No description available.

No description available.

The current research explores how adult attachment patterns present after an acquired brain injury (ABI) and possible associations with psychological distress, social isolation and health-related quality of life (HRQOL). It was hypothesised that attachment anxiety and attachment avoidance would explain additional variance in HRQOL and that this possible association would be mediated through psychological distress and social isolation. For this quantitative research a non-experimental, cross sectional cohort design was implemented. Forty individuals with ABI completed the Experiences in Close Relationships—Relationship Structures questionnaire, the Quality of Life in Brain Injury questionnaire, the EuroQol-5 Dimension Scale, the Hospital Depression and Anxiety Scale and the Friendship Scale. The results suggest that levels of attachment anxiety and attachment avoidance after an ABI are similar to those reported in healthy samples. Moreover, higher rates of attachment anxiety and attachment avoidance were associated with lower HRQOL, as well as increased levels of anxiety and social isolation. No association was found with depression. However, depression was shown to be the largest significant predictor of HRQOL after ABI (β = -.41, p < .005). Social isolation was also shown to predict HRQOL after ABI (β = .32, p < .05). Mediation analysis suggests that both attachment anxiety and attachment avoidance have an indirect relationship with HRQOL through social isolation, or through social isolation and psychological distress. It is concluded that adult attachment is an important theory to consider after ABI, due to its possible indirect relationship with HRQOL. These findings suggest that professionals should consider individuals' attachment patterns for treatment purposes and try to foster secure attachment patterns during rehabilitation.

Title: Reliability of Child SCAT 3 Component Scores in Children at Rest and Following Exercise Author Names: Jeff Billeck, BPE, CAT(C)1, Mike Ellis, MD2, Jeff Leiter, PhD2, Joanne Parsons, PhD, BPT3. Jason Peeler, PhD, CAT(C)4 Problem: A lack of research exists regarding the test-retest reliability of the Child Sport Concussion Assessment Tool 3 (Child SCAT 3) in healthy non-concussed adolescent females in both baseline and post-exercise settings. Method: This study consisted of two testing sessions. Within each session the Child Sport Concussion Assessment Tool 3 (Child SCAT 3) was administered once prior to exercise and once after a bout of exercise. Results: Individual component scores displayed a wide range of reliability and response stability values. A positive correlation existed within one session, between child symptom scores and slower rates of heart rate recovery after exercise. Conclusions: Overall, the Child SCAT 3 appears to be a moderately reliable assessment tool when used to evaluate uninjured female children. However, further research is required to clarify the exact sources of method error within individual Child SCAT 3 component scores. / May 2016

The present study included three traumatic brain injury (TBI) groups (good effort mild TBI, poor effort mild TBI, and good effort moderate/severe TBI) and two neurologic control groups (dementia and unilateral left hemisphere stroke). Language impairment was examined using the following measures: Wechsler Adult Intelligence Scale-III Verbal Comprehension Index and the Vocabulary, Similarities, Information, and Comprehension subtests; the Boston Naming Test; the Phonemic and Semantic cue conditions of the Controlled Oral Word Association Test; the Auditory Comprehension subtest of the Cognistat; Wide Range Achievement Test-3 Reading subtest; and the Peabody Picture Vocabulary Test. When effort was controlled, there was a significant effect of injury severity on language impairment. Poor effort and diagnosable malingering were responsible for most of the neuropsychological test evidence of language impairment in mild TBI.

Attention impairment is one of the most common complaints following Traumatic Brain Injury (TBI). Multiple studies have shown that performance on neuropsychological tests of attention is affected by many factors, including injury severity and effort. The aim of this study was to determine the effect of injury severity on neuropsychological tests across different domains of attention while controlling for effort. The domains of focused attention, selective attention, divided attention, sustained attention, and working memory were assessed by performance on the Digit Span Forward subtest, the Stroop Color Word Test, the Trail Making Test, the Conners' Continuous Performance Test - II, and Digit Span Backwards subtest, respectively. Effort was determined according to performance on the Portland Digit Recognition Test and the Test of Memory Malingering. Effort was found to have a greater effect on test performance (.79) than injury severity (.47). Clinical implications of the findings are discussed.

Traumatic brain injury (TBI) is a devastating disease causing disability and death, and currently there are no effective treatments available. Therefore, there is an utmost need to improve our understanding of the pathophysiology of TBI and to identify potential therapies that can provide neuroprotection after injury. The aims of this thesis were to develop an in vivo and in vitro model of TBI, in which to assess the potential neuroprotective effects of an omega-3 polyunsaturated fatty acid (PUFAs), docosahexaenoic acid (DHA). Method The controlled cortical impact (CCI) in vivo model of TBI was optimized and performed in mice. Both a behavioural (Morris water maze (MWM) for cognitive deficits) and histological endpoints (astrogliosis, lesion size and activated microglia) were used to assess severity and neuroprotective effects of DHA. An in vitro model of mechanical TBI was also set up and optimized. This model employed 3D astrocyte cultures obtained from GFP positive rat pups. The CCI impactor from the in vivo studies was used to damage the cultures, and at 24 hours, 5 days and 10 days the astrogliosis and cell number was measured. Results The optimization of the in vivo studies demonstrated that at impaction depth of 2.2 mm produced an injury that was significantly different to the sham injury, in MWM performance and increased astrogliosis. Interestingly, there was an increase in the amount of astrogliosis on the contralateral side of the brain. A second study performed using the 2.2 mm injury parameters was performed, where an injection of DHA was administered via the tail vein 30 min after injury. The DHA-treated group did not demonstrate any neuroprotection compared to the injury-only group. However, there was an increase in the amount of astrogliosis in the contralateral hippocampus of the DHA-treat group. In the fat-1 studies it was shown that older male mice performed worse in the MWM, that the fat-1 gene did not confer neuroprotection but did lead to increased astrogliosis. The in vitro study revealed that astrocytes in the lesioned gels demonstrated an increase in astrogliosis, there was also an increase in the number of cell in the cultures following the lesion. Conclusion In conclusion, the in vivo model of CCI replicated components of the human TBI including a behavioural deficit and pathophysiological changes. Omega-3 PUFAs failed to demonstrate functional neuroprotection in this model, but histologically, promoted an increase in reactive astrogliosis. The development of a novel in vitro model of focal injury in a 3D culture system, that elicits reactive astrogliosis, could be used to support further studies of the astrocytic responses to mechanical injury.

Traumatic brain injury (TBI) is a common cause of morbidity and mortality in people of all ages. Following the acute mechanical insult, TBI evolves over the ensuing minutes and days. Understanding the secondary factors that contribute to TBI might suggest therapeutic strategies to reduce the long-term consequences of brain trauma. To assess secondary factors that contribute to TBI, we studied a lateral fluid percussion injury (FPI) model in mice. Following FPI, the brain cortex became acidic, consistent with data from humans following brain trauma. Administering HCO3- after FPI prevented the acidosis and reduced the extent of neurodegeneration. Because acidosis can activate acid sensing ion channels (ASICs), we also studied ASIC1a-/- mice and found reduced neurodegeneration after FPI. Both HCO3- administration and loss of ASIC1a also reduced functional deficits caused by FPI. These results suggest that FPI induces cerebral acidosis that activates ASIC channels and contributes to secondary injury in TBI. They also suggest a therapeutic strategy to attenuate the adverse consequences of TBI.

Acute rehabilitation hospitals assist brain injury patients and families who face a life- changing event to achieve greater independence and quality of life. During the acute rehabilitation phase of recovery, care is focused on the patient; however, there is a nationwide movement to implement patient- and family-centered care because caregivers experience grief and uncertainty about how to care for their loved one during hospitalization and upon discharge. The purpose of this staff education project was to educate rehabilitation staff on how to identify and to meet the needs of family members of brain injury patients in an acute rehabilitation center in the western United States. The patient- and family-centered care theoretical framework and Knowles's theory of adult learning supported the development and implementation of the educational program. The project site stakeholders identified educational opportunities to assist staff to meet caregiver needs and improve outcomes. Thirty-two staff including registered nurses, licensed vocational nurses, patient care technicians, and nurse managers, received education for the support of caregivers for patients with brain injuries. The program was evaluated using a 5-point Likert type questionnaire. After receiving the education all participants agreed or strongly agreed that content increased their knowledge, skills, and confidence in caring for family caregivers of brain injury patients. Implications of this project for social change include the potential to improve patient outcomes through caregiver knowledge and skills to provide care to patients with brain injury.

During hospitalization, sleep can be interrupted or even elusive. It has been established that quality sleep is essential in neural repair. Previous research has indicated that many nurses are unaware of the impact of sleep disturbance on brain injury recovery and do not understand how to promote sleep in the neurorehabilitation setting. The purpose of this project was to determine whether educational intervention would influence nurses' knowledge and attitudes toward sleep. Benner's (2001) novice to expert theory provided a framework for the project. With the collaboration of a neuropsychologist, this study produced a sleep knowledge and attitudes instrument. Pulmonary sleep specialists, rehabilitation physicians, and neuropsychologists who were experts in the treatment of sleep disorders and brain injury validated the instrument. Following instrument validation, 19 rehabilitation nurses completed the instrument prior to receiving sleep hygiene education. Immediately after education, a posttest was administered. Pretest and posttest data were compared via Wilcoxon signed-rank tests. Results indicated a statistically significant increase nurses' knowledge (p = .015) and attitudes (p = .028) toward sleep. These findings support the use of didactic methods of sleep hygiene education for nurses. Providing nurses with sleep knowledge and improving their attitudes toward sleep may shift nursing focus to sleep as an activity rather than inactivity, and it has the potential to improve quality of patient care by empowering nurses to implement good sleep hygiene practices on inpatient units. Additional research is indicated to determine whether the increase in knowledge and improvement in attitudes will be sustained and ultimately affect patient sleep outcomes.