L'être humain utilise trois systèmes sensoriels distincts pour réguler le maintien de la station debout: la somesthésie, le système vestibulaire, et le système visuel. Le rôle de la vision dans la régulation posturale demeure peu connu, notamment sa variabilité en fonction de l'âge, du type développemental, et des atteintes neurologiques. Dans notre travail, la régulation posturale induite visuellement a été évaluée chez des participants au développement et vieillissement normaux âgés de 5-85 ans, chez des individus autistes (développement atypique) âgés de 12-33 ans, ainsi que chez des enfants entre 9-18 ans ayant subi un TCC léger. À cet effet, la réactivité posturale des participants en réponse à un tunnel virtuel entièrement immersif, se mouvant à trois niveaux de vélocité, a été mesurée; des conditions contrôles, où le tunnel était statique ou absent, ont été incluses. Les résultats montrent que la réactivité (i.e. instabilité) posturale induite visuellement est plus élevée chez les jeunes enfants; ensuite, elle s'atténue pour rejoindre des valeurs adultes vers 16-19 ans et augmente de façon linéaire en fonction de l'âge après 45 ans jusqu'à redevenir élevée vers 60 ans. De plus, à la plus haute vélocité du tunnel, les plus jeunes participants autistes ont manifesté significativement moins de réactivité posturale comparativement à leurs contrôles; cette différence n'était pas présente chez des participants plus âgés (16-33 ans). Enfin, les enfants ayant subi un TCC léger, et qui étaient initialement modérément symptomatiques, ont montré un niveau plus élevé d'instabilité posturale induite visuellement que les contrôles, et ce jusqu'à 12 semaines post-trauma malgré le fait que la majorité d'entre eux (89%) n'étaient plus symptomatiques à ce stade. En somme, cela suggère la présence d'une importante période de transition dans la maturation des systèmes sous-tendant l'intégration sensorimotrice impliquée dans le contrôle postural vers l'âge de 16 ans, et d'autres changements sensorimoteurs vers l'âge de 60 ans; cette sur-dépendance visuelle pour la régulation posturale chez les enfants et les aînés pourrait guider l'aménagement d'espaces et l'élaboration d'activités ajustés à l'âge des individus. De plus, le fait que l'hypo-réactivité posturale aux informations visuelles chez les autistes dépende des caractéristiques de l'environnement visuel et de l'âge chronologique, affine notre compréhension des anomalies sensorielles propres à l'autisme. Par ailleurs, le fait que les enfants ayant subi un TCC léger montrent des anomalies posturales jusqu'à 3 mois post-trauma, malgré une diminution significative des symptômes rapportés, pourrait être relié à une altération du traitement de l'information visuelle dynamique et pourrait avoir des implications quant à la gestion clinique des patients aux prises avec un TCC léger, puisque la résolution des symptômes est actuellement le principal critère utilisé pour la prise de décision quant au retour aux activités. Enfin, les résultats obtenus chez une population à développement atypique (autisme) et une population avec atteinte neurologique dite transitoire (TCC léger), contribuent non seulement à une meilleure compréhension des mécanismes d'intégration sensorimotrice sous-tendant le contrôle postural mais pourraient aussi servir comme marqueurs sensibles et spécifiques de dysfonction chez ces populations. Mots-clés : posture, équilibre, vision, développement/vieillissement sensorimoteur, autisme, TCC léger symptomatique, réalité virtuelle. / Maintaining upright stance is essential for the accomplishment of several goal-directed behaviors, such as walking. Humans use three distinct sensory systems to regulate their posture: the somatosensory, the vestibular and the visual systems. The role of vision in postural regulation remains poorly understood, notably its variability across the life-span, developmental type and neurological insult. Hence, visually-driven postural regulation was examined in typically developing and aging participants (5-85 years-old), as well as in atypically developing individuals with autism (12-33 years-old) and in children having sustained mTBI (9-18 years-old). In order to do so, participants' postural reactivity was assessed in response to a fully immersive virtual tunnel moving at 3 different velocities; control conditions were also included wherein the tunnel was either static or absent. Results show that visually-induced postural reactivity was strongest in young children, then attenuated to become adult-like between 16-19 years of age, and started increasing again linearly with age after 45 years until becoming strong again around 60 years. Moreover, at the highest tunnel velocity, younger autistic participants showed significantly less postural reactivity compared to age-matched controls and young adults (16-33 years-old). Finally, children having sustained mTBI, who were initially moderately symptomatic, exhibited increased visually-induced instability compared to their matched controls up to 12 weeks post-injury, although most of them (89%) were no longer highly symptomatic. Altogether, this suggests the presence of an important transition period for the maturation of the systems underlying sensorimotor integration in postural control at around 16 years of age, and further sensorimotor changes after 60 years of age; this over-reliance on vision for postural regulation in childhood and late adulthood could guide the design of age-appropriate facilities/ activities. Furthermore, the fact that postural hypo-reactivity to visual information present in autism is contingent on both the visual environment and on chronological age, enhances our understanding of autism-specific sensory anomalies. Additionally, the fact that children with mTBI show balance anomalies up to 3 months post-injury, even when they are no longer highly symptomatic may be related to altered processing of dynamic visual information and could have implications for the clinical management of mTBI patients, since symptoms resolution is commonly used as a criterion for return to activities. Finally, results stemming from populations with atypical development (autism) and with so-called transient neurological insult (mild TBI) not only contribute to enhance our understanding of sensorimotor integration mechanisms underlying postural control, but could also consist of sensitive and specific markers of dysfunction in these populations. Keywords : posture, balance, vision, sensorimotor development/ aging, autism, symptomatic mTBI, virtual reality.

Background: The hippocampus and corpus callosum have been shown to be vulnerable in head injury. Various neuroimaging modalities and quantitative measurement techniques have been employed to investigate pathological changes in these structures. Cognitive and behavioural deficiencies have also been well documented in head injury. Aims: The aim of this research project was to investigate structural changes in the hippocampus and corpus callosum. Two different quantitative methods were used to measure physical changes and neuropsychological assessment was performed to determine cognitive and behavioural deficit. It was also intended to investigate the relationship between structural change and neuropsychology at 1 and 6 months post injury. Method: Forty-seven patients with head injury (ranging from mild to severe) had undergone a battery of neuropsychological tests and an MRI scan at 1 and 6 months post injury. T1-weighted MRI scans were obtained and analysis of hippocampus and corpus callosum was performed using region-of-interest techniques and voxel-based morphometry which also included comparison to 18 healthy volunteers. The patients completed neuropsychological assessment at 1 and 6 months post injury and data obtained was analysed with respect to each assessment and with structural data to determine cognitive decline and correlation with neuroanatomy. Results: Voxel-based morphometry illustrated reduced whole scan signal differences between patients and controls and changes in patients between 1 and 6 months post injury. Reduced grey matter concentration was also found using voxel-based morphometry and segmented images between patients and controls. A number of neuropsychological aspects were related to injury severity and correlations with neuroanatomy were present. Voxel-based morphometry provided a greater number of associations than region-of-interest analysis. No longitudinal changes were found in the hippocampus or corpus callosum using region-of-interest methodology or voxel-based morphometry. Conclusions: Decreased grey matter concentration identified with voxel-based morphometry illustrated that structural deficit was present in the head injured patients and does not change between 1 and 6 months. Voxel-based morphometry appears more sensitive for detecting structural changes after head injury than region- of-interest methods. Although the majority of patients had suffered mild head injury, cognitive and neurobehavioural deficits were evidenced by a substantial number of patients reporting increased anxiety and depression levels. Also, the findings of relationships between reduced grey matter concentration and cognitive test scores are indicative of the effects of diffuse brain damage in the patient group.

L'être humain utilise trois systèmes sensoriels distincts pour réguler le maintien de la station debout: la somesthésie, le système vestibulaire, et le système visuel. Le rôle de la vision dans la régulation posturale demeure peu connu, notamment sa variabilité en fonction de l'âge, du type développemental, et des atteintes neurologiques. Dans notre travail, la régulation posturale induite visuellement a été évaluée chez des participants au développement et vieillissement normaux âgés de 5-85 ans, chez des individus autistes (développement atypique) âgés de 12-33 ans, ainsi que chez des enfants entre 9-18 ans ayant subi un TCC léger. À cet effet, la réactivité posturale des participants en réponse à un tunnel virtuel entièrement immersif, se mouvant à trois niveaux de vélocité, a été mesurée; des conditions contrôles, où le tunnel était statique ou absent, ont été incluses. Les résultats montrent que la réactivité (i.e. instabilité) posturale induite visuellement est plus élevée chez les jeunes enfants; ensuite, elle s'atténue pour rejoindre des valeurs adultes vers 16-19 ans et augmente de façon linéaire en fonction de l'âge après 45 ans jusqu'à redevenir élevée vers 60 ans. De plus, à la plus haute vélocité du tunnel, les plus jeunes participants autistes ont manifesté significativement moins de réactivité posturale comparativement à leurs contrôles; cette différence n'était pas présente chez des participants plus âgés (16-33 ans). Enfin, les enfants ayant subi un TCC léger, et qui étaient initialement modérément symptomatiques, ont montré un niveau plus élevé d'instabilité posturale induite visuellement que les contrôles, et ce jusqu'à 12 semaines post-trauma malgré le fait que la majorité d'entre eux (89%) n'étaient plus symptomatiques à ce stade. En somme, cela suggère la présence d'une importante période de transition dans la maturation des systèmes sous-tendant l'intégration sensorimotrice impliquée dans le contrôle postural vers l'âge de 16 ans, et d'autres changements sensorimoteurs vers l'âge de 60 ans; cette sur-dépendance visuelle pour la régulation posturale chez les enfants et les aînés pourrait guider l'aménagement d'espaces et l'élaboration d'activités ajustés à l'âge des individus. De plus, le fait que l'hypo-réactivité posturale aux informations visuelles chez les autistes dépende des caractéristiques de l'environnement visuel et de l'âge chronologique, affine notre compréhension des anomalies sensorielles propres à l'autisme. Par ailleurs, le fait que les enfants ayant subi un TCC léger montrent des anomalies posturales jusqu'à 3 mois post-trauma, malgré une diminution significative des symptômes rapportés, pourrait être relié à une altération du traitement de l'information visuelle dynamique et pourrait avoir des implications quant à la gestion clinique des patients aux prises avec un TCC léger, puisque la résolution des symptômes est actuellement le principal critère utilisé pour la prise de décision quant au retour aux activités. Enfin, les résultats obtenus chez une population à développement atypique (autisme) et une population avec atteinte neurologique dite transitoire (TCC léger), contribuent non seulement à une meilleure compréhension des mécanismes d'intégration sensorimotrice sous-tendant le contrôle postural mais pourraient aussi servir comme marqueurs sensibles et spécifiques de dysfonction chez ces populations. Mots-clés : posture, équilibre, vision, développement/vieillissement sensorimoteur, autisme, TCC léger symptomatique, réalité virtuelle. / Maintaining upright stance is essential for the accomplishment of several goal-directed behaviors, such as walking. Humans use three distinct sensory systems to regulate their posture: the somatosensory, the vestibular and the visual systems. The role of vision in postural regulation remains poorly understood, notably its variability across the life-span, developmental type and neurological insult. Hence, visually-driven postural regulation was examined in typically developing and aging participants (5-85 years-old), as well as in atypically developing individuals with autism (12-33 years-old) and in children having sustained mTBI (9-18 years-old). In order to do so, participants' postural reactivity was assessed in response to a fully immersive virtual tunnel moving at 3 different velocities; control conditions were also included wherein the tunnel was either static or absent. Results show that visually-induced postural reactivity was strongest in young children, then attenuated to become adult-like between 16-19 years of age, and started increasing again linearly with age after 45 years until becoming strong again around 60 years. Moreover, at the highest tunnel velocity, younger autistic participants showed significantly less postural reactivity compared to age-matched controls and young adults (16-33 years-old). Finally, children having sustained mTBI, who were initially moderately symptomatic, exhibited increased visually-induced instability compared to their matched controls up to 12 weeks post-injury, although most of them (89%) were no longer highly symptomatic. Altogether, this suggests the presence of an important transition period for the maturation of the systems underlying sensorimotor integration in postural control at around 16 years of age, and further sensorimotor changes after 60 years of age; this over-reliance on vision for postural regulation in childhood and late adulthood could guide the design of age-appropriate facilities/ activities. Furthermore, the fact that postural hypo-reactivity to visual information present in autism is contingent on both the visual environment and on chronological age, enhances our understanding of autism-specific sensory anomalies. Additionally, the fact that children with mTBI show balance anomalies up to 3 months post-injury, even when they are no longer highly symptomatic may be related to altered processing of dynamic visual information and could have implications for the clinical management of mTBI patients, since symptoms resolution is commonly used as a criterion for return to activities. Finally, results stemming from populations with atypical development (autism) and with so-called transient neurological insult (mild TBI) not only contribute to enhance our understanding of sensorimotor integration mechanisms underlying postural control, but could also consist of sensitive and specific markers of dysfunction in these populations. Keywords : posture, balance, vision, sensorimotor development/ aging, autism, symptomatic mTBI, virtual reality.

Adenosine Triphosphate (ATP) can be released as a signal between cells in an autocrine and paracrine manner that binds purinergic receptors. Highly conserved, purinergic receptors expressed on the cell surface of neurons and astrocytes are capable of being activated across eight orders of magnitude from hundreds of nanomolar ATP to millimolar. Genetically encoded fluorescent protein biosensors have been used to detect ATP outside the cell, but a high affinity extracellular ATP sensor is required to study the ATP signaling dynamics from nanomolar to micromolar magnitudes. Previously, our lab developed a first generation sensor of extracellular ATP called ECATS1 (Conley et al.). To develop an improved sensor, we caried out site-directed mutagenesis of the sensor's ATP binding site and identified a mutant that exhibited a 4-fold increase in ATP binding affinity in solution. We then optimized the membrane-tethering of the sensor to achieve the 4-fold increase in extracellular ATP binding affinity when measured on live cell.s This second-generation sensor was dubbed ECATS2. As a proof-of-concept application, we sought to detect ATP release from cells using <i>in vitro</i> models of edema. We subjected HEK293A cells to hypo-osmotic shock (HOS), revealing ATP release at micromolar levels. Then we tested HOS in cultured cortical astrocytes, also revealing micromolar ATP release. However, when we tested neuron-astrocyte co-cultures, we no longer observed ATP release in response to HOS. Interestingly, this implies that co-culture either entirely prevented ATP release from astrocytes or dampened it into the nanomolar range below the limit of ECATS2 detection. Thus, we have validated the development of a higher affinity, second-generation sensor and used it to discover that ATP release from astrocytes after HOS can be affected by the presence of neurons. <br>

Mechanical trauma to the brain, both big and small, and the method to protect the brain in its presence is a crucial field of research given the large population exposed to neuronal trauma daily and the benefit available through better understanding and injury prevention. A population of particular interest and risk are youth athletes in contact sports due to large accelerations they expose themselves to and their developing brains. To better monitor the risk these athletes are exposed to, their accumulation of head acceleration events (HAEs), a measure correlated with harmful neurological changes, was tracked over sport seasons. It was observed that few significant differences in HAEs accumulated existed between players of ages from middle school to high school, but there did exist a difference between sports with girls' soccer players accumulating fewer HAEs than football players. This highlights to risk youth athletes are exposed to and the importance of improved technique and individual player size. To better monitor HAEs for each individual, a novel head segmentation program was developed that extracts player specific geometries from a single T1 MRI scan that can improve the accuracy of HAE monitoring. Acceleration measures processed with individualized head model versus those using a standardized head model typically displayed higher accelerations, highlighting the need for individualized measure for accurate monitoring of HAEs and risk of neurological changes. In addition to the large accelerations present in contact sports, the small but constant strains produced by neural implants embedded in the brain is also an important field of neuro-mechanical research as the physical properties of neural implants have been found to contribute to the chronic immune response, a major factor preventing the widespread implementation of neural implants. To reduce the severity of the immune response and provide improved chronic functionality, researchers have varied neural implant design and materials, finding general trends but not precise relationships between the design factors and how they contribute the mechanical strain in the brain. Performing a large series of mechanical simulations and Cotter's sensitivity analyses, the relationships between neural design factors and the stain they produce in the brain was examined. It was found that the direction which neural implants are loaded contributes the most to the strain produced in the brain followed by the degree of bonding between the brain and the electrode. Directly related to the design of electrodes themselves, it was found that in most cases reducing the cross-sectional area of the probe resulted in a larger decrease of mechanical strain compared to softening the implant. Finally, a study was performed quantifying the resting micromotion of the brain utilizing a novel method of soft tissue micromotion measurement via microCT, applicable within the skull and the throughout the rest of the body.

No description available.

Timely access to child mental health services is a widespread concern. Many children with diagnosable disorders do not receive help. Untreated disorders can cause significant child and family impairment. Barriers to treatment can impede access. Few specialists, long wait lists and clinic-based services can be problematic. Families encounter treatment barriers related to travel (i.e., time off work or school; inconvenience; financial burden), stigma, and child resistance to therapy. Alternative models of care are needed. Distance telephone treatment (e.g., Strongest Families), can bridge the access gap. There is little understanding about the participants’ experience with distance treatment. The research objectives were: 1. to establish if therapeutic alliance exists between a) a parent-coach and b) a child-coach, when distance treatment is delivered by telephone with no face-to-face contact; 2. to explore the parents’ distance experiences and opinions; 3. to develop and validate the Treatment Barrier Index (TBI) scale derived from participants’ experiences; and 4. to use the TBI to examine treatment barrier differences (and therapeutic processes) between two delivery systems (Distance vs Face-to-face). Therapeutic alliance exists between adult-coach and child-coach with distance treatment. Participants found distance treatment to be more private and felt less stigmatized because of visual anonymity, compared to their opinions of face-to-face services. The TBI results indicated fewer perceived barriers with distance treatment. A significant difference was found between delivery systems in terms of perceived barriers, therapeutic alliance and self-disclosure as a group of variables. This suggests that there may be differences in therapeutic processes between systems. Therapeutic alliance scores were enhanced with distance treatment and found to positively correlate with self-disclosure and outcome scores; suggesting that these processes are important in the context of distance intervention. Cost-effective distance systems using non-professionals may be one way to increase access to child mental health services. Although some families may prefer the physical presence of face-to-face services, others prefer distance services. The results from these studies may help to inform system design improvements aimed at increasing service access. Improving models of care to meet participants’ needs could lead to increased service utilization, ultimately improving child health outcome.

Spasticity is highly prevalent in neurological conditions involving upper motor neuron lesions (UMNL). Lower limb spasticity is known to impair gait and limit participation in physical activity. Multimodal interventions including botulinum toxin A, orthoses, and physiotherapy have shown longer lasting improvements compared to unimodal interventions. Studies to date, however, have not examined the long term efficacy of this multimodal intervention nor have they examined the impact across a breadth of domains necessary to comprehensively and fully understand its impact. The aim of this study was to investigate the efficacy of a multimodal intervention to treat lower limb spasticity in adults using a longitudinal mixed-methods approach, including a comprehensive set of outcome measures spanning the domains of the International Classification of Functioning, Disability and Health (ICF) model. Seven-teen participants with chronic UMNL were included in the analysis as per inclusion criteria and showed improvements at 6 and 12 months, compared to baseline, within all domains of the ICF model. / Graduate / 0571 / 0382 / 0384 / jazkim@uvic.ca

L'objectif de cette thèse est d'étudier l'effet d'un entraînement explicite de la conscience phonémique (CP) en anglais L2 et les apports potentiels du tableau blanc interactif (TBI) comme instrument permettant de réaliser cet entraînement avec des apprenants de CE1. A partir des travaux de pédagogues tels que Borel-Maisonny et Caleb Gattegno, nous avons conçu des aides multimodales qui sont à la fois visuelles, sonores et kinesthésiques. Les couleurs de l'approche Gattegno ont été reprises pour créer des cartes de couleur auxquelles nous avons joint une représentation sonore du phonème. La carte sonore est également manipulable sur le TBI. En ce sens, la manipulation sur TBI pourrait aider la manipulation mentale des éléments. Les représentations des phonèmes constituent des représentations externes multimodales intégrées (REMI). Ces REMI ont été intégrées à un dispositif d'apprentissage permettant de valider les hypothèses de recherche. Il s'agissait non seulement d'évaluer l'efficacité de tâches explicites de conscience phonémique dans le cadre de l'apprentissage de l'anglais, mais également d'évaluer l'efficacité de l'utilisation du TBI pour réaliser les tâches de conscience phonémique. Ces hypothèses de recherche ont été testées à l'aide de trois groupes d'apprenants : deux groupes expérimentaux et un groupe contrôle. Un groupe a effectué des tâches explicites de conscience phonémique avec les REMI sur TBI (groupe ConsPhonoTBI), un groupe a effectué ces mêmes tâches de manière classique, c'est-à-dire mentalement sans aide multimodale (groupe ConsPhono), tandis que le groupe contrôle a fait des activités de vocabulaire anglais. La comparaison du groupe contrôle avec le groupe ConsPhono permet de déterminer l'effet d'un entraînement explicite de la conscience phonémique, tandis que la comparaison du groupe ConsPhono avec le groupe ConsPhonoTBI permet de déterminer l'effet des aides multimodales et de leur utilisation sur TBI dans le cadre de cet entraînement explicite. Cette recherche a pour objet une intervention dans le domaine du travail puisque les enseignants et les apprenants sont considérés comme étant en situation de travail. Cette recherche s'inscrit alors dans le cadre de l'ergonomie cognitive. En l'occurrence, la quasi-expérimentation a été menée en 2011-2012 auprès d'apprenants issus de classes de CE1 situées dans l'Isère. Dans la méthodologie de recherche mixte adoptée, les données qualitatives et quantitatives ont été triangulées et permettent d'obtenir des résultats ayant une validité interne. L'étude indique que le travail explicite de la conscience phonémique a un effet sur le niveau atteint dans ce domaine et que l'utilisation des REMI sur TBI permet d'atteindre un meilleur niveau dans le même laps de temps. Par ailleurs, cette étude indique que l'utilisation du TBI pour mener cet entraînement explicite permet à des enseignants non-spécialistes en langue de se décentrer pour réguler l'activité, de proposer une prononciation correcte aux élèves, renforçant ainsi le sentiment d'auto-efficacité au sens de Bandura (2003). En outre, le TBI favorise les échanges entre les apprenants au niveau du groupe classe et permet une découverte collective des phonèmes anglais.

Spasticity is highly prevalent in neurological conditions involving upper motor neuron lesions (UMNL). Lower limb spasticity is known to impair gait and limit participation in physical activity. Multimodal interventions including botulinum toxin A, orthoses, and physiotherapy have shown longer lasting improvements compared to unimodal interventions. Studies to date, however, have not examined the long term efficacy of this multimodal intervention nor have they examined the impact across a breadth of domains necessary to comprehensively and fully understand its impact. The aim of this study was to investigate the efficacy of a multimodal intervention to treat lower limb spasticity in adults using a longitudinal mixed-methods approach, including a comprehensive set of outcome measures spanning the domains of the International Classification of Functioning, Disability and Health (ICF) model. Seven-teen participants with chronic UMNL were included in the analysis as per inclusion criteria and showed improvements at 6 and 12 months, compared to baseline, within all domains of the ICF model. / Graduate / 2015-04-24 / 0571 / 0382 / 0384 / jazkim@uvic.ca