Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / In this pilot study, 28 subjects ages 0 to 6 years who had sustained head injuries were assessed as to their functional status at one and six months post hospital discharge. The functional assessments used were the Rand Child Health Scale, the Battelle Developmental Inventory Screening Test, the Battelle Developmental Inventory Motor Domain, and the Pediatric Evaluation of Disability Inventory. Correlations between these functional measures and trauma scores reported through the National Pediatric Trauma Registry (Glasgow Coma Scale; Injury Severity Score, and Pediatric Trauma Score) were calculated to determine the predictive capacity of the trauma scores in determining functional outcome. The trauma scores were not found to be reliable predictors of functional outcome in these young children. / 2031-01-01

The purpose of the current study was to explore potential differences in pre- and post-concussion performance on a computerized neurocognitive concussion test between African American and White high-school and collegiate student-athletes. A prospective case-control design was used to compare baseline and 2- and 7-day post-concussion computerized neurocognitive performance and symptoms between 48 White and 48 African American athletes matched for age, gender, and concussion history. The Immediate Post-Concussion Assessment Cognitive Test (ImPACT) version 2.0 (NeuroHealth System, LLC, Pittsburgh, PA, USA) computer software program was used to assess neurocognitive function (i.e., verbal and visual memory, motor processing speed, and reaction time) and concussion symptoms. Regardless of race/ethnicity, there were significant decrements in computerized neurocognitive performance and increased symptoms following a concussion for the entire sample. African Americans and Whites did not differ significantly on baseline or post-concussion verbal memory, visual memory, reaction time, and total reported symptoms. However, African American participants were 2.4× more likely to have at least one clinically significant cognitive decline on ImPACT at 7 days post-concussion and scored lower at 7 days post-concussion compared with baseline on processing speed than White participants. The authors concluded that the baseline ImPACT test was culturally equivalent and construct valid for use with these two racial/ethnic groups. However, in contrast, the findings support deleterious performance for the African American athletes compared with the White athletes on the ImPACT post-concussion evaluation that is of critical clinical relevance and warrants further research.

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Employee turnover is a major issue that health care organizations experience. One factor that contributes significantly to turnover is burnout. A significant amount of research on burnout has been conducted in health care settings, however it has primarily focused on health care professionals. Several job characteristics that associated with burnout may be particularly impactful for non-professionals. An area of health care that provides unique challenges and stressors is that of traumatic brain injury rehabilitation. Brain injury professionals report experience burnout and report experiencing higher levels of burnout the more time they spend with patients. There is a lack of research on the unique experiences of support staff in traumatic brain injury rehabilitation centers. This study explored the phenomena of burnout, turnover, and job satisfaction from the perspective of support staff in a post-hospital brain injury rehabilitation center. I conducted group interviews and administered surveys to explore the unique experiences of support staff. I used grounded theory method to analyze data. The analysis resulted in a balance model of support staff’s work experience. This model is a framework of risk and protective factors that appeared to influence whether these frontline rehabilitation staff experienced negative outcomes from this often challenging/stressful work environment. The model includes four axial categories: Doing the Work; Protective Factors; Risk Factors; and Imbalance of Factors. Within the four axial categories are twenty open-coding level categories. Implications for brain injury rehabilitation organizations and areas for future research are discussed.

Occupational accidents are a main source of traumatic brain injuries (TBIs), with TBIs accounting for a substantial portion of all work-related deaths. Motor vehicle accidents and falls are consistently leading causes of head injury and fatality across industries. These injuries can have serious long-term consequences on an individual's quality of life and lead to large economic costs within society. This thesis investigated sources of occupational TBI prevention within two industries, construction and professional motorsports. In the last twenty years there have been major safety advancements within these industries, and yet the risk of TBI still exists. There is a need for safety standards that better reflect real-world injury scenarios. First, this thesis considered improvements to construction hard hat safety standards by evaluating the ability of Type 1 and Type 2 hard hats to reduce head injuries due to falls. Hard hats were evaluated over a range of real-world fall heights and three impact locations, using a twin-wire drop tower. Linear acceleration was used to predict injury risks. Type 2 hard hats substantially reduced skull fracture and concussion risk when compared to Type 1, indicating that if more workers wore Type 2 hard hats the risk of severe head injuries in the construction industry would be reduced. Next, this thesis compared real-world motorsport crash simulations and head impact laboratory tests designed to simulate real-world head impacts. Deformation and change in velocity were used to compare the energy managed by each system. The laboratory results generally tested higher severity impacts, with higher accelerations, compared to the simulations, despite managing a similar amount of energy. This indicates a large amount of the energy involved in the simulations was managed by the surrounding protective systems. The differences between systems create challenges for representing real-world crashes in a laboratory setting. Overall, the comparison in this thesis raises considerations for future helmet testing protocols in order to better match real-world simulations. / Master of Science / Occupational accidents are a main source of traumatic brain injuries (TBIs), with TBIs accounting for a substantial portion of all work-related deaths. Motor vehicle accidents and falls are consistently leading causes of head injury and fatality across industries. These injuries can have serious long-term consequences on an individual's quality of life and lead to large economic costs within society. This thesis investigated sources of occupational TBI prevention within two industries, construction and professional motorsports. In the last twenty years there have been major safety advancements within these industries, and yet the risk of TBI still exists. There is a need for safety standards that better reflect real-world injury scenarios. This thesis considered improvements to construction hard hat safety standards by evaluating the ability of two different hard hat types to reduce head injuries due to falls. It also compared real-world motorsport crash simulations and head impact laboratory tests designed to simulate real-world head impacts. This comparison raises considerations for future helmet testing protocols in order to better represent real-world simulations.

Dementia is increasingly recognized as a major and growing threat to public health worldwide, and there is a critical need for prevention and treatment strategies. However, it is necessary that appropriate methodologies are used in the identification of risk factors. The purpose of this dissertation research was to develop further the body of literature featuring Markov chains as an analytic tool for data derived from longitudinal studies of aging and dementia. Data drawn from 649 participants in the University of Kentucky’s Alzheimer’s Disease Center’s (UK ADC) Biologically Resilient Adults in Neurological Studies (BRAiNS) cohort, which was established in 1989 and follows adults age 60 years and older who are cognitively normal at baseline to death, were used to conduct three studies. The first study, “Mild cognitive impairment: Statistical models of transition using longitudinal clinical data,” shows that mild cognitive impairment is a stable clinical entity when a rigorous definition is applied. The second study, “Self-reported head injury and risk of cognitive impairment and Alzheimer’s-type pathology in a longitudinal study of aging and dementia,” shows that when the competing risk of death is properly accounted for, self-reported head injury is a clear risk factor for late-life dementia and is associated with increased beta-amyloid deposition in the brain. The third study, “Incorporating prior-state dependence among random effects and beta coefficients improves multistate Markov chain model fit,” shows that the effect of risk factors, like age, may not be constant over time and may be altered based on the subject’s cognitive state and that model fit is significantly improved when this is taken into account.

The lived experiences of the family of a Traumatic Brain Injury (TBI) survivor is an under represented, yet growing field of qualitative psychological research. This thesis used a case study approach with a family in which one member sustained TBI thirteen years previously. Using conversational unstructured interview techniques, I participated with the family in eliciting public narratives around their experiences since the accident. These public stories were also thickened by individual interviews, which both supported and contradicted the public narratives. In the analysis I found two major narrative lines, the first of which was the baby-narrative which held that the injured person must not be injured any further in word or deed and must be protected at all time. The second dominant narrative was the fighting-narrative, which was characterised by language and actions around fighting/battling on behalf of the injured person against uncaring ‘others’. Several important suppressed or counter narratives emerged during the individual interviews, which could not be spoken about publically. I conclude that the power of the two dominant narratives is fuelled by constant rehearsal and enactment, which actually freezes the family and does not allow it to move forward. Suppressed stories are discussed as a possible avenue for therapeutic growth and for the evolution of the family story as they age.

Reitan and Wolfson's General Neuropsychological Deficit Scale and Left and Right Neuropsychological Deficit Scales were applied to Halstead-Reitan test data of individuals with psychotic or substance abuse disorders with and without a head injury.

Olfactory receptor neurons (ORNs) maintain the ability to regenerate. These neurons reside in the olfactory epithelium and project axons that connect to the olfactory bulbs. Despite the diffuse distribution of ORNs in the olfactory epithelium, they converge at discrete glomeruli in the olfactory bulb. In the P2 IRES tau-lacZ mouse, the P2 ORN subtype has been previously mapped to two glomeruli, using X-gal staining. To determine if age affects ORN regeneration, left olfactory nerve transections were performed on P2 mice from immature (five-weeks old) and mature (1 6-weeks old) groups. Following recovery, the olfactory bulbs were processed to observe ORN regeneration. A significant difference was seen in the number and mapping of full P2 glomeruli between lesioned and control olfactory bulbs, but not between the age groups. This suggests that age differences between the two groups in this study were not large enough to affect the regeneration of P2 ORNs.

Background: It is now well established that there are core cognitive impairments associated with a diagnosis of schizophrenia. In parallel with our increased understanding of these core deficits, our awareness that mentally ill offenders (MIOs) are at additional risk of cognitive impairment due to an increased rate of traumatic brain injury and substance abuse has also grown. Absent from the literature is evidence of whether these cognitive impairments change over longer periods of time in MIO’s and whether these changes, or baseline abilities, impact an individual’s risk of violence. Furthermore, the negative impact head injury has on an individuals’ cognitive, behavioural and psychological functioning is well documented. These changes can lead to an increased likelihood of violence and crime, yet there is currently a scarcity of knowledge regarding the prevalence of head injury within mentally ill offenders in Scotland and its association with risk-related outcomes. Aims: The aims of the present thesis were to; (a) Examine the course of cognition in N=49 mentally ill offenders who underwent neuropsychological assessment while in the State Hospital, Scotland in 2004-5, and assess whether baseline or change in cognition predicts violent incidents or risk at follow-up, and; (b) Examine the cross-sectional association between head injury, substance abuse and risk-related outcomes of all individuals within the forensic network in Scotland for whom data could be extracted (N=428). Hypotheses: (a) We hypothesized that processing speed, verbal comprehension, working memory, delayed verbal memory, delayed non-verbal memory, impulsivity, inattention and problem-solving would decline over a 10-year period, and that deficits in impulsivity, emotion recognition, working memory and delayed memory would predict patients’ risk-related outcomes in a sample of mentally ill offenders. (b) It was also hypothesized that the presence of head injury and/or substance abuse within patients would predict worse risk-related outcomes, namely: quantity of violent offences, risk of harm to self, risk of harm to others and severity of violent offences. Analysis: We conducted a series of repeated measures MANOVAs, MANCOVAs and hierarchical linear regressions in SPSS Statistics to test our hypotheses. Individuals with a primary or secondary diagnosis of a learning disability were excluded. Results: (a) Our results propose that cognitive abilities significantly change over time (F(1.51, 30.1) = 5.98, p = .011), but direction of change is ability dependent. We found that impulsivity (Effect Size (ES) = .253), inattention (ES = .233), working memory (ES = .288) and auditory delayed memory (ES= .268) worsen over time. Measures of impulsivity and working memory significantly predicted some, but not all, risk-related outcomes, however these effects became diluted once additional variables with shared variance were added into the predictive models. We did not find that traumatic brain injury, substance misuse or alcohol misuse significantly mediated change in cognition over time. (b) In the national cohort study, results suggested that head injury had a significant effect on HCR total scores, F(1,259) = 6.679, p = .010 (partial eta square = .025), violence during admission (χ2 = 5.545, p = .022) and violent offences at a .1 p-value only, F(1,259) = 3.495, p = .063 (partial eta square = .013). Drug misuse only had a significant impact on total violent offences, F(1,259) = 8.933, p = .003 (partial eta square = .033) and nothing else. Furthermore, the interaction between alcohol misuse and schizophrenia also only had impact on total violent offences, F(1, 259) = 7.516, p = .007 (partial eta square = .028). Head injury was not significantly associated with either historical or current self-harm, however alcohol misuse, drug misuse and schizophrenia were. Conclusions: Our results highlight the unstable nature of cognition in mentally ill offenders and the impact that head injury has on violence-related outcomes, over and above substance misuse and a diagnosis of schizophrenia. This has potentially renovating implications for clinical practice regarding risk management, assessment, and treatment planning.