No description available.

The prevalence and sequelae of moderate-to-severe (M/S) traumatic brain injury (TBI) are significant and pervasive problems, and effective rehabilitation techniques are key. Errorless learning is regarded as a useful tool for memory impairments; however, the efficacy of errorless learning in a M/S TBI population is unclear. The primary goal (aim 1) of this study was to evaluate the efficacy of a single session of errorless vs. errorful learning in a group of M/S TBI survivors and matched controls. A secondary goal (aim 2) was to investigate the neural time course of errorless learning in participants with M/S TBI by analyzing the error-related negativity (ERN) component of the scalp-recorded event-related potential (ERP). The ERN is an electrophysiological measure of error processing that is disrupted in M/S TBI survivors. Measures of neuropsychological performance, self- and informant-report of executive functioning, and affect further informed both study aims. Data from 28 M/S TBI survivors (9 female) and 28 controls (9 female) were analyzed for aim 1, with data from 19 M/S TBI survivors (6 female) and 20 controls (8 female) analyzed for aim 2. There were significant differences between the TBI and control groups with regard to executive, mood, and neuropsychological functioning. Results from aim 1 indicated that TBI participants were slower across learning conditions, while both groups had significantly faster reaction times in the errorless condition. Regarding accuracy, there was not a statistically significant main effect of learning condition (p = .07), group (p = .06), or Group x Condition x Accuracy interaction (p = .33). Indices of memory and executive functioning, and group (TBI, Control) used in regressions predicted accuracy in both learning conditions (ps < .01). The memory composite was a significant independent predictor of errorless accuracy. Results from aim 2 indicated a reliable ERN was present across conditions, although there were no main effects of Condition, Group, or Group x Condition interactions on ERN amplitude or latency (ps > .22). ERN latency was not predictive of accuracy for either condition (ps > .08). Group was a significant independent predictor of accuracy in the errorless condition (p = .05), but not the errorful condition (p = .45). Findings indicate that memory functioning was a better predictor of accuracy than executive functioning or group membership. This suggests that the errorless learning benefit may be specific to memory functioning, rather than other cognitive variables. This conclusion aligns with research reporting that benefits of errorless learning depend upon the severity of memory impairments. Results from ERN analyses are only partially supported by previous research, and further work is needed to clarify the role of neural representations of errorless learning in M/S TBI.

This study sought to determine how the severity of injury and cause of injury influences engagement in productive work. Using archival research, 1,322 records of adults diagnosed with Traumatic Brain Injury (TBI) were examined for the following variables: engagement in productive employment, job stability, severity of injury, cause of injury, satisfaction with life, and participation activities after TBI. Analysis of variance revealed significant differences in job stability and engagement in productive work between pre-injury and postinjury, which suggests that TBI has an impact on job stability. While no statistically significant differences were found in engagement in productive work among participants with mild, moderate, or severe TBI, there were significant differences in engagement in productive work based on cause of injury. Specifically, the study found that patients with vehicle-related TBI had significantly lower job engagement in productive work when compared with other causes of TBI. In addition, the multiple regression indicated that severity of injury, measured using Glasgow Coma Scale (GCS) score, is a significant predictor of employment outcome when severity of injury is treated as a continuous variable rather than a categorical variable that involves mild, moderate, and severe TBI. This finding suggests that patients with mild TBI may have different employment outcomes based on their GCS score; the case is the same for patients with moderate and severe TBI. Findings from this research have implications for employers, service providers, and policy makers. Employers must understand that TBI reduces employee productivity, which can be increased by focusing on participation activities and life satisfaction efforts. Rehabilitation centers have to focus on community integration efforts and efforts aimed at ensuring that TBI patients secure meaningful employment.

Prior research has established that a history of post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI) increases the risk of suicide behavior. Few studies have examined the role of specific PTSD symptom clusters and suicide attempts. The current study is among a handful of studies that have examined the association between the presence of PTSD symptom clusters and suicide attempts among Veterans with PTSD and/or TBI. The study utilized archival data from a sample of 137 Veterans receiving mental health treatment at the Denver Veteran Affairs Medical Center. Results from logistic regression analyses indicated that PTSD symptom clusters were not associated with an increased risk for suicide behavior among individuals with and without a history of TBI. Results suggest that looking at the presence of PTSD symptoms is not sufficient to account for the risk of suicide behavior. Clinical and research implications on the need to examine the role of PTSD symptom severity and suicide behavior are discussed.

The Polytrauma/TBI Rehabilitation Center (PRC) of the Veterans Affairs Hospital (VAH) treats patients with Traumatic Brain Injury (TBI). These patients have major motor and cognitive disabilities. Most of the patients stay in the hospital for many months without major improvements. This suggests that patients, family and the VAH could benefit if healthcare provider had a way to better assess or "predict" patients' progression. The individual progress of patients over time is assessed using a pre-defined multi-component performance measure Functional Independence Measures (FIM) at admission and discharge, and a semi-quantitative documentation parameter Clinical Pathway (CP) at weekly intervals. This work uses already de-identified and transformed data to explore developing a clinical outcome predictive model for patients with TBI, as early as possible. The clinical outcome is measured as percentage of recovery using CP scores. The results of this research will allow healthcare providers to improve the current resource management (e.g. staff, equipment, space) through setting goals for each patient, as well as to provide the family more accurate and timely information about the status and needs of the patient.

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

Epilepsy is a common neurological disease affecting 6 million people in Europe. Early prevention and accurate diagnosis and treatment are of importance to obtain seizure freedom. In this thesis new applications of carbon-11-labelled tracers in PET and autoradiographic studies were explored in focal epilepsy. Patients with low-grade gliomas often experience epileptic seizures. A retrospective PET-study assessing seizure activity, metabolic rate measured with 11C-methionine and other known prognostic factors was performed in patients with glioma. No correlation was found between seizure activity and uptake of methionine. The presence and termination of early seizures was a favourable prognostic factor. Activation of the neurokinin-1 (NK1) receptor by substance P (SP) induces epileptic activity. PET with the NK1 receptor antagonist GR205171 was performed in patients with temporal lobe epilepsy (TLE) and healthy controls. In TLE patients an increased NK1 receptor availability was found in both hemispheres, most pronounced in anterior cingulate gyrus ipsilateral to seizure onset. A positive correlation between NK1 receptors and seizure frequency was observed in ipsilateral medial structures consistent with an intrinsic network using the NK1-SP receptor system for transmission of seizure activity. The uptake of 18F-fluoro-deoxy-glucose (FDG) is related to cerebral blood flow (CBF). Previously, methods to estimate blood flow from dynamic PET data have been described. A retrospective study was conducted in 15 patients undergoing epilepsy surgery investigation, including PET with 11C-FDG and 11C-Flumazenil (FMZ). The dynamic FMZ dataset and pharmacokinetic modeling with a multilinear reference tissue model were used to determine images of relative CBF. Agreement between data of FDG and CBF was analyzed showing a close association between interictal brain metabolism and relative CBF. Epilepsy often occurs after traumatic brain injuries. Changes in glia and inhibitory neuronal cells contribute to the chain of events leading to seizures. Autoradiography with 11C-PK11195, 11C-L-deprenyl and 11C-Flumazenil in an animal model of posttraumatic epilepsy studied the temporal and spatial distribution of microglia, astrocytes and GABAergic neurons. Results showed an instant increase in microglial activity that subsequently normalized, a late formation of astrogliosis and an instant and prolonged decease in GABA binding. The model can be used to visualize pathophysiological events during the epileptogenesis.

Concussions are a common type of traumatic brain injury resulting in a series of physical, emotional, and psychosocial symptoms. Following a concussion, emotional processing is thought to be altered through small functional and structural disruptions that impact information processing pathways, which may eventually manifest as behavioral impairments. Thus, the use of both behavioral and functional outcomes may be effective for assessing the changes in emotional processing that may occur following a concussion. The primary purpose of this study was to examine behavioral and neurocognitive differences in response to emotional face images between individuals with and without a history of concussion. Fifty participants (18 female; 32 male) were recruited and assigned to either the concussed (n = 23; Mage = 24.1 ± 1.0) or non-concussed (n = 27; Mage = 23.2 ± 0.6) group based on medical and self-reported concussion history. Participants completed a modified emotional oddball paradigm where representative positive (smiling), negative (frowning), and neutral faces from the Radboud Faces Database were displayed. Neuroelectric measures of P3 amplitude and latency, as well as behavioral measures of response accuracy and reaction time were assessed during the experiment. The concussion group showed significant reductions in accuracy, but no difference in reaction time compared to the non-concussed group. An increase (i.e., slower) in P3 latency was also found in the concussed group, with no observed group differences in P3 amplitude. Findings suggest that concussions may lead to chronic neuroelectric and behavioral deficits in classifying emotional, facial expressions.

Bad Paper follows the lives of former military service members, who have received an other-than-honorable discharge, but also have service-connected post traumatic stress disorder (PTSD). Due to the "suck it up" culture of the military, many of these veterans would not report any psychological troubles in fear of being labeled "weak" and potentially affecting their promotions. With no outlet for their PTSD, drugs and alcohol became a way of "self-medicating," which led to their dismissal from the service. A dishonorable discharge, commonly called "bad paper," from the military disqualifies veterans from receiving help from the VA. The process to overturn this status is arduous and veterans must navigate the bureaucracy of the Veterans Affairs (VA) administration as well as the individual military branches with virtually no help from either.

abstract: The objective of this small animal pre-clinical research project was to study quantitatively the long-term micro- and macro- structural brain changes employing multiparametric MRI (Magnetic Resonance Imaging) techniques. Two separate projects make up the basis of this thesis. The first part focuses on obtaining prognostic information at early stages in the case of Traumatic Brain Injury (TBI) in rat animal model using imaging data acquired at 24-hours and 7-days post injury. The obtained parametric T2 and diffusion values from DTI (Diffusion Tensor Imaging) showed significant deviations in the signal intensities from the control and were potentially useful as an early indicator of the severity of post-traumatic injury damage. DTI was especially critical in distinguishing between the cytotoxic and vasogenic edema and in identification of injury regions resolving to normal control values by day-7. These results indicate the potential of quantitative MRI as a clinical marker in predicting prognosis following TBI. The second part of this thesis focuses on studying the effect of novel therapeutic strategies employing dendritic cell (DC) based vaccinations in mice glioma model. The treatment cohorts included comparing a single dose of Azacytidine drug vs. mice getting three doses of drug per week. Another cohort was used as an untreated control group. The MRI results did not show any significant changes in between the two treated cohorts with no reduction in tumor volumes compared to the control group. The future studies would be focused on issues regarding the optimal dose for the application of DC vaccine. Together, the quantitative MRI plays an important role in the prognosis and diagnosis of the above mentioned pathologies, providing essential information about the anatomical location, micro-structural tissue environment, lesion volume and treatment response. / Dissertation/Thesis / Masters Thesis Bioengineering 2014