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One of the primary reasons many college students with disabilities, and more specifically college student veterans with disabilities, do not seek support services is due to the stigma associated with disability, especially cognitive and mental health disabilities. The purpose of the present study was to explore how public university faculty in the state of Illinois perceive a college student veteran with the concurrent disabilities of post traumatic stress disorder (PTSD) and traumatic brain injury (TBI). This information was gleaned by means of a mixed-method, online survey. Through iterative, comparative, qualitative analysis, characteristics used to describe college student veterans with the PTSD and TBI were classified into six emergent prototypes. These prototypes included (1) the mature independent student; (2) the American hero; (3) the special needs student; (4) the isolated student; (5) the volatile student; and (6) the wounded warrior. Secondary analyses quantitatively examined the relationship between contact with a student veteran and the proportion of positive responses given for each participant as well as the relationship between contact with a student veteran and the proportion of negative responses given for each participant. Pearson correlation analysis indicated no significant relationship between prior contact factor scores and the proportion of positive responses given by faculty r(269) = .032, p = .597 nor was there a significant relationship detected between prior contact factor scores and the proportion of negative responses given by faculty r(269) = -.020, p= .745. Tertiary analysis examined the proportion of positive to negative perceptions by faculty. Overall, faculty responses were more negative than positive. Implications for best practices at the administration level as well as for faculty and students were discussed. Limitations to the study were also discussed.

Music therapists have utilized technology in their clinical work for decades. Yet music therapy delivered in a telehealth model – telemusic therapy – has rarely been described in the literature until recently. This study stems from telemusic therapy services the researcher-interventionist was contracted to provide to adult acquired brain injury (ABI) survivors. The existing literature has primarily reported on synchronous telemusic therapy conducted via internet-based videoconference platforms with individual clients or groups who were colocated but not face-to-face with the clinician. Technological issues were cited as limitations. Only one article described small group telemusic therapy where participants were each located at their individual homes; no literature was found for large groups of non-colocated participants. Further, the telemusic therapy literature very rarely reports empirical data. This thesis presents the results of a pilot study exploring the feasibility and effectiveness of telemusic therapy on well-being for adult brain injury survivors who participate independently from their homes. This retrospective study utilized a quasi-experimental, pre/post-session repeated measures design to examine data from a 20-session, 10-week, group telemusic therapy program (N = 15). Clinician-developed pre/post measures of well-being were administered each session. A Qualtrics Likert scale survey exploring audiovisual quality, emotional support, the therapeutic relationship, and social-emotional connection between participants was issued during the 5th and 10th weeks. Results: Mean and median difference of pre/post measures were significant for increasing well-being at α = 0.5. Frequency distributions of the survey ratings of more than or very much adequate for quality of audio and video: 78.6% – 85.7%; ratings of more than or very much adequate for emotional support, formation of a therapeutic relationship and creating connections with other participants, respectively: 85.7%, 78.6%, 92.9 %. The results support the feasibility and effectiveness of group telemusic therapy for increasing well-being in adult ABI survivors who attend from their individual homes. Study limitations include small N, low return rate for surveys, and unvalidated measures.It is noteworthy that in each session, the music therapy group successfully engaged in real-time active music making with all members playing and all microphones on. No audio delay was detected. This phenomenon has been described in the literature as improbable. The cause of such low latency is unknown. These findings demonstrate that participants using personal computers or laptops and residential broadband Internet experience the audio and visual components of synchronous music therapy as more than adequate. A real-time telehealth model is a viable means for providing group music therapy. / Music Therapy

Traumatic brain injury (TBI) in infants is detrimental to their development and can result in death; despite these risks, limited research has been conducted for this population. This studies purpose was to quantify biomechanical properties and microstructural changes after compressive and tensile loading of infant human brain surrogate, fetal porcine brain. Samples were loaded independently at strain rates of 0.00625s-1, 0.025s-1, and 0.10s-1 at strain levels of 0%, 15%, 30%, and 45% using the Mach-1TM Micromechanical Testing Device. After loading to the specified strain level, samples were chemically fixed using 10% formalin. Samples were then stained using H&E to evaluate the microstructure. Results showed strain rate dependency and non-linearity with higher stress levels in compression than in tension. The histological analysis confirmed microstructural changes with statistically relevant deformations after loading. These results can assist in understanding infant TBI and help develop accurate head computational models and optimal protective headgear.

A finite element model was developed for a range of human head-sUAS impacts to provide multiple case scenarios of impact severity at two response regions of interest: global and local. The hypothesis was that for certain impact scenarios, local response injuries of the brain (frontal, parietal, occipital, temporal lobes, and cerebellum) have a higher severity level compared to global response injury, the response at the Center of Gravity (CG) of the head. This study is the first one to predict and quantify the influence of impact parameters such as impact velocity, location, offset, and angle of impact to severity of injury. The findings show that an sUAS has the potential of causing minimal harm under certain impact scenarios, while other scenarios cause fatal injuries. Additionally, results indicate that the human head’s global response as a less viable response region of interest when measuring injury severity for clinical diagnosis. It is hoped that the results from this research can be useful to assist decision making for treatments and may offer different perspectives in sUAS designs or operation environments.

Military personnel often experience mild traumatic brain injury (mTBI) from exposure to improvised explosive devices (IEDs). Soldiers typically endure blast trauma from the IED pressure wave as well as blunt trauma from ensuing head impacts. Researchers have not reached a consensus on whether the biomechanical response from blunt or blast trauma plays a more dominant role in mTBI because the specific biomechanical sources of injury are often undetermined. Consequently, the goal of this dissertation was to conduct three separate studies in order to characterize the mechanical behavior of the brain after exposure to mTBI conditions. For Study 1, mild blunt and blast trauma were induced in Sprague-Dawley rats using a custom-built device. In-house diffusion tensor imaging (DTI) software was used to make 3-D reconstructions of white matter fiber tracts before and after injury (1, 4, and 7 days). Axonal integrity was characterized by examining the fiber count, fiber length, and fractional anisotropy (FA). In-house image analysis software also quantified the microstructural variations in Hematoxylin and Eosin (H&E) stained brain sections, where significant differences in parameters such as the area fraction (AF) and nearest neighbor distance (NND) correlated to voids that formed after water diffused extracellularly from axons. Study 2 employed a computational approach involving the development of a finite element (FE) model for the rat head followed by the simulation of blunt and blast trauma, respectively. FE parameters such as von Mises stress, pressure, and maximum principal strain were analyzed at various locations including the skull, cerebral cortex, corpus callosum, and hypothalamus to compare injury cases. Study 3 involved interruption mechanical testing of porcine brain, a suitable animal surrogate of human brain. Compression, tension, and shear experiments were performed at a strain rate of 0.1 s-1 to examine the differential mechanical response. Microstructural changes in H&E stained brain sections were analyzed with in-house image analysis software to quantify differences among stress states at strains of 0.15, 0.30, and 0.40. Studies 1 and 2 confirmed that the brain behaves differently in response to blunt and blast trauma, respectively, while Study 3 further demonstrated the stress state dependent behavior of brain tissue.

Individuals with Traumatic Brain Injury (TBI) exhibit impaired performance on social cognition and theory of mind (ToM) measures, like the Video Social Inference Test (VSIT). The frontal lobe, being the primary region involved in higher level cognitive functions mediates the neural mechanisms involved in social cognition and ToM abilities, according to studies on brain and behaviour. The goal of this study was to examine if individuals with TBI who did not damage their frontal lobe would perform differently on the VSIT than individuals with TBI who did. This study was a secondary analysis of documented imaging data and VSIT scores obtained from 51 adults with moderate-to-severe TBI (23 females). A comparison was made between scores obtained on the VSIT between participants with and without frontal lobe lesions. The results indicated that there was no significant difference between the two groups, in other words, site of lesion in participants with TBI did not predict performance on the VSIT. The results suggest that while the VSIT may yield critical information about social cognition, it is not sensitive to individual site of lesion. There is evidence that aspects of social cognition are impaired in this clinical population, however, most research in this area is obstructed by the complex nature of TBI neuropathology in addition to small heterogenous samples involved in studies. Further research in this area is required in order to reveal and enhance our understanding of social cognition deficits following TBI. Keywords: social cognition, traumatic brain injury, theory of mind, frontal lobe lesions, video social inference test / Thesis / Master of Science (MSc)

<p>Traumatic brain injury (TBI) is characterized by a violent or sudden blow to the head that causes tearing or bruising of the brain tissue and its supporting blood vessels. Determination of the mechanical properties of gray and white matter is critical for the creation of computational models of healthy and TBI-damaged brain tissues. Current in vivo methods to characterize brain tissue, such as 3D amplified MRI (aMRI) and magnetic resonance elastography (MRE), are highly vulnerable to motion artifacts and have limited techniques to exert mechanical loads on the brain. Therefore, in vitro testing was employed to estimate the chemical composition of gray and white matter using Fourier Transform Infrared (FTIR) spectroscopy and the stress responses of the brain tissues to high compressive deformations via unconfined compression. Attenuated total reflectance (ATR) was run in conjunction with FTIR spectroscopy to eliminate the need for sample preparation. Unconfined compression of gray and white matter samples was performed to 70% of the total sample height at a constant strain rate of 0.35/s. Results showed significant increases in the absorbances of white matter (<em>p</em> < 0.05) in the characteristic lipid and carbohydrate regions of the FTIR spectra when compared to gray matter. Within the initial 10% toe-region of the stress-strain curve, white matter is observed to absorb significantly greater compressive loads (<em>p </em>< 0.05) than gray matter. These results indicate an incomplete characterization of brain tissue; therefore, additional in vitro and in vivo methods are still necessary, separately or in combination, to accurately characterize brain tissue mechanics in TBI and non-TBI patients.</p>

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24512号 / 医博第4954号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 花川 隆, 教授 古川 壽亮, 教授 中本 裕士 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Historical redlining, a discriminatory practice of the 1930s, present-day social vulnerability (SVI), and sports and recreational injury (SRI) hospitalizations are interconnected topics that highlight the intersection of race, class, and health in the United States but the relationships have not been studied to date. Thus, the overall aim of this dissertation is to examine the effects of historical redlining and present-day social vulnerability on SRI hospitalizations in the United States. The first study systematically reviewed studies that examined the relationships between neighborhood characteristics and SRI using multilevel modeling approach. Studies reviewed show that certain neighborhood factors, such as living in urban communities, were associated with increased risk of SRI. The second study examined the association between historical redlining and present-day neighborhood SVI in the United States. Results show that formerly redlined areas have higher SVI presently. The third study examined the association between historical redlining and present-day SRI hospitalization in the United States. Results show that redlining was not associated with increased odds of SRI hospitalizations, but was associated with longer length of hospital stay (LOS) among Black and Hispanic patients, and higher total hospital charges among Hispanic patients. The fourth study examined the association between individual and neighborhood social vulnerability and sports and recreation-related traumatic brain injury (SR-TBI) hospitalizations among pediatric patients in the United States. Results show that Native American children had higher odds of hospitalization for SR-TBI, longer LOS, but lower odds of discharge to post-acute care compared to White children. Older age was associated with higher odds of hospitalization and longer LOS while male sex was associated with shorter LOS for SR-TBI in children. Compared to children with private insurance, children with public insurance had longer LOS while uninsured children had shorter LOS. Also, hospitalization in neighborhood with higher overall SVI was associated with longer LOS. This study advances our knowledge on the impact of structural racism on present-day SRI outcomes and will inform policy makers to prioritize health equity by addressing the underlying social determinants of health and the root causes of disparities in SRI outcomes. / Doctor of Philosophy / Every year, around 9 million people get hurt while playing sports or participating in recreational activities in the United States. Out of these, more than a third go to the emergency department for treatment, and several thousands need to stay in the hospital because their injuries are more serious. Even though only a small number of sports and recreational injuries (SRI) require hospitalization compared to those treated in the emergency department or outpatient clinics, these injuries tend to be more severe. They can cause significant harm to a person's physical, mental, and emotional well-being, and they also put a lot of pressure on the healthcare system and society as a whole. This dissertation assessed how historical discrimination against certain neighborhoods, called redlining, and present-day social vulnerability affect sports and recreational injury hospitalizations in the United States. This research found that the neighborhood where people live or are hospitalized matter for how often they are hospitalized for SRI, their length of stay in hospital, the amount of money they pay while in hospital, and how often they receive follow-up care after leaving hospital. While historical redlining was not directly linked to higher odds of hospitalization, it was associated with longer hospital stays for Black and Hispanic patients and higher costs for Hispanic patients. This research also found that children from socially vulnerable backgrounds were more likely to be hospitalized for sports-related traumatic brain injuries (SR-TBI) and stay in hospital longer, but were less like to receive follow-up care after leaving hospital. For instance, children from Native American backgrounds were three times more likely to be hospitalized for SR-TBI and stayed in the hospital 27% longer, but were 99.9% less likely to receive follow-up care after leaving hospital compared to White children. Also, children with public health insurance tended to have longer stays in hospital for SR-TBI compared to those with private health insurance. This research highlights how structural discrimination can impact health outcomes, and suggests that policymakers should address the root causes of health disparities in order to promote health equity.