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Objective:To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans. Setting:Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA). Participants:Post-9/11 veterans with at least 3 years of VA care. Design:Cross-sectional, retrospective, observational study. Main measures:International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory. Results:Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination. Conclusions:There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.

Moderate-to-severe traumatic brain injury (M/S TBI) can affect an individual's ability to perform daily tasks. For example, individuals with M/S TBI are more likely to commit errors on tasks such as making a meal or wrapping a present. The neural processes involved in such errors are poorly understood. Studies suggest that neurophysiologic markers of cognitive control and error processing may be helpful in gaining additional insight into errors on naturalistic action tasks. Unfortunately, previous experimental methods left a methodological gap which limited the use of neurophysiological markers in the study of naturalistic action. Several recent studies in healthy adults have suggested one method of bridging the gap by having individuals observe another person's errors. The current study was the first study to employ the method in a TBI population as a possible means of gaining additional insight into the detrimental effects of M/S TBI on the performance of naturalistic actions. In order to gain additional insight into the effects of M/S TBI on the completion of naturalistic tasks I used two neurophysiologic markers of cognitive control and error processing. They were the observer error related negativity (oERN) and the P300 components of the scalp-recorded event-related potential (ERP). I hypothesized that individuals with M/S TBI would demonstrate error-specific changes in the two oERN and P300 that would correlate with self-reported difficulties in daily functioning. The study consisted of two experiments. One compared 15 individuals with M/S TBI to 17 demographically similar healthy controls on an error related naturalistic action based picture task. The second compared an overlapping sample of 16 individuals with M/S TBI to 16 demographically similar controls as they watched a confederate complete the Erikson flanker task, a commonly used task in the study of electrophysiological markers. Accuracy (error vs. correct) and group (M/S TBI vs. control) effects were analyzed using 2 x 2 repeated measures ANOVAs on ERP amplitude and latency. Pearson product-moment correlations were calculated to evaluate the relationship between the P300 and oERN and measures of self-reported executive functioning (Frontal Systems Behavior Scale, FrSBe) and neuropsychological measures. Findings supported a difference between the control and M/S TBI groups in how errors were processed during the naturalistic actions based picture task. There was an interaction between group membership and response accuracy (error vs. correct) on P300 amplitude and P300 latency. Controls demonstrated reduced P300 amplitude and latency on error trials compared to correct trials. Individuals with M/S TBI did not demonstrate a significant difference between correct trials and error trials on P300 amplitude and latency. The amplitude and latency of the P300 were correlated with self-reported functional difficulties in individuals with M/S TBI but not control participants. A Fisher's r -- z analysis indicated that correlations differed significantly between groups; however, an outlier was identified in the correlational data. Removal of the outlier data led to non-significant results in the Fisher's r -- z analysis. Taken together, results of the picture task supplied evidence that for individuals with M/S TBI differences in neurophysiologic markers between groups could be explained by reduced adaptation to complexity or by possible deficits in a secondary error processing pathway for complex errors. Future research could focus on better defining the functional relationship between P300 amplitude and latency and increased errors in naturalistic actions following M/S TBI. Observation of the flanker task did not elicit oERN waveforms from either healthy controls or from individuals with M/S TBI. The results could be due to problems with the current task, but also raised some concerns about previous studies using the flanker task which employed a slightly different methodology requiring participants to count errors. The current study did not require participant to count errors. As a whole, the study supplied partial support for using electrophysiological markers of error processing to gain additional understanding increased errors in the performance of naturalistic actions following M/S TBI.

Purpose To examine the effects of Animal Assisted Therapies with Farm Animals (AATF) with domesticated ducks on depression and anxiety. Aim The proposed study will use single-group time series design and collect survey data to explore the changes in anxiety and depression in patients exposed to AATF. The study will be guided by the Self-Efficacy Theory. The study will involve 30 patients with TBI living in The Crumley House Rehabilitation Center in Limestone, TN. Hypothesis. Engaging in AATF with domesticated ducks will be associated with decrease in anxiety and depression. Approach - Theoretical Framework. Bandura’s Self-Efficacy Theory will be used to guide this study examining AATF effects on anxiety and depression in patients with TBI. Salutogenesis, Social Support, and Self-Efficacy theories were compared in order to select the best theoretical framework for this study. Methods Time series Quasi-experimental design. The study will examine the effects of AATF on anxiety and depression among patients with traumatic brain injury (TBI). Because of the unique characteristics of the patient population (all patients have history of TBI) in this facility no other rehabilitation center can be utilized for comparison. Time series design will ensure that all of the participants will be exposed to the therapeutic intervention, it will not be affected by the conventional treatments the participants are receiving. Projected Results and Anticipated Limitations It is expected that AATF will be effective in reduction of Anxiety and Depression symptoms in the patient with TBI Limitations • Possibility of dropouts may compromise sample size and lead to lower statistical power. • AATF based intervention is impossible to conduct in blinded environment. That in turn may contribute to participant’s expectation of positive outcomes of the interventions in this study. This may be considered an example of subject bias. • AATF treatment cannot be completely standardized. Because the treatment is based on interaction with live animals, animal behavior may be different during each visit to the duck pen. Because of that there is a possibility that the study cannot be exactly replicated. • The participants may have different duration or complexity of treatments for anxiety and depression. This may present a confounding factor that we are not able to control in this study. Conclusion This is a pilot study to examine the effects of AATF with domesticated ducks. This study may serve as a basis in developing more research on this topic with expanding the methodology and sampling in the future.

Traumatic brain injury, concussion, and subconcussion are different clinical conditions associated with head injury. These conditions share a common origin, mechanical forces directly or indirectly transmitted to the head. In sports, modalities with high exposure to head traumas require further investigation, especially those in which strikes directly to the head are allowed and a determinant of success, such as combat sports. The causes and effects of brain injuries in combat sports such as Mixed Martial Arts, boxing, Muay Thai, and kickboxing are complex and require a comprehensive investigation of many factors. The objective of this dissertation was to explore the main causes that justify combat sports as the main sport sample when it comes to head injury and the effects of chronic exposure to head trauma in this population. Original studies were developed to assess the head injury risk in competition and in training, the level of knowledge of athletes and coaches, and the consequences of chronic exposure to head traumas in the balance function, brain activity, and spinal cord excitability. The risk of a fight ending due to head strikes in competition is directly related to the weight category, and the risk seems to be exacerbated in female athletes. Combat sports athletes are exposed to numerous strikes to the head in simulated fights on a weekly basis in training, when healthcare professionals are absent. During this time that makes up the bulk of exposures, therefore, athletes and coaches are the ones managing potential cases of concussion. However, coaches are not familiar with assessment tools and don’t often seek out concussion knowledge. Alarmingly, coaches, often prior athletes themselves, are the main source of concussion knowledge for their athletes. High exposure to head trauma both in competition and training in addition to iv poor knowledge and behavior are liable to cause consequences in the nervous system. Athletes chronically exposed to head trauma presented subtle deficits in static balance in the most basic human stance, which is the double-leg over a firm surface. Moreover, while the literature consistently shows impairments in brain function, our study expanded the association between head trauma and nervous system deficits to the least studied component of the nervous system, the spinal cord. While athletic training promotes neuroplastic benefits in spinal cord excitability, these were hindered in a sample of athletes chronically exposed to head traumas. The studies in this dissertation demonstrated that athletes in combat sports are chronically exposed to intentional and repetitive head traumas, and that this exposure is likely associated with long-term functional detriments in balance and spinal cord excitability. / Graduate

Video modeling (VM) is a video-based intervention (VBI) that has been implemented with individuals with disabilities to teach various life and educational skills. It is a tool that allows learners to watch a target skill modeled on a pre-recorded video. The learner is able to re-watch a new skill as many times as needed, and the teacher is given the flexibility needed to work with multiple students while providing individualized instruction. The participant in this study was a 13-year-old male with a traumatic brain injury (TBI) and intellectual disability (ID). The participant was enrolled in a life skills class at his junior high school and received special education services under the classification of TBI. This study used a delayed multiple-baseline, across-skills design to examine increased consistency for completing different sports skills in physical education (PE), including a basketball chest pass, football forward pass, and soccer inside foot pass. VM was used successfully to increase task completion rates for all three sports skills. The participant was able to perform the basketball chess pass with 75% to 87.5% accuracy, and the football forward pass and soccer pass with 87.5% accuracy. Prior to the study he could only complete each skill with less than 25% accuracy. Future research is needed on larger samples to empirically demonstrate the efficacy of VM to improve PE skills for special needs students.

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