Les mécanismes excitotoxiques et le rôle de transporteurs de glutamate dans la physiopathologie des traumatismes crâniens = Excitotoxic mechanisms and the role of glutamate transporters in the pathophysiology of traumatic brain injury

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Les mécanismes excitotoxiques et le rôle de transporteurs de glutamate dans la physiopathologie des traumatismes crâniens = Excitotoxic mechanisms and the role of glutamate transporters in the pathophysiology of traumatic brain injury

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

A qualitative study of the emotional coping and support needs of children living with a parent with a brain injury

Primary objective: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children. Design: The study was qualitative, using a thematic analysis approach. Methods and procedure: Six children between 9 and 18 years of age, six parents (three with ABI), and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide. Results: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs. Conclusions: The results reveal an interaction between the child’s experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child, and the children’s need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

Traumatic Brain Injury in Iowa, January 2016

Traumatic Brain Injury (TBI) is an important public health issue in Iowa. TBI occurs when an individual experiences a bump, blow, or jolt to the head or a penetrating injury to the head that results in abnormal function of the brain.

Observed Social Problem Solving and Friendship Quality in Children with a Traumatic Brain Injury

Children who have experienced a traumatic brain injury (TBI) are at risk for a variety of maladaptive cognitive, behavioral and social outcomes (Yeates et al., 2007). Research involving the social problem solving (SPS) abilities of children with TBI indicates a preference for lower level strategies when compared to children who have experienced an orthopedic injury (OI; Hanten et al., 2008, 2011). Research on SPS in non-injured populations has highlighted the significance of the identity of the social partner (Rubin et al., 2006). Within the pediatric TBI literature few studies have utilized friends as the social partner in SPS contexts, and fewer have used in-vivo SPS assessments. The current study aimed to build on existing research of SPS in children with TBI by utilizing an observational coding scheme to capture in-vivo problem solving behaviors between children with TBI and a best friend. The current study included children with TBI (n = 41), children with OI (n = 43), and a non-injured typically developing group (n = 41). All participants were observed completing a task with a friend and completed a measure of friendship quality. SPS was assessed using an observational coding scheme that captured SPS goals, strategies, and outcomes. It was expected children with TBI would produce fewer successes, fewer direct strategies, and more avoidant strategies. ANOVAs tested for group differences in SPS successes, direct strategies and avoidant strategies. Analyses were run to see if positive or negative friendship quality moderated the relation between group type and SPS behaviors. Group differences were found between the TBI and non-injured group in the SPS direct strategy of commands. No group differences were found for other SPS outcome variables of interest. Moderation analyses partially supported study hypotheses regarding the effect of friendship quality as a moderator variable. Additional analyses examined SPS goal-strategy sequencing and grouped SPS goals into high cost and low cost categories. Results showed a trend supporting the hypothesis that children with TBI had fewer SPS successes, especially with high cost goals, compared to the other two groups. Findings were discussed highlighting the moderation results involving children with severe TBI.

Effect of recombinant human erythropoietin expressions of apoptosis genes in rats following traumatic brain injury

Purpose: To explore the effect of recombinant human erythropoietin (r-HuEPO) on apoptosis in rats after traumatic brain injury. Methods: A total of 48 traumatic brain-injured Sprague Dawley (SD) rats were obtained by improved Feeney’s traumatic brain injury model, and were randomly divided into four groups: normal salinetreated rats (control) and rats treated with r-HuEPO at doses of 1000 U/kg, 3000 U/kg and 5000 U/kg. Brain tissues were collected on the 7th day after trauma surgery. Apoptotic cells, and NF-kappa B (NFĸB)-, c-myc-, and Fas/Fasl-positive cells were identified in brain tissues by immunohistochemical assay. Results: After treatment with r-HuEPO (3000 and 5000 U/kg), expression of NF-κB and Fas/Fasl were significantly decreased (p < 0.05) compared to control rats, especially at the 5000 U/kg dose (p < 0.01). However, for c-myc, no significant difference was observed between r-HuEPO treatment and control groups (p > 0.05). Compared to the 1000 U/kg r-HuEPO group, Fas/Fasl expression levels were significantly lower in the 3000 and 5000 U/kg r-HuEPO groups (p < 0.05). Additionally, expression of NF-κB and Fasl in the 5000 U/kg r-HuEPO group was significantly lower than that in the 3000 U/kg r- HuEPO group (p < 0.05). Moreover, the number of apoptotic cells in the r-HuEPO group (5000 U/kg) was significantly lower than in the control group (p < 0.05). Conclusion: Thus, r-HuEPO may be beneficial for treating traumatic brain injury via inhibition of NFkappa B and Fas/Fasl expressions.

MEASURING HEAD IMPACT CONTACT PRESSURE IN COLLEGIATE FOOTBALL GAMES TO CORRELATE HEAD KINEMATICS TO BRAIN KINETICS ELUCIDATING BRAIN INJURY DYNAMICS

Does a brain store thoughts and memories the way a computer saves its files? How can a single hit or a fall erase all those memories? Brain Mapping and traumatic brain injuries (TBIs) have become widely researched fields today. Many researchers have been studying TBIs caused to adult American football players however youth athletes have been rarely considered for these studies, contradicting to the fact that American football enrolls highest number of collegiate and high-school children than adults. This research is an attempt to contribute to the field of youth TBIs. Earlier studies have related head kinematics (linear and angular accelerations) to TBIs. However, fewer studies have dealt with brain kinetics (impact pressures and stresses) occurring during head-on collisions. The National Operating Committee on Standards for Athletic Equipment (NOCSAE) drop tests were conducted for linear impact accelerations and the Head Impact Contact Pressures (HICP) calculated from them were applied to a validated FE model. The results showed lateral region of the head as the most vulnerable region to damage from any drop height or impact distance followed by posterior region. The TBI tolerance levels in terms of Von-Mises and Maximum Principal Stresses deduced for lateral impact were 30 MPa and 18 MPa respectively. These levels were corresponding to 2.625 feet drop height. The drop heights beyond this value will result in TBI causing stress concentrations in human head without any detectable structural damage to the brain tissue. This data can be utilized for designing helmets that provide cushioning to brain along with providing a resistance to shear.

Indicators for Traumatic Brain Injury, December 2008

Although it is not a cause or intent of injury, traumatic brain injury (TBI) is included as a specific indicator due to its deadly and debilitating nature. Although the death and hospitalization rates of TBI injuries in Iowa (17.3/100,000 and 56.8/100,000, respectively) is lower than the national NCIPC states’ 2004 average (17.9/100,000 and 74.2/100,000, respectively), the TBI death rate is still the highest among all the specific indicators for death in Iowa. On average, there are 1.5 TBI‐related deaths/day, 5 hospitalizations, and nearly 40 TBI‐related ED visits per day in all of Iowa.

SOLUTIONS: Assistive Technology for People with Brain Injury, February 22, 2016

The Brain A project of the Iowa Department of Public Health and the Iowa Advisory Council on Brain Injuries, produced with assistance from the Iowa Program for Assistive Technology University of Iowa Center for Disabilities and Development and Easter Seals This booklet was supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H21MC26929 titled: Traumatic Brain Injury Implementation. This information or content and conclusions are those of the authors/s and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. Government.

A Redução do Tempo de Pré-Admissão e da Duração do Internamento em Fisiatria é Custo-Efectiva na Reabilitação do Traumatismo Crânio-Encefálico?

Objectivos: Em doentes com traumatismo crânio-encefálico (TCE), o aumento da duração do pré-internamento (internamento em cuidados agudos hospitalares de outras especialidades, antes da admissão em Medicina Física e de Reabilitação) e do internamento no Serviço de Medicina Física e de Reabilitação pode não justificar a sua inclusão ou manutenção na reabilitação em internamento, podendo esta não ser custo-efectiva comparativamente a modelos em ambulatório. O objectivo principal deste trabalho foi avaliar o impacto da duração do pré-internamento e do internamento em Medicina Física e de Reabilitação nos ganhos de funcionalidade obtidos por doentes com TCE. Material e Métodos: Doentes internados por TCE em Medicina Física e de Reabilitação (MFR) entre 1/1/1996 e 31/12/2010 (pré-amostra n = 79). Critérios de inclusão: TCE; pré-internamento <6 meses; internamento em MFR >7 dias. Critérios de exclusão: défices neurológicos e músculo-esqueléticos antes do TCE; intercorrências que condicionassem o programa de reabilitação. Amostra n = 64. O género, idade e os tempos de pré-internamento e de internamento em MFR são as variáveis independentes. Com base nos registos de entrada e alta em MFR, analisou-se a variação de vários parâmetros funcionais (variáveis dependentes). Aplicaram-se modelos estatísticos lineares generalizados: regressão logística, regressão linear múltipla e regressão ordinal logística, nas variáveis com escalas binária, intervalar ou ordinal, respectivamente. Para testar se houve melhoria após o internamento em MFR, aplicou-se o teste paramétrico t para amostras emparelhadas. Resultados: Género (feminino: 32.81%, masculino: 67.19%); média de idades (34.73±14.64 anos); duração média (pré-internamento: 68.03±36.71 dias, internamento em MFR: 46.55±:29.23 dias). O internamento em MFR conduziu a ganhos estatisticamente significativos (p < 6.54x10-2) em todas as variáveis dependentes. A duração de pré-internamento tem uma influência não linear estatisticamente significativa na duração de internamento em MFR (estimativa DPI: 1.18, estimativa DPI2: -5.92x10-3, p DPI: 9.17x10-3, p DPI2: 1.52x10-2). A redução da duração de pré-internamento está associada a uma evolução mais favorável em 20 variáveis, das quais 10 com influência estatisticamente significativa (p < 0.12). O aumento do tempo de internamento em MFR está significativamente associado a maiores ganhos nas escalas MIF e Barthel (p < 4.31x10-3). Conclusões: A duração de pré-internamento tem uma influência não linear na duração do internamento em MFR e constitui um parâmetro de prognóstico funcional em reabilitação. A sua redução é custo-efectiva na reabilitação do TCE e recomenda-se que seja um factor a considerar na selecção de doentes para a reabilitação em internamento. O programa de reabilitação em internamento gera ganhos significativos de funcionalidade, estando uma duração maior associada a ganhos mais favoráveis.