There is a robust body of research regarding outcomes following pediatric acquired brain injury (ABI). However, these studies generally explore medium-term outcomes (i.e., 3 to 12-months postinjury), whereas functioning during acute stages following ABI is poorly understood. In particular, there is limited knowledge regarding caregiver functioning during a child’s hospitalization immediately after ABI. This study sought to identify and model caregiver and child predictors of ‘caregiver confidence’ in caring for their hospitalized child. Caregivers of 45 children with diverse types of new-onset acquired brain injuries completed self-report measures of their own psychological functioning, stress, and confidence levels, as well as their perceptions of their child’s stress and coping. Results showed that caregiver psychological functioning was negatively associated with caregiver confidence, and caregiver perceptions of child coping were positively associated with caregiver confidence. Child functional status did not serve as a significant mediator in this relationship as per the hypothesized model.

The 567-item MMPI-2 is the most widely used personality measure; it requires a sixth-grade reading level, takes 60-90 minutes to administer, and reports robust psychometrics. However, traumatic brain injury (TBI) sequelae can cause cognitive deficits that affect test-taking abilities and item endorsement during differential diagnoses of neurological and personality factors. Therefore, this study examined the clinical utility of the shortened 338-item MMPI-2-RF inventory with a post-acute TBI population as a practical alternative. The MMPI-2-RF requires a fifth-grade reading level and takes 35-50 minutes to administer. The MMPI-2-RF also includes revised versions of the MMPI-2 Validity Scales and new substantive scales that may better psychometrically account for personality in TBI sequelae, such the Somatic/Cognitive Scales. This study conducted an incremental validity analysis of the MMPI-2-RF with a non-litigating, post-acute care TBI population in Central Texas. The goal of the study was to explore the measure’s performance, or its ability to capture functional dimensions in a TBI sample. More specifically, the study examined the construct validity of MMPI-2 to MMPI-2-RF Validity and Restructured Clinical Scales, and criterion validity for the Somatic/Cognitive Scales with neuropsychological and neurobehavioral functioning measures. An archival neuropsychological database (N = 60) was analyzed of patients who participated in TBI rehabilitation treatment at a Central Texas hospital. MMPI-2-RF profiles were retrospectively scored with MMPI-2 archival data. Statistical analysis between MMPI-2 to MMPI-2-RF Validity and Restructured Clinical Scales was conducted. MMPI-2-RF Somatic/Cognitive Scales and criterion measures of Weschler Adult Intelligence Scale, 4th Edition (WAIS-IV), The Weschler Memory Scales, 4th Edition (WMS-IV), The Booklet Category Test, 2nd Edition (BCT), and the Neurobehavioral Functioning Inventory (NFI) were examined. Patient demographics and measurement qualities were reported with the sample. / text

This research provides an analysis of the relationship between demographic information and between specific vocational rehabilitation services and employment outcome in RSA consumers with traumatic brain injury (TBI). The findings suggest that these is a relationship between a consumers' race (i.e., White, Black, Hispanic, and Hawaiian), level of education, and presence of substance abuse. No relationship was identified between a consumers' gender, age, or race of Asian or American Indian consumers. When specific services of assessment, job placement, job search, and diagnosis/treatment were provided consumers were more likely to obtain employment. The specific services of job placement, job search and diagnosis/treatment also predicted consumers' employment outcome. Only three of these services, job placement, job search, and diagnosis/treatment were significantly related to consumers' weekly earnings at case closure. Diagnosis/Treatment was positively related, while job placement and job search were negatively associated.

Spontaneous subarachnoid hemorrhage (SAH) is a form of hemorrhagic stroke that accounts for approximately 7% of all strokes worldwide. Recently, researchers have gained insight into some possible genetic influences involved in the response to SAH. The goal of this study was to investigate the potential contribution of different mouse genetic backgrounds to brain injury after SAH. SAH was induced in 7 inbred strains of mice, and the degree of large artery vasospasm and brain injury was assessed. After 48 hours, SAH mice showed a significant reduction in middle cerebral artery diameter and increased neuronal injury in the cerebral cortex compared to sham controls. The degree of vasospasm and brain injury varied across strains. This data suggests that vasospasm and neuronal injury may not correlate, and that different genetic factors may influence each one. Future investigations may provide invaluable insight into the causes of these inter-strain differences and potential genetic contributors.

In recent years, increased focus has been placed on the role of intrauterine infection and inflammation in the pathogenesis of fetal brain injury leading to neurodevelopmental disorders such as cerebral palsy. At present, the mechanisms by which inflammatory processes during pregnancy cause this effect on the fetus are poorly understood. Our previous work has indicated an association between experimentally-induced intrauterine infection, increased proinflammatory cytokines, and increased white matter injury in the guinea pig fetus. In order to further elucidate the pathways by which inflammation in the maternal system or the fetal membranes leads to fetal impairment, a number of studies investigating aspects of the disease process have been performed. These studies represent a body of work encompassing novel research and results in a number of human and animal studies. Using a guinea pig model of inflammation, increased amniotic fluid proinflammatory cytokines and fetal brain injury were found after a maternal inflammatory response was initiated using endotoxin. In order to more closely monitor the fetal response to chorioamnionitis, a model using the chronically catheterized fetal ovine was carried out. This study demonstrated the adverse effects on fetal white matter after intrauterine exposure to bacterial inoculation, though the physiological parameters of the fetus were relatively stable throughout the experimental protocol, even when challenged with intermittent hypoxic episodes. The placenta is an important mediator between mother and fetus during gestation, though its role in the inflammatory process is largely undefined. Studies on the placental role in the inflammatory process were undertaken, and the limited ability of proinflammatory cytokines and endotoxin to cross the placenta are detailed herein. Neurodevelopmental disorders can be monitored in animal models in order to determine effective disease models for characterization of injury and use in therapeutic strategies. Our characterizations of postnatal behaviour in the guinea pig model using motility monitoring and spatial memory testing have shown small but significant differences in pups exposed to inflammatory processes in utero. The data presented herein contributes a breadth of knowledge to the ongoing elucidation of the pathways by which fetal brain injury occurs. Determining the pathway of damage will lead to discovery of diagnostic criteria, while determining the vulnerabilities of the developing fetus is essential in formulating therapeutic options. / Thesis (Ph.D, Anatomy & Cell Biology) -- Queen's University, 2008-03-06 20:24:03.417

Traumatic brain injury is one of the leading causes of death and disability in the North America, and can result in long-term physical and psychological consequences, which over time change brain injury from a medical problem to an issue of quality of life. Various self-care activities can significantly improve the quality of life in people living with a chronic health condition. However, research on self-care in these populations has focused on the physical aspect of self-care, often excluding other domains of functioning. There is minimal self-care research involving people who had a traumatic brain injury; however, it is important to understand how they experience and make sense of their injury and its consequences in order to develop more effective approaches to their rehabilitation and support systems. In this study, I interviewed adults with traumatic brain injury who had their injury at least two years prior to the study. Narrative analysis of their stories revealed that the participants faced the following difficulties: constructing an explanation for the injury, dealing with losses and limitations, feeling misunderstood and insignificant, and dealing with memory deficits and physical problems. The ways in which participants tried to overcome these difficulties was understood as self-care. It manifested in a variety of ways, including deliberate health-related behaviours, changes in one’s way of thinking, emotional regulation strategies, and linguistic and paralinguistic means used in the narratives. I discuss ways to understand the findings using different theoretical models, such as illness narratives, social disenfranchisement, and social disability models. The results of the study strongly suggest that our understanding of self-care should encompass both physical and psychological health.

Spontaneous subarachnoid hemorrhage (SAH) is a form of hemorrhagic stroke that accounts for approximately 7% of all strokes worldwide. Recently, researchers have gained insight into some possible genetic influences involved in the response to SAH. The goal of this study was to investigate the potential contribution of different mouse genetic backgrounds to brain injury after SAH. SAH was induced in 7 inbred strains of mice, and the degree of large artery vasospasm and brain injury was assessed. After 48 hours, SAH mice showed a significant reduction in middle cerebral artery diameter and increased neuronal injury in the cerebral cortex compared to sham controls. The degree of vasospasm and brain injury varied across strains. This data suggests that vasospasm and neuronal injury may not correlate, and that different genetic factors may influence each one. Future investigations may provide invaluable insight into the causes of these inter-strain differences and potential genetic contributors.

The purpose of this study was to evaluate the performance of adolescents with traumatic brain injury on a written persuasive discourse task. Nine adolescents with TBI (mean age = 14 years 4 months) and nine age, gender and education matched peers completed a written essay on the topic of whether trained animals in circuses should be allowed to perform for the public. Language measures included productivity (number of words, number of T-units and mean length of T-unit) and complexity (number of clauses, clause density and clause breakdown). Pragmatic measures were drawn from the developmental persuasive discourse literature and included essential elements of argument (claim, number of reasons, number of elaborations, conclusion, irrelevancies, repetition of information and attitude). In comparison to their age-matched peers, the TBI group produced significantly fewer reasons to support their claims, significantly more repetitions of information and failed to take alternative perspectives on the topic. There were no significant differences on any measures of language productivity or complexity, however the TBI group performed consistently below their peers on these measures. The results are discussed alongside current literature in the field of discourse production and persuasion. Implications for clinical practice and future directions for research in this area are also offered.

This study investigated the effects of working memory constraints on the comprehension of expository texts by adolescents with severe Traumatic Brain Injury (TBI). The performance of adolescents with TBI will be compared against a group of typically developing (TD) gender and age-matched peers. The research questions are: (1) How does the performance of adolescents with TBI compare to typically developing gender and age-matched peers on tasks examining comprehension of expository texts?; and (2) Does comprehension of expository text decrease when working memory constraints are increased for adolescents with TBI? Fifteen participants will participate in the study. One group of five adolescents with severe TBI and a second group of ten gender and age-matched typically developing adolescents without TBI completed a battery of assessments including: Test of Nonverbal Intelligence 3rd Edition (TONI-3), Clinical Evaluation of Language Fundamentals 4th Edition (CELF-4), Peabody Picture Vocabulary Test 3rd Edition (PPVT-3) and the Working Memory Span Task (Tompkins et al 1994). All participants also completed an experimental task which involved listening to an expository passage and answering comprehension questions. Scores were then submitted to statistical analysis using ANOVA methodology to determine the significance of any within and between group differences. Results showed that there was no significant group by task interaction effect. The study did show that there was a significant difference between the TBI and TD groups on the measure of working memory. Results of the study will enhance our understanding of how adolescents with TBI comprehend expository information. This study will also help to create a foundation for further research into this area which is critical for student’s success in secondary education.

There is a robust body of research regarding outcomes following pediatric acquired brain injury (ABI). However, these studies generally explore medium-term outcomes (i.e., 3 to 12-months postinjury), whereas functioning during acute stages following ABI is poorly understood. In particular, there is limited knowledge regarding caregiver functioning during a child’s hospitalization immediately after ABI. This study sought to identify and model caregiver and child predictors of ‘caregiver confidence’ in caring for their hospitalized child. Caregivers of 45 children with diverse types of new-onset acquired brain injuries completed self-report measures of their own psychological functioning, stress, and confidence levels, as well as their perceptions of their child’s stress and coping. Results showed that caregiver psychological functioning was negatively associated with caregiver confidence, and caregiver perceptions of child coping were positively associated with caregiver confidence. Child functional status did not serve as a significant mediator in this relationship as per the hypothesized model.