No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

Recovery of movement and function of the upper limb post acquired brain injury (ABI) is problematic. Constraint induced movement therapy (CIMT) involves constraint of the less affected limb for 90% of waking hours for two or more consecutive weeks while intensively training the hemiplegic upper extremity using both physical and behavioural methods. Despite the robust evidence base for CIMT large gaps remain including two key issues which have emerged from two systematic reviews conducted within this thesis. Firstly the majority of research has not used the full multi component core CIMT protocol, and secondly the current level of CIMT implementation within the United Kingdom (UK) is unknown. A subsequent UK wide online survey was conducted to investigate therapist knowledge and application of CIMT in practice. Two main points were made; firstly the majority of therapists did not use CIMT (62.9% n==306) due 10 resource barriers and lack of training, and secondly those who did use CIMT, did not implement the whole package. A clinical feasibility randomised controlled trial (RCT), incorporating standardisation methods to ensure treatment fidelity, was therefore conducted and confirmed that CIMT could be applied using a multi disciplinary approach in a UK clinical setting to the stroke and traumatic brain injury population (TBI). Success was highlighted by the high adherence rates and overall improved outcomes in terms of upper limb function and quality of life compared to those receiving conventional Bobath based upper limb therapy. This feasibility was further highlighted during a focus group study which described a therapist journey from an initial challenge stage to modelling in which therapists discussed the use of CIMT in their future practice. Overall this doctoral work has determined use, and barriers and subsequent enablers to CIMT implementation in the UK in addition to providing a feasible framework for delivering CIMT in the NHS setting.

Mild traumatic brain injury (TBI) may be complicated by long term cognitive and affective symptoms. Conventional imaging findings often do not correlate with the clinical picture in these patients, and frequently underestimate the extent of damage. Quantitative MR imaging techniques are sensitive to microstructural damage in brain grey matter (GM) and white matter (WM) which appear uninjured on conventional MRI. Previous work has predominantly evaluated their use in acute TBI in moderate and severely injured patients, or in chronic TBI across the severity spectrum. This thesis explored the application of quantitative T1 (qT1) and quantitative T2 (qT2) relaxometry and diffusion tensor imaging (DTI) in the acute evaluation of 44 mild and 9 moderate TBI patients in whom neuropsychological assessment had been performed, and compared the results to those of 30 matched control subjects. By combining the scan data with results from the cognitive testing, this work sought to identify correlations between regions of detectable microstructural damage and the neurocognitive functions related to them. Differences between groups were observed in whole brain normal appearing GM in qT1, and in frontal lobe normal appearing GM and WM in qT1 and DTI measures. Differences were also observed in memory performance and executive function between patients and control subjects which correlated with injury severity. Significant negative correlations were revealed between whole brain WM qT1 time and executive function and negative correlations were shown between frontal and left temporal GM qT1 time and both memory performance and phonemic fluency. Also demonstrated were a positive correlation between frontal GM MD and phonemic fluency, and a negative correlation between frontal GM FA and both memory and executive function. Lastly, increases in WM FA in the corpus callosum, corona radiata, superior longitudinal fasciculus and cingulum were shown to negatively correlate with all components of verbal fluency. This work has demonstrated, using quantitative MR imaging, acute differences at a microstructural level between TBI patients and matched control subjects, in tissue appearing normal on conventional imaging. Furthermore, it has shown that these changes correlate with post-concussive cognitive deficits. It is likely that these changes represent damage as a result of traumatic brain injury in the regions responsible for the cognitive functions found to be impaired.

Background: Individuals who have sustained a traumatic brain injury (TB I) may face a number of challenges in physical, psychological, and social domains, which may result in emotional distress. Changes in level of functioning and self-concept have been found to be particularly salient in the experience of emotional distress, as individuals with a TBI may mourn the loss of their previous abilities, roles, and relationships which defined their identity. Objectives: This study aims to examine whether the relationship between level of functioning and emotional distress may be explained by discrepancies between pre- injury and post-injury self-concept. Design: A single sample within-group design was used to investigate the associations between self-discrepancies, level of functioning, and emotional distress. Method: Seventy individuals with a TBI were recruited from statutory and voluntary community services. Participants completed the Head Injury Semantic Differential ill to measure self-discrepancies, and the Beck Depression Inventory 2nd edition and the Beck Anxiety Inventory to measure emotional distress. The Mayo-Portland Adaptability Inventory-4 was completed by a health professional or significant other to obtain a measure of participants' current level of functioning on domains of abilities, adjustment and participation. Results: Correlational analyses revealed pre-injury and ideal self-states were significantly different (in the same direction) from current self, but also significantly different from each other. Significant associations were also found between lower levels of functioning and higher levels of self-discrepancies. Regression analyses provided support for the hypothesis that higher psychological distress and lower levels of functioning would be mediated by self-discrepancies. Conclusions: Self-discrepancies clearly play an important role in an individual's level of functioning and experience of emotional distress post-TB!. The complex interaction between these constructs requires future research to further elucidate their relationships. In addition, the development of more holistic approaches in clinical interventions and rehabilitation for this client group are recommended.