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Approximately 1.7 million traumatic brain injuries (TBI) occur annually in the United States, with an annual estimated societal cost of at least $76.5 billion. Addressing the growing TBI epidemic will require a multi pronged approach: developing novel treatment strategies and enhancing existing preventative measures. The specific aims of this thesis are: (1) to modulate astrocyte activation as a potential therapeutic strategy post TBI, (2) to determine the relationship between tissue deformation and alterations in electrophysiological function in the living brain, and (3) to investigate underlying mechanisms of functional changes post TBI by utilizing stretchable microelectrode arrays (SMEAs). In response to disease or injury, astrocytes become activated in a process called reactive astrogliosis. Activated astrocytes generate harmful radicals that exacerbate brain damage and can hinder regeneration of damaged neural circuits by secreting neuro developmental inhibitors and glycosaminoglycans (GAGs). Since mechanically-activated astrocytes upregulate GAG production, delivery of GFP-TAT, a mock therapeutic protein conjugated to the cell-penetrating peptide TAT, increased significantly after activation. A TAT-conjugated peptide JNK inhibitor was delivered to activated astrocytes and significantly reduced activation. These results suggest a potentially new, targeted therapeutic utilizing TAT for preventing astrocyte activation with the possibility of limiting off-target, negative side effects. While modulating astrocyte activation is a promising treatment strategy for TBI, effective therapeutic treatments are still lacking. Preventing TBI, by developing more effective safety systems, remains crucial. We determined functional tolerance criteria for the hippocampus and cortex based on alterations in electrophysiological function in response to controlled mechanical stimuli. Organotypic hippocampal and cortical slice cultures were mechanically injured at tissue strains and strain rates relevant to TBI, and changes in electrophysiological function were quantified. Most changes in electrophysiological function were dependent on strain and strain rate in a complex, nonlinear manner. Our results provide functional data that can be incorporated into finite element (FE) models to improve their biofidelity of accident and collision reconstructions. TBI causes alterations in macroscopic function and behavior, which can be characterized by alterations in electrophysiological function in vitro. We utilized a novel in vitro platform for TBI research, the SMEA, to investigate the effects of TBI on pharmacologically induced, long lasting network synchronization in the hippocampus. Mechanical stimulation of organotypic hippocampal slice cultures significantly disrupted this network synchronization 24 hours after injury. Our results suggest that the ability of the hippocampal neuronal network to develop and sustain network synchronization was disrupted after mechanical injury, while also demonstrating the utility of the SMEA for TBI research. Herein, we identified a novel therapeutic strategy for treating the deleterious effects of astrocyte activation post-TBI. We also developed tolerance criteria relating mechanical injury parameters to electrophysiological function, an important step in developing more accurate computational simulations of TBI. Equipping FE models with new information on the functional response of the living brain will enhance their biofidelity, potentially leading to improved safety systems while reducing development costs. Finally, we utilized a novel in vitro TBI research platform, the SMEA, to investigate the effects of TBI on long-lasting network synchronization in the hippocampus. Compared to more labor intensive in vivo approaches, the ability of the SMEA to efficiently test TBI hypotheses within a single organotypic slice culture over extended durations could increase the speed of drug discovery through high-content screening. This multi-pronged approach is necessary to address the growing public health concern of TBI.

While the cognitive disturbances that frequently follow severe TBI are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that that a significant proportion of individuals with TBI demonstrate deficits in the perception of affective information from the face, voice, bodily movement and posture. As accurate evaluation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area with TBI groups. The present research aims to redress this absence. The literature on emotion perception deficits in TBI is examined, and a theoretical rationale for intervention is presented. Several lines of research are reviewed which suggest that rehabilitation targeting such deficits is tenable. These include research on emotion perception remediation with other cognitively impaired populations, findings from cognitive neuroscience suggesting the potential for neuronal restoration after brain damage, and the successful applications of remediation techniques, in particular errorless learning and self-instruction, for treating other cognitive deficits in a range of neurological disorders and TBI. Discussion of this research is followed by a description of two randomised controlled trials aimed at improving emotion perception in individuals with TBI. The findings are discussed with reference to useful theoretical models of rehabilitation, learning and emotion perception. Suggestions for future directions of research are outlined together with relevant design issues.

While the cognitive disturbances that frequently follow severe TBI are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that that a significant proportion of individuals with TBI demonstrate deficits in the perception of affective information from the face, voice, bodily movement and posture. As accurate evaluation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area with TBI groups. The present research aims to redress this absence. The literature on emotion perception deficits in TBI is examined, and a theoretical rationale for intervention is presented. Several lines of research are reviewed which suggest that rehabilitation targeting such deficits is tenable. These include research on emotion perception remediation with other cognitively impaired populations, findings from cognitive neuroscience suggesting the potential for neuronal restoration after brain damage, and the successful applications of remediation techniques, in particular errorless learning and self-instruction, for treating other cognitive deficits in a range of neurological disorders and TBI. Discussion of this research is followed by a description of two randomised controlled trials aimed at improving emotion perception in individuals with TBI. The findings are discussed with reference to useful theoretical models of rehabilitation, learning and emotion perception. Suggestions for future directions of research are outlined together with relevant design issues.

This thesis is focused on the problematics of aftercare in patients with brain damage. The thesis has an informative character and its aim is to introduce the problematics to the readers and give them valuable advices. This topic has come to the fore of the interest of the professional and general public especially in recent years. Partly because numbers of brain damage especially those of the traumas are increasing, but also because of the development of acute medicine, which is nowadays at a very high level, there is an increase in the number of patients who survive brain damage. However, the problem is a large quantity of these patients have permanent consequences, and they and their closest neighbors have to deal with. These permanent consequences are manifested as cognitive impairment, impairment of sensory functions, physical disability and changes in behavior and emotions. Following care in patients with brain damage is a major problem in our country. We see the problem especially in the continuity and availability of care for locally available services and rehabilitation care for these individuals. The continuity of care after the patient is released from the acute bed is very low and sometimes chaotic. To obtain the necessary informations for thesis and to achieve the goals, it was necessary to study a large amount of professional literature. Used sources are specialized Czech and foreign literature, professional journals and articles searched in professional databases. This thesis should show the possible problems of patient aftercare with brain damage. The results of the thesis can be used as a subsidy to professional conferences, seminars or courses to deal with the issue. The thesis could increase public interest about this topic.

The present study investigates the effect of brain damage on verbal-spatial-cognitive (VSC) and sensorimotor (SM) measures included in the McCarron-Dial System (MDS). The subjects include 141 brain damaged adults and 42 psychiatric controls. The following research questions are addressed: (a) Does the brain damaged group differ significantly from controls? (b) Are there significant differences among left, right, anterior, posterior, and diffuse brain damaged groups? (c) Do early onset, late onset, acute, and chronic damaged groups differ significantly? and (d) Does a cerebral palsy group differ significantly from a non-CP brain damaged group?

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

When children have a moderate to severe traumatic brain injury (TBI), they are treated in a continuum of care that includes triage and emergency care, hospitalization, rehabilitation and outpatient therapy. Physical and cognitive recovery from brain injury may take several years. Children’s recovery varies, depending on numerous factors including pre-injury conditions and injury severity. While children and families are eager to return home to familiar activities, there are often significant physical, cognitive, behavioral and emotional changes that challenge families. Successful community reintegration depends on the ability of the family to understand and support the child, dealing with and responding effectively to those challenges. The purpose of this study is to understand how parents manage the care and community reintegration of their child who has experienced a TBI over time. This study utilized a mixed methods approach exploring the dimensions of the health challenge faced by parents caring for a child after a TBI, critical turning points as they face health challenges, and approaches for movement toward resolving health challenges. Story theory and story inquiry method were used to gather stories from 10 parents of children who experienced moderate to severe traumatic brain injury between the ages of 12 and 18, and between 2 and 5 years ago. Parents’ perceptions of their child’s quality of life and their ability to manage their child’s health challenge were explored using the Pediatric Quality of Life Inventory and Family Management Measure. Health challenges identified were: living with overwhelming personal upheaval, navigating the unknown, and struggling with how to support independence/dependence. Turning points were chronological or epiphanies. Approaches for movement toward resolving were continuously re-creating a new normal, being fully engaged in meeting the needs of one’s child, and embracing caring relationships to construct the new normal. Qualitative and quantitative data were analyzed to synthesize the findings. Results include a sense of ease in managing the health condition of the child associated with continuously creating a new normal. Healthcare providers can support and strengthen family management of children after TBI by understanding the health challenge, critical turning points and how parents move toward resolving. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

While dyspraxia has been studied from the neuro-anatomical aspects, few studies have explored the experience of adults with dyspraxia in the course of their everyday activities. This study reveals the unique and complex experiences of five adults as they struggle to live with dyspraxia.The research is underpinned by the phenomenological perspective. Participants were filmed performing everyday activities of their choice and were interviewed on their experiences of dyspraxia with everyday activities.The stories and videos reveal the struggle participants have with their unknowing and unwilling bodies, puzzled thinking, unfamiliar surroundings, and unhandy tools. Despite the enormity of their struggles, participants persevere, using individual strategies to overcome obstacles. The findings show that the lived-experience of dyspraxia tends to remain hidden from the person, as well as the clinician. Much of what is taken for granted during everyday activities is shattered in the lives of people with dyspraxia. The automatic, smooth, unconscious way activities are done, tools are handled and the world is experienced is altered. The path to recovery remains unclear as dyspraxia makes itself known one day and not the next. Sheer determination and a hope for the future helps participants carry on with trying to reclaim the person they lost as a result of the dyspraxia.The importance for understanding, by clinicians of the impact of dyspraxia on people's everyday lives cannot be underestimated. Implications for practice are discussed, as these relate to formal definitions of dyspraxia, client-centred practice, as well as diagnosis, assessment, intervention, and education.