Thesis (M.A.)--Miami University, Dept. of Speech Pathology and Audiology, 2004. / Title from first page of PDF document. Includes bibliographical references (p. 54-59).

Orientador: Liciana Vaz de Arruda Silveira / Resumo: Introdução: O traumatismo cranioencefálico constitui um dos principais problemas de saúde pública e está entre as principais causas de morte, incapacidade ou invalidez. As suas características variam de acordo com a população envolvida, sendo de expressiva importância o conhecimento das características das internações de modo a elaborar diretrizes básicas para programas de prevenção e também intervenções específicas na área assistencial. Objetivos: Caracterizar o perfil epidemiológico do traumatismo cranioencefálico (TCE) na Unidade de Terapia Intensiva do Hospital de Base de Bauru e elaborar um Guia de orientações pós-alta hospitalar para o cuidador. Métodos: Estudo quantitativo, retrospectivo e de natureza documental, baseado na análise de prontuários eletrônicos de pacientes vítimas de traumatismo cranioencefálico internados no período de janeiro a julho de 2016. Resultados: Foram admitidos 156 pacientes (29,65%) com traumatismo cranioencefálico; 139 prontuários atendiam os critérios de inclusão e foram analisados. Houve predomínio de idosos e adultos (idade 41 anos ou mais), representando 58,28% da amostra; prevalência do sexo masculino (82%) e traumatismos causados por quedas (39,57%), seguidos de espancamentos (15,11%) e acidentes motociclísticos (14,39%). Desses pacientes, 24 evoluíram a óbito; 19 pacientes receberam alta com algum déficit (neurológico, motor ou visual) e com 27 dispositivos invasivos. Conclusão: Apesar das altas taxas de prevalência de traumatismo cra... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

BACKGROUND: Prospective memory difficulties are one of the most common deficits following acquired brain injury. The application of smartphones as a compensatory aid to these difficulties has shown promising results. This study looked to investigate these benefits further. OBJECTIVE: The aims of this study were to investigate whether receipt of reminder prompts through ones smartphone improved completion of pre-planned tasks, in addition to whether it also had secondary implications for participant's wellbeing, confidence, independent functioning, and whether it had any impact on caregiver strain levels. METHOD: This study used an ABAB case series design with mild to moderate acquired brain injury. Task completion rates were monitored across four phases (prompts vs. no prompts). Quantitative questionnaires were administered pre, post and at three months follow up to assess coping with memory difficulties. A qualitative questionnaire explored the perceived impact of the smartphone reminders on everyday functioning, in addition to a 3 month follow up measure assessing attrition rates in smartphone use. RESULTS: Visual inspection analysis suggested greater task completion when reminders were provided. The quantitative questionnaires showed increased use of a Smartphone as reminder device post intervention and at follow up. A basic thematic analysis highlighted a perception that the smartphone system increased task completion, confidence in coping with memory demands, supported emotional wellbeing and reduced dependence on others. As a memory aid it was also less stigmatising and promoted dignity. The three month follow up questionnaire highlighted that all participants continued to use their smartphone as a memory aid. CONCLUSIONS: Use of a smartphone as a memory compensation aid may improve completion of pre-set tasks. Secondary benefits may include increased confidence in coping with memory demands, reduced dependence on others for help, and reduced anxiety or frustration around forgetting.

Despite evidence indicating negative consequences of repetitive head impacts (RHIs) on the brain, the long-term effects remain largely unknown. Contact sports, such as football, expose players to multiple collisions. Professional sports players have undergone thousands of concussive and sub-concussive RHIs over their careers. In this study we used structural 3T MRI to evaluate cortical thickness of 86 former NFL players (mean age ± SD = 54.9 ± 7.9 years old) and 24 former professional non-contact sport athletes as controls (mean age ± SD =57.2 ± 6.9 years old). Cortical thickness was compared between groups using FreeSurfer. The NFL players displayed decreased cortical thickness in the right temporal lobe and fusiform gyrus (cluster-wise p-value=0.0003, 90% CI=0.0001-0.0005) and the left pre- and postcentral gyrus (cluster-wise p-value=0.0096, 90% CI=0.0084-0.0109). When looking only at NFL subjects impaired in measurements of mood and behavior (n=36) compared to controls, NFL players displayed a similar but more extensive cluster of decreased cortical thickness in the right temporal lobe and fusiform gyrus (cluster-wise p-value=0.0001, 90% CI=0.0000-0.0002) and in the left supramarginal gyrus and pre- and postcentral gyrus, (cluster-wise p-value=0.0002, 90% CI=0.0000-0.0004). Reduced cortical thickness in NFL players is suggestive of the long-term effects of RHIs. Still, future studies are necessary for examining the time-course of damage and the implications of regional cortical thinning.

L'œdème cérébral et l'hypoxie cérébrale post-traumatiques sont les acteurs principaux de l'apparition des lésions ischémiques secondaires. L'erythropoïétine (Epo) sous sa forme recombinante humaine possède une activité anti-oedémateuse dans un modèle expérimental de TC diffus. Son action sur l'hypoxie cérébrale post-traumatique reste néammoins méconnue. De plus, les effets indésirables hématologiques de l'Epo ont conduit à la synthèse de dérivés de l'Epo ne possèdant pas d'activité hématopoïétique comme l'érythropoïetine carbamylée (CEpo). Dans ce contexte, mon travail de thèse a eu pour but d'évaluer les propriétés de l'Epo et de la CEpo dans le modèle de TC diffus. Un traitement intraveineux par CEpo à la dose de 50 µg/Kg a ainsi permis de diminuer précocemment l'œdème cérébral post-traumatique évalué in vivo par IRM de diffusion et ex vivo par gravimétrie spécifique. Cette propriété a impliqué l'inhibition de la phosphorylation de la voie Erk et s'est accompagnée de l'amélioration des fonctions motrices et cognitives jusqu'à 10 jours après le TC. Après une étude de validation sur des rats sains soumis à différentes conditions d'oxygénation, une méthode de mesure IRM de la saturation locale en oxygène (lSO2) cérébrale combinant l'effet BOLD avec la mesure du volume sanguin cérébral a montré une diminution de l'oxygénation cérébrale post-traumatique. Cette hypoxie cérébrale n'était pas en lien avec une diminution du débit sanguin cérébral attestée par méthode de premier passage d'un agent de constraste. Un collapsus des capillaires cérébraux était par ailleurs retrouvé en microscopie électronique. L'Epo à la dose de 5000 UI/Kg a été capable de restaurer l'oxygénation cérébrale en diminuant l'œdème astrocytaire péricapillaire. L'ensemble de ce travail a permis d'établir les bénéfices d'un traitement par Epo ou par CEpo sur l'œdème cérébral et l'hypoxie cérébrale post-traumatiques. / Post-traumatic brain oedema and brain hypoxia play a key role for the development of secondary ischaemic lesions. Erythopoïetin (Epo) is an anti-oedematous agent in the impact-acceleration model. However its action on brain hypoxia remains unkonwn. Neuroprotective derivatives of Epo that lack haematopoïétic properties, like carbamylated Epo (CEpo), have been developped to counter Epo side effects. In this context, our study aimed to assess the effect of Epo and CEpo on post-traumatic diffuse brain oedema and brain oxygenation. CEpo (50 µg/Kg) decreased brain oedema assessed by diffusion-weighted MRI and specific gravimetry 6 hours after the trauma. The anti-oedematous effect of CEpo was linked to Erk inhibition and was associated with an improvement of cognitive and motor functions, evaluated until 10 days after the insult. MRI using the combination of BOLD contrast and blood volume fraction measurement demonstrated a decrease of local brain oxygenation in our model, without franck ischemia (measurement of mild transit time by a first passage method). Epo (5000 UI/Kg) improved brain oxygenation by decreasing post-traumatic cerebral capillaries collapse due to astrocytic end-foot swelling. All these results demonstrated that Epo and CEpo could be seen as promising neuroprotective agents in traumatic brain injury.

As a field, Behavior Analysis lacks an evidence based solution to assessing and treating language deficits in individuals with brain injuries. Research suggests that using direct instruction with persons with brain injuries is the most effective approach for teaching skills. Research on the PEAK Relational Training System suggests it may be applicable to adults with brain injuries because it does not have an age maximum and it assesses and trains complex language skills. The purpose of the current research is to determine the PEAK Relational Training System's potential applicability in assessing language and cognition functioning in adults with brain injury. 20 adults with brain injuries served as the participants for this study. Using a Pearson Correlation, the relationship between performance on the PEAK assessment and the Ross Information Processing Assessment (RIPA-2), pre-morbid education levels, Glasgow Coma Scale scores, and the location of injury in the brain was analyzed. Significant relationships between PEAK and RIPA-2 scores and PEAK and number of years since injury were shown. Furthermore, implementation of the PEAK was shown to be highly reliable. The current research has shown the effectiveness of the PEAK Relational Training System Direct Training Assessment for adults with brain injury.

This diploma thesis is a part of the GAJU project entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 128/2016/S)". At the time when the thesis was elaborated, only the patients who suffered the cerebrovascular accident were engaged in the project, since in the hospital, no suitable patient after brain injury who would need a multidisciplinary team in home care had ever been sought. The selection of the patients was based on the communicative skills criteria e.g. if the skills to participate in the directed conversation based on the Functional Independence Measure Questionnaire (FIM), WHO Disability Assessment Schedule 2.0 and the follow-up questions concerning social issues, physiotherapeutic methods and techniques were preserved. Within the framework of the project, the research has not been finished yet. Given the above mentioned reasons, this thesis is therefore mainly focused on the identification of patients' needs after the cerebrovascular accident (CVA), on the period starting from its first incidence during the first three months period after the discharge from the hospital to home care. The complex results will be presented as a part of the publication activity of the project. The thesis comprises a theoretical and a practical part. The theoretical part presents a comprehensive view on the care for the patients who suffered the cerebrovascular accident. I addressed both the basic characteristics of the cerebrovascular accident and the organisation of the care for the patients in the Czech Republic; furthermore, the coordinated rehabilitation team, the role of a social worker, possibilities of social help provided by the welfare system to patients and their families, and the psychical condition of the patient. In the last chapter, I outline the general concept of human needs according to A. Maslow and describe important needs of the sick people. As far as the research part is concerned, my goal is to identify the needs of patients in home care after the brain injury. In connection with the aim of the thesis, two research questions were defined. The first question is: "What are the needs of the patients after brain injury?". The second question is: "What is the role of a social worker in meeting the needs of a patient with brain injury?" The qualitative research strategy was used; the instructional dialogue technique with patients after brain injury in the South Bohemia Region within the project. When analyzing the data collected from the patients during the first three months after the discharge from the hospital to the home care, seven major patient needs emerged need of help, need of psychical equilibrium, need of self-reliance, need of being without paint, need of recovering to the condition before CVA incidence, and need of establishing a new system of activities. Two of these needs, the need of recovering to the condition before CVA incidence and the need of establishing a new system of activities could be considered as principal, because the other needs are in general heading towards them. Furthermore, the analysis of the results showed the role of a social worker by means of which these needs can be saturated The results of the present thesis are used as a partial part from which the complex results of coordinated rehabilitation of patients after brain injury of the GAJU project are complied. The needs analysis of patients brought the proposals of dealing with/saturation of these needs and therefore had a direct impact on the lives of the respondents. The results of the research will become a part of the publication outputs of the above-mentioned projects.

The thesis is a part of the project called Coordinated rehabilitation of the patients with the brain injury (reg. n. GAJU 138/20146/S). The objective of this work is to find out what needs the families of patients with the brain injury have. This thesis has a theoretical and a practical part. According to research set consisting of 14 caregivers of patients after cerebrovascular accident and only one that cares about a patient after cranial trauma, the theoretical part describes a CMP characteristic, coordinated rehabilitation, the basic terms about family and the chosen concepts of needs. Based on the objective of the thesis, the research question was stated: What are the needs of family members who care about the patients with the brain injury in the home environment? The research was made by the qualitative strategy and the semi-structured interviews with the family members in South Bohemia region who cares about the people with the brain injury in the home environment. It was important that people with the brain injury have already been joined to the project. The interviews were done in the application called Atlas.ti. According to the analysis of the collected data, there are 9 main needs that are connected to each other. Concretely, it is a need of a care about the patient, about the house, the need of a family help, the need of professional and social services, economic security and quicker help by the social service, furthermore the need of free time, psychological well-being and being in touch with the society. The results of this thesis are a part of the complex results of the project GAJU called Coordinated rehabilitation of patients with the brain injury (ref. n. GAJU 138/20146/S). The analysis of the needs of family members was used to propose the solutions/saturation of the needs in order to influence the real life of interviewers.

The thesis is focused on the social work with people after brain damage and is part of the GAJU project called "Coordinated Rehabilitation of Patients after Brain Damage (Reg. No. GAJU 138/2016 / S)". Collaboration with social workers from the region of České Budějovice was part of this thesis. Their work also consists of working with people after brain damage. The purpose of the collaboration was to map out follow-up services after hospitalization of people after brain damage. Information about these organizations has been shared with the patients who were included in the GAJU project. The complex results of the project will be elaborated within the publishing activities. The diploma thesis is divided into two parts. The first - the theoretical part - is focused on the basic description of brain damage, there is more about the cerebral stroke, the coordinated rehabilitation team, the role of the social worker. There is also described the burden that the social worker as a person in the helping profession may face and burnout syndrome as a possible consequence of this burden. In the research part, the main objective was to find out what positives and negatives the social workers perceive in working with people after brain damage. This objective was completed through interviews with the social workers situated in České Budějovice. We can fully understand the extend of the social workers' work with people after brain damage thanks to the interviews. In connection with the goal, research questions have been identified: What are the positive and negative aspects of social work related to work with patient after brain damage according to the subjective opinion of a social worker? Another one: What influences the perception of positives and negatives which the social workers experience during their work? A qualitative research strategy was used, a technique of interviewing with use of instructions was chosen for the interviews with fourteen social workers of the organizations, whose target group also includes people after brain damage. Data was processed in Atlas.ti 7. The administration which is more and more demanding due to the legislation. That results in less time with client and more time with paperwork. Finance which is related to the funding of services, lack of resources for employee remuneration and the financial difficulty for clients. Lack of qualified staff, time consuming activities that are closely tied to the extensive administration and the fact that social workers often work beyond their job responsibilities and competencies. Non-cooperation of a client's family or lack of interest of family on the client, there is also the legislation, which is often in contradiction with practice according to interviews. The social workers have to follow the actual amendments of the law and that is time-consuming and exhausting, absence of follow-up organizations for patients after brain damage, lack of competencies/authority/information of social workers, insufficient motivation, lack of financial remuneration or lack of benefits for employees, conflicts with authorities, barriers that may occur during work of a social worker or insufficient resources. The analysis also reveals that social workers subjectively perceive these positives during their work with patients after brain damage: client satisfaction, helping people, the good feeling after job well done, positive feedback, fulfilling job, positive in relation to the work environment. The results of the thesis show that the positive aspects dominates over the negative ones. Work in a multidisciplinary team has been perceived positively amongst the social workers and beneficial for the clients and for the team. This work will serve as a sub-part for the elaboration of complex outcomes of coordinated rehabilitation of patients after brain damage from the GAJU project. Research results will become part of the publication outputs from the above-mentioned project.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Studies over recent years have highlighted the important role of creatine in health and in treating various neurological diseases. However, its role in secondary damage induced by traumatic brain injury (TBI) is not fully understood. The aim of this study was to evaluate the effect of creatine supplementation on the oxidative damage and susceptibility to seizures after TBI. For this, we used the model of fluid percussion injury (FPI) in rats, where brain damage is caused by a liquid column that causes a pressure on the dura intact of animal, which was previously exposed. Our results revealed that at 4 and 8 days after TBI, there was increased oxidative damage characterized by increased protein carbonylation and levels of species thiobarbituric acid reactive substances (TBARS), and also there was a reduction in Na+, K+ -ATPase activity. Statistical analysis (two way ANOVA) also revealed that creatine supplementation (300 mg / kg orally), beginning 30 minutes after TBI and continuing until 3, or 7 days after injury, reduced protein carbonylation and TBARS when analyzed at 4 and 8 days after injury. However, creatine supplementation did not protect the inhibition of Na+, K+-ATPase 4 and 8 days after TBI. Furthermore, the analysis electroencephalographic (EEG) showed that injection of a subconvulsant dose (35 mg / kg, intraperitoneally) of pentylenetetrazol (PTZ), 4 but not 8 days after TBI, decreased latency to the tonic- clonic seizures and increased the time spend in generalized seizure, when compared to the control group. Creatine supplementation had no effect on the convulsive parameters induced by PTZ injection. The experiments in this study suggest that in this experimental model of TBI, oxidative damage seems not to be directly involved in susceptibility to seizures after neuronal injury since the antioxidant capacity exerted by creatine does not protect against PTZ-induced seizures after TBI / Estudos realizados ao longo dos últimos anos têm destacado o importante papel da creatina na saúde bem como no tratamento de diversas doenças neurológicas. Entretanto, seu papel no dano secundário induzido por traumatismo cranioencefálico (TCE) não está totalmente compreendido. O objetivo de nosso estudo foi avaliar o efetio da suplementação com creatina sobre o dano oxidativo e suscetibilidade a convulsões após TCE. Para isto, utilizamos o modelo de lesão por percussão de fluido (LPF) em ratos, onde a lesão encefálica é provocada por uma coluna líquida que exerce uma pressão sobre a duramáter intacta dos animais, a qual foi previamente exposta. Nossos resultados revelaram que em 4 e 8 dias após TCE, houve o aumento do dano oxidativo caracterizado pelo aumento de carbonilação protéica e dos níveis de espécies reativas ao ácido tiobarbitúrico (TBARS) e, também, houve uma redução da atividade da enzima Na+, K+-ATPase. A análise estatística (ANOVA de duas vias) também revelou que a suplementação com creatina (300 mg/kg, via oral), iniciando 30 minutos após o TCE e prolongando-se até o 3º, ou 7º dia após a lesão, reduziu a carbonilação protéica e os níveis de TBARS, quando analisado no 4º e 8º dia após a injuria. Entretanto a suplementação com creatina não protegeu da inibição da enzima Na+, K+-ATPase 4 e 8 dias após a TCE. Além disso, a análise eletroencefalográfica (EEG) revelou que a injeção de uma dose subconvulsivante (35 mg/Kg, intraperitoneal) de pentilenotetrazol (PTZ), em 4, mas não em 8 dias após TCE, diminuiu a latência para as convulsões tônico-clônicas generalizadas e aumentou o tempo de sua duração, quando comparado ao grupo controle. A suplementação de creatina não exerceu qualquer efeito sobre os parâmetros convulsivos induzidos pela injeção de PTZ. Os experimentos realizados no presente estudo sugerem que, neste modelo experimental de TCE, o dano oxidativo parece não estar diretamente envolvido na suscetibilidade a convulsões após lesão neuronal uma vez que, a capacidade antioxidante exercida pela creatina não protege das crises convulsivas induzidas por PTZ após TCE.