The elderly are a rapidly growing population in the United States and have the highest rate of TBI-related hospitalization. Across all levels of severity, elderly persons have uniformly poorer outcomes including quality of life, community integration, disability, and mortality, but there is a significant lack of published research regarding communication outcome in the elderly population. The likelihood that speech-language pathologists (SLPs) will clinically treat elderly clients with TBI is great; understanding the effects that age of injury has on communication may inform clinicians’ abilities to accurately and efficiently assess, diagnose, and treat the elderly. The present study examined the relationship between age of onset of injury and severity of communication deficits following traumatic brain injury (TBI); the study included a review of published research and a survey of SLP estimates of severity of impairment. Limitations of the study and directions for further research are discussed. / text

In the following study, a lexical emotion recognition test via written stimuli was administered to 10 (8 male and 2 female) brain injured participants. Performance of brain injured individuals was compared to 30 non brain injured adults. A two way analysis of variance (groups, conditions) revealed significant effects for groups, conditions, and the interaction of groups and conditions. Implications and significance of the present results for future research are discussed. / text

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Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community. / October 2006

Boredom is a common human experience, yet little is known about its underlying neural mechanisms. This thesis first set out to investigate the construct of boredom and more closely examined its relationship to phenomenologically similar mood states of depression, apathy and anhedonia. Next, deficits in sustained attention, and novelty seeking were examined in patients with traumatic brain injury (TBI), who are characterized by atypically high levels of boredom. Study 1 established that although related to varying degrees to apathy, anhedonia, and depression, boredom is indeed a distinct emotional experience. Furthermore, two boredom proneness subtypes - agitated and apathetic - were identified which varied in their relationships to depression. The relationship between boredom and depression was found to be high only in the agitated boredom prone subtype, which is characterised by a high degree of motivation to engage in meaningful, stimulating activities despite the fact that all attempts to do so fail to satisfy. In Study 2, the relationship between boredom proneness and depression was found to be greater in TBI patients than in healthy controls. Using a behavioral measure of sustained attention (SART; Robertson et al., 1997), Study 3 demonstrated a relationship between boredom proneness and sustained attention in healthy controls, such that RTs were faster and commission errors more prevalent in the agitated boredom prone subtype. No relationship between boredom proneness and sustained attention was found in TBI patients. So while attention and boredom show a clear relationship in the healthy brain, this relationship may be disrupted in TBI patients. Finally, Study 4 demonstrated an association between agitated boredom proneness and a preference for novel stimuli across participant groups. In addition, patients had a poorer ability to discriminate between similar and dissimilar stimuli than controls, which was more evident in the agitated boredom prone group. It may be the case then that agitated boredom prone individuals fail to satisfy their desire to engage in stimulating activities in part because they fail to accurately identify when something is indeed novel. Taken together, these results highlight important distinctions between apathetic and agitated boredom proneness, and the way in which these subtypes relate to depression, attention, and novelty seeking, in brain injured patients and healthy controls. More work is needed to determine the role played by boredom in TBI, particularly as this evolves from acute to chronic stages of the illness. Importantly, identifying boredom as a key element in depressive mood disorders, attention deficits (e.g., attention deficit hyperactivity disorder), and novelty seeking behaviour, facilitates the design and implementation of appropriate intervention strategies. For example, it will become increasingly important to deal with boredom as a significant component of depression. Thus, the work presented here represents a novel and important contribution to the study of boredom in that it brings the field one step closer to understanding and treating the experience. Further investigation with greater numbers of patients is necessary to fully explicate the relationship between boredom and depression, attention, and novelty seeking in TBI.

Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community.

Objective: The primary goal of this study was to investigate the possibility of a relationship between traumatic brain injury (TBI) and adolescent autonomy. Adolescents and their parent reported on lhree types of autonomy; renective autonomy, reactive autonomy, and functional independence. Adolescent cognitive skills, reading ability, and affective states, along with parent perceptions of !.he adolescents' executive functioning and parent-related stress were assessed in an attempt to elucidate the mechanisms through which TBI and autonomy interact. Participants and Methods: Participants included 20 adolescents, 12 to 19 years of age, with a history ofTS! and 19 age· and gender·matched adolescents wilh no history of TBI. Each adolescent was accompanied by one parent who completed parental reports while the adolescent underwent testing and completed questionnaires. Adolescents were screened for cognitive functioning and reading ability using subtests ofthe Reynolds Intellectual Assessment Scale (RIAS) and the Wide Range Achievement Test _ 4th Edition (WRAT4). Adolescents then completed questionnaires to assess depression (Beck Depression Inventory - 2nd Edition, SOl-TO and anxiety (Beck Anxiety Inventory, BAI). Lastly but most importantly. the adolescents completed questionnaires to assess reflective autonomy using a modified version of the Ryff Psychological Well Being Scale, and reactive autonomy (Adjectives Checklist, ACL). Meanwhile, parents completed a brief demographics questionnaire, a report of their adolescent's functional independence (Adaptive Behavior Assessment System II. ABAS-IO. executive functioning (Behavior Rating Inventory of Executive Functioning, BRIEF), and parenting-related stress (Stress Index for Parents of Adolescents, SlPA). Results: Significant group differences were noted on measures of reflective autonomy, but not on reactive aUlonomy. A history ofTBI was also influential in parent ratings of functional independence and executive functioning, but not levels of parent stress. The adolescents with TBI did not repon higher levels of depression or anxiety. Within the TBI group, significant correlations were found between parent ratings of adolescent functional independence and executive functioning, yet no correlations were found between adolescent and parent reports of autonomy, adolescent reports of autonomy and affect, or between parent ratings of adolescent functional independence/executive functioning and parent stress levels. Conclusions: These findings provide some indication of a potential relationship between TBI and both self-repons and parent repons of autonomy. Adolescent's with a history of TBI in this sample felt less in control of their decision making process regarding actions/behaviors, and were viewed by their parents as are less functionally independent. These findings do not provide any indication of a potential relationship between TBI and an adolescent's ability to resist external innuence. However, the number of participants was limited and there were several other factors which complicate the interpretation of this lack of difference between adolescents with and without TBI. Clearly. further investigation of this phenomenon is warranted, yet these findings suggest that clinicians working with adolescents with brain injury might benefit by considering both internal and external perceptions of autonomy in treatment implementation. / Graduate

Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community.

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