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.

The investigation of factors underlying deficits in self-awareness and self-regulation

Primary objective: To examine a theoretical model which suggests that a contribution of both psychological and neuropsychological factors underlie deficits in self-awareness and self-regulation. Research design: Multivariate design including correlations and analysis of variance (ANOVA). Methods: Sixty-one subjects with acquired brain injury (ABI) were administered standardized measures of self-awareness and self-regulation. Psychological factors included measures of coping-related denial, personality-related denial and personality change. Neuropsychological factors included an estimate of IQ and two measures of executive functioning that assess capacity for volition and purposive behaviour. Main outcomes and results: The findings indicated that the relative contribution of neuropsychological factors to an outcome of deficits in self-awareness and self-regulation had a more direct effect than psychological factors. In general, measures of executive functioning had a direct relationship, while measures of coping-related and personality-related denial had an indirect relationship with measures of self-awareness and self-regulation. Conclusion: The findings highlighted the importance of measuring both neuropsychological and psychological factors and demonstrated that the relative contribution of these variables varies according to different levels of self-awareness and self-regulation.

Study of behavioural and neural bases of visuo-spatial working memory with an fMRI paradigm based on an n-back task

The goal of this study was to propose a new functional magnetic resonance imaging (fMRI) paradigm using a language-free adaptation of a 2-back working memory task to avoid cultural and educational bias. We additionally provide an index of the validity of the proposed paradigm and test whether the experimental task discriminates the behavioural performances of healthy participants from those of individuals with working memory deficits. Ten healthy participants and nine patients presenting working memory (WM) deficits due to acquired brain injury (ABI) performed the developed task. To inspect whether the paradigm activates brain areas typically involved in visual working memory (VWM), brain activation of the healthy participants was assessed with fMRIs. To examine the task's capacity to discriminate behavioural data, performances of the healthy participants in the task were compared with those of ABI patients. Data were analysed with GLM-based random effects procedures and t-tests. We found an increase of the BOLD signal in the specialized areas of VWM. Concerning behavioural performances, healthy participants showed the predicted pattern of more hits, less omissions and a tendency for fewer false alarms, more self-corrected responses, and faster reaction times, when compared with subjects presenting WM impairments. The results suggest that this task activates brain areas involved in VWM and discriminates behavioural performances of clinical and non-clinical groups. It can thus be used as a research methodology for behavioural and neuroimaging studies of VWM in block-design paradigms.

Congenital heart disease affects local gyrification in 22q11.2 deletion syndrome.

22q11.2 deletion syndrome (22q11.2DS) is a common genetic condition associated with cognitive and learning impairments. In this study, we applied a three-dimensional method for quantifying gyrification at thousands of points over the cortical surface to imaging data from 44 children, adolescents, and young adults with 22q11.2DS (17 males, 27 females; mean age 17y 2mo [SD 9y 1mo], range 6-37y), and 53 healthy participants (21 males, 32 females; mean age 15y 4mo [SD 8y 6mo]; range 6-40y). Several clusters of reduced gyrification were observed, further substantiating the pattern of cerebral alterations presented by children with the syndrome. Comparisons within 22q11.2DS demonstrated an effect of congenital heart disease (CHD) on cortical gyrification, with reduced gyrification at the parieto-temporo-occipital junction in patients with CHD, as compared with patients without CHD. Reductions in gyrification can resemble mild polymicrogyria, suggesting early abnormal neuronal proliferation or migration and providing support for an effect of hemodynamic factors on brain development in 22q11.2DS. The results also shed light on the pathophysiology of acquired brain injury in other populations with CHD.

Exploration des effets d’un programme de réadaptation visant l’amélioration des activités et la participation des personnes cérébrolésées. Application à l’activité cuisine

Thèse réalisée en cotutelle France- Québec

Who knows best? Awareness of divided attention difficulty in a neurological rehabilitation setting

Objective: To explore whether patients relearning to walk after acquired brain injury and showing cognitive-motor interference were aware of divided attention difficulty; whether their perceptions concurred with those of treating staff. Design: Patients and neurophysiotherapists (from rehabilitation and disabled wards) completed questionnaires. Factor analyses were applied to responses. Correlations between responses, clinical measures and experimental decrements were examined. Results: Patient/staff responses showed some agreement; staff reported higher levels of perceived difficulty; responses conformed to two factors. One factor (staff/patients alike) reflected expectations about functional/motor status and did not correlate with decrements. The other factor (patients) correlated significantly with dual-task motor decrement, suggesting some genuine awareness of difficulty (cognitive performance prioritized over motor control). The other factor (staff) correlated significantly with cognitive decrement (gait prioritized over sustained attention). Conclusions: Despite some inaccurate estimation of susceptibility; patients and staff do exhibit awareness of divided attention difficulty, but with a limited degree of concurrence. In fact, our results suggest that patients and staff may be sensitive to different aspects of the deficit. Rather than 'Who knows best?', it is a question of 'Who knows what?.

Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease - effect of motor and cognitive demands of games: a longitudinal, controlled clinical study

Objectives To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit (TM) training in patients with Parkinson's disease and healthy elderly people. Design Longitudinal, controlled clinical study. Participants Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people. Interventions Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer. Main outcome measures Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test. Results Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task. Conclusions The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes. (C) 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

2D-Tasks for Cognitive Rehabilitation

Neuropsychological Rehabilitation is a complex clinic process which tries to restore or compensate cognitive and behavioral disorders in people suffering from a central nervous system injury. Information and Communication Technologies (ICTs) in Biomedical Engineering play an essential role in this field, allowing improvement and expansion of present rehabilitation programs. This paper presents a set of cognitive rehabilitation 2D-Tasks for patients with Acquired Brain Injury (ABI). These tasks allow a high degree of personalization and individualization in therapies, based on the opportunities offered by new technologies.

PREVIRNEC A new platform for cognitive tele-rehabilitation

Acquired Brain Injury (ABI), either caused by vascular or traumatic nature, is one of the most important causes for neurological disabilities. People who suffer ABI see how their quality of life decreases, due to the affection of one or some of the cognitive functions (memory, attention, language or executive functions). The traditional cognitive rehabilitation protocols are too expensive, so every help carried out in this area is justified. PREVIRNEC is a new platform for cognitive tele-rehabilitation that allows the neuropsychologist to schedule rehabilitation sessions consisted of specifically designed tasks, plus offering an additional way of communication between neuropsychologists and patients. Besides, the platform offers a knowledge management module that allows the optimization of the cognitive rehabilitation to this kind of patients.