Predictive validity of the Westmead Post-Traumatic Amnesia Scale for functional outcomes in school-aged children who sustained traumatic brain injury

The Westmead Post-Traumatic Amnesia Scale (WPTAS) is routinely used for the assessment of post-traumatic amnesia (PTA) in children who sustained traumatic brain injury (TBI). Yet, the WPTAS' predictive validity for functional outcomes is largely unknown. We aimed to determine whether PTA duration measured by the WPTAS (i) differentially predicts functional outcomes and (ii) contributes to predictions of outcomes beyond the Glasgow Coma Scale (GCS) in children who sustained TBI. Participants were children and adolescents with moderate-to-severe TBI (n = 55) aged 8–15 years. PTA duration was assessed with the WPTAS. Outcomes at the first outpatient follow-up were scored on the Kings Outcome Scale for Childhood Head Injury (KOSCHI) and the TBI Outcome Domain Scale-Extended (ODS-E). Longer PTA and lower GCS were both significantly correlated with worse (i) global outcomes: presence of disability on the KOSCHI and lower score on the ODS-E and (ii) select specific outcomes on the ODS-E: mobility, mood and cognition. PTA duration predicted cognitive outcome on the ODS-E independently, beyond GCS. Together, PTA duration and GCS, predicted the global KOSCHI outcome, as well as the ODS-E mobility and mood outcomes. Neither GCS nor PTA duration correlated with the ODS-E communication, impulsivity/disinhibition, headache, fatigue, sensory impairments or somatic complaints outcomes. PTA duration measured by the WPTAS is a significant unique predictor of functional cognitive outcomes in children who sustained moderate-to-severe TBI, and in combination with the GCS, a significant predictor of global, and several specific functional outcomes.     

Rethinking Traumatic Brain Injury from Intimate Partner Violence: A Theoretical Model of the Cycle of Transmission

ABSTRACT

Despite growing evidence of the repeated nature of traumatic brain injury (TBI) in women experiencing intimate partner violence (IPV), there is no theoretical model depicting TBIs as a cyclical process throughout a lifetime. Situational analysis methodology was used on interviews with 10 women who self-reported passing out from being hit in the head during an episode of IPV to create a theoretical model depicting the cycle of transmission of TBI. We define the cycle of transmission of TBI as the way that women experience multiple TBIs over the course of their lifetime and how TBI can be perpetuated in a family or community. The cycle begins in childhood or adolescence, when women receive a TBI from abuse, sports, or motor vehicle accident. They enter into abusive relationships with men who are also described as living with a TBI and the women receive other TBIs during this relationship. With repeating head trauma, women described increasing TBI symptoms: problems with memory, cognition, executive functioning, depression, and concentration. If they do seek help, they must choose between healthcare and protective shelter. With either choice, the element of instability could be introduced and the cycle of transmission continues. This theoretical model shows that it is necessary to move beyond individual behaviors to think about how TBIs are transmitted through communities and how untreated symptoms can impact help-seeking behavior and perpetuate other risk factors for receiving a TBI.     

Ten Principles for Interpreting Neuroscientific Pronouncements Regarding Human Nature

As the field of brain research continues to advance, much is being discovered about the various aspects of the brain that are associated with certain feelings, thoughts, and behaviors. However, certain studies, or popularized accounts thereof, overreach in their pronouncements, drawing unwarranted conclusions regarding human nature. There are ten principles that will assist the non‐specialist in critically assessing both now and future discoveries reported from the neurosciences, with a focus on helping theologians using neuroscientific data in multidisciplinary work regarding human nature.     

JAMES B. ASHBROOK AND HIS HOLISTIC WORLD: TOWARD A “UNIFIED FIELD THEORY” OF MIND,BRAIN, SELF,WORLD, AND GOD

James B. Ashbrook's “new natural theology in an empirical mode” pursued an integrated understanding of the spiritual, psychological, and neurological dimensions of spiritual life. Knowledge of neuroscience and personality theory was central to his quest, and his understandings were necessarily revised and amplified as scientific findings emerged. As a result, Ashbrook's legacy may serve as a case example of how to do religion‐and‐science in a milieu of scientific change. The constant in the quest was Ashbrook's core belief in the basic holism of brain, mind, personality, the nature of reality, and the underlying reality of God.     

Involving Police Departments in Early Awareness of Concussion Symptoms during Domestic Violence Calls

ABSTRACT

Police officers around the world respond to and investigate calls regarding domestic violence (DV) daily. Police departments operate with standard protocols, particularly when engaging in investigations that involve allegations of strangulation or sexual assault. Operating under advisement of the Maricopa County Attorney’s Office, the Mesa Police Department (Mesa, AZ) has established protocols for detecting, recording, and prosecuting DV cases that involve strangulation and sexual assault. Allegations of strangulation (defined as impeded breathing) or sexual assault prompt officers to offer a forensic nursing exam (FNE) combined with strangulation treatment by forensic nurses at the Mesa Family Advocacy Center. Recognizing the potential for head injury to the assault victim in all DV situations, including intimate partner violence (IPV), the police department has added concussion-awareness training, as well as a point-of-incident investigative tool for its officers to record neurological function of the victim. Officers were instructed to use the ConQVerge device to measure and record the Near Point of Convergence (NPC) as a test of neurological impairment in suspected head injuries. In this article, we discuss the challenges and opportunities for assisting victims of DV strangulation and sexual assault (including non-DV sexual assault) with on-site assessment and consent for further medical assessment and treatment. Additionally, rates of domestic assault victims that report a crime, but decline to follow through with forensic medical tests, are reported for the first time. Lessons learned from the project that inform strategic operations in this space are offered to other agencies prior to the implementation of similar procedures.     

Selfhood triumvirate: From phenomenology to brain activity and back again

Recently, a three-dimensional construct model for complex experiential Selfhood has been proposed (Fingelkurts, Fingelkurts, & Kallio-Tamminen, 2016b,c). According to this model, three specific subnets (or modules) of the brain self-referential network (SRN) are responsible for the manifestation of three aspects/features of the subjective sense of Selfhood. Follow up multiple studies established a tight relation between alterations in the functional integrity of the triad of SRN modules and related to them three aspects/features of the sense of self; however, the causality of this relation is yet to be shown. In this article we approached the question of causality by exploring functional integrity within the three SRN modules that are thought to underlie the three phenomenal components of Selfhood while these components were manipulated mentally by experienced meditators in a controlled and independent manner. Participants were requested, in a block-randomised manner, to mentally induce states representing either increased (up-regulation) or decreased (down-regulation) sense of (a) witnessing agency (“Self”), or (b) body representational-emotional agency (“Me”), or (c) reflective/narrative agency (“I”), while their brain activity was recorded by an electroencephalogram (EEG). This EEG-data was complemented by first-person phenomenological reports and standardised questionnaires which focused on subjective contents of three aspects of Selfhood. The results of the study strengthen the case for a direct causative relationship between three phenomenological aspects of Selfhood and related to them three modules of the brain SRN. Furthermore, the putative integrative model of the dynamic interrelations among three modules of the SRN has been proposed.     

Risk- and protective factors for memory plasticity in aging

ABSTRACT

Risk and protective factors for cognitive function in aging may affect how much individuals benefit from their environment or life experiences by preserving or improving cognitive abilities. We investigated the relations between such factors and outcome from episodic-memory training in 136 healthy young and older adults. Tested risk factors included carrying the ?4 variant of the apolipoprotein E allele (APOE), age, body mass index, blood pressure, and cholesterol. Protective factors included higher levels of education, intelligence quotient (IQ), physical activity, fatty acids, and vitamin D. Average increases in memory performance were seen after training, with ample variation between individuals. Being young, female, and having higher IQ were positive predictors of memory improvement. No other relationships were observed. Similar benefit was observed across APOE allelic variation. This indicates that beyond IQ, age, and sex, known risk -and protective factors of cognitive function in aging were not significantly related to memory plasticity.