Advancing Neuroscience and Clinical Applications for:

Brain Injury, Recovery, Rehabilitation, and Restoration

CDC: Centers for Disease Control and Prevention Handouts

Our team was involved in helping create the following links regarding discharge instructions, recovery tips, and return to work instructions.


Discharge Instructions

 

Recovery Tips

 

Return to Work Instructions

 

Pac-12 Student-Athlete Health & Well Being Initiative

The Pac-12 Initiative is a collective effort between the Conference and member universities to find ways to reduce injuries, share current best practices and latest studies, and conduct research to uncover new ways to keep student-athletes as safe as possible. In 2019, the Pac-12 Grant Program committed funding to Dr. Angela Lumba-Brown for leading a study, "The Subtypes of Concussion - Classification and Recovery Trajectories in Pac-12 Student Athletes," aimed at advancing the science of concussion care and changing how concussions are diagnosed and managed.

 

Brain Trauma Evidence-Based Consortium (B-TEC)

Launched in 2014 with funding by the U.S. Department of Defense to Stanford University, and subcontracted to the Brain Trauma Foundation, B-TEC brings together brain injury experts from the Brain Trauma Foundation, Stanford University, Oregon Health and Sciences University, and Portland State University. The Consortium's aim is to develop an evidence-based classification for the spectrum of traumatic brain injury, including concussion, and to model post-injury trajectories and outcomes.

Core Objectives:

1. To establish evidence for concussion subtypes, describing their prevalence in head injured patients, and informating how each subtype recovers. Goals of this work are to lead to targeted management strategies to effect better care.

2. To maximize the utility of scientific effortrs to-date that address the epidemic of concussion and brain trauma, for the purpose of deriving a clinically useful classification system, and evidence-based guidelines for diagnosis, prognosis, treatment, and outcomes. 

3. To create a consortium among the neurotrauma community that will inspire a commitment to the principles of evidence-based medicine in the design and conduct of brain trauma research.

4. To continue updating the Brain Trauma Foundation traumatic brain injury guidelines.

Key Research Areas:

  • Concussion Subtypes
  • Sports-related Concussion
  • Head Injury in Children
  • Classification of Severe Traumatic Brain Injury
  • Pediatric Management of Severe Traumatic Brain Injury
  • Adult In-Hospital Management of Severe Traumatic Brain Injury
  • Pre-Hospital Management of Severe Traumatic Brain Injury in Adults and Children
  • Brain Injury Algorithm Development

Founded by Center Director, Dr. Jamshid Ghajar, in 1986, the Brain Trauma Foundation was created to provide ongoing support for research on TBI. In the three decades since its founding, the Foundation continues to focus on conducting innovative clinical research, updating evidence-based guidelines, and working towards improving outcomes for the millions of people who suffer from traumatic brain injuries every year.

Featured Faculty Research

Odette Harris, MD, MPH
Paralyzed Veterans of America Professor of Spinal Cord Injury Medicine

Publications

  • Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury. Neurotrauma reports Hawryluk, G. W., Selph, S., Lumba-Brown, A., Totten, A. M., Ghajar, J., Aarabi, B., Ecklund, J., Shackelford, S., Adams, B., Adelson, D., Armonda, R. A., Benjamin, J., Boone, D., Brody, D., Dengler, B., Figaji, A., Grant, G., Harris, O., Hoffer, A., Kitigawa, R., Latham, K., Neal, C., Okonkwo, D. O., Pannell, D., Rosenfeld, J. V., Rosenthal, G., Rubiano, A., Stein, D. M., Stippler, M., Talbot, M., Valadka, A., Wright, D. W., Davis, S., Bell, R. 2022; 3 (1): 240-247

    Abstract

    Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines, supported by the Brain Trauma Foundation. Methodologists experienced in TBI guidelines were recruited to support project development alongside two cochairs and a diverse steering committee. An expert multi-disciplinary workgroup was established and vetted to inform key clinical questions, to perform an evidence review and the development of recommendations relevant to pTBI. The methodological approach for the project was finalized. The development of up-to-date evidence- and consensus-based clinical care guidelines and algorithms for pTBI will provide critical guidance to care providers in the pre-hospital and emergent, medical, and surgical settings.

    View details for DOI 10.1089/neur.2022.0008

    View details for PubMedID 35919507

    View details for PubMedCentralID PMC9279118

  • Rationale and Methods for Updated Guidelines for the Management of Penetrating Traumatic Brain Injury NEUROTRAUMA REPORTS Hawryluk, G. W. J., Selph, S., Lumba-Brown, A., Totten, A. M., Ghajar, J., Aarabi, B., Ecklund, J., Shackelford, S., Adams, B., Adelson, D., Armonda, R. A., Benjamin, J., Boone, D., Brody, D., Dengler, B., Figaji, A., Grant, G., Harris, O., Hoffer, A., Kitigawa, R., Latham, K., Neal, C., Okonkwo, D. O., Pannell, D., Rosenfeld, J., Rosenthal, G., Rubiano, A., Stein, D. M., Stippler, M., Talbot, M., Valadka, A., Wright, D. W., Davis, S., Bell, R. 2022; 3 (1): 240-247

    View details for DOI 10.1089/neur.2022.0008

    View details for Web of Science ID 000813892800001

  • Sex differences in cortical thickness and diffusion properties in patients with traumatic brain injury: a pilot study. Brain injury Adamson, M. M., Main, K., Harris, O. A., Kang, X. 1800: 1-15

    Abstract

    OBJECTIVE: Cortical thickness and diffusion properties are important measures of gray and white matter integrity in those with traumatic brain injury (TBI). Many studies show that healthy adult females have greater cortical thickness than males across numerous brain sites. In this study, we explored this sex difference in patients with TBI.METHOD: Participants consisted of 32 patients with TBI and 21 neurologically healthy controls. All were scanned by magnetic resonance imaging (MRI). Differences in cortical thickness and diffusion properties were examined between groups (i.e., TBI/control, male/female).RESULTS: Patients with TBI had more cortical thinning (both hemispheres) compared to controls. They also showed decreased fractional anisotropy (FA) for several major white matter tracts. Healthy females had significantly greater cortical thickness compared to healthy males. However, this difference was smaller among the patients with TBI. We found no sex differences in diffusion properties. There were moderate correlations between cortical thickness, diffusion properties, and cognitive performance, as measured by the Trail Making Test B.CONCLUSION: These findings contribute to a growing discussion on sex differences in cortical thickness and diffusion properties. Sexual dimorphism could necessitate different clinical profiles, targets, and rehabilitation strategies in patients with TBI.

    View details for DOI 10.1080/02699052.2022.2034046

    View details for PubMedID 35113752

Ashwin Ramayya, MD, PhD
Assistant Professor of Neurosurgery

Publications

  • Naturalistic acute pain states decoded from neural and facial dynamics. Nature communications Huang, Y., Gopal, J., Kakusa, B., Li, A. H., Huang, W., Wang, J. B., Persad, A., Ramayya, A., Parvizi, J., Buch, V. P., Keller, C. J. 2025; 16 (1): 4371

    Abstract

    Pain remains poorly understood in task-free contexts, limiting our understanding of its neurobehavioral basis in naturalistic settings. Here, we use a multimodal, data-driven approach with intracranial electroencephalography, pain self-reports, and facial expression analysis to study acute pain in twelve epilepsy patients under continuous neural and audiovisual monitoring. Using machine learning, we successfully decode individual participants' high versus low pain states from distributed neural activity, involving mesolimbic regions, striatum, and temporoparietal cortex. Neural representation of pain remains stable for hours and is modulated by pain onset and relief. Objective facial expressions also classify pain states, concordant with neural findings. Importantly, we identify transient periods of momentary pain as a distinct naturalistic acute pain measure, which can be reliably discriminated from affect-neutral periods using neural and facial features. These findings reveal reliable neurobehavioral markers of acute pain across naturalistic contexts, underscoring the potential for monitoring and personalizing pain interventions in real-world settings.

    View details for DOI 10.1038/s41467-025-59756-5

    View details for PubMedID 40350488

    View details for PubMedCentralID 6146950

  • The Barriers to Neurosurgical Care in The Gambia. Neurosurgery practice Ceesay, O. I., Vaca, S., Gephart, M. H., Park, J. J., Ramayya, A. G. 2025; 6 (1): e00125

    Abstract

    Neurosurgery has experienced significant growth over the past century, but much of that development has been centralized in Europe and North America. Despite their high burden of neurosurgical conditions, African countries like The Gambia continue to face barriers in accessing neurosurgical care. We intend to accentuate the barriers to neurosurgical care in The Gambia, elucidate pragmatic ways of improving this issue, and highlight models of sustainable neurosurgical development that have been used in similar lower- and middle-income countries. Our study analyzed the limited literature available on The Gambia's neurosurgical capabilities, disease burden, and outcomes. The keywords "Gambia" and "Neurosurgery" were searched on PubMed, from inception to July 1, 2024. Then, a complementary search was performed on Google using the keywords "The Gambia," "Healthcare," "Neurosurgery," and "Africa." The pertinent data from our search were collected and composed into a review. Neurosurgery in The Gambia is still in its infancy. Although several domestic general surgeons and a few visiting neurosurgeons have performed neurosurgical procedures in the past, the country did not have a designated neurosurgical department until 2018. Although neurosurgical activity has ramped up in The Gambia recently, the country continues to trail behind both regionally and internationally in neurosurgical care capacity. While the shortage of a neurosurgical workforce is the core of this issue, paucity of neurosurgical research and training and the limited availability of neuroimaging also amplify this problem. Neurosurgery in The Gambia is plodding because of workforce shortage, paucity of research, and inadequate neuroimaging. Eradicating these barriers would be salient in attaining sustainable neurosurgical development. With the devotion of the local team and the philanthropic efforts of international partners, The Gambia can experience similar advances seen in other lower- and middle-income countries.

    View details for DOI 10.1227/neuprac.0000000000000125

    View details for PubMedID 39958480

    View details for PubMedCentralID PMC11809989

  • The Barriers to Neurosurgical Care in The Gambia NEUROSURGERY PRACTICE Ceesay, O. I., Vaca, S., Gephart, M. H., Park, J. J., Ramayya, A. G. 2025; 6 (1)

    View details for DOI 10.1227/neuprac.0000000000000125

    View details for Web of Science ID 001369583400002

Irene L. Llorente
Assistant Professor of Neurosurgery

Publications

  • Patient-derived glial enriched progenitors repair functional deficits due to white matter stroke and vascular dementia in rodents SCIENCE TRANSLATIONAL MEDICINE Llorente, I. L., Xie, Y., Mazzitelli, J. A., Hatanaka, E. A., Cinkornpumin, J., Miller, D. R., Lin, Y., Lowry, W. E., Carmichael, S. 2021; 13 (590)

    Abstract

    Subcortical white matter stroke (WMS) accounts for up to 30% of all stroke events. WMS damages primarily astrocytes, axons, oligodendrocytes, and myelin. We hypothesized that a therapeutic intervention targeting astrocytes would be ideally suited for brain repair after WMS. We characterize the cellular properties and in vivo tissue repair activity of glial enriched progenitor (GEP) cells differentiated from human-induced pluripotent stem cells, termed hiPSC-derived GEPs (hiPSC-GEPs). hiPSC-GEPs are derived from hiPSC-neural progenitor cells via an experimental manipulation of hypoxia inducible factor activity by brief treatment with a prolyl hydroxylase inhibitor, deferoxamine. This treatment permanently biases these cells to further differentiate toward an astrocyte fate. hiPSC-GEPs transplanted into the brain in the subacute period after WMS in mice migrated widely, matured into astrocytes with a prorepair phenotype, induced endogenous oligodendrocyte precursor proliferation and remyelination, and promoted axonal sprouting. hiPSC-GEPs enhanced motor and cognitive recovery compared to other hiPSC-differentiated cell types. This approach establishes an hiPSC-derived product with easy scale-up capabilities that might be effective for treating WMS.

    View details for DOI 10.1126/scitranslmed.aaz6747

    View details for Web of Science ID 000642350100002

    View details for PubMedID 33883275

  • Customized Brain Cells for Stroke Patients Using Pluripotent Stem Cells STROKE Kokaia, Z., Llorente, I. L., Carmichael, S. 2018; 49 (5): 1091-1098

    View details for DOI 10.1161/STROKEAHA.117.018291

    View details for Web of Science ID 000430662100020

    View details for PubMedID 29669871

    View details for PubMedCentralID PMC5916498

  • Hydrogel-delivered brain-derived neurotrophic factor promotes tissue repair and recovery after stroke JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM Cook, D. J., Nguyen, C., Chun, H. N., Llorente, I. L., Chiu, A. S., Machnicki, M., Zarembinski, T. I., Carmichael, S. T. 2017; 37 (3): 1030-1045

    Abstract

    Stroke is the leading cause of adult disability. Systemic delivery of candidate neural repair therapies is limited by the blood-brain barrier and off-target effects. We tested a bioengineering approach for local depot release of BDNF from the infarct cavity for neural repair in chronic periods after stroke. The brain release levels of a hyaluronic acid hydrogel + BDNF were tested in several stroke models in mouse (strains C57Bl/6, DBA) and non-human primate ( Macaca fascicularis) and tracked with MRI. The behavioral recovery effects of hydrogel + BDNF and the effects on tissue repair outcomes were determined. Hydrogel-delivered BDNF diffuses from the stroke cavity into peri-infarct tissue over 3 weeks in two mouse stroke models, compared with 1 week for direct BDNF injection. Hydrogel delivery of BDNF promotes recovery of motor function. Mapping of motor system connections indicates that hydrogel-BDNF induces axonal sprouting within existing cortical and cortico-striatal systems. Pharmacogenetic studies show that hydrogel-BDNF induces the initial migration of immature neurons into the peri-infarct cortex and their long-term survival. In chronic stroke in the non-human primate, hydrogel-released BDNF can be detected up to 2 cm from the infarct, a distance relevant to human functional recovery in stroke. The hydrogel can be tracked by MRI in mouse and primate.

    View details for DOI 10.1177/0271678X16649964

    View details for Web of Science ID 000394660400024

    View details for PubMedID 27174996

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