While multiple Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans suffer from mild Traumatic Brain Injury (mTBI), Post-traumatic Stress Disorder (PTSD), and co-morbid mTBI and PTSD, there remains difficulty disentangling the specific symptoms associated with each disorder using self-report and neurocognitive assessments. We propose that neurological soft signs (NSS), which are tasks associated with general neurologic compromise, may prove useful in this regard. Based on our review of the literature we hypothesized that individuals with PTSD would present with a greater number of NSS than controls or individuals with mTBI. Further, we hypothesized a synergistic effect, such that individuals with mTBI + PTSD would present with the greatest number of NSS. To test these hypotheses, we analyzed a subset of individuals (N=238) taken from a larger study of neurocognitive functioning in veterans. Participants completed a battery of neuropsychological measures, which included the Behavioral Dyscontrol Scale (BDS), the current study’s measure of NSS. A subset of other neuropsychological measures were also included to examine the utility of NSS over and above traditional neuropsychological measures. Individuals were removed from the study if they sustained a moderate/severe TBI or did not meet validity criteria on the Green’s Word Memory Test or the Negative Impression Management subscale of the Personality Assessment Inventory. Binomial logistic and multinomial logistic regression were used to examine the ability of NSS to discriminate between the study groups, first by themselves and then after the variance explained by the traditional neuropsychological measures was accounted for. Exploratory cluster analyses were performed on neuropsychological measures and NSS to identify profiles of cognitive performance in the data set. Results indicated that individuals in the mTBI and/or PTSD group had more NSS compared to controls. Of the individual NSS items only a go/no-go task of the BDS discriminated between groups, with worse performance among individuals in the mTBI, PTSD, and mTBI + PTSD group compared to controls. In contrast, the overall BDS score and individual NSS, in general, did not discriminate between the mTBI, PTSD, and mTBI + PTSD group. Overall, the current study suggests that, when eliminating participants who do not meet validity criteria, NSS do not aid in discriminating between individuals with mTBI, PTSD, and mTBI + PTSD.

Women are twice as likely to suffer from depression as men, yet stress and depression research has relied primarily on the responses of males. Early life stress is hypothesized to influence the development of vulnerability to depression while adult stress exposure can act as a trigger in those predisposed. This relationship is mediated by other environmental factors. Maternal care and the social environment appear to be particularly important for mammals. The purpose of this thesis was twofold: to develop an animal model of depression for use in female rats based on the chronic mild stress (CMS) model previously validated for use in male rodents, and to apply this model in female offspring of mothers exposed to physical restraint in the second half of gestation representing an early life insult. Results indicate that a modified CMS model was able to alter hedonic and physiological responses not present in the original model. Housing condition interacted with CMS in that effects were evident only in singly housed rats. While gestational stress (GS) altered maternal weight and behavioural profiles related to offspring care and anxiety, little to no behavioural effects were noted in juvenile or adult offspring. Applying the modified CMS model to adult female offspring resulted in an anhedonic-like response that recovered rapidly prior to the third week of CMS. Weight in GS female rats was attenuated throughout life beginning post weaning. When taken together, these results demonstrate that stress-based models, previously established in males, must be altered to accommodate the hormonally intact female rat in two ways: first, to eliminate extraneous variables that may interfere with the estrous cycle and mask possible stress effects, and secondly, to consider the appropriateness of individual stressors to induce a stress response in females. While a general lack of effect was noted in response to CMS, this was interpreted as a strong influence of housing and supportive early life experiences in protecting the female rat from the establishment of stress effects related to depression and anxiety. The housing practices employed here may be considered a model of stress-resilience and represents an encouraging avenue of future research.

Women are twice as likely to suffer from depression as men, yet stress and depression research has relied primarily on the responses of males. Early life stress is hypothesized to influence the development of vulnerability to depression while adult stress exposure can act as a trigger in those predisposed. This relationship is mediated by other environmental factors. Maternal care and the social environment appear to be particularly important for mammals. The purpose of this thesis was twofold: to develop an animal model of depression for use in female rats based on the chronic mild stress (CMS) model previously validated for use in male rodents, and to apply this model in female offspring of mothers exposed to physical restraint in the second half of gestation representing an early life insult. Results indicate that a modified CMS model was able to alter hedonic and physiological responses not present in the original model. Housing condition interacted with CMS in that effects were evident only in singly housed rats. While gestational stress (GS) altered maternal weight and behavioural profiles related to offspring care and anxiety, little to no behavioural effects were noted in juvenile or adult offspring. Applying the modified CMS model to adult female offspring resulted in an anhedonic-like response that recovered rapidly prior to the third week of CMS. Weight in GS female rats was attenuated throughout life beginning post weaning. When taken together, these results demonstrate that stress-based models, previously established in males, must be altered to accommodate the hormonally intact female rat in two ways: first, to eliminate extraneous variables that may interfere with the estrous cycle and mask possible stress effects, and secondly, to consider the appropriateness of individual stressors to induce a stress response in females. While a general lack of effect was noted in response to CMS, this was interpreted as a strong influence of housing and supportive early life experiences in protecting the female rat from the establishment of stress effects related to depression and anxiety. The housing practices employed here may be considered a model of stress-resilience and represents an encouraging avenue of future research.

Syftet var att undersöka hur chefer och medarbetare upplever att stödet är anpassat för att hjälpa unga vuxna med lindrig intellektuell funktionsnedsättning, samt om det behöver förbättras för framtiden. Det genomfördes med kvalitativ ansats där två chefer och två omsorgsassistenter intervjuades med stöd av en intervjuguide. Intervjuguiden täckte de fyra teman normalisering, identitet, utanförskap och socialt tillhörighet. Resultatet analyserades via en induktiv tematiserings metod och via teorierna KASAM och empowerment. Det mest framträdande resultatet var att informanterna är ense om att stödet har brister och inte är anpassat till den valda målgruppen, speciellt när det kommer till självbestämmande, familjebildning och arbetsmarknaden. / The purpose of this study was to examine how managers and employees experience the care for young adults with mild intellectual disabilities and if something needs to be done to make the support more adjusted to the these individuals. This was conducted with a qualitative study where two managers and two employees, who meets the target group of the study thought their profession, was interviewed. The interview guide covered the four main themes; normalization, individuality, alienation and social belonging. The results were analyzed through an inductive thematic analysis method through the theories SOC and empowerment. The most striking result was that the informants all agree that the support they have to offer isn’t adapted for the target group, especially when it comes to self-determination, building a family and labor market.

Concussion affects the adolescent population in large numbers, primarily because of the popularity of team sports that are played in middle and high school. This adolescent age group is more susceptible to the adverse effects of concussion due to physiological immaturity, and recovery for this population takes longer than in adults. Speech-language pathologists, who are trained to treat cognitive-communication deficits, are present in the majority of school systems throughout the United States, and could be a useful resource to manage and treat students who incur concussion. However, speech-language pathologists historically have not treated students with concussion, and may not be receiving adequate education regarding concussion in graduate programs. This study sought to ascertain the education, training, and experience regarding concussion of speech-language pathologists in Texas secondary schools. Anonymous survey responses were collected via an Internet survey platform, yielding 49 respondents for the final data pool. The answers provided by these respondents indicate Texas speech-language pathologists are not yet receiving adequate concussion education and training. Respondents reported low confidence levels in several key areas of concussion knowledge, and doubt regarding the speech-language pathologist's role in managing concussion. Recommendations include concussion-targeted graduate school curriculum as an extension of traumatic brain injury curriculum, increased continuing education efforts by ASHA regarding concussion and the speech-language pathologist's role in treating concussion, and further advocacy by ASHA for speech-language pathologists to be part of concussion management teams based in schools. / text

Objective: The nature of disaster research makes it difficult to adequately measure the impact that significant events have on a population. Large, representative samples are required, ideally with comparable data collected before the event. When Christchurch, New Zealand, was struck by multiple, devastating earthquakes, there presented an opportunity to investigate the effects of dose-related quakes (none, one, two or three over a 9-month period) on the cognition of Canterbury’s elderly population through the New Zealand Brain Research Institute’s (NZBRI’s) cognitive screening study. The related effects of having a concomitant medical condition, sex, age and estimated- full scale IQ (Est-FSIQ) on cognition were also investigated. Method: 609 participants were tested on various neuropsychological tests and a self-rated dementia scale in a one hour interview at the NZBRI. Four groups were established, based on the number of major earthquakes experienced at the time of testing: “EQ-dose: None” (N = 51) had experienced no quakes; “EQ-dose: One” (N = 193) had experienced the initial quake in September 2010; “EQ-dose: Two” (N = 82) also experienced the most devastating February 2011 quake; and “EQ-dose: Three” (N = 265) also the June 2011 quake at testing. Results: Two neuropsychological variables of Trail A and the AD8 were impacted by an EQ-dose effect, while having a medical condition was associated with poorer function on the MoCA, Rey Copy and Recall, Trail A, and AD8. Having a major medical condition led to worse performance on the Rey Copy and Recall following the major February earthquake. Males performed significantly better on Trail A and Rey Planning, while females better on the MoCA. Older participants (>73) had significantly lower scores on the MoCA than younger participants (<74), while those with a higher Est-FSIQ (>111) had better scores on the MoCA and Rey Recall than participants with a lower Est-FSIQ. Finally, predicted variable analysis (based on calculated, sample-specific Z-scores) failed to find a significant earthquake effect when variables of age, sex and Est-FSIQ were controlled for, while there was a significant effect of medical condition on each measure. Conclusion: The current thesis provides evidence suggesting resilience amongst Canterbury’s elderly population in the face of the sequence of significant quakes that struck the region over a year from September 2010. By contrast, having a major medical condition was a ‘more significant life event’ in terms of impact on cognition in this group.

The purpose of this study was to determine if there was a functional relation between a peer-delivered modified system of least prompts procedure (SLP) and an increase in level and trend of performance on finding the area of polygons or finding the volume of cylinders, spheres, and cones, and could the peer tutor reliably implement the modified SLP procedure with middle school students with mild to severe disabilities. A multiple probe days across participants design was used. Results from this study show that there was a functional relation across students in which students were able to make progress on academic math skills when taught by a peer tutor using the modified SLP procedure. The peer tutor was able to reliably implement the procedure to multiple students. Limitations and implications for practice are discussed.

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.

Darbo tikslas: įvertinti ankstyva Parkinsono liga (PL) be demencijos sergančių asmenų pažinimo funkcijas naudojant Kembridžo kompiuterinės neuropsichologinio ištyrimo sistemos testų rinkinį, palyginti rezultatus su kontrolinės grupės asmenų duomenimis bei nustatyti kognityvinių rodiklių ryšius su biologiniais žymenimis ir klinikiniais nekognityviniais PL simptomais. Darbo uždaviniai: ištirti ankstyva PL sergančių asmenų dėmesio, atminties, regos erdvinę ir vykdomąsias funkcijas, naudojant kompiuterizuotų testų rinkinį CANTAB eclipse 3.0.0, ir palyginti juos su kontrolinių asmenų duomenimis; nustatyti pacientų kognityvinių funkcijų ryšį su UPLVS skale įvertintu ligos sunkumu, transkranijinės sonografijos (TKS) metodu nustatytu juodosios medžiagos (JM) echogeniškumu, presinapsinio dopamine transporterio koncentracija dryžuotame kūne, nustatyta radionuklidinės kompiuterinės tomografijos (RKT) su I¹²³-FP-CIT būdu, miego, nuovargio bei demografiniais veiksniais, gyvenimo kokybės rodikliais, PL gydyti skiriamų vaistų vartojimu; išanalizuoti kompiuterizuotais testais įvertintų kognityvinių funkcijų diagnostinę vertę sergant ankstyva PL. Metodai. Tyrimas atliktas Vilniaus universiteto ligoninės Santariškių klinikų Neurologijos centre. Atrinkta 115 pacientų, sergančių ankstyva kliniškai tikėtina PL, kurie atitiko įtraukimo kriterijus bei nebuvo neįtraukimo kriterijų, ir 42 pagal amžių, lytį, mokymosi trukmę atrinkti kontroliniai tiriamieji, kurie nesirgo PL ar kitomis... [toliau žr. visą tekstą] / The aim of the study: to evaluate the cognitive functions of patients with early-stage Parkinson‘s disease (PD) without dementia using Cambridge Neuropsychological Test Automated Battery (CANTAB Eclipse 3.0.0), to compare the obtained results with the data of control subjects, to determine the associations of the variables of cognitive testing with biological markers and clinical non-cognitive symptoms of PD. Objectives: to examine attention, memory, visuospatial and executive functions of patients with early-stage PD without dementia using CANTAB Eclipse 3.0.0 and to compare the obtained results with the data of control subjects; to investigate the relationship between the cognitive functions of patients with early-stage PD and the severity of disease measured by UPDRS score, the echogenic properties of brainstem nigral substance (SN) examined by transcranial sonography (TCS), the striatal binding of presinaptic dopamine transporter determined by single-photon emission computed tomography (SPECT) with I¹²³-FP-CIT, sleep, fatigue, demographic factors and quality of life scores, the usage of medications for early-stage PD; to analize the diagnostic characteristics of particular computerised tests for evaluation of cognitive function in patients with early-stage PD. Methods. The study was performed at the Department of Neurology of Vilnius University Hospital Santariškių Klinikos. 115 patients diagnosed with clinically probable early-stage PD who met inclusion criteria and... [to full text]

The aim of the study: to evaluate the cognitive functions of patients with early-stage Parkinson‘s disease (PD) without dementia using Cambridge Neuropsychological Test Automated Battery (CANTAB Eclipse 3.0.0), to compare the obtained results with the data of control subjects, to determine the associations of the variables of cognitive testing with biological markers and clinical non-cognitive symptoms of PD. Objectives: to examine attention, memory, visuospatial and executive functions of patients with early-stage PD without dementia using CANTAB Eclipse 3.0.0 and to compare the obtained results with the data of control subjects; to investigate the relationship between the cognitive functions of patients with early-stage PD and the severity of disease measured by UPDRS score, the echogenic properties of brainstem nigral substance (SN) examined by transcranial sonography (TCS), the striatal binding of presinaptic dopamine transporter determined by single-photon emission computed tomography (SPECT) with I¹²³-FP-CIT, sleep, fatigue, demographic factors and quality of life scores, the usage of medications for early-stage PD; to analize the diagnostic characteristics of particular computerised tests for evaluation of cognitive function in patients with early-stage PD. Methods. The study was performed at the Department of Neurology of Vilnius University Hospital Santariškių Klinikos. 115 patients diagnosed with clinically probable early-stage PD who met inclusion criteria and... [to full text] / Darbo tikslas: įvertinti ankstyva Parkinsono liga (PL) be demencijos sergančių asmenų pažinimo funkcijas naudojant Kembridžo kompiuterinės neuropsichologinio ištyrimo sistemos testų rinkinį, palyginti rezultatus su kontrolinės grupės asmenų duomenimis bei nustatyti kognityvinių rodiklių ryšius su biologiniais žymenimis ir klinikiniais nekognityviniais PL simptomais. Darbo uždaviniai: ištirti ankstyva PL sergančių asmenų dėmesio, atminties, regos erdvinę ir vykdomąsias funkcijas, naudojant kompiuterizuotų testų rinkinį CANTAB eclipse 3.0.0, ir palyginti juos su kontrolinių asmenų duomenimis; nustatyti pacientų kognityvinių funkcijų ryšį su UPLVS skale įvertintu ligos sunkumu, transkranijinės sonografijos (TKS) metodu nustatytu juodosios medžiagos (JM) echogeniškumu, presinapsinio dopamine transporterio koncentracija dryžuotame kūne, nustatyta radionuklidinės kompiuterinės tomografijos (RKT) su I¹²³-FP-CIT būdu, miego, nuovargio bei demografiniais veiksniais, gyvenimo kokybės rodikliais, PL gydyti skiriamų vaistų vartojimu; išanalizuoti kompiuterizuotais testais įvertintų kognityvinių funkcijų diagnostinę vertę sergant ankstyva PL. Metodai. Tyrimas atliktas Vilniaus universiteto ligoninės Santariškių klinikų Neurologijos centre. Atrinkta 115 pacientų, sergančių ankstyva kliniškai tikėtina PL, kurie atitiko įtraukimo kriterijus bei nebuvo neįtraukimo kriterijų, ir 42 pagal amžių, lytį, mokymosi trukmę atrinkti kontroliniai tiriamieji, kurie nesirgo PL ar kitomis... [toliau žr. visą tekstą]