Objective: To investigate whether traumatic brain injury (TBI) plays a role in impulsivity, risk-taking, aggression and other behaviour problems in young offenders. Setting: Youth Offending Teams in the South West of England. Participants: Participants were 21 young offenders with community sentences, aged between 14 and 18 years old. Design: A cross-sectional correlational design. Main measures: A background questionnaire gathered information about the frequency and severity of TBIs, which was used to calculate the “TBI dose”. The Stoplight task and the Stroop test provided behavioural measures of risk-taking and interference control respectively. Self-report questionnaires provided measures of impulsivity (UPPS Impulsivity Scale), aggression (Reactive and Proactive Aggression Questionnaire) and behaviour (Strength and Difficulties Questionnaire). Results: Seventy-six per cent of the sample reported at least one TBI. TBI was not significantly correlated with either any of the other variables. Impulsivity was significantly positively correlated with reactive aggression. Conclusion: This exploratory study concludes that, in the current sample, TBI is not associated with impulsivity or risk-taking. Therefore, it is equally possible that impulsivity and reactive aggression pre-exist TBI. Future research should use a longitudinal design and a larger sample.

This diploma work deals with the situation of married couples, people who suffered a brain damage. After a brain damage many various mental changes of grave importance may appear apart from the physical consequences. These consequences affect not only the person that suffered the brain damage but also his closest mainly his partner and affect also the quality of their marriage. The theoretical part of the diploma work deals primarily with the importance of the marriage from the sociological and the psychological point of view as well. Further the work focuses on the brain damage itself and its consequences. The attention is further drawn to the impact of such situation on the husband or wife of a person after brain damage. Following part deals with the motivations for marriage. The empirical part of the work focuses on qualitative research based on eight individual in-depth interviews with husbands/wives of a person after a brain damage. The main goal of the work is to map the motivation of a husband/wife of the individual after a brain damage for remaining in marriage and identify other factors connected with this motivation.

Adults with mild to moderate acquired brain injury (ABI) often pursue post-secondary or professional education after their injuries in order to enter or re-enter the job market. An increasing number of these adults report problems with reading-to-learn. The problem is particularly concerning given the growing population of adult survivors of ABI. Combat-related brain trauma and sports concussions are two factors contributing to increases in traumatic brain injuries, while higher incidences of stroke in young adults and better rates of survival after brain tumors are contributing to increases in non-traumatic brain injuries. Despite the rising need, empirical evaluation of reading comprehension interventions for adults with ABI is scarce. This study used a within-subject design to evaluate whether adult college students with ABI with no more than moderate cognitive impairments benefited from using a multi-component reading comprehension strategy package to improve comprehension of expository text. The strategy package was based on empirical support from the cognitive rehabilitation literature that shows individuals with ABI benefit from metacognitive strategy training to improve function in other academic activities. Further empirical support was drawn from the special education literature that demonstrates other populations of struggling readers benefit from reading comprehension strategy use. In this study, participants read chapters from an introductory-level college Anthropology textbook in two different conditions: strategy and no-strategy. The results indicated that providing these readers with reading comprehension strategies was associated with better recall of correct information units in two free recall tasks: one elicited immediately after reading the chapter, and one elicited the following day. The strategy condition was also associated with better efficiency of recall in the delayed task and a more accurate ability to recognize statements from a sentence verification task designed to reflect the local and global coherence of the text. The findings support further research into using reading comprehension strategies as an intervention approach for the adult ABI population. Future research needs include identifying how to match particular reading comprehension strategies to individuals, examining whether reading comprehension performance improves further through the incorporation of systematic training, and evaluating texts from a range of disciplines and genres.

People with acquired brain injury (ABI) present with impairments in working memory and executive functions, and these cognitive deficits contribute to difficulty self-regulating the production of expository writing. Cognitive processes involved in carrying out complex writing tasks include planning, generating text, and reviewing or revising text produced. Intervention targeting the process of revision during the writing process may contribute to improved self-regulation of expository writing for people with ABI, of which college undergraduates are a subset of writers experiencing challenges. This study evaluated a computer-based revision prompting intervention for expository essay writing for undergraduate writers with acquired brain injury using a single-case, non-concurrent multiple-probe design across four participants. Primary outcome measures included number of revisions and quality scores. I used brief interviews to evaluate participants’ writing knowledge at the start of the study, and a post-intervention questionnaire to evaluate participant perceptions of the intervention, and perceived changes in writing ability. Visual inspection of data points plotted for Overall Quality Scores indicated a functional relation between the intervention and increased Overall Quality Scores compared to baseline, observed as a change in level at three distinct points in time across three participants. Visual inspection of data points plotted for number of revisions revealed no increase from baseline to intervention phases. Results suggest that the computer-based revision prompting intervention has potential to improve expository writing in undergraduate writers with ABI, though mechanisms of improvement require clarification in subsequent studies. I discuss results in terms of potential mechanisms of improvement, including cueing of self-monitoring and prior knowledge, and stimulation of task schemas for self-regulation of expository writing.

Traumatic brain injury (TBI) is a major cause of death among trauma patients and is associated with a high rate of mortality due to complications such as bacterial pneumonia, sepsis, and subsequent coagulopathies. While severe TBI is positively associated with the development of pneumonia, mild traumatic brain injury (mTBI) results in a paradoxical decrease in mortality following bacterial pneumonia via an unidentified mechanism. New evidence suggests that mTBI stimulates vagus nerve signaling resulting in an anti-inflammatory state that is mediated by neurotransmitters (NT) such as acetylcholine (ACh) and substance P (Sub P). This anti-inflammatory state induced by mTBI has been correlated with an increased resistance to pneumonia (PNA) in mice and has been shown to be mediated in part by increased bacterial clearance in the lungs via enhanced neutrophil recruitment. However, it has not been investigated whether this reduced mortality is due to alterations in the coagulation system and if they have any effect on either the severity or occurrence of disseminated intravascular coagulation (DIC), a common sequelae of pneumonia-induced sepsis. Our study investigates whether administration of mTBI prior to pneumonia challenge in mice decreases mortality by ameliorating DIC. We assess and define DIC in our mouse models by changes in plasma coagulation parameters including fibrinogen, D-dimer, and plasminogen activator inhibitor-1 (PAI-1) Our study found that mTBI administration prior to pneumonia significantly decreased mortality in mice gavaged with high concentrations of Pseudomonas aeruginosa (Psd.). We also found that mTBI administration prior to pneumonia rescued fibrinogen levels and increased D-dimer levels in plasma, suggesting a compensated fibrinolytic state and amelioration of DIC. Circulating neutrophil and absolute leukocyte counts were also increased in mTBI/pneumonia models compared to those with pneumonia alone, supporting previous evidence implicating mTBI as the origin of enhanced bacterial clearance in lungs. Taken together, these data suggest that the increase in survival seen in patients with mTBI is in part due to alterations in coagulation.

Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion, with approximately 3.6 million sports related concussions occurring yearly in the United States alone (Bailes, 2015, Azad et al., 2015). An MTBI is an acute brain injury resulting from mechanical energy to the head from external forces (Bailes 2015). Symptoms of an MTBI include visual disturbances, dizziness, nausea and vomiting, light sensitivity, loss of balance, and a general feeling of fatigue (Bailes 2015). MTBI’s are first diagnosed through changes in ImPACT baseline scores as well as Vestibular Ocular Motor Screening (Mucha et al., 2014). Repetitive MTBI and/or repetitive sub-concussive head trauma have been tentatively linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE) (Gardner et al., 2015). The major limitation of the link between MTBI and CTE is that CTE can only be diagnosed post-mortem (Azad et al., 2015). Due to that limitation, the prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear (Gardner et al., 2015). Newer methods of research including SNTF immunostaining and L-COSY are being further developed and studied to better diagnose MTBI and its link to CTE by exploring changes in brain protein formation and brain neurochemistry (Johnson et al., 2015, Lin et al., 2015). Through research development and case studies on professional American football players and boxers, a link between MTBI, particularly repetitive MTBI and CTE has been formed (Maroon et al., 2014).

Postmortem brains from young athletes with a history of repetitive concussive head injury and military service personnel with history of blast neurotrauma revealed evidence of parenchymal contusion, myelinated axonopathy, microvasculopathy, neuroinflammation, neurodegeneration, and phosphorylated tauopathy consistent with chronic traumatic encephalopathy (CTE) (L. E. Goldstein et al., 2012). The mechanisms by which head trauma induces acute concussion and chronic sequelae are unknown. To elucidate the mechanistic connection between traumatic brain injury (TBI), acute concussion and chronic sequelae, including CTE, require the use of animal models. This doctoral dissertation investigated the hypothesis that closed-head impact injury in mice triggers acute neurological signs associated with sport-related concussion as well as brain pathologies and functional sequelae associated with CTE. To test this hypothesis, we developed a mouse model of impact neurotrauma that utilizes a momentum transfer device to induce non-skull deforming head acceleration, triggering transient neurological signs consistent with acute concussion and traumatic brain injury (TBI) in unanesthetized C57BL/6 mice. The Boston University Concussion Scale (BUCS) was developed to assess neurological signs that are consistent with acute concussion in humans. Mice exhibited contralateral circling and limb weakness, locomotor abnormalities, and impaired gait and balance that recapitulate acute concussion in humans. Concussed mice recovered neurological function within three hours, but demonstrated persistent myelinated axonopathy, microvasculopathy, neuroinflammation, and phosphorylated tauopathy consistent with early CTE. Concussive impact injury also induced blood-brain barrier disruption, neuroinflammation (including infiltration peripheral monocytes and activation microglia), impaired hippocampal axonal conduction, and defective long-term potentiation (LTP) of synaptic transmission in medial prefrontal cortex. Kinematic analysis during impact injury revealed head acceleration of sufficient intensity to induce acute concussion, traumatic brain injury (TBI), early CTE-linked pathology, and related chronic sequelae. Surprisingly, the presence or degree of concussion measured by BUCS did not correlate with brain injury. Moreover, concussion was observed following impact injury but not blast exposure under conditions that induce comparable head kinematics. Empirical pressure measurements and dynamic modeling revealed greater pressure on the head and compression wave loading in the brain during impact compared to blast neurotrauma. These findings suggest acute concussion is triggered by focal loading of energy that transit the brain before onset of macroscopic head motion. By contrast, the forces associated with rapid head motion is sufficient to induce CTE-linked pathology. Our results indicate that while acute concussion and chronic sequelae may be triggered by the same insult, the pathophysiological responses underpinning these effects are engaged through distinct mechanisms and time domains. Our results indicate that concussion is neither necessary nor sufficient to induce acute brain injury or chronic sequelae, including CTE. / 2018-02-17T00:00:00Z

Paediatric acquired brain injury (pABI) can lead to an array of long term physical, cognitive, emotional, and behavioural difficulties. Due to the long-term sequelae of more severe pABI, it presents a significant challenge to the child’s family. Studies have suggested that social support can positively impact psychological adjustment following a stressful life event, and can aid personal resilience. There remains limited qualitative investigation of subjective family and parental adjustment experiences following pABI. Researchers have argued for future research that include the experiences of parents who have children younger than 16 years old, and are able to shed light on the individual experiential journey of parents. The current study used interpretative phenomenological analysis (IPA) to explore to the experiences of adjustment and social support of parents of children with pABI. Purposive sampling was used to recruit 10 participants who were individually interviewed. Five superordinate themes emerging from the data were identified: 1) Lives changed forever, 2) Sense of self, 3) Interaction with services, 4) The psychological experience, 5) Coping and adjustment. Relevant literature and implications for future research and clinical practice are discussed.

Our murine model of mild traumatic brain injury (mTBI) has shown improved survival after Pseudomonas aeruginosa (Psd) challenge as compared to controls (tail trauma or sham injury). Previous work suggests an mTBI-specific involvement of the neuro-immune axis which augments the innate immune response, increasing survival. Additional factors for the enhanced mTBI survival were explored via microarray analysis of lungs harvested 48 hours post-trauma, the point prior to Psd challenge in our model. At 48 hours post-trauma, mTBI lungs have a number of upregulated ATP synthesis and mitochondrial gene sets. Increased available energy could prime the mTBI lungs, allowing an earlier and more robust response to Psd infection, possibly contributing to the increased mTBI survival. This is supported by increased neutrophil recruitment in the bronchoalveolar lavage of mTBI mice four hours after Psd instillation. Downregulated gene sets related to cellular connections suggest that neutrophils recruited to the lung have an easier extravasation pathway into the air space of mTBI lungs compared to control. Based on genetic and neutrophil recruitment data, it is possible that mTBI creates an energetically prepared and easily accessible lung better tailored for recruiting and allowing entry of neutrophils in response to an infection compared to control.

Define the steps associated with implementation of evidence based practice. Describe barriers and solutions to implementation of evidence based practice in various work environments. Describe elements of evidence based practice as it relates to all phases of recovery from a brain injury.