Mild Traumatic Brain Injury (mTBI) can be broken into two categories; complicated and uncomplicated. These categories are based on structural imaging scans during the assessment of the injury. If abnormalities appear in the scan, we refer to it as complicated. The present research aims at determining whether there are differences in the neuropsychological deficits in the presences of positive neuroimaging as opposed to negative neuroimaging. This was accomplished with meta-analytic techniques. It was found that neuroimaging does not predict neuropsychological functioning in the chronic state of mTBI.

Patients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of communicating in the hospital setting. Barriers to effective communication were identified as lack of time, education and access to the devices. Recommendations for future research include developing a documentation component that emphasizes nursing assessment and intervention through collaboration with the SLP. Additional recommendations for research include the examination of impact of AAC use on patient satisfaction and outcomes. Communication using AAC is necessary in order to improve patient outcomes for traumatic brain injured individuals. This can be achieved through increased collaboration with the SLP, and increased nursing knowledge of the available devices and their implementation.

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Thesis (Ed.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Problem The purpose of this study was to investigate the relation of anxiety to learning in brain injured adults, and to determine how their performance was affected by reassurance instructions, additional practice, and variations in task content and difficulty. Scope The study involved forty patients with brain injury of cerebrovascular origin who were admitted to the neurological service of a hospital in the Massachusetts Public Health system. The patients ranged in age from fifty to sixty six, and in intelligence quotient from eighty to one hundred and twelve. They were evenly divided on sex, but the lateral distribution of lesion favored the right cerebral hemisphere with seventy per cent of the patients having damage on that side, and thirty per cent on the contralateral side. None of the patients had dysphasic language disorders or visual disorders, and at the time of participation in the study all were scheduled to commence therapy within a period of two weeks. Procedure Patients scoring in the upper and lower forty per cent of the distribution of anxiety scores on both the Buss Anxiety Rating Scale, and the Manifest Anxiety Scale were matched in respect to age, intelligence, sex, and the lateral location of cerebral lesion. They were then assigned to either an additional practice or a reassurance instructions treatment category on the basis of a table of random numbers. [TRUNCATED] / 2999-01-01

Background Estimates of 1.6 million to 3.8 million concussions or mild traumatic brain injuries (mTBI) occur annually in adolescent athletes participating in contact sports (Daneshvar et al., 2011). Current clinical guidelines call for interventions to include education, assessment, screening, and long term management of injury by the adolescent's primary care provider (PCP) (Giza et al., 2013). Without proper knowledge of the injury's physiological process and progression, providers are possibly increasing the risk of continued brain injury in this population (Reddy & Collins, 2009). Purpose This doctorate of nursing practice project aimed to determine if a gap existed between provider knowledge about the current guidelines for management of mTBI in adolescent athletes of Arizona. Knowledge obtained from this survey could be further used to drive practice change. Methods A quantitative needs assessments study was conducted via data collection obtained through PCP's participation in an anonymous electronic survey using the survey software Qualtrics. Survey links were sent to potential participant's email addresses throughout Yuma County, AZ. An additional survey link was posted to the Arizona Nurses Association e-newsletter. The survey consists of 28 questions divided into three categories of demographics, knowledge, and practice questions. Outcomes Survey results were limited due to only 21 providers responding to the request for participation. From this sampling, it was determined that participant's clinical knowledge and practice related to screening, assessment, long term management, and continuity of care between the ED provider and follow up care with the primary provider were not congruent with current practice guidelines.

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The re-creation of a holistic narrative that integrates the pre- and post-injury self is integral to recovery following acquired brain injury (ABI). However, individuals may struggle with deficits in linguistic skills required for narrative, along with reduced functioning, feelings of grief, difficulties with cognition, and other communicative challenges. This mixed-methods study analyzed data gathered from six non-aphasic adult participants with ABI during semi-structured interviews and through assessments. Thematic analyses showed that individuals experience a change in their sense of self prevs. post-injury, reflected in their self-narratives, and that even clinically undiagnosed changes in speech, language, and communication are impactful. Results from linguistic analysis and assessments suggest a relationship among a person’s cognitive capacity, his/her sense of loss, and pre- vs. post-injury narrative of self speech rates. Participants spoke comparatively slower about their post-injury self, with those participants with higher feelings of loss showing a reduction in their speech rates comparatively more. / Graduate / 0290 / 0460 / 0382 / bje@uvic.ca

Disruption to the life narrative is a common long-term experience following acquired brain injury. It can lead to barriers in being able to fulfil roles and engage in daily activities and occupations. Disruption occurs not only for the person who sustains the brain injury, but is also an experience for significant others in their lives. This narrative study gathered participants’ personal ‘sense making’ of life events following such disruption. Extended narrative interviews were combined with a photo-elicitation technique for six people with acquired brain injury and six people who had a significant other in their life with an acquired brain injury, all living in a rural area. It involved discussion around the patterning of their daily activities and roles both pre and post injury. Narrative analysis led to individual case studies of barriers and opportunities to lives impacted by brain injury. Issues were highly individualised and whilst the rural context presented an advantageous place to live for some due to tranquillity, it was less advantageous for others. However, synthesis of findings across cases considered the narrative form produced by the twelve accounts. This revealed that individuals drew on attributes of previous roles and careers to construct meaning and manage their lives, even when they could no longer engage with past roles and careers. Approaches to self-management post injury appeared to follow a pattern of drawing on internal schema underpinned by values, skills and meaning of previous roles and careers. This constitutes a form of capital built up from life pre-injury that is being utilised to achieve health and wellbeing, which I have called ‘embodied occupational capital’. An opportunity to work with individuals whose lives are affected by acquired brain injury has been offered, by way of focusing on this ‘embodied occupational capital’ to empower them to make positive change.

Vascular endothelial growth factor (VEGF) may play a role in neuroprotection after traumatic brain injury (TBI) in addition to being a regulator of angiogenesis. Gene therapy using an adenovirus carrying an engineered zinc-finger protein (Adv-ZFP) and transcription factor construct targeted to the VEGF gene, has been shown to upregulate genomic expression of VEGF-A isoforms in skeletal muscle. Our objective was to use this gene therapy to explore cell survival in TBI. Rats were subjected to a unilateral fluid percussion injury (FPI) in the cortex. Groups consisted of control, injured and injured-treated animals. Adv-ZFP-VEGF was injected into the cortex and hippocampus. Engineered ZFP-VEGF increases VEGF-A protein levels and correlates with increased CA2 hippocampal cell survival and reduction in apoptotic cell death following TBI. NF200 expression in TBI+VEGF animals was comparable to levels in naive animals. This study suggests a therapeutic strategy to treat delayed cell death in a model of TBI.