Background: Childhood Traumatic Brain Injury (TBI) has been identified as a crucial public concern, causing interrup-tion in children’s cognitive development, sometimes resulting in permanent impairment or even death. Hence documen-tation in health and school records regarding their functioning or environmental restrictions post injury, seems vital for the facilitation of communication between a child’s systematic and ongoing environment. Especially since children’s health has been described as a holistic construct comprised of psycho, social and physical well-being. Requiring continual inter-disciplinary and collaborative efforts over their course of development. Aim: To explore literature related to cognitive functioning and recommended support for children who have experienced a TBI, and how professional’s document their associated problems within medical and school records regarding activities in or outside the classroom. Method: A sys-tematic review, strictly comprised of empirical studies. Selected due to its sequential structural design for attainment of literature relevant to the research topic of choice and quality assessment procedures which enable reduction of threats to bias findings. Results: A total of 9 articles were yielded after quality assessment and depicted that. Reduced processing speeds in cognitive ability domains can be regarded as the default or baseline outcomes after a childhood TBI. Predictors within these different domains impacted their adequate academic, social function and varied depending on age at injury (2-4yrs or 4-8yrs), Injury severity (mild, moderate/severe), family function and time points. Early and severe TBI showed significant residual impairments across all time points, whilst the mild to moderate groups showed low to average func-tioning, as with the typical sample groups after two-year time points. Executive, attention skills impairment and post injury support within home and school settings. Showed to have the highest impact on both behaviours in, outside the classroom and academic performance. Documentation: Mainly biological and admission details were documented in the medical records. Within school records, all except one most recent study used either parental, teacher reports or direct measures to assess functioning of TBI affected children within school. Hereby a need for documentation of environmental factors within medical records, high quality transition of their TBI information within their school settings and continual docu-mentation of their progress or supports in school is required.

Magnetic Resonance Imaging (MRI) is the most prominent non-invasive technique used in clinical diagnosis and biomedical research. Its development as an imaging technique has been aided by contrast agents (CAs) which enhance contrast to noise ratio in the images. This dissertation deals with paramagnetic lanthanide- and superparamagnetic iron-based nanoparticles (NPs) which are potential CAs at clinical field of 3 T and a high field of 9.4 T. Chapter 1 provides a brief overview of colloidal nanoparticles, with an emphasis on their surface chemistry and magnetic properties for bio-applications. Chapter 2 employs europium as an optical probe to illustrate the contribution of inner, second and outer sphere relaxation towards longitudinal and transverse relaxivities of paramagnetic NP-based CAs. Chapter 3 investigates the positive and the negative contrast enhancement abilities and magnetization of paramagnetic NPs comprising a core of sodium dysprosium fluoride with a sodium gadolinium fluoride shell. Their surface chemistry is tuned to target prostate cancer specifically. The application of these NPs is further extended in Chapter 4 to track an intraneuronal protein called tau following mild traumatic brain injury. Chapter 5 deals with facile synthesis and long-term stability of superparamagnetic iron NPs for their potential application as CAs. Chapter 6 illustrates the concept of MRI correlation using ‘T1-only’ and ‘T2-only’ NPs. Chapter 7 investigates on the dynamics involved in the phospholipids coating the surface of NPs. Chapter 8 concludes on the work detailed in the previous chapters and outlines the future outlook. / Graduate / 2020-01-15

In the last decade, traumatic brain injuries (TBIs) and spinal cord injuries (SCIs) has become one of the most scrutinised medical challenges of our time. However, the lower quality of life experienced by the sufferer and the associated socio-economic cost of both TBI and SCI remain a huge burden for society. There is currently no reliable way to evaluate the level of functional damage caused by TBI and SCI related mechanical forces without invasive examination. The types of axonopathy involved in such injuries are the combinations of coupled mechanical-electrophysiological phenomena at multiple length and time scales, extremely challenging to approach by experimental means alone. It is therefore highly desirable to complement experimental studies with computational work to further the understanding of such multiscale problems. This thesis firstly proposes a novel 3D finite element framework coupling mechanics and electrophysiology to model cellular and subcellular phenomena, such as nerve dislocation and membrane damage by micropipette. The former study shows that 1D simulations focussing solely on the stretch component of the axonal damage are unable to capture the same electrophysiological damage that a 3D framework predicts. The latter study shows that local membrane deformation can lead to electrophysiological alterations at the axonal level solely through geometrical effects and without the need to account for ion channel activity alterations. This was demonstrated for micropipette suction in a patch clamp where the consideration of the 3D flow of current was sufficient to alter its electrophysiology, offering an alternative explanation to the damage mechanism hypothesised by published experimental work. At the axonal and tissue scale, previous models have often simplified the modelling of damage by using a single axon model. It is however unclear whether an altered axonal electrophysiology can truly be representative of the compound electrophysiology of multiple axons or fibre. Three different models: axonal, fibre and tissue level models, were evaluated and compared for their ability to model macroscale electrophysiology deficits. The results of the three models suggest that the recovery of compound action potential amplitude post-mechanical stretch can not be straightforwardly scaled from axonal level to fibre level. Furthermore, the electrophysiological recovery may not be solely dependent on mechanical recovery of the tissue. This thesis identified the need for scale specific models in the context of TBI and SCI. In particular, lipid bilayer membrane geometrical distortion following mechanical insult at the subcellular scale and functional tissue alteration at the tissue scale both require a different approach. The models proposed herein successfully identify mechanisms overlooked in previous experimental literature. In order to fully capture experimental behaviour, future models will need to account for other mechanisms such as mechanoporation, reorganisation of paranodal junctions and injury related Calcium ion imbalance.

Wearable assistive robotics have the potential to address an unmet medical need of reducing disability in individuals with chronic hand impairments due to neurological trauma. Despite myriad prior works, few patients have seen the benefits of such devices. Following application experience with tendon-actuated soft robotic gloves and a collaborator's orthosis with novel flat-spring actuators, we identified two common assumptions regarding hand orthosis design. The first was reliance on incomplete studies of grasping forces during activities of daily living as a basis for design criteria, leading to poor optimization. The second was a neglect of increases in muscle tone following neurological trauma, rendering most devices non-applicable to a large subset of the population. To address these gaps, we measured joint torques during activities of daily living with able-bodied subjects using dexterity representative of orthosis-aided motion. Next, we measured assistive torques needed to extend the fingers of individuals with increased flexor tone following TBI. Finally, we applied this knowledge to design a cable actuated orthosis for assisting finger extension, providing a basis for future work focused on an under-represented subgroup of patients.

Football safety has increased over time, in part due to improvements in equipment and body mechanics, but there are still inherent risks involved, including exposure to repetitive head impacts (RHI). Significant head impacts can result in a constellation of symptoms including nausea, vomiting, headache, dizziness, and amnesia, which typically assist in the diagnosis of concussion. However, it has been shown that subconcussive impacts may result in microstructural changes and physiological alterations in the brain. This is particularly concerning because athletes may be undergoing changes in the brain in the absence of outwardly visible symptoms. Poorer neurologic outcomes later in life have been associated with cumulative exposure rather than number of diagnosed concussions. Accelerometers installed in helmets have shown that college football players may receive up to 1,850 head impacts throughout the course of one season. The concussion rate is obviously much lower, indicating there are a high number of head impacts per diagnosed concussion. Axons are especially susceptible to damage from RHI because of their extension throughout the nervous system. The subtle changes thought to result from RHI are not easy to measure, but several modalities have been proposed. These include diffusion tensor imaging (DTI), plasma tau protein, and King-Devick testing. The proposed study will look to quantify cumulative head impact exposure in college football players prior to the start of a season and see if this has any impact on the variables. They will then participate in one season of football wearing helmet accelerometers to measure the number of head impacts sustained. Changes in the variables will be compared to non-contact sport college athletes. Data will be analyzed to determine if number of head impacts correlates with changes in variables and if prior head impact exposure has any effect on these changes. Data obtained from this study will have significant implications in the field of head injury. It may strengthen the use of several markers of brain injury that could be utilized in the future. Additionally, the effects of cumulative head impact exposure and one season of head impacts will be thoroughly examined. This information can be provided to trainers, coaches, and athletes to further improve football safety.

The objective of this work presented here is to extend the capabilities of siloxane waveguide technology in the field of biochemical sensing. Recent advances in the integration of polymeric optical waveguides with electronics onto standard printed circuit boards (PCBs) allow the formation of cost-effective lab-on-achip modules suitable for mass production. This technology has been primarily designed for on-board data communication. The focus of this research is to investigate the possibility of realising a Siloxane polymer based lab-on-chip sensor. Different siloxane-polymer-based optical waveguide sensor structures have been designed and analysed from the aspect of biochemical sensing. An evanescent-wave absorption sensor based on mode-selective asymmetric waveguide junctions is proposed for the first time. The device mitigates the common optical effect of spurious response in absorption sensors due to the analyte transport fluid. Head injury is the leading cause of death in the population of people under 40 years. Currently, 3 out of 5 deaths in emergency rooms are due to severe brain injuries in the developed world. Researchers at the Neurosciences Critical Care Unit (NCCU) at Addenbrooke's Hospital have managed to correlate biochemical changes with the severeness of the injury and the likelihood of patient recovery. Considerable progress has been made to develop a lab-on-chip sensor capable of continuously monitoring glucose, lactate and pyruvate concentrations in the brain fluid, hence the contribution to the current trend in the advancement of portable lab-on-chip technologies for the deployment of point-of-care diagnostic tools. A novel recognition layer has been developed based on porphyrin in combination with glucose, lactate and pyruvate oxidase for measuring all the analytes, enabling fast and reversible chemical reactions to be monitored by optical interrogation. The operational wavelength of the developed recognition layer is 425 nm, which required the formation of polymer features that were beyond the fabrication capabilities at the time. Through considerable process development and the adoption of nanoimprinting lithography, siloxane polymer based optical waveguides were fabricated allowing the realisation of highly sensitive optical sensors. Based on the results that are presented here, it can be concluded the functionalization of siloxane polymer waveguide have a potential for realising biochemical sensors in the future. The new fabrication technique will allow the formation of more robust and complex lab-on-chip sensors based on this material.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-11-18T12:09:41Z No. of bitstreams: 1 Roberto Oliveira Rodrigues_.pdf: 1330100 bytes, checksum: 8ee5aecb5382bb35a0d509f9898574a8 (MD5) / Made available in DSpace on 2016-11-18T12:09:41Z (GMT). No. of bitstreams: 1 Roberto Oliveira Rodrigues_.pdf: 1330100 bytes, checksum: 8ee5aecb5382bb35a0d509f9898574a8 (MD5) Previous issue date: 2016-09-30 / UEMA – Universidade Estadual do Maranhão / TCE se caracteriza como uma lesão resultante do impacto físico interno ou externo com grande impacto socioeconômico desta forma, a assistência qualificada é de fundamental importância para reduzir os índices de morbimortalidade. Objetivo: elaborar um guia assistencial para atendimento de pacientes adultos com traumatismo cranioencefpalico no serviço de emergência do Hospital Municipal Gentil filho de Caxias/MA. Método: revisão de literatura, os Descritores de Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH) definidos para a busca nas bases de dados foram: craniocerebral trauma, protocols e nursing. A coleta de dados foi realizada nos meses de agosto a setembro de 2015. Os estudos utilizados na confecção deste guia foram selecionados com base nos critérios: a) inclusão: artigos completos e gratuitos, publicados em periódicos indexados que abordaram a temática do estudo; publicados no período de 2000 a 2016, considerando as duas últimas atualização do Colégio Americano de Cirurgiões; estudos anteriores ao período estipulado (2000) que são considerados relevantes e não apresentam evidências melhores; teses e dissertações; manuais nacionais e internacionais relacionados à temática deste estudo; b) critérios exclusão: monografias; resumos simples e expandidos publicados em anais de congressos. Resultados: foram encontradas 2872 publicações disponíveis nas bases de dados selecionadas, sendo 852 da MEDLINE; 743 da BDENF; 589 no SciELO; 390 no LILACS; e 297 no COCHRANE. Após aplicação dos critérios de inclusão e exclusão, destes restaram 32 estudos. Conclusão: Observou-se a importância da utilização de um guia assistencial para atendimentos a vitimas de Traumatismo Cranioencefálico, pois os cuidados iniciais como: ABCDE do trauma, elevação de cabeceira, monitoração hidroeletrolítica e controle da hipotensão diminuem significativamente os índices de morbidade e mortalidade. / TCE is characterized as an injury resulting from internal or external physical impact with great socio-economic impact in this way, quality care is crucial to reduce morbidity and mortality rates. Objective: To prepare a nursing care guide for the treatment of adult patients suffering from traumatic brain injury in the emergency response of the General Hospital of Caixas – MA. Methods: The Medical Subject Headings (MeSH) used for database search were: craniocerebral trauma, protocols and nursing. The data collection was performed during 2015 between August and September and the studies used as references on this protocol were selected through the following criteria: published papers on periodic in the last 10 years talking about the theme, thesis and dissertations, international and national manuals related to our subject; papers published on events were not used in our study. Results: found 2872 publications available in selected databases, with 852 of MEDLINE; 743 of BDENF; 589 in SciELO; 390 in LILACS; and 297 COCHRANE. After application of the inclusion and exclusion criteria, these remaining 32 studies. Conclusion: there was the importance of using a clinical protocol for nurses to care to victims of Traumatic brain injury, because the initial care as ABCDE trauma, head elevation, electrolyte monitoring and control of hypotension significantly decrease the morbidity and mortality.

The purpose of this session is to examine the vestibular consequences of mild traumatic brain injury (TBI) and blast exposure. Preliminary data will be presented showing characteristics of vestibular dysfunction and postural instability related to mild TBI and blast exposure. Also reviewed will be the latest findings including recent data collected at the War Related Illness & injury Center showing vestibular impairments in those with mTBI. The target audience is audiologists, physical therapists, neurologists, otolaryngologists. This session will cover intermediate level of content.

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