AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8868/282
National Brain Aneurysm & Tumor Center.
*Corresponding Author: ES Nussbaum, National Brain Aneurysm & Tumor Center.
Citation: LA Nussbaum, TM Janjua, ES Nussbaum (2023), The Potential Role of Peripheral Somatosensory Stimulation in the Treatment of Mental Health Symptoms following Traumatic Brain Injury, J. Neuroscience and Neurological Surgery, 13(7); DOI:10.31579/2578-8868/282
Copyright: © 2023, ES Nussbaum. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 14 November 2023 | Accepted: 01 December 2023 | Published: 08 December 2023
Keywords: anxiety ; depression ; neuromodulation ;PTSD ; somatosensory stimulation ; TBI ; trauma
Background
Patients with traumatic brain injury (TBI) may develop symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety. Despite decades of research investigating treatment options, these mental health symptoms remain a major cause of quality-of-life impairment. In a series of patients with PTSD being treated with peripheral somatosensory stimulation (PSS), we further evaluated 3 patients who had suffered from TBI to detail their clinical response to therapy.
Methods
Three patients with TBI and PTSD underwent daily PSS therapy over a 4-week period. Patients were evaluated using a Veterans Affairs TBI scale of cognitive impairment and subjective mental health symptoms at baseline and then at the conclusion of the treatments. All data were obtained through a self-reported survey.
Results
Three men with TBI and PTSD completed one month of daily PSS therapy. No adverse events were described by the patients. All patients demonstrated improvement in terms of their scores assessing cognitive impairment and subjective symptoms. The Patients beginning with greater impairment appeared to derive more benefit from therapy.
Conclusions
PSS stimulation appeared to improve symptoms in three patients with TBI and PTSD. Symptoms related to both anxiety and depression were improved. We suggest that further investigation into the potential usefulness of PSS therapy in patients with TBI and mental health symptoms is warranted.
A significant percentage of patients with TBI will develop symptoms of PTSD, particularly following severe trauma [1-5]. These individuals may struggle with anxiety, depression, and even suicidal ideation in extreme cases. The mental health symptoms associated with PTSD in the setting of TBI result in a tremendous societal burden in terms of impaired quality of life, functional disability, medical costs, and unemployment [3-14]. It is estimated that more than 7 million Americans are diagnosed with PTSD every year. [2-5] In addition to pharmacotherapy and psychological interventions, treatment for PTSD has included various methods of relaxation including yoga and deep breathing exercises. [7-10,15] Peripheral somatosensory stimulation (PSS) therapy is a non-invasive technique which may be beneficial to patients with a variety of neurological disorders. [16-19] We recently evaluated the impact of PSS on symptoms in patients with PTSD. [20] Three of these patients had a history of TBI, and this report focuses on our experience with this small subset of TBI patients.
We treated 6 patients who had been diagnosed with and suffered from active PTSD symptoms with PSS using the NeuroGlove device. NeuroGlove is a non-invasive device that provides PSS stimulation in the form of pneumatic puffs of air directed at the volar surface of the distal forearm, the palm, and the fingers. Subjects used the device at home for 1 hour of therapy per day (30 minutes using each hand) for 4 weeks and were directed to synchronize their breathing to the firing (on/off cycle) of the machine to encourage relaxation during device use. The results of this trial have been previously reported. [20]
Of the six patients in the trial, 3 had a prior history of significant TBI. All felt that the TBI had at least in part contributed to their PTSD. We interviewed these patients to obtain detailed information regarding their response to treatment and analyzed the results obtained in this small subgroup of patients with TBI, focusing on their mental health symptoms of anxiety, depression, and general well-being to evaluate the potential usefulness of PSS in this subgroup of patients. We utilized the Veterans Affairs TBI Evaluation of Cognitive Impairment and Subjective Symptoms Scoring System [21]. This scale surveys patients in terms of their ability to function in 9 areas: memory and attention, judgement, social interaction, orientation, motor activity, visual spatial orientation, subjective symptoms, neurobehavioral symptoms (irritability, anxiety), and communication ability. Each of the 9 areas was graded based on an ordinal response as: 0 for normal, 1 for mild impairment, 2 for moderate impairment, or 3 for severe impairment.
Three men with a history of TBI and active PTSD completed the trial. Mean age was 45 years; age range was 40-54. Compliance with the treatment protocol was excellent based on patient reporting and our ability to query the devices for a log of treatment times. All three patients enjoyed the treatments and stated that they looked forward to using the device. All patients were interested in continuing to use the device after the conclusion of the 4-week treatment regimen. No adverse events were reported related to device use.
The results of the evaluation based on the Veterans Affairs TBI Evaluation are shown in Table 1. All patients demonstrated overall improvement in their scores with the greatest effects noted in patients 1 and 3. Although patient 2 improved, his baseline total score was low suggesting that his symptoms related to TBI were minimal even at baseline. The greatest improvements were seen in patient’s subjective symptoms and orientation. The total scores at baseline compared to the conclusion of the trial are depicted in Figure 1.
| Category | Patient 1 Baseline - Conclusion | Patient 2 Baseline - Conclusion | Patient 3 Baseline - Conclusion |
| Memory | 3 - 1 | 2 - 2 | 3 - 2 |
| Judgement | 2 - 1 | 0 - 0 | 3 - 2 |
| Social Interaction | 2 - 1 | 0 - 0 | 3 - 2 |
| Orientation | 3 - 1 | 1 - 0 | 3 - 1 |
| Motor Activity | 2 - 1 | 0 - 0 | 3 - 2 |
| Visual Spatial Orientation | 3 - 1 | 0 - 0 | 3 - 2 |
| Subjective Symptoms | 3 - 1 | 2 - 1 | 2 - 1 |
| Neurobehavioral Effects | 3 - 1 | 0 - 0 | 3 - 2 |
| Communication | 2 - 1 | 0 - 0 | 3 - 2 |
| Total Score | 21 - 9 | 5 - 3 | 26 - 16 |
Table 1: Scores Obtained at Baseline and Conclusion of Treatments in 3 Patients with TBI and PTSD
Figure 1: Bar graph comparing total scores at baseline and at trial conclusion
The relationship between TBI and symptoms of PTSD, depression, and anxiety has been well-described. [1-5] PTSD is a potentially disabling condition that appears to represent a form of anxiety disorder associated with hypervigilance and increased sympathetic output. [6-12] Although the mainstay of treatment for PTSD was originally pharmacologic, an increasing emphasis has been placed on psychological interventions and various relaxation techniques including yoga and deep breathing exercises. [8-12,15] Similarly, depression and anxiety are prevalent conditions with tremendous societal and personal costs [12-14].
Our previous work demonstrated a statistically significant improvement in symptoms of PTSD, anxiety, and depression with the use of PSS. [20,22] The scientific bases for such improvement may be related to the role played by sensory processing in anxiety, depression, and PTSD. PTSD has been associated with a variety of physiological alterations within the brain, and increasing evidence suggests that impaired sensory processing may play a critical role in the development and pathophysiology of this disorder. [23] Haricharichan et al postulated that alterations in the neural pathways important for processing sensory input have a cascading effect on the ability to perform higher cognitive functions implying that abnormal sensory processing may be contributory and associated with PTSD [24]. In addition, it has been shown that individuals with PTSD have decreased prefrontal cortex activation resulting in impaired sensory integration and emotional regulation [25-7]. Engel-Yeger et al identified reproducible patterns of sensory hypersensitivity in patients suffering from PTSD [28].
Interestingly, a variety of physiological alterations within the brain have been associated with anxiety and depression, and increasing evidence suggests that impaired sensory processing may play a critical role in these disorders [29-34]. Of note, various sensory inputs have been shown to impact symptoms in patients with depression and anxiety; auditory stimulation with music, olfactory stimulation with particular odors, and gustatory stimulation with particular foods have all been shown to improve mood and relieve anxiety [35-38]. Transcranial magnetic stimulation and vagal nerve stimulation have also been used to ameliorate anxiety and depressive disorders [39-40]. Based on these findings, we hypothesized that tactile PSS might be beneficial in patients with the mental health symptoms related to TBI.
It should be noted that PSS has been shown to be of therapeutic benefit in a variety of neurological disorders. PSS has shown promise in humans after stroke and also in rodent models of cerebral ischemia where PSS can actually prevent ischemic injury if applied early enough. [41-43]. The mechanism for this protection remains unclear but may include enhanced neuronal reorganization encouraging neuronal recovery and/or improved regional cerebral perfusion through the recruitment of local collateral blood supply [44]. Interestingly, similar benefits have been demonstrated in patients with Parkinson’s disease, and PSS has also shown promise following traumatic brain injury and in inflammatory, auto-immune conditions such as multiple sclerosis [45-49].
Based on this, we analyzed a small subgroup of 3 patients with PTSD and TBI who were treated with one month of PSS on a daily basis. All three patients were evaluated using the Veterans Affairs TBI Evaluation, and all showed improvement in their scores over the course of the 4-week trial. As noted above, patient 2 appeared to have minimal symptoms related to TBI and showed limited improvement. It is notable that the other two patients had significant impairment at baseline, and both showed meaningful improvement in their scoring by the conclusion of the trial.
We describe our experience with 3 patients with TBI who underwent one month of PSS treatment on a daily basis. This is a very small group of patients precluding significant conclusions regarding efficacy of PSS on patients with TBI. Nevertheless, this study was meant to evaluate in very preliminary fashion the potential usefulness of PSS in patients with TBI, potentially forming the basis for a larger study. All patients showed improvement in their symptoms suggesting that further investigation into the potential use of PSS in the treatment of patients with TBI is warranted.
The study was approved by the Western (WCG) Institutional Review Board (protocol code: 20233103, date of approval: 7/19/2023).
This study was registered with clinicaltrials.gov prior to initiation any work or patient enrollment. The trial number is NCT06050590.
Drs. Leslie and Eric Nussbaum are shareholders in Neuro Glove, LLC
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
