title: Mild Traumatic Brain Injury in Childhood: Injury Outcomes, Teacher Perspectives and Educating Educators

authors: Case, Rosalind Jane Leamy

subjects: neuropsychology

abstract: Paediatric mild traumatic brain injury (mTBI) has the potential to impact on a wide range of developmental functions in childhood. However, the relationship between mTBI and persistent developmental difficulties is controversial, with some suggestion that children’s post-injury difficulties may actually predate the injury. Regardless of cause, however, mTBI seems to be associated with developmental impairment in childhood that may impact on academic performance and overall school functioning. In spite of the high prevalence of mTBI amongst young people, educators and school services may not be aware of the implications of such injuries and how post-concussive symptoms should be managed in educational settings. It seems that the conflicting findings regarding mTBI outcomes in childhood may contribute to a lack of knowledge amongst educators about how to manage mTBI and associated difficulties in primary-school-aged students. There is a need to further clarify the existence and nature of developmental impairments after paediatric mTBI and consider their implications in educational settings. Furthermore, there is a need to understand more regarding the capacities of educators to address issues that may arise as a result of such impairments and consider how teaching practices in this area can be enhanced.
In Study 1, the emotional, behavioural, social, intellectual, neuropsychological (comprised of memory, attention, and executive function) and academic functioning of 41 children who had sustained mTBI 14-months prior was investigated. The findings of those assessments were compared with those from a non-injured cohort of children matched on age, gender, ethnicity and school decile. Assessment measures included the Strengths and Difficulties Questionnaire (SDQ) as a measure of emotional, behavioural and social functioning, the Behavior Rating Inventory of Executive Function (BRIEF) as a measure of executive function, Woodcock Johnson Tests of Cognitive Abilities (WJ III COG) and CNS Vital Signs (CNSVS) as measures of global neuropsychological functioning, a short-form version of the Wechsler Intelligence Scale for Children (WISC-IV) as a measure of intelligence, the brief battery of the Woodcock Johnson Tests of Academic Achievement (WJ III ACH) as measure of academic achievement, and a teacher questionnaire regarding school functioning. Information obtained from parents and teachers regarding pre-injury diagnoses and learning problems did not reveal significant premorbid difficulties amongst the clinical group. The results of Study 1 showed that children who have sustained mTBI demonstrate higher rates of emotional and behavioural problems than those in a matched cohort, while executive function and social functioning was found to be similar across the two groups. Children with mTBI evidence significantly lower intellectual functioning and academic achievement, and are more likely to demonstrate learning disorders. Given the developmental impairments identified in the sample and the possible implications of such difficulties in school settings, it was considered important to evaluate teachers’ perceptions of childhood TBI and how such impairments might be managed at school.
Study 2 looked at the perceptions of educators regarding childhood TBI. Nineteen primary school teachers in the Waikato and Bay of Plenty regions engaged in semi-structured interviews that covered their understanding of TBI, its mechanisms and consequences. Participants also discussed the use of programme adaptations for children with persistent difficulties after mTBI and perceived barriers to uptake. The majority of participants had a limited understanding of mTBI and its implications in childhood. None of the participants had received prior education regarding paediatric TBI and identified this as an area of weakness that they perceived could be addressed by professional development. However, participants were not aware of any available professional development opportunities specifically relating to paediatric TBI. Participants perceived significant barriers to the delivery of appropriate educational approaches for children with developmental impairments, including limited resourcing and funding for special education and poor communication between the education and health sectors, resulting in a lack of information and support for educators.
Study 3 involved the development, delivery and evaluation of a professional development workshop and written information resource for teachers. The workshop and written information resource were delivered in three local primary schools to 38 participants. A knowledge quiz regarding mTBI was administered pre- and post-workshop. Participants also completed an evaluation of the workshop and brochure rating the usefulness of and their satisfaction with the materials. A repeated-measures experiment showed that knowledge levels significantly increased following participation in the workshop. The majority of participants were satisfied with the content of the workshop and expected to make changes to their practice with children who had experienced mTBI and were evidencing emotional, behavioural and/or cognitive symptoms.
The results of this research indicate that while the cause of post-concussive difficulties may be ambiguous, children who have experienced mTBI are at higher risk of demonstrating developmental problems across a wide range of domains. These problems have the potential to impact on school functioning; however, teachers may not be aware of these issues and thus may not be well-placed to support children who are experiencing difficulties through the post-concussive period and beyond. On the other hand, teachers demonstrate insight into their limitations in this regard and appear keen to address their professional development needs in this area. A brief professional development approach that focuses on the epidemiology and possible consequences of mTBI in childhood, along with a range of programme adaptation strategies that teachers can opt to employ as necessary, may be useful in improving teacher knowledge, educational practice and, ultimately, functional outcomes for children who have experienced mTBI. The need for screening and intervention services for children with mTBI is highlighted, along with a reconceptualisation of how special needs are addressed in school settings.

text: Mild Traumatic Brain Injury in Childhood: Injury Outcomes, Teacher Perspectives and Educating Educators Paediatric mild traumatic brain injury (mTBI) has the potential to impact on a wide range of developmental functions in childhood. However, the relationship between mTBI and persistent developmental difficulties is controversial, with some suggestion that children’s post-injury difficulties may actually predate the injury. Regardless of cause, however, mTBI seems to be associated with developmental impairment in childhood that may impact on academic performance and overall school functioning. In spite of the high prevalence of mTBI amongst young people, educators and school services may not be aware of the implications of such injuries and how post-concussive symptoms should be managed in educational settings. It seems that the conflicting findings regarding mTBI outcomes in childhood may contribute to a lack of knowledge amongst educators about how to manage mTBI and associated difficulties in primary-school-aged students. There is a need to further clarify the existence and nature of developmental impairments after paediatric mTBI and consider their implications in educational settings. Furthermore, there is a need to understand more regarding the capacities of educators to address issues that may arise as a result of such impairments and consider how teaching practices in this area can be enhanced.
In Study 1, the emotional, behavioural, social, intellectual, neuropsychological (comprised of memory, attention, and executive function) and academic functioning of 41 children who had sustained mTBI 14-months prior was investigated. The findings of those assessments were compared with those from a non-injured cohort of children matched on age, gender, ethnicity and school decile. Assessment measures included the Strengths and Difficulties Questionnaire (SDQ) as a measure of emotional, behavioural and social functioning, the Behavior Rating Inventory of Executive Function (BRIEF) as a measure of executive function, Woodcock Johnson Tests of Cognitive Abilities (WJ III COG) and CNS Vital Signs (CNSVS) as measures of global neuropsychological functioning, a short-form version of the Wechsler Intelligence Scale for Children (WISC-IV) as a measure of intelligence, the brief battery of the Woodcock Johnson Tests of Academic Achievement (WJ III ACH) as measure of academic achievement, and a teacher questionnaire regarding school functioning. Information obtained from parents and teachers regarding pre-injury diagnoses and learning problems did not reveal significant premorbid difficulties amongst the clinical group. The results of Study 1 showed that children who have sustained mTBI demonstrate higher rates of emotional and behavioural problems than those in a matched cohort, while executive function and social functioning was found to be similar across the two groups. Children with mTBI evidence significantly lower intellectual functioning and academic achievement, and are more likely to demonstrate learning disorders. Given the developmental impairments identified in the sample and the possible implications of such difficulties in school settings, it was considered important to evaluate teachers’ perceptions of childhood TBI and how such impairments might be managed at school.
Study 2 looked at the perceptions of educators regarding childhood TBI. Nineteen primary school teachers in the Waikato and Bay of Plenty regions engaged in semi-structured interviews that covered their understanding of TBI, its mechanisms and consequences. Participants also discussed the use of programme adaptations for children with persistent difficulties after mTBI and perceived barriers to uptake. The majority of participants had a limited understanding of mTBI and its implications in childhood. None of the participants had received prior education regarding paediatric TBI and identified this as an area of weakness that they perceived could be addressed by professional development. However, participants were not aware of any available professional development opportunities specifically relating to paediatric TBI. Participants perceived significant barriers to the delivery of appropriate educational approaches for children with developmental impairments, including limited resourcing and funding for special education and poor communication between the education and health sectors, resulting in a lack of information and support for educators.
Study 3 involved the development, delivery and evaluation of a professional development workshop and written information resource for teachers. The workshop and written information resource were delivered in three local primary schools to 38 participants. A knowledge quiz regarding mTBI was administered pre- and post-workshop. Participants also completed an evaluation of the workshop and brochure rating the usefulness of and their satisfaction with the materials. A repeated-measures experiment showed that knowledge levels significantly increased following participation in the workshop. The majority of participants were satisfied with the content of the workshop and expected to make changes to their practice with children who had experienced mTBI and were evidencing emotional, behavioural and/or cognitive symptoms.
The results of this research indicate that while the cause of post-concussive difficulties may be ambiguous, children who have experienced mTBI are at higher risk of demonstrating developmental problems across a wide range of domains. These problems have the potential to impact on school functioning; however, teachers may not be aware of these issues and thus may not be well-placed to support children who are experiencing difficulties through the post-concussive period and beyond. On the other hand, teachers demonstrate insight into their limitations in this regard and appear keen to address their professional development needs in this area. A brief professional development approach that focuses on the epidemiology and possible consequences of mTBI in childhood, along with a range of programme adaptation strategies that teachers can opt to employ as necessary, may be useful in improving teacher knowledge, educational practice and, ultimately, functional outcomes for children who have experienced mTBI. The need for screening and intervention services for children with mTBI is highlighted, along with a reconceptualisation of how special needs are addressed in school settings.

year: 2014

title: Marks of conscious engagement when performing a motor task with or without a robotic arm

authors: Wright, Madison

subjects: conscious control

abstract: Utilizing prosthetic limbs effectively and alleviating the conscious burden through
minimizing conscious control is important to address and understand in the ever-changing
world of technology. Prosthetics can be difficult to learn how to use effectively and using them
increases conscious awareness which is termed a burden. The conscious burden prosthetics
have on users is consistently addressed by a multitude of studies and garners for more in depth
research to understand and identify solutions to alleviate this burden. Conscious motor control
is defined as the level of awareness of an individual performing a movement related skill or
task, where the higher the conscious control the more an individual is thinking of their
movements while executing them. The aim of this thesis was to measure conscious burden
objectively by examining the marks of conscious engagement when performing a reaction time
task with and without a robotic arm.

Chapter 1 is an introduction to this thesis including a literature review of relevant topics
such as prosthetic limbs, conscious movement control, subjective and objective measurements
of conscious movement control and electroencephalography (EEG). Prosthetic rejection rates,
conscious burden and prosthetic limb learning are also addressed. The outline of the experiment
for this thesis is included and discussed more in depth in Chapter 2.

Chapter 2 is the experiment in full examining the level of conscious control while
participating in a reaction time based motor learning task using a robotic arm versus own arm.
There were two conditions, the complex condition (multi-choice) and simple condition (single
choice). A secondary task of tone counting was included in half the trials to examine whether
more conscious processing is involved when working with the robotic arm versus normal arm
while doing the reaction time task. It was expected that there would be higher conscious control
and slower reaction times when participants used the robotic arm compared to their own arm.

EEG was used to assess the connectivity between the left temporal verbal-analytical (T7) site
and the motor planning mid-frontal (Fz) site of the brain. Connectivity of T7-Fz is used to
measure the verbal-analytical engagement in motor planning which is then used to measure
conscious control. The results revealed the complex condition had a significantly higher
reaction time dual-task cost for arm compared to robotic arm and a higher T7-Fz connectivity
dual-cost (difference in performance for single versus dual task) for the robotic arm in the
complex condition compared to simple condition. We concluded that use of a robotic arm
increases verbal-analytical engagement when performing a motor task compared to using the
own arm.

Chapter 3 is the overall discussion of the experimental findings for the use of robotic
arms in reaction time tasks measuring conscious control and what it may mean for future
research. Implicit motor learning is discussed as well as implicit motor learning interventions
such as dual-task learning, analogy learning and errorless learning. There are also other
learning interventions to promote intuitive control in prosthetic limb learning such as gaze
training and neurofeedback.

text: Marks of conscious engagement when performing a motor task with or without a robotic arm Utilizing prosthetic limbs effectively and alleviating the conscious burden through
minimizing conscious control is important to address and understand in the ever-changing
world of technology. Prosthetics can be difficult to learn how to use effectively and using them
increases conscious awareness which is termed a burden. The conscious burden prosthetics
have on users is consistently addressed by a multitude of studies and garners for more in depth
research to understand and identify solutions to alleviate this burden. Conscious motor control
is defined as the level of awareness of an individual performing a movement related skill or
task, where the higher the conscious control the more an individual is thinking of their
movements while executing them. The aim of this thesis was to measure conscious burden
objectively by examining the marks of conscious engagement when performing a reaction time
task with and without a robotic arm.

Chapter 1 is an introduction to this thesis including a literature review of relevant topics
such as prosthetic limbs, conscious movement control, subjective and objective measurements
of conscious movement control and electroencephalography (EEG). Prosthetic rejection rates,
conscious burden and prosthetic limb learning are also addressed. The outline of the experiment
for this thesis is included and discussed more in depth in Chapter 2.

Chapter 2 is the experiment in full examining the level of conscious control while
participating in a reaction time based motor learning task using a robotic arm versus own arm.
There were two conditions, the complex condition (multi-choice) and simple condition (single
choice). A secondary task of tone counting was included in half the trials to examine whether
more conscious processing is involved when working with the robotic arm versus normal arm
while doing the reaction time task. It was expected that there would be higher conscious control
and slower reaction times when participants used the robotic arm compared to their own arm.

EEG was used to assess the connectivity between the left temporal verbal-analytical (T7) site
and the motor planning mid-frontal (Fz) site of the brain. Connectivity of T7-Fz is used to
measure the verbal-analytical engagement in motor planning which is then used to measure
conscious control. The results revealed the complex condition had a significantly higher
reaction time dual-task cost for arm compared to robotic arm and a higher T7-Fz connectivity
dual-cost (difference in performance for single versus dual task) for the robotic arm in the
complex condition compared to simple condition. We concluded that use of a robotic arm
increases verbal-analytical engagement when performing a motor task compared to using the
own arm.

Chapter 3 is the overall discussion of the experimental findings for the use of robotic
arms in reaction time tasks measuring conscious control and what it may mean for future
research. Implicit motor learning is discussed as well as implicit motor learning interventions
such as dual-task learning, analogy learning and errorless learning. There are also other
learning interventions to promote intuitive control in prosthetic limb learning such as gaze
training and neurofeedback.

year: 2024

title: New Zealand’s indigenous forests – their status and drivers of change

authors: Allen, Robert

abstract: New Zealand’s remaining indigenous forests and shrublands are of immense cultural, environmental, and economic significance. A representative plot-based sample of these forests and shrublands has recently allowed an unbiased depiction of their composition
and structure. This is necessary for international reporting, performance assessment and management prioritisation. Their composition, structure, and function are driven by a diverse array of factors, many of which are complexly interrelated. The imprint of disturbances is pervasive and it is necessary to understand disturbances to interpret human-related impacts. For example, understanding impacts of exotic browsing mammals is only possible within a context of forest ecosystem development and tree demographic processes. There are now extensive areas of shrublands successional to forest, often composed of mixtures of indigenous and exotic species. These shrublands expand the pportunities for ecosystem services from, for example, carbon sequestration to water quality. An increasing area of indigenous forests and shrublands are managed for distinctive Māori aspirations that include sustainable use.

text: New Zealand’s indigenous forests – their status and drivers of change New Zealand’s remaining indigenous forests and shrublands are of immense cultural, environmental, and economic significance. A representative plot-based sample of these forests and shrublands has recently allowed an unbiased depiction of their composition
and structure. This is necessary for international reporting, performance assessment and management prioritisation. Their composition, structure, and function are driven by a diverse array of factors, many of which are complexly interrelated. The imprint of disturbances is pervasive and it is necessary to understand disturbances to interpret human-related impacts. For example, understanding impacts of exotic browsing mammals is only possible within a context of forest ecosystem development and tree demographic processes. There are now extensive areas of shrublands successional to forest, often composed of mixtures of indigenous and exotic species. These shrublands expand the pportunities for ecosystem services from, for example, carbon sequestration to water quality. An increasing area of indigenous forests and shrublands are managed for distinctive Māori aspirations that include sustainable use.

year: 2015