The purpose of this study was to examine the extent to which learning and recall are facilitated by semantic and phonological targets. A list-learning paradigm was administered to 10 individuals with a history of traumatic brain injury. Participants were asked to recall and identify words that were present on the list. The lists consisted of semantically related associate words and phonologically related associate words. Participants recalled significantly more semantically related associates than phonological associates. Demographic factors such as age, time-post injury, and educational attainment did not have a significant effect on the recall ability for either word target type. Word recognition ability also was not influenced by target type. The results of this study found adults with TBI use a semantic network following brain injury and that semantic targets are more beneficial for recall than phonological targets. / text

Learning and memory impairments are among the most common and enduring cognitive consequences of traumatic brain injury (TBI). Researchers have yet to reach a consensus with regard to the basic cognitive mechanism underlying new learning and memory disturbances after TBI. The purpose of the present study was to investigate the current views regarding the cognitive processes thought to explain impairments in verbal learning and memory subsequent to brain injury. Specifically, this study sought to examine the roles of the central executive component of working memory and processing speed in verbal learning ability following TBI. Latent variable structural equation modeling (SEM) was used to analyze the data of 70 post-acute care TBI patients between the ages of 16 and 65, who completed a full neuropsychological evaluation. Results indicated that verbal learning and memory difficulties following TBI were explained primarily in terms of the central executive aspects of working memory, after accounting for the relative contributions of processing speed in the model. The direct effect of processing speed on verbal learning and memory was not significant when working memory was taken into account in the model. Rather, the effects of processing speed on verbal learning ability were largely indirect through the central executive component of working memory. Results highlight the importance of both working memory and processing speed in supporting verbal learning and memory processes after TBI. Practical implications for targeting remediation efforts and directing approaches to memory rehabilitation are discussed in light of the study’s findings. / text

La prévalence des troubles du sommeil et de douleur chronique est élevée chez le patient ayant subi un traumatisme crânien cérébral léger (TCCL). L’interaction entre ces plaintes est suggérée chez les patients avec un TCCL mais son étiologie reste encore peu connue. Les résultats de recherche présentés dans le premier article de cette thèse suggèrent que les patients avec un TCCL qui souffrent de douleur ont une modification des ondes cérébrales durant leur sommeil, ce qui pourrait expliquer en partie comment les deux symptômes interagissent. De plus, la douleur, surtout si associée à des troubles de l’humeur, semble jouer un rôle majeur dans la persistance des symptômes post-commotionnels. Le deuxième article de cette thèse décrit une exacerbation des symptômes post-commotionnels chez le patient ayant eu un TCCL et souffrant de douleur. La persistance ou l’apparition de la douleur chronique à long terme serait prédite par le polymorphisme val66met du gène brain-derived neurotrophic factor (BDNF). Une étude subséquente, présentée dans le troisième article, nous a permis d’approfondir les bases génétiques et cellulaires du rôle du BDNF dans la persistance des symptômes post-commotionnels. Des polymorphismes fréquents dans le gène BDNF ont révélé des variantes liées au mauvais pronostic suite à un TCCL. De plus, l’analyse de cellules extraites de patients ayant subi un TCCL démontrent que l’expression de la protéine BDNF peut être modifiée chez le patient de génotype met66 et ayant subi un TCCL, lui conférant ainsi un rôle neuroprotecteur potentiel. En résumé, nous avons tenté de démontrer dans cette thèse que la douleur suite à un TCCL joue un rôle important dans les perturbations du sommeil et dans la persistance des symptômes post-commotionnels. Une prédisposition génétique pourrait contribuer à expliquer le mauvais pronostic et la chronicité des symptômes post-commotionnels suite à un TCCL. / Mild traumatic brain injury (MTBI) is a major public health concern as patients are left, amongst other symptoms, with sleep complaints and chronic pain. An interaction between these symptoms is suggested. For instance, a night of poor sleep is usually followed by hypersensitivity to pain and chronic pain always leads to sleep complaints. This interaction is suggested following an MTBI, however, data sustaining that hypothesis are still lacking. Data from the first article suggest that pain and other post-concussion symptoms are correlated with sleep-wake disturbances post-MTBI. MTBI patients with pain have more rapid electroencephalographic (EEG) waves during sleep than those without pain. This may suggest that there is an intrinsic physiological relationship between the two complaints. Moreover, pain seems to play an important role in the persistence of post-concussive symptoms. The second article of this thesis describes and details the exacerbation of post-concussive symptoms in the presence of pain following MTBI. The val66met polymorphism in the Brain-derived neurotrophic factor (BDNF) gene is an important predisposing factor for chronic pain. Lastly, a subsequent study, presented in the third article details the genetic and cellular basis of the role of BDNF in the persistence of post-concussive symptoms. Common polymorphisms in the BDNF genes were genotyped and revealed variants related to post-concussive symptoms following MTBI. Moreover, protein expression studies in lymphoblast cells of MTBI patients showed a modified expression of BDNF with the met genotype that might be neuroprotective. In summary, this thesis first shows that pain contributes to sleep-wake disturbances following MTBI and that the chronicity of post-concussive symptoms, including chronic pain, may be dependent on polymorphisms in the BDNF gene.

Atliktas perspektyvusis stebėjimo tyrimas, kurio metu buvo tirti sunkią galvos smegenų traumą patyrę vaikai, gydyti KMUK Vaikų intensyviosios terapijos skyriuje. Pacientų būklė pagal GBS vertinta išvykstant iš gydymo įstaigos ir po šešių mėnesių. Darbo tikslas Nustatyti sunkią galvos smegenų traumą patyrusių vaikų ligos baigčių prognozinius veiksnius. Darbo uždaviniai 1. Įvertinti ankstyvas ir vėlyvas sunkią galvos traumą patyrusių vaikų ligos baigtis. 2. Nustatyti sunkią galvos traumą patyrusių vaikų vidinio kaukolės slėgio ir smegenų perfuzinio slėgio ryšį su ligos baigtimis. 3. Nustatyti sunkią galvos traumą patyrusių vaikų traumos pobūdžio ryšį su ligos baigtimis. 4. Nustatyti paciento būkės vertinimo skalių ir laboratorinių tyrimų kritines reikšmes ir jų prognozinę vertę. 5. Nustatyti laboratorinių tyrimų kritines reikšmes ir jų prognozinę vertę. Išgyveno 80,5 proc. sunkią galvos smegenų traumą patyrusių vaikų. Išvykstant iš gydymo įstaigos 50 proc. pacientų, o po šešių mėnesių – 24,2 proc. pacientų traumos baigtis buvos bloga. Įtakos traumos baigtims turėjo kraujavimas po kietuoju smegenų dangalu, smegenų edema, kaukolės kaulų lūžiai. Nustatytos laktatų, gliukozės kiekio kraujo serume, vaikų traumų skalės, Glazgo komų skalės ir vaikų mirštamumo indekso 2 kritinės reikšmės, prognozuojančios mirtį, blogą baigtį išvykstant iš gydymo įstaigos ir po šešių mėnesių. Dekompresinė kraniotomija, atlikta, kai VKS = 24,5 mmHg,o SPS = 46.5 mmHg ligos baigčių nepakeitė. / The prospective observational study involved children after severe traumatic brain injury treated in Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital. The outcome according to Glasgow Outcome Scale was assessed on discharge and after six months The aim of the study was to determine the prognostic factors in children after severe traumatic brain injury. The objectives of the study: 1. To evaluate early and late outcomes in children after severe traumatic brain injury 2. To evaluate the relation of intracranial pressure and cerebral perfusion pressure with outcome in children after severe traumatic brain injury. 3. To evaluate the relation between type of injury and outcome. 4. To determine the threshold values for trauma scoring scales and to evaluate their prognostic significance. 5. To determine the threshold values for laboratory findings and to evaluate their prognostic significance. The survival rate was 80.5 %.half of patients had bad outcome on discharge and 24.4 % – had bad outcome after six months. The prognostic factors of outcome for children after severe traumatic brain injury were subdural hemorrhage, cerebral edema and skull fracture. Threshold values of Pediatric Trauma Score, Glasgow Coma Score and Pediatric index of Mortality 2 for death and bad outcomes on discharge and after six months were ascertained. Decompressive craniectomy performed at ICP ≥ 24.5 mmHg, CPP ≤ 46.5 mmHg had no impact on outcome in children after severe traumatic... [to full text]

Šiuo tyrimu siekta įvertinti, kaip keičiasi vaikų po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo būklė taikant kineziterapiją ankstyvuoju reabilitacijos etapu bei nustatyti veiksnius, kurie labiausiai įtakoja vaikų po traumos pažintinių funkcijų ir motorikos atsigavimą. Tyrimo uždaviniai: 1. Įvertinti vaikų po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo pažintinių funkcijų ir motorikos sutrikimus ankstyvojo reabilitacijos etapo pradžioje. 2. Įvertinti vaikų po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo pažintinių funkcijų ir motorikos kitimą ankstyvajame reabilitacijos etape taikant individualizuotą kineziterapiją. 3. Nustatyti veiksnius, turinčius įtakos vaikų po sunkaus trauminio galvos smegenų sužalojimo pažintinių funkcijų bei motorikos atsigavimui ankstyvajame reabilitacijos etape ir įvertinti jų prognozinę vertę. Atlikus tyrimą nustatyta, kad vaikams po sunkaus ir vidutinio sunkumo trauminio galvos smegenų sužalojimo ankstyvajame reabilitacijos etape stebimi motorikos (raumenų tonuso, raumenų jėgos, judesių koordinacijos) ir pažintinių funkcijų (sąmonės) sutrikimai sąlygoja šių vaikų hipokinezę bei savarankiškos veiklos sutrikimus. Individualizuota kineziterapija, taikoma vaikams po trauminio galvos smegenų sužalojimo ankstyvajame reabilitacijos etape, daugumai ligonių ženkliai pagerina jų savarankiškumą, tačiau pusei vaikų po sunkaus trauminio galvos smegenų sužalojimo ankstyvojo reabilitacijos... [toliau žr. visą tekstą] / Aim of the study – to establish the factors influencing the recovery of cognitive and motor functions during application of physical therapy in ESR among children suffering severe and moderate TBI. Objectives: 1. To evaluate the cognitive and motor disorders at baseline (start of ESR) among children suffering severe and moderate TBI. 2. To evaluate the changes of cognitive and motor functions applying personally-adjusted physical therapy during ESR for children suffering severe and moderate TBI. 3. To establish the factors influencing the recovery of cognitive and motor functions during ESR among children suffering severe and moderate TBI and to estimate factors’ predictive validity. The children after severe and moderate traumatic brain injury have motor (muscle tone and force, movements coordination) and cognitive (consciousness) disorders during early stage of rehabilitation resulting in hypokinesis and restricted independent activity. Individually-adjusted physical therapy during early stage of rehabilitation for patients after traumatic brain injury significantly improves their independence, though by the end of early stage of rehabilitation among severe traumatic brain injury cases the disorders of balance and walking still persist. About half of those children have motor disorders (toileting, dressing lower and upper body, bathing, independent walk, and walking stairs) and cognitive disorders (communication, social interaction, and problem solving). The motor... [to full text]

This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968).

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Traumatic brain injury (TBI) has a 20% mortality rate and a 10-15% rate of resultant permanent disability. The consequences of TBI range from brief loss of consciousness, to prolonged coma or death. Mild TBI is amongst the common causes of admission to trauma centers all over the world. Future technologies such as magnetic resonance elastography and robotic surgery demand information about the physical properties of brain tissue. Walsh and Schettini described the mechanical behavior of brain tissue under normal status as nonlinear viscoelastic behavior and defined the associated biomechanical changes and responses in a quantitative measurement of the material changes. Yet, there is still a lack of data concerning time-dependent deformation and mechanical property changes associated with TBI. My goal in this project was to describe these mechanical responses and to create a system for measuring and evaluating the mechanical response of brain tissue in vivo. This was to be achieved by inducing cortical contusions with a calibrated weight-drop method in seventy-four young adult male Sprague-Dawley rats. Instrumented indentation was performed on control brains and 1 hour to 3 weeks after contusion with intact dura using a 4-mm-diameter flat punch indenter to a maximum depth of 1.2 mm at loading. Loading rates did not exceed 0.34 N/min and 1.2 mm/min. In order to obtain force displacement data, we studied the elastic response of the traumatized brain tissue and the deformation process (creep) during the loading and unloading of indenter. After euthanasia, the brain was removed and evaluated histologically with different methods to reveal acute and chronic changes related to the contusion. The results revealed that the biomechanical properties of the brain tissue were changed after cortical contusion. Brain tissue elasticity decreased in the edematous brain at one day following the contusion and increased at 3 weeks, in association with reactive astroglial changes. This experimental technique, combined with mathematical modeling, might eventually lead to a better understanding of the physical changes in brain following TBI.

Traumatic brain injury (TBI) has a 20% mortality rate and a 10-15% rate of resultant permanent disability. The consequences of TBI range from brief loss of consciousness, to prolonged coma or death. Mild TBI is amongst the common causes of admission to trauma centers all over the world. Future technologies such as magnetic resonance elastography and robotic surgery demand information about the physical properties of brain tissue. Walsh and Schettini described the mechanical behavior of brain tissue under normal status as nonlinear viscoelastic behavior and defined the associated biomechanical changes and responses in a quantitative measurement of the material changes. Yet, there is still a lack of data concerning time-dependent deformation and mechanical property changes associated with TBI. My goal in this project was to describe these mechanical responses and to create a system for measuring and evaluating the mechanical response of brain tissue in vivo. This was to be achieved by inducing cortical contusions with a calibrated weight-drop method in seventy-four young adult male Sprague-Dawley rats. Instrumented indentation was performed on control brains and 1 hour to 3 weeks after contusion with intact dura using a 4-mm-diameter flat punch indenter to a maximum depth of 1.2 mm at loading. Loading rates did not exceed 0.34 N/min and 1.2 mm/min. In order to obtain force displacement data, we studied the elastic response of the traumatized brain tissue and the deformation process (creep) during the loading and unloading of indenter. After euthanasia, the brain was removed and evaluated histologically with different methods to reveal acute and chronic changes related to the contusion. The results revealed that the biomechanical properties of the brain tissue were changed after cortical contusion. Brain tissue elasticity decreased in the edematous brain at one day following the contusion and increased at 3 weeks, in association with reactive astroglial changes. This experimental technique, combined with mathematical modeling, might eventually lead to a better understanding of the physical changes in brain following TBI.

Bendras darbo tikslas: Įvertinti asmenų, patyrusių trauminį galvos smegenų pažeidimą, pažintinių funkcijų ir savarankiškumo sutrikimus ūmiu ligos periodu, panaudojant specializuotus vertinimo metodus bei Tarptautinę funkcionavimo, negalumo, ir sveikatos klasifikaciją. 1. Potemės „Pažintinių funkcijų vertinimas asmenims, patyrusiems trauminį galvos smegenų pažeidimą“ uždaviniai: 1. Įvertinti pacientų, patyrusių galvos smegenų traumą, pažintinių funkcijų lygį ūmiame periode. 2. Nustatyti pacientų, patyrusių galvos smegenų traumą, pažintinių funkcijų lygį, priklausomai nuo amžiaus, galvos smegenų traumos sunkumo. 3. Įvertinti pacientų, patyrusių galvos smegenų traumą, pažintines funkcijas panaudojant Tarptautinę funkcionavimo, negalumo ir sveikatos klasifikaciją. 4. Įvertinti pacientų, patyrusių galvos smegenų traumą, pažintinių funkcijų pokytį priklausomai nuo amžiaus, galvos smegenų traumos sunkumo. 2. Potemės „Savarankiškumo vertinimas asmenims, patyrusiems trauminį galvos smegenų pažeidimą“ uždaviniai: 1. Įvertinti pacientų, patyrusių galvos smegenų traumą, savarankiškumo gebėjimus ūmiame periode. 2. Nustatyti pacientų savarankiškumo lygį, priklausomai nuo amžiaus, galvos smegenų traumos sunkumo bei pažintinių funkcijų lygio. 3. Įvertinti pacientų, patyrusių galvos smegenų traumą, savarankiškumą panaudojant Tarptautinę funkcionavimo, negalumo ir sveikatos klasifikaciją. 4. Įvertinti pacientų, patyrusių galvos smegenų traumą, savarankiškumo gebėjimų pokytį priklausomai nuo... [toliau žr. visą tekstą] / The aim of the study: Evaluation of cognitive functions and self-dependence during the period of acute disease for the persons after traumatic brain injury (TBI), using specialized methods of evaluation and International Classification of Functioning, Disability and Health. 1.Goals of sub-theme: ,,Evaluation of cognitive functions and self-dependence for the patients after traumatic brain injury (TBI). 1. Evaluate person‘s after traumatic brain injury cognitive level in acute period. 2. Determine patient‘s level of cognitive functions after traumatic brain injury, according to their age, difficulty of brain injury. 3. Evaluate patient‘s after traumatic brain injury, cognitive functions with the help of International Classification of Functioning, Disability and Health. 4. Evaluate patient‘s after traumatic brain injury change of cognitive functions according to their age, difficulty of brain injury . 2. Goals of sub-theme: „Evaluation of self-dependence for the persons after traumatic brain injury (TBI)“: 1.Evaluate person‘s abilities of self-dependence during the acute period. 2. Determine patient’s after traumatic brain injury, level of cognitive functions, according to their age, difficulty of brain injury. 3. Evaluate patient‘s after brain injury change of cognitive functions with the help of International Classification of Functioning, Disability and Health. 4. Evaluate patient‘s after traumatic brain injury change of cognitive functions, according to their age... [to full text]