Context Of Traumatic Brain Injury Research Articles

Does Facebook Use Provide Social Benefits to Adults with Traumatic Brain Injury?

Drawing on the social compensation hypothesis, this study investigates whether Facebook use facilitates social connectedness for individuals with traumatic brain injury (TBI), a common and debilitating medical condition that often results in social isolation. In a survey (N = 104 participants; n = 53 with TBI, n = 51 without TBI), individuals with TBI reported greater preference for self-disclosure on Facebook (vs. face-to-face) compared to noninjured individuals. For noninjured participants, a preference for Facebook self-disclosure was associated with the enactment of relational maintenance behaviors on Facebook, which was then associated with greater closeness with Facebook friends. However, no such benefits emerged for individuals with TBI, whose preference for Facebook self-disclosure was not associated with relationship maintenance behaviors on Facebook, and did not lead to greater closeness with Facebook friends. These findings show that the social compensation hypothesis has partial utility in the novel context of TBI, and suggest the need for developing technological supports to assist this vulnerable population on social media platforms.

56 TBI Severity Moderates the Association between Subjective and Objective Attention in Older Veterans

Objective:Prior work on associations between self-reported cognition and objective cognitive performance in Veterans has yielded mixed findings, with some evidence indicating that mild traumatic brain injury (TBI) may not impact the associations between subjective and objective cognition. However, few studies have examined these relationships in both mild and moderate-to-severe TBI, in older Veterans, and within specific cognitive domains. Therefore, we assessed the moderating effect of TBI severity on subjective and objective cognition across multiple cognitive domains.Participants and Methods:This study included 246 predominately male Vietnam-Era Veterans (age M=69.61, SD=4.18, Range = 60.87 – 85.16) who completed neuropsychological testing and symptom questionnaires as part of the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI). Participants were classified as having history of no TBI (n=81), mild TBI (n=80), or moderate-tosevere TBI (n=85). Neuropsychological composite scores in the domains of memory, attention/executive functioning, and language were included as the outcome variables. The Everyday Cognition (ECog) measure was used to capture subjective cognition and, specifically, the ECog domain scores of memory, divided attention, and language were chosen as independent variables to mirror the objective cognitive domains. General linear models, adjusting for age, education, apolipoprotein E ε4 carrier status, pulse pressure, depressive symptom severity, and PTSD symptom severity, tested whether TBI severity moderated the associations of domain-specific subjective and objective cognition.Results:Across the sample, subjective memory was associated with objective memory (β=-.205, 95% CI [-.332, -.078], p=.002) and subjective language was associated with objective language (β=-.267, 95% CI [-.399, -.134], p<.001). However, the main effect of subjective divided attention was not associated with objective attention/executive functioning (p=.124). The main effect of TBI severity was not associated with any of the objective cognitive domain scores after adjusting for the other variables in the model. The TBI severity x subjective cognition interaction was significant for attention/executive functioning [F(2,234)=5.18, p=.006]. Specifically, relative to Veterans without a TBI, participants with mild TBI (β=-.311, 95% CI [-.620, -.002], p=.048) and moderate-to-severe TBI (β=-.499, 95% CI [-.806, -.193], p=.002) showed stronger negative associations between subjective divided attention and objective attention/executive functioning. TBI severity did not moderate the associations between subjective and objective cognition for memory or language domains. The pattern of results did not change when the total number of TBIs was included in the models.Conclusions:In this DoD-ADNI sample, stronger associations between subjective and objective attention were evident among individuals with mild and moderate-to-severe TBI compared to Veterans without a TBI history. Attention/executive functioning measures (Trails A and B) may be particularly sensitive to detecting subtle cognitive difficulties related to TBI and/or comorbid psychiatric symptoms, which may contribute to these attention-specific findings. The strongest associations were among those with moderate-to-severe TBI, potentially because the extent to which their attention difficulties are affecting their daily lives are more apparent despite no significant differences in objective attention performance by TBI group. This study highlights the importance of assessing both subjective and objective cognition in older Veterans and the particular relevance of the attention domain within the context of TBI.

Development and Characterization of a Probe Device toward Intracranial Spectroscopy of Traumatic Brain Injury

Traumatic brain injury is a leading cause of mortality worldwide, often affecting individuals at their most economically active yet no primary disease-modifying interventions exist for their treatment. Real-time direct spectroscopic examination of the brain tissue within the context of traumatic brain injury has the potential to improve the understanding of injury heterogeneity and subtypes, better target management strategies and organ penetrance of pharmacological agents, identify novel targets for intervention, and allow a clearer understanding of fundamental biochemistry evolution. Here, a novel device is designed and engineered, delivering Raman spectroscopy-based measurements from the brain through clinically established cranial access techniques. Device prototyping is undertaken within the constraints imposed by the acquisition and site dimensions (standard intracranial access holes, probe’s dimensions), and an artificial skull anatomical model with cortical impact is developed. The device shows a good agreement with the data acquired via a standard commercial Raman, and the spectra measured are comparable in terms of quality and detectable bands to the established traumatic brain injury model. The developed proof-of-concept device demonstrates the feasibility for real-time optical brain spectroscopic interface while removing the noise of extracranial tissue and with further optimization and in vivo validation, such technology will be directly translatable for integration into currently available standards of neurological care.

Men’s gendered experiences of rehabilitation and recovery following traumatic brain injury: A reflexive thematic analysis

ABSTRACT Research shows that gender influences men’s health-related beliefs and behaviours – including those within the context of traumatic brain injury (TBI) – making it a factor that should be considered when designing and implementing interventions for this population. To incorporate an understanding of such gendered influences in future educational materials for men with TBI, as well as their caregivers and clinicians, this qualitative study was informed by social constructionism, and aimed to explore how gender is related to men’s post-TBI perceptions and behaviours in rehabilitation and recovery. Semi-structured interviews were conducted with 22 men with mild and moderate-severe TBI at the acute (≤ 3 months post-TBI) and chronic (> 3 months post-TBI) phases of injury. A reflexive thematic analysis approach was applied to interview data, guided by the concept of hegemonic masculinity as described by Connell, R.W. (2005. Masculinities [2nd ed.]. Polity). Three key themes were identified: (1) “I’m a man, I’m a rock”: Undermining treatment, (2) “I’m going to face that challenge”: Facilitation of recovery, and (3) “I don’t feel as useful as a guy as I was before”: Perceptions on return to work. These findings may be translated into gender-informed therapy strategies and materials.

The interplay between neuroendocrine and sleep alterations following traumatic brain injury.

Sleep and endocrine disruptions are prevalent after traumatic brain injury (TBI) and are likely to contribute to morbidity. To describe the interaction between sleep and hormonal regulation following TBI and elucidate the impact that alterations of these systems have on cognitive responses during the posttraumatic chronic period. Review of preclinical and clinical literature describing long-lasting endocrine dysregulation and sleep alterations following TBI. The bidirectional relationship between sleep and hormones is described. Literature describing co-occurrence between sleep-wake disturbances and hormonal dysregulation will be presented. Review of literature describing cognitive effects of seep and hormones. The cognitive and functional impact of sleep disturbances and hormonal dysregulation is discussed within the context of TBI. Sleep and hormonal alterations impact cognitive and functional outcome after TBI. Diagnosis and treatment of these disturbances will impact recovery following TBI and should be considered in the post-acute rehabilitative setting.

Dynamic association between perfusion and white matter integrity across time since injury in Veterans with history of TBI.

ObjectiveCerebral blood flow (CBF) plays a critical role in the maintenance of neuronal integrity, and CBF alterations have been linked to deleterious white matter changes. Although both CBF and white matter microstructural alterations have been observed within the context of traumatic brain injury (TBI), the degree to which these pathological changes relate to one another and whether this association is altered by time since injury have not been examined. The current study therefore sought to clarify associations between resting CBF and white matter microstructure post-TBI.Methods37 veterans with history of mild or moderate TBI (mmTBI) underwent neuroimaging and completed health and psychiatric symptom questionnaires. Resting CBF was measured with multiphase pseudocontinuous arterial spin labeling (MPPCASL), and white matter microstructural integrity was measured with diffusion tensor imaging (DTI). The cingulate cortex and cingulum bundle were selected as a priori regions of interest for the ASL and DTI data, respectively, given the known vulnerability of these regions to TBI.ResultsRegression analyses controlling for age, sex, and posttraumatic stress disorder (PTSD) symptoms revealed a significant time since injury × resting CBF interaction for the left cingulum (p < 0.005). Decreased CBF was significantly associated with reduced cingulum fractional anisotropy (FA) in the chronic phase; however, no such association was observed for participants with less remote TBI.ConclusionsOur results showed that reduced CBF was associated with poorer white matter integrity in those who were further removed from their brain injury. Findings provide preliminary evidence of a possible dynamic association between CBF and white matter microstructure that warrants additional consideration within the context of the negative long-term clinical outcomes frequently observed in those with history of TBI. Additional cross-disciplinary studies integrating multiple imaging modalities (e.g., DTI, ASL) and refined neuropsychiatric assessment are needed to better understand the nature, temporal course, and dynamic association between brain changes and clinical outcomes post-injury.

Traumatic Prefrontal Encephalopathy and Amotivational Apathetic Syndrome: Revisiting the Historical Limitations of Standardized Neuropsychological Assessments

The field of neuropsychology has made significant gains regarding the development and implementation of diagnostic measures and assessment techniques for frontal lobe pathology. Nevertheless, it is becoming increasingly evident that the existing battery of tests remains relatively insensitive to the ever-growing range of functions known to be mediated by the prefrontal regions. In the present study, a 62 year-old gentleman was involved in a pedestrian motor vehicle accident and suffered bilateral prefrontal, left parietal, and left occipital trauma (as evidenced by magnetic resonance imaging (MRI) scans). Secondary to this accident, he complained of significant depression, thought disturbances, and paranoia, while family members reported additional personality changes. A consistent diagnosis of frontal lobe syndrome was established across three independent neuropsychological evaluations, in which his postrehabilitative scores on a range of standardized assessments were consistently above average, regardless of his significant social, affective, and motivational changes following the accident. This case demonstrates the limitations and insensitivity that current standardized measures still obtain for assessing prefrontal lobe injury. The results are interpreted within the context of test development relevant to neuroscience rather than strictly psychometric concerns. The importance of these constraints on the evaluation of frontal lobe syndrome is discussed within the context of traumatic brain injury from contact sports and military combat. For the healthy left frontal lobe, intentional acts involve substantial energy, the desire or intent to engage socially, and the intent to engage in positive affective and verbally interactive activities. These appear to be diminished with the amotivational syndrome arising from dysfunctional left frontal lobe origin and medial frontal pathology with reduced activation of social reward systems and dopaminergic pathways (25, 24). While the patient with left frontal pathology may present with diminished energy and behavioral slowing or inertia, heightened energy or impulsivity may result from right frontal pathology and, by inference, the release of left frontal systems (e.g., decreased caution). Both are described in the scientific literatures as delayed response deficits. However, with left frontal pathology the patient may initiate only following inordinate delays with behavioral slowing or bradykinesia, whereas the patient with right frontal pathology may initiate substantially prior to implementing the organizational planning or caution for successful task completion. Hypoactivity bradykinesia may derive from medial frontal lobe or left frontal lobe pathology and hyperactive or impulsive features with pathology within the homologous regions of the right frontal lobe supplementary motor or orbitofrontal cortex (24, 29). Neuropsychological comprehension of frontal lobe functioning has grown exponentially in scope and research specificity. In the early to mid 1900's, diagnoses of mental illness and abnormal emotionality began to shift towards the implication of dysfunction in specific brain regions. Potential solutions included surgical resection of the brain via frontal lobotomy or lobectomy, which rapidly grew in popularity. German physiologist Friedrich Goltz, in the late 1800's, ablated canine neocortex. Goltz's (23) reporting of character changes in his subjects influenced Swiss physician Gottlieb Burkhardt to translate this early medical intervention to human patients. Portuguese neurologist Egas Moniz (41) was

Chapter 42 - Cellular and molecular neuronal plasticity

The brain has the capability to adapt to function when tissue is compromised. This capability of adaptation paves the road to recovery and allows for rehabilitation after a traumatic brain injury (TBI). This chapter addresses neuroplasticity within the context of TBI. Here neuroplasticity is defined as changes in neuronal structure and function, including synaptic changes as well as modifications in neural pathways. First, the influence of TBI pathology on neuroplasticity is addressed. Here, proteins that are important in neuroplasticity are introduced and a description given of how these are affected in a temporal and severity-dependent manner. Secondly, given that we are becoming increasingly aware that the brain's response to injury is highly influenced by the environmental milieu, the manner in which behavioral manipulations have an effect on TBI-associated neuroplasticity is addressed. A description is given of how specific environmental qualities may facilitate or hinder neuroplasticity. Finally, the long-term effects of neuroplasticity and the relevance it has to rehabilitation are described.