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motor and cognitive benefits similar to continuous EE after TBI, which
supports the hypothesis and lends credence to EE as a preclinical model
of neurorehabilitation. To further optimize the model, ongoing studies
are evaluating longer delays in implementing EE after TBI.
Keywords: controlled cortical impact, environmental enrichment,
preclinical model
D6-08
TELEPHONE PROBLEM SOLVING TREATMENT FOR AC-
TIVE DUTY SERVICE MEMBERS WITH MILD TRAUMATIC
BRAIN INJURY:A RANDOMIZED CONTROLLED TRIAL
Nancy Temkin
1
, Kathleen Bell
2,5
, Jesse Fann
3
, Jo Ann Brockway
2
,
Wesley Cole
4
, CONTACT Study Group
6
1
University of Washington (UW), Neurological Surgery & Biostatis-
tics, Seattle, USA
2
UW, Rehabilitation Medicine, Seattle, USA
3
UW, Psychiatry and Behavioral Sciences, Seattle, USA
4
Defense and Veterans Brain Injury Center, Womack Army Medical
Center, Brain Injury Medicine, Fort Bragg, USA
5
Currently University of Texas Southwestern, Physical Medicine and
Rehabilitation, Dallas, USA
6
INTRuST, Consortium, San Diego, USA
During combat deployments service members (SMs) are at risk for
sustaining mild TBI (mTBI) and experiencing persistent symptoms
and co-morbid emotional and physical issues. Military duty demands,
access to resources, and the stigma of treatment pose barriers to SMs
receiving necessary care. Telehealth approaches can be effective in
overcoming treatment barriers. Problem-solving interventions show
promise for treating TBI-related issues. Our objective was to evaluate
the efficacy of problem-solving therapy delivered by telephone on
persisting distress and physical symptoms in active duty service
members with combat-related mild traumatic brain injury (mTBI). We
recruited 356 SMs with mTBI sustained while deployed and ran-
domized them into one of two interventions: 1) telephone-based
problem-solving treatment (PST); 2) TBI-education only (EO). Pri-
mary outcomes included the Rivermead Post-Concussion Symptoms
Questionnaire (RPCSQ) and the Brief Symptom Inventory (BSI-18).
Secondary outcomes included additional measures of emotional and
physical health and treatment satisfaction. Outcomes at 6-months
post-enrollment were obtained for 89.9% of the sample and compared
to baseline ratings. Mixed-effects regression suggested PST resulted
in significant improvements over EO in emotional health (BSI-18
p
=
.007) but not post-concussion symptoms (RPCSQ p
=
.182). Sec-
ondary analyses revealed PST resulted in improvements over EO on
other health-related ratings, including quality of sleep and depression,
and that SMs preferred PST over EO. Therefore, telephone-based PST
was acceptable and effective at reducing symptoms of emotional
distress in SMs returning from deployment with mTBI.
Keywords: Military, Mild traumatic brain injury, Randomized
controlled trial, Telehealth, Problem-solving treatment
D6-09
BRAIN-INITIATED EXERCISE PROGRAM PROMOTES
GREATEST RECOVERY AFTER SCI
Jean Peduzzi Nelson
1
, Thomas Bolig
1
, Perani Chander
1
, Taania
Girgla
1
, Victoria Drzyzga
1
, Kimberly Morck
1
, Jay Meythaler
2
1
Wayne State University School of Medicine, Department of Anatomy
& Cell Biology, Detroit, USA
2
Wayne State University School of Medicine, Department of Physical
Medicine & Rehabilitation, Dearborn, USA
Although rehabilitation is considered useful for spinal cord injury
(SCI), non-brain-initiated rehabilitation may actually be detrimental
by interfering with the re-organization of circuitry especially after
interventions that stimulate repair. Recent studies find detrimental
effects of passive stretch in SCI rats. Our goal is to directly compare
two rehabilitation methods (exercises with and without brain initi-
ation) to no rehabilitation in SCI. Our hypothesis is that the brain-
initiated therapy program would be the most effective. Lewis rats
(n
=
24) with a T9 SCI (MASCIS device) were randomly assigned to
three groups: 1. no rehabilitation; 2. non-brain-initiated exercises
[passive stretch (20 min/day,5 days/week), motorized bicycle
(15 min/day, 3 days/wk)]; 3. brain-initiated exercises [swimming
(12 min/day, 2 days/wk); treadmill and ladder walking (30 min, 2
days/wk); environmental enrichment (1 hr/day, 2 days/wk)]. Out-
come measures included BBB, inclined plane and beam tests.
Muscle weight, levels of corticosterone using ELISA and number of
newly generated hippocampal cells (Ki-67) were quantified. The
brain-initiated exercise group demonstrated the most recovery in all
functional tests while the non-brain-initiated exercise group per-
formed worse than the no rehabilitation group. In the inclined plane
test, the brain-initiated exercise group performed significantly better
than the non-brain-initiated group at weeks 7 and 8 post-injury
(p
=
0.017). The mean extensor muscle weight was significantly
greater in the brain-initiated exercise group than the other 2 groups.
The mean flexor weights were again greatest in the brain-initiated
exercise group but not significantly different. The corticosterone
levels were similar in all groups. The brain-initiated exercise group
had more newly generated hippocampal cells that may be an indi-
cator of plasticity. The greater functional motor recovery with brain-
initiated therapy supports the hypothesis that brain-initiated exercise
is the best for functional recovery. Stress did not influence the re-
sults. Exercise in people that are not brain-initiated (passive stretch/
ROM) may need to be modified and the cost-benefit ratio of robotics
re-examined.
Keywords: exercise, plasticity, neurogenesis, spinal cord injury
D7 Poster Session VIII - Group D: Astrocyte
D7-01
THROMBIN PHOSPHORYLATES MYOSIN LIGHT CHAIN
IN ASTROCYTES VIA THE RHO KINASE PATHWAY
Sue Hong
1,2
, Hantamalala Ralay Ranaivo
1
, Allison Rusie
1
, Mark
Wainwright
1,2
1
Ann & Robert H. Lurie Children’s Hospital of Chicago, Dept of
Pediatrics, Division of Neurology, Chicago, USA
2
Ann & Robert H. Lurie Children’s Hospital of Chicago, Dept of
Pediatrics, Division of Critical Care, Chicago, USA
Background:
The blood brain barrier (BBB) is compromised following
neurotrauma and results in exposure of astrocytes to increased levels of
serum proteins including thrombin. Thrombin activates astrocytes and
microglia, and promotes further breakdown of the BBB. In endothelial
cells the rho/rho kinase (ROCK) pathway is an important mediator of
barrier integrity by regulating myosin light chain (MLC) phosphory-
lation. The role of ROCK and myosin light chain kinase (MLCK) in the
mechanisms by which astrocytes maintain BBB integrity is not well
understood. The aim of this study is to elucidate the role thrombin plays
in MLC phosphorylation in astrocytes.
A-112