Le immagini mentali sono un analogo della percezione? Studiando i pazienti con danni cerebrali, abbiamo visto che le menomazioni percettive sono spesso associate a limitazioni nella capacità di creare immagini (Farah 1988, 2000). Nella recente letteratura tuttavia sono riportati casi di doppia dissociazione, in cui funzioni percettive sono preservate e quelle immaginative danneggiate, o viceversa, funzioni percettive danneggiate ma intatta capacità immaginativa. Nel seguente studio l’obiettivo è indagare i rapporti tra la percezione e immaginazione in pazienti con danno cerebrale, in 5 diversi domini: forme, colori, volti, materiale ortografico e relazioni spaziali. Nel primo studio l'obiettivo era di esplorare le immagini mentali e la capacità di percezione visiva in pazienti con lesioni cerebrali attraverso una batteria di test sviluppata da Bachoud Levi, Bartolomeo, Chokron nel 2001 e adattata per il campione italiano da Antonietti, Oliveri, Incorpora et al. (2008). In un secondo studio abbiamo indagato le relazioni tra imagery e stile cognitivo visualizzatore/verbalizzatore, proponendo 2 questionari (VVQ e QSVV). Infine in un terzo studio, attraverso indagini strumentali (DTI, TAC, RMN) in un gruppo di pazienti con danno focale e deficit specifici di imagery, abbiamo individuato le correlazioni tra deficit nei diversi domini dell’imagery e della percezione con i danni corrispondenti a livello neurale. / Is imagery an analogous of perception? By studying patients with brain damage we saw that perceptual impairments are often associated to limitations in the ability to create images (Farah 1988, 2000). In recent literature we found cases of double dissociation, in which perceptual functions are preserved and those imaginative impaired or, vice versa, there are damaged perception functions but intact imaginative capacity. We aim to investigate the relationships between perception and imagery in patients with brain damage, in 5 different domains: shapes, colour, faces, orthographic material and spatial relationships. In the first study the aim was to explore mental imagery and visual perception skills in patients with brain injury through a battery of tests developed by Bachoud-Lèvi, Bartolomeo, Chokron in 2001, and readapted for the Italian sample by Antonietti, Oliveri, Incorpora et aal (2008). In a second study we investigated the relationships between imagery test performance and visualizer/verbalizer cognitive style, detected by proposing 2 questionnaires (VVQ and QSVV). Finally in a third study, through instrumental investigations (DTI, TAC, MRI) in a group of patient with focal damage and specific imagery deficit, we aimed to correlate imagery and perception deficits to corresponding impairment in neural correlates.

The main purpose of the dissertation is to understand meaning-making practices used by people suffering from acquired brain damage with severe physical and communicative disabilities, in order to create and sustain their identity and personhood in relation to other people. The study emanates from the idea that identity and personhood, also in relation to disability, are created/sustained in ongoing interaction between people in everyday situations, and that the ability to narrate is central to such a creation of identity. Therefore, it is of particular interest to try to understand what communicative and storytelling abilities/possibilities people with severe acquired brain damage have in presenting their identity. The study is ethnographic and based upon a year-long field study of participant observations at a day centre for people with acquired brain damage. Gathered data consist of written field notes, informal interviews conducted with both participants and personnel and approximately 70 hours of video data. The study shows how an identity as ‘severely disabled’ is created in the co-created storytelling between participants and personnel and that this identity seems to mean that one is dependent upon others to get along in everyday life at least if one listens only to spoken stories. Yet the study also shows that there exist different opinions about what this identity as ‘severely disabled’ could mean that there is a wish among the participants to be able to present a desirable identity as “normal”, and that such an identity comes to mean to be independent and self-determined. Normality, however, must be understood in relation to surrounding society (and the grand cultural narratives that surround us). Thus the study shows that normality in relation to severe disabilities is almost impossible to achieve because normality in relation to illness/disease/body contains the hope of a cure or an improvement. The participants in this study, however, have all been labelled as incurable – there is no hope of such a cure or improvement. That, on the other hand, does not mean that the participants do not try to tell such stories anyway in their quest to achieve this desirable identity. However, in order to hear this story we need to listen to stories that usually remain untold. A palpable hierarchy between different modes of language use was identified, where verbal/spoken language is supreme, resulting in the disabled participants not being perceived as competent interactors/communicators due to their difficulties in using verbal communication. Hence their ways of creating/telling stories, through embodiment and enactment, are not recognised as valid ways to create/tell stories; this is discussed in relation to both practical implications for health care settings as well as for further narrative research. / Avhandlingens huvudsyfte är att förstå meningsskapande praktiker som personer som drabbats av förvärvad hjärnskada med grava såväl fysiska som kommunikativa funktionshinder använder för att skapa och upprätthålla sin identitet och sitt personskap i relation till andra människor. Studien utgår ifrån att identitet och personskap, också i relation till funktionshinder, är något som skapas och upprätthålls i det pågående samspelet mellan människor i vardagliga situationer och att förmågan att berätta är central för detta identitetsskapande. Därför är det av särskilt intresse att försöka förstå vilka möjligheter personer med grava förvärvade hjärnskador har när det gäller att kommunicera och använda berättandet som ett sätt att presentera sin identitet. Studien är etnografisk och baseras på ett årslångt fältarbete bestående av deltagande observationer på ett dagcenter för människor med förvärvade hjärnskador. Insamlade data består av fältanteckningar, informella intervjuer med både deltagare och personal och ca 70 timmar videomaterial. Studien visar hur en identitet som ’gravt funktionshindrad’ skapas i det gemensamma berättandet mellan deltagare och personal och att denna identitet verkar innebära att man är beroende av andra för att klara sitt vardagliga liv, åtminstone om man enbart lyssnar till talade berättelser. Likväl visar studien även att det kan råda delade meningar om vad denna identitet som ’gravt funktionshindrad’ kan innebära och att det bland deltagarna finns en strävan att kunna presentera en önskvärd identitet som ”normal” och att en sådan identitet innebär att vara oberoende och självbestämmande. Normalitet måste dock förstås i relation till omgivande samhälle (och de stora, kulturella berättelser som omger oss) och studien visar att normalitet i samband med grava funktionshinder är i det närmaste omöjligt att uppnå då normalitet i relation till sjukdom/kropp innefattar ett hopp om att bli frisk, eller åtminstone bättre. Deltagarna i denna studie har emellertid diagnostiserats som obotliga – det finns inget hopp om förbättring. Detta innebär inte desto mindre att deltagarna ändå försöker berätta sådana berättelser i strävan efter att uppnå en önskvärd identitet. Dock; för att höra denna berättelse krävs ett lyssnande på berättelser som vanligtvis förblir oberättade. En tydlig hierarki mellan olika former av språkanvändning identifieras, där det talade ordet och den talade berättelsen ses som överlägsen. Detta får till konsekvens att de funktionshindrade inte ses som kompetenta aktörer/kommunikatörer pga. av sina svårigheter att kommunicera verbalt och att deras sätt att skapa berättelser, genom förkroppsligande framställningar, inte erkänns som legitima sätt att berätta. Detta diskuteras både i relation till olika praktiska implikationer för vårdinstitutioner och för vidare narrativ forskning.

Text in Afrikaans / In this study an instrument is suggested for implementation by the Educational Psychologist to design a support programme, aimed at handling family members' stress where a child has sustained a brain injury. Attention was paid to the phenomenon "brain injured child" to ascertain demands and needs (physical, cognitive, psychological and emotional). Specific note was taken of the toll on each family member in their observance, experience, assistance and giving· meaning to the child. Reference was made to existing support programmes for such family members from the acute care phase to the final acceptance and readjustment of the family. With this study the need for a continuous support programme and the contents of such a programme was addressed. Using these guidelines the Educational Psychologist will be able to prepare the family for the stress possibilities in dealing with the brain injured child. / Met hierdie studie is 'n instrument daargestel vir die ontwerp van 'n hulpverleningsprogram vir gebruik deur die Opvoedkundige Sielkundige. Hierdie hulpprogram het as doel, die hantering van stres, deur die gesin van 'n kind, wat 'n breinbesering opgedoen het. In die studie is aandag gegee aan die tipiese gedrag wat oor die algemeen van 'n breinbeseerde kind verwag kan word. Daar is ook gepoog om te bepaal hoe elke lid van die gesin die breinbeseerde kind beleef, aan hom betekenis gee, en hom probeer help ten opsigte van die eise (fisiek en emosioneel) wat hy stel. Verder is daar gekyk na bestaande hulpverlening (gerig op die hantering van stres) aan die gesinslede van 'n breinbeseerde kind vanaf die akute versorgingsfase tot en met die aanpassing en herorganisering van die gesin. Met hierdie studie is 'n behoefte aan 'n kontinue hulpverleningsprogram en die inhoud van so 'n program by gesinslede aangespreek. Aan die hand van die riglyne sal die Opvoedkundige Sielkundige 'n gesin kan voorberei op die stres wat hulle ten opsigte van die hantering van 'n breinbeseerde kind te wagte kan wees. / Psychology of Education / M. Ed. (Voorligting)

I hjärnan finns neuron och gliaceller. Förut trodde man att neuroner var dem enda som hade en viktig funktion i hjärnan men på senare tid har upptäckt att gliaceller har en större betydande roll än man tidigare trott. Gliaceller är ett samlingsnamn som innefattar bland annat microglia celler, oligodendrocyter och astrocyter. Östrogen är ett steroidhormon som har många viktiga funktioner i kroppen som bland annat reproduktionen, immunförsvaret, skelettet och endokrina system. Östrogen binder till östrogenreceptorer och de finns 3 stycken olika som kallas för östrogenreceptor alfa (α), östrogenreceptor beta (β) och G-proteinkopplade östrogenreceptor (GRP30). Alla dessa östrogenreceptorer har man funnit i hjärnan. Syftet med detta projektarbete är att ge en djupare förståelse om östrogens signalering i hjärnans gliaceller och om östrogens signalering kan ge någon relevant funktion till framtida farmakologiska behandlingar.  Systematisk litteraturstudie gjordes och sökningar på databasen PubMed. Begränsade antalet träffar med sökord, inklusionskriterier och exklusionskriterier. Artiklar granskades sedan via ett urvalssystem och relevanta artiklar användes för att besvara syfte och frågeställningar.  Östrogensignaleringen på gliaceller har många olika effekter. En signalering på östrogenreceptor β på oligodendrocyter leder till mognad, differentiering, bättre överlevd och att remyeliniseringen aktiverades. Medan en östrogens signalering på microglia cellens östrogenreceptorer α, β och GRP30 leder dämpning av inflammation och förbättrad kognitiv funktion. Östrogensignaleringen på astrocyter ger flera olika effekter såsom metabolismen av glukos, progesteron syntesen, glutamattransportören GLT-1, tillväxtfaktorn TGF-α, upptaget av glutamat samt ökad proteinproduktion av AMPA-receptor. Den nya kunskapen om östrogens signalering på hjärnans gliaceller kan leda till framtida farmakologiska behandlingar vid hjärnskada och ischemisk stroke. Östrogenet har visat på neuronskyddande effekter via signalering på gliaceller. Svagheten är att de endast är djurstudier som ligger till grund för kunskapen om östrogens signalering på gliaceller. I framtiden skulle det behövas styrkas med studier gjorda på människa. En styrka är att djurstudierna ger en fingervisning om östrogen signaleringen eftersom hjärnans uppbyggnad är likvärdig.

MPH / Department of Public Health / Cerebral palsy (CP) is the common cause of physical disability in children. The nature and severity of impairments vary, but the demands placed upon mothers are significant. It is one of the prolonged conditions which have become a serious health problem worldwide. The purpose of this study was to explore and describe the challenges of mothers caring for cerebral palsy children at Thulamela Municipality, in the Vhembe District, South Africa. The objectives of this study were as follows: (1). To explore the challenges by mothers of cerebral palsy children in relation to physical, psychological and social care, (2) To explore their challenges in relation to available resources for proper referral of mothers caring for cerebral palsy children. The study used a qualitative approach using explorative and descriptive design in exploring the challenges of mothers caring for children with cerebral palsy. The study population comprised mothers of children with Cerebral Palsy living in the Vhembe District who attends the rehabilitation therapy services at Tshilidzini Hospital. A non-probability, purposive sampling technique was used to select the mothers. Five focus groups, each consisting of eight mothers were composed. Semi-structured group guide consisting of open-ended questions were used. Data was transcribed, verbatim and coded into themes and subthemes using context thematic analysis method. Themes that emerged include: a theoretical framework for the study, effects of caring on the family’s socio-economic life, challenges experienced by mothers caring for cerebral palsy children, challenges in relation to education and training and challenges experienced by mothers caring for cerebral palsy. The findings of the study might benefit the society about the challenges experienced by mothers when caring for their disabled children. The study might help government to develop and implement policies which will empower parents and the community as a whole / NRF

Indiana University-Purdue University Indianapolis (IUPUI) / Posttraumatic epilepsy, the development of temporal lobe epilepsy (TLE) following traumatic brain injury, accounts for 20% of symptomatic epilepsy. Reorganization of mossy fibers within the hippocampus is a common pathological finding of TLE. Normal mossy fibers project into the CA3 region of the hippocampus where they form synapses with pyramidal cells. During TLE, mossy fibers are observed to innervate the inner molecular layer where they synapse onto the dendrites of other dentate granule cells, leading to the formation of recurrent excitatory circuits. To date, the molecular mechanisms contributing to mossy fiber sprouting are relatively unknown. Recent focus has centered on the involvement of tropomycin-related kinase receptor B (TrkB), which culminates in glycogen synthase kinase 3β (GSK3β) inactivation. As the neurite outgrowth promoting collapsin response mediator protein 2 (CRMP2) is rendered inactive by GSK3β phosphorylation, events leading to inactivation of GSK3β should therefore increase CRMP2 activity. To determine the involvement of CRMP2 in mossy fiber sprouting, I developed a novel tool ((S)-LCM) for selectively targeting the ability of CRMP2 to enhance tubulin polymerization. Using (S)-LCM, it was demonstrated that increased neurite outgrowth following GSK3β inactivation is CRMP2 dependent. Importantly, TBI led to a decrease in GSK3β-phosphorylated CRMP2 within 24 hours which was secondary to the inactivation of GSK3β. The loss of GSK3β-phosphorylated CRMP2 was maintained even at 4 weeks post-injury, despite the transience of GSK3β-inactivation. Based on previous work, it was hypothesized that activity-dependent mechanisms may be responsible for the sustained loss of CRMP2 phosphorylation. Activity-dependent regulation of GSK3β-phosphorylated CRMP2 levels was observed that was attributed to a loss of priming by cyclin dependent kinase 5 (CDK5), which is required for subsequent phosphorylation by GSK3β. It was confirmed that the loss of GSK3β-phosphorylated CRMP2 at 4 weeks post-injury was likely due to decreased phosphorylation by CDK5. As TBI resulted in a sustained increase in CRMP2 activity, I attempted to prevent mossy fiber sprouting by targeting CRMP2 in vivo following TBI. While (S)-LCM treatment dramatically reduced mossy fiber sprouting following TBI, it did not differ significantly from vehicle-treated animals. Therefore, the necessity of CRMP2 in mossy fiber sprouting following TBI remains unknown.