Recently, the literature concerned with the possibilities and limitations of working memory training has been growing rapidly. Nonetheless, there are still no clear answers about the principles of its effectiveness or transfer effect. The main questions we ask are about effectiveness of cognitive training in patients after stroke or TBI. To our knowledge this group hasn't been studied in this context yet. To do this, we compare two types of cognitive training - extensively studied N-back training (n=11) and still more popular group cognitive therapy (n=9) with a placebo control group (n=5) who recieves "training" in a simple computer game. The placebo control group then continues in N-back training. Our hypothesis is that after 3 weeks the two trainings should lead to significantly higher gains in cognitive tests scores than the placebo condition. Also, we expected N-back to be more effective than group cognitive training in domains more closely related to executive control. We tested attention, fluid intelligence, short-term and working memory. We also recorded participants well-being. Following training, there were no significant differences between N-back and group training. N-back group scored significantly higer on Trail Making Test A than control group (p=0,026). Although our study doesn't...

National concern over traumatic brain injury (TBI) is growing rapidly. Recent focus is on mild TBI (mTBI), which is the most prevalent injury level in both civilian and military demographics. A preeminent sequelae of mTBI is cognitive network disruption. Advanced neuroimaging of mTBI victims supports this premise, revealing alterations in activation and structure-function of excitatory and inhibitory neuronal systems, which are essential for network processing. However, clinical neuroimaging cannot resolve the cellular and molecular substrates underlying such changes. Therefore, to understand the full scope of mTBI-induced alterations it is necessary to study cortical networks on the microscopic level, where neurons form local networks that are the fundamental computational modules supporting cognition. Recently, in a well-controlled animal model of mTBI, we demonstrated in the excitatory pyramidal neuron system, isolated diffuse axonal injury (DAI), in concert with electrophysiological abnormalities in nearby intact (non-DAI) neurons. These findings were consistent with altered axon initial segment (AIS) intrinsic activity functionally associated with structural plasticity, and/or disturbances in extrinsic systems related to parvalbumin (PV)-expressing interneurons that form GABAergic synapses along the pyramidal neuron perisomatic/AIS domains. The AIS and perisomatic GABAergic synapses are domains critical for regulating neuronal activity and E-I balance. In this dissertation, we focus on the neocortical excitatory pyramidal neuron/inhibitory PV+ interneuron local network following mTBI. Our central hypothesis is that mTBI disrupts neuronal network structure and function causing imbalance of excitatory and inhibitory systems. To address this hypothesis we exploited transgenic and cre/lox mouse models of mTBI, employing approaches that couple state-of-the-art bioimaging with electrophysiology to determine the structural- functional alterations of excitatory and inhibitory systems in the neocortex.

Deficits in executive function are commonly reported following Traumatic Brain Injury (TBI) and are important for establishing functional impairments. Understanding the nature of executive dysfunction following TBI is often complicated by secondary factors that can impact measured ability. This study sought to clarify the persistent effects of TBI on executive function, as measured by the Wisconsin Card Sorting Test (WCST), while accounting for effort given during testing, as measured by the Portland Digit Recognition Test. Results suggested a dose-response relationship between TBI severity and subsequent WCST deficits. Mild TBI patients who provided good effort during testing showed no observable differences from locally matched controls on WCST performance. Effort during testing was found to have a larger overall effect on WCST performance than moderate-to-severe TBI or dementia. The present study highlights the need to account for secondary factors, such as effort during testing, to accurately measure cognitive dysfunction following compensable injuries.

A significant subset of mild traumatic brain injury (mild TBI) and chronic pain (CP) patients report, and sometimes show objective evidence of, persisting cognitive problems. Despite differences in injury mechanisms, there is considerable overlap in the types of persisting cognitive symptoms that are reported by the two populations. Psychogenic, rather than physiogenic, factors are thought to play an important role in the maintenance of these persisting symptoms. The current investigation examined the contributions somatization, depression, and anxiety had on an objective measure of “working attention.” In order to best elucidate the influences these psychological factors had on attentional performance, only individuals who passed well-validated and popular indicators of cognitive and self-report validity were included in the study. Two hundred and forty-nine individuals (n = 116 TBI; n = 133 CP) met the inclusionary criteria for the study. Psychological factors were assessed using Scales 1 (Hypochondriasis), 2 (Depression), 3 (Hysteria), and 7 (Psychasthenia) of the Minnesota Multiphasic Personality Inventory-II. “Working attention” was measured using the demographically-adjusted T-scores for the Working Memory and Processing Speed Indexes of the Wechsler Adult Intelligence Scale- 3. Results indicated that a high rate of psychological complications was observed in the mild TBI and CP groups but not the moderate-severe traumatic brain injury (M/S TBI) comparison group. Analysis indicated that psychological elevations were not significantly related to spontaneously-reported symptoms or working attention deficits for the mild TBI group but were for the CP and M/S TBI groups. The current results are important for understanding the psychological complications that may occur in individuals exhibiting persisting cognitive problems in these clinical populations.

Objective: Children and adolescents with a history of traumatic brain injury (TBI) are at increased risk for developing social incompetence and impairment in broad psychosocial functioning. The aim of this study was to examine the relationship between history of TBI, social competence, and broad psychosocial functioning using meta-analytic methods. Methods: Studies relating to social outcome following pediatric TBI were searched for using scientific, academic databases. Sixteen studies (N=2,005) met inclusion criteria, and relevant data relating to social functioning was extracted. Meta-analytic methods were used in order to obtain Hedges's g effect size data for mild, moderate, and severe TBI groups. Meta-regressions were also used to examine the effect of potential moderating variables, including Glasgow Coma Scale (GCS), socioeconomic status (SES), gender, control group (typically developing (TD) or orthopedic injury (OI)), and time/age related variables. Finally, publication bias was calculated using funnel plots and Rosenthal's fail-safe N. Results: A dose-response effect was observed with mild (Hedges's g = -0.387), and moderate (Hedges's g = -0.459) groups demonstrating smaller effects when compared to the severe group (-0.814) on measures of broad psychosocial function. A dose-response effect was also observed on measures of social competence, with mild (Hedges's g = -0.098) and moderate (Hedges's g = -0.450) TBI groups demonstrating smaller effect sizes when compared to the severe TBI group (Hedges's g = -0.832). The GCS was a significant predictor of both broad psychosocial functioning (B = 0.065, p < 0.001) and social competence (B = 0.079, p < 0.001), such that more severe injuries predicted poorer social outcomes. Gender was a significant predictor of effect size (B = 0.018, p = 0.05), such that higher proportions of females was associated with smaller effect sizes. Finally, the type of control group used in these studies was also a significant predictor of effect size (B = 0.369, p = 0.03), such that studies that used TD produced larger effect sizes when compared to studies that used OI. Overall, there was little evidence for publication bias. Conclusions: Children and adolescents with a history of TBI demonstrated significant differences from their peers in social competence and broad psychosocial functioning following TBI. The severity of the injury is important in understanding and predicting social outcomes following pediatric TBI. Implications of these findings are discussed.

The incidence of mild blast traumatic brain injuryhas risen due tothe increased use of improvised explosive devices (IEDs) in militaryconflicts. Mild blast TBI (mbTBI) is especially relevant due to its lack of acutely observable symptoms, and to its association with long-term neurodegenerative and neuropsychiatric disorders. Predominantly, TBI patients often suffer from chronic stress, neuropathic pain and headaches, which greatly compromise the health and quality of life of these individuals. Treatments for neuropathic pain have been empirically found and produce little effect in lessening neuropathic pain, likely due to the lack of targeted therapies. This highlights the need for better understanding of the molecular mechanisms underlying neuropathicpain, TBI and chronic stress that could lead to mechanistic therapeutic targets. Oxidative stress is an important mechanism of the pathophysiology of neuropathic pain, TBI and chronic stress. We hypothesize that acrolein, an endogenously formed neurotoxin, is able to stay active in the body for up to 10 days, is involved in the pathophysiology of neuropathic pain in TBI and chronic stress. This study aims to correlate acrolein elevation in the body with neuropathic pain, deepen the understanding of underlying mechanisms of pain in TBI and chronic stress, and mitigate this pain with acrolein scavenging. The ultimate goal of this research is to provide therapies for TBI and chronic stress patients that can eliminate pain and significantly improve their healthand quality of life

Thesis advisor: Belle Liang / Traumatic brain injury (TBI) survivors often experience isolation from their primary support network following their injury (Marsh, Kersel, Havill, & Sleigh, 1998). Computer-mediated support groups (CMSGs) offer a virtual platform for individuals with complex medical concerns to exchange emotional and informational support (Braithwaite, Waldron, & Finn, 1999). To date, no research has examined the use of CMSGs, such as TBI-related Facebook support groups, for TBI survivors. There is also limited research investigating how emotional and informational support provided and received (i.e., supportive exchanges) relate to well-being and online relational health (Liang et al., 2002). This study examined the relationship between four supportive exchanges and well-being and relational health for TBI survivors using TBI-related Facebook support groups, as well as whether a gender norm—emotional control—and network preference moderated these relationships. Participants included 191 TBI survivors recruited across 14 TBI-related Facebook support groups. Multiple regression analyses tested whether four supportive exchanges directly predicted well-being and relational health after controlling for age and extraversion. Results revealed that supportive exchanges did not predict well-being. However, emotional support provided, emotional support received, and informational support received all predicted higher levels of online relational health. Informational support provided predicted lower levels of online relational health. Additional multiple regression analyses tested whether emotional control and four aspects of network preference moderated the relationship between supportive exchanges and well-being and relational health. Although higher levels of emotional control directly predicted lower levels of relational health, and a preference for weak-tie support networks (e.g., online acquaintances) predicted lower levels of well-being, the moderating effects were generally not significant. The findings underscore the importance of supportive exchanges in developing online relational health for TBI survivors using Facebook support groups. It also suggests that this relationship was not dependent on emotional control and network preference. Future research should investigate other factors affecting supportive online communication for TBI survivors and when they may benefit most from online support. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Syfte:Syftet med litteraturstudien var att undersöka hur en smartphone kan användas inom rehabilitering efter FHS, i vilken utsträckning smartphonen används. Vilka effekter smartphonen kan ge på i det dagliga livet samt betydelsen en smartphone kan utgöra. Metod:För att besvara syftet så utfördes en litteraturstudie som innefattar kvalitativ och kvantitativ forskning baserad på åtta studier.  Resultat:Smartphonen har många fördelar som ett kompensatoriskt hjälpmedel samt är betydelsefull för personerna i det dagliga livet på många sätt. Signifikanta effekter kunde uppmätas som ledde till att fler aktiviteter både påbörjas och avslutades i rätt tid, därmed så hanteras många av grundproblemen med förvärvad hjärnskada (FHS), såsom svårigheter med minne, planering, initiering och organisering. Smartphonen föredrogs också av användarna framför andra hjälpmedel.  Slutsats:Studien visar att de finns stora fördelar med att implementera smartphonen som en del av rehabiliteringen av förvärvad hjärnskada. Vidare visar studien att smartphonen är den del av människors liv oavsett med eller utan FHS.  Det finns behov av vidare forskning inom ämnet då det finns få studier som belyser smartphonens som kompensatoriskt hjälpmedel i dagsläget. / Aim: The aim of this literature study was to describe how the smartphone is used as a compensatory aid in rehabilitation and the importance it can have for people with acquired brain injury. Method: To answer the purpose, a literature study was carried out which included qualitative and quantitative research based on eight studies. Result: The smartphone has many advantages as a compensatory aid and it shows important for people with acquired brain injury in their daily life in many ways. Significant effects could be measured which led to more activities being initiated and completed at the right time, thus many of the basic problems with acquired brain injury are addressed, such as problems with memory, planning, initiation and organization. The smartphone was also preferred by the users in front of other devices. Conclusion: The study shows great advantages in implementing the smartphone as part of the rehabilitation of acquired brain injury. Furthermore, the study shows that the smartphone is the part of people's lives regardless of if they suffer from acquired brain damage or not. There is a need for further research within the subject since there are few studies that shed light on smartphone's as compensatory aid at present.

O trauma crânio-encefálico contuso (TCEC) é freqüentemente seguido por um período de amnésia pós-traumática (APT), importante indicador da gravidade desse tipo de trauma e subsídio nas decisões sobre a reabilitação dessas vítimas. Considerando as diversas dificuldades que têm sido apontadas na literatura para estabelecer a duração da APT e algumas lacunas no conhecimento dessa síndrome, este estudo teve como objetivos: identificar os fatores relacionados à APT de longa duração (> 24 horas) entre as características apresentadas pelas vítimas de TCEC na fase aguda do trauma, comparar a qualidade de vida das vítimas que apresentaram APT de longa duração, com as demais e analisar a relação entre qualidade de vida e duração da APT, computando ou não o período de coma. Foi realizado um estudo prospectivo longitudinal, com abordagem quantitativa, descritiva correlacional, utilizando dados tanto da fase aguda de tratamento (internação hospitalar pós-trauma), como também da avaliação de qualidade de vida realizada entre três e seis meses após o evento traumático. Foram alvo desta investigação 187 vítimas de TCEC, com idade superior a 14 anos, sem diagnóstico anterior de demência ou TCEC, atendidas em Pronto-Socorro de hospital de referência para atendimento de trauma na cidade de São Paulo, nas primeiras 12 horas após evento traumático e internadas nesse hospital entre dezembro de 2006 e outubro de 2007. As variáveis independentes analisadas para identificar fatores associados a longo tempo de APT foram idade, sexo, gravidade do trauma crânio-encefálico, local e tipo de lesão, número de lesões encefálicas diagnosticadas e uso de medicação com atividade em sistema nervoso central ou corticóides. A maioria da casuística era sexo masculino (86,2%), vítimas de acidentes de trânsito (58,3%), com indicação de TCEC leve pela ECGl (61,5%). A média da idade foi 38 anos (± 16,81), da duração de APT foi 7,8 dias (±12,2), incluindo o tempo de coma e 5,0 dias (±6,7), sem incluir esse período. Os fatores associados a APT de longa duração, identificados em modelo de regressão logística ajustado pela variável área de lesão (intra/extra axial), foram: ECGl inicial <= 12 (OR= 20,17) MAIS/cabeça >=3 (OR= 2,80) e uso de Fenitína (OR= 2,60), Midazolan (OR=2,83) ou ambas as drogas (OR= 3,83). Quando comparada à qualidade de vida entre as vítimas que apresentaram APT de longa e curta duração, observou-se diferença significativa entre os grupos nos domínios Capacidade Funcional, Limitação para Atividades Físicas e Atividade Social da SF-36 Health Survey (SF-36). O grupo com APT de longa duração apresentou resultados mais desfavoráveis do que o de curta nesses três domínios. As análises de correlação entre domínios da SF-36 e duração da APT considerando ou não o tempo de coma indicaram que a medida do tempo de APT deve excluir o período coma, tendo em vista que as correlações foram mais expressivas quando essa forma de medida da APT foi utilizada / The closed traumatic brain injury (CTBI) is usually followed by a post-traumatic amnesia (PTA) period, important indicative of gravity to this kind of trauma and used to decisions for rehabilitation of the victims. Considering difficulties to establish the permanence of PTA in the available literature, as well as lack of knowledge of this Sindrome, this study had as main objectives: identify main points related to PTA of long term (> 24 hours) for CTBI victims during the hard period of trauma, compare victims\' quality of life for those who presented long term with those who doesn´t, and analysis the relationship between quality of life and PTA period, being the patients or not, in coma period. This is a quantitative study that was made using prospective, longitudinal and correlational approach, using data from both main intense phase of the treatment (pos trauma hospitalization) and quality of life valuation considered 3 to 6 months after the traumatic event. It was aim of this research 187 CTBI victims, with their age superior of 14 years old, with no demency diagnosis before the event or TBI, all attended by the emergency of a Refence hospital for trauma patients in São Paulo city, in their first 12 hours after the trauma and interned in this same hospital in the period of December 2006 and October 2007. The independent variables analysed to identify association points for the long term PTA was age, sex, brain encephalic trauma gravity, local and lesion kind, number of encephalic lesion diangosticated and medicament with action in the central neurologic system used or corticoids. The main patients were male (86.2%), victims from traffic accidents (58.3%), with indication of mild CTBI by GCS (61.5%). Age media of 38 years old (± 16.81), PTA period was 7.8 days (±12.2), including coma period and 5.0 days (±6.7), without including this period. Points associated with long term PTA, identified by logistic regression model adjusted by the variable of the lesion area (intra/extra axial), was: GCS initial <= 12 (OR= 20.17) AIS/head >=3 (OR= 2.80) and use of Fenitoin (OR= 2.60), Midazolan (OR=2.83) or both drugs (OR= 3.83). When compared to quality of life of the victims that presented PTA long and short term, it is seen significant difference in the groups observing domain, functional capacity, limitation for physical and social activities from the SF-36 Health Survey (SF-36). The group with long term PTA has presented worst results than the short term in these three domains. The related analysis made between domain of SF-36 and PTA time (duration) considering or not coma period of time has indicated that the measure of time from PTA must exclude coma period, as well as the studies and correlations were much more expressive when this measure of PTA was used

Background: Childhood Traumatic Brain Injury (TBI) has been identified as a crucial public concern, causing interrup-tion in children’s cognitive development, sometimes resulting in permanent impairment or even death. Hence documen-tation in health and school records regarding their functioning or environmental restrictions post injury, seems vital for the facilitation of communication between a child’s systematic and ongoing environment. Especially since children’s health has been described as a holistic construct comprised of psycho, social and physical well-being. Requiring continual inter-disciplinary and collaborative efforts over their course of development. Aim: To explore literature related to cognitive functioning and recommended support for children who have experienced a TBI, and how professional’s document their associated problems within medical and school records regarding activities in or outside the classroom. Method: A sys-tematic review, strictly comprised of empirical studies. Selected due to its sequential structural design for attainment of literature relevant to the research topic of choice and quality assessment procedures which enable reduction of threats to bias findings. Results: A total of 9 articles were yielded after quality assessment and depicted that. Reduced processing speeds in cognitive ability domains can be regarded as the default or baseline outcomes after a childhood TBI. Predictors within these different domains impacted their adequate academic, social function and varied depending on age at injury (2-4yrs or 4-8yrs), Injury severity (mild, moderate/severe), family function and time points. Early and severe TBI showed significant residual impairments across all time points, whilst the mild to moderate groups showed low to average func-tioning, as with the typical sample groups after two-year time points. Executive, attention skills impairment and post injury support within home and school settings. Showed to have the highest impact on both behaviours in, outside the classroom and academic performance. Documentation: Mainly biological and admission details were documented in the medical records. Within school records, all except one most recent study used either parental, teacher reports or direct measures to assess functioning of TBI affected children within school. Hereby a need for documentation of environmental factors within medical records, high quality transition of their TBI information within their school settings and continual docu-mentation of their progress or supports in school is required.