Aquired brain injury is still a current topic and a serious problem nowadays. After a treatment, a lot of consequences appear which cause a long-term inability to work and invalidation of many people. One of the serious problems is a disorder of cognitive functions which disables people to get back to a normal life. One of the options how to affect the cognitive functions impairment is a system called CogniPlus. Theoretical part of this work presents aquired brain injury, its dividing, basic classification and the consequences. Furthermore, this work dedicates to rehabilitation of cognitive functions using both computers and conventional methods. It also shows the work of the occupational therapist and the possibility of cognitive function testing. The aim of the research is to find out if CogniPlus cognitive function training is more effective than the conventional pencil-paper method. 20 people were tested in this study. Unfortunately, one of them had to quit due to health problems. The experimental and the control group had a therapy once or twice a week. All the participants went through Addenbrooke cognitive test and through a questionnaire of cognitive mistakes at the beginning and at the end of the testing. The experimental group showed a significant improvement in the global score ACE and...

Cette étude qualitative descriptive de type exploratoire a pour but d’explorer les perceptions des adolescents, de leurs parents et des professionnels impliqués quant à l’inclusion sociale des adolescents ayant vécu un traumatisme craniocérébral (TCC) modéré, notamment en ce qui concerne la reprise des rôles sociaux une fois le congé définitif du centre de réadaptation obtenu. Le modèle écologique de Bronfenbrenner (1979, 1986), adapté par Lefebvre & Levert (2005) auprès de la clientèle TCC, est utilisé comme cadre de référence. Des entrevues semi-dirigées ont été réalisées auprès de trois adolescents ayant vécu un TCC modéré, de même que leurs parents, et un groupe de discussion auprès de quatre professionnels. Les résultats montrent que les perceptions des adolescents ayant vécu un TCC modéré, de même que celles de leurs parents, portent sur différents aspects de leur vie, tels que l’adolescent en tant que personne, la famille, les amis, l’environnement, l’école et les loisirs. Il est en effet ressorti une multitude de répercussions, ces dernières facilitant, parfois contraignant, l’inclusion sociale de l’adolescent TCC modéré. De manière générale, les professionnels partagent les mêmes perceptions qu’eux. Toutefois, ces derniers ajoutent certains aspects non recueillis lors des entretiens auprès des adolescents TCC modéré et de leurs parents. Les résultats de cette étude devraient permettre aux professionnels de la santé une meilleure compréhension de l’inclusion sociale vécue par ces personnes, en plus d’offrir des balises permettant à ceux-ci de mieux soutenir l’inclusion sociale des adolescents TCC et de venir en aide aux familles dans cette situation difficile. / This exploratory descriptive qualitative study explores the perceptions of adolescents, their parents and professionals involved as to the social inclusion of adolescents who have suffered a moderate traumatic brain injury (TBI), particularly with regard to recovering their social roles once discharged from the rehabilitation centre. Bronfenbrenner’s ecological model (1979, 1986), adapted by Lefebvre & Levert (2005) for TBI clientele, is used as the conceptual framework. Semi-structured interview were conducted with three adolescents who had suffered a moderate TBI, and with their parents. In addition, a focus group was conducted with four professionals. The results show that the perceptions of adolescents who have suffered a moderate TBI, as well as their parents’, touch different aspects of their life, such as the adolescent as a person, the family, friends, the environment, school and leisure activities. We indeed noted a great number of repercussions, which facilitate and sometimes limit the social inclusion of a moderate TBI adolescent. The professionals share the same perceptions in general as them. However, the professionals add certain aspects that did not come up in interviews with the moderate TBI adolescents and their parents. The results of this study should enable health professionals to better understand the social inclusion experienced by these people. They should also offer professionals guidelines for them to better support the social inclusion of TBI adolescents and help the families get through this difficult situation.

A complete understanding of the functional and structural impairments driving persistent post-concussive symptom (PCS) expression in approximately one-third of those who suffer from mild traumatic brain injury (mTBI) is essential for the development of effective treatment strategies and improving quality of life. While traditional outcome measures, such as neuropsychological testing and structural magnetic resonance imaging, are sensitive to the severe functional impairments and widespread tissue damage frequently seen after moderate-to-severe injuries, more advanced measures that are sensitive to the subtle changes in cognitive function and tissue microstructure that may underlie persistent PCS are necessary for the assessment of recovery from mTBI. Toward this end, the current study investigates the utility of eye-tracking analysis and high-definition fiber tractography (HDFT) as advanced measures of functional and microstructural outcome in 11 adults with chronic mTBI and varying levels of PCS (ages 20-60; mean time post-injury = 9.53 ± 6.74 years) in comparison to 10 healthy adults (ages 20-54). Performance on neuropsychological and eye-tracking tasks of processing speed, attention, and working memory, and HDFT-derived quantitative measures of the microstructural integrity of the forceps major, inferior fronto-occipital fasciculus, middle longitudinal fasciculus, and superior longitudinal fasciculus were compared between groups, and the results were used to define discriminatory functions for mTBI classification. The relationships between neuropsychological and eye-tracking measures of cognitive function and HDFT-derived measures of tract integrity were explored, as was the utility of these functional and structural measures for predicting persistent PCS in chronic mTBI. The results suggest that eye-tracking analysis may be more specific to cognitive impairments resulting from mTBI than neuropsychological testing, and HDFT is highly sensitive and specific to the subtle microstructural changes that persist chronically in this population. Furthermore, white matter integrity assessed using HDFT is more strongly associated with impairments in processing speed, attention, and memory indicated through eye-tracking analysis relative to performance on neuropsychological tests. Finally, although the predictive utility of eye-tracking and HDFT for the experience of persistent PCS was not demonstrated in the present sample, the possibility that these data are confounded by symptom exaggeration, comorbid mental health impairment, or lack of self-awareness for functional deficits cannot be ruled out, and future research using large, homogenous sample of mTBI is necessary to validate the present findings.

There is a paucity of studies, clinical and experimental, attesting to the benefit of cerebral perfusion pressure (CPP) directed pressor therapy following traumatic brain injury (TBI). The current study evaluates this therapy in a swine model of TBI and hypotension. Forty-five anesthetized and ventilated swine received TBI followed by a 45% blood volume bleed. After 1 h, all animals were resuscitated with 0.9% sodium chloride equal to three times the shed blood volume. The experimental group (PHE) received phenylephrine to maintain CPP > 80 mm Hg; the control group (SAL) did not. Outcomes in the first phase (n = 33) of the study were as follows: cerebro-venous oxygen saturation (S cvO2), cerebro-vascular carbon dioxide reactivity (δScvO2), and brain structural damage (β-amyloid precursor protein [βAPP] immunoreactivity). In the second phase (n = 12) of the study, extravascular blood free water (EVBFW) was measured in the brain and lung. After resuscitation, intracranial and mean arterial pressures were >15 and >80 mm Hg, respectively, in both groups. CPP declined to 64 ± 5 mm Hg in the SAL group, despite fluid supplements. CPP was maintained at >80 mm Hg with pressors in the PHE group. PHE animals maintained better ScvO2 (p < 0.05 at 180, 210, 240, 270, and 300 min post-TBI). At baseline, 5% CO2 evoked a 16 ± 4% increase in ScvO2, indicating cerebral vasodilatation and luxury perfusion. By 240 min, this response was absent in SAL animals and preserved in PHE animals (p < 0.05). Brain EVBFW was higher in SAL animals; however, lung EVBFW was higher in PHE animals. There was no difference in βAPP immunoreactivity between the SAL and PHE groups (p > 0.05). In this swine model of TBI and hypotension, CPP directed pressor therapy improved brain oxygenation and maintained cerebro-vascular CO2 reactivity. Brain edema was lower, but lung edema was greater, suggesting a higher propensity for pulmonary complications.

This review is a brief summary of the effects of nicotine on neural plasticity and behavior, with a focus on the preclinical literature and the effects of nicotine on neurotrophic factors. Focus areas include underlying mechanisms of nicotine addiction and the therapeutic potential for nicotine and nicotinic receptor agonists in Parkinson’s disease, Alzheimer’s disease, traumatic brain injury, as well as cutting across these different areas of research with a brief review of the antiinflammatory effects of nicotine. It is clear that agonists at nicotinic receptors have therapeutic potential, but this should be weighed in the context of the effects of nicotine across the brain and its enhancement of neurotrophic factors. Although nicotine may have neuroprotective properties, it is important to keep in mind that these same effects underlie its addictive characteristics.

No description available.

Traumatic brain injury (TBI) incidence rates are increasing among the U.S. population and represent substantial acute and chronic care costs. A confounding factor in TBI treatment is the incidence rates of concomitant mental health disorders including depression, anxiety, and posttraumatic stress disorder (PTSD). Clinical data establish that the prevalence of any of these 3 diagnoses complicates the treatment of TBI regardless of whether the diagnosis was pre-existing or occurred because of the TBI, such that prognosis and recovery are negatively impacted. Despite this evidence, psychological assessment is not a first line step in the approach to TBI. The purpose of this research was to assess the prevalence of psychological screening among TBI patients for depression, anxiety, and PTSD to enable conclusions about the current standard of care in TBI management. Meta-analysis of peer reviewed journals on TBI management was used to determine if there was considerable evidence to support that depression, anxiety, and PTSD were being addressed as the standard of care in TBI management. Mean analysis of literature search results established that there was not considerable evidence to support a conclusion that depression, anxiety, and PTSD assessment were standard of care in TBI management. Among the recommendations resulting from this finding were for additional studies on TBI points of care to determine how mental health is currently being managed among TBI patients, and for a change in current TBI treatment protocols to incorporate mental health assessment as part of overall TBI management. If these, and the remaining recommendations, were implemented, it was affirmed that these would have a positive social impact resulting in improved patient outcomes, decreased healthcare costs, and better healthcare delivery for TBI patients.

Sammanfattning/Abstract Brundin Larsson, Sara (2022). Hjärntrötthet- ”Det är detta att det är osynligt”. Specialpedagogprogrammet, Institutionen för skolutveckling och ledarskap, Lärande och samhälle, Malmö universitet, 90 hp. Förväntat kunskapsbidrag Min önskan är att uppmärksamma hjärntrötthet hos barn och unga och vilka konsekvenser en sådan trötthet kan innebära för en skolelev. Hur resonerar elever och deras vårdnadshavare om skolans bemötande och vad har mötet betytt för barnet eller den unge i deras skolarbete. Studien vill därmed ge ett bidrag till vad skolpersonal, men i synnerhet specialpedagoger, bör känna till om hjärntrötthet och vilka anpassningar drabbade kan vara hjälpta av under kortare eller längre tid. Syfte och frågeställningar Syftet med studien är att, genom livsvärldsberättelser, öka kunskapen om vilka behov elever med hjärntrötthet kan ha och hur det kan påverka deras vardag i skolan, utifrån ett elev- och vårdnadshavarperspektiv. Ytterligare ett syfte är att beskriva informanternas upplevelser av samarbetet med skolan och de anpassningar som gjorts där. Vilka svårigheter och behov upplever hjärntrötta elever, och deras vårdnadshavare, att de har? Hur har elever och vårdnadshavare upplevt mötet med skolan och de anpassningar man gjort för att möta deras behov? Vad anser informanterna att pedagoger särskilt bör tänka på när de möter elever med hjärntrötthet? Teori I denna studie används livsvärldsfenomenologin som teoretiskt ramverk (Bengtsson &amp; Berndtsson, 2015).  Anledningen till valet av ett livsvärldsfenomenologiskt perspektiv på denna studie är att genom intervjuer kunna få ta del av elevers och deras vårdnadshavares upplevelser av hur det är att leva med hjärntrötthet som ung elev, samt hur informanterna upplevt samarbetet med skolan. Ansatsen möjliggör att få ta del av deras livsvärld kring hjärntrötthet. De olika teoretiska begreppen; subjekt, sammanflätningar, regional värld, levd kropp och instrument används som en grund och ram för att förstå och tolka informanternas livsberättelser. Metod Detta är en kvalitativ studie där tre elever och deras vårdnadshavare intervjuats om sina upplevelser av mötet med skolan som hjärntrött elev. Eftersom en önskan fanns om ett öppet samtal, med mina forskningsfrågor som utgångspunkt, valdes semistrukturerade intervjuer. Resultat Genom informanternas livsberättelser framkommer att det är krävande att befinna sig i miljöer med mycket ljud. Efter en tids exponering för mycket ljud får de ont i huvudet och dagar som är extra utmanande kan innebära att de måste ligga och vila resten av dagen hemma, eller flera dagar för att återfå energi. De har alla behov av att ibland kunna komma ifrån klassrummet, speciellt då det är pratigt, för att få sitta i en lugn miljö.        Avgränsning av arbetsuppgifter finns också ett stort behov av. Att få mer tid för att slutföra arbetsuppgifter, eller dela upp olika moment med pauser emellan, skulle medföra att de både mår bättre och kan prestera bättre i skolan. Informanterna uttrycker också att det är viktigt att de blir lyssnade på och att man tar deras mående på allvar.        Elever som lider av hjärntrötthet har behov som många gånger inte behöver vara så svåra för skolan att anpassa sig till men dessa elever kan bli missförstådda, då kunskap om hjärntrötthet inte är så utbredd. Känslighet för mycket ljud, mycket information och högt tempo gör dem sårbara. Då vi i skolan ska utforma lärmiljöer där alla elever ges möjlighet att prestera utifrån sina förutsättningar är det viktigt att sprida kunskap om hjärntrötthet. Nyckelord Anpassningar, barncancer, hjärnskakning, hjärntrötthet, pauser

Introduction : La surveillance analgésique est essentielle pour préserver le confort des patients sédationnés non-communicants après un traumatisme craniocérébral (TCC). Bien que le réflexe de dilatation pupillaire (RDP) et les comportements puissent être utilisés pour évaluer l'analgésie, ils nécessitent l'application de stimulus nociceptifs. Récemment, le réflexe photomoteur (RPM) élicité via un flash lumineux non douloureux s’est montré utile pour prédire l’état analgésique des patients sans TCC. Nous avons examiné si le RPM peut prédire l’état analgésique et la réponse comportementale des patients TCC non-communicants. Méthode : Quinze patients TCC ventilés mécaniquement (11 hommes; 54±20 ans) ont été évalués avec un vidéo-pupillomètre et une échelle comportementale (BPS) dans les 72 heures suivant l’admission aux soins intensifs. À chaque évaluation, le diamètre pupillaire au repos et le RPM ont été enregistrés, suivis immédiatement du RDP et des comportements pendant un stimulus nociceptif calibré. Les concentrations sanguines d’analgésiques/sédatifs ont été mesurées. Résultats : 103 évaluations ont été réalisées. Lorsque les réflexes pupillaires ont été élicités, le diamètre pupillaire a varié de -19 % en moyenne pour le RPM et de +10 % en moyenne pour le RDP. Les variations du RPM et du RDP étaient plus prononcées chez les participants qui présentaient un score BPS > 3 (un signe reconnu de sous-analgésie) par rapport à ceux avec un score BPS = 3. Les analyses de régression multiple montrent un chevauchement significatif entre les fluctuations des réflexes pupillaires et la concentration sanguine de fentanyl, mais pas celle du propofol. Conclusion : Le RPM pourrait être utile pour évaluer les besoins analgésiques avant une procédure nociceptive chez les patients TCC sédationnés non-communicants. / Background: Analgesia monitoring is essential to preserve comfort in critically ill sedated patients with traumatic brain injury (TBI). While pupil dilation (PD) and pain behaviors can be used to assess analgesia, these indicators require application of noxious stimulations. Recently, the pupillary light reflex (PLR) has emerged as a non-noxious parameter that may be used to predict analgesia requirements in non-brain-injured patients. Here, we investigated whether PLR can be used for the purpose of analgesia monitoring in critically ill sedated TBI patients. Methods: Fifteen mechanically ventilated TBI patients (11 men; 54±20 years) under perfusions of analgesia and sedation were assessed at predefined time within 72 hours of intensive care unit admission. Data collection was performed using video-pupillometry and the Behavioral Pain Scale (BPS). At each assessment, pupil size and PLR at rest were recorded followed immediately by the documentation of PD and pain behaviors elicited by a calibrated noxious stimulation. Blood concentrations of analgesics/sedatives were monitored. Results: 103 assessments were completed. PLR resulted in an average decrease of -19% in pupil diameter and PD resulted in average increase of +10%. Variations in PLR and PD were more pronounced in participants who showed a BPS score > 3 (a recognized sign of sub analgesia) compared to those with no behavioral reaction. Multiple regression analyzes showed a significant overlap between fluctuations in pupillary reflexes and blood levels of fentanyl, not propofol. Conclusions: PLR may be useful to assess analgesia requirements before a nociceptive procedure in critically ill sedated patients with TBI.

No description available.