Evaluating the Neuropsychological Presentation of Traumatic Brain Injuries

This Neurobehavioral Capstone focused on traumatic brain injury (TBI), which is one of the leading causes of death and disability in the United States for children and young adults. TBI refers to a disruption of the brain’s normal functioning as a result of an acute external force. The most common causes for a TBI include falls, vehicular accidents, struck by or against an object, and assaults. The incidence for each cause of a TBI changes with respect to age. Severity of a TBI is determined using the Glasgow Coma Scale, which monitors the patient’s eye movements, verbal response and motor response. Neuropsychological testing assesses the patient’s physical, cognitive, and behavioral deficits. These deficits include, but are not limited to, memory, processing speed, speech, executive function, and decision making. Results of neuropsychological testing help set a course for treatment and monitors the patient’s recovery. This treatment course may include physical therapy, cognitive therapy, speech therapy, occupational therapy, and psychological counseling. Observations at Bancroft NeuroRehab included the observation of neuropsychological testing of patients with TBIs and how their deficits helped direct their individualized treatment. The neuropsychological testing results also helped localize the specific areas in the brain affect by the acute injury for each patient. These observations will be discussed in light of the Neurobehavioral research in the area of TBI

Evaluating the Impact of Collaborative Care and Rehabiliation on Concussion Patients: Clinical Observations and Literary Review

Current research suggests that 1.6 - 3.8 million people each year suffer from concussions (Chin et al. 2016). The impact of concussions on the brain cannot be seen with traditional brain imaging, but screening tools can indicate whether the physical and cognitive symptoms presented are consistent with a concussion diagnosis. In addition to physical symptom reporting, concussion rehabilitation has shifted to focus on additional mental health factors. The aims of this capstone project were to gain a more in-depth understanding of the neurobiological and psychosocial factors influencing the recovery from a concussion, understand the rehabilitative process of a concussion, as well as observe the neurobehavioral implications of experiencing and recovering from a concussion. The experience included observing Dr. Arlene Goodman, M.D.,at the Saint Peter’s Sports Medicine Institute, as she used screening tools, rehabilitation exercises and self-reported patient data to help facilitate recovery and to determine whether the patient was likely to experience Persistent Post Concussive Syndrome (PCS). The clinic also provided collaborative care through the help of a social worker. My experience highlights that improving the mental health of the patient through psychological intervention has the potential to provide the best rehabilitative outcomes

The Neurobehavioral Interaction Between Physiological and Psychological Aspects of Rehabilitation

Introduction: The Neurobehavioral interplay between physiological occurrences and the subsequent psychological changes, and vice versa, are sometimes not directly investigated when trying to understand and treat various injuries. Objective: The purpose of this Capstone project is to observe and further understand physiological and psychological interactions and the effects of those interactions in the rehabilitative process. Methods: This Capstone project is based around observing several different physical therapy sessions at the Children’s Hospital of Philadelphia and JFK Rehabilitation Institute, while conducting a literature review of previously published studies. This literature review is focused on the psychological and physiological aspects that play a role in the therapeutic and rehabilitative process. Functional ability, cognitive ability, motivation, emotion, and behavior were some of the main measures that were observed and reviewed. A journal was kept recording any relatable observations made. Results: This project was not research based. Instead, the results consist of reviewing the literature from a Neurobehavioral perspective, while incorporating observable characteristics including the physiological and psychological impacts on the therapeutic process. Within each physical therapy session, the behavior, motivation, and emotion of the therapist and patient played a big role in the ability of the patient to successfully complete the required motor function. There were also indications of improving mental status and emotion once the patient was able to overcome a difficult motor task, which was previously not successfully completed. The general consensus of the literature review concludes that there is a relationship between physiological changes and psychological effects, and vice versa. Discussion: The direct and indirect interactions between physiological and psychological changes should be looked at more thoroughly in the rehabilitative process, whether it be from a disabling illness or simple musculoskeletal pain

Social cognitive abilities and social functioning in children with Asperger’s Disorder: a comparison with Attention Deficit/Hyperactivity Disorder

Objective: The current literature has linked the ability to understand one’s own mental states with theory of mind, inferring another’s mental states. It is suggested that children with Asperger’s Disorder (AS) are delayed in the acquisition of social cognitive abilities (Baron-Cohen, 1989, 1991), which may relate to social behavior (Baron-Cohen, 1985, 1991). Other children with social deficits, such as those with Attention Deficit/Hyperactivity Disorder (ADHD), demonstrate poor social functioning due to performance deficits and not deficits in underlying social cognitive abilities (see Landau & Moore, 1991). This research investigated the relationship between social cognitive abilities and social functioning and attempted to demonstrate a link between social cognitive abilities and social functioning in children with AS. Method: Children with AS and ADHD (7-12 years) were recruited from a private practice; typically developing children were recruited by participant referral and advertisements. Children completed the Mind in the Eyes Child Version and a two-subtest WASI, if needed. Parents completed the Vineland Adaptive Behavior Scale –II Socialization Domain, the Social Skills Rating System (SSRS), and the Behavior Rating Inventory of Executive Function(BRIEF) parent report. Demographic information was also collected. Results: Children with AS demonstrated poorer Mind in the Eyes performance and social functioning overall, followed by children with ADHD and typically developing children. Findings of poorer performance on the Mind of the Eyes task in children with AS compared to children with ADHD approached significance. Children with AS displayed significant deficits in areas of interpersonal relationships and play and leisure skills, but demonstrated similar coping skills as children with ADHD. Both ADHD and AS groups performed more poorly than controls on measures of social functioning. Conclusions: Results do not support a relationship between social functioning and mental state attribution. It is suggestive of an overlap in the type of social deficits experienced by children with AS and ADHD. This research adds to the research on mental state attribution for children with AS and ADHD and has implications for those conducting social skills training with children, as there may be a need to include methods forgeneralizing social skills related to mental state attribution.Ph.D., Clinical Psychology -- Drexel University, 201

Evidence for the Need for a Pediatric Concussion Quality of Life Measure in addition to the PCSS

While pediatric concussion is an area of significant scientific concern, only recently has the field begun to consider health related quality of life issues after concussion. The clinical management of pediatric concussion generally focuses on symptoms and epidemiology. The purpose of the current evaluation was to examine whether a quality of life measure can provide important information not readily measured by a symptom scale. 280 participants with concussion, age 7 to 21 completed two pencil and paper measures, the Post Concussion Symptom Scale (PCSS) and the newly created Pediatric Life After Concussion Evaluation Scale (PLACES). Data showed that the emotion domain on the PCSS was not significant for time since injury F(2,248) = 6.23, p F(2,253) = 1.96, p =.143). While the PCSS and PLACES had a strong correlation (r = .73, p This poster will be presented at the American Academy of Clinical Neuropsycholog

The Relationship Between Pediatric Quality of Life and Post Concussion Symptoms

This will be presented at the American Academy of Pediatric Neuropsychology. Objective: To understand how symptoms impact the the pediatric patient’s day to day functioning during recovery. The tasks that students are exposed to in school deplete cognitive reserves, which further has consequences for learning, emotional functioning, symptom expression, and quality of life. Methods: 280 participants with concussion, age 7 to 21, completed a packet that included the Post Concussion Symptom Scale (PCSS) and a self report measure, at their medical visit to a regional concussion clinic. A pencil and paper self rating instrument (Pediatric Life After Concussion Evaluation Scale) was developed to examine pediatric concussion patient’s self perceptions of their recovery. The Pediatric Life After Concussion Evaluation Scale (PLACES) consisted of 20 questions. The instrument took less than 15 minutes to complete. Results: There was a strong positive relationship between total quality of life symptom load (PLACES Total) and total post concussion symptom load (PCSS) (r = .732, p2=.549, F(1,196)=238.43, p Conclusions: Children and adolescents have important perspectives on their recovery from concussion. The impact of concussion affects multiple domains of function. In addition to post concussion symptoms, pediatric patients with concussion report concerns about their learning, emotions, and social interactions. Further, elevated post concussion symptom load is related to overall worse quality of life

Evaluation of Smell and miRNA Biomarkers in Alzheimer’s Disease (AD)

Abstract and poster under embargo until May 31, 2019

Whole Genome Deep Sequencing of HIV-1 Reveals the Impact of Early Minor Variants Upon Immune Recognition During Acute Infection

Deep sequencing technologies have the potential to transform the study of highly variable viral pathogens by providing a rapid and cost-effective approach to sensitively characterize rapidly evolving viral quasispecies. Here, we report on a high-throughput whole HIV-1 genome deep sequencing platform that combines 454 pyrosequencing with novel assembly and variant detection algorithms. In one subject we combined these genetic data with detailed immunological analyses to comprehensively evaluate viral evolution and immune escape during the acute phase of HIV-1 infection. The majority of early, low frequency mutations represented viral adaptation to host CD8+ T cell responses, evidence of strong immune selection pressure occurring during the early decline from peak viremia. CD8+ T cell responses capable of recognizing these low frequency escape variants coincided with the selection and evolution of more effective secondary HLA-anchor escape mutations. Frequent, and in some cases rapid, reversion of transmitted mutations was also observed across the viral genome. When located within restricted CD8 epitopes these low frequency reverting mutations were sufficient to prime de novo responses to these epitopes, again illustrating the capacity of the immune response to recognize and respond to low frequency variants. More importantly, rapid viral escape from the most immunodominant CD8+ T cell responses coincided with plateauing of the initial viral load decline in this subject, suggestive of a potential link between maintenance of effective, dominant CD8 responses and the degree of early viremia reduction. We conclude that the early control of HIV-1 replication by immunodominant CD8+ T cell responses may be substantially influenced by rapid, low frequency viral adaptations not detected by conventional sequencing approaches, which warrants further investigation. These data support the critical need for vaccine-induced CD8+ T cell responses to target more highly constrained regions of the virus in order to ensure the maintenance of immunodominant CD8 responses and the sustained decline of early viremia

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants