Fear of predators causes PTSD-like changes in brains of wild animals

August 7, 2019

Science Daily/University of Western Ontario

Fear can be measured in the brain and fearful life-threatening events can leave quantifiable long-lasting traces in the neural circuitry of the brain with enduring effects on behaviour, as shown most clearly in post-traumatic stress disorder (PTSD).

A new study by Western University demonstrates that the fear predators inspire can leave long-lasting traces in the neural circuitry of wild animals and induce enduringly fearful behaviour, comparable to effects seen in PTSD research.

The findings of this study, led by Western University's Liana Zanette, Scott MacDougall-Shackleton and Michael Clinchy, were published today in Scientific Reports -- Nature.

For the first time, Zanette, her students and collaborators experimentally demonstrated that the effects predator exposure has on the neural circuitry of fear in wild animals can persist beyond the period of the immediate 'fight or flight' response and instead can remain measurable more than a week later, in animals exposed in the interim to natural environmental and social conditions.

"These results have important implications for biomedical researchers, mental health clinicians, and ecologists," explains Zanette, a biology professor in Western's Faculty of Science and a renowned expert on the ecology and neurobiology of fear. "Our findings support both the notion that PTSD is not unnatural, and that long-lasting effects of predator-induced fear with likely effects on fecundity and survival, are the norm in nature."

Retaining a powerful enduring memory of a life-threatening predator encounter is clearly evolutionarily beneficial if it helps the individual avoid such events in the future and a growing number of biomedical researchers have begun to propose that PTSD is the cost of inheriting an evolutionarily primitive mechanism that prioritizes survival over the quality of life.

Ecologists are recognizing that predators can affect prey numbers not just by killing prey, but by scaring them, as well. For example, Zanette and her collaborators have shown in a previous study that scared parents are less able to care for their young.

The long-lasting effects of fear on the brain demonstrated in this new study suggest predator exposure could impair parental behaviour for a prolonged period thereafter with greater negative effects on offspring survival than previously envisaged.

The team conducted the study on wild-caught, black-capped chickadees at Western's Advanced Facility for Avian Research (AFAR). For two days, individual birds were exposed to audio playbacks of the vocalizations of either predators or non-predators and then housed together in flocks outdoors for seven days during which time they were not exposed to any further experimental cues. After this seven-day period, enduringly fearful behaviour was quantified by measuring each individual's reaction to hearing a chickadee alarm call, and long-lasting effects on the neural circuitry of fear were assessed by measuring the levels of a genetic transcription factor in the brain (amygdala and hippocampus).

https://www.sciencedaily.com/releases/2019/08/190807112939.htm

Brain stimulation for PTSD patients

Sweat response can make stimulators responsive

August 7, 2019

Science Daily/University of Houston

Electrical engineers report that the tiny beads of sweat, which appear in patients experiencing PTSD or other neuropsychiatric disorders can be measured and used to design and more responsive brain stimulator for therapy.

For 8-million adults who suffer from post-traumatic stress disorder in any given year, medication and cognitive therapy have been the treatment protocol. Now, University of Houston assistant professor of electrical engineering Rose T. Faghih is reporting in Frontiers in Neuroscience that a closed-loop brain stimulator, based on sweat response, can be developed not only for PTSD patients, but also for those who suffer an array of neuropsychiatric disorders.

"Sweat primarily helps maintain body temperature; however, tiny bursts of sweat are also released in response to psychologically arousing stimuli. Tracking the associated changes in the conductivity of the skin, which can be seamlessly measured using wearables in real-world settings, thus provides a window into a person's emotions," reports Faghih.

For people with movement disorders like Parkinson's disease and essential tremor, who have not responded to medication, application of high-frequency electric current to the brain, or deep brain stimulation, is regarded as most effective. Electrodes are placed in certain areas of the brain to regulate abnormal functions and a pacemaker-like device, placed in the upper chest, controls the amount of stimulation the brain receives. Open-loop stimulators, the most widely-used, deliver continuous stimulation until manually re-adjusted by a physician. Closed-loop stimulators, which provide stimulation in response to biomarkers of pathologic brain activity, have been developed for movement disorders, but are yet to be explored for the treatment of neuropsychiatric disorders.

Signaling the onset of a PTSD episode, skin develops the tiniest sheen of perspiration. That symptom of the body's fight or flight response signals a change in the skin's electrical conductivity and provides a window into the brain's state of emotional arousal. Using skin conductance to create the framework for a deep brain stimulator seemed logical to Faghih after reviewing group studies of Vietnam combat veterans with PTSD. Among the findings, PTSD subjects had the largest skin conductance responses when confronted with combat-related words. In a similar study comparing Vietnam combat veterans with and without PTSD and non-combat controls, PTSD veterans had the highest baseline skin conductance levels.

"Skin conductance additionally has the advantage of being easily measured with wearable devices that afford convenience, seamless integration into clothing and do not involve risk of surgically implanted sensors," said Faghih.

The ultimate goal will be to develop closed-loop prototypes that can eventually be used for treating patients in a variety of neuropsychiatric disorders. Faghih's graduate researchers Dilranjan Wickramasuriya and Md. Rafiul Amin were first and second authors, respectively, of the article.

https://www.sciencedaily.com/releases/2019/08/190807105630.htm

How side hit to the head could damage brain, lead to concussion

While probing the origins of concussion, researchers identify which regions of the brain are more vulnerable to damage

August 1, 2019

Science Daily/Stevens Institute of Technology

Play contact sports for any length of time and at one point or another you're probably going to have your 'bell rung' by a powerful blow to the head from a hard hit or fall. Rising awareness of the severe, abiding repercussions of strong impacts to the head -- concussions, mild traumatic brain injury, neurological disorders -- have led scientists to focus on what exactly happens inside a skull during a big hit.

Mehmet Kurt, a mechanical engineer at Stevens Institute of Technology who studies the biomechanics of the brain and the skull at rest and during rapid head movements, has now bioengineered simulations that track how the brain behaves upon impact, reconstructing the inertial stresses and strains that prevail inside a brain that's just been hit hard from the side.

"The brain not only rings, but it has a distinct pattern of ringing when the head is hit from the side and experiences rotational acceleration," said Kurt, whose work may not only have implications for brain injury assessment, but for sports helmet makers in search of measurable parameters that can simply distinguish 'concussion' from 'no concussion' to help the industry set safety standards. The paper appears in the July 30 issue of Physical Review Applied.

By analyzing a combination of simulated and human data of brain movement that have led to concussions, Kurt and his group, including Stevens graduate student Javid Abderezaei, digitally reveal that side impacts to the head lead to rotational accelerations that cause mechanical vibrations to concentrate in two brain regions: the corpus collosum, the bridge that links the hemispheres, and the periventricular region, white matter lobes at the brain's root that help speed muscle activation.

Kurt and Abderezaei, with Kaveh Laksari of University of Arizona and Songbai Ji of Worcester Polytechnic Institute, found that the skull's internal geometry and the gelatinous nature of the brain cause these two regions to resonate at certain frequencies and receive more mechanical energy in the form of shearing forces than the rest of the brain. More shear strain presumably yields more tissue and cell damage, particularly since shear, opposing motions tend to deform brain tissue more readily than other biological tissues.

"A hit to the head creates non-linear movement in the brain," said Abderezaei. "That means that small increases in amplitude can lead to unexpectedly big deformations in certain structures."

These non-linear vibrations are not surprising in a complex organ featuring a range of tissue densities. Add in the restraining effects of the tough protective membranes, particularly the falx and the tentorium, that hold the brain in place from both above and below, and certain regions are bound to come off worse in side hits.

Identifying the parts of the brain that are most at hazard in side impacts makes them prime targets for further investigation in quest of insights into concussions and detailed brain behavior in collisions. Such knowledge can't come soon enough more than 300,000 American children and teenagers suffer sports-related concussions every year.

https://www.sciencedaily.com/releases/2019/08/190801093312.htm

Nearly three-quarters of traumatic brain injuries in under-19s caused by consumer products

Beds are leading cause of non-fatal head injuries in infants, while contact sports cause most head injuries in older children

July 29, 2019

Science Daily/Taylor & Francis Group

A vast report, looking at the products and activities associated with non-fatal traumatic brain injuries for youngsters aged up to 19, in 66 US hospitals' emergency departments, has revealed that floors, beds and American football are posing some of the greatest risks.

The study, published in Brain Injury, shows that 72% of cases across all age groups were attributable to consumer products that are regulated by the U.S. Consumer Product Safety Commission.

"Structural designs, such as uneven flooring, often contribute to falls, which is the leading cause of traumatic brain injury in children," says lead author Dr Bina Ali from the Pacific Institute for Research and Evaluation in the US.

She adds: "In most cases, infants and children are safe in bed and when playing sports outside, but our study highlights some of the risks and the priorities in different age groups for preventing serious head injuries."

Authors reviewed injury surveillance data from over four years, from (inclusive of) 2010 to 2013. They focused on children and adolescents in five age groups between 0 to 19 years and identified the products associated with their injuries. The investigation provides a comprehensive understanding of the contribution of consumer product-related traumatic brain injuries in children and adolescents.

Children and adolescents accounted for approximately one million non-fatal traumatic brain injury cases treated in emergency departments per year.

In infants under a year, a quarter were caused by falling from beds, while floors were the second leading cause at 14%.

The authors highlight bunk beds as especially risky. In children aged one to four years, 10% were caused by beds, 10% by stairs and 10% by floors.

As children became more mobile, the leading causes of head injuries moved outside the home.

·     At aged five to nine years, floors were still the leading cause (6%), but bicycle accidents came second at 5%.

·     In the final two age groups, 10-14 years and 15-19 years, American football was the leading cause of traumatic brain injury -- at 14% in the younger age group and 9% in the oldest. Basketball came second at 6% and 5% respectively.

·     Other activities that contributed to traumatic brain injuries in the final two age groups included bicycles (5% in 10 to 14-year-olds and 3% in 15 to 19-year-olds) and soccer (5% in 10 to 14-year-olds and 4% in 15 to 19-year-olds).

"Simple measures such as removing trip hazards, using stair gates and guard rails, avoiding hard surface playgrounds and wearing helmets could help reduce the risk of injury, as well as adult education to ensure proper use of consumer products and adherence to safety guidelines" says Ali.

The authors note several limitations to the study. For example, it only included patients treated in hospital emergency departments, so it could not assess cases treated at doctors' offices and school health clinics. Due to a lack of location information, the authors were unable to investigate where injuries were sustained. They were also unable to examine how injuries varied by socioeconomic status.

https://www.sciencedaily.com/releases/2019/07/190729094545.htm

Hit your head, lose your sense of smell

July 23, 2019

Science Daily/University of Montreal

It's long been known that people who suffer a major concussion can lose their sense of smell temporarily and also develop affective problems, such as anxiety and depression. Now scientists have found that's true even for people who get a minor concussion.

Falling off a bike with a helmet on, having a fender-bender in one's car, taking a tumble on the ski slopes, slipping on ice and hitting one's head -- these kinds of minor accidents can provoke the same kinds of olfactory and anxiety problems, the researchers found.

In a study published in Brain Injury, an international team led by Université de Montréal neuropsychologists compared 20 hospital patients who had mild concussions to 22 who'd broken limbs but had no concussion. Within 24 hours of their accident, just over half of those with mild concussions had a reduced sense of smell, versus only 5 per of the patients with broken bones. A year later, although their sense of smell was back to normal, the first group of patients had significantly more anxiety than the control group.

"A lot of people will suffer a mild concussion at some point in their life, so realizing they have trouble smelling is the first step to telling their doctor about it," said lead author Fanny Lecuyer Giguère, who did the research as part of her doctoral thesis in neuropsychology supervised by UdeM associate professor of psychology Johannes Frasnelli. "It's important that patients report any loss of smell, because it's not something their general practitioner or emergency-room physician normally asks about."

Identifying the problem is a short step to getting personalized treatment, she added, with closer follow-up to see if the loss of smell and anxiety persist, indicating the severity of the injury. Physicians should also educate their patients so that they check whether symptoms crop up in the weeks following their accident, she said. "It's a question of raising awareness: the more people are told to watch for signs of olfactory loss and anxiety, the easier it will be for doctors to respond."

To test their capacity to identify smells, Lecuyer Giguère visited hospital patients in the alpine ski resort of Visp, Switzerland between December 2016 and February 2017. Almost all those with mild concussions had had a skiing accident. They were all seen within the first 24 hours following their accident, as were those with fractures but no concussion. With scented "Sniffin' Sticks' (felt-tip pens) to smell, they were asked to identify synthetic odours of roses, garlic, cloves and solvent, and more.

A year later, the patients were sent a follow-up questionnaire and a set of scratch-and-sniff booklets. By comparing the two groups of patients' results in the day following their injury and 12 months later, the researchers were able to determine that most who'd lost their sense of smell gained it back within six months of their accident.

What did not significantly diminish, however, were their symptoms of anxiety: thoughts that made them worry, difficulties to relax, and sudden feelings of panic. About 65 per cent of the concussed patients reported such symptoms.

Future studies should look at a larger sample of patients to better examine the association between anxiety and olfaction, the authors concluded.

https://www.sciencedaily.com/releases/2019/07/190723182253.htm

Novel therapy administered after TBI prevents brain damage

Treated mice had no seizures, which are common after brain trauma

July 16, 2019

Science Daily/University of Texas Health Science Center at San Antonio

Could a therapy administered 30 minutes after a traumatic brain injury prevent damage that leads to seizures and other harmful effects? Researchers think so.

An experimental treatment given to mice after a traumatic brain injury (TBI) reduced damage almost to the levels of mice that never had a TBI, researchers at UT Health San Antonio reported. The study was published July 4 in the Journal of Cerebral Blood Flow and Metabolism.

The scientists hope to convert the discovery into a simple and effective treatment for use in emergency rooms or by first responders shortly after a TBI has occurred in military and civilian settings. Currently, no treatment options exist for TBI patients.

"After a traumatic brain injury, about 40% of mice experience a seizure within one week, and many continue to experience seizures for years, leading to epilepsy disease," said study senior author Mark S. Shapiro, Ph.D., professor of cellular and integrative physiology at UT Health San Antonio. "This closely parallels what happens in human patients, followed by cognitive dysfunction and changes in emotional state."

Damaging effects

After a TBI, dangerous inflammation occurs throughout the brain, causing nerve cells to die and the blood-brain barrier, which is critical to maintaining normal brain function, to break down, said lead author Fabio A. Vigil, Ph.D., postdoctoral fellow in Dr. Shapiro's lab.

Preventing abnormal electrical activity

The novel therapy increases the activity of "M-type" KCNQ potassium ion channels, which are proteins that can halt uncontrolled electrical currents in nerve cells. Abnormal currents begin immediately after a TBI, even before a seizure has a chance to occur, and the therapy aims to counteract this, thus nipping in the bud this destructive chain of events.

"No seizures were observed in the treated mice whatsoever," Dr. Vigil said.

Neurologist's perspective

"We need treatments that alter some of the disabling consequences of TBI," said study co-author Jose E. Cavazos, M.D., Ph.D., a neurologist and epilepsy specialist at UT Health San Antonio. "Current antiseizure medications don't prevent the development of post-traumatic epilepsy. Our study examined this critically important therapeutic gap, and proposes a novel pharmacological intervention shortly after TBI that might prevent post-traumatic epilepsy."

If such a therapy can be developed, it would be a game-changer for patients, Dr. Cavazos said. Approximately 6% of all epilepsy cases are caused by head trauma.

"Think about the possibility of taking a medication shortly after the injury and preventing disabling epileptic seizures months to years later," Dr. Cavazos said.

Post-trauma impact

Study co-author Robert Brenner, Ph.D., of UT Health San Antonio, provided expertise in seizures and seizure monitoring. He said the study's most important finding is that reducing excess electrical activity in the central nervous system via a therapy such as this has beneficial post-trauma effects that extend well beyond action as an anticonvulsant. These effects include reducing dangerous inflammation and widespread cell death.

Ongoing and future research

This therapeutic approach is being evaluated for its suitability in humans, Dr. Shapiro said. This includes assessments of its chemical properties, stability, and effects on other organs such as the heart.

Future directions are to test newly developed compounds that have similar action to the compound used in this study, but with highly increased potency and selectivity for KCNQ potassium ion channels in the brain.

https://www.sciencedaily.com/releases/2019/07/190716174105.htm

Raising eyebrows on neuroinflammation: Study finds novel role for 'skin plumping' molecule

Neuroscientists identify surprising brain action of cartilage component hyaluronic acid

July 11, 2019

Science Daily/Florida Atlantic University

Scientists have discovered a novel mechanism and role in the brain for hyaluronic acid -- a clear, gooey substance popularized by cosmetic and skin care products. Hyaluronic acid may be the key in how an immune signal moves from the blood stream to the brain, activating the brain's resident immune cells, the microglia. Findings from this study have important implications for better treatments for stroke, neurodegenerative diseases, as well as head injuries.

This clear, gooey substance, which is naturally produced by the human body, has been popularized by cosmetic and skin care products that promote healthier, plumper and more supple skin. Also recognized for its abilities to speed up wound healing, reduce joint pain from osteoarthritis, and relieve dry eye and discomfort, a neuroscientist at Florida Atlantic University's Brain Institute (I-BRAIN) and Schmidt College of Medicine, has discovered a novel mechanism and role in the brain for hyaluronic acid.

In a study published in the journal Brain, Behavior and Immunity, Ning Quan, Ph.D., lead author, a professor of biomedical science in FAU's Schmidt College of Medicine and a member of I-BRAIN, and collaborators, have discovered that hyaluronic acid may be the key in how an immune signal moves from the blood stream to the brain, activating the brain's resident immune cells, the microglia.

This unsuspected molecule may be the main signal passed between these cells, and this new discovery could lead to novel opportunities to shut down brain inflammatory responses. Findings from this study have important implications for better treatments for stroke, neurodegenerative diseases, as well as head injuries.

"We normally think of hyaluronic acid with respect to cartilage formation and also for its role in many processes including cancer progression and metastasis," said Quan. "However, what we have uncovered in our study is a completely unique role for this molecule. We have been able to document a connection between the blood cells and the brain cells, showing that the activating signal passed between these cells is hyaluronic acid."

Quan and collaborators from the Sichuan University, The Ohio State University, and the University of Illinois Urbana-Champaign, demonstrate that inflammation in the central nervous system is oftentimes quenched or restricted, as neurons are extremely vulnerable to inflammation-caused damages. However, this inflammation can be aberrantly amplified through endothelial cell-microglia crosstalk when the brain constantly receives inflammatory signals. Quan's work identified hyaluronic acid as the key signal released by endothelial cells to stimulate microglia and promote oxidative damage.

"To prevent the inflammation from being intensified in the brain, you have to stop the communication between the two cell types," said Xiaoyu Liu, Ph.D., another corresponding author of the study in FAU's Schmidt College of Medicine and I-BRAIN. "We found ascorbyl palmitate, also known as 'Vitamin C Ester,' to be quite effective in inhibiting microglia and reducing the production of inflammatory hyaluronic acid."

In the past, Vitamin C Ester has been widely used as a source of vitamin C and an antioxidant food additive. Now, this latest discovery suggests a novel function of Vitamin C Ester: treating central nervous system inflammation.

"As the newest addition to our Department of Biomedical Science, Dr. Quan's work already is making an important impact on our mission to advance understanding of human health and disease," said Janet Robishaw, Ph.D., senior associate dean for research and chair of the Department of Biomedical Science in FAU's Schmidt College of Medicine. "Long known as a popular skin and joint supplement, this discovery identifies a novel role for hyaluronic acid to potentially treat conditions caused by inflammation in the central nervous system."

Inflammation can occur in the central nervous system as a result of head trauma or stroke, or as part of a systemic immune response. Inflammation within the central nervous system has been associated with chronic neurodegenerative diseases including Alzheimer's disease, Parkinson's disease and multiple sclerosis.

"Neurological disorders such as Parkinson's disease and Alzheimer's disease impact all races, genders, and geographical backgrounds," said Randy Blakely, Ph.D., executive director of FAU's I-BRAIN. "Findings from this study may thus have global implications for how we treat neurodegeneration arising from traumatic brain injuries and brain changes associated with aging and dementia. This exceptional research by Dr. Quan and his colleagues is a testament to the cutting-edge work that is being conducted by our Brain Institute members and the research faculty in FAU's Schmidt College of Medicine."

https://www.sciencedaily.com/releases/2019/07/190711141439.htm

Study finds no correlation between brain function and head impacts after 2 seasons of tackle football

July 11, 2019

Science Daily/Nationwide Children's Hospital

Many parents, potential players and medical providers are increasingly wary of youth contact sports participation. The concern over the potential short- and long-term effects of head impacts experienced by youth football players has likely driven decreasing participation, according to a group of researchers.

To date, most studies that have attempted to understand connections between neurocognitive function and sub-concussive head impacts have been retrospective -- and inconclusive. Tracking athletes in real time can account for confounding factors such as pre-participation cognitive ability.

This was the idea behind a study led by Sean Rose, MD, pediatric sports neurologist and co-director of the Complex Concussion Clinic at Nationwide Children's Hospital. He collaborated with MORE Foundation, The Sports Neurology Clinic, and other researchers to follow more than 150 youth tackle football players ages 9 to 18.

Recently, they published the results of the first two years of the study in Journal of Neurotrauma, and the researchers plan to continue the study an additional two years. The data from the first season was published in 2018 in Journal of Head Trauma Rehabilitation.

"When trying to determine the effects of repeated, sub-concussive head impacts, prospective outcomes studies are an important addition to the existing retrospective studies," says Dr. Rose. "We designed this study to include a wide variety of neurocognitive outcomes tests, to give us new insights into how repeated hits might influence outcomes."

The pre and postseason assessments used to measure outcomes included:

·     Neuropsychological (cognitive) testing

·     Symptoms assessment

·     Vestibular and ocular-motor screening

·     Balance testing

·     Parent-reported ADHD symptoms

·     Self-reported behavioral adjustment

Sensors placed in the helmets recorded sub-concussive head impacts during practices and games. In the full 166 player group, a computerized test of processing speed declined over time. The other 22 outcome measures improved or did not change over time. Neither the total number of impacts nor the intensity of impacts correlated with change in outcomes from before season 1 to after season 2 in the 55 players who participated in both seasons of the study.

"So far, the study is showing us that sub-concussive impacts don't seem to be associated with changes in neurocognitive function over two seasons of youth football. And we're finding that other factors, such as ADHD and younger age are more predictive of worsening scores on our pre and post-season tests," says Dr. Rose. "However, we remain concerned about repetitive head impacts in children, and longer follow up times are necessary to look for delayed effects on neurocognition."

https://www.sciencedaily.com/releases/2019/07/190711141313.htm

Survivors' near-miss experiences on 9/11 linked to post-traumatic stress

Findings contribute to an understanding of what counts as exposure to trauma

July 11, 2019

Science Daily/University at Buffalo

People who narrowly avoid disaster do not necessarily escape tragedy unharmed, and their knowledge of the victims' fate shapes how survivors respond to traumatic events, according to the results of a new paper by a University at Buffalo psychologist that explores the effects of near-miss experiences associated with the 9/11 terrorist attacks.

"There is a misfortune to being fortunate," says Michael Poulin, an associate professor of psychology at UB and lead author of the paper published in the journal Social Psychological and Personality Science.

"You would think that having a near-miss experience is unequivocally good news. That means it didn't happen to you. Although obviously that's far more preferable than having tragedy befall you, it turns out that merely being aware of that fact can be burdensome -- and it's particularly true when it's vivid that others were not as fortunate."

Poulin's study, with Roxane Cohen Silver, professor of psychological science, medicine and public health at The University of California, Irvine, deepens the understanding of how large-scale trauma affects mental health.

"We tend to focus understandably on those who were affected, but our data suggest that even people who were not directly affected in any obvious way can be upset by mentally comparing what didn't happen to them in light of what actually happened to someone else, who easily could have been them."

Despite the frequency with which "survivor guilt" appears in casual conversation and popular culture, this study turns out to be among the few to directly examine near miss experiences.

"Survivor guilt is widely understood to be true, almost like a kind of clinical lore," says Poulin, an expert in stress and coping. "But in the context of near-miss experiences, there's just not much there if you go looking for empirical data on the existence of survivor guilt."

Near-miss experiences are difficult to study because of the challenges involved in finding a representative sample, but 9/11 provided Poulin and Silver with the opportunity to conduct rigorous research on the phenomenon -- even though neither of the scientists were at first interested in doing so.

"This project shaped much of my graduate career," says Poulin. "Professor Silver, my co-author and advisor at the time, studies responses to trauma, in particular mass tragedies. Despite that focus, as a research team we talked it over and agreed not to go anywhere near this event. It was too raw and painful to think about a psychological study."

That conversation changed in the days after the attack when media outlets began speculating on its psychological effects with no research to support their commentary.

"What we originally considered to be exploitative suddenly appeared to be necessary," says Poulin. "This was something that needed to be studied."

The researchers used a 1,433-participant sample provided by an online research company, which assessed a near-miss experience by asking, "Did you or someone close to you experience a near miss as a result of the Sept. 11 terrorist attacks?"

Some examples include:

·     My brother-in-law on the 90th floor where he works called in sick.

·      I got a job in the World Trade Center a couple months before, and did not take it.

·     My son-in-law would have been on that flight, but my daughter got sick and he took her to the hospital.

The findings suggest that the near-miss participants reported higher levels of re-experiencing symptoms (sudden, traumatic memories of the event) that persisted over three years and probable post-traumatic stress disorder.

The PTSD is, not surprisingly, affected more by direct exposure, but that near-misses exist as an independent predictor suggests that their role is not related exclusively to familiarity with the victims.

"I think this study contributes to a broader debate that people are having in the world of psychology about what counts as being exposed to trauma," says Poulin. "This is also something clinicians should continue to be aware of in terms of evaluating their clients' mental health.

"It's not just 'Did this happen to you?'" "But 'Did something almost happen to you?'" Poulin notes that these findings are based on one event of a particular magnitude and whether they can be generalized is still as yet an unanswered empirical question.

"But it would be important to find that answer," he says.

https://www.sciencedaily.com/releases/2019/07/190711122703.htm

After concussion, biomarkers in the blood may help predict recovery time

July 3, 2019

Science Daily/American Academy of Neurology

A study of high school and college football players suggests that biomarkers in the blood may have potential use in identifying which players are more likely to need a longer recovery time after concussion, according to a study published in the July 3, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"With so many people sustaining concussions and a sizeable number of them having prolonged symptoms and recovery, any tools we can develop to help determine who would be at greater risk of problems would be very beneficial, so these results are a crucial first step," said study author Timothy B. Meier, PhD, of the Medical College of Wisconsin in Milwaukee and a member of the American Academy of Neurology.

The study involved 41 high school and college football players who experienced a concussion during the season. None of the players lost consciousness with their concussions. The players were matched with 43 football players of the same level, age and position who did not have a concussion during that season.

All of the participants had blood tests at the beginning of the season. Those who had concussions had blood tests within six hours after the injury, then again 24 to 48 hours later and also eight, 15 and 45 days later. Those who did not have concussions had tests at similar times for comparison.

The tests looked at levels of seven biomarkers for inflammation that have been related to more severe brain injury. Of the seven biomarkers, two were elevated for those with concussion at six hours after the injury compared to the athletes with no concussion. The biomarkers interleukin 6 and interleukin 1 receptor antagonist were both elevated at six hours after concussion.

For interleukin 6, levels at the beginning of the study were 0.44 picograms per milliliter (pg/mL) for those who later had concussions and 0.40 pg/mL for those who did not have concussions. At six hours after the injury, those with concussions had levels of 1.01 pg/mL, compared to levels of 0.39 at a similar time for those without concussions.

"These results demonstrate a meaningful increase in the levels of interleukin 6 for athletes who sustained a concussion compared to athletes who did not," said Meier.

Athletes with higher levels of interleukin 6 six hours after the injury were also more likely to take longer to recover from their symptoms. Overall, the athletes with concussions had symptoms for an average of 8.9 days. Eight of the 17 athletes with concussion and high interleukin 6 levels at six hours after injury, compared to their levels at the beginning of the season, still had concussion symptoms eight days after the injury.

"Eventually, these results may help us better understand the relationship between injury and inflammation and potentially lead to new treatments," Meier said.

https://www.sciencedaily.com/releases/2019/07/190703171853.htm

Concussion rates are nearly double what we thought -- and summer is prime injury time

July 2, 2019

Science Daily/University Health Network

A new study has uncovered concussion rates that are nearly double what has previously been recorded, showcasing the need for increased education about concussion and access to more specialized, best-in-practice concussion care.

With concussions seeming more common than ever before, researchers at Toronto Rehabilitation Institute -- University Health Network, set out to answer the question, Are we looking at a true epidemic, or just better recognition?

By embarking on the largest-scale study on concussions ever undertaken in Canada, the researchers discovered that 150,000 of Ontarians (1.2% of province's population) are diagnosed with a concussion each year. That's almost twice as high as previously recorded, and may represent a closer estimate of the true picture of concussion in Ontario.

Their findings were published the Journal of Head Trauma Rehabilitation.

"Past research has looked at the incidence of concussion by examining a particular population; cause of injury; or use a single reporting source, such as records from the Emergency Department. This can under-represent estimates of the real incidence of concussion," says lead author, Laura Langer.

"Our study revealed concussion rates that are almost double what has been previously reported, and highlights the critical importance of looking at everyone who sought medical attention for their concussion."

These more accurate estimates support the importance ongoing awareness around concussion symptoms and management, and the need for more specialized concussion clinics near populations that need them the most.

Video: https://www.youtube.com/watch?v=aJcCd8QINvU&feature=youtu.be

Concussions in Ontario -- who is at risk?

By leveraging the ICES Data Repository -- a province-wide archive that integrates multiple clinical and administrative health databases -- the team captured an unprecedented, comprehensive, view of concussion rates in Ontario between 2008 and 2016.

Here is what they found:

·     About 150,000 Ontarians experience a concussion each year

·     Children under 5 years old experience the highest rate of concussion among all Ontarians

·     Adults over 65 -- especially women -- experience a higher rate of concussion than younger adults

·     26% all of concussions are diagnosed in the summer

·     Rural communities experience a higher rate of concussion than non-rural communities

·     Though most concussions are diagnosed in the Emergency Department, more and more patients with concussion symptoms are visiting their own doctors

Epidemic or better recognition?

According to the team, the high rate of reported concussions is likely influenced by a number of factors, including increased public awareness from athletes and the media, new mandatory reporting laws, and the release of numerous diagnostic and management guidelines for physicians and patients.

Future directions

Access to the ICES Data Repository presents a unique opportunity for Ontario to be a world leader in concussion care and research.

As patients increasingly look to their own doctors for a diagnosis, the researchers identify a need to continue raising awareness about causes and symptoms, and a growing obligation to educate doctors on concussion care.

Furthermore, since about 1 in 7 Ontarians with a concussion will experience persistent, post-concussive symptoms, it's critical to develop tools to identify who will face long-term problems, so we can individualize early treatments to prevent long-term complications.

The study was funded by, and conducted in collaboration with, Ontario Neurotrauma Foundation. Toronto Rehabilitation Institute is also financially supported by the Toronto Rehab Foundation.

This study made use of de-identified data from the ICES Data Repository, which is managed by ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues.

https://www.sciencedaily.com/releases/2019/07/190702152800.htm

Predicting post-injury depression and PTSD risk

June 5, 2019

Science Daily/University of Pennsylvania School of Nursing

Although injury is unexpected and acute, it can result in long-term health problems and disability. Up to half of all patients experience postinjury depression and posttraumatic stress disorder (PTSD) in the months after injury, increasing suboptimal recovery, disability, and costs for care. For patients like urban black men, some of whom have experienced prior trauma, childhood adversity and neighborhood disadvantage, acute postinjury stress responses are exacerbated.

Addressing the psychological effects of injury can improve health and reduce the negative outcomes of injury. Yet, in a national survey, only seven percent of trauma centers incorporate routine screening for PTSD symptoms.

An original investigation from the University of Pennsylvania School of Nursing (Penn Nursing) explores the risk and protective factors that contribute to postinjury mental health symptoms in urban black men. It finds that those men with violent injuries as compared to non-violent injuries have more severe postinjury mental health symptoms. But importantly it shows the need to take into consideration prior life experiences, such as adverse childhood experiences, neighborhood disadvantage, pre-injury health and psychological resources in addition to acute stress responses to an injury event, in order to identify injured patients at highest risk for poor postinjury mental health outcomes.

"The intersection of prior trauma and adversity, prior exposure to challenging neighborhood disadvantage, and poorer preinjury health and functioning should not be overlooked in the midst of acute injury care when assessing for the risk of postinjury mental health symptoms," said lead-investigator Therese S. Richmond, PhD, CRNP, FAAN, the Andrea B. Laporte Professor of Nursing, and Associate Dean for Research & Innovation.

Results of the study are set for publication in an upcoming issue of JAMA Surgery in an article titled "Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries."

The three-and-a-half-year study focused on outcomes in more than 600 urban black men who were hospitalized for serious injury. The researchers followed study participants for three months after hospital discharge to access for depression and PTSD symptoms. Almost one half of study participants met the diagnostic criteria for depression and/or PTSD at follow-up.

"This study takes a life-trajectory approach, helps inform potential points of intervention to improve outcomes, and adds to understanding both risk and protective factors across the life trajectory in an understudied group at high risk for injury," said Richmond. "We must integrate psychological care into the very essence of trauma care if we are to improve outcomes from serious injuries. Because symptoms develop after hospital discharge, further developing and using screening instruments designed to predict the future development of postinjury mental health problems is warranted to focus services on those patients at highest risk."

https://www.sciencedaily.com/releases/2019/06/190605133516.htm

Brain area tied to emotions is larger in vets, service members with mild TBI and PTSD

'An intriguing structural finding'

April 29, 2019

Science Daily/Veterans Affairs Research Communications

A new study finds that veterans and active-duty service members with combat-related PTSD and mild traumatic brain injury had larger amygdalas -- the region of the brain that processes such emotions as fear, anxiety, and aggression -- than those with only brain injuries.

The findings appeared online April 25 in the Journal of Head Trauma Rehabilitation.

Through magnetic resonance imaging, the researchers found that the right and left sides of the amygdala in people with combat-related PTSD and mild traumatic brain injury (mTBI) were larger than those in people with only combat-related mTBI. The amygdala is an almond-shaped section of tissue in the temporal portion of the brain and is key to triggering PTSD symptoms.

The researchers caution that the findings were based on an observational study and therefore can't prove a cause-and-effect relationship -- only a correlation.

The study included 89 veterans and active-duty military personnel, about a third of whom had both PTSD and mTBI. The rest formed the mild-TBI-only control group. A mild traumatic brain injury is also known as a concussion.

"This is an intriguing structural finding, given the role of the amygdala in the challenging [neuropsychological] symptoms witnessed in casualties of combat-related mTBI and PTSD," the researchers write. "Further investigation is needed to determine whether amygdala size could be used to screen people at risk for PTSD, or whether it could be used to monitor the [effectiveness of medical solutions]."

The study's lead author, Dr. Mingxiong Huang, is a neuroimaging scientist at the VA San Diego Health Care System. He says the finding of a larger amygdala in veterans with combat-related PTSD and mTBI was a bit of a surprise.

"Some previous PTSD research showed declines in amygdala volume based on the assumption of a loss of size due to injuries," says Huang, also a professor in the department of radiology at the University of California San Diego (UCSD). "Our finding of increased amygdala volume seems to point to different mechanisms, such as an exposure to repetitive fear and stress."

Such exposure, he adds, may lead to an abnormal growth of the neural networks within the amygdala, a development that has been reported in animal studies but hasn't been fully explored in human PTSD studies. More studies involving people with non-combat PTSD are needed to generalize this finding to other types of PTSD, he notes.

A co-author of the paper, Dr. Douglas Chang, is a physician and researcher at VA San Diego.

"The amygdala is involved with processing threat perception and arousal and with linking emotion to experience in complex ways," says Chang, who is also a professor of orthopedic surgery at UCSD. "A larger amygdala volume may be a sign of hyperactivity with an enlarged neural network. But we don't know whether this is an attempt by the brain to cope with PTSD or whether the growth and enlargement is causing symptoms, like an electrical storm."

He adds: "The situation may also resemble scar tissue formation on skin. Is this an organized response by the body to heal itself, or is the scar tissue going haywire and forming a grossly disfigured area? Another possibility is that this study simply identified at-risk people for PTSD with a pre-existing condition: an enlarged amygdala."

Combat-related PTSD and mTBI are leading health care concerns in veterans and service members. It's not unusual for both conditions to occur in the same person, based on evidence from a cross section of studies. Some of the symptoms are similar, such as depression, anxiety, insomnia, fatigue, and changes in memory and concentration. However, the effects of PTSD and mTBI on neural pathways in the brain, as well as the impact of the co-existence of the two, are not fully understood.

Scientists in Huang's study conducted the testing at VA San Diego and at two Marine Corps bases in California. They measured intracranial volume, a key statistic used to analyze the size of the brain and brain regions, especially in cases of neurodegenerative diseases.

The size of the right amygdala was 0.122 percent of total brain volume, on average, in the group with mTBI and PTSD. It was 0.115 percent in the cohort with only mTBI. The size of the left amygdala was 0.118 percent of brain volume in those with mTBI and PTSD, compared with 0.112 percent in the mTBI group. The researchers found both of those differences to be "statistically significant."

The study team also examined the caudate, the hippocampus, the anterior cingulate cortex, and the cerebral cortex. Those brain regions, like the amygdala, are in the limbic system, which controls basic emotions, including fear, pleasure, and anger. The researchers found no "statistically significant" differences in those regions, suggesting that only changes in the amygdala are linked to PTSD symptoms in people with mTBI, according to Chang.

The study authors say the findings have several implications for research and treatment.

"To be able to see a structural difference between these two cohorts and in this stage of PTSD really points to something going on with the amygdala," Chang says. "Can we use this as a screening tool to identify people at risk? Maybe this is an adaptive response that we can monitor and use to track different kinds of mental health treatment approaches. Maybe yoga is helpful, maybe mindfulness meditation is helpful, maybe exercise is helpful. Perhaps there are drugs that can protect somebody against these traumas or to help improve their conditions. To be able to identify something that's changed in a quantitative way is amazing. It opens the door to many possibilities to help treat this problem."

https://www.sciencedaily.com/releases/2019/04/190429182805.htm

Veterans suffer from 'culture shock' when returning to university

April 26, 2019

Science Daily/Taylor & Francis Group

The study, based on interviews with 20 military veterans on a US college campus found that civilians' trivial concerns, inappropriate clothing, lack of respect for lecturers and willingness to criticise the President of the United States clashed with the conservative values instilled in ex service personnel. These cultural differences led to veterans arguing with other students, and becoming increasingly isolated and ostracized from their peers.

"Veterans are one and a half times more likely to commit suicide than civilians, and they're also at a greater risk of depression, suicide, and substance abuse," says William T. Howe Jr, the author of the study from the University of Oklahoma.

"The situation is so bad that veteran suicide has been classified as an epidemic, and a national call has gone out to researchers to try to address this issue."

As part of the effort, Howe interviewed 20 ex service personnel who attend the University of Oklahoma. His study, published in the Journal of Intercultural Communication Research found that despite veterans being the same age as other college students, military service had instilled them with vastly different cultural values, which meant they experienced 'cultural shock' when going from a military environment to a college campus. Interestingly this was true for both combat and non-combat veterans, suggesting that it is not combat that is making it difficult for veterans to return to civilian life, but military training and an adoption of military culture.

"Veterans have been through tougher times, even in basic training alone, than many people may realise, therefore to them complaining about writing a paper is silly when they compare it to their past experiences of facing death," says Howe.

As well as being unable to relate to civilians feeling stress over 'trivial' matters like exams, ex military personnel were often upset by the way their classmates dressed, and their perceived lack of respect towards authority figures.

"In the military good hygiene, grooming, and making sure your clothes are clean and professional are of vital importance, so to a veteran, students coming to class not groomed properly, or in clothes that they perceive as being too casual conflicts with their military values," says Howe.

"In addition, while lecturers at university often encourage open discussion, this is distinctly different from what veterans experienced in the military, where communication is top-down and upward dissent is discouraged. Veterans often got angry when other students talked during lectures."

Finally, while most students enjoyed talking about politics, veterans were very uncomfortable and unwilling to do this. "The United States Military has very conservative and strict rules that individuals must abide by. For example they are not allowed to criticise the President -- doing so could result in forfeiture of pay, dishonorable discharge, and even imprisonment" says Howe.

The culture clash was often exacerbated by differences in the style of language used by veterans and civilians. For example veterans often used military jargon and acronyms when interacting with civilians, and would grow frustrated when other students couldn't understand them. Veterans also felt that the profanities and dark humor they used was often misinterpreted by civilians and seen as crude and vulgar when, for the veterans, this was a normal way of speaking.

"Another issue was the directness of communication by veterans," says Howe. "In the army it is seen as natural to say "do this" and expect others to do it. However this sort of speech usually resulted in the veterans being disliked by others and ostracized from the group."

The study showed that veterans responded to this culture clash in three separate ways: by trying to see things from the perspective of the other students, by verbally lashing out and confronting the person, and finally by remaining silent.

By far the most commonly used strategy was silence: 100% of veterans interviewed said that they often kept quiet or refused to speak their mind in class. The reasons for this varied from not wanting to talk about politics to being afraid of getting in trouble for saying something others would perceive as inappropriate. However eventually some veterans erupted and had verbal conflicts with others.

"Many veterans entered a 'spiral of silence', and in doing so continued to feel more and more isolated," says Howe. "Any prolonged silence about a troubling issue is not good for an individual, and the worry is that this extreme isolation could lead to a feeling that life is not worth living and a decision to permanently silence themselves with suicide."

According to Howe the findings show that more needs to be done to help veterans and civilians understand one another, and to reintegrate veterans into society.

"The military takes 8-12 weeks to strip military members of their civilian culture and replace it with a military culture. To not spend the same time and effort to reverse the process at the end of a servicemember's time in uniform is irresponsible," says Howe.

https://www.sciencedaily.com/releases/2019/04/190426100341.htm

Coal could yield treatment for traumatic injuries

April 24, 2019

Science Daily/Rice University

Scientists discover coal-derived 'dots' are effective antioxidant

Graphene quantum dots drawn from common coal may be the basis for an effective antioxidant for people who suffer traumatic brain injuries, strokes or heart attacks.

Their ability to quench oxidative stress after such injuries is the subject of a study by scientists at Rice University, the Texas A&M Health Science Center and the McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).

Quantum dots are semiconducting materials small enough to exhibit quantum mechanical properties that only appear at the nanoscale.

Rice chemist James Tour, A&M neurologist Thomas Kent and UTHealth biochemist Ah-Lim Tsai and their teams found the biocompatible dots, when modified with a common polymer, are effective mimics of the body's own superoxide dismutase, one of many natural enzymes that keep oxidative stress in check.

But because natural antioxidants can be overwhelmed by the rapid production of reactive oxygen species (ROS) that race to heal an injury, the team has been working for years to see if a quick injection of reactive nanomaterials can limit the collateral damage these free radicals can cause to healthy cells.

An earlier study by the trio showed that hydrophilic clusters modified with polyethylene glycol (PEG) to improve their solubility and biological stability are effective at quenching oxidative stress, as a single nanoparticle had the ability to neutralize thousands of ROS molecules.

"Replacing our earlier nanoparticles with coal-derived quantum dots makes it much simpler and less expensive to produce these potentially therapeutic materials," Tour said. "It opens the door to more readily accessible therapies."

Tests on cell lines showed a mix of PEG and graphene quantum dots from common coal is just as effective at halting damage from superoxide and hydrogen peroxides as the earlier materials, but the dots themselves are more disclike than the ribbonlike clusters.

The results appear in the American Chemical Society journal ACS Applied Materials & Interfaces.

The Tour lab first extracted quantum dots from coal in 2013 and reported on their potential for medical imaging, sensing, electronic and photovoltaic applications. A subsequent study showed how they can be engineered for specific semiconducting properties.

In the new study, the researchers evaluated the dots' electrochemical, chemical and biological activity. The Rice lab chemically extracted quantum dots from inexpensive bituminous and anthracite coal, modified them with the polymer and tested their abilities on live cells from rodents.

The results showed that quantum dot doses in various concentrations were highly effective at protecting cells from oxidation, even if the doses were delayed by 15 minutes after the researchers added damaging hydrogen peroxide to the cell culture dishes.

The disclike, 3-5-nanometer bituminous quantum dots are smaller than the 10-20-nanometer anthracite dots. The researchers found the level of protection was dose-dependent for both types of particles, but that the larger anthracite-derived dots protected more cells at lower concentrations.

"Although they both work in cells, in vivo, the smaller ones are more effective," Tour said. "The larger ones likely have trouble accessing the brain as well."

https://www.sciencedaily.com/releases/2019/04/190424153645.htm

Taking care of people with TBI: New tool could speed caregiver research

April 17, 2019

Science Daily/Michigan Medicine - University of Michigan

A traumatic brain injury happens in an instant: a battlefield blast, a car crash, a bad fall. But the effects can last a lifetime -- and can leave the survivor dependent on daily care from their loved ones for decades.

Now, a new tool seeks to give a voice to those caregivers, who spend countless hours tending to the daily needs of family members whose moods, thinking and abilities seemed to change overnight.

Developed by researchers from across the country who worked with hundreds of caregivers of people with TBI, it provides a new standard way to measure the physical, mental and emotional effects of caring for survivors of TBI.

The researchers hope it can form the basis for a new wave of research that could inform clinical care for patients and their caregivers, as well as, caregiver training and support programs, and even caregiver reimbursement policies.

They've published the results of a rigorous evaluation of the tool in a special supplement to the journal Archives of Physical Medicine and Rehabilitation, and are sharing the tool on several platforms for researchers.

They also hope the tool, called TBI-CareQOL Measurement System, could be useful to researchers who want to study caregivers of other patients whose "new normal" is very different from the one they had before, and isn't likely to change.

Many TBI survivors suffered their injury in the prime of life, and many during service to the nation. TBI is the most common injury among service members who returned from the wars in Iraq and Afghanistan, with nearly 384,000 service members and veterans affected. One-third of them, and another 90,000 civilians who sustain TBIs each year, are left with moderate to severe disability from their injury.

"Caregivers of persons with TBI are underserved and overlooked," says Noelle Carlozzi, Ph.D., the University of Michigan Medical School psychologist who led the effort. "The medical system treats the patient and sends them home, but behind many of our severely injured patients are family caregivers who we don't do enough to train, support or study in a scientific way."

Carlozzi heads the Center for Clinical Outcomes Development and Application, based in the Department of Physical Medicine and Rehabilitation of Michigan Medicine, U-M's academic medical center.

A team effort

In the new papers, she and her colleagues from Northwestern University, Wayne State University/the Rehabilitation Institute of Michigan, the Walter Reed National Military Medical Center/Defense and Veterans Brain Injury Center, Baylor College of Medicine/TIRR Memorial Hermann, and the University of Delaware lay out how they developed and tested the TBI-CareQOL tool.

The team worked with 560 caregivers who took care of 344 civilians and 216 military service members or veterans who had suffered a TBI more than a year earlier. They found the caregivers through their own institutions and through outreach efforts from the Hearts of Valor caregiver support network run by the Operation Homefront nonprofit organization, and by the Brain Injury Association of Michigan.

By taking time out of their already busy schedules to fill out banks of computerized questionnaires that the research team developed, the caregivers made it possible to create the new tool.

The researchers also got permission to look at the medical records of the patients the caregivers were taking care of, so they could know the severity of the injury and other information.

Thanks to this help, Carlozzi says, the TBI-CareQOL tool should enable a much stronger form of research on caregivers' health and quality of life. This could help bring new resources to this field of study.

Capturing many measures

The tool includes measures of how much of a sense of loss the caregiver feels for themselves or the loved one they're caring for, how much anxiety they feel about their ability to tend to their loved one's needs, how trapped they feel in their role as caregiver, and how much strain the daily demands of their loved one's care places on them. This latter measure includes feelings of being stressed, overwhelmed or even downtrodden by caregiver responsibilities.

Carlozzi notes that in addition to these new measures, the new tool includes standard measures of health-related quality of life used to study patients with many conditions. Called PROMIS measures, they have been previously validated in other studies; the new papers validate them among caregivers of people with TBI.

The team envisions that most caregivers who take part in future studies that use the TBI-CareQOL tool will do so on tablets, smartphones or computers. They've designed it so that caregivers answer questions most pertinent to them based on their answers to previous questions -- which means it takes up the shortest time possible but still gets complete information. A paper form will also be available.

The computerized version will be available through Assessmentcenter.net, as well as other online data capture systems. They will also make it available through a website that the team is developing. In the meantime, paper forms are available by contacting Carlozzi.

Potential uses

Measuring caregivers' current state, and how it changes over time, could become part of the routine clinical care for patients with TBI, she says. How well a caregiver is faring can affect how well the patient does, for instance with therapy, medications and behavioral health issues.

"We hope that in addition to the TBI-CareQOL being used for research, clinicians will adopt these measures to screen caregivers during office visits by patients with TBI, and figure out who needs additional services," she says, noting that caregivers usually attend their loved ones' appointments because patients with TBI can have trouble remembering or accurately reporting what their clinicians said or recommended.

Assessing caregivers could also help fine-tune the financial, social and service support they receive from various sources. Currently, some family caregivers who have lead responsibility for caring for current and former military service members with TBI can receive compensation for their time. So can some caregivers of people injured in automobile accidents in states with no-fault auto insurance.

But often these payments are not enough to provide a level of income similar to what they could receive in the workplace, even though many caregivers have to leave their jobs or cut back on their hours in order to care for a loved one with serious lasting issues from their TBI. That financial stress can often compound the emotional stress caregivers feel.

In upcoming papers, Carlozzi and her colleagues will report their findings from measures related to disruption of family life -- a topic that has special importance to military and veteran caregivers, who often have small children to care for at the same time they're caring for a TBI-survivor spouse. They also hope to do more to measure sleep and activity levels in caregivers.

"Thanks to the efforts of all our partners, and our funding from the National Institutes of Health and the Defense and Veterans Brain Injury Center, we're glad to share this validated, rigorous tool for assessing the quality of life of caregivers of persons with TBI, which we hope will provide a much-needed understanding of their lives and opportunities to help improve their care," says Carlozzi.

https://www.sciencedaily.com/releases/2019/04/190417111443.htm

Animal-assisted therapy improves social behavior in patients with brain injuries

April 9, 2019

Science Daily/University of Basel

Animal-assisted therapy can foster social competence in patients with brain injuries and increase their emotional involvement during therapy. These were the findings of a clinical trial conducted by psychologists from the University of Basel and published in the journal Scientific Reports.

After a severe traumatic brain injury, patients often exhibit problems in their social behavior. For instance, they may suffer from reduced emotional empathy and show impaired emotional expression, all contributing to communicative problems in social interactions.

Stimulating engagement and motivation

Animal-assisted therapy is increasingly being used in rehabilitation in order to improve these deficits in patients' social competence. Integrating animals into therapy can, for example, stimulate patient engagement and motivation. In collaboration with REHAB Basel, the clinic for neurorehabilitation and paraplegiology, and the Swiss Tropical and Public Health Institute, researchers in the Faculty of Psychology at the University of Basel have now undertaken the first systematic study on in-patients with acquired brain injury to assess the effectiveness of this therapy method.

The study involved conducting animal-assisted therapy sessions for 19 adult participants alongside conventional therapy sessions. The patients' social behavior were recorded and evaluated during over 200 animal-assisted and conventional therapy sessions. The study also documented patient mood and satisfaction and their treatment motivation -- an important criterion in therapeutic success.

More positive emotions

The results showed that in the presence of an animal -- which included guinea pigs, miniature pigs, rabbits and sheep -- patients exhibited more active social engagement than during the conventional therapy sessions. They expressed nearly twice as many positive emotions and communicated more frequently both verbally and non-verbally. The animal-assisted therapy had no effect on negative emotions, such as rage or anger. If an animal was present during the therapy session, patients considered themselves more satisfied and their motivation to actively participate in the therapy higher; this was congruent with the assessments of the therapists.

"The results suggest that animal-assisted therapy can have a positive effect on the social behavior of patients with brain injuries," concluded the study's principal investigator, Dr. Karin Hediger from the University of Basel in Switzerland.

"Animals can be relevant therapeutic partners, because they motivate patients to care for the animal. Secondly, animals provide a stimulus for patients to actively engage in the therapeutic activities." Thus, animal-assisted therapy may be a promising supplement to conventional neurorehabilitation, says the psychologist.

https://www.sciencedaily.com/releases/2019/04/190409083230.htm

Device-guided breathing lowers heart rate, sympathetic activity in people with PTSD

Study finds greatest improvements in those with severe symptoms

April 7, 2019

Science Daily/American Physiological Society

Device-guided breathing may improve physiological symptoms in people with severe posttraumatic stress disorder (PTSD), according to a new study. The findings will be presented today at the American Physiological Society's (APS) annual meeting at Experimental Biology 2019 in Orlando, Fla.

PTSD is a mental health condition that may develop after a person has experienced a traumatic or life-threatening event, including military combat, natural disasters and physical or sexual abuse. Flashbacks, nightmares and severe anxiety associated with PTSD can lead to episodes of rapid breathing, muscle tension and short-term increases in heart rate and blood pressure. The physical manifestations of PTSD can increase the long-term risks of hypertension and heart disease.

Researchers from Emory University in Atlanta explored the use of device-guided breathing to regulate sympathetic nerve activity -- a nervous system response that regulates small changes to the cardiovascular system -- and blood pressure control in military veterans with PTSD. The research team confirmed diagnosis and severity of PTSD in each volunteer using the Clinician-Administered PTSD Scale (CAPS). Volunteers were then divided into two groups -- moderate or severe -- based on their CAPS results. Within each group, the participants were randomly assigned to the breathing device (RESPeRATETM) or sham (fake) device.

RESPeRATE produces musical tones to guide the user to a slower-than-normal rate of breathing of about five to six breaths per minute. The device measures inhalation and exhalation rates through a band of sensors worn around the abdomen. The sham device works similarly, but guides the user to breathe 14 breaths per minute, which is within a normal range.

The researchers found that heart rate and muscle sympathetic nerve activity (MSNA) decreased substantially in the severe PTSD group using the breathing device when compared to the device-using moderate group. The volunteers with moderate PTSD who used RESPeRATE also showed an improvement in these factors, but the positive changes were not as significant as the people with more severe PTSD.

"A non-pharmacological intervention [such as device-guided breathing] could be beneficial in the treatment of PTSD, especially in severe cases. Further work is needed to determine if [device-guided breathing] could reduce the risk of future hypertension in this population," wrote Monica Vemulapalli, first author of the study. If device-guided breathing can lead to sustained reductions in MSNA, then it could potentially reduce risk of hypertension.

https://www.sciencedaily.com/releases/2019/04/190407144213.htm

Impact of concussions reduced in children with more years of sport experience

April 4, 2019

Science Daily/York University

More years in sports -- not less -- may help protect the brains of children who have had a concussion, against future concussions, a new study says.

Research from York University's Faculty of Health found that children who have played in a performance sport for at least seven years, and have a history of concussion, recover better from concussions than children who have fewer years in the sport. Their years in the sport may give them more skill-related motor "reserve" that helps them to get back to the level they were playing at previously.

"Our results suggest there's an advantage to staying with skilled activity to the point where your brain can maintain performance even when it's still being affected in subtle ways by a past injury," says senior author, Lauren Sergio, professor in the School of Kinesiology and Health Science and Centre for Vision Research at York University. "This performance may be protective and would reduce vulnerability to another concussion when playing with non-concussed peers."

Sergio and her former postdoctoral student and lead author, Marc Dalecki, now an assistant professor in the School of Kinesiology at Louisiana State University, along with co-author Alison Macpherson, professor in York's School of Kinesiology & Health Science, examined factors that may influence performance recovery after a concussion.

"The findings of this study are important because it demonstrates that athletes with more years of experience return to pre-concussion levels more quickly than inexperienced athletes," says Macpherson. "This can be one factor to help guide decisions about returning athletes to play."

Their study looked at 126 youth, aged eight to 17 years old, 64 with a history of concussion and 62 without, over a two-year period from 2013 to 2015. Participants, parents, team managers, and coaches were interviewed in order to obtain detailed information about the concussion history. All concussion history participants were defined as "asymptomatic" in accordance with current return-to-play protocol guidelines at the time of testing. Participants were asked to perform two visuomotor tasks over 20 trials that required sliding the index finger of the dominant hand along a dual-touch screen laptop, with touch screens in the vertical and horizontal planes.

In the first condition, they moved their hand on the vertical screen in the same direction as the target on the screen. In the second condition, participants had to slide their finger along the horizontal touch screen in the opposite direction of a presented target on the screen. In other words, in order to move the cursor to the left, they had to slide their finger to the right. This type of condition is similar to passing a hockey puck to a teammate on the left while skating to the right.

Researchers found youth with a concussion history with seven or more years of sport experience and higher levels of eye-limb coordination-related sport experience had quicker motor skill recovery times (around 12 months) compared to their peers with less than six years of sport experience (around 30 months or two seasons later). They found no differences in these results when factoring sex or age.

https://www.sciencedaily.com/releases/2019/04/190404104401.htm

How the brain fights off fears that return to haunt us

April 1, 2019

Science Daily/University of Texas at Austin

Neuroscientists at The University of Texas at Austin have discovered a group of cells in the brain that are responsible when a frightening memory re-emerges unexpectedly, like Michael Myers in every "Halloween" movie. The finding could lead to new recommendations about when and how often certain therapies are deployed for the treatment of anxiety, phobias and post-traumatic stress disorder (PTSD).

In the new paper, out today in the journal Nature Neuroscience, researchers describe identifying "extinction neurons," which suppress fearful memories when they are activated or allow fearful memories to return when they are not.

Since the time of Pavlov and his dogs, scientists have known that memories we thought we had put behind us can pop up at inconvenient times, triggering what is known as spontaneous recovery, a form of relapse. What they didn't know was why it happened.

"There is frequently a relapse of the original fear, but we knew very little about the mechanisms," said Michael Drew, associate professor of neuroscience and the senior author of the study. "These kinds of studies can help us understand the potential cause of disorders, like anxiety and PTSD, and they can also help us understand potential treatments."

One of the surprises to Drew and his team was finding that brain cells that suppress fear memories hid in the hippocampus. Traditionally, scientists associate fear with another part of the brain, the amygdala. The hippocampus, responsible for many aspects of memory and spatial navigation, seems to play an important role in contextualizing fear, for example, by tying fearful memories to the place where they happened.

The discovery may help explain why one of the leading ways to treat fear-based disorders, exposure therapy, sometimes stops working. Exposure therapy promotes the formation of new memories of safety that can override an original fear memory. For example, if someone becomes afraid of spiders after being bitten by one, he might undertake exposure therapy by letting a harmless spider crawl on him. The safe memories are called "extinction memories."

"Extinction does not erase the original fear memory but instead creates a new memory that inhibits or competes with the original fear," Drew said. "Our paper demonstrates that the hippocampus generates memory traces of both fear and extinction, and competition between these hippocampal traces determines whether fear is expressed or suppressed."

Given this, recommended practices around the frequency and timing of exposure therapy may need revisiting, and new pathways for drug development may be explored.

In experiments, Drew and his team placed mice in a distinctive box and induced fear with a harmless shock. After that, when one of the mice was in the box, it would display fear behavior until, with repeated exposure to the box without a shock, the extinction memories formed, and the mouse was not afraid.

Scientists were able to artificially activate the fear and suppress the extinction trace memories by using a tool called optogenetics to turn the extinction neurons on and off again.

"Artificially suppressing these so-called extinction neurons causes fear to relapse, whereas stimulating them prevents fear relapse," Drew said. "These experiments reveal potential avenues for suppressing maladaptive fear and preventing relapse."

https://www.sciencedaily.com/releases/2019/04/190401115757.htm