Chronic Traumatic Encephalopathy (CTE) has been linked to contact sports, most notably boxing and American football, due to their propensity for repetitive head impacts. Concerns in the community for the safety of athletes in all contact sports has driven a significant amount of research into concussions, their long term effects, and strategies for treatment and prevention. Knowledge of long term brain health in response to neurotrauma is limited, a gap especially noticeable in the literature on non-catastrophic brain injuries sustained as a child. Concussion is a common injury that is often self-resolving with no lasting neurologic or cognitive deficits. Although repetitive brain trauma is hypothesized to be necessary and sufficient to lead to CTE, no human or animal models have definitively demonstrated the pathophysiologic connection or confirmed the mechanism of symptoms. The research to date has been case based, lacking prospective cohorts, with data complicated by convenience sampling. These factors limit the generalizability of conclusions. CTE is neuropathologically defined with variable symptoms; however, it is only diagnosable at postmortem autopsy making the etiology and prevalence difficult to understand. As more research is published to understand if there is an association between a neurocognitive degenerative disease and contact sports, the concentration is on professional athletes. Yet professional athletes do not represent the overwhelming majority of all contact sport participants. The proposed study will compare adults who participated in youth football, but not beyond the high school level, to a control group of adults who did not play contact sports. Evaluating their cognitive function with an online assessment, the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A), data will be analyzed for signs of clinical cognitive impairment. The objective is to measure adults who represent the high percentage of youth football players who do not continue to the advanced levels. Data obtained from this study will help communities make informed decisions, and create the foundation for future studies on long term benefits and risks of contact sports for children.

abstract: Development of post-traumatic epilepsy (PTE) after traumatic brain injury (TBI) is a major health concern (5% - 50% of TBI cases). A significant problem in TBI management is the inability to predict which patients will develop PTE. Such prediction, followed by timely treatment, could be highly beneficial to TBI patients. Six male Sprague-Dawley rats were subjected to a controlled cortical impact (CCI). A 6mm piston was pneumatically driven 3mm into the right parietal cortex with velocity of 5.5m/s. The rats were subsequently implanted with 6 intracranial electroencephalographic (EEG) electrodes. Long-term (14-week) continuous EEG recordings were conducted. Using linear (coherence) and non-linear (Lyapunov exponents) measures of EEG dynamics in conjunction with measures of network connectivity, we studied the evolution over time of the functional connectivity between brain sites in order to identify early precursors of development of epilepsy. Four of the six TBI rats developed PTE 6 to 10 weeks after the initial insult to the brain. Analysis of the continuous EEG from these rats showed a gradual increase of the connectivity between critical brain sites in terms of their EEG dynamics, starting at least 2 weeks prior to their first spontaneous seizure. In contrast, for the rats that did not develop epilepsy, connectivity levels did not change, or decreased during the whole course of the experiment across pairs of brain sites. Consistent behavior of functional connectivity changes between brain sites and the "focus" (site of impact) over time was demonstrated for coherence in three out of the four epileptic and in both non-epileptic rats, while for STLmax in all four epileptic and in both non-epileptic rats. This study provided us with the opportunity to quantitatively investigate several aspects of epileptogenesis following traumatic brain injury. Our results strongly support a network pathology that worsens with time. It is conceivable that the observed changes in spatiotemporal dynamics after an initial brain insult, and long before the development of epilepsy, could constitute a basis for predictors of epileptogenesis in TBI patients. / Dissertation/Thesis / M.S. Bioengineering 2012

Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated along with a summary of the existing evidence supporting intracranial monitoring in traumatic brain injury. In chapter 4, intracranial pressure, cerebral perfusion pressure, and pressure reactivity insults are demonstrated to be common, prognostically important, and responsive to long-term changes in management policies. Further, while these insults often occur independently, coexisting insults portend worse prognosis. In chapter 5, I examine possible imaging antecedents of raised intracranial pressure and demonstrate that initial subarachnoid haemorrhage is associated with the subsequent development of elevated intracranial pressure. In addition, elevated glucose during the intensive care stay is associated with worse pressure reactivity. Cortical blood flow and brain tissue oxygenation are demonstrated to be sensitive to increases in intracranial pressure in chapter 6. In chapter 7, a method is proposed to estimate the cerebral perfusion pressure limits of reactivity in real-time, which may allow for more nuanced intensive care treatment. Finally, I explore a recently developed visualisation technique for intracranial physiological insults and apply it to the cerebral perfusion pressure limits of reactivity. Taken together, this thesis outlines the scope, risk factors and consequences of intracranial insults after severe traumatic brain injury. Novel signal processing applications are presented that may serve to facilitate a physiological, personalised and precision approach to patient therapy.

Objective: Research has demonstrated deficits in socio-emotional processing following childhood traumatic brain injury (TBI; Tonks et al., 2009a). However, it is not known whether a link exists between socio-emotional processing, TBI and offending. Drawing on Ochsner’s (2008) socio-emotional processing model, the current study aimed to investigate facial emotion recognition accuracy and bias in young offenders with TBI. Setting: Research was conducted across three youth offender services. Participants: Thirty seven participants completed the study. Thirteen participants reported a high dosage of TBI. Design: The study had a cross sectional within and between subjects design. Main Measures: Penton-Voak and Munafo’s (2012) emotional recognition task was completed. Results: The results indicated that young offenders with a TBI were not significantly worse at facial emotion recognition compared to those with no TBI. Both groups showed a bias towards positive emotions. No between group differences were found for emotion bias. Conclusion: The findings did not support the use of Ochsner’s (2008) socio-emotional processing model for this population. Due to the small sample size, inadequate power and lack of non-offender control groups, it is not possible to draw any firm conclusions from the results of this study. Future research should aim to investigate whether there are any links between TBI, socio-emotional processing and offending.

xv, 162 p. ; ill. (some col.) A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Each year, over 65,000 brain injury survivors are discharged home from hospitals with ongoing rehabilitation needs due to acquired impairments, such as dysphagia. Emerging empirical evidence supports the benefits of intensive swallowing exercise programs when dysphagia results from muscle weakness. However, many of these survivors cannot complete intensive home exercise programs due to co-occurring cognitive impairments in memory or initiation. This project investigated the potential benefits of a new experimental assistive technology device, the Television Assisted Prompting (TAP) system to increase completion of home swallowing exercises. The TAP system was designed as a treatment package to provide both automated prompts and multimedia motivational instructional exercise videos via a person's home television. Three participants were recruited, all of whom had survived a hemispheric stroke and presented with neurogenic dysphagia and co-occurring cognitive impairments. Two home program delivery conditions were alternately presented on randomized days in a single-case experimental alternating treatment design: TAP delivery (e.g., TV prompting with motivational videos) or typical practice (TYP) delivery (e.g., care provider prompting as needed to follow assigned written home programs). The same exercises were presented in each condition. Measures included feasibility (e.g., reliability of the TAP system), efficacy (e.g., number of exercises completed per session), and satisfaction. Results revealed that two of three participants showed dramatic benefits from the TAP system. Participant 1 was 17 times more likely to complete exercises when prompted by the TAP system; participant 2 was six times more likely. Participant 3 completed exercises with equal likelihood on TAP or TYP days. All three participants reported preference for TAP system delivery and requested to increase the frequency of TAP delivery to every day. Care providers unanimously reported preference for the TAP system to prompt patients and reduce their burden of care. The TAP system malfunctioned during 21.70% (23/106) of scheduled sessions; two participants needed clarifications, instruction to use the system, or customized modifications in order to interact independently with the device. Recommendations for system improvements and applications to the field of assistive technology are provided. / Adviser: McKay Moore Sohlberg

xiii, 79 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Traumatic brain injury has reached epidemic levels, and yet there are still large questions that need to be addressed regarding the underlying pathology and the related behavioral deficits. Adequately measuring the neurological sequelae associated with TBI in vivo requires the use of sophisticated imaging procedures, while quantifying behavioral deficits requires precise, sensitive testing procedures. The current analysis examined three potential biomarkers of TBI using MRI technology, as well as examining both fine motor and psychological function on a cohort of TBI participants at least 12 months post-injury. Ten participants with a history of traumatic brain injury and ten matched controls were recruited for the present analysis. All participants completed a series of four MRI scans, as well as a simple motor task and a cognitive test battery. Between group analysis revealed that the two groups could be differentiated based on two MRI measures (BOLD and FA), and on three behavioral measures (Fitts motor task, self-reported symptoms, and impulse control). A within group correlation analysis of the TBI participants did not reveal any significant relationship between the MRI data and behavioral deficits. A group-wide regression analysis, however, revealed that MRI markers of cortical damage significantly predicted deterioration in the Fitts motor task performance. The results of the current study suggest that the long-term effects of TBI are not confined to executive function, and that one's performance of a fine motor task has diagnostic potential. / Adviser: Paul van Donkelaar

Transition from elementary to middle or junior high schools has been associated with slowed reading and mathematics achievement for students in general education as well as students with disabilities. Little is known about how this transition affects students with autism spectrum disorder (ASD), traumatic brain injury (TBI), or emotional/behavioral disturbance (EBD). Reading and math scores from state achievement tests used for federal accountability reporting were analyzed from 125,646 Oregon students between 2006 and 2013. About half were female, about half qualified for free or reduced price lunch, and about 34% identified as an ethnic or racial minority. Piecewise longitudinal growth models were analyzed using hierarchical linear and nonlinear modeling, separately for reading and math achievement. Scores for all students, on average, rose slightly faster before transition than after transition. Students who experienced a school transition in Grade 6 were more negatively impacted than those who transitioned in Grade 7, while students who stayed in the same school from Grade 3 to 8 experienced the least impact. Initial scores in reading and math for students with ASD were lower than students without disabilities; students with EBD were lower still, and students with TBI had the lowest. Before transition, students with ASD and EBD accelerated faster in reading than students without disabilities whereas in math, students with ASD or EBD showed improved scores immediately after transition. Students with EBD maintained post-transition trajectories similar to students without disabilities. Students with EBD had the most pronounced deceleration in reading scores after the transition whereas students with TBI had the most deceleration in math.

This thesis concerns with the functioning of coordinated team co-operation in organizations which provide social services to persons after acquired brain injury. Due to the frequency of occurrence and its deadful impact, these injuries become one of the most serious diseases not only in the Czech Republic but in the world. A person who has suffered brain injury is struggling with a number of socio-economic changes. A precondition for achieving full social integration of this individual is to ensure timely care and cooperation of individual experts on the given case. Such cooperation among experts is often missing in interconnected organizations. This can cause slowdown of the process of integration of an individual back to their everyday life. Equally important is the cooperation with family members who have an irreplaceable influence on the rehabilitation. The thesis is divided into two parts - theoretical and research. The theoretical part focuses on the consequences of acquired brain injury as well as on the the possibilities of social security provided by the state. Also, much of the text concerns with the coordinated rehabilitation and multidisciplinary collaboration which has a significant impact on improving the quality of life of people after brain injury. The data collection was carried out with the help of the method of qualitative research strategy, the technique of semi-structured interview with social workers in organizations of the city of Ceske Budejovice who provide social services according to Act 108/2006 Coll., on social services, as amended. The research is aimed at finding out how the coordinated rehabilitation is implemented in social services working with persons after acquired brain injury and then to create a proposal to streamline the implementation of coordinated rehabilitation in these organizations. Following the objectives, two research questions were examined: Which experts are involved in coordinated rehabilitation in social services providing services to people after brain injury? How is the cooperation of the team working with people after brain injury implemented? The data was processed in Atlas.ti 7. The research was carried out within the successfully accepted project at the Faculty of Health and Social Sciences, called Coordinated rehabilitation of patients with brain injury (reg. No. GAJU 138/2016/S), funded by the Grant Agency of the University of South Bohemia. The research results show insufficient cooperation of experts in social services providing care to persons with acquired brain injury. In spite of an acute need of coordinated and multidisciplinary support to such persons, the organizations miss specific professionals or employ workers who carry out works of other professions without the necessary qualification. The time, organizational and financial demands of teamwork make it impossible to provide high-quality multidisciplinary care, which is an important precondition for reintegration of people with brain injury back into work and social life. Team multidisciplinary cooperation brings a lot of positives, on the other hand, it also encounters barriers, which need to be further discussed in order to come to suitable solutions that are not only in the interest of the client and his family, but also great for the whole multidisciplinary team.

abstract: Traumatic brain injury (TBI) most frequently occurs in pediatric patients and remains a leading cause of childhood death and disability. Mild TBI (mTBI) accounts for 70-90% of all TBI cases, yet its neuropathophysiology is still poorly understood. While a single mTBI injury can lead to persistent deficits, repeat injuries increase the severity and duration of both acute symptoms and long term deficits. In this study, to model pediatric repetitive mTBI (rmTBI) we subjected unrestrained juvenile animals (post-natal day 20) to repeat weight drop impact. Animals were anesthetized and subjected to sham or rmTBI once per day for 5 days. At 14 days post injury (PID), magnetic resonance imaging (MRI) revealed that rmTBI animals displayed marked cortical atrophy and ventriculomegaly. Specifically, the thickness of the cortex was reduced up to 46% beneath and the ventricles increased up to 970% beneath the impact zone. Immunostaining with the neuron specific marker NeuN revealed an overall loss of neurons within the motor cortex but no change in neuronal density. Examination of intrinsic and synaptic properties of layer II/III pyramidal neurons revealed no significant difference between sham and rmTBI animals at rest or under convulsant challenge with the potassium channel blocker, 4-Aminophyridine. Overall, our findings indicate that the neuropathological changes reported after pediatric rmTBI can be effectively modeled by repeat weight drop in juvenile animals. Developing a better understanding of how rmTBI alters the pediatric brain may help improve patient care and direct "return to game" decision making in adolescents. / Dissertation/Thesis / Masters Thesis Biology 2014

abstract: Modern medical conditions, including cancer, traumatic brain injury, and cardiovascular disease, have elicited the need for cell therapies. The ability to non-invasively track cells in vivo in order to evaluate these therapies and explore cell dynamics is necessary. Magnetic Resonance Imaging provides a platform to track cells as a non-invasive modality with superior resolution and soft tissue contrast. A new methodology for cellular labeling and imaging uses Nile Red doped hexamethyldisiloxane (HMDSO) nanoemulsions as dual modality (Magnetic Resonance Imaging/Fluorescence), dual-functional (oximetry/ detection) nanoprobes. While Gadolinium chelates and super paramagnetic iron oxide-based particles have historically provided contrast enhancement in MRI, newer agents offer additional advantages. A technique using 1H MRI in conjunction with an oxygen reporter molecule is one tool capable of providing these benefits, and can be used in neural progenitor cell and cancer cell studies. Proton Imaging of Siloxanes to Map Tissue Oxygenation Levels (PISTOL) provides the ability to track the polydimethylsiloxane (PDMS) labeled cells utilizing the duality of the nanoemulsions. 1H MRI based labeling of neural stem cells and cancer cells was successfully demonstrated. Additionally, fluorescence labeling of the nanoprobes provided validation of the MRI data and could prove useful for quick in vivo verification and ex vivo validation for future studies. / Dissertation/Thesis / Masters Thesis Bioengineering 2014