Cusimano Michael D, Korman Melissa B, Kazolis George, Zhang Stanley, Tepperman Lorne
Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Neurotrauma Rep. 2021 Feb 1;2(1):48-58. doi: 10.1089/neur.2020.0033. eCollection 2021.
Traumatic brain injury (TBI), including concussion, is the commonest neurological condition in high-income countries and is the second commonest condition next to migraines. Although most of these injuries are unintentional, substance abuse and age-related physiological factors have been implicated as causal factors of fall-related TBIs. Our study used qualitative methods and a life course perspective to examine whether life events and psychosocial antecedents, such as early adverse childhood experiences, play a role in the occurrence of non-intentional fall-related TBI. In-depth interviews were conducted with 27 patients who sustained a TBI due to unintentional falls. Transcripts were qualitatively analyzed to explore factors related to their prior life experiences that may have been related to the reasons that led to their falls. The results reveal that childhood family conflict and peer-influenced risky behaviors may have contributed to poorer mental and physical health in adulthood, which in turn contributed to injuries. Respondents whose behaviors did not play a direct role in their injury event were labeled "Stumblers." These patients' falls were seen as being related to unfortunate unique environmental and situational factors and could colloquially be described as "accidental falls." We also identified a distinct group of patients who had a cumulative life experience starting in early childhood that contributed to a pattern of riskier behaviors, ultimately culminating in a fall-related TBI. The second group of patients were labeled "Tumblers" as they chose to participate in risky activities, regardless of whether they considered them to be risky, which ultimately led to the fall-related TBI. This group was identified by a purposeful volitional state that sought out the "opportunity for accidental fall." Childhood family conflict and peer-influenced risky behaviors were important precursors to mental and physical health states in this group.
创伤性脑损伤（TBI），包括脑震荡，是高收入国家最常见的神经系统疾病，仅次于偏头痛，位列第二。虽然这些损伤大多是意外造成的，但药物滥用和与年龄相关的生理因素被认为是与跌倒相关的创伤性脑损伤的致病因素。我们的研究采用定性方法和生命历程视角，来检验生活事件和心理社会因素，如童年早期的不良经历，是否在非故意跌倒相关的创伤性脑损伤的发生中起作用。对27名因意外跌倒而遭受创伤性脑损伤的患者进行了深入访谈。对访谈记录进行定性分析，以探讨与他们之前的生活经历相关的因素，这些因素可能与导致他们跌倒的原因有关。结果显示，童年家庭冲突和同伴影响的危险行为可能导致成年后较差的身心健康，进而导致受伤。那些行为在其受伤事件中没有直接作用的受访者被标记为“绊倒者”。这些患者的跌倒被视为与不幸的独特环境和情境因素有关，可以通俗地描述为“意外跌倒”。我们还确定了一组不同的患者，他们从童年早期开始就有累积的生活经历，导致了一系列更危险的行为模式，最终以与跌倒相关的创伤性脑损伤告终。第二组患者被标记为“摔倒者”，因为他们选择参与危险活动，无论他们是否认为这些活动有风险，这最终导致了与跌倒相关的创伤性脑损伤。这一组的特点是一种有目的的意志状态，寻求“意外跌倒的机会”。童年家庭冲突和同伴影响的危险行为是这一组身心健康状态的重要先兆。
