Objective: Following a sport related concussion (SRC) visible symptoms generally dissipate in 7-10 days post-injury. However, little is known about the cumulative effects of SRCs both in terms of structural damage to the white matter of the brain and neurocognitive performance. To address this issue, the relationship between the number of SRCs (frequency), axonal white matter (WM) damage and neurocognitive performance was examined. There were three predictions. First, increases in SRC frequency will be associated with decreases in performance on neurocognitive tests. Second, the frequency of SRC will be associated with axonal injury measured three WM tracts: the corpus callosum, the fronto-occipital fasciculus and the inferior longitudinal fasciculus. Third, less accurate and slower performance on a response inhibition task (STOP-IT) will be associated with greater axonal injury. Methods: A cross-sectional correlational design was utilised. Participants were rugby players with a history of SRC, rugby players with no history of SRC and control athletes (N=40) who completed a neurocognitive test battery and had a DTI brain scan. The neurocognitive battery consisted of the following standardised tests: Speed and Capacity of Language Processing Test, CogState Electronic Battery, Stroop Colour and Word Test, Controlled Oral Word Association Test, the Trail Making Test and the experimental test STOP-IT Electronic Test. White matter axonal injury was measured by DTI using fractional anisotropy (FA) and mean diffusivity (MD) metrics. The DTI data was processed using FSL to extract FA and MD DTI metrics in three a-priori regions of interest. Results: Spearman’s correlation analyses did not find significant associations between SRC frequency and neurocognitive performance on the FAS (rs=0.053, 95% CI [-0.27, 0.36]), TMT-A (rs=0.058, 95% CI [-0.26, 0.37]), TMT-B (rs= -0.046, 95% CI [-0.27, 0.36]) and the Stroop Interference (rs= -0.25, 95% CI [-0.07, 0.52]). Similarly, no significant Spearman’s correlations were found between SRC frequency and the computerised neurocognitive tests STOP-IT-SSRT (rs= -0.04, 95% CI [-0.28, 0.35])), STOP-IT–Accuracy (rs= -0.05, 95% CI [-0.27, 0.36]), CogState Detection subtest (rs= -0.15, 95% CI [-0.17, 0.44]), CogState Identification subtest (rs= -0.065, 95% CI [-0.26, 0.37]), CogState One card learning subtest (rs= 0.24, 95% CI [-0.08, 0.52]) or the CogState One back task subtest (rs= 0.06, 95% CI [-0.26, 0.37]). In terms of the DTI data there were no significant associations between SRC frequency and axonal injury measured by FA values in the CC (rs= 0.005, 95% CI [-0.31, 0.32]), ILF (rs= 0.028, 95% CI [-0.29, 0.34]) or FOF (rs= -0.022, 95% CI [-0.30, 0.33]). The same was pattern was found for MD values in the CC (rs= 0.081, 95% CI [-0.24, 0.39]), ILF (rs= -0.16, 95% CI [-0.16, 0.45]) or FOF (rs= -0.15, 95% CI [-0.17, 0.44]) Finally, there were no significant Spearman’s correlations between axonal injury FA values and the STOP-IT SSRT in any of the ROIs: CC (rs= 0.005, 95% CI [-0.31, 0.32]), ILF (rs= 0.028, 95% CI [-0.29, 0.34]) or FOF (rs= -0.022, 95% CI [-0.30, 0.33]). Equally, there were no significant correlations between MD values STOP-IT SSRT in the CC (rs= -0.028, 95% CI [-0.29, 0.34]), ILF (rs= -0.16, 95% CI [-0.16, 0.45]) or FOF (rs= -0.15, 95% CI [-0.17, 0.44]). Likewise, there were no significant Spearman’s correlations between accuracy on the STOP-IT and FA values and in any of the ROIs: CC (rs= 0.19, 95% CI [-0.13, 0.48]), ILF (rs= -0.045, 95% CI [-0.27, 0.35]) and FOF (rs= -0.032, 95% CI [-0.29, 0.34]), or MD values in the CC (rs= -0.11, 95% CI [-0.21, 0.41]), ILF (rs= 0.017, 95% CI [-0.30, 0.33]) or FOF (rs= 0.082, 95% CI [-0.24, 0.39]). This study did not find support for the hypothesis that cumulative SRCs are associated with poorer performance on neurocognitive tests or with axonal injury as measured by FA and MD DTI metrics. Conclusion: The null findings suggest that there are no cumulative effects of SRCs. The current findings are inconsistent with previous cross-sectional research that indicates that there are long-term changes to diffusivity measures present after single SRCs as well as cumulative effects in contact sport athletes. Likewise they are at odds with evidence suggesting that after three SRCs neurocognitive performance can be affected. The study needs to be extended to include a larger sample to ensure the results are not due to low statistical power.

This session is developed by, and presenters invited by, Hearing, Balance, Tinnitus – Assessment and Intervention: Adult. This combined mini-series will present both clinical and research findings addressing the auditory and vestibular consequences of traumatic brain injury (TBI). Presenters will elucidate TBI’s effect on auditory processing, vestibular function, and tinnitus with case studies to illustrate management strategies relevant for each of the patient groups.

No description available.

Traumatic Brain Injury (TBI) is an increasingly diagnosed constellation of injuries derived from acute mechanical trauma to the brain. With the rise of advanced neuroimaging techniques recent focus has oriented primarily towards the mild-moderate range of TBI which previously was missed diagnostically. Characteristically, these advances have shown increasing areas of micro-hemorrhage in susceptible areas of the brain and to date there are no treatment modalities targeting micro-hemorrhages or their sequelae. This dissertation explores the effects of the resulting heme processing response in the days following injury with a particular focus on inducing early heme clearance from the parenchyma using a rat central fluid percussion injury model in the mild-moderate injury range. Since heme is released ~24-48 hours post-injury and is known to be cytotoxic we observed there may be a critical window for treatment to clear heme before it is spontaneously released and to increase the buffering capacity of the tissue. We targeted heme clearance by using drugs known to increased expression of Nrf2, an upstream transcriptional regulator of the canonical heme processing protein heme oxygenase 1 (HO-1), and tracking expression of HO-1, the iron sequestration/storage proteins Lipocalin 2 (LCN2) and Ferritin (FTL), as well as the activity of matrix metalloproteinases 2 and 9 (MMP2, MMP9). We examined both tissue known to be frankly hemorrhagic (the neocortex) as well as tissue lacking any identifiable bleed (the hippocampus). We demonstrated that using the HO-1 inducers Hemin and Sulforaphane in a single dose paradigm given 1 hour post-injury heme clearance was accelerated in the neocortex with the majority of heme pigment processed by 24 hours post-injury. Further there was significant attenuation of protein expression in HO-1 and ferritin as well as the enzyme activity of MMP2 and MMP9 in both the neocortex and the hippocampus. Behavioral attenuation was also seen in both rotarod and Morris water maze tests. While we intended to target hemorrhagic processing after injury, and indeed demonstrated improved clearance of heme from post-injury hemorrhagic regions of the brain, in both tissues studied we observed remarkably similar responses to the drugs utilized in protein expression, enzyme activity, and behavioral improvement which may suggest a globally improved pathologic state or that there are unidentified pathologic micro-hemorrhages or leaky vessels which extend further into the brain parenchyma than currently identified.

The purpose of this study was to examine potential predictors of PTG across time in Veterans with acquired physical disabilities. Specifically, this study aimed to understand how various demographic and injury characteristics, coping styles, appraisals of injury, and social support might predict trajectories of PTG from discharge from inpatient rehabilitation through 12 months after baseline. Initial curvature analyses suggested that a cubic polynomial trend best fit the movement of PTG over time, generally conforming to an initial increase, decrease, and then plateau or slight increase. Four HLMs were run to examine whether demographic and injury characteristics, coping styles, appraisals of injury, and social support predicted the height of this cubic architecture of PTG across baseline, 1, 3, 6, and 12-month follow ups, and a final HLM examined whether any statistically significant fixed effects in the first four HLMs interacted with time in the prediction of participants’ PTG trajectories. Estimated premorbid IQ was negatively associated, while age was positively associated with the height of PTG over time. Reframing and religious coping were positively associated with PTG over time, as were challenge appraisals. Three types of social support did not independently predict PTG trajectories, although bivariate correlations suggested the presence of isolated relationships between different types of social support and PTG at certain time points. None of the significant predictors interacted with time in predicting participants’ PTG trajectories.

Traumatic Brain Injury (TBI) affects approximately 1.7 million persons in the United States annually, 75% are categorized as mild (mTBI). Most persons who experience mTBI will recover, however an estimated 10% will develop Postconcussion Syndrome (PCS). Evidence supports a relationship between perceived stress, salivary cortisol, and depressive symptoms in persons after TBI; however, there are no known studies exploring these relationships in the PCS patient population. A sample of 17 men and women diagnosed with PCS were recruited from Southwest and Central Virginia. Data collection included the Rivermead Postconcussion Questionnaire, Perceived Stress Scale-10, Center for Epidemiological Studies-Depression Scale and the PROMIS Emotional Distress (ED)- Depression Short form (SF). Salivary cortisol was collected with a SalivaBio Oral Swab Collection System. Data were analyzed with Wilcoxon Rank-Sum and Pearson’s Chi Square. Spearman’s Rank Order Correlation Coefficients were used to compare variables for correlation. We found a statistically significant relationship between stress and depression (Spearman rho=0.87; p <0.0001); however, we did not find a statistically significant relationship between stress and cortisol (Spearman rho=-0.11; p =0.6887) or depression and cortisol as measured by the CES-D (Spearman rho=-0.10; p=0.6989) and the PROMIS ED-Depression SF (Spearman rho= -0.40; p=0.1327). While perceived stress may impact report of depressive symptoms in persons diagnosed with PCS, much is unknown about the influence of other factors in the development of this syndrome. More research is needed to identify mechanisms behind the presence of PCS to further inform our understanding of this condition, and to apprise the development of nursing interventions.

According to the Center for Disease Control’s (CDC) report to the Congress, there are 2.2 million emergency department visits; 80,000 hospitalizations; and 50,000 deaths each year due to traumatic brain injury. Adults 65 years and older account substantially for the majority of the hospitalization and deaths. Over 70% of the traumatic brain injuries of the older adults are classified as mild to moderate; however, even with these milder injuries, older adults present with a significantly higher morbidity and mortality compared to all other age groups (LeBlanc et al., 2006). With that in mind, it seems essential to develop a deeper understanding of the causes behind higher mortality and morbidity of traumatic brain injury in the elder population. It is well documented that increased age is accompanied by increased CNS inflammation. Recently, our laboratory showed that inflammation drives brain pathology. Specifically, we reported that the axon initial segment of cortical neurons was structurally and functionally compromised in an inflamed CNS environment. With this in mind, we proposed that age-related inflammation predisposes that brain to exacerbated pathologic consequence. To test this hypothesis, we administered a mild to moderate central fluid percussion brain injury in aged and young adult mice. Using immunocytochemical labeling against the axon initial segment protein ankyrinG combined with laser scanning confocal microscopy, we quantitatively compared axon initial segment number and length between age groups and within age groups with and without injury. Additionally, we also quantified global axonal pathology by immunolabeling for amyloid precursor protein (APP) positive swelling as an indicator of compromised axonal transport. We proposed that ankyrinG labeling will be both reduced in the aged injured mice compared against aged uninjured, young adult injured and young adult non-injured. We observed a significant increase in APP accumulations due to injury independent of aging, and due to aging independent of injury. No significant changes in the effect of injury between young and aged injured mice were observed. Although AIS length was not altered between age groups following injury, our results demonstrate that the elderly population presents with significantly shorter initial segments. The consequence of this shortening is not clear but may reflect compensatory changes in the brain to maintain homeostasis.

Many postsecondary institutions face challenges when veterans with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) enroll in college and become student-veterans. Staff and faculty may need to better understand how to accommodate these student-veterans as they transition from military to student life. The purpose of this study was to explore the perspectives of 3 groups at a Texas community college regarding classroom accommodations for student-veterans with PTSD or TBI: (a) student-veterans with PTSD or TBI, (b) the faculty, and (c) the disability counselors. Schlossberg's theory assessing an individual's assets and abilities in transition was the conceptual framework for this study. The research questions asked about the perspectives of student-veterans with PTSD or TBI, the faculty, and the disability services staff. A case study design was used, and inclusion criteria included 5 enrolled student-veterans with a PTSD or TBI diagnosis, 5 faculty members who have taught student-veterans, and 3 Disability Resource Center (DRC) staff at the community college. Semi-structured interview questions aligned with the research questions and data were analyzed for credibility, reliability, interpretation, and themes related to classroom accommodations. Findings from the study revealed student participants felt more could be done to accommodate student-veterans. Faculty participants expressed concerns regarding a lack of training related to accommodations. DRC participants reported reluctance from some student-veterans to use accommodations. Findings contribute to positive social change by identifying gaps in practices and by aiding staff and faculty with professional development to better provide accommodations for student-veterans with PTSD or TBI.

No description available.

No description available.