No description available.

No description available.

No description available.

No description available.

No description available.

In Part 1 the Literature on the Neuropsychology of Theory of Mind (ToM) was investigated in a Systematic Literature Review of scanning and Acquired Brain Injury (ABI) lesion studies. The quality of study methodologies and the tests used to assess ToM were evaluated, and findings about the brain regions implicated in ToM were summarised. The quality of some tests of ToM used in the literature was critiqued due to their failure to tap into all three components of a recent definition of ToM (Stone et al, 2003). The quality of the methodology of studies was also examined. Brain regions implicated in ToM according to the review included the frontal cortices, the temporal poles and the posterior cingulate.In Part 2 an Empirical Paper is presented. Many social problems are often evident after ABI and deficits in ToM have recently been discovered in ABI populations (Milders et al, 2006). ToM deficits may contribute to and help explain social difficulties such as finding social interactions hard. Few tests of ToM are widely used with individuals with ABI. A new video test of ToM was designed and piloted on non-brain injured participants and participants with ABI. There was a correlation with performance on the new test and an existing measure of ToM and participants with ABI scored significantly less highly on both tests of ToM. The new test shows promise and further research with the measure is recommended. The results also highlight the utility of routinely assessing social cognition after ABI.

Traumatic brain injury (TBI) is the leading cause of disability in young adults and a major public health problem. Persistent cognitive impairments are common, and constitute a significant source of long-term disability. The specific pathophysiological mechanisms underlying these impairments remain poorly understood. As it disconnects brain networks, white matter damage can be a key determinant of cognitive impairment after TBI. Neuroimaging and neuropsychological methods were employed to explore the relationships between indices of brain structure and cognitive function. The participants were 40 TBI patients and 40 healthy controls. First, relationships between focal lesions and cognitive performance were investigated using structural magnetic resonance imaging (MRI) and a battery of neuropsychological tests. The results demonstrated that lesion location and load are not good indices of the cognitive deficits - probably because diffuse axonal injury is poorly assessed by standard MRI. By contrast, diffusion tensor imaging (DTI) can be used to quantify the microstructure of white matter. A ‘whole-brain’ technique, tract-based spatial statistics (TBSS), was used to flexibly analyse the structure of white matter tracts. Despite only small amounts of focal damage observed using standard MRI, TBSS revealed widespread white matter abnormalities after TBI. White matter damage was found in patients with no evidence of focal damage, and in patients classified as ‘mild’ clinically. Relationships between white matter tract structure and specific cognitive functions were then explored. The structure of the fornix, an important white matter pathway of the hippocampus, correlated with verbal associative memory across the patient and control groups. By contrast, structure of frontal lobe connections showed distinct relationships with executive function in these two groups. The results emphasise the importance of white matter pathology after TBI and suggest that disruption to specific white matter tracts is associated with particular patterns of cognitive impairment, but also highlight the complexity of these relationships.

The majority of literature concerning carers of people with acquired brain injury (ABI) concentrates on the negative consequences. Knowledge of post-traumatic growth (PTG) and positive gain from caring is expanding in the literature. The aim of this study was to explore the experience and report of PTG in carers of people with ABI. Chapter 2 looked at the self-report of PTG, positive and negative changes in relation to coping and mental health symptoms. The results of thirty-six carers suggest that carers will report at least one positive change as a result of being a carer. However, a stronger relationship between negative than positive changes for mental health symptoms and maladaptive coping. The experiences of being a wife of someone with ABI were further explored in Chapter 3. Thematic analysis using Interpretive Phenomenological Analysis (IPA) was used to analyse interviews of wives’ experiences and report of PTG. The themes identified relate to adjustment, coping and the life domains associated with PTG, in particular to interpersonal relationships and philosophy of life. Consideration of informal carers led to speculation of the motivations of professional carers, including psychological therapists. A literature review (Chapter 1) was conducted of the empirical evidence describing the influence of personality and family of origin on choice of career as a psychological therapist. The results are discussed in relation to methodological limitations, clinical implications and future directions for research. Chapter 4 offers reflections on the process of carrying out research and the impact, particularly of qualitative research, on the researcher. Some clinical implications from Chapters 2 and 3 are expanded to that contained within the chapters.

The lived experiences of the family of a Traumatic Brain Injury (TBI) survivor is an under represented, yet growing field of qualitative psychological research. This thesis used a case study approach with a family in which one member sustained TBI thirteen years previously. Using conversational unstructured interview techniques, I participated with the family in eliciting public narratives around their experiences since the accident. These public stories were also thickened by individual interviews, which both supported and contradicted the public narratives. In the analysis I found two major narrative lines, the first of which was the baby-narrative which held that the injured person must not be injured any further in word or deed and must be protected at all time. The second dominant narrative was the fighting-narrative, which was characterised by language and actions around fighting/battling on behalf of the injured person against uncaring ‘others’. Several important suppressed or counter narratives emerged during the individual interviews, which could not be spoken about publically. I conclude that the power of the two dominant narratives is fuelled by constant rehearsal and enactment, which actually freezes the family and does not allow it to move forward. Suppressed stories are discussed as a possible avenue for therapeutic growth and for the evolution of the family story as they age.

Injuries to the brain are the leading cause of permanent disability and death. Survivors of acquired brain injury (ABI) experience cognitive impairments and emotional problems. These often persist into community rehabilitation and are among the most significant needs for those in chronic stages of rehabilitation. There is a dearth of research providing evidence of music therapy addressing cognitive deficits and emotional needs in a holistic approach. This research answers the question how can brief group music therapy address cognitive functional gains and emotional needs of people with acquired brain injury. A mixed methods design was used to investigate the effect of 16 sessions of weekly group music therapy on attention and memory impairments, and emotional needs of ten ABI survivors in community rehabilitation. Quantitative data were collected to determine the effect of treatment on attention and memory functioning, mood state, and the satisfaction of emotional needs. Qualitative data were collected to reveal survivors’ experiences of brain injury and brief group music therapy. Analysis of the data showed that the intervention improved sustained attention (p<.05, r=.80) and immediate memory recall (p>.05, r=.46), and that the effect of treatment increased with dosage. Overall, the intervention was more effective than standard care, and cognitive functional gains continued after treatment for some ABI survivors. The intervention addressed emotional needs of feeling confident (p<.05, d=.88), feeling part of a group (p<.05, d=.74), feeling productive/useful (p<.05, d=.90), feeling supportive (p<.05, d=.75), feeling valued (p<.05, d=.74), and enjoyment (p<.05, d=.34). Improvements in these domains were observed in the immediate term and over the course of therapy. Music therapy enabled emotional adjustment through the development of selfawareness and insight. This study offers a music therapy method to deliver a holistic approach in rehabilitation. It demonstrates that music therapy can provide a cost effective, holistic treatment for ABI survivors.