Despite evidence indicating negative consequences of repetitive head impacts (RHIs) on the brain, the long-term effects remain largely unknown. Contact sports, such as football, expose players to multiple collisions. Professional sports players have undergone thousands of concussive and sub-concussive RHIs over their careers. In this study we used structural 3T MRI to evaluate cortical thickness of 86 former NFL players (mean age ± SD = 54.9 ± 7.9 years old) and 24 former professional non-contact sport athletes as controls (mean age ± SD =57.2 ± 6.9 years old). Cortical thickness was compared between groups using FreeSurfer. The NFL players displayed decreased cortical thickness in the right temporal lobe and fusiform gyrus (cluster-wise p-value=0.0003, 90% CI=0.0001-0.0005) and the left pre- and postcentral gyrus (cluster-wise p-value=0.0096, 90% CI=0.0084-0.0109). When looking only at NFL subjects impaired in measurements of mood and behavior (n=36) compared to controls, NFL players displayed a similar but more extensive cluster of decreased cortical thickness in the right temporal lobe and fusiform gyrus (cluster-wise p-value=0.0001, 90% CI=0.0000-0.0002) and in the left supramarginal gyrus and pre- and postcentral gyrus, (cluster-wise p-value=0.0002, 90% CI=0.0000-0.0004). Reduced cortical thickness in NFL players is suggestive of the long-term effects of RHIs. Still, future studies are necessary for examining the time-course of damage and the implications of regional cortical thinning.

L'œdème cérébral et l'hypoxie cérébrale post-traumatiques sont les acteurs principaux de l'apparition des lésions ischémiques secondaires. L'erythropoïétine (Epo) sous sa forme recombinante humaine possède une activité anti-oedémateuse dans un modèle expérimental de TC diffus. Son action sur l'hypoxie cérébrale post-traumatique reste néammoins méconnue. De plus, les effets indésirables hématologiques de l'Epo ont conduit à la synthèse de dérivés de l'Epo ne possèdant pas d'activité hématopoïétique comme l'érythropoïetine carbamylée (CEpo). Dans ce contexte, mon travail de thèse a eu pour but d'évaluer les propriétés de l'Epo et de la CEpo dans le modèle de TC diffus. Un traitement intraveineux par CEpo à la dose de 50 µg/Kg a ainsi permis de diminuer précocemment l'œdème cérébral post-traumatique évalué in vivo par IRM de diffusion et ex vivo par gravimétrie spécifique. Cette propriété a impliqué l'inhibition de la phosphorylation de la voie Erk et s'est accompagnée de l'amélioration des fonctions motrices et cognitives jusqu'à 10 jours après le TC. Après une étude de validation sur des rats sains soumis à différentes conditions d'oxygénation, une méthode de mesure IRM de la saturation locale en oxygène (lSO2) cérébrale combinant l'effet BOLD avec la mesure du volume sanguin cérébral a montré une diminution de l'oxygénation cérébrale post-traumatique. Cette hypoxie cérébrale n'était pas en lien avec une diminution du débit sanguin cérébral attestée par méthode de premier passage d'un agent de constraste. Un collapsus des capillaires cérébraux était par ailleurs retrouvé en microscopie électronique. L'Epo à la dose de 5000 UI/Kg a été capable de restaurer l'oxygénation cérébrale en diminuant l'œdème astrocytaire péricapillaire. L'ensemble de ce travail a permis d'établir les bénéfices d'un traitement par Epo ou par CEpo sur l'œdème cérébral et l'hypoxie cérébrale post-traumatiques. / Post-traumatic brain oedema and brain hypoxia play a key role for the development of secondary ischaemic lesions. Erythopoïetin (Epo) is an anti-oedematous agent in the impact-acceleration model. However its action on brain hypoxia remains unkonwn. Neuroprotective derivatives of Epo that lack haematopoïétic properties, like carbamylated Epo (CEpo), have been developped to counter Epo side effects. In this context, our study aimed to assess the effect of Epo and CEpo on post-traumatic diffuse brain oedema and brain oxygenation. CEpo (50 µg/Kg) decreased brain oedema assessed by diffusion-weighted MRI and specific gravimetry 6 hours after the trauma. The anti-oedematous effect of CEpo was linked to Erk inhibition and was associated with an improvement of cognitive and motor functions, evaluated until 10 days after the insult. MRI using the combination of BOLD contrast and blood volume fraction measurement demonstrated a decrease of local brain oxygenation in our model, without franck ischemia (measurement of mild transit time by a first passage method). Epo (5000 UI/Kg) improved brain oxygenation by decreasing post-traumatic cerebral capillaries collapse due to astrocytic end-foot swelling. All these results demonstrated that Epo and CEpo could be seen as promising neuroprotective agents in traumatic brain injury.

As a field, Behavior Analysis lacks an evidence based solution to assessing and treating language deficits in individuals with brain injuries. Research suggests that using direct instruction with persons with brain injuries is the most effective approach for teaching skills. Research on the PEAK Relational Training System suggests it may be applicable to adults with brain injuries because it does not have an age maximum and it assesses and trains complex language skills. The purpose of the current research is to determine the PEAK Relational Training System's potential applicability in assessing language and cognition functioning in adults with brain injury. 20 adults with brain injuries served as the participants for this study. Using a Pearson Correlation, the relationship between performance on the PEAK assessment and the Ross Information Processing Assessment (RIPA-2), pre-morbid education levels, Glasgow Coma Scale scores, and the location of injury in the brain was analyzed. Significant relationships between PEAK and RIPA-2 scores and PEAK and number of years since injury were shown. Furthermore, implementation of the PEAK was shown to be highly reliable. The current research has shown the effectiveness of the PEAK Relational Training System Direct Training Assessment for adults with brain injury.

This diploma thesis is a part of the GAJU project entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 128/2016/S)". At the time when the thesis was elaborated, only the patients who suffered the cerebrovascular accident were engaged in the project, since in the hospital, no suitable patient after brain injury who would need a multidisciplinary team in home care had ever been sought. The selection of the patients was based on the communicative skills criteria e.g. if the skills to participate in the directed conversation based on the Functional Independence Measure Questionnaire (FIM), WHO Disability Assessment Schedule 2.0 and the follow-up questions concerning social issues, physiotherapeutic methods and techniques were preserved. Within the framework of the project, the research has not been finished yet. Given the above mentioned reasons, this thesis is therefore mainly focused on the identification of patients' needs after the cerebrovascular accident (CVA), on the period starting from its first incidence during the first three months period after the discharge from the hospital to home care. The complex results will be presented as a part of the publication activity of the project. The thesis comprises a theoretical and a practical part. The theoretical part presents a comprehensive view on the care for the patients who suffered the cerebrovascular accident. I addressed both the basic characteristics of the cerebrovascular accident and the organisation of the care for the patients in the Czech Republic; furthermore, the coordinated rehabilitation team, the role of a social worker, possibilities of social help provided by the welfare system to patients and their families, and the psychical condition of the patient. In the last chapter, I outline the general concept of human needs according to A. Maslow and describe important needs of the sick people. As far as the research part is concerned, my goal is to identify the needs of patients in home care after the brain injury. In connection with the aim of the thesis, two research questions were defined. The first question is: "What are the needs of the patients after brain injury?". The second question is: "What is the role of a social worker in meeting the needs of a patient with brain injury?" The qualitative research strategy was used; the instructional dialogue technique with patients after brain injury in the South Bohemia Region within the project. When analyzing the data collected from the patients during the first three months after the discharge from the hospital to the home care, seven major patient needs emerged need of help, need of psychical equilibrium, need of self-reliance, need of being without paint, need of recovering to the condition before CVA incidence, and need of establishing a new system of activities. Two of these needs, the need of recovering to the condition before CVA incidence and the need of establishing a new system of activities could be considered as principal, because the other needs are in general heading towards them. Furthermore, the analysis of the results showed the role of a social worker by means of which these needs can be saturated The results of the present thesis are used as a partial part from which the complex results of coordinated rehabilitation of patients after brain injury of the GAJU project are complied. The needs analysis of patients brought the proposals of dealing with/saturation of these needs and therefore had a direct impact on the lives of the respondents. The results of the research will become a part of the publication outputs of the above-mentioned projects.

The thesis is a part of the project called Coordinated rehabilitation of the patients with the brain injury (reg. n. GAJU 138/20146/S). The objective of this work is to find out what needs the families of patients with the brain injury have. This thesis has a theoretical and a practical part. According to research set consisting of 14 caregivers of patients after cerebrovascular accident and only one that cares about a patient after cranial trauma, the theoretical part describes a CMP characteristic, coordinated rehabilitation, the basic terms about family and the chosen concepts of needs. Based on the objective of the thesis, the research question was stated: What are the needs of family members who care about the patients with the brain injury in the home environment? The research was made by the qualitative strategy and the semi-structured interviews with the family members in South Bohemia region who cares about the people with the brain injury in the home environment. It was important that people with the brain injury have already been joined to the project. The interviews were done in the application called Atlas.ti. According to the analysis of the collected data, there are 9 main needs that are connected to each other. Concretely, it is a need of a care about the patient, about the house, the need of a family help, the need of professional and social services, economic security and quicker help by the social service, furthermore the need of free time, psychological well-being and being in touch with the society. The results of this thesis are a part of the complex results of the project GAJU called Coordinated rehabilitation of patients with the brain injury (ref. n. GAJU 138/20146/S). The analysis of the needs of family members was used to propose the solutions/saturation of the needs in order to influence the real life of interviewers.

The thesis is focused on the social work with people after brain damage and is part of the GAJU project called "Coordinated Rehabilitation of Patients after Brain Damage (Reg. No. GAJU 138/2016 / S)". Collaboration with social workers from the region of České Budějovice was part of this thesis. Their work also consists of working with people after brain damage. The purpose of the collaboration was to map out follow-up services after hospitalization of people after brain damage. Information about these organizations has been shared with the patients who were included in the GAJU project. The complex results of the project will be elaborated within the publishing activities. The diploma thesis is divided into two parts. The first - the theoretical part - is focused on the basic description of brain damage, there is more about the cerebral stroke, the coordinated rehabilitation team, the role of the social worker. There is also described the burden that the social worker as a person in the helping profession may face and burnout syndrome as a possible consequence of this burden. In the research part, the main objective was to find out what positives and negatives the social workers perceive in working with people after brain damage. This objective was completed through interviews with the social workers situated in České Budějovice. We can fully understand the extend of the social workers' work with people after brain damage thanks to the interviews. In connection with the goal, research questions have been identified: What are the positive and negative aspects of social work related to work with patient after brain damage according to the subjective opinion of a social worker? Another one: What influences the perception of positives and negatives which the social workers experience during their work? A qualitative research strategy was used, a technique of interviewing with use of instructions was chosen for the interviews with fourteen social workers of the organizations, whose target group also includes people after brain damage. Data was processed in Atlas.ti 7. The administration which is more and more demanding due to the legislation. That results in less time with client and more time with paperwork. Finance which is related to the funding of services, lack of resources for employee remuneration and the financial difficulty for clients. Lack of qualified staff, time consuming activities that are closely tied to the extensive administration and the fact that social workers often work beyond their job responsibilities and competencies. Non-cooperation of a client's family or lack of interest of family on the client, there is also the legislation, which is often in contradiction with practice according to interviews. The social workers have to follow the actual amendments of the law and that is time-consuming and exhausting, absence of follow-up organizations for patients after brain damage, lack of competencies/authority/information of social workers, insufficient motivation, lack of financial remuneration or lack of benefits for employees, conflicts with authorities, barriers that may occur during work of a social worker or insufficient resources. The analysis also reveals that social workers subjectively perceive these positives during their work with patients after brain damage: client satisfaction, helping people, the good feeling after job well done, positive feedback, fulfilling job, positive in relation to the work environment. The results of the thesis show that the positive aspects dominates over the negative ones. Work in a multidisciplinary team has been perceived positively amongst the social workers and beneficial for the clients and for the team. This work will serve as a sub-part for the elaboration of complex outcomes of coordinated rehabilitation of patients after brain damage from the GAJU project. Research results will become part of the publication outputs from the above-mentioned project.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Studies over recent years have highlighted the important role of creatine in health and in treating various neurological diseases. However, its role in secondary damage induced by traumatic brain injury (TBI) is not fully understood. The aim of this study was to evaluate the effect of creatine supplementation on the oxidative damage and susceptibility to seizures after TBI. For this, we used the model of fluid percussion injury (FPI) in rats, where brain damage is caused by a liquid column that causes a pressure on the dura intact of animal, which was previously exposed. Our results revealed that at 4 and 8 days after TBI, there was increased oxidative damage characterized by increased protein carbonylation and levels of species thiobarbituric acid reactive substances (TBARS), and also there was a reduction in Na+, K+ -ATPase activity. Statistical analysis (two way ANOVA) also revealed that creatine supplementation (300 mg / kg orally), beginning 30 minutes after TBI and continuing until 3, or 7 days after injury, reduced protein carbonylation and TBARS when analyzed at 4 and 8 days after injury. However, creatine supplementation did not protect the inhibition of Na+, K+-ATPase 4 and 8 days after TBI. Furthermore, the analysis electroencephalographic (EEG) showed that injection of a subconvulsant dose (35 mg / kg, intraperitoneally) of pentylenetetrazol (PTZ), 4 but not 8 days after TBI, decreased latency to the tonic- clonic seizures and increased the time spend in generalized seizure, when compared to the control group. Creatine supplementation had no effect on the convulsive parameters induced by PTZ injection. The experiments in this study suggest that in this experimental model of TBI, oxidative damage seems not to be directly involved in susceptibility to seizures after neuronal injury since the antioxidant capacity exerted by creatine does not protect against PTZ-induced seizures after TBI / Estudos realizados ao longo dos últimos anos têm destacado o importante papel da creatina na saúde bem como no tratamento de diversas doenças neurológicas. Entretanto, seu papel no dano secundário induzido por traumatismo cranioencefálico (TCE) não está totalmente compreendido. O objetivo de nosso estudo foi avaliar o efetio da suplementação com creatina sobre o dano oxidativo e suscetibilidade a convulsões após TCE. Para isto, utilizamos o modelo de lesão por percussão de fluido (LPF) em ratos, onde a lesão encefálica é provocada por uma coluna líquida que exerce uma pressão sobre a duramáter intacta dos animais, a qual foi previamente exposta. Nossos resultados revelaram que em 4 e 8 dias após TCE, houve o aumento do dano oxidativo caracterizado pelo aumento de carbonilação protéica e dos níveis de espécies reativas ao ácido tiobarbitúrico (TBARS) e, também, houve uma redução da atividade da enzima Na+, K+-ATPase. A análise estatística (ANOVA de duas vias) também revelou que a suplementação com creatina (300 mg/kg, via oral), iniciando 30 minutos após o TCE e prolongando-se até o 3º, ou 7º dia após a lesão, reduziu a carbonilação protéica e os níveis de TBARS, quando analisado no 4º e 8º dia após a injuria. Entretanto a suplementação com creatina não protegeu da inibição da enzima Na+, K+-ATPase 4 e 8 dias após a TCE. Além disso, a análise eletroencefalográfica (EEG) revelou que a injeção de uma dose subconvulsivante (35 mg/Kg, intraperitoneal) de pentilenotetrazol (PTZ), em 4, mas não em 8 dias após TCE, diminuiu a latência para as convulsões tônico-clônicas generalizadas e aumentou o tempo de sua duração, quando comparado ao grupo controle. A suplementação de creatina não exerceu qualquer efeito sobre os parâmetros convulsivos induzidos pela injeção de PTZ. Os experimentos realizados no presente estudo sugerem que, neste modelo experimental de TCE, o dano oxidativo parece não estar diretamente envolvido na suscetibilidade a convulsões após lesão neuronal uma vez que, a capacidade antioxidante exercida pela creatina não protege das crises convulsivas induzidas por PTZ após TCE.

OF DIPLOMA THESIS Author: Bc. Lenka Macková Supervisor: Mgr. Olga Marková Title: Evaluation of quality of life in patients with brain acquaired brain injury from the perspective of occupational therapy Abstract: Acquired brain injury is one of the most common causes of a reducing quality of life. The concept of quality of life is defined differently in different areas and there is no uniform definition. The theoretical part introduces the operationalization and conceptualization of concept of the quality of life and the use of evaluation of quality of life in occupational therapy in the Czech Republic and abroad. The aim of diploma thesis is to describe how acquired brain injury affects the quality of life, how to evaluate the quality of life in occupational therapy, and what quality of life areas are influenced after acquired brain injury and to evaluate subjectively the impact of occupational interventions on quality of life in these patients. The practical part contains 6 case studies of patients after acquired brain injury. Patients were assessed for quality of life through a WHODAS 2 subjective quality of life questionnaire and semi-structured interviews.This assessment was carried out before and after occupational intervention in patients after 2 months. The interviews and the results of the...

abstract: The objective of this small animal pre-clinical research project was to study quantitatively the long-term micro- and macro- structural brain changes employing multiparametric MRI (Magnetic Resonance Imaging) techniques. Two separate projects make up the basis of this thesis. The first part focuses on obtaining prognostic information at early stages in the case of Traumatic Brain Injury (TBI) in rat animal model using imaging data acquired at 24-hours and 7-days post injury. The obtained parametric T2 and diffusion values from DTI (Diffusion Tensor Imaging) showed significant deviations in the signal intensities from the control and were potentially useful as an early indicator of the severity of post-traumatic injury damage. DTI was especially critical in distinguishing between the cytotoxic and vasogenic edema and in identification of injury regions resolving to normal control values by day-7. These results indicate the potential of quantitative MRI as a clinical marker in predicting prognosis following TBI. The second part of this thesis focuses on studying the effect of novel therapeutic strategies employing dendritic cell (DC) based vaccinations in mice glioma model. The treatment cohorts included comparing a single dose of Azacytidine drug vs. mice getting three doses of drug per week. Another cohort was used as an untreated control group. The MRI results did not show any significant changes in between the two treated cohorts with no reduction in tumor volumes compared to the control group. The future studies would be focused on issues regarding the optimal dose for the application of DC vaccine. Together, the quantitative MRI plays an important role in the prognosis and diagnosis of the above mentioned pathologies, providing essential information about the anatomical location, micro-structural tissue environment, lesion volume and treatment response. / Dissertation/Thesis / Masters Thesis Bioengineering 2014

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2017-03-17T12:45:33Z No. of bitstreams: 1 PDF - Fábio Henrique Costa Ferreira.pdf: 13187089 bytes, checksum: d4ae565d43e98eb970955e2f76203929 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2017-03-22T15:19:26Z (GMT) No. of bitstreams: 1 PDF - Fábio Henrique Costa Ferreira.pdf: 13187089 bytes, checksum: d4ae565d43e98eb970955e2f76203929 (MD5) / Made available in DSpace on 2017-03-22T15:19:26Z (GMT). No. of bitstreams: 1 PDF - Fábio Henrique Costa Ferreira.pdf: 13187089 bytes, checksum: d4ae565d43e98eb970955e2f76203929 (MD5) Previous issue date: 2016-11-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Objective: To identify the prevalence of traumatic brain injury (TBI) in traffic accident victims with motorcycle assisted in a hospital of emergency and trauma. Methods: Cross- sectional study with a probabilistic sample composed by 309 medical records of patients victims of traffic accidents involving motorcycles during the period from January to December 2014, attended in Hospital Dom Luiz Gonzaga Fernandes in Campina Grande - PB. The research instrument consisted of a form containing the following variables: gender, age, day and hospitalization time, presence and type of bone fracture, presence of TCE, helmet, Glasgow coma scale, Marshall classification and the occurrence of death. It was realized a descriptive analysis of data using SPSS software 18. For bivariate analyzes were used the chi - square test and Fisher's exact, considering the value of statistical significance (p <0.05). Results: The prevalence of traumatic brain injury in traffic accident victims with motorcycle was 24.3%. There was a predominance of male victims (79.6%) and the age group of 21-30 years. It was found that the highest frequency of hospital admissions were recorded on Sundays (31.1%) and Saturdays (15.9%), predominantly night shifts (36.9%) and afternoon (28.8%).It was found statistically significant differences in the associations between TCE and helmet use (p = 0.008) and TCE and death (p = 0.001). Conclusion: It was observed a high prevalence of TBI in motorcycles traffic accident victims. The non-use of the helmet was associated with a higher frequency of TBI and the victims with TBI had higher risk to progress to death. / Objetivo: Identificar a prevalência de trauma cranioencefálico (TCE) em vítimas de acidente de trânsito com motocicleta atendidas em um hospital de emergência e trauma. Métodos: Estudo transversal com amostra probabilística composta de 309 prontuários de pacientes vítimas de acidentes de trânsito com motocicletas, no período de Janeiro a Dezembro de 2014, atendidas no Hospital Regional de Emergência e Trauma Dom Luiz Gonzaga Fernandes, em Campina Grande – PB. O instrumento de pesquisa consistiu de um formulário contendo as seguintes variáveis: sexo, faixa etária, dia da semana e horário de internação, presença e tipo de fratura óssea, presença de TCE, uso de capacete, escala de coma de Glasgow, classificação de Marshall e ocorrência de óbito. Realizou-se análise descritiva dos dados através do software SPSS 18. Para análises bivariadas foram empregados os testes de Qui-Quadrado e Exato de Fisher, considerando-se o valor de significância estatística ( p < 0,05). Resultados: A prevalência de traumatismo cranioencefálico em vítimas de acidentes de trânsito com motocicleta foi de 24,3%. Houve predomínio de vítimas do sexo masculino (79,6%) e da faixa etária de 21-30 anos. Verificou-se que as maiores frequências de internações foram registradas aos domingos (31,1%) e sábados (15,9%), predominando os turnos da noite (36,9%) e tarde (28,8%). Observaram-se diferenças estatisticamente significantes para as associações entre TCE e uso de capacete (p = 0,008) e TCE e óbito (p = 0,001). Conclusão: Pôde-se observar uma elevada prevalência de TCE em vítimas de acidentes de trânsito com motocicletas. A não-utilização do capacete foi associada a uma maior frequência de TCE e as vítimas que apresentaram TCE apresentaram maior chance de evoluir para o óbito.