Previous studies on retardates with rigidity of boundaries phenomena have not been concerned with the presence of brain injury. The primary objective of this experiment was to ascertain the degree of difference in rigidity between brain injured and non-brain injured retardates.

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The objective of this work was to evaluate the efficacy of an induced normothermia protocol by comparing patient mortality and outcomes in patients treated at Boston Medical Center (BMC) before and after the implementation of the protocol. The controls (regular fever management) and the cases (induced normothermia) were demographically similar, except there were more whites (p = 0.01) in the control group and more of the patients in the control group were transferred to BMC from outside hospitals (p = 0.006), although there was not a higher incidence of death among patients who were transferred from outside hospitals (p = 0.55). The patients in the case group were kept normothermic throughout the first 7 days of their hospital stay more effectively than those in the control group (p = 0.0001). Average intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were not different between the two groups, although mean arterial pressure (MAP) was (p = 0.84; p = 0.08; p = 0.02, respectively). Mortality was lower in the case group by hospital discharge (p = 0.007) and patients in the case group were more likely to achieve a positive functional outcome (p = 0.03). In light of these findings, there is a need for high-quality prospective trials to assess the efficacy of induced normothermia compared to regular fever management.

Working is a form of societal participation highly valued in American culture. The state-federal vocational rehabilitation system helps people with disabilities obtain and maintain employment in their communities. Although some people with traumatic brain injury return to work with minor adjustments, high proportions do not return to former employment or find work after their injuries. Analyzing vocational rehabilitation services, and other variables that impact competitive employment outcomes for this population, is important. This study examined the association of types and degree of limitations to functional capacities, and competitive employment outcomes; and selected VR services, and competitive employment, after controlling for demographic variables. The sample for this study consisted of 340 consumers of Illinois state-federal VR system whose cases were closed in fiscal years 2006 and 2007. Eligible individuals with TBI who did not receive services were also described (N=120). The present study also provided information on the types and reasons for case closure, length of rehabilitation, case expenditure, types and number of services received, and weekly earnings at case closure. Contrary to expectations, the degree of limitation across all areas of functional capacity, used by VR counselors to determine severity of disability, and priority for services, were not found to be significantly related to competitive employment among customers with TBI. Results also found that, when relevant demographic characteristics are controlled, the odds of achieving competitive employment increased significantly for VR clients with TBI in Illinois who received job placement and on-the-job supports. For clients who were of minority background, received SSI/SSDI at application, or had lower socioeconomic status (based on income, education and pre-service work status), these odds significantly decreased. Service variables were stronger predictors of competitive employment than demographic variables. Implications, future directions, and limitations of this study are also discussed.

Cognitive impairment is the most frequent cause of disability in humans following traumatic brain injury (TBI), yet the behavioral tasks used to assess cognitive behavior in rodent models of brain injury are underrepresented in the field. Additionally, few of these tasks have been used to assess behavior across degrees of injury severity. The goal of the present study was to compare four behavioral tasks commonly used in the field in frontally-injured rats with both mild and moderate-to-severe brain injuries. At the start of the study, rats were assigned to two of the following behavioral tasks: Dig scent discrimination (Dig) task, novel object recognition (NOR) task, Morris water maze (MWM), and passive avoidance (PA) task. Four days prior to injury, Dig rats were trained to dig in unscented sand and MWM rats were trained to locate a hidden platform positioned in the northeast quadrant of the MWM. Following training, bilateral controlled cortical impact injuries were induced (mild bilateral frontal TBI, moderate-to-severe bilateral frontal TBI, or non-injured, sham). Following a seven day recovery period, rats were tested on the two assigned behavioral tasks. Following testing, linear mixed effects modeling was performed assessing performance differences on the four tasks as a function of injury (injured vs. non-injured), injury severity (mild TBI vs. moderate-to-severe TBI), and task interaction. The results indicated that, while all four behavioral tasks were effective at assessing injury, some of the tasks were more effective at differentiating between injury severities than others. Specifically, the Dig task and MWM were effective at differentiating between rats with mild TBIs and rats with moderate-to-severe TBIs. Interactions between tasks also occurred such that Dig rats also assigned to the NOR task had significantly higher learning curves on the scent discriminations. The results from the current study indicate that all four behavioral tasks have the potential to assess cognitive impairment after TBI. However, these results are only a beginning. More work is needed before we can fully understand the efficacy of each of these tasks as behavioral assessment measures for cognitive functioning after TBI.

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The Marianjoy Rehabilitation Hospital (MRH) Occupational Therapy (OT) Pediatric Visual-Vestibular Dysfunction (PVVD) program is a clinical education and training program that aims to teach OT clinicians to better assess and treat PVVD in children with CNS cancer and/or other neurologic conditions. With a growing number of children surviving and participating in daily life with chronic and disabling health conditions, it is imperative that OTs stay informed on how to best support these children to live their best lives. Through education and training efforts of OTs at MRH, and by providing clinicians with tools to implement assessment and intervention techniques aimed to address PVVD, the program intends to expand OT practice and improve care for children with PVVD. In turn, this program will impact short and long-term health outcomes for these children. In addition to these training and clinical support efforts, the program will examine how effective these interventions are and publish results in order to advance OT practice and rehabilitation science as a whole. In combination with the outlined dissemination plan, the MRH OT PVVD program has the potential to significantly and positively influence OT practice and the lives of children with and at-risk for PVVD.

Every year 2.8 million Americans suffer a traumatic brain injury (TBI). Despite the prevalence and debilitating consequences of TBI, effective treatment options are scarce due to the limited understanding of the neurobiological effects of injury, especially in acute phases when the cellular processes leading to neuropathology are first initiated. To identify changes in neural function and cerebral blood flow (CBF) that might account for TBI-induced cognitive and sensory deficits, we took a multidisciplinary approach, examining synaptic function, cortical activity patterns, and microvascular hemodynamics. we used a weight drop model in mice to induce mild TBI, the most common form in humans, and focused on responses within the first hours of injury where existing data are particularly limited. For synaptic function, we measured excitatory and inhibitory input onto pyramidal cells in the piriform cortex with whole-cell recordings in acute brain slices. Increased excitation appeared at one hour but excitatory-inhibitory balance was reestablished by 48 hours, highlighting the importance of studying rapid-onset injury responses. We also compared neural activity before and after TBI using in vivo two-photon calcium imaging of pyramidal cells in visual cortex. While neural activity substantially decreased in most cells one hour after injury, a minority of cells showed hyperactivation or prolonged increases in intracellular calcium, again indicating major physiological disturbances during immediate post-injury phases. Finally, we measured in vivo changes in CBF throughout the cortical microvasculature with laser speckle contrast imaging and optical coherence tomography, tracking injury effects up to three weeks after TBI. CBF and capillary flow were dramatically reduced within minutes and remained suppressed for over one hour. As neurons’ high energetic needs require a constant supply of glucose and oxygen from local vasculature, decreased CBF likely contributes to altered neural activity and loss of ion homeostasis and thus potentially cognitive and sensory deficits after TBI. Our results reveal that even mild injury creates rapid, pronounced, and heterogeneous alterations in neural activity and capillary flow. The transient nature of these effects suggests that the first two hours after injury may be a key window for delivering interventions, and that restoring CBF may reduce damage due to metabolic stress.

Individuals with and acquired brain injury (ABI) often experience low motivation to engage in rehabilitation. However, measures of motivation and engagement in ABI populations are scarce. Currently, four such measures exist: the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self (BMQ-S), the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q), the BMQ-Relative (BMQ-R), and the Rehabilitation Therapy Engagement Scale (RTES), but are without sufficient psychometric investigations and lack a theoretical framework. The purpose of this thesis was to evaluate the psychometric properties of the BMQ-S, MOT-Q, BMQ-R, and RTES in adults with an ABI, and to discuss how motivation theory can inform assessment of motivation in ABI. Thirty-nine adult ABI participants and 20 clinicians were recruited from an ABI rehabilitation program. Patient participants completed the BMQ-S, the MOT-Q, and self-rated measures of insight, apathy, depression, and anxiety. Clinician participants completed the BMQ-R, the RTES, and clinician-rated measures of insight and apathy. The MOT-Q and the BMQ-S had excellent internal consistency and test-retest reliability. The MOT-Q correlated with insight, while the BMQ-S correlated with apathy, depression, anxiety, and insight. The MOT-Q and the BMQ-S did not correlate with each other. The RTES and BMQ-R had excellent internal consistency and good inter-rater reliability. The RTES and the BMQ-R correlated with apathy and insight, and with each other. In light of the result that the BMQ-S and the MOT-Q did not correlate, it was determined that each measure may represent equally important but distinct aspects of motivation. By drawing upon Self-determination Theory, it was concluded that the BMQ-S and the MOT-Q may represent intrinsic and extrinsic motivation, respectively, and that utilizing both can provide a more comprehensive understanding of what factors are influencing a patient’s level of motivation to engage. / Thesis / Master of Science (MSc) / Low motivation to engage in rehabilitation is a common problem in acquired brain injury (ABI) populations. Four current measures of patient and clinician-rated motivation and engagement designed for ABI exist: the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self (BMQ-S), the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q), the BMQ-Relative (BMQ-R), and the Rehabilitation Therapy Engagement Scale (RTES). However, these measures have insufficient investigations into whether they accurately measure motivation, and lack a theoretical framework as a basis of assessment. The goal of this thesis was to determine the reliability and validity of four motivation and engagement measures in an ABI population, and discuss the role of motivation theory in improving assessment of motivation in ABI. The results of this thesis suggest that all measures have good to excellent reliability and validity, and that the BMQ-S and the MOT-Q may represent distinct but equally important aspects of motivation in ABI.