This Master's thesis focuses on Occupational therapy for patients after application of botulinum toxin to upper limb. The aim of the thesis was to evaluate and compare a progress of functional independence in patients after acquired brain injury. There were twenty patients involved in the research, who were further divided into two groups and separated by ten people in each group. Both groups underwent the application of botulinum toxin whereas the experimental group A went through the occupational therapy. The control group had ordinary rehabilitation at home and without any occupational intervention for the duration of twelve week under guided self-rehabilitation contract of spastic paresis, so-called GSC. A programme of the group A included over the counter rehabilitation outpatient occupational therapy. The patients attended the course twice a week for the duration of four weeks. Afterwards, they received a home programme for the duration of eight weeks, during which they had two examinations at occupational therapy. All the participants were evaluated by Global Subjective Self-Assessment which is focused on spasticity. There were further evaluated according to Functional Independece Measure and modified Frenchay Arm Test. The experimental group with outpatient occupational therapy was...

The evidence base for Mindfulness-Based Cognitive Therapy (MBCT) is growing, but there is a lack of experimental validation among populations with acquired brain injuries (ABI). The purpose of this study was to investigate the acceptability and effectiveness of MBCT in fostering psychological recovery among adults with ABI. More specifically, this study was conducted to:(a) extend Finucane and Mercer’s (2006) study by applying MBCT to another population (i.e., adults with ABI); (b) corroborate the Bedard et al. (2008) finding of MBCT’s effectiveness in reducing depression in adults with TBI; (c) establish if empirical findings of the effectiveness of MBCT on depression and anxiety in the general population and in primary care patients with active symptoms of depression and anxiety extended to adults with ABI; and (d) explore the effect of MBCT treatment on measures of locus of control, satisfaction with life, self-awareness, and coping in adults with ABI. A mixed methods design was used and participants were recruited from two community-based brain injury programs. The final sample comprised 12 adults with mild, moderate, and severe injuries. Interview and self-report measures were administered pre- and post-treatment. Qualitative data were collected through semi-structured focus groups following MBCT treatment. Depression, denial, and self-awareness among participants showed statistically significant improvements and participants’ demonstrated statistically significant increases in positive reframing and active coping. Focus group data confirmed MBCT as an acceptable and effective approach for adults with ABI, and also speak to implications for the use of MBCT in ABI populations specifically. The need for a larger replication study with a control group is discussed. / Graduate

Introduction : Les troubles cognitifs et comportementaux après une lésion cérébrale peuvent entraîner des limitations d’activités et des restrictions de participation. Un programme de réadaptation, pluridisciplinaire et holistique a été développé à la Pitié Salpêtrière. D’une durée de 7 semaines, il vise l’amélioration de la participation en associant des rééducations individuelles et des mises en situation écologiques (ex : préparation de repas, reprise des transports en commun...). Les effets du programme n’ont jamais été investigués. Objectif : 1) définir et valider le programme de réadaptation par l’équipe multidisciplinaire à l’aide d’un modèle logique et 2) documenter l’effet du programme sur l’activité «préparer les repas». Méthode : Mesures répétées pré (T1 et T2) et post programme (T3, T4, T5 jusqu’ à 6 mois) avec 7 sujets uniques. Outil de mesure : Cooking Task (CT) (Chevignard, 2000), Profil des Activités Instrumentales (PAI) (Bottari, 2009) et Mesure des Habitudes de Vie (MHAVIE) (Noreau, 2002). Résultats : Objectif 1 : la documentation de chaque activité du programme est validée par des groupes d’experts. Objectif 2 : Les méthodes « two standard deviation band» et “non-overlap of all pairs” (NAP) pour cas unique démontrent des différences significatives entre les périodes pré et post programme au nombre total d’erreurs au CT (6/7 sujets), en besoin en aide (PAI). L’item préparation de repas de la MHAVIE suggère une amélioration pour 4/7 sujets. Discussion : L’ensemble des résultats du CT (diminution des erreurs), du PAI et de la MHAVIE suggère une amélioration globale de l’activité « préparer un repas » à la suite du programme de réadaptation. / Background: Cognitive and behavioural difficulties following acquired brain injury (ABI) may lead to severe limitations in activities and restrictions in participation. A specific ABI, holistic and multidisciplinary rehabilitation program was developed at the Salpêtrière hospital (Paris, France). Over a 7-week period, the program aims to improve participants’ participation by combining individual rehabilitation and environmental scenarios such as meal preparation, transportation etc. Program effects have never been investigated. Objectives: 1) to define and validate the rehabilitation program by a multidisciplinary team using a logic model and 2) to document the program's effect on the activity "prepare meals." Method: Repeated measurements pre-program (T1 and T2) and post-program (T3, T4, T5 up to 6 months) with 7 subjects using the Cooking Task (CT) (Chevignard, 2000), Instrumental Activities of Daily Living (IADL) (Bottari, 2009), and Measure of Life Habits (LIFE-H) (Noreau, 2002). Results: Using the two standard deviation band method and “non-overlap of all pairs” (NAP) methods for small n design, significant differences in pre and post program measures were found for the total number of errors in CT (6/7 subjects), the need of assistance (IADL). The results of the LIFE-H suggest an effect of improving the preparation of meals for 4/7 subjects. Discussion: The combined results from the CT (fewer errors), IADL and LIFE-H suggest an overall improvement in the activity "preparing a meal" after the rehabilitation program.

Philosophiae Doctor - PhD / This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968). / South Africa

As head injuries and their sequelae have become an increasingly salient matter of public health, experts in the field have made great progress elucidating the biological processes occurring within the brain at the moment of injury and throughout the recovery thereafter. Given the extraordinary rate at which our collective knowledge of neurotrauma has grown, new insights may be revealed by examining the existing literature across disciplines with a new perspective. This article will aim to expand the scope of this rapidly evolving field of research beyond the confines of the central nervous system (CNS). Specifically, we will examine the extent to which the bidirectional influence of the gut-brain axis modulates the complex biological processes occurring at the time of traumatic brain injury (TBI) and over the days, months, and years that follow. In addition to local enteric signals originating in the gut, it is well accepted that gastrointestinal (GI) physiology is highly regulated by innervation from the CNS. Conversely, emerging data suggests that the function and health of the CNS is modulated by the interaction between 1) neurotransmitters, immune signaling, hormones, and neuropeptides produced in the gut, 2) the composition of the gut microbiota, and 3) integrity of the intestinal wall serving as a barrier to the external environment. Specific to TBI, existing pre-clinical data indicates that head injuries can cause structural and functional damage to the GI tract, but research directly investigating the neuronal consequences of this intestinal damage is lacking. Despite this void, the proposed mechanisms emanating from a damaged gut are closely implicated in the inflammatory processes known to promote neuropathology in the brain following TBI, which suggests the gut-brain axis may be a therapeutic target to reduce the risk of Chronic Traumatic Encephalopathy and other neurodegenerative diseases following TBI. To better appreciate how various peripheral influences are implicated in the health of the CNS following TBI, this paper will also review the secondary biological injury mechanisms and the dynamic pathophysiological response to neurotrauma. Together, this review article will attempt to connect the dots to reveal novel insights into the bidirectional influence of the gut-brain axis and propose a conceptual model relevant to the recovery from TBI and subsequent risk for future neurological conditions.

Traumatic Brain Injury (TBI) is the leading cause of death and disability in children and adolescents in the U.S. and disproportionately affects young children. The negative consequences of early childhood TBI include deficits in behavior and attention, cognitive abilities, and academic skills. Behavior problems in particular are one of the most common and persistent consequences following TBI in young children. Therefore, interventions are needed that target the adverse effects of TBI on behavior. The purpose of the current work was to examine the initial outcome, feasibility, acceptability, and satisfaction of a time-limited and intensive format of Parent-Child Interaction Therapy (PCIT) for families with a child aged 2 to 5 years who had sustained a TBI and displayed clinically elevated externalizing behavior problems. The open trial included 10 families that completed a baseline assessment, received the intervention over 5 weeks, and completed post-intervention and 2-month follow-up assessments. Results indicated that children who completed the intervention showed significant improvements in both externalizing and internalizing behavior problems at post-intervention and 2-month follow-up, with the exception of non-significant change in self-regulation at post-intervention and 2-month follow-up, and attention problems at 2-month follow-up. In addition, significant improvements were found on all cognitive measures examining working memory, receptive language, and executive functioning at post-intervention and 2-month follow-up. Similarly, caregivers who completed the intervention displayed significant improvements in their parenting skills during play with their child and reported significant reductions in overall caregiver stress and caregiver stress related to their child’s difficult behaviors. Despite limitations inherent in an open trial (e.g., small sample, lack of a control group, generalizability), the current study addressed a relatively unexplored research question and suggests that an intensive format of PCIT may be a promising approach for improving domains commonly affected by early childhood TBI (e.g., behavioral, cognitive, and family functioning) prior to the development of more severe and persistent problems.

Objectives: After mild traumatic brain injury (mTBI), psychological factors can contribute to persisting post-concussion symptoms (PCS). Consistent with constructive theories of memory, negative expectations for increased symptoms after mTBI may contribute to misattributing symptoms to the mTBI and underestimating pre-injury symptoms, called the “good old days’ bias” (Gunstad & Suhr, 2001). The good old days’ bias is not thought to be a general retrospective recall bias but studies to date have largely not controlled for normative memory processes including those that lead to a biased, more positive recall of the past. Therefore, the current study examines whether there is a good old days’ bias after mTBI above and beyond normal memory biases. This study also examines how soon after mTBI the good old days’ bias affects recall of pre-injury symptoms in the first month after mTBI in adolescents as well as whether the good old days’ bias causes pre-injury symptom severity to be underestimated or if symptoms are entirely forgotten. Finally, the clinical significance of symptom recall biases is investigated. Method: The sample is 42 adolescents who sustained an mTBI (ages 13-18 years; 24 males) and 42 uninjured adolescents (ages 13-18 years; 24 males, ). The mTBI group rated current and retrospective post-concussion symptom ratings within one week and again, at one month, post-injury. The control group rated current and retrospective post-concussion symptoms at baseline and one month later. Cross-sectional and longitudinal comparisons using non-parametric statistical tests were used. Results: Wilcoxon signed-rank tests showed that, by one month post-mTBI, adolescents report fewer total, physical, and emotional pre-injury symptoms than they had reported within one week of their concussion. The control group did not demonstrate this good old days’ bias. There were no between-group differences in retrospective PCS ratings at either time point. Chi-square analyses found that the mTBI group was as likely as the control group to recall “no” pre-injury/past symptoms one month post-injury after having initially reported some pre-injury symptoms. Only four more adolescents were classified as “recovered” if their one-month PCS ratings were compared with pre-injury PCS ratings made within 1-week post-concussion rather than pre-injury ratings from 1-month post-injury. Discussion: There was mixed evidence for a good old days’ bias by one month post-concussion. This bias was not demonstrated in healthy adolescents, suggesting that the good old days’ bias is found specifically after concussion. During the acute post-injury period, the good old days’ bias may only be apparent by studying changes in concussed individuals’ own PCS ratings. The good old days’ bias leads to underestimating the severity of pre-injury symptoms rather than forgetting them entirely. The good old days’ bias does not greatly affect symptom recovery tracking by one month post-concussion. Future studies should directly examine expectations about concussion and their effect on current and retrospective symptom reporting. / Graduate / 2019-07-10

Traumatic brain injury is a topic that in recent years has received increased scrutiny by the media and is viewed as a cause for public health concern in athletes that are participating in contact sports. There has been an apparent rise in the reported number of traumatic brain injuries over the last decade possibly due to a number of factors such as an increase in enrollment of sports and suspected better understanding of brain injury in the sports world. Direct or indirect impact forces applied involving acceleration/deceleration and linear/angular forces primarily cause trauma to the brain. This insult results in evident diffuse axonal and focal injuries to varying degrees in brain tissue. The spectrum of pathophysiology in traumatic brain injury involves structural, neurochemical, metabolic, vascular, inflammatory, immunologic, and ultimately cell death, which plays a hand directly in the nonspecific presentation of symptoms reported by athletes as well as the progression of recovery. Traumatic brain injury is typically associated with short- and long-term sequelae, however, inducing repetitive episodes of trauma over a career, as may happen in sports, may lead to a progressive neurodegenerative disease known as chronic traumatic encephalopathy. Chronic traumatic encephalopathy has been known to affect boxers previously, but in recent years the attention has shifted and found this disease in athletes from other sports. The spectrum of disease in chronic traumatic encephalopathy involves a progressive tauopathy that spreads across different regions of the brain in a classified four staged grading system. Several risk factors have been identified in placing athletes at risk for traumatic brain episodes, however no risk factors have been directly linked to chronic traumatic encephalopathy. Much information is lacking in a complete understanding of traumatic brain injury and chronic traumatic encephalopathy, therefore emphasizing the importance of further research and consistently improving modifications in the protocols for assessment, recognition, management, and return to play criteria for injured athletes. Furthermore, despite the gaps in knowledge, preventative measures should serve a particular role in reducing the incidence of detected traumatic brain injuries, which should include policy changes, sport rule changes, and especially changes to the accepted sports culture through mandatory education.

This study investigated the effects of lesion presence within larger brain networks (e.g., default mode network (DMN), salience network (SN), and mentalizing network (MN)) in the chronic phase of a pediatric traumatic brain injury (TBI) and the effect on social function. We compared children with a TBI to children with an orthopedic injury (OI) with three different aims. The first aim was to determine whether network volume differed by group (e.g., TBI vs. OI). Second, investigate if lesion presence in a sub component region of the network resulted in total network volume loss for that network. Finally, learn whether network volume would predict outcome on the Behavior Assessment System for Children, Second Edition (BASC-2). Approximately 184 participants (65% male; 70% Caucasian) between the ages of 6-17 years completed testing and a structural MRI scan in the chronic stage (at least one-year post-injury) of the injury. Injury severity included complicated mild, moderate, and severe TBI. Radiological findings were analyzed using recommendations from the Common Data Elements' core (presence or absence of a lesion) and supplementary (lesion type and location) recommendations. Volumetrics for all participants were obtained with FreeSurfer to quantify total network volumes for the DMN, SN, and MN. The parent of each participant completed a behavioral measure for externalizing and internalizing behaviors. Three sets of statistical analyses were completed, including multivariate analysis of covariance, analysis of covariance, and multiple regression, for each of the three aims of the study, respectively. There were significant differences in total DMN volume between the two groups and participants with lesions solely in the MN had lower total MN volume. Moreover, lower total MN volume was associated with worse functioning on measures of externalizing and internalizing behaviors. The larger implications, including developmental and social implications, of these findings are discussed.

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