at this year’s IBIA Congress (6). Specifically, I presented on Exploring Accelerometry Versus Questionnaire Assessment of Sleep in Youth with Concussion. Given the lack of consensus regarding the best method for measuring sleep disturbance in this population, this study’s objective was to examine the relationships between accelerometer-based and self-report assessments of sleep disturbance among recently concussed youth. Data was gathered from a larger prospective cohort of youth aged 5 to 18 years old, who had experienced a concussion within the previous month and who were still symptomatic at the time of study enrollment (7). Based on a sample (n = 21) of participants with self-reported sleep disturbances, the data included their scores on the Pittsburgh Sleep Quality Index (8) and accelerometry-based measures of their sleep, obtained using ActiGraph GT3X monitors (9). Our analysis did not identify any relevant statistically significant correlations between these measures, and we concluded that the questionnaires and accelerometers appeared to be measuring different attributes of sleep. In summary, our findings supported the continued use of both of these types of measures when assessing sleep following TBI (6).
Based on my previous work and ongoing research interests, I was curious to learn about The Sleep and Concussion Questionnaire, also presented at IBIA, and developed by the Hull-Ellis Concussion and Research Clinic at the Toronto Rehabilitation Institute (10,11). Dr. Catherine Wiseman-Hakes shared the findings from a preliminary longitudinal analysis of the questionnaire, which measures sleep and daytime wakefulness after a concussion. The development of this questionnaire is a significant step forward in determining how to measure sleep disturbance in youth with a concussive injury, as it is one of the first to do so. This area of measurement is particularly important, considering both the prevalence of post-concussive sleep disturbance, and the lack of subjective measures of sleep quality currently available for clinicians and researchers to use in this population. This tool addresses a gap in the available self-reported measures for identifying and tracking post-concussion changes in sleep over time. Despite its promise, limitations of this measure include the unreliable accuracy of self-report in youth (12). Therefore, additional valid, feasible, and objective measures of sleep quality, with improved reliability, may be concurrently useful in supplementing the information provided by this type of questionnaire.
The valuable information I learned at the IBIA congress has links to both my previous and ongoing areas of scientific investigation. My passion for effecting positive change in the lives of others through rehabilitation research has been shaped by many of my previous experiences, and I am excited to continue to investigate post-concussive sleep issues within the field of brain injury. At this time, I am continuing to explore the impact of fatigue, among other symptoms, within a different clinical population. My current Master’s thesis work involves an investigation of the needs of cancer survivors who are returning to or staying in the workforce. There are many challenges that cancer survivors often face due to emotional stress, persistent fatigue, and cognitive impairments. As a result, establishing effective return-to-work accommodations can be difficult (13,14). My thesis will support cancer rehabilitation research by promoting an understanding of supports that can be implemented to help cancer survivors return to work successfully, while also improving their quality of life. I will be conducting this research under the supervision of Dr. Bonnie Kirsh, with help from the Cancer Rehabilitation and Survivorship Clinic at the Princess Margaret Cancer Centre.
Considering the scope of my diverse interests in rehabilitation research, my experience at the IBIA congress left me inspired by a heightened awareness of brain injury-related issues and how these issues are relevant across the rehabilitation sciences. From my perspective, large multidisciplinary conferences like the IBIA World Congress allows delegates to take an in-depth look into some of the novel areas currently being explored. Events like this also serve to renew my confidence that investigators and stakeholders will continue to collaborate with the intent to improve the quality of life among individuals affected by brain injury, on a global scale. Moving forward, I am both honoured and excited that Toronto will be home to the IBIA World Congress in 2019. Until that time, I am eager to continue to disseminate my work and share in the ongoing developments and progress in this growing field of rehabilitation research.
- Viola-Saltzman M, Musleh C. Traumatic brain injury-induced sleep disorders. Neuropsychiatric Disease and Treatment. 2016;12:339–48.
- Mollayeva T, Kendzerska T, Colantonio A. Self-report instruments for assessing sleep dysfunction in an adult traumatic brain injury population: a systematic review. Sleep Medicine Reviews. 2013;17(6):411–423.
- Perez-Chada D, Perez-Lloret S, Videla AJ, Cardinali D, Bergna MA, Fernández-Acquier M, Larrateguy L, Zabert GE, Drake C. Sleep disordered breathing and daytime sleepiness are associated with poor academic performance in teenagers. A study using the Pediatric Daytime Sleepiness Scale (PDSS). Sleep. 2007;30(12):1698–703.
- Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning in adolescents. Child Development. 1998;69(4):875–887.
- Theadom A, Starkey N, Jones K, Cropley M, Parmar P, Barker-Collo S, Feigin VL. Sleep difficulties and their impact on recovery following mild traumatic brain injury in children. Brain Injury. 2016;30(10):1243–1248.
- Berger I, Obeid J, DeMattteo C. Exploring accelerometry versus questionnaire assessment of sleep in youth with concussion. In: International Brain Injury Association’s 12th World Congress on Brain Injury. Brain Injury; 2017. [In Press]
- CanChild Centre for Childhood Disability Research. Safely returning children and youth to activity after mTBI/concussion | CanChild. [accessed 2017 Jun 4]. https://www.canchild.ca/en/research-in-practice/current-studies/safely-returning-children-and-youth-to-activity-after-mtbi-concussion
- Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research. 1988;28:193–213.
- ActiGraph. GT3X | ActiGraph. [accessed 2017 Jun 4]. http://actigraphcorp.com/support/activity-monitors/gt3x/
- Wiseman-Hakes C, Ouellet M-C. Sleep and Concussion Questionnaire-revised. 2016 [accessed 2017 May 4]. https://www.researchgate.net/publication/304037738_Sleep_and_Concussion_Questionnaire-Revised
- Wiseman-Hakes C, Bayley M, Lyn R, Chandra T, Comper P. The Hull-Ellis Concussion and Research Clinic: the Sleep and Concussion Questionnaire©; a preliminary longitudinal analysis of sleep and day-time wakefulness. In: International Brain Injury Association’s 12th World Congress on Brain Injury. Brain Injury; 2017. [In Press].
- Sadeh A, Raviv A, Gruber R. Sleep patterns and sleep disruptions in school-age children. Developmental Psychology. 2000;36(3):291–301.
- Taskila T, de Boer AGEM, van Dijk FJH, Verbeek JHAM. Fatigue and its correlates in cancer patients who had returned to work-a cohort study. Psycho-Oncology. 2011;20(11):1236–1241.
- Brown RF, Owens M, Bradley C. Employee to employer communication skills: balancing cancer treatment and employment. Psychooncology. 2013 Feb;22(2):426-33.