Blast-induced traumatic brain injury (bTBI) has been described as the defining injury of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Previously, most blast injury research has focused on the effects of blast on internal, gas filled organs due to their increased susceptibility. However, due to a change in enemy tactics combined with better armor and front-line medical care, bTBI has become one of the most common injuries due to blast. Though there has been a significant amount of research characterizing the brain injury produced by blast, a sound understanding of the contribution of each component of the shockwave to the injury is needed. Large animal models of bTBI utilize chemical explosives as their shockwave source while small animal models predominantly utilize compressed air-driven membrane rupture as their shockwave source. We designed and built a multi-mode shock tube capable of utilizing compressed gas (air or helium)-driven membrane rupture or chemical explosives (oxyhydrogen – a 2:1 mixture of hydrogen and oxygen gasses, or RDX – high order explosive) to produce a shockwave. Analysis of the shockwaves produced by each mode of the McMillan Blast Device (MBD) revealed that compressed air-driven shockwaves exhibited longer duration positive phases than compressed helium-, oxyhydrogen-, or RDX-driven shockwaves of similar peak overpressure. The longer duration of compressed air-driven shockwaves results in greater energy being imparted on a test subject than would be imparted by shockwaves of identical peak overpressures from the other sources. Animals exposed to compressed air-driven shockwaves exhibited more extensive brain surface hematoma, more blood-brain barrier compromise, more extensive reactive astrocytosis, and greater numbers of activated microglia in their brains than did animals exposed to oxyhydrogen-driven shockwaves of even greater peak overpressure. Taken together, these data suggest that compressed air-driven shockwaves contain more energy than their chemical explosive-derived counterparts of equal peak overpressure and can result in greater injury in an experimental animal model. Additionally, these data suggest that exposure to longer duration shockwaves, which is common in certain realworld scenarios, can result in more severe bTBI. The results of this study can be used to aid design of blast wave mitigation technology and future clinical intervention.

Children with a recent history of TBI often demonstrate impaired memory, which can be affected by impaired attention, processing speed or impaired verbal information processing. The purpose of this study was to determine if qualitative differences exist among the narrative recall of TBI patients that is not adequately accounted for by standard scoring methods. Sixty-six TBI subjects ranging in age from 6 to 16 were given the Wide Range and Memory and Learning (WRAML) Story Memory subtest and selected subtests from the Wechsler Intelligence Scale for Children - Third Edition (WISC-III). Mean elapsed time since injury was 53 days. Recall of the story on the WRAML subtest was hand-recorded by the examiner. A supplemental scoring method accounted for differences in length, errors, and disorganization. Comparisons were made to a randomly selected control group consisting of 16 hospitalized subjects between 7 and 15 years with no history of head injury, neurological condition or event. Findings suggest the WRAML Story Memory subtest is relatively robust in providing information regarding the quality of recall, with the exception of not accounting for the addition of erroneous details. Subjects with both cortical and subcortical injuries were more likely to add superfluous details to their stories. Results also demonstrated significant differences between the TBI subjects and control group in how well the stories were recalled, primarily in the order of details recalled and in retention after a 30 minute delay. Location was not a significant predictor of narrative organization. Although using this comprehensive supplemental scoring system a regular basis has practical limitations, hand-recording the narrative takes relatively little time and does appear to provide useful additional information concerning the nature of the child's verbal memory difficulties. Furthermore, the more knowledgeable the child, parents and teacher are about these difficulties and about remediation strategies, the more likely the child will have a successful learning experience upon return to the classroom.

Bakgrund I Sverige drabbas årligen 50 000 personer av förvärvad hjärnskada. Vanliga komplikationer är funktionsnedsättning i övre extremitet, skuldersmärta, spasticitet och sänkt livskvalitet. En fysioterapeutisk rehabiliteringsmetod som försöker minska dessa komplikationer, men som ännu inte utvärderats vetenskapligt är Vasa-konceptet. Syfte Att undersöka vilken effekt en fem veckor lång intervention enligt Vasa-konceptet hade på nämnda komplikationer hos tre personer med förvärvad hjärnskada. Metod   Studien har en Singel Subject Experimentell Design med AB-design för att kunna följa förändringsprocessen över tid hos tre individer. Utfallsmått var Reaching Performance Scale, Patient-Specifik Funktionell Skala, Numerisk Skala, Modifierad Ashworth Skala och Modifierad Short version of Stroke Specific Quality of Life Scale. Studien pågick under sex veckor. Data bearbetades med visuell analys av trender, lutning och stabilitet. Resultat Arm/handfunktionen ökade hos två av tre deltagare. Den självskattade arm/handfunktionen ökade hos samtliga deltagare. Skuldersmärtan slutade öka hos en deltagare och övriga hade ingen smärta under interventionen, förutom vid några enstaka tillfällen. Spasticiteten i armbågsflexorer ökade hos en deltagare och förblev oförändrad hos övriga. I handledsflexorer minskade spasticiteten hos två av deltagarna och var oförändrad hos en. Livskvaliteten ökade hos samtliga deltagare. Konklusion Interventionen i studien hade positiva effekter på arm/handfunktion, skuldersmärta och livskvalitet. Ytterligare studier krävs dock för att kunna bekräfta dessa effekter av Vasa-konceptet. / Background Each year 50 000 persons are affected by acquired brain injury in Sweden. Common complications include disability in the upper extremity, shoulder pain, spasticity and reduced quality of life. A physiotherapeutic rehabilitation method which tries to reduce these complications, but has not yet been evaluated scientifically is the Vasa-concept. Purpose To examine the impact of a five-week intervention with the Vasa-concept on the mentioned complications in three persons with acquired brain injury. Method The study has a Single Subject Experimental Design with an AB-design, focusing on changes over time in three individuals. Outcome measures were Reaching Performance Scale, Patient-Specific Functional Scale, Numeric scale, Modified Ashworth Scale and Modified Short version of Stroke Specific Quality of Life Scale. The entire study lasted for six weeks. Data were processed by visual analysis of trends, tilt and stability. Results Upper extremity function increased in two of three participants. Self-rated upper extremity function increased in all participants. Shoulder pain stopped to increase in one participant and did not occur in the remainders, except for a few occasions. Spasticity in elbow flexors increased in one participant and was unchanged in the remainders. In wrist flexors the spasticity decreased in two participants and was unchanged in one. Quality of life increased in all participants. Conclusion The intervention had positive effects on arm/hand function, shoulder pain and quality of life. Further studies are needed to confirm these effects of the Vasa concept.

An alteration in the function of the brain caused by an external force is called a Traumatic Brain Injury (TBI). There are language features located in different areas of the brain, and depending on where a person gets a TBI, the person can experience different communicative difficulties. These can manifest as aphasia, dysarthria or cognitive communicative disorders. The experiences of TBI that have been discovered in previous studies are for instance about how persons with TBI experience their diminished functions, life adjustment after the injury, the role and support of the relatives, that the environment treats them differently after the injury and emotional consequences. For the purpose of investigation and intervention, ICF is a useful tool since the difficulties that a person may have can be connected to its various components. The purpose of this study is to examine what experiences persons with TBI have regarding their brain injury and their communicative difficulties, and also how these can be connected to ICF. To answer the research questions, a qualitative method involving content analysis was used, based on semi-structured interviews with four participants. The participants expressed that their TBI had affected them in various ways, communicative, cognitive, physically and socially. The participants experienced their injuries and difficulties as limiting and that some periods had been lonely. However they also stated that there were some positive aspects in the situation, for example improved family relations and that they valued life in another way. Although the injuries, difficulties and rehabilitation of the participants have differed, the participants stories have been similar to some extent. In the future it would be interesting to conduct further studies in Sweden that examine which experiences persons with TBI have regarding the injury itself, but particularly regarding their communication after the TBI. It is important with more studies since that would give speech language pathologists a greater understanding for how people with TBI experience their situation and their communication after the injury. / Traumatisk hjärnskada (TBI) innebär att ett yttre våld har orsakat en förändring av hjärnfunktionen. I hjärnan finns språkliga funktioner som är belägna inom olika delar av hjärnan. Beroende på var i hjärnan en person får en TBI, leder det till olika kommunikativa svårigheter. Svårigheterna kan yttra sig som afasi, dysartri eller kognitiva kommunikativa störningar. De upplevelser av TBI som har framkommit i tidigare studier handlar bland annat om hur personer som har TBI upplever sina nedsatta funktioner, livsomställningen efter skadan, anhörigas roll och stöd, att omgivningen behandlar dem annorlunda efter skadan och emotionella konsekvenser. Vid utredning och behandling är ICF ett användbart verktyg eftersom att en persons svårigheter kan kopplas till ICF:s olika komponenter. Syftet med föreliggande studie är att undersöka vilka upplevelser personer som har TBI har erhållit i relation till sin hjärnskada, deras kommunikativa svårigheter samt hur dessa kan kopplas till ICF. För att besvara frågeställningarna användes en kvalitativ metod med semi-strukturerade intervjuer av fyra personer och innehållsanalys av dessa. Deltagarna i föreliggande studie uttryckte att deras TBI hade påverkat dem på olika sätt: kommunikativt, kognitivt, fysiskt och socialt. Deltagarna upplevde sina skador och svårigheter som begränsande och att de i vissa perioder hade upplevt isolering. De berättade dock att det fanns positiva aspekter av situationen såsom förbättrade familjerelationer och att livet värderades på ett annat sätt. Trots att deltagarnas skador, svårigheter och rehabilitering har skiljt sig åt, har deltagarnas berättelser haft likartad karaktär, även om de också till viss del har varierat. I framtiden vore det intressant med fler svenska studier som undersöker vilka upplevelser personer som har TBI har i relation till sina hjärnskador, men framförallt gällande sin kommunikation efter hjärnskadan. Det skulle vara betydelsefullt med fler studier eftersom att det skulle ge logopeder en större förståelse för hur personer som har TBI upplever sin situation och sin kommunikation efter skadan.

Objective: To determine the extent to which aspects of the Sport Concussion Assessment Tool 3 (SCAT3) or Child SCAT3 (C-SCAT3), and the King-Devick Test (KDT) predict Three-Dimensional Multiple Object Tracking (3D-MOT) speed. Participants: A sample of 304 healthy, non-concussed participants with a sporting history (101 females, 203 males) ranging in age from 7-29 years (mean age = 16.05 +/- 4.36) were included in the analysis. Methods: Participants completed the SCAT3, KDT and 3D-MOT in a single visit. Data Analysis: A regression analysis was performed to determine the extent to which aspects of the SCAT3 (immediate memory (IM), coordination (COOR), delayed recall (DR)), and the KDT predicted 3D-MOT speed. Results: Using the stepwise method, it was found that KDT, DR and COOR explain a significant amount of the variance in the speed of the 3D-MOT (F(3, 256)) = 11.82, p < .000 with an R2 = .12. The analysis shows that KDT (Beta = -0.01, p < .000), DR (Beta = 0.07, p < .02), and COOR (Beta = .23, p < .03), were significant predictors of 3D-MOT speed. Conclusions: This study suggests that the KDT, DR, and COOR significantly account for 12% of the 3D-MOT scores, however, there is a large portion of variability unaccounted for by the SCAT3 or C-SCAT3 and KDT. This shows that 3D-MOT likely accounts for central cognitive functions above and beyond the SCAT3 or C-SCAT3 and KDT. Future studies should examine this relationship at baseline, post-injury, and through concussion recovery. This could provide valuable information to better inform clinicians responsible for making return to play determinations. Keywords: Concussion, Mild Traumatic Brain Injury, 3D-MOT, King-Devick Test, Sport Concussion Assessment Tool 3, Child Sport Concussion Assessment Tool 3. / Graduate / 0769 / 0633 / 0566 / oslundk@uvic.ca

Le traumatisme crânien (TC) représente un des problèmes majeurs de santé publique, pour lequel à l’heure actuelle il n’existe aucun traitement. Le TC induit une neuro-inflammation délétère qui pourrait contribuer à l’apparition des lésions de la substance blanche (SB). Ces dernières sont à l’origine de lourdes conséquences neurologiques chez les patients victimes de TC. Néanmoins, très peu d’études se sont intéressées à ces lésions bien que plus sévères que les lésions de la substance grise. Ainsi une meilleure connaissance de leur évolution et des causes devient indispensable. L’hyperactivation de la poly(ADP ribose)polymérase (PARP) joue un rôle délétère dans les conséquences post-traumatiques, notamment sur la neuro-inflammation. Ainsi son inhibition pourrait être bénéfique le développement des lésions de la SB. Dans ce contexte, l’objectif de notre travail a été d’évaluer le rôle de la PARP dans les lésions de la SB dans un modèle expérimental de TC induit par impact cortical contrôlé chez la souris. Dans une première partie, nous avons étudié l’évolution de la démyélinisation dans le corps calleux, une structure riche en SB, entre 6 heures et 3 mois post-TC. Parallèlement, les évolutions de la lésion cérébrale, des déficits sensorimoteurs, de la neuro-inflammation et de l’œdème cérébral ont été étudiées. Le TC induit (1) une démyélinisation dès 7 jours et au moins jusqu’à 3 mois post-TC, précédée par (2) une lésion cérébrale entre 24 et 72 heures suivie par une cicatrisation, (3) une neuro-inflammation entre 6 heures et 7 jours et (4) un œdème cérébral entre 6 et 72 heures post-TC. De plus, le TC induit des déficits sensorimoteurs à 6 heures et 3 mois. Ces résultats montrent que ce modèle est adapté pour étudier les lésions de la SB post-TC, et que la neuro-inflammation et l’œdème cérébral pourrait être impliqués dans la démyélinisation. Dans une deuxième partie, nous avons étudié le rôle de la PARP dans les lésions de la SB suite à TC à l’aide de souris knockout (KO) et wild-type (WT) pour le gène de la PARP. Nous avons mis en évidence que les souris KO ne présentent pas de démyélinisation bilatérale du corps calleux après un TC par rapport aux souris WT à 7 jours post-TC, démontrant pour la première fois l’implication de cette enzyme dans les lésions de la SB consécutives à un TC. De plus, nous avons constaté que les souris KO non traumatisées présentent une diminution de myélinisation comparativement aux souris WT non traumatisées, suggérant un rôle de la PARP dans le processus physiologique de la myélinisation.En conclusion, l’ensemble de ce travail expérimental a permis (1) une meilleure caractérisation de la démyélinisation post-TC et des mécanismes potentiellement impliqués dans cette dernière, et (2) de démontrer pour la première fois le rôle délétère de la PARP dans la démyélinisation induite par un TC. Nos travaux suggèrent le potentiel de l’inhibition de la PARP comme stratégie thérapeutique pour la prévention des lésions de la SB post-traumatiques. / Traumatic brain injury (TBI) is a leading cause of death and disability for which there is no neuroprotective treatment up to date. It results in neuroinflammation that may participate in lasting motor and cognitive impairments accompanied by changes in white matter (WM) tracts. WM lesions, evidenced by demyelination, are associated with neurological disorders and in clinical studies are common consequences in patients with chronic TBI. Several studies suggest a contribution of an overactivation of the poly(ADP-ribose) polymerase (PARP) to the neuroinflammatory response which may lead to demyelination. The first part of this study was dedicated to a detailed in vivo assessment of the evolution over time of neurological disorders, cerebral lesion and edema, neuroinflammation and white matter injury induced by controlled cortical impact (CCI) between 6 hours and 12 weeks post-TBI. Notably in the corpus callosum, a significant demyelination starting at 7 days appeared to be a major consequence to post-traumatic neuroinflammation associated with motor dysfunctions. The second part of this study was dedicated to the evaluation of PARP’s role in WM lesions post-TBI, using PARP knockout (KO) mice. Our main findings reveal a diminished demyelination in the corpus callosum of TBI PARP KO as opposed to TBI PARP wildtype specimens. Hence, these data suggest for the first time PARP’s deleterious role in post-traumatic demyelination. In conclusion, taken together these data give an overall view of motor/sensorimotor deficits, neuroinflammation and demyelination in a CCI model of TBI that could help to validate pharmacological strategy for preventing post-traumatic WM injury. Notably, PARP’s inhibition seems to be a valid candidate as this enzyme participates in the establishment of a demyelinating process.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Family members of service personnel with polytraumatic injuries face a wide range of challenges. Research has shown that family member adaptation and adjustment to the caregiver role has a significant impact on the well-being of the person with the injuries. The Veterans Health Administration is rapidly developing services to meet the needs of severely injured service personnel and their family members. The purpose of the present study was to test the feasibility of a method of assessment to identify the needs of individual family members of service personnel and veterans receiving inpatient rehabilitation services at the Polytrauma Rehabilitation Center (PRC) located within the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia. Family member needs and emotional distress levels were quantitatively assessed. Qualitative data was collected with the intent of gaining a better understanding of the needs of families of individuals with severe injury from within a military cultural context. Results of this study suggest emotional distress levels of family members of persons receiving treatment on the PRC are not clinically significant. Study participants report overwhelming satisfaction with the program of care offered to patients and family members on the PRC. Furthermore, results of this study suggest that family members benefited from participating in the study. A strength-based family care pathway that utilizes an individual assessment of family needs is proposed and recommended for use with family members of individuals enrolled in the Veterans Health Administration polytrauma network services.

Following traumatic brain injury (TBI), the hippocampus is particularly vulnerable to damage, and BDNF, an endogenous neurotrophin that activates the TrkB receptor, has been shown to play a key role in the brain’s neuroprotective response. Activation of the TrkB signaling pathway by BDNF in the CNS promotes cell survival and aids in cell growth. However, due to its inability to cross the blood brain barrier (BBB), the therapeutic advantages of BDNF treatment following TBI are limited. 7,8-Dihydroxyflavone (7,8-DHF) is a flavonoid that mimics the effects of BDNF, is a potent TrkB receptor agonist, and can successfully cross the BBB. Our lab has previously demonstrated that administration of 7,8-DHF post-TBI results in improved cognitive functional recovery, increased neuronal survival, and reduced lesion volume. The current study examined the effects of 7,8-DHF on neurogenesis and neuronal migration in the dentate gyrus following TBI. In this study, adult male Sprague-Dawley rats were subjected to moderate controlled cortical impact injury (CCI) or sham surgery. Injured animals received 5 daily single doses of 7,8-DHF treatment (i.p) or vehicle starting either 60 mins after injury or 2 days after injury. BrdU was administered in 3 doses at 2 days post-injury for animals sacrificed at day 15, and single daily doses at days 1-7 post-injury for animals sacrificed at day 28 to label cell proliferation. Animals were sacrificed at 15 days or 28 days post-injury to examine cell proliferation, generation of new neurons, and differentiation of newly generated cells using proliferation marker Ki67, immature neuronal marker DCX, and BrdU double-labeling with markers for mature neurons (NeuN), astrocytes (GFAP) and microglia (Iba1). We found that administration of 5 doses (5mg/kg) of 7,8-DHF beginning two days post-injury had the strongest effect on neurogenesis and migration, but did not have a significant prolonged effect on cell proliferation at 15 days post-injury. We also found that 7,8-DHF treatment given early or 2 days post-TBI did not affect the neuronal differentiation in the granule cell layer. However, a higher percentage of BrdU/GFAP+ and BrdU/IBa1+ cells were found in the hilus regions in 7,8-DHF treated animals, suggesting newly generated cells in this region are mostly glial cell types. Our results suggest that 7,8-DHF has neurotrophic-like therapeutic effects following injury, and due to increased neurogenesis (compared to injured animals treated with vehicle), may effectively contribute to greater cell survival long-term. Additionally, potential long-term survival coupled with increased outward migration from the subgranular zone may result in increased integration of newly formed neurons into existing hippocampal circuitry, further contributing to cognitive recovery.

The changes in emotivity and behavior are common after acquired brain injury, which complicates the readaptation of an individual to his environment. Compared to cognitive problems, these changes are not so greatly regarded because their complexity requires care in the context of its special neuropsychological treatment. The objective of the theoretical part of this thesis was to elucidate the issue of acquired brain injury and summarize current knowledge and experience in the field of therapeutic work with this specific group of people. The aim of the empirical part of this thesis was to design an appropriate educationally based preventive program that would focus on the experience of personality change after ABI. The goal of this program was to provide patients with information about the usual consequences of ABI and to provide a place to share the problems they experience. The effectiveness of this program was measured via the European Brain Injury Questionnaire (EBIQ) and the Zung Self-rating Depression Scale (ZSDS). The results were compared in the experimental group (N=30) before and after the completion of the program and in the control group (N=30). In the group that undertook the intervention, the EBIQ-P showed significant improvement in the subscale Physical. The ZSDS results showed...