Dissertations / Theses on the topic 'Brain injury – diagnosis'
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McGrath, Joanna Ruth. "Fear following brain injury." Thesis, Oxford Brookes University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325266.
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Kinkela, Jessica H. "Diagnosis Threat in Mild Traumatic Brain Injury." Ohio University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1223597555.
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Carter-Allison, Samantha Natalie. "Diagnosis threat and injury beliefs after mid traumatic brain injury." Thesis, King's College London (University of London), 2015. https://kclpure.kcl.ac.uk/portal/en/theses/diagnosis-threat-and-injury-beliefs-after-mid-traumatic-brain-injury(c6ba3d52-13d9-46ea-aeee-d34ed2e43943).html.
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Background: Diagnosis threat is a form of stereotype threat, where individuals with a history of mild traumatic brain injury (mTBI) have shown performance decrements on cognitive tasks, owing to negative expectancies around cognitive ability elicited by cues in the environment. This study systematically reviews experimental studies to gauge the presence/absence of an effect of diagnosis threat on neuropsychological task performance in mTBI. It also investigates whether methodological variation and methodological quality contribute to variation in study findings. Method: A systematic search of four online databases (Medline, PyscINFO, SportDISCUS, PsycEXTRA) was conducted to identify diagnosis threat studies that employed an experimental paradigm. Neuropsychological test outcomes were extracted, along with information on inclusion criteria, mTBI diagnostic criteria, participant characteristics and study design. Methodological quality was assessed using modified Scottish Intercollegiate Guidelines Network (SIGN) criteria. Results: A total of nine studies were identified. Evidence for diagnosis threat was found, although there was considerable heterogeneity across study results. The most robust finding was the impact of diagnosis threat on the cognitive domain of attention/working memory. No clear associations between methodological variation, methodological quality and study outcome were noted. Conclusions: The review found evidence for diagnosis threat, although the strength of this effect may be smaller than previously thought. Although there was heterogeneity across elements of study design, there was no obvious relationship between these factors and outcome. However, the substantial variation makes comparison difficult. These issues are similar to findings in other examinations of stereotype threat. Further research is needed to replicate findings and add clarity to the impact of diagnosis threat on both objective and subjective measures, and to further investigate the role of possible moderating variables. A more formal meta-analysis in the area may also be helpful to clarify findings in the research field. Future studies should aim to create established operational definitions and outcomes to improve consistency and comparability between studies.
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Scholtz, Brendon P. "Effects of Cautioning and Education in the Detection of Malingered Mild Traumatic Brain Injury." Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5247/.
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This study examined the effectiveness of cautioning and education on simulating a mild traumatic brain injury on several neuropsychological measures. The measures used included the Word Memory Test (WMT), Wechsler Adult Intelligence Scales® - Third Edition (WAIS®-III), Wechsler Memory Scales®-3rd Edition instrument (WMS®-III), 16-item version of the Rey Memory Test, and a self-report symptom checklist. Five experimental groups were used including clinical and non-clinical controls, as well as three simulation groups. The design and implementation of this study also attempted to correct several methodological short comings of prior research by increasing the incentives for participants, expanding the generalizability of findings and examining research compliance and participant self-perception through debriefing. Discriminant analysis was utilized to determine if specific functions existed that would correctly classify and distinguish each experimental group. Several discriminant functions had at least moderate canonical correlations and good classification accuracy. Results also include utility estimates given projected varying base rates of malingering.
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Gesler, Toni L. "Differential diagnosis of head injury and depression in adults." Virtual Press, 2005. http://liblink.bsu.edu/uhtbin/catkey/1343468.
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A differential diagnosis between head injury and depression is critical to ensure proper treatment and appropriate interventions. Knowledge about this can only aid counseling psychologists' work with this population and, identifying a measure that can assist in this process is essential. The purpose of this study is to measure the utility of the Dean — Woodcock Neuropsychological Assessment System (D-WNAS) in distinguishing individuals with head injury from those who have a primary diagnosis of depression, and general neurological impairment. Participants included 433 adults (222 males, 211 females) between the ages 20-55 years of age (mean = 35.3 years, SD = 10.97 years) from the Midwestern United States. During the individual's treatment in the neuropsychological laboratory, each person was administered the following: the Dean-Woodcock Structured Interview (Dean & Woodcock, 1999), mental status exam, the Woodcock Johnson — Revised Tests of Cognitive Ability (WJ-R COG; Woodcock & Johnson, 1989b), the Woodcock Johnson — Revised Tests of Achievement (WJ-R ACH; Woodcock & Johnson, 1989a), and the Dean-Woodcock Sensory Motor Battery (DWSMB; Dean & Woodcock, 1999). This study indicates that responses to D-WNAS can be used to reliably classify adults into groups of depression, head injury, and general neuropsychological impairment. In particular, responses to the D-WSMB portion of the D-WNAS can be used to reliably classify adults into groups of depression, head injury, and general neuropsychological impairment. Classification results revealed that the original grouped cases were classified with 62.6 % (p < .001) accuracy and with 73.2% overall accuracy when the head injury and general neurological impairment groups were combined and compared to depression and normative groups. The WJ-R COG and WJ-R ACH were not as reliable as the D-WSMB at predicting group membership.Department of Counseling Psychology and Guidance Services
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Clements, Andrea D. "Mild Traumatic Brain Injury in Multiple Trauma Patients: the Problem of Delayed Diagnosis." Digital Commons @ East Tennessee State University, 1997. https://dc.etsu.edu/etsu-works/7217.
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Excerpt: With all that is currently known about symptoms that indicate mild traumatic brain injury (MTBI), it is unfortunate that many individuals go undiagnosed for long periods of time after sustaining such an injury.
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Riddick, Amy H. "The Utility of Depression Screening Measures After Traumatic Brain Injury." Also available to VCU users online at:, 2007. http://hdl.handle.net/10156/1439.
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Mercer, Walt N. (Walt Neilson). "Performance of Brain-Injured versus Non-Brain-Injured Individuals on Three Versions of the Category Test." Thesis, University of North Texas, 1994. https://digital.library.unt.edu/ark:/67531/metadc278878/.
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To date, no research exists examining criterion-related validity of alternate, computerized forms of the Category Test. The intent of this study was to address criterion-related validity of three full forms of the Category Test. In that, the goal was to examine equivalency of each version in their ability to differentiate brain-injured from non-brain-injured individuals. Forty-nine (N = 49) healthy adults and 45 (N = 45) brain-injured adults were tested using three versions of the Category Test, the BDI, and the WAIS-R NI. ANOVA indicated no significant differences between versions of the Category Test or an interaction between Category Test version and group membership on the total error score. MANOVA performed between versions of the Category Test and Subtest error scores indicated significant differences between versions on Subtest 3 and Subtest 6. Group membership (brain-injured v. non-brain-injured) produced a significant main effect on all subtests of the Category Test except Subtest 2. Several exploratory analyses were performed examining the relationship between neuropsychological impairment, group membership based on Category Test error scores, and the WAIS-R NI. Clinical applications, such as the use of serial testing to index neurorehabilitation gains, were discussed.
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Collingwood, Lisa M. (Lisa Marie). "Performance of Psychiatric and Head Injury Patients on the General Neuropsychological Deficit Scales." Thesis, University of North Texas, 1997. https://digital.library.unt.edu/ark:/67531/metadc278771/.
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Reitan and Wolfson's General Neuropsychological Deficit Scale and Left and Right Neuropsychological Deficit Scales were applied to Halstead-Reitan test data of individuals with psychotic or substance abuse disorders with and without a head injury.
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Wang, Silun, and 王思倫. "Diffusion tensor MR imaging as a biomarker for the evaluation of whitematter injury in rodent models." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43085416.
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Dempsey, Laura Alicia. "Development and application of diffuse optical tomography systems for diagnosis and assessment of perinatal brain injury." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10047766/.
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Diffuse optical tomography (DOT) was investigated as a means of non-invasively monitoring neonatal brain function at the cot-side. Two DOT devices designed and built at UCL were used in this work: a continuous-wave (CW-DOT) system and a time-resolved (TR-DOT) system known as MONSTIR II. Both systems are sensitive to changes in absorption within the interrogated tissue and can be used to create images of relative changes in oxy- and deoxyhaemoglobin concentration. MONSTIR II also has the capacity to isolate changes in absorption from those in scattering by obtaining photon flight-time information. These DOT devices were used to explore whether infant neuropathologies, such as perinatal arterial ischaemic stroke (PAIS), can be detected earlier than is currently achieved clinically. To test the efficacy of DOT for early PAIS diagnosis, stroke-affected infants were initially studied with a CW-DOT system. Significant differences in interhemispheric correlation were found between the control group and the PAIS group, with the latter having impaired connectivity in the frequency range of 0.0055-0.080 Hz. The efficacy of MONSTIR II for imaging similar neuropathological infants was evaluated using a complex anatomically-accurate neonatal head phantom created using a novel 3D printing technique. To experimentally determine the optimal combination of near-infrared wavelengths for studying brain function with MONSTIR II, a widely applicable systems-testing protocol based on functional activation was developed. To mitigate the inherently slow sampling of TR-DOT systems, a variational form Kalman filter (VKF) was implemented to improve the spatio-temporal resolution of MONSTIR II for imaging transient neuropathological events. The VKF was tested on two dynamic phantoms designed to mimic neonatal seizures. Finally, MONSTIR II was used to acquire data from healthy and brain injured infants. Preliminary results from a neonate with PAIS suggest a significant asymmetry between hemispheres for wavelength intensity ratio data.
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Strout, Teresa J. "Malingering of mild closed head injury sequelae with the neuropsychological symptom inventory : a study of the effect of prior knowledge." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1063204.
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Clinical neuropsychologists who assess patients following mild closed head injury (CHI) are often asked to offer an opinion whether there is evidence of malingering. Factors that impact the ability of a person to intentionally portray impairment are quite important since mis-diagnosis of malingering can result in delayed treatment. In this study knowledge of the sequelae of mild CHI was provided to normal college students in an effort to change reporting of symptoms and influence the type of malingering strategy used when completing the Neuropsychological Symptom Inventory (NSI). Subjects were randomly assigned to either a prior knowledge malingering group (PK;N=57), no prior knowledge malingering group (NPK;N=58), or control group (CON;N=61). The results showed that PK subjects endorsed more general and attention/concentration symptoms than NPK or CON subjects. The results also showed PK subjects were as likely to be detected by the NSI lie scale as NPK subjects. Thus, the NSI lie scale demonstrated sensitivity to malingering despite subjects having brief instruction about mild CHI. Also, having prior knowledge did not result in significantly different strategies when completing the NSI. Instead, both malingering groups reportedly used exaggeration and attempted to be consistent as frequent strategies.Department of Educational Psychology
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Budenz-Anders, Judey. "Predicting closed head injury status with the Dean-Woodcock Sensory Motor Battery." Virtual Press, 2006. http://liblink.bsu.edu/uhtbin/catkey/1336626.
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The purpose of this study was to examine the utility of the Dean-Woodcock Sensory Motor Battery (DWSMB) as a diagnostic tool for identifying individuals with and without closed-head injury, comparing the predictive power of a two- and three-factor representation (DWSMB; Dean & Woodcock, 2003). The current study's major research questions focused on the predictive utility of the structure of the DWSMB. The simplified two-factor model (Total Sensory and Total Motor), based on the DWSMB manual (Dean & Woodcock), was compared to a three-factor theoretical model (Basic Sensory, Higher Sensory and Motor Functions) (R.S.Dean, personal communication, March 29, 2006) for this study. Logistic Regression was used to analyze the data. Results from this study demonstrate that when using the two-factor solution, the overall correct prediction of group membership was 73.8 % (59.4% for CHI and 85.2% for normals). The Total Motor Impairment variable was the only meaningful predictor. The results from the three-factor solution show an 84.2 % overall correct prediction rate (71.4 % for CHI and 95.1 % for normals). The significant contributors for identifying CHI when using the three-factor model included Basic Sensory and Motor Functions. Everything favors the three-factor model as being more precise. All indicators of prediction accuracy and goodness of fit favored the three-factor model. Based on these results, the DWSMB was determined to be a good screening instrument for identifying children in school contexts who should be referred for a neuropsychological examination to confirm pre-existing CHI that interfere with school functioning.Department of Educational Psychology
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Bass, Catherine. "Performance of Children With and Without Traumatic Brain Injury on the Process Scoring System for the Intermediate Category Test." Thesis, University of North Texas, 1997. https://digital.library.unt.edu/ark:/67531/metadc278018/.
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The clinical utility of the Intermediate Category Test, a measure of executive functioning in children 9 to 14 years of age, is currently limited by the availability of only a Total Error score for normative interpretation. The Process Scoring System (PSS) was developed to provide a standardized method of assessing specific processing patterns and problem-solving errors. The purpose of this study was to determine the ability of the PSS scores to discriminate between children with and without suspected executive deficits, thereby providing evidence of criterion-related validity.
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Akin, Faith W., and Jorge M. Serrador. "Diagnosis and Treatment of Vestibular Disorders in mTBI." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2430.
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The purpose of this session is to examine the vestibular consequences of mild traumatic brain injury (TBI) and blast exposure. Preliminary data will be presented showing characteristics of vestibular dysfunction and postural instability related to mild TBI and blast exposure. Also reviewed will be the latest findings including recent data collected at the War Related Illness & injury Center showing vestibular impairments in those with mTBI. The target audience is audiologists, physical therapists, neurologists, otolaryngologists. This session will cover intermediate level of content.
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Edmed, Shannon L. "The influence of psychosocial factors on expectations and persistent symptom report after mild traumatic brain injury." Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/78670/6/Shannon_Edmed_Thesis.pdf.
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This thesis examines how psychosocial factors influence the report of persistent symptoms after mild traumatic brain injury. Using quasi-experimental methods, the research program demonstrates how factors unrelated to trauma-induced physiological brain damage can contribute to persistent symptoms after a mild traumatic brain injury. The results of this thesis highlight the possibility that outcome from mild traumatic brain injury could be improved by targeting psychosocial factors.
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Reneker, Jennifer Christine. "Differential Diagnosis of Dizziness Following a Sports-Related Concussion." Kent State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1445530345.
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Khong, Pek-Lan, and 孔碧蘭. "Diffusion tensor MR imaging in the evaluation of treatment-induced white matter injury in childhood cancer survivors." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B38320666.
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Santos, Ana Carla Ferreira Silva dos. "Validação do diagnóstico de enfermagem ‘Controle Emocional Instável’ no trauma cranioencefálico." Pós-Graduação em Ciências da Saúde, 2017. https://ri.ufs.br/handle/riufs/6684.
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The consequences resulting from Traumatic brain injury (TBI) cause disabilities or physical disabilities (motor, visual, among others), cognitive (memory, attention, learning, among others) and or behavioral/emotional (loss of self-confidence, depression, anxiety, difficulty of Self-Control, irritability, aggression, among others) that can be temporary or permanent. The study aimed to perform the validation of content and clinical aspects of nursing diagnosis of ""Labile emotional control" in treated TBI outpatients. Methodological and descriptive study that used the model of Fehring for validation. The research was developed in two steps: Content validation and clinical validation. In the former, there was the participation of 31 experts to evaluate, by means of electronic questionnaire, the taxonomic structure of NANDA International concerning the diagnosis "Labile emotional control". The later was performed in the outpatient clinic of the University Hospital of the Federal University of Sergipe, between the months of August and September 2016 with a sample consisting of 40 patients in two distinct groups with mild TBI (n=20) and moderate TBI (n=20). For comparison of proportions among groups the z test (two groups) was used and with Bonferroni correction (3 groups). The results showed that the majority of experts considered the domain 05 (perception/cognition), Class 4 (cognition) and the wording (Labile emotional control) suitable for diagnosis, although they suggested modifications in the current definition of diagnosis Two of the defining characteristics were considered major (removal of the social situation and the expression of incoherent emotions with the triggering factor) and 11 secondary (removal of the professional situation, lack of contact with the eyes, crying without excessive feel sorrow, uncontrollable crying, involuntary crying, difficulty using facial expressions, embarrassment on the expression of emotions, tears, laughter in excess without feeling happiness, uncontrollable laughter and involuntary laughter. The total score of the diagnosis “Labile emotional control” was 0.69, considered valid. In the clinical validation, the characteristics that are considered important for the mild TBI were: professional situation leave, avoidance of social situation, embarrassment on the expression of emotions, expression of emotions would be inconsistent with the triggering factor and the secondary were absence of eye contact, excessive crying without feeling sadness, uncontrollable crying , involuntary crying, difficulty using facial expressions and tears and the irrelevant ones were laughter in excess without feeling happiness, uncontrollable laughters and involuntary laughter. In the moderate TBI group the following were identified as main characteristics: professional situation leaves, avoidance of social situation, excessive crying without feeling sadness, embarrassment on the expression of emotions, expression of emotions would be inconsistent with the triggering factor and the secondary were absence of eye contact, uncontrollable crying, involuntary crying, difficulty using facial expressions, tears, uncontrollable laughter and involuntary laughter. The total score was similar in both groups, 0.74, considered to be validated for the NANDA Taxonomy-I. It is concluded that almost all of the defining characteristics were considered valid for the diagnosis "Labile Emotional Control" in TBI.As consequências advindas do Trauma Cranioencefálico (TCE) provocam deficiências ou incapacidades físicas (motora, visual, entre outras), cognitivas (memoria, atenção, aprendizagem, entre outras) e ou comportamentais/emocionais (perda de autoconfiança, depressão, ansiedade, dificuldade de autocontrole, irritabilidade, agressão, entre outras) que podem ser temporárias ou permanentes. O estudo objetivou realizar a validação de conteúdo e clínica do diagnóstico de Enfermagem “Controle emocional instável” em pacientes com TCE atendidos ambulatoriamente. Estudo metodológico e descritivo que utilizou o modelo de Fehring para a validação. Foi desenvolvido em duas etapas: validação de conteúdo e clínica. Na primeira, houve a participação de 31 experts para avaliar, por meio de questionário eletrônico, a estrutura taxonômica da NANDA International relativo ao diagnóstico “Controle emocional instável”. A segunda etapa foi realizada no ambulatório do Hospital Universitário da Universidade Federal de Sergipe, entre os meses de agosto e setembro de 2016 com uma amostra constituída por 40 pacientes em dois grupos distintos com TCE leve (n=20) e TCE moderado (n=20). Para comparação de proporções entre grupos foi utilizado o teste Z (dois grupos) e correção de Bonferroni (3 grupos). Os resultados apontaram que a maioria dos experts considerou o domínio 05 (Percepção/cognição), a Classe 4 (Cognição) e o enunciado (Controle emocional instável) adequados ao diagnóstico, embora tenham sugerido modificações na definição atual do diagnóstico. Duas características definidoras foram consideradas principais (afastamento da situação social e expressão de emoções incoerentes com o fator desencadeador) e 11 secundárias (afastamento da situação profissional, ausência de contato com o olhar, choro excessivo sem sentir tristeza, choro incontrolável, choro involuntário, dificuldade de usar expressões faciais, embaraço relativo à expressão das emoções, lágrimas, risadas em excesso sem sentir felicidade, risadas incontroláveis e risadas involuntárias. O escore total do diagnóstico “Controle emocional instável” foi de 0,69, considerado válido. Na validação clínica, as características consideradas principais para o grupo do TCE leve foram: afastamento da situação profissional, afastamento da situação social, embaraço relativo à expressão das emoções, expressão de emoções incoerentes com o fator desencadeador e as secundários foram ausência no contato pelo olhar, choro excessivo sem sentir tristeza, choro incontrolável, choro involuntário, dificuldade de usar expressões faciais e lágrimas e as irrelevantes concerne a risada em excesso sem sentir felicidade, risadas incontroláveis e risadas involuntárias. No grupo do TCE moderado foram identificadas como características principais o afastamento da situação profissional, afastamento da situação social, choro excessivo sem sentir tristeza, embaraço relativo à expressão das emoções, expressão de emoções incoerentes com o fator desencadeador e as secundárias foram ausência no contato pelo olhar, choro incontrolável, choro involuntário, dificuldade de usar expressões faciais, lágrimas, risadas incontroláveis e risadas involuntárias. O escore total foi semelhante nos dois grupos, 0,74, considerado validado para a Taxonomia da NANDA-I. Conclui-se que a quase totalidade das características definidoras foram consideradas válidas para o diagnóstico “Controle emocional instável” no TCE.
Aracaju, SE
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Conde, Ana Catarina Magalhães. "Avaliação fisioterapêutica na concussão em atletas: uma revisão bibliográfica." Bachelor's thesis, [s.n.], 2018. http://hdl.handle.net/10284/7088.
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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em FisioterapiaIntrodução: a concussão, muito embora não seja das problemáticas mais discutidas no desporto, tem vindo a ganhar o seu espaço, sendo considerada uma emergência nesta área, e com maior relevância na área da investigação. Objetivo: perceber os métodos utlizados na realização de uma avaliação fisioterapêutica na concussão, em atletas. Metodologia: pesquisa realizada na Science Direct, Pubmed, B-on e outras fontes, com as palavras chave Concussion, Brain Injury, Head Trauma, Evaluation, Assessment, Exam, Diagnosis, Physical Therapy, Physiotherapy, Sport e com o operador de lógica AND e OR. Resultados: foram encontrados 10 artigos, abrangendo diversos parâmetros, nomeadamente a avaliação do equilíbrio, escalas e questionários, avaliação da coluna vertebral, avaliação do sistema vestibular e oculomotor e por fim, avaliação neuropsicológica, com o intuito de auxiliar no diagnóstico e identificação da concussão. Conclusão: através dos parâmetros avaliados, concluiu-se quais os que devem ser aplicados no momento da lesão e aplicados apenas a partir do segundo dia após esta.
Introduction: the concussion, although is not one of the most discussed problems in sports, it has been earning space, being considered an emergency in this area, and with greater relevance in research. Purpose: the aim of this study was understood which instruments are used for physical therapy assessment of concussion, in athletes. Methods: research realized in Science Direct, Pubmed, B-on and other sources, with the key-words Concussion, Brain Injury, Head Trauma, Evaluation, Assessment, Exam, Diagnosis, Physical Therapy, Physiotherapy, Sport and with the logic operator AND and OR. Results: were found 10 articles, that included various parameters, namely the balance assessment, scales and questionnaires, spine assessment, vestibular and oculomotor system assessment and finally, neuropsychological assessment, with the objective of assist in diagnosis and identification of concussion. Conclusion: through the evaluate parameters, it was concluded which were must be applied immediately after concussion, and which must be applied only after the second day after this injury.
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Costa, João Tiago da Silva. "A variabilidade no consumo de recursos nos traumatismos crânio-encefálicos." Master's thesis, Escola Nacional de Saúde Pública. Universidade Nova de Lisboa, 2013. http://hdl.handle.net/10362/11520.
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RESUMO - Portugal atravessa um contexto socioeconómico conturbado onde se têm imposto várias reformas, nomeadamente ao nível da Saúde.
Atualmente, o financiamento do internamento hospitalar é feito por grupos de diagnóstico homogéneo com base num sistema prospetivo, reunindo os episódios em grupos clinicamente coerentes e homogéneos, de acordo com o consumo de recursos necessário para o seu tratamento, tendo em conta as suas características clínicas. Apesar do objetivo deste sistema de classificação de doentes, é aceite que existe variabilidade no consumo de recursos entre episódios semelhantes, sendo que a mesma variabilidade pode representar uma diferença significativa nos custos de tratamento.
Os Traumatismos Cranio-encefálicos são considerados um problema de saúde pública, pelo que os episódios selecionados para este estudo tiveram por base os diagnósticos mais comuns relacionados com esta problemática. Procurou-se estudar a relação entre o consumo esperado e o observado bem como, a forma em que esta relação é influenciada por diferentes variáveis. Para verificar a existência de variabilidade no consumo de recursos, bem como as variáveis mais influentes, foi utilizada a regressão linear e constatou-se que variáveis como a idade, o destino pós-alta e o distrito têm poder explicativo sobre esta relação. Verificou-se igualmente que na sua generalidade as instituições hospitalares são eficientes na prestação de cuidados.
Compreender a variabilidade do consumo de recursos e as suas implicações no financiamento poderá suscitar a dúvida se a utilização de GDH será o mais adequado à realidade portuguesa, de forma a ajustar as políticas de saúde, mantendo a eficiência e a qualidade dos cuidados.ABSTRACT - Portugal is going through a rough crisis, which has provoked deep changes in policies, namely in Healthcare. Currently, the funding for hospitals is done using Diagnosis Related Groups, based on a prospective payment system, gathering all of the cases in clinically coherent and homogenous groups, accordingly with the level of the resource consumption that is necessary for their treatment, taking into account their characteristics. Despite of the objective of this patient classification system, it’s widely accepted that exists some degree of variation in resource consumption between similar cases, which can lead to a significant difference in the costs of treatment. Traumatic Brain Injury is considered as an public health problem, and as such, the cases that were selected for this study were based on the most common clinical diagnosis related with this theme. In this research, it was intended to study the relation between the expected and the effective resource consumption, and the influence of different variables. In order to verify the existence of variation, as well as the most influent variables, a linear regression was built, using variables as such as age, discharge destination and geographical districts, which can explain the relation between them. Also, it was verified that, generally, the hospitals were efficient in health care providing. Understanding the variation of resource consumption and it’s implicantions can raise the doubt if the use of DRG’s is the most adequate to the Portuguese reality, in order to adjust the healthcare policies, maintaining the efficiency and quality of care.
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Qureshi, Adnan Nabeel Abid. "Computer aided assessment of CT scans of traumatic brain injury patients." Thesis, University of Bedfordshire, 2015. http://hdl.handle.net/10547/601083.
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One of the serious public health problems is the Traumatic Brain Injury, also known as silent epidemic, affecting millions every year. Management of these patients essentially involves neuroimaging and noncontrast CT scans are the first choice amongst doctors. Significant anatomical changes identified on the neuroimages and volumetric assessment of haemorrhages and haematomas are of critical importance for assessing the patients’ condition for targeted therapeutic and/or surgical interventions. Manual demarcation and annotation by experts is still considered gold standard, however, the interpretation of neuroimages is fraught with inter-observer variability and is considered ’Achilles heel’ amongst radiologists. Errors and variability can be attributed to factors such as poor perception, inaccurate deduction, incomplete knowledge or the quality of the image and only a third of doctors confidently report the findings. The applicability of computer aided dianosis in segmenting the apposite regions and giving ’second opinion’ has been positively appraised to assist the radiologists, however, results of the approaches vary due to parameters of algorithms and manual intervention required from doctors and this presents a gap for automated segmentation and estimation of measurements of noncontrast brain CT scans. The Pattern Driven, Content Aware Active Contours (PDCAAC) Framework developed in this thesis provides robust and efficient segmentation of significant anatomical landmarks, estimations of their sizes and correlation to CT rating to assist the radiologists in establishing the diagnosis and prognosis more confidently. The integration of clinical profile of the patient into image segmentation algorithms has significantly improved their performance by highlighting characteristics of the region of interest. The modified active contour method in the PDCAAC framework achieves Jaccard Similarity Index (JI) of 0.87, which is a significant improvement over the existing methods of active contours achieving JI of 0.807 with Simple Linear Iterative Clustering and Distance Regularized Level Set Evolution. The Intraclass Correlation Coefficient of intracranial measurements is >0.97 compared with radiologists. Automatic seeding of the initial seed curve within the region of interest is incorporated into the method which is a novel approach and alleviates limitation of existing methods. The proposed PDCAAC framework can be construed as a contribution towards research to formulate correlations between image features and clinical variables encompassing normal development, ageing, pathological and traumatic cases propitious to improve management of such patients. Establishing prognosis usually entails survival but the focus can also be extended to functional outcomes, residual disability and quality of life issues.
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Deye, Nicolas. "Cardiac Arrest-Induced Brain Injury : Diagnostic And Prognostic Values of Circulating Biomarkers." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCC150.
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Le pronostic de l’arrêt cardiaque (AC) reste dramatique. Diagnostiquer sa cause rapidement et prédire précocement son pronostic ("pronostication") de manière fiable permettrait de mieux guider les traitements initiaux, en évitant de traiter futilement les patients avec faible probabilité d’évolution favorable ou à l’inverse de permettre d’intensifier le traitement de patients avec forte probabilité d’évolution favorable. Les biomarqueurs, dont l’utilité diagnostique et pronostique reste débattue, semblent actuellement insuffisamment sensibles et précis, surtout dans les 1ères heures après la reprise de l’activité circulatoire spontanée (RACS). Dans l’algorithme pronostique, seule la Neuron Specific Enolase (NSE) est validée après le 3ème jour post-AC et en 2ème intention. Notre première étude a montré que la valeur diagnostique des biomarqueurs "spécifiques" des lésions cérébrales en post-AC (protéine S100B : S100 et surtout NSE) était insuffisante, à l’admission en réanimation, pour étayer précisément le diagnostic de cause neurologique d’AC. Si la coronarographie précoce est l’outil diagnostique de référence de l’AC de probable cause cardiaque, les biomarqueurs ne peuvent remplacer le scanner cérébral pour diagnostiquer une cause neurologique d’AC. La deuxième étude a évalué, au 1er jour post-AC, S100 et NSE avec 2 témoins d’œdème cérébral proposés comme outils pronostiques : le diamètre de l’enveloppe du nerf optique (DENO) par échographie et le rapport de dédifférenciation substance grise / substance blanche (DSG/B) par scanner cérébral. Même si une relation directe ne peut être affirmée formellement entre ces paramètres, l’élargissement du DENO à J1 post-AC était corrélé aux lésions cérébrales, surtout l’œdème cérébral et les lésions neuronales suspectés sur l’élévation de la NSE (à l’admission et à J1) et la baisse de DSG/B. Si NSE, DSG/B et DENO à J1 étaient liés, S100, plus spécifique de la glie, n’était pas corrélée au DENO ni au DSG/B. NSE et S100 à l’admission, à J1 et J2 post-RACS et DENO à J1 étaient associées à la mortalité hospitalière. La troisième étude évaluait la valeur pronostique des biomarqueurs à la phase précoce de l’AC (NSE et S100 étant prélevées en médiane 220 min après la RASC). S100, réalisée en aveugle des cliniciens, était le biomarqueur le plus précis à l’admission en réanimation pour prédire correctement le pronostic défavorable à la sortie de l’hôpital et à 3 mois après AC, par rapport au lactate, pH et créatininémie, et surtout à la NSE. Les variations de S100 dans le temps permettaient d’affiner cette prédiction. S100 à l’admission était un facteur indépendant du pronostic défavorable à la sortie de l’hôpital, avec la durée sans massage cardiaque, le rythme initial non-choquable, le lactate initial et la présence de convulsion clinique. Selon les recommandations, la pronostication nécessite théoriquement d’être différée et multimodale, les biomarqueurs seuls n’étant pas recommandés, surtout précocement. Les biomarqueurs ne peuvent constituer une alternative, en comparaison à l’imagerie, pour l’aide diagnostique de la cause d’AC. A l’inverse, certains biomarqueurs comme la S100 après admission pourraient facilement et spécifiquement discriminer les AC ayant une certitude de pronostic défavorable. Associée à d’autres outils prédictifs clinico-radiologiques, la S100 pourrait être incorporée dans des algorithmes permettant de guider les thérapeutiques initiales. Une pronostication correcte précoce pourrait éviter des traitements invasifs inutiles, ou au contraire optimiser certaines thérapeutiques agressives. Le choix de méthodes recommandées et automatisées de contrôle ciblé de la température, très efficaces mais invasives et onéreuses, ou l’indication d’utiliser -ou pas- une assistance cardio-circulatoire extra-corporelle pourrait bénéficier d’une telle stratégie précoce de sélection des patientsOutcome of cardiac arrest (CA) remains dramatic. To quickly diagnose the cause of CA and establish a reliable outcome prediction (prognostication) as early as possible could help to guide initial treatments. It could avoid futile treatments in patients with low chance of survival or of good neurological recovery, or conversely allow treatment optimization in patients expected to have a high likelihood of good neurological outcome. Usefulness of biomarkers to guide clinicians in finding the CA diagnosis and helping prognostication is debated. Biomarkers are considered as not sensitive and accurate enough, especially within the first hours after return of spontaneous circulation (ROSC). Their use is only recommended in prognostication for Neuron Specific Enolase (NSE) as a second line tool and after the third day from CA. Our first study confirmed that biomarkers “specific” of brain injury (S100B protein: S100 and moreover NSE) cannot sufficiently discriminate the neurological cause of CA on ICU admission. If early coronary angiogram is the standard for diagnosing a probable cardiac cause of CA, biomarkers cannot replace brain computed-tomography (CT) in CA from a neurological cause. The second study evaluated, during the 1st day after ROSC, the link between biomarkers (S100 and NSE) and 2 surrogates of brain oedema recently proposed as outcome predictors: echography of the optic nerve sheath diameter (ONSD), and grey to white matter attenuation ratio (GWR) on brain CT-scan. Even though we cannot conclude on a definitive relationship between these parameters, ONSD enlargement at day 1 was associated with specific brain damage after CA, such as brain oedema and mostly axonal injuries, as reflected by increases in NSE (on admission and at day 1) and low GWR measurements. Whereas NSE, GWR and ONSD at day 1 were correlated, S100, which is more specific of glial injuries, did not reach significance. NSE and S100 on admission, at days 1 and 2 after ROSC, as well as ONSD at day 1, were associated with survival at hospital discharge. The third study evaluated the prognostic value of several biomarkers in the early phase after CA (NSE and S100 being sampled at median 220 min after ROSC). S100, blinded to physicians, was the biomarker with the best accuracy after ICU admission to correctly predict unfavourable outcome at hospital discharge and at 3 months after CA, compared with all other biomarkers such as lactate, pH, creatinine, and especially NSE. S100 variations during the first day after admission refined prognostication. Initial S100 was an early independent predictive factor associated with unfavourable outcome at hospital discharge, with the no-flow duration, initial lactate value, initial non-shockable rhythm, and the presence of clinical seizure. According to guidelines, prognostication theoretically needs to be delayed and multimodal, biomarkers alone not being recommended especially in the early phase after CA. Biomarkers cannot seem to be an alternative option compared to imaging to precisely diagnose the CA cause. By contrast, some biomarkers, such as S100 after admission, could easily and specifically discriminate CA patients with certainty of unfavourable outcome. Associated with other predictive tools (clinical or using imaging), biomarkers could interestingly be incorporated in early decisional algorithms to optimally guide initial therapies. This correct patient classification could help to avoid unuseful treatments versus to maximize aggressive therapies. The choice of recommended servo-controlled targeted temperature management devices, very efficient but invasive and expensive, or the indication -or not- of a cardio-circulatory assist device implementation should be guided in the early stage after ROSC using this simple strategy of patient selection
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Layton, Donald Charles. "The relationship between Glasgow Coma Scale ratings and the neuropsychological functioning in acutely head injured thirteen through twenty-six year olds." Virtual Press, 1985. http://liblink.bsu.edu/uhtbin/catkey/442601.
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The purpose of this study was to determine if the Glasgow Coma Scale (GCS) provides a valid indication of severity after closed head injury. A second purpose was to determine the nature of the deficits seen with head injured persons shortly after injury.The subjects were 69 patients ages 13 through 26 selected from consecutive closed head injury admissions to a large acute care hospital. The subjects received comprehensive neuropsychological testing after having passed the Galveston Orientation and Amnesia Test.Two a priori hypotheses were specified for each of eight neuropsychological test groupings (i.e., motor, memory, visuographic, achievement, abstraction and concept formation, language, problem solving, and psychometric intelligence). For each of the eight test groupings two, one-way multivariate analyses of covariance (MANCOVA) were used to determine statistical significance. Premorbid IQ was used as a covariate in all of the analyses. Specifically, these a priori contrasts were GCS group (8 compared with GCS group 9-15 and GCS group 9-12 compared with GCS group 13-15. Each of the significant MANCOVA tests was followed with discriminant analysis.The results revealed that 15 out of the 16 null hypotheses were rejected (p<.05 or less) thus providing clear evidence for the usefulness of the GCS as an indicator of the severity of injury. Most notable of the results is that the GCS group comparison of 9-12 and 13-15 reached significance in seven of the eight comparisons. Given this finding, there seems justification for the GCS division of 9-12 denoting a moderately injured group and 13-15 denoting a mildly injured group as was proposed in previous research. Redundancy indexes of 6% to 25% were obtained which indicated small to relatively large effect sizes for the various criterion variates.With discriminant analysis it was determined that accurate classification into GCS groups could be achieved in 64% to 94% of the cases based upon a combination of premorbid IQ and the criterion variates. This represented an increase in classification accuracy of from 13% to 51%to be over what could be accomplished with knowledge of the premorbid IQ alone. The motor test composite, problem solving test composite and abstraction and concept formation composite revealed the highest rates of reclassification.
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Ferguson, Smith Ayanay Camille. "The Predictive Contributions of Spatial Planning to Adaptive and Cognitive Functioning in Children Diagnosed with Brain Tumors." Digital Archive @ GSU, 2006. http://digitalarchive.gsu.edu/psych_diss/17.
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To date, the effect of planning ability on adaptive functioning has not been extensively examined in children treated for brain tumors. Findings indicate that individuals with brain tumors are more likely to experience poor planning ability (Boyd & Sautter, 1993) and that children with even mild neurological complications demonstrate impairments in adaptive functioning (Fletcher et al., 1990). The purpose of this study is to assess spatial planning and to examine its utility in predicting adaptive and cognitive functional impairment in children diagnosed and treated for brain tumors. Forty children diagnosed with a brain tumor (mean age at diagnosis 8.6 years) were administered the Rey-Osterrieth Complex Figure (ROCF) task, the Vineland Adaptive Behavior Scale (VABS), and the Stanford-Binet Intelligence Scale: Fourth Edition (SB:IV) at an average of one year post diagnosis (post acute) and again at two years post diagnosis (long term). The results of this investigation did not support the use of spatial planning skills as a predictor of adaptive functioning at one year or two years post diagnosis. However, spatial planning skill was an important predictor of cognitive functioning, accounting for a significant amount of variance at both one year and two years post diagnosis. These results were not expected and therefore further analyses were performed in order to better understand the data and results. Additional analyses suggest that it is spatial skill and not spatial planning that predicts adaptive functioning. Further research should continue to ask questions that will impact how we understand executive, adaptive, and cognitive functioning outcomes in children diagnosed with brain tumors.
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Gomez, Carrillo Andrea. "Low Frequency Oscillations of Hemodynamic Parameters as a Novel Diagnostic Measure for Traumatic Brain Injury." Wright State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=wright1627226821857103.
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Logan, Martin C. "A comparative analysis of causal attribution between post-secondary students diagnosed with a mild to moderate traumatic brain injury and students without a mild to moderate traumatic brain injury." Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/10168.
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The focus of the study consisted of a comparative analysis of the causal attributions of students who have, and have not, been diagnosed with a mild to moderate traumatic brain injury (M/MTBI). The experimental and control groups were matched on age, gender, and educational setting. Brain injury was measured by diagnosis and medical assessment. Causal attribution was ascertained through personal responses to a scenario-oriented dimension scale. Causal attribution in a failure situation was examined using three dimension: locus, stability and controllability. Controllability was further divided into personal and external control. Students with a M/MTBI attribute the cause of failure significantly more to an internal, stable and uncontrollable cause; however, there was no significant difference with external control. Attributing failure to an internal, stable and uncontrollable cause can create a sense of helplessness and emotional distress. It is important for counsellors, instructors and peers to develop a better understanding and acceptance of students diagnosed with a M/MTBI. With deeper understanding comes acceptance and the opportunity for students to succeed and learn new ways to cope with the diagnosis of an injury. This research will broaden the domain of causal attribution and advance the theory where there is currently no attributional research. Through the completion of this study other researchers should be able to replicate and expand future exploration in the area of causal attribution as it relates to M/MTBI.
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Beck, Kelley D. "Personality and the prediction of outcome following rehabilitation in persons with acquired brain injuries: The Millon Behavioral Medicine Diagnostic (MBMD)." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9121/.
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Neuropsychological rehabilitation following acquired brain injury is increasingly recognized as essential with the advancements in research evidence of its effectiveness, particularly as current estimates of disability following the most common forms of brain injury (traumatic brain injury and cerebrovascular accident) are so high. Improvements in predictive capabilities of researchers and clinicians are paramount in designing effective interventions. As many variables associated with outcome following brain injury are not controllable (e.g. severity of the injury, age, education), it is essential that rehabilitation programs design interventions to target those variables that are susceptible to amelioration. While personality factors have been shown to affect outcome in other medical illnesses, only a few studies have examined the influence of personality on outcome following neurorehabilitation for acquired brain injury. The results of these studies have been mixed. This study used the Millon Behavioral Medicine Diagnostic (MBMD) to predict outcome as measured by the Mayo-Portland Adaptability Index (MPAI-4) following brain injury rehabilitation in a heterogeneous sample of persons with acquired brain injuries (N = 50). It was hypothesized that specific coping styles scales from the MBMD (Introversive, Dejected, Oppositional), which are based on Millon's personality system, would predict outcome. Results indicated that both the Introversive and Oppositional coping styles scales accounted for significant amounts of variance in outcome beyond that accounted for by the severity of the injury alone (p < .001). In both cases, individuals with mild/moderate-moderate/severe limitations following completion of the rehabilitation program had significantly higher scores on the Introversive and Oppositional coping compared to individuals with more successful outcomes. The hypothesis that a dejected coping style would predict outcome was not supported. Implications for rehabilitation are discussed in the context of Millon's personality system.
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Jones, Brittany M. G. "Development of Microcontroller-based Handheld Electroencephalography Device for use in Diagnostic Analysis of Acute Neurological Emergencies (E-Hand)." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1445608971.
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Iqbal, Md Hasan. "The Development and Validation of a One Tier Diagnostic Assessment to Test Premedical Students’ Misconceptions about Traumatic Brain Injury." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1464271962.
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Bailey, Janelle Lee. "Language Pathways Defined in a Patient with Left Temporal Lobe DamageSecondary to Traumatic Brain Injury: A QEEG & MRI Study." BYU ScholarsArchive, 2014. https://scholarsarchive.byu.edu/etd/4363.
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Though the current understanding of language processing is incomplete, it has been established that the left hemisphere is dominant for language in the majority of the population. Damage to language centers of the brain and to white matter tracts connecting these language centers results in a language deficit known as aphasia. Neuroplasticity in the brain can often compensate for these language deficits by strengthening neuronal connections between the right and left hemisphere, or by enhancing the neuronal connectivity of undamaged areas in the left hemisphere. Thus the brain can compensate for damaged language centers by using alternative cortical areas. These compensatory language areas may be homologous areas of the right hemisphere, or other undamaged portions of the left hemisphere. Various imaging techniques have been used to demonstrate this phenomenon. The current neuroimaging technique known as quantitative electroencephalographic brain imaging allows investigators to evaluate the functional anatomical location of language processing. When this mapping is overlaid on a magnetic resonance image, investigators are able to locate areas in the brain of the participant that are electrically activated during elicited speech tasks. This method was used in a single case study to examine the brain of an individual with a unique traumatic brain injury in which the anterior portion of the individual's left temporal lobe was surgically removed and considerable recovery of language subsequently occurred. The stimulus for the quantitative electroencephalography included identifying syntactically incorrect sentences. Imaging results from the participant with traumatic brain injury were compared to imaging results obtained from an age-matched control. Differences in quantitative electroencephalography between the two participants included a delayed P1-N1-P2 response and an absent P600 in the participant with traumatic brain injury. Behavioral results include an increased number of incorrect responses from the participant with traumatic brain injury as compared to the control participant. These results imply an interesting cortical distribution of language processing that could be further assessed by functional magnetic resonance imaging.
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Duis, Sandra S. "Differential performances on the wide range assessment of memory and learning of children diagnosed with reading disorder, attention- deficit/hyperactivity disorder, and traumatic brain injury." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1063200.
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The purpose of this investigation was to compare the performances on the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990) of children with different developmental and neurological disorders. The primary question was whether the WRAML subtests significantly differentiate among children with Developmental Reading Disorders (RD; n = 44), with Attention-Deficit/Hyperactivity Disorder (ADHD; n = 37), with Traumatic Brain Injury (TBI; n = 30), and without developmental or neurological disabilities (n = 103). Archival data from the TBI Project at James Whitcomb Riley Hospital for Children and from the Division of Psychology at Alfred I. duPont Institute was analyzed. The results of a discriminant functions analysis indicated that significant differences among the groups do exist on the WRAML and that the groups were discriminated from one another by three distinct types of tasks (i.e., functions): rote memory, verbal learning, and meaningful memory. Furthermore, based on WRAML performance alone, participants had a 63% chance of being classified into their proper diagnostic group. In addition to supporting the use of multi-dimensional tasks to assess memory, the results of this study have clinical relevance for developing diagnosis-specific recommendations for memory and learning problems.Department of Educational Psychology
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Thomas, Sarah Helen. "A BRAIN-COMPUTER INTERFACE FOR CLOSED-LOOP SENSORY STIMULATION DURING MOTOR TRAINING IN PATIENTS WITH TETRAPLEGIA." UKnowledge, 2019. https://uknowledge.uky.edu/cbme_etds/56.
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Normal movement execution requires proper coupling of motor and sensory activation. An increasing body of literature supports the idea that incorporation of sensory stimulation into motor rehabilitation practices increases its effectiveness. Paired associative stimulation (PAS) studies, in which afferent and efferent pathways are activated in tandem, have brought attention to the importance of well-timed stimulation rather than non-associative (i.e., open-loop) activation. In patients with tetraplegia resulting from spinal cord injury (SCI), varying degrees of upper limb function may remain and could be harnessed for rehabilitation. Incorporating associative sensory stimulation coupled with self-paced motor training would be a means for supplementing sensory deficits and improving functional outcomes. In a motor rehabilitation setting, it seems plausible that sensory feedback stimulation in response to volitional movement execution (to the extent possible), which is not utilized in most PAS protocols, would produce greater benefits. This capability is developed and tested in the present study by implementing a brain-computer interface (BCI) to apply sensory stimulation synchronized with movement execution through the detection of movement intent in real time from electroencephalography (EEG). The results demonstrate that accurate sensory stimulation application in response to movement intent is feasible in SCI patients with chronic motor deficit and often precedes the onset of movement, which is deemed optimal by PAS investigations that do not involve a volitional movement task.
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Oster, Isabel Maria [Verfasser], and Ludwig [Akademischer Betreuer] Gortner. "Diagnostic approach to children with minor traumatic brain injury and children with headaches in Germany : The role and limitations of the electroencephalogram and imaging studies (MRI) / Isabel Maria Oster ; Betreuer: Ludwig Gortner." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2016. http://d-nb.info/1114136379/34.
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Hermann, Bertrand. "Nouvelles approches diagnostiques et thérapeutiques pour les patients souffrant de troubles de la conscience Wisdom of the caregivers: pooling individual subjective reports to diagnose states of consciousness in brain-injured patients, a monocentric prospective study Unexpected good outcome in severe cerebral fat embolism syndrome." Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS638.
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Le diagnostic et le traitement des troubles de conscience est complexe. Dans ce travail, nous avons i) introduit une nouvelle échelle comportementale pour mesurer l’état de conscience, fondée sur l’intelligence collective, ii) validé la mesure de l’indice métabolique du PET au fluorodeoxyglucose comme étant l’une des meilleures techniques de neuroimagerie pour le diagnostic de l’état de conscience minimale (ECM), et iii) mis au point un signe clinique d’ECM nouveau et fiable, l’habituation du réflexe de sursaut au bruit. Ces résultats sont en faveur de la réinterprétation de l’ECM comme étant un état médié par le cortex. Par ailleurs, l’investigation des effets comportementaux et électrophysiologiques de la stimulation électrique transcrânienne en courant continu (tDCS) préfrontale chez les patients souffrant de troubles de la conscience nous a permis de mettre en évidence un effet authentique et direct de la stimulation sur la conscience, agissant via la modulation de l’activité corticale et de la connectivité cortico-corticale résiduelle. Enfin, dans le but de développer de nouveaux paradigmes de stimulation, influencés par la théorie, nous avons utilisé la tDCS et la stimulation électrique transcranienne en courant alternatif (tACS) chez des sujets sains pour tester des prédictions de la théorie de l’espace de travail neuronal global lors d’une tâche visuelle d’accès conscient, avec des effets hétérogènes. Au total, nos résultats plaident pour l’investigation systématique des effets de la stimulation sur l’activité cérébrale et pour le développement de procédures de stimulation plus efficaces et cibléesAccurate diagnosis and treatment of consciousness disorders (DoC) remains a challenging issue. In this work, we introduced a new behavioral scale for DoC capitalizing on the wisdom of the crowd phenomenon, we validated the FDG-PET metabolic index of the best preserved hemisphere as one of the best neuro-imaging technique for minimally conscious state (MCS) diagnosis and proposed a new and reliable clinical sign of MCS, the habituation of auditory startle reflex. In addition to enriching and refining our repertoire of diagnostic procedures available for DoC diagnosis, our results support the interpretation of the generic and elusive MCS as a cortically-mediated state, which reflects the preservation of activity within specialized cortical networks and could include both conscious and non-conscious states. On the therapeutic side, by investigating the effects of prefrontal transcranial direct current stimulation (tDCS) on behavior and brain activity of patients suffering from DoC, we provided evidence for a genuine and direct cortical effect of the stimulation on consciousness through the modulation of residual cortical activity and cortico-cortical connectivity. Finally, in an attempt to develop theory-driven stimulation paradigms, we used tDCS and transcranial alternative stimulation to test predictions of the global neuronal workspace theory on conscious access in healthy subjects, with heterogeneous stimulation responses. Taken together, our results advocate for the systematic investigation of stimulation effect on brain activity and for the future development of more powerful and targeted stimulation procedures
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Wu, Hui-Chun, and 吳蕙君. "Self-Identity Process in Patients diagnosed with Moderate to Severe Traumatic Brain Injury." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/09278578534739065255.
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碩士國立東華大學
諮商與臨床心理學系
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Purpose: The purpose of this study was to investigate the identity process and post-trauma experience of adults with moderate to severe traumatic brain injury (TBI). How do individuals with TBI cope with the following challenges after traumatic event? From participates’ subjective experience, we’d like to take a look on the life world in the traumatic experiences, to understand the relationships among sense of body, cognitive impairment, and self- identity for the participants. Methods: The depth interviews were conducted and the participants in this study were adults with moderate to severe traumatic brain injury from a certain hospital in north Taiwan and researcher’s social network. The participants recruited should have basic cognitive and communicative function. They were interviewed once to four times by semi-structured qualitative interview. Results: In general situated structure, it is showed that trauma as the unexpected event, making individual’s biographical disruption from the ordinary routine life. The changing process of self-identity was still in function during the brain injury care. Four different unique processes were emerged as: ‘from chaos to enlightenment’, ‘from survivor to residue’, ‘from victim to witnesses, and ‘from split to empty’. Discussion and Conclusion: This study is implicated the possibility of reconceptualization of identity and disability. Individuals’ way of being was going to change when the event happened. We find that relationship building plays an important role in the pathway of identification. The outcome signified the clinical practice to include the person identity exploration, and to design caring rehabilitation program with disease association group and significant others are important step in future.
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"Towards a Hand-Held Multi-Biomarker Point-of-Care Diagnostic to Quantify Traumatic Brain Injury." Doctoral diss., 2017. http://hdl.handle.net/2286/R.I.45472.
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abstract: According to sources of the Centers for Disease Control and Prevention, approximately 1.7 million traumatic brain injury (TBI) cases occur annually in the United States. TBI results in 50 thousand deaths, nearly 300 thousand hospitalizations and 2.2 million emergency room visits causing a $76 billion economic burden in direct and indirect costs. Furthermore, it is estimated that over 5 million TBI survivors in the US are struggling with long-term disabilities. And yet, a point-of-care TBI diagnostic has not replaced the non-quantitative cognitive and physiological methods used today. Presently, pupil dilation and the Glasgow Coma Scale (GCS) are clinically used to diagnose TBI. However, GSC presents difficulties in detecting subtle patient changes, oftentimes leaving mild TBI undiagnosed. Given the long-term deficits associated with TBIs, a quantitative method that enables capturing of subtle and changing TBI pathologies is of great interest to the field.
The goal of this research is to work towards a test strip and meter point-of-care technology (similar to the glucose meter) that will quantify several TBI biomarkers in a drop of whole blood simultaneously. It is generally understood that measuring only one blood biomarker may not accurately diagnose TBI, thus this work lays the foundation to develop a multi-analyte approach to detect four promising TBI biomarkers: glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE), S-100β protein, and tumor necrosis factor-α (TNF-α). To achieve this, each biomarker was individually assessed and modeled using sensitive and label-free electrochemical impedance techniques first in purified, then in blood solutions using standard electrochemical electrodes. Next, the biomarkers were individually characterized using novel mesoporous carbon electrode materials to facilitate detection in blood solutions and compared to the commercial standard Nafion coating. Finally, the feasibility of measuring these biomarkers in the same sample simultaneously was explored in purified and blood solutions. This work shows that a handheld TBI blood diagnostic is feasible if the electronics can be miniaturized and large quantity production of these sensors can be achieved.Dissertation/Thesis
Doctoral Dissertation Biomedical Engineering 2017
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Wolfová, Beata. "Adaptace neuropsychologického dotazníku EBIQ pro účely diagnostiky emočních a psychosociálních problémů po poranění mozku." Master's thesis, 2012. http://www.nusl.cz/ntk/nusl-305696.
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Neurorehabilitation for people suffering from brain injury has traditionally focused on rehabilitation of the somatic and cognitive functions. Research into the emotional aspects of brain injury has, however, been limited. The theoretical part of this thesis was therefore to map diagnostic tools suitable for the investigation of emotional problems of patients after brain injury and to classify these tools for the needs of neuropsychological practice. In the empirical part the author focused on the adaptation and pilot verification of the EBIQ (European Brain Injury Questionnaire) neuropsychological questionnaire, for a sample of patients having experienced brain injury and their immediate family and friends. The practical outcome of work in addition to the psychometric characteristics is a Czech working version EBIQ-P (version for patients) and EBIQ-R (version for family members), including well-prepared instructions for evaluating the results and examples for use in clinical practice. EBIQ provides an alternative to the previously used questionnaires SCL-90 and MMPI-100, since these, according to our findings and the findings from other studies on the group of patients after brain injury provide invalid results.