Page 82 - NNS 2014 Program & Abstract Book

can be used to track both acute and chronic recovery following con-
cussion. Future studies can investigate whether the improvements in
RTclin were subject to practice effect, and what clinical interventions
had the greatest effect on RTclin improvement.
Key words
concussion, mild traumatic brain injury, simple reaction time
B1-17
GENDER DIFFERENCES IN SYMPTOM REPORT FOL-
LOWING MILD TBI IN ADOLESCENTS AND YOUNG
ADULTS DEPEND ON AGE
Rabinowitz, A.R.1, Li, X.2, McCauly, S.R.2,3, Wilde, E.A.2,3, Smith,
D.H.1, Levin, H.S.2,3
1University of Pennsylvania, Philadelphia, PA
2Baylor College of Medicine, Houston, TX
3Michael E. DeBakey VA Medical Center, Houston, TX
Female gender has been associated with higher levels of post-mTBI
symptoms and prolonged symptomatic recovery (Ponsford et al.,
2012; Elbin, 2011). An examination of longitudinal symptom report in
mTBI and orthopedic injury patients may elucidate the nature of these
differences and inform the mechanisms underlying them.
Participants were adolescents and young adults aged 12–30 years.
Sixty-six mTBI patients and 64 orthopedic injury controls were re-
cruited as a consecutive series of admissions to emergency centers of
three Level-1 trauma centers. Patients were administered the Rivermead
Post-Concussion Symptom Questionnaire at 96 hours and 3 months
post-injury. Generalized Estimating Equations were used to assess age-
related group and gender differences in symptoms over time.
Results revealed a significant group effect on total symptom score
(X2
1 = 39.7, p < 0.0001) with mTBI patients reporting more symptoms
than orthopedic injury patients. Symptoms decreased over time for
both groups (X2
1 = 13.9, p = 0.0002), and females in both groups re-
ported more symptoms than males (X2
1 = 7.6, p = 0.0059) However
both of these effects were dependent on age (time*age: X2
1 = 4.3,
p = 0.0042; gender*age: X2
1 = 4.3, p = 0.0393), such that older patients
demonstrated poorer symptomatic recovery than younger patients, and
gender differences in symptom report dissipated with age.
The girls and young women in our sample reported greater symp-
tom severity following both mTBI and orthopedic injury. However,
this gender difference was only evident among younger participants.
Like the older females in our sample, older males reported a higher
level of symptoms at 96 hours post-injury, relative to younger males,
and their symptoms remained stable at 3 months post-injury. Possible
mechanisms underlying these effects will be discussed.
Key words
concussion, mTBI, sex differences, symptoms
B1-18
VERIFICATION OF CIRCUIT-DIRECTED REHABILITA-
TION PARADIGM FOR BRAIN INJURY-INDUCED CIRCUIT
REORGANIZATION
Thomas, T.C.1–3, Khodadad, A.2,4, Adelson, P.D.1,2, Lifshitz, J.1–3
1BARROW Neurological Institute at Phoenix Children’s Hospital,
Phoenix, USA
2Child Health, University of Arizona College of Medicine, Phoenix, USA
3Phoenix VA Healthcare System, Phoenix, USA
4Neuroscience, University of Strasbourg, Strasbourg, France
After experimental diffuse traumatic brain injury (TBI), there is behav-
ioral, functional, molecular and neuropathological evidence that injured
circuits are immediately disrupted, then dismantled and eventually re-
organized. In rodents, by 28 days post-TBI, late-onset sensory sensitivity
to whisker stimulation is a phenotypic expression of maladaptive circuit
reorganization in the somatosensory thalamocortical circuit. A molecular
biomarker of circuit activation and integrity could determine the impact
of type, onset and duration of therapeutic intervention on circuit reor-
ganization. Activity-regulated cytoskeleton-associated protein (Arc), an
immediate early gene, has gene expression tightly coupled to behavioral
paradigms in vivo, including injury-induced changes with manual whis-
ker stimulation. In these experiments, we determine the dynamics of Arc
transcription after whisker somatosensation in a natural environment as a
potential approach for therapeutic intervention. For this study, adult male
Sprague Dawley rats (*300g) were encouraged to explore novel tubes
for 15 minutes to activate the whisker circuit. At various time points
following whisker stimulation, tissue biopsies were removed from pri-
mary somatosensory barrel field (S1BF) cortex and ventral posterior
medial nucleus (VPM) of the thalamus for quantitative real-time PCR
analysis for comparison with exploration-naı¨ve rats. Whisker stimulation
through novel tubes resulted in a 8-fold increase Arc mRNA expression
at 30 minutes in the S1BF in comparison to naive (F(4,13) = 4.417;
p =0.018). There were no changes in Arc expression in the VPM. These
data demonstrate that exploration through novel tube configurations is
capable of directed activation of the whisker circuit. Exploration of tube
configurations may be useful as a verification of circuit-directed reha-
bilitation for brain injury-induced circuit reorganization.
Supported, in part, by NIH R03 NS077098, NIH R01 NS065052
and PCH Mission Support
Key words
circuit reorganization
B1-19
INCIDENCE OF OUTPATIENT FOLLOW-UP SERVICES IN
FUNCTIONALLY-RECOVERED MILD TBI PATIENTS
Yue, J.K.1, Sharma, S.1, Vassar, M.J.1 , Cooper, S.R.1, Yuh, E.L.1,
Mukherjee, P.1, Valadka, A.B.2, Gordon, W.A.3, Okonkwo, D.O.4,
Manley, G.T.1
1Brain and Spinal Injury Center, University of California, San
Francisco, CA, USA
2Seton Brain and Spine Institute, Austin, TX, USA
3Mount Sinai School of Medicine, New York, NY, USA
4University of Pittsburgh Medical Center, Pittsburgh, PA, USA
To date, uniform standards for follow-up of mild traumatic brain injury
(mTBI) patients remains elusive. Although there exists a myriad of
multidisciplinary services for TBI outpatient rehabilitation, access is
problematic due to underdiagnosis, lack of coverage, and inadequate
systems for coordinating outpatient care. Typically resources are utilized
by moderate to severe TBI patients and less available to the mTBI
population. Statistics regarding the percentage of mTBI patients returning
for follow-up also have not been systematically compiled. The Trans-
forming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot
Study collected NIH Common Data Elements (CDEs) regarding the type
and frequency of follow-up services after discharge from acute care.
These self-reported finding were analyzed with a cohort of TBI patients
presenting at three Level 1 Trauma Centers who underwent brain CT. To
target mTBI in the functionally recovered as the main effect, patients
with admission GCS < 14, extracranial abbreviated injury scale score of
> 2, unfavorable outcome by Glasgow Outcome Scale Extended (GOSE)
of 1-4 at 6-months or received inpatient rehabilitation during recovery
A-50