Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances?

In a subgroup of patients with mild traumatic brain injury (TBI) residual symptoms, interfering with outcome and return to work, are found. With neuropsychological assessment cognitive deficits can be demonstrated although the pathological underpinnings of these cognitive deficits are not fully understood. As the admission computed tomography (CT) often is normal, perfusion CT imaging may be a useful indicator of brain dysfunction in the acute phase after injury in these patients.In the present study, directly after admission perfusion CT imaging was performed in mild TBI patients with follow-up neuropsychological assessment in those with complaints and a normal non-contrast CT. Neuropsychological tests comprised the 15 Words test Immediate Recall, Trailmaking test part B, Zoo Map test and the FEEST, which were dichotomized into normal and abnormal. Perfusion CT results of patients with normal neuropsychological test scores were compared to those with abnormal test scores.In total eighteen patients were included. Those with an abnormal score on the Zoo Map test had a significant lower CBV in the right frontal and the bilateral parieto-temporal white matter. Patients with an abnormal score on the FEEST had a significant higher MTT in the bilateral frontal white matter and a significant decreased CBF in the left parieto-temporal grey matter. No significant relation between the perfusion CT parameters and the 15 Words test and the Trailmaking test part B was present.In conclusion, impairments in executive functioning and emotion perception assessed with neuropsychological tests during follow up were related to differences in cerebral perfusion at admission in mild TBI. The pathophysiological concept of these findings is discussed.     

A Dance with Many Secrets: The Experience of Emotional Harm from the Perspective of Past Professional Female Ballet Dancers in Canada

Originating in the Italian and French courts, ballet is an age-old art that fuses aesthetics and athleticism (Wulff, 2008). Despite changing times, ballet masters and mistresses tenaciously hold on to a sense of deep traditionalism. However, some scholars suggest that unwavering devotion to the art may conceal troubled embodied relations and oppressive practices (Gvion, 2008). In this study, we drew on the phenomenological research tradition in an effort to further examine the power relations that play out on the body in the world of Canadian professional ballet (Papaefstathiou, Rhind, & Brakenridge, 2013). Twenty past professional female ballet dancers from across Canada participated in this study. Our dedicated dancers were relentless. They sacrificed body and mind in the pursuit of excellence in a broader cultural context that expected nothing less. The dancers normalized harmful emotional experiences, inappropriate sexual transgressions, and chronic injury (Gvion, 2008). They also described experiences of neglect—and feeling replaceable—after the onset of injury. We have attempted to theorize our findings within the context of embodiment literature and the work of gender theorists. Emboldened by our dancers’ voices, we have shed light—and broken secrets—regarding some of the harmful practices that still characterize professional ballet in Canada. We hope that our work might further continue efforts to democratize power imbalances in professional ballet and ultimately enhance holistic dancer development and health.     

Moral injury and the ethics of teaching tainted legacies

Cases like that of John Howard Yoder – a pacifist theorist who perpetrated sexual violence – raise difficult questions about teaching material implicated in traumatic pasts. This paper argues that “moral injury” provides a useful framework for understanding the dynamics of teaching prominent cases of tainted legacies like Yoder's and for developing best pedagogical practices across the field of religious ethics. The moral injury framework empowers students to think critically and self‐reflectively about authority, conceptions of the good, the various stakes for different persons and communities in social issues, and the need for moral repair. It establishes the importance of professor and student preparation; propels students into the moral questioning and analysis that constitutes “ethics”; draws attention to the connections between and intersectionality of various moral problems while also attending to important moral distinctions; and affords opportunities to study individual and institutional efforts at moral repair.     

Counter‐intuitive moral judgement following traumatic brain injury

Several neurological patient populations, including traumatic brain injury (TBI), appear to produce an abnormally ‘utilitarian’ pattern of judgements to moral dilemmas; they tend to make judgements that maximize the welfare of the majority, rather than deontological judgements based on the following of moral rules (e.g., do not harm others). However, this patient research has always used extreme dilemmas with highly valued moral rules (e.g., do not kill). Data from healthy participants, however, suggest that when a wider range of dilemmas are employed, involving less valued moral rules (e.g., do not lie), moral judgements demonstrate sensitivity to the psychological intuitiveness of the judgements, rather than their deontological or utilitarian content (Kahane et al., Social Cognitive and Affective Neuroscience, 7, 2011, 393). We sought the moral judgements of 30 TBI participants and 30 controls on moral dilemmas where content (utilitarian/deontological) and intuition (intuitive/counter‐intuitive) were measured concurrently. Overall TBI participants made utilitarian judgements in equal proportions to controls; disproportionately favouring utilitarian judgements only when they were counter‐intuitive, and deontological judgements only when they were counter‐intuitive. These results speak against the view that TBI causes a specific utilitarian bias, suggesting instead that moral intuition is broadly disrupted following TBI.     

Repetition priming reveals hemispheric differences in compound word processing

The left (LH) and right (RH) hemispheres are thought to implement different mechanisms for visual word recognition; the LH’s parallel encoding strategy is more efficient than the RH’s serial, letter-by-letter analysis. Here we examine differences in hemispheric language processing strategy by investigating repetition priming of compound words (e.g. buttercup) and their constituents (e.g. butter, cup). Eighty-eight right-handed participants (29 M, 59 F) completed a lexical decision experiment in which centrally-presented compounds primed related (whole compound, first constituent, second constituent) and unrelated targets presented laterally to the left or right visual field; participants made button-press word/nonword decisions. Consistent with the LH parallel/RH serial distinction, repetition priming prompted an RH advantage for first constituents, whereas the LH performed equally efficiently in response to both first and second constituents. These data thus highlight differences in the hemispheres’ language processing strategies, offering new evidence supporting a relative parallel/serial distinction in LH/RH visual word recognition.     

Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

Rate of Torque Development and Feedforward Control of the Hip and Knee Extensors: Gender Differences

The purpose of this study was to determine whether women demonstrate decreased rate of torque development (RTD) of the hip and knee extensors and altered onset timing of the vastus lateralis and gluteus maximus during a drop-jump task when compared with men. On average, women demonstrated significantly lower normalized RTD of the hip extensors (women: 11.6 ± 1.3 MVT.s^?1, men: 13.1 ± 0.9 MVT.s^?1; p ≤ .01); however, there was no significant difference in knee extensor RTD. Women also demonstrated significantly earlier activation of their vastus lateralis (women: 206.0 ± 130.6 ms, men: 80.9 ± 69.6 ms; p ≤ .01) and gluteus maximus (women: 85.7 ± 58.6 ms, men: 54.5 ± 35.4 ms; p = .02). In both men and women, there was a significant negative correlation between the hip extensor RTD and the vastus lateralis electromyographic onset time (men: r = –.386, p = .046; women: r = –.531, p = .008). The study findings suggest that women may utilize a feedforward control strategy in which they activate their knee extensors earlier than men to compensate for deficits in hip extensor RTD. The impaired capacity to rapidly stabilize the hip and knee joints during dynamic maneuvers may contribute to the increased risk of anterior cruciate ligament injury observed in women.