This study examines the background and qualifications of plaintiff and defense experts using the H-Index score as quantification of expert background and qualifications. The goal is to better understand the similarities and differences among the professionals offering paid expert witness testimony in mild traumatic brain injury (mTBI) civil litigation. In this quantitative study, descriptive statistics include the mean and standard deviation scores for the data to support examining measures of central tendency and variance, respectively. The study includes the use of logistic regression and the Wilcoxon signed-rank test, and their statistical assumptions were tested to determine whether they would be used or if it was more appropriate to use a non-parametric test. The study included two research questions: How do the qualifications of plaintiff and defense expert witnesses in mild traumatic brain injury civil litigation compare? and to what extent does a higher h-index correlate with a favorable litigation outcome in a mild traumatic brain injury case? The findings for the hypothesis tests associated with the research questions led to the acceptance of the null hypothesis in each test. There was a lack of asymptotic significance in Hypothesis 1 and a lack of significance in Hypothesis 2. The findings from these tests shall support the discussion of the implications of this research and the direction of future research.

One goal of this study was to evaluate the emergence of mands and intraverbals following tact acquisition for individuals with aphasia due to acquired brain injury. A second goal was to evaluate the transfer of shortened latencies as a function of tact training across untrained operants. In Study 1, the dependent measure was accuracy of responding and in Study 2, the dependent measures were rate and latency of responding. Participants for Study 1 were two uninjured adults (pilot) and two adults with brain injury (ABI). Both sets of participants were directly taught to tact up to 6 stimuli. Once tacts were acquired, the response forms were assessed under mand and intraverbal conditions. All pilot participants and one ABI participant showed mand transfer for all stimuli. Tact to intraverbal transfer varied across participants. One adult with brain injury served as a participant for Study 2. Fluency training was used to teach tacts for 15 stimuli. Response latencies were gathered for all operants before and after training. The participant met the designated aim (rate of responding) and showed a decrease in latencies for tacts and untrained intraverbals. Changes in mand latencies varied. Fluency gains showed partial retention. Results from Study 1 provide further evidence for interdependence across operants during rehabilitative training. Results from Study 2 provide preliminary support for the utility of fluency training for verbal behavior after brain injury. Future research should explore the components of fluency training and their effects on the verbal behavior of individuals with ABI.

Veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn are presenting for treatment with high rates of combat-related posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), spurring a need for clinical research on optimal treatment strategies. While exposure therapy has long been supported as an efficacious treatment for combat-related PTSD, some clinicians are hesitant to utilize this treatment for veterans with TBI history due to presumed cognitive deficits that may preclude successful engagement. The purpose of this study was to compare exposure therapy process variables in veterans with PTSD only and veterans with PTSD+TBI. Results suggest that individuals with PTSD+TBI engage successfully in exposure therapy, and do so no differently than individuals with PTSD only. Additional analyses indicated that regardless of TBI status, more severe PTSD was related to longer sessions, more sessions, and slower extinction rate during imaginal exposure. Finally, in a subset of participants, self-report of executive dysfunction did not impact exposure therapy process variables. Overall, findings indicate that exposure therapy should be the first-line treatment for combat-related PTSD regardless of presence of TBI history.

Att drabbas av traumatisk hjärnskada (Traumatic Brain Injury; TBI) innebär att hjärnan utsättas för ett yttre våld som kan orsaka kortvariga samt långvariga funktionsnedsättningar. Det kan medföra livsförsändningar både för den drabbade och för de närstående. Syftet med denna litteraturstudie var att beskriva upplevelsen av att vara närstående till en person med traumatisk hjärnskada. Studien utfördes i form av en litteraturstudie med kvalitativ innehållsanalys som analyserades med manifest ansats där människors upplevelse och erfarenheter var i fokus. I studien inkluderades 13 vetenskapliga artiklar. Under analysprocessen av valda artiklar identifierades sex slutkategorier; Ta ansvar och ge upp sina egna behov, Få förändrade och nya roller, Brist på information från hälso-och sjukvården, Vara psykiskt belastad, känsla av ensamhet och isolering; Förlust av relationer. Resultatet visade att närstående upplevde olika svårigheter relaterade till att leva med en person med traumatisk hjärnskada. Att vara närstående till en person med traumatisk hjärnskada kan skapa ekonomiska, sociala, psykiska, känslomässiga och sexuella konsekvenser vilket medför stora förändringar i sociala roller och relationer. Sjuksköterskor behöver kunskap om hur det är att vara närstående till personer med traumatisk hjärnskada samt ha en förståelse för deras upplevelse för att kunna bemöta dem på ett adekvat sätt. Sjuksköterskans kunskap och förståelse kan förbättra närståendes upplevelse av sjukvården samt att de får stöd i sin situation.

Within the past few decades brain injury, or traumatic brain injury (TBI), has gained widespread attention. Early focus was on more severe forms of TBI; severity typically measured using the Glasgow Coma Scale. In more recent years, however, mild traumatic brain injury (mTBI), most notably concussions, has gained increasing interest due to the high frequency of concussions suffered in athletes of all levels and, recently, in military personnel due to blast injuries. Studies being performed have focused not only on ways to help minimize the incidence of concussion as well as treating concussive symptoms, but also on detecting concussions. Many concussions go unreported due to inadequate knowledge of concussive symptoms amongst the general population. Because many concussions go unnoticed and hence unreported the individual who has sustained a concussion is at risk for a more serious injury in the future. One such injury is Second Impact Syndrome (SIS). Second Impact Syndrome is essentially a synergistic event where the sum of two seemingly mild concussions combine to create an event that is potentially fatal. The findings during the autopsy are that there is insignificant damage to the brain to cause death. The damage that occurs, however, is on a molecular level causing a strain on the metabolic processes of the brain called dysautoregulation. Without an understanding of the changes that have occurred on a molecular level in SIS the assignment of cause and manner of death is difficult for the medical examiner. Currently, in order to diagnose SIS, a thorough scene investigation, along with the documentation of a previous head injury is needed. Without a full understanding of SIS and the pathophysiology changes that take place a medical examiner (ME) could misclassify the cause and manner of death in a death due to SIS. In the future, eliminating the prerequisite of identification and documentation of previous head injuries in order to diagnose SIS is needed. This paper evaluates the literature on the current knowledge of TBI and concussions in an attempt to create a protocol on how a medical examiner should approach a case where autopsy findings are unremarkable.

Clinical Researchers recently identified NFL players and US military veterans as high-risk populations for sustaining repetitive Traumatic Brain Injury (TBI) and developing the neurodegenerative disease Chronic Traumatic Encephalopathy (CTE). American culture celebrates military veterans as national heroes, and NFL players as popular athletes and social icons. Both subcultures are constructed around hyper-masculine ideals embedded in tenants of violence and aggression, suffer repeated TBIs due to this nature, and are ultimately at high-risk for developing CTE. The TBI/CTE phenomenon also affects family members who assume care-taking responsibilities for these first two populations as their loved one’s symptoms persist. The purpose of this research is to understand the TBI/CTE experiences of NFL players, military veterans, and their caretakers, and how all three populations intersect with mediatization and the social and medical legitimation of TBI/CTE in America. Using narratives from all three populations, I explore how power dynamics within the NFL and US military have intersected with modern media outlets and functioned to socio-medically legitimize a sick role for those who suffer from persistent symptoms of TBI and CTE.

Traumatic brain injury (TBI) contributes to global mortality and disability more than any other traumatic injury. Individuals who sustained a TBI undergo profound changes in their cognitive, physical, and emotional functions. Noticeable behavioral changes include irritability, aggression, low self-awareness, impulsivity, rumination, and more. These contribute to the individual's inability to control emotions and thus participate in interactions and activities, naturally influencing the person, their environment, and the community. While traditional therapy approaches are beneficial for some of the mentioned challenges, extensive evidence shows that emotional regulation is not effectively addressed, often resulting in behavioral outcomes in the therapeutic environment alone. Mindfulness interventions focus on the present moment's thoughts, sensations, and surroundings with an open and curious mindset, helping participants cope with stressors that often lead to anxiety and problematic behavioral patterns. Nevertheless, the standard Mindfulness does not accommodate the TBI-related challenges. Cultivating Awareness by Living Mindfully (CALM), is a Mindfulness-based group intervention for adults who sustained a TBI. It aims to increase self-awareness and improve emotional regulation by practicing mindfulness techniques and implementing them in everyday activities and interactions. This 12-week program is low-cost and easily applicable to a variety of practice and community settings. The program incorporates principles from the latest evidence-based therapy approaches and is designed specifically to accommodate TBI-related challenges. The theoretical foundations consist of complementing knowledge bases including Mindfulness, the occupational therapy framework - the multi-context approach, and brain-based learning, which are principles from the latest research on optimizing learning for this population. This combination of frameworks aims to makes Mindfulness and its many associated health benefits accessible for individuals post-TBI. This doctoral paper includes a plan for program evaluation, funding, and dissemination

Brain injury has become the signature wound of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF), based on estimates that 10% of all returning warriors may have sustained a brain injury secondary to blast exposures. Traumatic brain injury (TBI) affects the lives of survivors as well as their loved ones, and the consequences associated with TBI inform well-being for all involved. This research uses grounded theory to understand contributing factors of female spousal well-being, specifically the female partners of servicemen who have sustained mild to moderate traumatic brain injury (mMTBI) during combat in OIF/OEF. Through the use of sequential interviews and transcript analysis, the Combat Related Traumatic Brain Injury (CoRTs) Model of Spousal Well-Being emerged illustrating the dynamic relationships among supports, role engagement, the process of redefining self, perceptions of personal empowerment and subjective wellbeing. Four key conclusions were identified from these findings: a) mMTBI affects the life of the surviving service member as well as the life of his partner, b) the myriad consequences of combat-related mMTBI on the female spouse prompted these women to engage in a journey of redefining self, c) communities of influence became the centerpiece from which participants could move forward with their lives or remain in their current state, and d) successful engagement in roles of choice provided study participants experiences from which to establish their new self, fostered perceptions of empowerment, and informed well-being. The CoRTs Model of Well-Being and conclusions provide a framework for future programming designed to target the needs of veterans and family members whose lives have been disrupted by brain injury sustained in combat. / Ph. D.

The Aim The aim of this study was to examine the effects of Animal Assisted Therapies with Farm Animals (AATF) with domesticated ducks on depression, anxiety, and self-efficacy in patients with traumatic brain injury (TBI) . Furthermore, the following hypothesis was tested: Engaging in AATF with domesticated ducks will be associated with decrease in depression, anxiety, and an increase in self-efficacy. Methods The study examined the effects of AATF on anxiety and depression among patients with TBI. Time series quasi-experimental design structure was utilized. At the beginning of the study participants received Hospital Anxiety and Depression Survey (HADS) and General Self Efficacy (GSE) questionnaires to evaluate the depression, anxiety, and self-efficacy. After that AAFT intervention started. AAFT intervention included two one-hour sessions interacting with ducks every week for 12 weeks. At the end of 12-week period participants received the same questioners. This was repeated in four weeks after the intervention ended to evaluate the residual effects of the intervention on anxiety and depression. Results General Linear Model was employed to examine changes in anxiety, depression, and self-efficacy. Participants presented with anxiety level decrease when means of pre and post intervention anxiety levels were compared. We discovered that these differences were significant based on an alpha value of .05, p = .009. There were no statistically significant differences between anxiety levels immediately post intervention and in four weeks the intervention was complete. There were no statistically significant differences discovered between depression levels pre, post, and retest. Also, there were no statistically significant differences discovered between self-efficacy levels pre, post, and retest. Conclusions Our study supported the part of hypothesis regarding an inverse association between time spent working with ducks and anxiety. Mastery of skills, vicarious experiences, and verbal persuasion may be the factors that contribute to the beneficial outcomes of the interactions between persons with TBI and domesticated ducks.

Traumatic brain injury (TBI) is a leading cause of disability in the United States (Coronado et al., 2011). There is a recognized need for better motor assessments to help mitigate these disabilities. Advances in markerless motion capture and in magnetic resonance imaging (MRI) provide an opportunity to improve clinical assessments, and link them to damage measured in MRI scans. The primary aims of this research were to 1) develop a quantitative motor assessment (QMA), and seed a normative database to enable comparison of impaired behavior to unimpaired, 2) test the sensitivity of the QMA, and 3) link QMA results to underlying TBI damage.The QMA developed in Aim 1 consisted of five tests: finger oscillation, tremor, visually guided movement, reaction time, and balance. We administered the QMA and traditional analgous tests to 132 healthy 18-50 year olds. We later added a coginitive motor integration (CMI) test and a stength-dexterity pinch test, then administered them to 31 (16 male, mean age = 24.7) healthy individuals. We seeded a normative database for the QMA and CMI measures. (A normative database for the pinch test already exists.) Correlations between the QMA and traditional tests were weak but the QMA results followed expected trends.In the second aim, 31 (16 male, mean age = 24.7 years) individuals with TBI completed all of the motor tests, and age- and gender-matched controls completed the CMI and pinch tests. We tested the sensivity of the QMA, the CMI and pinch tests, and traditional tests by their ability to correctly identify TBI subjects based solely on test results. The QMA was more sensitive than the other test groups. In Aim 3, we performed a stepwise regression to evaluate the relationship between motor deficits and brain injury, using motor test results and MRI images from the TBI and control groups. We found significant relationships between deficits in precision and increases in superior lateral ventricular volumes, deficits in pointing tasks and decreases in fractional anisotropy (FA) in the corticospinal tract, deficits in rhythmicity during finger oscillation and decreased FA in the thalamocortical tract. There were also relationships between each of the motor deficit measures and the FA values in the corpus callosum. This was the first step in showing that a quantitative motor assessment using markerless motion capture is feasible. The QMA is sensitive and can be linked to underlying brain damage. Though the QMA is not yet ready for clinical use, this research provides insights that will help address gaps in TBI rehabilitation.