People who suffer a traumatic brain injury (TBI) experience challenges in returning to work differently and at a rate that surpasses the return to work transition for people who experience other types of disabling injuries. In part, this challenge is a result of a lack of policy structure that promotes the successful return to work transition. The purpose of this ethnographic study was to explore the policy implications of the return to work transition for TBI survivors, address the gap in the literature, and identify key factors that contribute to the success of return-to-work programs in Washington State. A hybrid of Smith's institutional ethnography approach and Foucault's critique of bureaucratic institutions was used as the framework for this study. Data were gathered from 12 interviews and 2 focus groups with TBI survivors who had access to TBI support groups and employers connected to the TBI community. Data were inductively coded and categorized using a comparative analytical method. The study results indicate that an inclusive culture, collaborative communication, TBI-focused knowledge, integrated support, and survivor/employer motivation to interact are key factors in the successful return to work process. This study promotes positive social change by providing information for use in expanding TBI employment policy, TBI employment education, and accommodation practices. The study findings are intended to inform new policies to improve employment post-TBI outcomes for TBI survivors, employers, and their community.

abstract: Of the 2.87 million traumatic brain injuries (TBI) sustained yearly in the United States, 75% are diffuse injuries. A single TBI can have acute and chronic influences on the neuroendocrine system leading to hypothalamic-pituitary-adrenal axis (HPA) dysregulation and increased affective disorders. Preliminary data indicate TBI causes neuroinflammation in the hippocampus, likely due to axonal damage, and in the paraventricular nucleus of the hypothalamus (PVN), where no axonal damage is apparent. Mechanisms regulating neuroinflammation in the PVN are unknown. Furthermore, chronic stress causes HPA dysregulation and glucocorticoid receptor (GR)-mediated neuroinflammation in the PVN. The goal of this project was to evaluate neuroinflammation in the HPA axis and determine if GR levels change at 7 days post-injury (DPI). Adult male and female Sprague Dawley rats were subjected to midline fluid percussion injury. At 7 DPI, half of each brain was post-fixed for immunohistochemistry (IBA-1) and half biopsied for gene/protein analysis. IBA-1 staining was analyzed for microglia activation via skeleton analysis in the hypothalamus and hippocampus. Extracted RNA and protein were used to quantify mRNA expression and protein levels for GRs. Data indicate increased microglia cell number and decreased endpoints/cell and process length in the PVN of males, but not females. In the dentate gyrus, both males and females have an increased microglia cell number after TBI, but there is also an interaction between sex and injury in microglia presentation, where males exhibit a more robust effect than females. Both sexes have significant decreases of endpoints/cell and process length. In both regions, GR protein levels decreased for injured males, but in the hippocampus, GR levels increased for injured females. Data indicate that diffuse TBI causes alterations in microglia morphology and GR levels in the hypothalamus and hippocampus at 7 DPI, providing a potential mechanism for HPA axis dysregulation at a sub-acute time point. / Dissertation/Thesis / Masters Thesis Biology 2019

Bakgrund: Personer med traumatisk hjärnskada kan få långvariga kroniska besvär. Anhöriga är ofta involverade i deras vård och finns med under hela vårdförloppet. Anhöriga har också en viktig roll och ansvar för det vardagliga livet i hemmet. Syfte: Syftet var att beskriva anhörigas erfarenheter av att leva med en närstående med traumatisk hjärnskada. Metod: En allmän litteraturstudie genomfördes, där elva artiklar analyserades med hjälp av innehållsanalytiskt tillvägagångssätt. Resultat: Det framkom fyra kategorier ifrån resultatartiklarna: att ta ansvar och anta olika roller, att leva i en oviss och oförutsägbar situation, att få stöd och att finna en egen inre kraft. Det var en stor påfrestning för anhöriga att anta den vårdande rollen för att stödja den traumatiskt hjärnskadade. Ovissheten kring den traumatiskt hjärnskadades prognos tillsammans med bristen på information och kunskap, satte de anhöriga i stress. Behovet av stöd till anhöriga var multidimensionellt där det initiala stödet kom främst från sjukvårdspersonalen medan det senare i förloppet övergick till familjen och samhället. Anhöriga fick använda egna resurser och egen inre kraft för att hantera sin situation. Konklusion: För att underlätta livet för anhöriga och traumatiskt hjärnskadade, behöver vården ha bättre strategier och samhället ha bättre kunskap och förståelse för sjukdomen. / Background: Individuals with traumatic brain injury can sustain chronical lasting sequalae’s. Relatives are often involved in their care and present during the whole process. Relatives also have an important role and responsibility in the everyday life. Aim: The aim was to describe relatives’ experiences of living with a next of kin with traumatic brain injury. Method: A general literary study was performed, where eleven articles were analyzed, with content analytic approach. Result: Four categories emerged from the result articles: to take responsibility and adopt different roles, to live in an uncertain and unpredictable situation, to receive support and to find own inner strength. It was a big strain for relatives to take on the caring role of supporting the traumatic brain injured. The uncertainty of the prognose, along with the lack of information and knowledge, putted the relatives in distress. The need of support was multidimensional where the initial support came from healthcare personnel and then from family and community. Relatives had to use own resources and inner strength to manage their situation. Conclusion: To ease life for relatives and traumatic brain injured, health care needs to have better strategies and the community better knowledge and understanding for the disease.

Magister Scientiae (Occupational Therapy) - MSc(OT) / The recovery process for traumatic brain injuries (TBIs) can be lengthy and taxing on the patient, family and healthcare resources. Part of this recovery process includes interventions for the improvement of executive functioning (EF) required for high level functioning such as return to work (RTW). However, evidence for best practice interventions to improve EF for RTW post TBI is lacking. Randomised control trials (RCTs) evaluating interventions for EF for RTW post TBI are available but have not been synthesised. The review aimed to determine the best practice interventions for improving EF for successful RTW post TBI. Method: A systematic review using a predetermined search strategy to find relevant titles published from inception to June 2020 in six electronic databases (EBSCOhost and PUBMED [both including MEDLINE]; CINAHL, Cochrane Database for Systematic Reviews, OT Seeker, and Taylor and Francis Online) was conducted following ethics approval by the Institutional Ethics Review Board. / 2023

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Indiana University-Purdue University Indianapolis (IUPUI) / Social support is a powerful therapeutic against fear and anxiety and is utilized in many psychotherapies. The concept that a familiar or friendly presence helps a person learn to overcome anxiety has been well-known for decades, yet, the basic neural mechanisms that regulate this psychosocial learning remain unknown. A first step towards elucidating these basic mechanisms is the development of a valid preclinical animal model. However, preclinical behavioral models exploring the use of a social presence in reducing anxiety have not been fully characterized. Therefore, it was our goal to identify a useful way in which to study the mechanisms of how a social presence can induce anxiolysis (the reduction of anxiety). We accomplished this goal by characterizing and validating a preclinical model, as well as demonstrating that the model was capable of measuring deficits in rats given a mild traumatic brain injury. To this end, we identified an existing, but uncharacterized model, the social interaction-habituation model, as an effective model of social familiarity-induced anxiolysis (SoFiA), which demonstrates socially enhanced safety learning, or psychosocial learning. We find that as social familiarity develops across time, anxiolysis develops. We identified that the use of a Bright Light Challenge is a useful anxiogenic stimulus to use during SI-habituation training. The anxiolysis acquired following SI-habituation testing is partner specific, and can be blocked by an inhibition of the medical prefrontal cortex, while it can be enhanced by D-cycloserine. We found that this model identified deficits in SoFiA acquisition in rodents exposed to a mild traumatic brain injury, which, in humans, has been linked to psychosocial deficits. This work is a step in creating ways in which we can study and better understand the regulatory processes of emotions mediated by social behavior.

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One of the primary reasons many college students with disabilities, and more specifically college student veterans with disabilities, do not seek support services is due to the stigma associated with disability, especially cognitive and mental health disabilities. The purpose of the present study was to explore how public university faculty in the state of Illinois perceive a college student veteran with the concurrent disabilities of post traumatic stress disorder (PTSD) and traumatic brain injury (TBI). This information was gleaned by means of a mixed-method, online survey. Through iterative, comparative, qualitative analysis, characteristics used to describe college student veterans with the PTSD and TBI were classified into six emergent prototypes. These prototypes included (1) the mature independent student; (2) the American hero; (3) the special needs student; (4) the isolated student; (5) the volatile student; and (6) the wounded warrior. Secondary analyses quantitatively examined the relationship between contact with a student veteran and the proportion of positive responses given for each participant as well as the relationship between contact with a student veteran and the proportion of negative responses given for each participant. Pearson correlation analysis indicated no significant relationship between prior contact factor scores and the proportion of positive responses given by faculty r(269) = .032, p = .597 nor was there a significant relationship detected between prior contact factor scores and the proportion of negative responses given by faculty r(269) = -.020, p= .745. Tertiary analysis examined the proportion of positive to negative perceptions by faculty. Overall, faculty responses were more negative than positive. Implications for best practices at the administration level as well as for faculty and students were discussed. Limitations to the study were also discussed.