Objectives: There is evidence that childhood traumatic brain injury (TBI) is associated with increased risk of offending and violent crime. This study aimed to explore associations between TBI in a group of delinquent and vulnerable young people (VYP) at risk of offending, and facial emotion recognition (FER) abilities, inhibition control (Stop-IT) and self-reported reactive-proactive aggression (RPQ). Methods: There were two studies. The first study used a cross sectional between group design to compare 45 VYP (with and without TBI) and a control group of 59 students on FER task measuring emotion recognition accuracy of six basic emotions. The second study examined differences between TBI and non-TBI groups in the VYP sample (N=21) on a Stop-IT task, FER accuracy and self-reported reactive-proactive aggression. Results: A history of TBI was reported by 60% of the VYP group (48.9% with loss of consciousness [LoC]), whereas 30% of the control group reported a history of TBI (25.4% with LoC). The VYP group (with and without TBI) demonstrated a similar pattern of reduced overall FER accuracy that was significantly different to the control group. Compared to the control group, The VYP groups (with and without TBI) were less accurate on recognising anger, disgust, sadness and surprise, but not happy and fear. There were no significant differences between the TBI- and non-TBI groups. The second study did not find any significant differences between the TBI and non-TBI groups on overall FER accuracy, Stop-IT performance, and RPQ scores. There were also no significant associations between these measures. Conclusions: Future research requires larger samples that enable investigating the association between different severity of TBI, FER and inhibition control ability. Better and more youth-friendly measures are also needed.

Traumatic brain injury (TBI) remains an important cause of morbidity and mortality within society. TBI may result in both focal and diffuse brain injury. Diffuse traumatic axonal injury (TAI) is an important pathological substrate of TBI, and can be associated with a range of clinical states, ranging from concussion through to death, the clinical severity being associated with a number of factors related to the injury. A retrospective study was conducted using 406 cases with TBI, from the archive of the Academic Department of Pathology (Neuropathology) University of Edinburgh, during the period from1982 and 2005. This cohort was sequential and provided a unique description of the range of pathologies associated with fatal TBI within the Edinburgh catchment area. All the data was collected on a proforma and analysed to provide a description of the incidence in the injury patterns among the Edinburgh cohort. This cohort was then used to provide cases to try and critically assess the mechanisms of axonal injury in TBI. A study was undertaken to investigate TAI in an experimental model of non-impact head injury in a gyrencephalic mammalian model (piglet model) and in human autopsy materials using immunohistochemical analysis of a range of antibodies, and to define the distribution of axonal injury with flow and neurofilament markers in TAI. A further objective was to examine the expression of β-APP as an indicator of impaired axonal transport, three neurofilament markers targeting NF-160, NF-200, and the phosphorylated form of the neurofilament heavy chain (NFH), in different anatomical regions of piglet and human brains. The double immunofluorescence labelling method was then employed to investigate the hypothesis of co-localisation between β-APP and each one of the previous neurofilament markers. The animal studies showed significant differences in NF-160 between sham and injured 3-5 days old piglet cases (6 hour survival) and between 3-5 days sham and injured, when stained with SMI-34 antibody. In 4 weeks old piglet cases (6 hour survival), immunoreactivity of β-APP was significantly higher in injured than control. No other significant differences for any of the antibodies were noted, based on age, velocity, and survival time. Human results suggested that the brainstem had a higher level of β-APP and NF-160 than the corpus callosum and internal capsule. Co-localisation of β-APP with NFs was not a consistent feature of TAI in piglet and human brains, suggesting that markers of impaired axonal transport and neurofilament accumulation are sensitive to TAI, but may highlight different populations involved in the evolution of TAI.

Class of 2015 Abstract / Objectives: Guidelines from the Brain Trauma Foundation recommend that after traumatic brain injury (TBI) patients should be given seizure prophylaxis for up to seven days. Currently, phenytoin is the first line therapy for this indication. However, levetiracetam is increasingly being used as an alternative because it does not require serum concentration monitoring and has a desirable safety profile. Studies evaluating levetiracetam have used a loading dose, followed by a maintenance dose of 1000 mg every 12 hours. The primary objective of this study was to evaluate the efficacy of low-dose (500 mg every 12 hours) levetiracetam for seizure prophylaxis after TBI. Methods: This was a retrospective cohort study conducted in a tertiary care, academic institution that is designated as a level 1 trauma center. Institutional review board approval was obtained prior to data collection. Consecutive patients with TBI between 2010 and 2012, who received levetiracetam for seizure prophylaxis, were included. Patients who met at least one of the following criteria were included: cortical contusion on computerized tomography scan, subdural hematoma, epidural hematoma, intracerebral hematoma, depressed skull fracture, penetrating head injury, or Glasgow Coma Scale (GCS) of 10 or less. Patients were excluded if they were less than 16 years of age, had a previous head injury, previous neurosurgery, history of seizure, or anti-seizure medication, or were given a loading dose of levetiracetam, or given a maintenance dose greater than 500 mg every 12 hours. The primary outcome was the occurrence of a seizure within seven days of TBI. A one-sample test of proportions was used to compare the rate of seizures while being treated with levetiracetam to a hypothesized value of 3.6 percent (from previous trials), using an a priori alpha for 0.05. Results: There were a total of 146 patients included in the study, who were treated with levetiracetam 500 mg every 12 hours. The median age was 51 years (interquartile range 31 to 65 years), 110 (75 percent) were male, and the median GCS on admission was 11 (interquartile range 5 to 14). The mechanisms of injury were fall (n equals 49), motor vehicle or motorcycle collisions (n equals 42), pedestrian or bicyclist (n equals19), assault (n equals16), suicide attempt (n equals 2), and other (n equals18). The median time to first dose of levetiracetam was 4 hours after injury (interquartile range 1 to 13 hours). After initiation of levetiracetam, there were 5 (3.4 percent) patients who had a seizure within seven days. This was not significantly different than the hypothesized population value (p equals 0.910). The median length of stay was 13 days (interquartile range 9 to 21) and 7 (4.8 percent) patients died during hospitalization. Conclusions: A low-dose of levetiracetam 500 mg every 12 hours after TBI was effective for early seizure prevention. This regimen may be an appropriate alternative to phenytoin or traditional dose levetiracetam for this indication. Future, prospective studies are needed to confirm these findings.

No description available.

BACKGROUND:Diffuse axonal injury is a common consequence of traumatic brain injury (TBI) and often co-occurs with hypoxia, resulting in poor neurological outcome for which there is no current therapy. Here, we investigate the ability of the multifunctional compound erythropoietin (EPO) to provide neuroprotection when administered to rats after diffuse TBI alone or with post-traumatic hypoxia.METHODS:Sprague-Dawley rats were subjected to diffuse traumatic axonal injury (TAI) followed by 30minutes of hypoxic (Hx, 12% O2) or normoxic ventilation, and were administered recombinant human EPO-alpha (5000IU/kg) or saline at 1 and 24hours post-injury. The parameters examined included: 1) behavioural and cognitive deficit using the Rotarod, open field and novel object recognition tests / 2) axonal pathology (NF-200) / 3) callosal degradation (hematoxylin and eosin stain) / 3) dendritic loss (MAP2) / 4) expression and localisation of the EPO receptor (EpoR) / 5) activation/infiltration of microglia/macrophages (CD68) and production of IL-1beta.RESULTS:EPO significantly improved sensorimotor and cognitive recovery when administered to TAI rats with hypoxia (TAI+Hx). A single dose of EPO at 1hour reduced axonal damage in the white matter of TAI+Hx rats at 1day by 60% compared to vehicle. MAP2 was decreased in the lateral septal nucleus of TAI+Hx rats / however, EPO prevented this loss, and maintained MAP2 density over time. EPO administration elicited an early enhanced expression of EpoR 1day after TAI+Hx compared with a 7-day peak in vehicle controls. Furthermore, EPO reduced IL-1beta to sham levels 2hours after TAI+Hx, concomitant to a decrease in CD68 positive cells at 7 and 14days.CONCLUSIONS:When administered EPO, TAI+Hx rats had improved behavioural and cognitive performance, attenuated white matter damage, resolution of neuronal damage spanning from the axon to the dendrite, and suppressed neuroinflammation, alongside enhanced expression of EpoR. These data provide compelling evidence of EPO's neuroprotective capability. Few benefits were observed when EPO was administered to TAI rats without hypoxia, indicating that EPO's neuroprotective capacity is bolstered under hypoxic conditions, which may be an important consideration when EPO is employed for neuroprotection in the clinic.

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.

Falls among the elderly population continue to be a growing concern in the healthcare industry and are marked by staggeringly high social and economic costs. The incidence of falls is known to increase with age, and currently the elderly population is growing at an astounding rate as baby-boomers are now entering this age group. Also, recovery following fall-related injuries decreases with increased age. These confounding factors currently make falls a very important area of research. Of the injuries typically seen in falls among the elderly, head injuries are one of the most debilitating. Death due to head trauma among the elderly is gaining national attention; head trauma is now considered the number one cause of death among elders who fall1. Among other technologies, medical helmets are often employed to protect against such injuries, but patient compliance with these helmets remains an issue. Current helmets use foams and cotton as padding, contributing to clumsy designs. Dilatent and honeycomb materials may be the future of this industry as their low weight and high efficacy per thickness make them ideal materials for thinner, lighter, less cumbersome head protection devices. This study outlines various modes of head injury and then highlights several head protection measures. The newer materials are tested using various methods to determine the most promising candidates for prototype designs. Next, three prototypes are assembled from the newer materials and compared directly based on the protection measures established. Finally, the top-performing prototype is compared against two existing medical helmets in a similar fashion. The results show that the best prototype significantly outperforms one of the existing medical helmets, and shows slight improvement over the other. These results establish the promise of these newer materials in the application of head protection devices.

Psychosocial factors represent complex and enduring challenges for people with a traumatic brain injury (TBI), their families and health and rehabilitation systems, particularly in relation to social isolation, change/loss of role and identity issues. Traditional rehabilitation approaches to psychosocial issues target cognitive rehabilitation and psychological adjustment of the individual with a TBI, which reflect the medical model of health. However, the International Classification of Functioning, Disability and Health (ICF) ushers a new era in TBI research and practice, which advances the conceptualisation of disability, to include the impact of environmental factors. The ICF identifies the Internet as one such environmental factor, which has the potential to facilitate or impede social participation of people with a disability. Empirical studies suggest the potential of the Internet to empower people with disabilities, via opportunities for social connection; social support; social role participation and identity experimentation. However, research has focused on people with sensory, physical, and mental health issues, with little known of the potential of the Internet for people with a TBI. This area of deficit warrants investigation, in view of the potential of the Internet to address many dimensions of psychosocial concern following TBI. This study explores the role of the Internet in the lives of people with a TBI, with a focus on the potential of the Internet to influence psychosocial recovery. Psychosocial recovery is conceptualised as the reconstruction of a positive identity, as found in subjective accounts of people with a TBI (Lewington, 1996), and strongly supported in the mental health consumer literature. Using a social constructionist approach, this study explores how people with a TBI use the Internet and how they make meaning of their Internet experience. This approach acknowledges the socially situated nature of Internet use and validates the subjective accounts of people with a TBI, whose perspectives are underrepresented in the rehabilitation literature. This study also trials the method of email-facilitated qualitative interviewing, to address face-to-face interviewing barriers, relating to cognitive-linguistic impairments (Lloyd, Gatherer, & Kalsy, 2006; Paterson & Scott-Findley, 2002). Thus, the Internet is the focus of the enquiry and the mediator of the method. The findings highlight the positive potential of the Internet to facilitate social participation for people with a TBI. Participants reported that features such as asynchronicity, reduced cues and anonymity made the Internet an accessible and usable technology, for social connection; social support; social role participation and identity reconstruction. A major theme emerging from the data was control of self, which this study conceptually linked to identity reconstruction and psychosocial recovery. Findings allayed concerns regarding the negative potential of the Internet to increase social isolation of vulnerable people, as participants regarded face-to-face relationships as more fulfilling than online friendships, supporting classic communication theories (Rice, 1987; Rice & Love, 1987), which propose that the Internet is a less personal medium than face-to-face communication, due to the feature of reduced cues. The findings of the method indicated that email facilitated qualitative interviewing addressed face-to-face interviewing barriers related to cognitive linguistic impairments; mobility factors; chronic health issues and environmental stimuli. Most participants indicated that asynchronicity, reduced cues, and anonymity facilitated control of communication, cognition and identity, thus enabling interview participation. The method had also advantages for the researcher, including time for reflection and the ability to yield richer data than in face-to-face contexts. However, the method was resource intensive, requiring information technology proficiency, familiarly with the impact of cognitive-linguistic impairments in online contexts and counselling experience. In addition, ethical guidelines required the involvement of a support person for the emotional protection of participants. This study makes two contributions to knowledge. One contribution relates to the potential of the Internet as an ICF environmental factor to address long-term psychosocial concerns, in addition to positively influencing psychosocial recovery from TBI, as reported by participants. This study contributes to a new era of research, which considers the impact of environmental factors on the experience of TBI, as framed by the ICF. The second contribution relates to the method of email facilitated qualitative interviewing, which advances knowledge of interviewing barriers for people with a TBI and addresses calls for innovative methods with this population. The findings of the method bring into question long held assumptions about the capacity of people with a TBI to participate in research and have implications for research design in qualitative and quantitative methodologies.

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.

A finite element model was developed for a range of human head-sUAS impacts to provide multiple case scenarios of impact severity at two response regions of interest: global and local. The hypothesis was that for certain impact scenarios, local response injuries of the brain (frontal, parietal, occipital, temporal lobes, and cerebellum) have a higher severity level compared to global response injury, the response at the Center of Gravity (CG) of the head. This study is the first one to predict and quantify the influence of impact parameters such as impact velocity, location, offset, and angle of impact to severity of injury. The findings show that an sUAS has the potential of causing minimal harm under certain impact scenarios, while other scenarios cause fatal injuries. Additionally, results indicate that the human head’s global response as a less viable response region of interest when measuring injury severity for clinical diagnosis. It is hoped that the results from this research can be useful to assist decision making for treatments and may offer different perspectives in sUAS designs or operation environments.