Every year millions of individuals suffer from traumatic brain injury (TBI) leading to permanent disabilities and even death. Mild TBI (mTBI) is the most common form of TBI comprising about 80-90% of all occurrences. Following a CNS insult like an mTBI, astrocytes can undergo activation resulting in the transformation into reactive astrocytes (RAs). RAs also play an important role in brain remodeling following an mTBI. Research on the mechanical complexity of the brain has important implications for understanding brain function and dysfunction, as well as for the development of new diagnostic and therapeutic tools for neurological disorders. This study aimed to develop and utilize an emph{in vitro} mTBI platform to investigate the intricate mechanical interplay between the extracellular matrix (ECM) and astrocytes following a simulated mTBI. Cellular mechanisms underlying mTBI and the contribution of mechanical forces that result in prolonged brain damage are yet to be comprehensively understood. Successfully devised mechanical characterization techniques for tissue-engineered models were developed utilizing atomic force microscopy and rheology. Astrocyte exposure to high-rate overpressure revealed altered mechanical properties of the surrounding matrix and decreased expression of laminin and collagen IV, which are critical for brain function and may contribute to pathologies associated with mTBI. The developed platform and methods provide new insights into the mechanistic complexity underlying ECM-astrocyte interactions following an mTBI. / Master of Science / Every year, millions of people suffer from traumatic brain injury (TBI), which can lead to permanent disabilities or even death. The most common form of TBI is mild TBI (mTBI), which accounts for 80-90% of all cases. After a mTBI, astrocytes, the most common cell type in the brain, can become activated and turn into reactive astrocytes (RAs). RAs play an important role in the brain's recovery following a mTBI. Understanding the mechanical complexity of the brain is crucial for developing new diagnostic and therapeutic tools for neurological disorders. This study aimed to investigate the mechanical interplay between the modeled tissue and astrocytes following a simulated mTBI using an emph{in vitro} platform. Development of mechanical characterization techniques allowed for any alterations caused by the astrocytes to their environment to be detectable. The astrocyte exposure to the simulated mTBI revealed altered mechanical properties of the surrounding environment and decreased expression of proteins laminin and collagen IV, which are critical to brain function and may contribute to pathologies associated with mTBI. This study provides new insights into the mechanistic complexity underlying the interaction between astrocytes and their environment, which could lead to the development of new treatments.

Both individual patient-related and injury-related factors predict functional outcomes following moderate-to-severe traumatic brain injury (M/S TBI). Other than binary outcomes such as death, little is known about the role of day-of-injury neuroimaging in predicting long- term outcomes. Classification systems for assessing the severity of injury using computerized tomography (CT) scans, such as the Marshall Classification System (MCS) or Rotterdam scale, have not been systematically studied to see how they relate to long-term rehabilitation and functional outcomes following M/S TBI. The MCS consists of six categories based on information about midline shift, basal cistern compression, surgery evacuation, and lesion size. The Rotterdam scale, however, is a summed score ranging from 1-6 based on the extent of basal cistern compression, extent of midline shift, presence/absence of an epidural lesion, and presence/absence of traumatic subarachnoid hemorrhage (tSAH) or intraventricular blood. The differences between these two CT scales suggest the possibility that MCS and Rotterdam scales may differ in their ability to predict subsequent rehabilitation outcomes. Thus, we compared the relative predictive value of MCS and Rotterdam scores on long-term rehabilitation functional outcomes using the Functional Independence Measure (FIM) at rehabilitation discharge and nine-month post-discharge follow up. The study included 88 participants (25 females, mean age: 42.0 [SD: 21.3]) with M/S TBI. Day-of-injury CT images were scored using both MCS and Rotterdam criteria. Functional outcomes were measured by the cognitive and motor subscales on the FIM at discharge and after nine-month follow up, and length of stay in rehabilitation. Data were analyzed using multiple linear regression models. Neither MCS nor Rotterdam scores nor rehabilitation length of stay significantly predicted motor or cognitive outcomes at discharge or nine-month follow-up. MCS and Rotterdam scales may have limited utility in predicting long- term functional outcome in a rehabilitation setting, but instead appear to be good predictors of acute outcomes, especially regarding mortality and elevated intracranial pressure (ICP). Future research could focus on CT characteristics such as midline shift to predict long-term rehabilitation outcomes to guide treatment instead of CT rating scales.

Traumatic brain injury (TBI) is a life-altering injury that can impact global functioning. The Centers for Disease Control (CDC) reports that yearly 2.2 million Americans experience a TBI, a large portion of whom are children and young adults who then face the prospect of attending university. Data emphasizes the number of younger individuals who may experience symptoms that can limit their ability to complete post-secondary education and continue on to the workforce (Allen & D'Amato, 2010). Individuals who experience a TBI have limited opportunities for advancement due to cognitive challenges and require additional support to achieve their full potential. To address the well-documented academic and employment-related obstacles that may await postsecondary students with TBI following their injuries, Project Career, a multi-site five-year initiative funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) was designed to promote the use of cognitive support technology (CST) and intensive case management to improve employment success among college and university students with TBI. The changes in behavior, emotions, communication and physical health experienced after sustaining a TBI are unique to each person, highlighting a need for individualized treatment and support (Cicerone, 2002; Whyte, Polansky, Fleming, Coslett, & Cavallucci, 1995). “Peer Connections for Success: A mentoring program for university students with TBI” will seek to develop a program that uses peer interaction to create individualized support that is grounded in theory and informed by the evidence. Several theories will guide the creation of the intervention; Social Comparison Theory (Festinger, 1954) and Adult Learning Theory (Knowles, 1984) both of which contribute to the best methods of learning for this population. Programs such as this have been applied to different populations however the evidence is limited for use with students with TBI. Evidence was collected to support the methods, assessments, and processes that were utilized in the program.

Thesis (Ed.D.)--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. / Problem The purpose of this study was to investigate the relation of anxiety to learning in brain injured adults, and to determine how their performance was affected by reassurance instructions, additional practice, and variations in task content and difficulty. Scope The study involved forty patients with brain injury of cerebrovascular origin who were admitted to the neurological service of a hospital in the Massachusetts Public Health system. The patients ranged in age from fifty to sixty six, and in intelligence quotient from eighty to one hundred and twelve. They were evenly divided on sex, but the lateral distribution of lesion favored the right cerebral hemisphere with seventy per cent of the patients having damage on that side, and thirty per cent on the contralateral side. None of the patients had dysphasic language disorders or visual disorders, and at the time of participation in the study all were scheduled to commence therapy within a period of two weeks. Procedure Patients scoring in the upper and lower forty per cent of the distribution of anxiety scores on both the Buss Anxiety Rating Scale, and the Manifest Anxiety Scale were matched in respect to age, intelligence, sex, and the lateral location of cerebral lesion. They were then assigned to either an additional practice or a reassurance instructions treatment category on the basis of a table of random numbers. [TRUNCATED] / 2031-01-01

Patients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of communicating in the hospital setting. Barriers to effective communication were identified as lack of time, education and access to the devices. Recommendations for future research include developing a documentation component that emphasizes nursing assessment and intervention through collaboration with the SLP. Additional recommendations for research include the examination of impact of AAC use on patient satisfaction and outcomes. Communication using AAC is necessary in order to improve patient outcomes for traumatic brain injured individuals. This can be achieved through increased collaboration with the SLP, and increased nursing knowledge of the available devices and their implementation.

Background: According to the Center for Disease Control and Prevention, approximately 1.6 to 3.8 million Americans suffer a sports related concussion each year. Concussion is defined as a transient alteration of the brain structure caused by a direct or indirect force. During the last decade, a vast amount of clinical research on the long term effects of repetitive head trauma has occurred, especially on the subject of chronic traumatic encephalopathy (CTE), depression and dementia. Objective: The purpose of this literature review is to examine the literature pertaining to multiple concussion and the long-term effects of multiple concussion such as neurodegenerative diseases and psychological. Methods: A literature review was conducted using an electronic search of the following databases: MEDLINE, Cochrane Database of Systematic Reviews, and SportDiscus. The key search terms included were concussion, "sport concussion" and "sports concussion". One of the above three terms needed to be in conjunction with one of the following key search terms: depression, dementia, "mild cognitive impairment", "chronic traumatic encephalopathy" (CTE), or "psychological disorder". Additional inclusion criteria also included studies that targeted the adult athlete population who had sustained more than one concussion. Studies only were included if they were peer-reviewed, in the English language, and were published after 1990. To be included in the review, the study must have examined the long term effects of repetitive concussion. Results: The research completed to date suggests there is a strong correlation between the number of concussions an athlete suffers and the long-term ramifications of neurodegenerative and psychological disorders. However, more research is needed.

Traumatic brain injury (TBI) history has been linked to damaged cognition and poorer quality of life. While this link has been established, there is not much known about this relationship in older adult populations experiencing normal cognitive decline. In the current study, mental status was predicted to moderate the relationship between TBI history and life satisfaction among older adults. Additionally, details of the injury - years since injury and time spent unconscious - were expected to play a role in this relationship. Per analyses, there was no relationship found between TBI history, mental status, and life satisfaction. Moreover, there was no link found between time since injury, time spent unconscious, mental status and life satisfaction. While insignificant, these results yield important findings. The results lend support to more positive long-term outcomes for those with a history of TBI than initially expected, especially if the TBI was mild and resulted in no loss of consciousness or a loss of consciousness less than 5 hours.

In this research study, the correlation and significance of head injuries in adult sex offenders that have committed crimes against children were measured and compared to a group of criminal offenders that have committed non-sex-related criminal offenses. Data on 30 randomly selected individuals from each of the two groups (60 individuals total) were collected to measure and compare the number of individuals with a head injury in each group. The purpose of this research was to gain a better understanding of why criminally deviant behaviors occur in adults. This research also hoped to encourage further research on this topic or similar topics that can lead to new ideas in prevention, intervention, and treatment plans in sex offenders.

The current study examined the prevalence of severe weather phobia in high school students who had experienced a traumatic weather event and considered possible predictor variables to distinguish between students who did and did not develop severe weather phobia after experiencing the traumatic weather event. Participants (N = 17) completed a diagnostic interview and various questionnaires. Severe weather phobia symptoms (e.g., excessive fear, avoidance, anticipatory anxiety, realization that fear is excessive, distress or dysfunction) were common in the sample. Higher levels of PTSD symptoms and certain coping styles distinguished between those with phobia or subclinical phobia and those without, indicating that traumatic responses to severe weather and coping with severe weather by using social support or restraint predicts the development of severe weather phobia.

Incurring high economic cost due to medical imaging modalities, there is a need for a low-cost, on site, diagnostic screening tool for the early detection of Traumatic Brain Injury (TBI). We hypothesize that patients with TBI will exhibit temporal and spatial gradient dynamics in the thermal signature on the surface of the skin, and that these dynamics reflect the inflammatory process. Hence, we implemented far-infrared (FIR) thermography using a blunt TBI rat model to analyze changes in the external, surface temperature gradient as an indication of internal inflammation. Results show a consistent increase in average surface temperature after 0.5 days of recovery post-impact. The trend in average surface temperature decreases after 1 day of recovery with a continual decline observed after a 4-day recovery. After 7 days of recovery, the average surface temperature begins to increase with a substantial surge seen 14 days post-impact. The trend appears to correlate well with the inflammatory process.