Using nationally representative data from South Africa, we examine lifetime prevalence of traumas and multiple traumas (number of events). Employing multiple regression analysis, the authors study the sociodemographic risk of trauma, and the association between trauma and distress. Results indicate most South Africans experience at least one traumatic event during their lives, with the majority reporting multiple. Consistent variation in risk is evident for gender and marital status, but not other sociodemographics. Trauma is positively related to high distress, and findings also support a cumulative effect of trauma exposure. Individuals with the most traumas (6+) appear at 5 times greater risk of high distress. This study highlights the importance of considering traumatic events in the context of other traumas in South Africa.

Indiana University-Purdue University Indianapolis (IUPUI) / The study aim is to identify pervasiveness and factors leading to secondary traumatic stress (STS) in school personnel to increase awareness of the need for support and help for school personnel who are affected by STS. School personnel is defined in this study as all personnel employed by schools and includes, teachers, administrators, staff, resource officers, custodians, lunch aids, bus drivers, nurses, social workers, etc. School personnel work together to support students and ensure that they learn not only educational material, but also social and emotional skills. They also provide a sense of safety for students. School personnel are tasked with providing seven hours of daily support to their students; however, lack of supports, constant stressors, and exposure to secondhand accounts of trauma, put school personnel at risk for STS. This dissertation includes a review of STS in school personnel, theory used to inform and understand STS, a systematic review of STS in school personnel, a cross-sectional study of STS in school personnel from a Midwestern County, and integration of findings including practical implications and need for future research.

Mild Traumatic Brain Injury (mTBI) can be broken into two categories; complicated and uncomplicated. These categories are based on structural imaging scans during the assessment of the injury. If abnormalities appear in the scan, we refer to it as complicated. The present research aims at determining whether there are differences in the neuropsychological deficits in the presences of positive neuroimaging as opposed to negative neuroimaging. This was accomplished with meta-analytic techniques. It was found that neuroimaging does not predict neuropsychological functioning in the chronic state of mTBI.

Atrophy of the corpus callosum (CC) is a documented consequence of moderate-to-severe traumatic brain injury (TBI), which has been expressed as volume loss using quantitative magnetic resonance imaging (MRI). Other advanced imaging modalities such as diffusion tensor imaging (DTI) have also detected white matter microstructural alteration following TBI in the CC. The manner and degree to which macrostructural changes such as volume and microstructural changes develop over time following pediatric TBI and their relation to a measure of processing speed is the focus of this longitudinal investigation. As such, DTI and volumetric changes of the CC in participants with TBI and a comparison group at approximately three and 18 months post injury and their relation to processing speed were determined.

Researchers studying the long-term cognitive sequelae of mild traumatic brain injury (mTBI) have produced disparate results. Some studies have shown little to no long-term cognitive effects while others have shown that persistent cognitive sequelae continue to affect a subgroup of patients. Meta-analysis has been used to try to integrate these contrasting results to foster a coherent understanding of the cognitive outcomes following mTBI. However, previous meta-analyses of long-term cognitive sequelae have used studies from a period of mTBI research where methodological rigor has been called into question (Carroll, Cassidy, Holm, Kraus, & Coronado, 2004). Using studies from this period, meta-analysts found little to no effect for long-term cognitive sequelae after mTBI: g = 0.07, d = 0.12 (Binder, Rohling, & Larrabee, 1997), g = 0.11(Frencham, Fox, & Mayberry, 2005), and d = -0.07 (Rohling et al., 2011). The present meta-analysis was conducted to address problems with methodological rigor in the studies used in these previous meta-analyses and address differences in meta-analytic methodology (Pertab, James, & Bigler, 2009). Studies published between January 2003 and August 2010 were rated using the 4-tiered American Academy Neurology (AAN) guidelines for methodological rigor to ensure homogeneity and the methodological rigor of included studies. Seven studies were identified that met criteria for a rating of I or II and five met criteria for the lower ratings of III or IV. When studies of all ratings were combined, a significant effect of g = 0.45 was observed. When only studies rated I and II were combined, a significant effect of g = 0.52 was observed while a significant effect of g = 0.38 was observed when only studies rated III and IV were combined. These effect sizes for long-term cognitive sequelae are much larger than those found in previous meta-analyses. Based on these results, it is likely that methodological rigor and/or heterogeneity amongst included studies can impact meta-analytic effect sizes associated with long-term cognitive sequelae following mTBI. However, analyses did not show that more rigorous studies (i.e., those rated I or II) had significantly higher effect sizes than less rigorous studies (i.e., those rated III or IV), t(10) = .636, p = .845. This non-significant finding may be a result of the analysis being underpowered given the small k. Significant effects for neuropsychological domain were also observed and are reported. Additionally, a conceptual critique of mTBI is made with recommendations for future development of the rating system that Cappa, Conger, and Conger (2011) have put forth for objectively rating the methodological rigor of neuropsychological studies. Concerns are addressed related to the mTBI literature in the areas of mTBI definition, definition of cognitive impairment, problems with the constructs of post-concussion syndrome (PCS) and persistent post-concussion symptoms (PPCS), heterogeneity of outcome measurement, and unaccounted for variables.

The SARS-CoV-2 pandemic has been a worldwide chronic, stress-inducing natural catastrophe associated with increased emotional challenging. Patients with Post-traumatic stress disorder (PTSD), self-injury behavior, and obesity are predisposed to aggravation of their symptoms at this time, requiring new therapeutic approaches to balance their disrupted neuro-hormonal stress axis. Here we present our observations of an off-label treatment with lamotrigine in an adolescent girl with PTSD, self-injury behavior, and obesity. Lamotrigine was an efficacious pharmaceutical intervention that helped the patient deal with chronic stress and associated anxiety. The results are discussed based on our previous basic research outcomes in animals and humans that focused on the glutamate-cortisol circuits within the limbic brain.

BACKGROUND: Several groups have instituted helmet initiatives with varying success across the world. Helmet use has been well documented to prevent traumatic brain injury. Despite the known benefits, many people, including university students, refuse to utilize helmets when riding bikes, mopeds, or motorcycles. We recognized a need within our community regarding the lack of helmet use at University of Florida and developed a program to institute change. METHODOLOGY: We identified community champions and hosted weekly round table discussion initiatives. Through these round table discussions we identified events already going on within the community and developed new opportunities to promote helmet use. We had stories from survivors and parents, utilized school administration support, and partnered with local bike shops. RESULTS: The pilot initiative was successful in increasing awareness across the city and got stakeholders excited in the process. It also spearheaded more data driven initiatives that will look at reduction of traumatic brain injuries in the clinical setting. CONCLUSION: This project highlights the University of Florida Helmet Initiative that has already generated renewed interest in safety and traumatic brain injury prevention. The school of nursing has implemented safety protocols and further support is being garnered by the administration across campus. Most importantly we have identified community champions that will carry the work forward.

Thesis (Ed.D.)--Boston University / Background: Season-ending injuries, particularly those to the anterior cruciate ligament (ACL), continue at a high-rate in many sports, particularly ski racing. Although many factors are thought to contribute to this injury rate in both genders, no study has looked at possible psychological influences. Hypothesis: There is a form of post-traumatic stress disorder (PTSD) that affects athletes after seeing someone in their own sport sustain a serious injury. The result could be a decrease in performance both on and off the mountain. In the worst-case scenario, this change in tactics could result in injury to themselves, representing an "injury contagion". Study Design: Case-control study; Level of evidence, 3. Methods: Students at four Eastern ski academies were studied for 3 consecutive years (2002-2005). The subjects ranged in age from 13-19 and consisted of 277 men (60.3%) and 182 women (39.7% ). When a subject sustained a season-ending injury, a peer group of that subject was tested for both psychological and performance effects. The results of this testing was compared to previous baseline testing and a similarly constructed control group from an academy without such an injury. Results: There were twelve season-ending injuries sustained over the three-year period. Significant data results were obtained from one aspect of the psychological testing of the peer group. There was a trend toward a possible "injury contagion" i.e. injury to a member of the peer group soon after injury to a teammate. Conclusions: Although the results of this study were inconclusive in establishing the existence of an "injury contagion", there were data to establish a psychological affect on some athletes after injury to one of their teammates. Clinical Relevance: Although a teammate's injury did not measurably effect performance and only showed mild evidence of a possible injury contagion, there were significant psychological affects noted in female subjects. School personnel should be trained in basic counseling techniques specific to this problem.

Blast-induced traumatic brain injury and hearing loss are two of the most common forms of the “invisible wounds of war” resulting from the United States’ Global War on Terror. Several published studies have been confirming recent reports from VA healthcare centers of blast-exposed Service Members complaining of auditory problems despite having hearing that is, for all intents and purposes, normal. Most common among these complaints is problems understanding speech in crowded and noisy situations. We hypothesized that problems with speech comprehension could either be the result of 1) damage to sensory areas in the auditory periphery or 2) blast-induced traumatic brain injury (TBI) to cortical networks associated with the processing of attention, memory, and other executive functions related to the processing of speech and linguistic information. In Chapter 1 of this thesis, we found that in a population of blast-exposed Veteran Service Members, problems with speech comprehension in noise were due to cognitive deficits likely resulting from issues related to their post-traumatic stress disorder (PTSD) diagnoses. Chapter 2 takes and expanded look at the topics of Chapter 1 with a more comprehensive battery of audiological, electrophysiological, and neuropsychological tests in active duty Service Members with and without a history of blast exposure. Unlike in veterans with PTSD, we found subclinical levels of peripheral auditory dysfunction, as well as evidence of compromised neural processing speed in the blast-exposed group. These deficits were also consistent with poorer performance on a standardized speech-in-noise test and lower self-reported ratings on an abbreviated version of the Speech, Spatial, and Qualities (SSQ) of Hearing questionnaire (Gatehouse and Noble, 2004). In Chapter 3,we modeled outcomes from the SSQ survey using objective measures of hearing function related to audibility, distortion of the neural representation of sound, attention, age, and blast status. We found for all subjects age and high frequency hearing thresholds predicted survey outcomes related to everyday listening ability. Within non-blast controls, however, measures of attention could differentiate between good and exceptional listening ability. Results from blast exposed subjects remained inconclusive. Collectively, these findings highlight the need for audiologists to take into account more than audiometric measures alone when diagnosing and treating hearing dysfunction in this unique and specialized patient population.

The Intensive Cognitive and Communication Rehabilitation program (ICCR), developed to advance young adults with acquired brain injury (ABI) to college, targets a range of cognitive domains (e.g., memory, writing, verbal expression) via classroom-style lectures, individual therapy, and technology- and computer-based interventions on an intensive schedule (i.e., six hours/day, four days/week, 12-week iterations). One of the driving hypotheses of this dissertation work is that cognitive rehabilitation programs that are embedded with principles of experience-dependent neuroplasticity (i.e., repetition, intensity, specificity, salience), like ICCR, should lead to changes in behavior and the brain. The initial two studies of this dissertation focused on the first aspect of this hypothesis (i.e., assessing the impact of ICCR on overall cognitive-linguistic function and specific cognitive domains important for academic success in young adults with ABI), while the final two studies addressed the second aspect (i.e., using fNIRS to measure brain activation during language and domain-general cognitive tasks in neurotypicals and individuals with ABI at a single timepoint and over time). In Study 1, young adults with ABI who participated in ICCR demonstrated significant gains in at least one standardized assessment of global cognitive-linguistic function, while control participants did not. Yet, the study did not reveal what specific cognitive domains important for academic success improved after the ICCR program—an essential intermediate step in evaluating the utility of these programs in preparing young adults with ABI for academic reentry. Study 2 addressed this unanswered question with a novel approach that aggregated items from standardized neuropsychological assessments into specific cognitive domains (e.g., attention, verbal expression, memory) and then, applied growth curve modeling to assess whether those domains improved significantly over time in young adults with ABI participating in the ICCR program. This study also directly compared whether the treatment group improved at a significantly faster rate in overall item accuracy and subdomain item accuracy than a deferred treatment/control usual care group, extending the findings from Study 1 with a larger participant sample. Study 3 was a pilot study using fNIRS to capture brain activation in expected regions during language and domain-general cognitive processing in neurotypicals and individuals with stroke-induced aphasia. Findings from the young healthy control group in this study would serve as a reference for interpreting brain activation patterns in the damaged brain in future work. This study also provided opportunities to determine the acceptability of the fNIRS behavioral tasks and acquisition procedures for individuals with stroke-induced aphasia and to assess the utility of a novel method for managing areas of lesion. Based on the robust findings of Study 1 and 2 (i.e., ICCR promoted gains in overall cognitive domains and specific cognitive processes important for college success) and the promising results of Study 3 (i.e., activation patterns during language and domain-general cognitive processing could be captured in neurotypicals and individuals with brain damage at a single timepoint using fNIRS), Study 4 was undertaken to assess pre- to post-treatment activation changes following ICCR participation via fNIRS. Five young adults with ABI underwent fNIRS measurement while performing the same behavioral task battery used in Study 3 (i.e. semantic feature, picture naming, arithmetic) before and after a 12-week semester of ICCR. This preliminary work provided opportunities 1) to apply fNIRS to measure treatment-related neuroplasticity in the ABI population; 2) to examine the extent to which treatment participants demonstrated changes in the brain following ICCR in conjunction with a positive treatment response and improved behavioral task accuracy; and 3) to identify methodological considerations for future studies in this area. In closing, this dissertation reviews key findings from each of these studies and discusses their implications for studying rehabilitation-induced recovery in adults with ABI in future work. / 2023-08-06T00:00:00Z