Class of 2011 Abstract / OBJECTIVES: The overall purpose of this study was to describe comorbidities, charges, and mortality associated with inpatient, adult traumatic brain injury (TBI) cases in the United States (US) for the year 2007. METHODS: This was a retrospective cohort analysis of discharge records located in the National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project (HCUP). Descriptive statistics are provided for comorbidities, charges, and mortality. Logistic regression was performed to find characteristics associated with mortality while multiple regression was used to assess charges. Independent variables included age, injury severity, procedures used, location of TBI, and primary payer. RESULTS: A total of 639,698 TBI cases were found which were associated with 267,061 hospital admissions, over $17 billion in hospital charges, and 20,620 deaths in the year 2007.Most common comorbidities were essential hypertension, sprains and strains of the back, tobacco use, fluid and electrolyte disorders, and alcohol-related disorders. Characteristics associated with increased mortality and charges included New Injury Severity Score (NISS) over 10, involvement of a firearm, falls, motor vehicle traffic, and intubation. CONCLUSION: The current study gives the most current picture of inpatient adult TBI cases throughout the US. Future research is warranted to ensure that optimal outcomes are being attained in this vulnerable patient population.

Currently, there are approximately 1.1 million caregivers who are caring for veterans who have served in the military following September 11 (9/11), 2001 (Ramchand et al., 2014). In this study, a mixed methods analysis of post 9/11 caregivers enrolled in the North Florida South Georgia Caregiver Support Program was completed with a convenience sample of 172 participants for quantitative analysis which included 16 participants for the phenomenological query. Correlations, t-tests, and ANOVAs were used to determine the associations among race, gender, age, caregiver type, diagnosis, tier level, and the presence of children in the home with caregiver burden as measured by the Zarit caregiver burden inventory (ZBI). T-tests resulted in a significantly higher ZBI with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = -2.36, p=.02. An ANOVA was conducted across caregiver role (parent, spouse, significant other and other) and the ZBI and a significant difference was found (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M=6.83; SD=3.10) than parental caregivers (M = 4.46; SD=2.70). The phenomenological research focused on shared lived experiences of post 9/11 caregivers of seriously injured veterans, including their experiences with the Caregiver Support Program, the impact of having children in the home, and the utilization of technology and online support with caregiving. Differences between spousal and parental caregivers were also explored. The caregivers’ shared experiences resulted in 22 major themes which included family adjustment, subjective demands, coping techniques, social support, Veterans Affairs (VA) and Department of Defense (DOD) services, self-care, intimacy, role strain, financial resources, and life course changes as the most prevalent. Caregivers and their families had a difficult time adjusting post injury, particularly with subjective demands. Caregivers relied mainly on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers tended to have more difficulty adjusting than did parental caregivers, which was also found in the quantitative study. While the Caregiver Support Program provided many services that were helpful to the caregivers, including a financial stipend, they wanted additional services which included additional financial support and services while citing issues with program implementation and staffing as major barriers. Children added complexity to the caregiving relationship and increased burden. Children displayed behavioral changes, mostly negative, but some positive such as giving both the caregiver and the veteran a sense of purpose. Lastly, technology and online support with caregiving was used more often than not with mixed feelings about the technology and its trustworthiness; with parents not utilizing these resources as much as spousal caregivers. The study concludes with implications for current and future social work practice and research, as well as the study’s strengths and limitations.

Brain injury (i.e., traumatic brain injury, stroke) is a considerable public health issue due to complicated outcomes of the injury, increasing incidence, and high costs linked with medical treatment. Rehabilitation centers are challenged to help individuals manage the resultant associated conditions and prevent secondary and chronic conditions. Research has shown that health promotion programs (HPP) that incorporate education about physical activity (PA) are one mode of rehabilitation that can improve the health of individuals with disabilities. However, PA is not included in the rehabilitation program for individuals with a brain injury, indicating a gap in the services provided. Consequently, the purpose of this study was to create and implement a physical activity centered education (PACE) program within an outpatient rehabilitation program. PACE consisted of an 8-week (16 session) program which aimed to (1) increase PA self-efficacy, (2) increase intention to change PA behaviors, (3) increase amount of PA completed regularly, and (4) promote positive rehabilitation outcomes. Based on previous research it was hypothesized that participation in PACE would result in (1) increased PA self-efficacy, (2) forward progression in intention to change PA behaviors, (3) increased amount of PA completed, and (4) improved rehabilitation outcomes (i.e., abilities, adjustment, participation). The PACE program resulted in an average increase of 16.1% in participants’ PA self-efficacy (effect size [ES] = 0.41), an increase from three of nine participants at pre-test to six of nine participants at post-test reporting to be in a stage of change in which they are most likely to be successful in regular PA participation (i.e., action or maintenance), and a comparable improvement in MPAI-4 scores (rehabilitation outcomes) after discharge to a rehabilitation program without a PA education component. In conclusion, the PACE program can improve PA self-efficacy, intention to change PA behaviors, and short-term rehabilitation outcomes.

No description available.

A common impairment after a traumatic brain injury (TBI) is a deficit in emotional recognition, such as inferences of others’ intentions. Some researchers have found these impairments in 39\% of the TBI population. Our research information needed to make inferences about emotions and mental states comes from visually presented, nonverbal cues (e.g., facial expressions or gestures). Theory of mind (ToM) deficits after TBI are partially explained by impaired visual attention and the processing of these important cues. This research found that patients with deficits in visual processing differ from healthy controls (HCs). Furthermore, we found visual processing problems can be determined by looking at the eye tracking data developed from industry standard eye tracking hardware and software. We predicted that the eye tracking data of the overall population is correlated to the TASIT test. The visual processing of impaired (who got at least one answer wrong from TASIT questions) and unimpaired (who got all answer correctly from TASIT questions) differs significantly. We have divided the eye-tracking data into 3 second time blocks of time series data to detect the most salient individual blocks to the TASIT score. Our preliminary results suggest that we can predict the whole population's impairment using eye-tracking data with an improved f1 score from 0.54 to 0.73. For this, we developed optimized support vector machine (SVM) and random forest (RF) classifier.

abstract: Mild TBI (mTBI) has been associated with subtle executive function (EF) and cognitive-communication deficits. In bilinguals, there are unique cognitive demands required to control and process two languages effectively. Surprisingly, little is known about the impact of mTBI on EF, communication, and language control in bilinguals. Therefore, the aim of this study was to examine the cognitive-communication abilities in bilinguals with a history of mTBI, identify any language control impairments, and explore the relationship between these language control impairments and domain-general cognitive control abilities. To this end, three-hundred and twenty-seven monolingual and bilingual college students with and without mTBI history participated in two experiments. In these experiments, EF, communication, and language control were examined using experimental and clinical tasks as well as self-rating scales. In Experiment 1, there was an interaction between mTBI history and language group (monolinguals vs. bilinguals) in how participants performed on a clinical measure of EF and a verbal fluency task. That is, only bilinguals with mTBI scored significantly lower on these tasks. In addition, there was a significant correlation between errors on a language switching task and performance on non-verbal EF tasks. In Experiment 2, a subgroup of bilinguals with persistent cognitive and behavioral symptoms reported greater everyday communication challenges in their first and second languages. Also, unbalanced bilinguals reported greater EF difficulties than monolinguals and balanced bilinguals regardless of mTBI history. In conclusion, bilinguals may face unique cognitive-communication challenges after mTBI. Factors related to the bilingual experience (e.g., language balance, daily language use) should be considered in clinical evaluation and future research. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2020

Traumatic brain injury (TBI) effects a large number of individuals, both civilians and military personnel, every year. The neuroinflammatory response mounted in the brain following a head injury continues long after the effects of initial subside. While it was initially thought to only occur in moderate or severe TBI, the deleterious effects of this cascade have recently been identified in patients with mild TBI (mTBI). Hypopituitarism is an often underreported condition and can result from TBI of all severity. The long-term sequelae of TBI can manifest in or exacerbate many other comorbidities of brain injury, such as neuroendocrine dysfunction or mental health conditions. Both TBI and hypopituitarism can present with symptoms similar to some psychiatric disorders, or exacerbation comorbid conditions. Veteran patients presenting to their primary care providers with symptoms of irritability, depression, anxiety, or cognitive and behavioral changes may meet criteria to receive diagnoses of psychiatric illnesses prevalent in the military population, while not being evaluated for pituitary dysfunction, and thus receive inadequate treatment. The proposed study aims to identify the prevalence of patients that are receiving psychiatric treatment that have both a history of mTBI and reduced levels of pituitary hormones on serum assays. By identifying a significant portion of this population, future studies can assess the impact that hormonal replacement has on success of psychotherapy, resolution of symptoms, and impact on functional status, among other factors.

Traumatic brain injury (TBI) and its associated neural and cognitive sequelae are of increasing interest in military populations. Blast-related TBI is becoming more commonplace in military Service Members and Veterans since Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn and their following conflicts. It is currently unclear whether blast-related injuries cause unique neural and cognitive deficits. The present investigation, in Study 1, aims to investigate the differences in blast-related and non-blast related TBI using traditional statistical techniques. In Study 2, this study will demonstrate the use of Qualitative Comparative Analysis (QCA) in diffusion tensor imaging data. QCA is a relatively new technique that examines configurations of variables that lead to a predefined outcome. QCA has the ability to uncover configurations of variables not yet considered in empirical literature, which may contribute new perspectives on the many different variables often associated with brain injury. Study 1 demonstrated no significant differences between uninjured and injured subjects in white matter integrity, and no differences between blast-related and non-blast related mechanisms. Study 2 demonstrated limited support for the use of QCA in diffusion tensor imaging. Evidence for the use of this method in other neuroimaging modalities is reviewed

Concussions are the injury and symptoms that can result from transmission of a biomechanical force to the brain. They represent a significant global health burden, and are the subject of a growing body of medical research. A concussion can only be definitively diagnosed by a medical professional based on symptoms, although advanced neuroimaging and biomarker-based approaches are promising future diagnostic tools. There is no treatment for concussion beyond following return-to-work or -play guidelines, which recommend avoiding strenuous physical and cognitive activities until they no longer exacerbate symptoms. Preclinical models of concussion have been used to examine pathophysiological processes underlying symptoms, which is an important step in developing tools for diagnosis and treatment. Historically the clinical translation of preclinical concussion research has been limited, and the use of anaesthesia, and preference for adult male rats may contribute to this. These means of reducing variability are justified, but preclinical research moving forward should address these limitations to translatability by including more clinically relevant subjects and avoiding anaesthesia. To this end, we developed a new preclinical model for pediatric concussion. Our awake closed head injury (ACHI) model is well-suited to this purpose because it produces a helmeted closed-head injury involving vertical and rotational displacement of the head, and does not require anaesthesia. Before the ACHI model can be used to investigate concussion mechanism, diagnosis, and treatment, it needs to be characterized to demonstrate that it produces clinically relevant neurobehavioral and pathological changes. We developed a modified neurologic assessment protocol to test neurologic function immediately after each injury. The Barnes maze, elevated plus maze, open field, and Rotarod were used to measure injury-related changes in cognition, anxiety, and motor function. The Barnes maze reversal task was used to detect more subtle cognitive impairments of executive function. Structural MRI was used to search for visible lesion, hemorrhage, or atrophy; and silver-stain histology was used to detect neurodegeneration. We determined repeated ACHI produced acute neurologic impairment with the NAP, and a mild spatial learning deficit potentially mediated impaired cognitive flexibility in the Barnes maze and reversal training. These were accompanied by neurodegeneration in the optic tract, hippocampus, and ipsilateral cortex during the first week of recovery. Thus, following the internationally recognised definition developed by the concussion in sport group, we demonstrated 1) an “impulsive” force transmitted to the head results in 2) the rapid onset of short-lived neurologic impairment that resolves spontaneously. This occurs 3) with normal structural neuroimaging, and 4) produces cognitive impairment, and LOC in a subset of cases. The ACHI model is the first in Canada to forego anaesthesia, and this is the first demonstration of neurocognitive impairment accompanied by diffuse neurodegeneration in the absence of structural MRI abnormalities after mild traumatic brain injury in juvenile male and female rats. / Graduate

Indiana University-Purdue University Indianapolis (IUPUI) / A common impairment after a traumatic brain injury (TBI) is a deficit in emotional recognition, such as inferences of others’ intentions. Some researchers have found these impairments in 39\% of the TBI population. Our research information needed to make inferences about emotions and mental states comes from visually presented, nonverbal cues (e.g., facial expressions or gestures). Theory of mind (ToM) deficits after TBI are partially explained by impaired visual attention and the processing of these important cues. This research found that patients with deficits in visual processing differ from healthy controls (HCs). Furthermore, we found visual processing problems can be determined by looking at the eye tracking data developed from industry standard eye tracking hardware and software. We predicted that the eye tracking data of the overall population is correlated to the TASIT test. The visual processing of impaired (who got at least one answer wrong from TASIT questions) and unimpaired (who got all answer correctly from TASIT questions) differs significantly. We have divided the eye-tracking data into 3 second time blocks of time series data to detect the most salient individual blocks to the TASIT score. Our preliminary results suggest that we can predict the whole population's impairment using eye-tracking data with an improved f1 score from 0.54 to 0.73. For this, we developed optimized support vector machine (SVM) and random forest (RF) classifier.