Specialist in Education (Ed.S.), University of Dayton, 2021, School Psychology

Objective: To examine the efficacy of an online traumatic brain injury (TBI) professional development intervention for preservice educators, In the Classroom After Concussion: Best Practices for Student Success. Design: A random total sample of 55 preservice educators, with 34 in the test group, and 21 in the control group. Test participants completed the pretest, nine online training modules, and the posttest. The control group completed only the pretest and posttest. Results: On the posttest assessment, in comparing the difference in scores from pretest to posttest, test group participants showed significantly greater gains in knowledge (M = 4.65, SD = 6.08) than the control group (M = .19, SD = 5.34). Conclusion: Given the increasing prevalence of TBI in school-aged children, it is paramount to develop and provide cost effect, evidence-based, and easily accessible trainings for TBI professional development. The In the Classroom trainings can be one solution. Implications for effective training will be discussed.

Committee: Susan Davies Ed.D (Committee Chair); Elana Bernstein Ph.D (Committee Member); Joni Baldwin Ed.D (Committee Member) Subjects: Counseling Education; Mental Health; Special Education

Specialist in Education (Ed.S.), University of Dayton, 2011, School Psychology

This survey examines teacher knowledge of Traumatic Brain Injury (TBI). Previous research has indicated teachers lack adequate knowledge of TBI. Also, students with TBI often go without special education services as a result of under-identification of TBI as a disability category within schools. The present survey examines teachers' knowledge, skills, and training related to TBI. Participant responses reveal that teachers are only somewhat knowledgeable about TBI and the majority of respondents had not received training on TBI. Results reveal that teachers with TBI training are significantly more knowledgeable than those without training.

Committee: Susan Davies (Committee Chair); Sawyer Hunley (Committee Member); Michelle Flaum (Committee Member); Alan Demmitt (Other) Subjects: Education; Special Education; Teacher Education

Doctor of Philosophy, The Ohio State University, 2023, Social Work

Background: Approximately 50% of individuals seeking treatment for substance use and mental health conditions in behavioral healthcare settings have a lifetime history of TBI affecting their ability to engage in behavioral health treatment. Identifying lifetime history of TBI using validated screening methods can optimize interventions for these individuals, however, TBI screening adoption has failed in these settings. Drawing on the Theory of Planned Behavior and Diffusion of Innovations Theory, this explanatory sequential mixed methods study aimed to improve our understanding about how provider characteristics (attitudes, subjective norms, perceived behavioral control (PBC), intentions), innovation-level factors (acceptability, feasibility, appropriateness), and contextual determinants affect TBI screening adoption in behavioral healthcare settings. Methods: In Phase I, 215 behavioral health providers in the United States completed a training introducing the OSU TBI-ID, followed by a web-based survey assessing attitudes, PBC, subjective norms, and intentions to screen for TBI (Time 1). After one-month, providers completed a second survey assessing the number of TBI screens conducted, and the acceptability, feasibility, and appropriateness of TBI screening (Time 2). Data were analyzed using structural equation modelling with logistic regressions (SEM) and logistic regression with moderation effects. Results informed development of a qualitative interview guide. In Phase II, 20 providers from Phase I participated in interviews to build upon the quantitative results. Data were analyzed thematically and integrated with the quantitative results. Barriers to adoption were also identified and linked to constructs from the Consolidated Framework for Implementation Research (CFIR). Results: Approximately 25% of providers adopted TBI screening, which was driven by motivations to trial the innovation. SEM demonstrated that more favorable attitudes toward TBI screening were (open full item for complete abstract)

Committee: Alicia Bunger (Advisor); Alan Davis (Committee Member); Jennifer Bogner (Committee Member) Subjects: Behavioral Sciences; Health Care; Public Health; Social Research; Social Work

Specialist in Education (Ed.S.), University of Dayton, 2020, School Psychology

Traumatic brain injury (TBI) poses significant challenges for students as they begin or reenter school. Impaired executive functioning (EF) is a particularly debilitating consequence of a TBI. The present study expanded upon existing research by evaluating longitudinal EF data in children who sustained TBIs. Participants were preselected due to their inclusion in an existing data set provided by Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio. Data were collected from three different hospital sites in the Ohio. The EF deficits as reported by caregivers and teachers at 18 months differed from their ratings seven years later. The average means (BRIEF T-scores) recorded seven years' post-injury were higher than the average mean scores recorded at 18 months. Data analysis indicated an inter-rater agreement between teachers and parent's perceptions of EF deficits, while student self-perceptions of EF deficits differed from teacher and caregiver perceptions. This study clarifies effects of early childhood TBI on EF in middle school and aims to improve school psychologists' understanding of how caregivers, teachers, and students themselves perceive these skills.

Committee: Susan Davies (Committee Chair) Subjects: Education; Educational Psychology; Middle School Education; Psychology; Special Education

MA, University of Cincinnati, 2019, Arts and Sciences: Psychology

Pediatric traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children and adolescents. In 2013, over 300,000 children under the age of 5 years presented to emergency departments with a TBI. Very young children (= 3years old) have double the risk of experiencing a TBI than older children. These very young children are at risk for more severe injuries due to both anatomical and environmental factors. Despite the high prevalence of injury in this population, they have traditionally been understudied. TBI in older children and adolescents is associated with deficits across a wide variety of areas, many of which may not become problematic until children have reached school age and are required to take on additional cognitive load. This, in addition to the fact that TBI can be difficult to identify and that young children are more difficult to assess in general when compared to older children and adolescents, may be one of the factors that has led to the majority of research in TBI to focus on older children. Studies in these older populations have illustrated the importance of the family environment and parental warm responsiveness in influencing both cognitive and behavioral outcomes, while studies in this very young population have demonstrated the importance of more distal environmental factors (e.g., social capital.) The current study investigated the potential moderating effect of caregiver warm responsiveness on adaptive, developmental, and health-related quality of life outcome following TBI in 30 children aged 0-2 years old. After being recruited from the emergency department at CCHMC, families returned 1 and 6 months post-injury for follow up visits. Separate linear mixed models examined moderation effects. An interaction was found between injury severity and parental responsiveness on parent-reported fine motor functioning; children with moderate injury severity scored higher than those with a severe injury at (open full item for complete abstract)

Committee: Shari Wade Ph.D. (Committee Chair); Chung-Yiu Peter Chiu Ph.D. (Committee Member); Kristen Jastrowski Mano Ph.D. (Committee Member) Subjects: Psychology

Master of Sciences, Case Western Reserve University, 2024, Biology

There are no biomarkers that are causally linked to axonal injury and neurodegeneration that occurs after a traumatic brain injury (TBI). Many of the biomarkers today are only used to decide whether a CT scan is necessary after TBI occurrence. A novel biomarker Acetylated tau (Ac-tau) which has been known to have high occurrences and to be causally linked to TBI can cross the Blood brain barrier (BBB), thereby offering the potential for an objective, quantifiable biomarker diagnostic test that can be used to screen for TBI, its severity and potentially ascertain probability of Alzheimer's Disease. Within the confines of the technological part of this thesis, a general overview of the nervous system, TBI will be discussed along with the novel technology. Additionally, the commercialization aspects of this invention will be covered as well in the latter parts of this thesis.

Committee: Leena Chakravarty (Advisor); Ryan Martin (Committee Chair); Christopher Cullis (Committee Member); Andrew Pieper (Committee Member); Jeffrey Klein (Committee Member) Subjects: Neurobiology; Neurology

Master of Science, The Ohio State University, 2023, Vision Science

Traumatic brain injury (TBI) is the leading cause of disability, morbidity, and mortality around the world. TBI can cause both short and long-term problems with brain function, including problems within the visual system. This leads to functional deficits in both the afferent and efferent visual pathways. A common visual complaint following TBI is photophobia. Photophobia, otherwise known as extreme sensitivity to light, is a potentially debilitating symptom whose definitive mechanism has not been elucidated. There is some evidence implicating intrinsically photosensitive retinal ganglion cells (ipRGCs), a small subset of retinal ganglion cells with a peak spectral sensitivity around 480 nm (blue light spectrum), in the etiology of photophobia. As ipRGCs are most sensitive to blue light, I hypothesized that individuals with TBI-associated photophobia avoid blue light-rich environments during their daily life activities. To test this hypothesis, individuals with TBI-associated photophobia were given Actiwatch Spectrum activity monitors that measured activity levels, sleep and wake cycles, and light exposure. Data were collected for 14 days, then the light exposure levels for these case participants were analyzed and compared to control participants without prior TBI. Red, green, and blue light exposure levels were evaluated in cases compared to controls, as well as green/blue light exposure ratios and green/red light exposure ratios. Time spent outdoors and sleep performance were also evaluated. No statistically significant differences were found in exposure to any of the light types between cases and controls, though cases appeared to take a longer time to fall asleep than controls. These results did not support the hypothesis that individuals with TBI-associated photophobia avoid blue light-rich environments. Further research is needed to fully understand the role of ipRGCs in mediating TBI-related photophobia.

Committee: Andrew Hartwick (Advisor); Donald Mutti (Committee Member); Nicklaus Fogt (Committee Member) Subjects: Health Sciences

Master of Science, The Ohio State University, 2023, Vision Science

Traumatic brain injuries (TBIs) are common and are a threat to public health, yet there are no established objective diagnostic markers for them. As an accessible extension of the brain, the retina in the back of the eye is a potential cite to detect neurodegenerative pathology associated with TBIs, but little is known about how retinal structure changes in humans with a history of multiple TBIs. Therefore, this study tested whether multiple traumatic brain injuries (TBIs) alter the objective structure or the objective function of retinal ganglion cells (RGCs) in human subjects. Case subjects (n = 25) with a history of repeated TBIs (4.12 ± 2.76 TBIs over 0-41 years) and healthy pair-matched control subjects (n = 30) were prospectively recruited. Retinal nerve fiber layer (RNFL) and Helne fiber layer (HFL) thickness were quantified with spectral-domain optical coherence tomography. Scanning laser polarimetry measured phase retardation, an indicator of neuronal integrity, in the RNFL and in the HFL. Although there was not a statistically significant difference in global phase retardation in the HFL of the two cohorts, global HFL thickness was significantly greater (p = 0.008) in the case subjects than in the control subjects. There was no statistically significant difference (p = 0.42) in global RNFL thickness between the case cohort (96.6 ± 9.4 microns) and the control cohort (94.9 ± 7.0 microns). There was no statistically significant difference (p = 0.80) in global RNFL phase retardation between the case cohort (57.9 ± 5.7 nm) and the control cohort (58.2 ± 4.6 nm). My results suggest there is thickening in HFL, but not in the RNFL, after multiple mild TBIs in human subjects. The fact that global HFL did not differ between the groups suggests that the photoreceptor axons remained intact, despite the tissue swelling. There were no differences in global RNFL phase retardation or in global RNFL thickness between the two cohorts. In total, my results support (open full item for complete abstract)

Committee: Philip Yuhas (Advisor); Dean VanNasdale (Committee Member); Andrew Hartwick (Committee Member) Subjects: Ophthalmology

Doctor of Philosophy, Case Western Reserve University, 2023, Neurosciences

Traumatic brain injury (TBI) is highly prevalent and frequently transitions into a chronic neurodegenerative disease sharing numerous pathologic features with Alzheimer's disease (AD). Patients often present with progressive neurocognitive impairment, psychiatric symptoms, and metabolic shift. One driving feature of AD is excessive mitochondrial fission due to increased expression and activity of dynamin-related protein 1 (Drp1), which binds fission 1 protein (Fis1). Here, we show that aberrant mitochondrial fission and fragmentation also occur in both acute and chronic TBI. However, with TBI this is associated with increased expression of Fis1 rather than Drp1. We also report elevated Fis1 in human brain from subjects with both TBI and AD, but not with AD alone. We show that elevated mitochondrial fission after TBI is associated with acutely and chronically impaired mitochondria, oxidative damage, blood-brain barrier (BBB) deterioration, neurodegeneration, and cognitive impairment. Remarkably, two weeks of daily treatment after brain injury with a selective pharmacologic agent that prevents Drp1-Fis1 interaction completely normalized mitochondrial fission and bioenergetics, and protected mice from oxidative damage, BBB deterioration, neurodegeneration, and cognitive impairment. Neuroprotection occurred acutely and lasted chronically 9 and 17 months after TBI in mice, which is the equivalent of many decades in people. However, there was no protective effect when the same treatment was delayed until 8 months after TBI. Additionally, we have demonstrated that a metabolic shift in favor of fatty acid oxidation occurs in our model of TBI, and acute P110 treatment is able to revert it. Our results demonstrate that early transient inhibition of excessive mitochondrial fission after some forms of brain injury may prevent development of chronic neurodegenerative disease in some patients.

Committee: Andrew Pieper (Advisor); Xin Qi (Committee Member); Heather Broihier (Committee Member); Wen-Cheng Xiong (Committee Chair) Subjects: Neurosciences

Master of Science, The Ohio State University, 2023, Vision Science

Purpose: The purpose of this study is to examine all three systems of the near triad and determine if there is a relationship between pupillometry metrics and the presence of binocular vision or accommodation dysfunction after TBI. A secondary objective of this study is to assess the usefulness of a smartphone-based pupillometer as a screening tool for binocular vision and accommodation dysfunction. Methods: Participants were 7 years or older with a lifetime history of at least one TBI. A sensorimotor examination was performed on each participant, including accommodative testing if the participant was under the age of 30 years old. Pupil function was assessed with a clinical pupillometer (RAPDx) and a smartphone pupilometer (Reflex PLR). The average pupil metrics of those with versus without binocular vision dysfunction (based on the sensorimotor exam) were compared using one-way ANCOVA controlling for age. The same analysis was performed for accommodative dysfunction for the group under 30 years old. Receiver operating curves and area under the curve was calculated for every pupil metric for each pupillometer to assess the diagnostic ability of each metric. Results: A total of 28 participants were recruited. Among those under 30 (n = 17), the pupils of those with a binocular vision dysfunction were larger at baseline, took longer to begin constricting, and changed diameter at a higher velocity compared to those without a vision dysfunction. In the over 30 group, the opposite was true. Those with a vision dysfunction had smaller baseline pupil diameters and changed diameter at a slower velocity compared to those without a vision dysfunction. Several pupil metrics measured with the clinical pupillometer demonstrated some ability to identify participants with a vision dysfunction. Only one metric found with the smartphone app showed any ability to identify participants with vision dysfunction. Conclusions: There is a possible association between pupillometry metric (open full item for complete abstract)

Committee: Marjean Kulp (Advisor) Subjects: Anatomy and Physiology; Biomedical Research; Health Care; Health Sciences; Ophthalmology

PhD, University of Cincinnati, 2022, Pharmacy: Pharmaceutical Sciences

Traumatic brain injury (TBI) is a significant cause of death and disability with an estimated 176 TBI-related deaths occurring each day within the United States alone. While everyone is exposed to factors that could lead to a TBI, certain groups of individuals are at a higher risk for sustaining neurotrauma than others. The technological evolution of modern warfare has led to the increased use of explosive devices. Consequently, military personnel are experiencing more TBI related injuries with an estimated 20% of all military personnel suffering at least one TBI during their deployment. TBI leads to long term complications including depression, deficits in memory and learning, and increased risk for suicide and suicidal ideation. The lack of effective preventative measures to prevent TBI significantly contributes to the high rates of injury. While the causes of TBI are situational, the majority of TBIs result from the body experiencing deleterious acceleration/deceleration forces. These forces result in a dissipative transfer of energy between the brain and the skull resulting in significant strain and shear stress on the brain tissue. Despite the common misconception that helmets can protect against TBI, they are unable to effectively mitigate energy transmission and leave wearers susceptible to head injury. A small quantifiable volume dubbed the compensatory reserve volume (CRV) permits energy transmission to brain tissue during acceleration/deceleration events. Recent work has found that increases in cerebral blood flow (CBF) are able to exhaust the CRV and reduce the absorption of energy and damage to the brain resulting from acceleration/deceleration forces. The most powerful biologic determinant of CBF and therefore the CRV is the concentration of inspired Carbon Dioxide (CO2). We therefore hypothesized that experimental hypercapnia (i.e. increased inspired concentration of CO2) may prevent and mitigate the actions of acceleration/deceleration-induce (open full item for complete abstract)

Committee: Matthew Robson Ph.D. (Committee Member); Gary Gudelsky Ph.D. (Committee Member); Eric Wohleb (Committee Member); Timothy Phoenix Ph.D. (Committee Member); Jennifer McGuire Ph.D. (Committee Member) Subjects: Pharmaceuticals

Master of Science, The Ohio State University, 2022, Vision Science

Sports-related concussions in pediatrics and adolescents can be asymptomatic and often go undiagnosed. Pupil testing strategies may be used as a potential objective screening tool for concussion. The purpose of this work was to perform longitudinal assessments of pupil responses to pulses of red and blue light in youth hockey players to assess the function of the neural circuitry mediating the pupillary light reflex, while also determining the repeatability of these responses. In addition, assessments of cognitive function and surveys of symptoms were performed to determine the repeatability of these concussion screening tools across the hockey season. There were 18 males, each 13 years old, enrolled in the cohort study at the start of the youth hockey season. Pupil responses to flashes of alternating red and blue light, applied at 0.1 Hz for 2 min, were recorded using the RAPDx pupillometer (Konan Medical). The data was collected in three sessions, each separated by approximately two months, conducted at the start, middle and end of the hockey season. Average pupil constriction during the first red versus first blue pulses, and the difference in constriction between the first and last pulses of red light were calculated. Symptoms were quantified with the Convergence Insufficiency Symptoms Survey (CISS) and Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ). Cognitive function was measured using CogState Brief Battery Assessment. The average difference between the pupil responses to the first red and the first blue flash, a marker of the contribution of melanopsin-driven responses to pupil constriction, was significantly correlated (R = 0.61; P < 0.001) with the change in pupil constriction that occurred across the pupil test, termed photopotentiation (measured as the difference in pupil responses to the first and last red flashes). Bland-Altman analyses demonstrated that there was not a significant difference in the pupil responses to the first red and (open full item for complete abstract)

Committee: Andrew Hartwick OD, PhD (Advisor); Phillip Yuhas OD, PhD (Committee Member); Catherine McDaniel OD, MS (Committee Member) Subjects: Neurosciences; Ophthalmology; Optics

Master of Science in Biomedical Engineering (MSBME), Wright State University, 2021, Biomedical Engineering

There is a need to improve methods of monitoring patients with traumatic brain injury (TBI) in hospital settings. Current monitoring techniques and diagnosis methods are expensive, invasive, do not provide continuous measures, expose the patient to radiation, are ambiguous in the information they provide, and/or cannot be implemented at the bedside. These techniques measure imperative markers of brain function including intracranial pressure (ICP), cerebral blood flow (CBF), and oxygenation in the brain, among others. Hospitals not only require a practical method for real-time monitoring of patients at the bedside, but also meaningful metrics that characterize TBIs, since the variety of methods results in complex and ambiguous criteria for defining TBIs. Trends in the literature show a reliance on functional assessments such as the Glasgow Coma Scale (GCS) to define TBIs, however studies have shown its complexity and context-dependence in predicting outcome. Real-time cerebral assessment is currently focused on ICP monitoring, but increased attention to hemodynamic measures to improve patient outcomes warrants new technologies and metrics. Therefore, in this thesis, a novel metric of low-frequency oscillations (LFOs) from hemodynamic monitoring is proposed to provide a more objective characterization of TBI. Literature suggests that these LFOs originate from the regulation of regional changes in CBF and energetic metabolism and not from systemic regulation of the cardiovascular system, making it a representative metric of brain function. Overall, this thesis will contribute to the clinical understanding of TBI through optical imaging-derived LFOs. To achieve this overall goal, the followings have been investigated between non-TBI and TBI groups: 1) quantification of absolute concentration changes of hemodynamic parameters, 2) assessment of the LFO spectrums of the oxygenated hemoglobin signals to identify prevalent LFOs, and finally 3) quantification of the average (open full item for complete abstract)

Committee: Ulas Sunar Ph.D. (Advisor); Brandon Foreman M.D., FACNS (Committee Member); Tarun Goswami Ph.D. (Committee Member) Subjects: Biomedical Engineering; Biomedical Research

Master of Arts, Miami University, 2021, Speech Pathology and Audiology

The percentage of concussions self-reported by collegiate athletes continues to be less than 50% despite the implementation of the National Collegiate Athletic Association's (NCAA) mandated concussion protocol. Unreported concussions leave affected athletes without beneficial medical, academic, and athletic intervention. This study's primary purpose was to identify factors positively and negatively influencing concussion reporting patterns in NCAA Division one (DI) athletes. A secondary purpose was to obtain the perspective of former collegiate athletes with a history of concussion on factors which may positively or negatively influence the culture of concussion reporting patterns in the future. Seven former NCAA DI athletes completed individual interviews to discuss their concussion experience in college including perceived support from various personnel, concussion education, and suggestions for changing the culture of concussion reporting. Athletic trainers (ATs) and parents were perceived to be supportive of concussion reporting, while participants relayed mixed feelings about coaches. All participants reported that the education received about concussion while in college was unmemorable and a majority expressed a lack of knowledge regarding symptoms of concussion. Suggestions for change included meetings dedicated solely to concussion education presented by a speaker with a personal history of concussion and increased use of visual educational materials.

Committee: Kelly Knollman-Porter Ph.D., CCC-SLP (Advisor); Renee Gottliebson Ph.D., CCC-SLP (Committee Member); Courtney Robinson M.S., CCC-SLP (Committee Member) Subjects: Health; Higher Education; Speech Therapy; Sports Medicine

Master of Science (MS), Ohio University, 2021, Clinical Psychology (Arts and Sciences)

Alzheimer's disease (AD) is a highly prevalent disorder among older adults and the primary cause of dementia in this group. Accurate assessment of risk factors could help prevent future cases of dementia, in the case of environmental risk factors, or allow individuals and families to plan for future care. Previous studies have investigated the predictive value of certain risk factors, including traumatic brain injury (TBI) and Apolipoprotein E (APOE) genetic status, with somewhat mixed findings. Specifically, some research has found that TBI can increase risk and lower age of onset for dementia in general, but findings are inconsistent across studies. The current study investigated risk for, onset of, and rate of cognitive decline in Alzheimer's disease as it relates to these risk factors in a large sample drawn from the National Alzheimer's Coordinating Center (NACC). While APOE e4 did predict risk for diagnosis and onset of AD, history of TBI did not affect either measure, and there was no interaction between APOE and TBI history in their prediction. With regard to rate of cognitive decline, history of TBI predicted a slower decline on the screener measure as well as both immediate and delayed memory measures. APOE predicted a faster decline on memory measures and interacted with TBI to predict delayed memory trajectory, such that e4 non-carriers with TBI history had a slower decline than non-carriers without TBI history, while the trajectory of e4 carriers was not affected by TBI history. These results suggest that TBI is not a significant risk factor for AD and does not alter age of onset or cognitive decline in individuals with AD. Additionally, TBI history does not appear to interact in a negative way with APOE status.

Committee: Julie Suhr PhD (Advisor); Nicholas Allan PhD (Committee Member); Peggy Zoccola PhD (Committee Member) Subjects: Aging; Psychology

Master of Arts, The Ohio State University, 2020, Speech and Hearing Science

The current study aims to evaluate the utility of time to follow commands (TFC), post-traumatic amnesia (PTA), and total duration of impaired consciousness (TFC + PTA) in predicting functional outcome after pediatric traumatic brain injury (TBI), as assessed by the Glasgow Coma Scale—Extended, Pediatric Revision (GOS-E Peds). Given the life-long needs of children with TBI, further research is necessary to identify predictors of functional outcomes. These predictors could guide clinicians when educating a child's caregivers about potential outcomes and prognosis for their child's long-term needs following TBI in order for them to utilize necessary support services following injury. This study obtained information from 60 children with complicated mild to severe TBI (mean age at injury = 13.7 years, range = 5-20 years) in the setting of a pediatric inpatient rehabilitation hospital and associated multidisciplinary brain injury follow-up clinic. Severity measures and outcomes were scored retrospectively on the basis of documentation from each patient's inpatient stay and outpatient follow-up evaluations at two-months and one-year post-injury. Correlations between measures of severity and functional outcome were obtained. TFC and TFC + PTA were found to be moderately correlated with GOS-E Peds scores at both the two-month follow up and the one-year follow-up. The results of this study suggest that TFC and TFC + PTA are important predictors of functional outcomes after TBI.

Committee: Jennifer Lundine PhD, CCC-SLP (Advisor); Stacy Harnish PhD, CCC-SLP (Committee Member) Subjects: Rehabilitation; Speech Therapy

Doctor of Philosophy, The Ohio State University, 2019, Mechanical Engineering

Millions of head and brain injuries occur each year in the United States with severities ranging from mild to traumatic. Mild traumatic brain injuries, commonly known as concussions are common among sporting activities, specifically American Football. Most research of football concussion injuries focuses on professional and collegiate level athletes. Work is needed to quantify how modern football helmets protect against concussion injuries at the youth level. For this investigation, two studies were carried out. These studies focused on determining how both helmet mass and head-helmet relative motion may affect a youth athlete's concussion risk during impact events. In these studies, impacts were carried out on a child crash test dummy (ATD) wearing youth football helmets of varying mass. The relative motion between the ATD head and football helmets was quantitatively measured throughout each impact using a motion capture system. Results from these studies displayed that both helmet mass and head-helmet relative motion can have a significant effect on injury metrics commonly used to predict concussion. However, helmet mass was found to have less of an effect on injury criteria values than other parameters such as helmet brand and impact direction. Additionally, head-helmet relative motion was found to be positively related to rotationally based injury criteria. The amount of relative motion between the head and helmet was dependent on each helmet's stand-off distance and padding design. While concussions are a mild brain injury with a large prevalence, drone, or UAS head impacts pose a risk for more traumatic head injuries but currently have a low prevalence. However, the rate of drone impacts is likely to increase as the industry is expanding at a rapid rate and benefits associated with drone use are driving new federal regulations which would allow for more widespread UAS flights over people. Before UAS flight over people is made legal, the risk of huma (open full item for complete abstract)

Committee: John H. Bolte IV PhD (Advisor); Yun-Seok Kang PhD (Committee Member); Laura C. Boucher PhD (Committee Member); James W. Gregory PhD (Committee Member) Subjects: Biomechanics; Biomedical Engineering; Mechanical Engineering

Master of Arts, The Ohio State University, 2018, Speech Language Pathology

The current study aims to collect pilot data to inform a more comprehensive look at the perspectives and experiences of survivors of pediatric traumatic brain injury (pTBI), their caregivers, as well as medical professionals who care for them to examine areas for innovation in research and clinical service delivery. Given the life-long needs of children with pTBI, documented inconsistent access to and utilization of services within this population, lack of practice guidelines, and the need for salience and community engagement in the rehabilitation process, there is an evident need for further research. To address areas where further research is needed, this study obtained information from three key stakeholder groups (five survivors of pTBI, their caregivers, and three medical professionals) about their experiences related to pTBI. Through semi-structured interviews and a qualitative process to identify themes in these interviews, this study found that survivors of pTBI and their caregivers commonly noted later developing issues, social challenges, and difficulty in their transitions back into their lives post-injury. In addition, both caregivers and medical professionals reported the need for additional follow-up, evidence-based research, and for staff members with specific training on pTBI.

Committee: Jennifer Lundine Ph.D., CCC-SLP (Advisor); Christy Ray , Ph.D., CCC-SLP (Committee Member) Subjects: Speech Therapy

Master of Arts, The Ohio State University, 2018, Speech Language Pathology

Adolescents with traumatic brain injury (TBI) may exhibit subtle cognitive-communication deficits that are not consistently identified by the formal assessments commonly used to qualify children for special education services. Expository discourse production is rarely used as an assessment tool with students who have TBI, despite its relevance to the curriculum. Research is needed to explore the cognitive-linguistic processes and linguistic features that are required for students to successfully produce exposition. The current study conducted microlinguistic and fluency analyses of verbal summaries produced by five adolescents with traumatic brain injury and five matched peers with typical development (TD). Each participant verbally summarized one narrative and two expository (compare-contrast, cause-effect) discourse lectures that were then transcribed and analyzed for microlinguistic measures, mazing behaviors, and pausing patterns. The group with TBI was significantly less productive than the group with TD during cause-effect and compare-contrast productions. No other microlinguistic differences were identified between groups. The group with TBI produced significantly fewer filled pauses per utterance during cause-effect production. The group with TBI also produced significantly more within-clause pauses per utterance during compare-contrast production. No significant differences were found between groups on any variable analyzed during narrative productions. On average, the group with TD produced more mazes, and the group with TBI produced more pauses of longer lengths. These findings support other studies that suggest that different types of exposition have different production requirements, and that they are distinct from narrative productions. The different patterns of mazing and pausing found between groups help to characterize discourse production by adolescents with TBI and are discussed in terms of decreased language processing abilities. Differences in (open full item for complete abstract)

Committee: Jennifer Lundine (Advisor); Rebecca McCauley (Committee Member) Subjects: Speech Therapy

Ph.D., Antioch University, 2017, Leadership and Change

This research focused on the lived experiences of fourteen military caregiving wives whose husbands were wounded, ill, or injured in a post-9/11 combat theater of war. All wives in this study had been vetted by and appointed to the Elizabeth Dole Military Caregiving Fellows Program and were either actively involved in the Fellowship or had become recent alumni of the two-year commitment at the time of this study. The purpose of this study was to provide a platform for their voices, understand their hopes, struggles, successes, and failures, and to give honor to their stories of military caregiving through the qualitative methodology of narrative inquiry. The stories as data were analyzed in two distinct ways. The first was using a plot analysis that exposed the story lines of the caregivers from the moment of their husbands' final deployment home to the present day, ranging from three to 13 years post onset. Using eight plot line elements, the arc of the story lines revealed one continuous story that was consistent among all caregivers, yet highly nuanced and unique. Thematic analysis was conducted as the second way of looking at the data. Moving dynamically along the flow of the story line, topical themes and their subthemes deepened the understanding and sense making the caregivers expressed at each stage of their evolution, providing the thematic road map of each journey. It was within this roadmap that a holistic picture emerged of the wives' journey through the emergent themes beginning with hope, to their own unraveling, to disillusionment with self, other, and the system, to the factors that eventually allowed them to turn toward a more empowered self, and finally, to the paradigm shift that ultimately allowed for transformative, inspired action. This dissertation is accompanied by the author's MP4 video introduction. The electronic version of this dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aur (open full item for complete abstract)

Committee: Elizabeth Holloway PhD (Committee Chair); Tony Lingham PhD (Committee Member); Deborah Johnson Hayes PsyD, LCSW, MPH (Committee Member) Subjects: Families and Family Life; Mental Health; Military Studies; Psychology