M.A. (Psychology) / The Post Traumatic Amnesic Syndrome, which follows a mild closed head injury, seems to be a common occurrence in the field of neuropsychology. The syndrome is primarily characterised by a transient memory loss of daily events, normally commencing within days after the injury. The symptoms include absent-mindedness, an inability to remember names, dates, numbers and faces, commands and orders given at work. Due to the relatively uncomplicated nature of a mild closed head injury, the syndrome is often overlooked and underestimated in terms of its intensity and psychological damage. Patients are sent home after a brief observation period and medical staff are of the opinion that the patients will recover successfully, without experiencing much psychological or cognitive strain. It is usually thought that the syndrome does not last for more than three to four months. The aim of the research was to determine the nature of the experience of not being able to remember daily events, as part of the post traumatic amnesic syndrome. The influence of the syndrome on the patients' support persons was also investigated

The effects of repeated mild concussive head injury on professional rugby players were examined. Data were collected for rugby players (n=26) and cricket player controls (n=21) using a comprehensive neuropsychological test battery comprising five modalities (Verbal Memory, Visual Memory, Verbal Fluency, Visuoperceptual Tracking and Hand Motor Dexterity) and a self-report Postconcussive Symptomology Questionnaire. Group statistical comparisons of the percentage of individuals with deficit were carried out for (i) rugby versus cricket; (ii) rugby forwards versus rugby backs; and (iii) rugby forwards versus cricket. Rugby players performed significantly poorer than controls on SA W AIS Digit Symbol Substitution subtest and on the Trail Making Test. On Digits Forward and Digit Symbol Incidental Recall, the results approached significance with the rugby players showing a tendency toward impairment on these tests. Rugby players exhibited impairment in areas of visuoperceptual tracking, speed of information processing and attention, and there are tendencies of impairment in verbal and/or visual memory. Results obtained on the self-report questionnaire strongly reinforced cognitive test results and a significant proportion of rugby players reported difficulties with sustained attention, memory and lowered frustration tolerance as well as symptoms of anxiety and depression. It was consistently noted that players in the more full contact positions (rugby forwards) were most susceptible to impairment, confirming that these players, who are exposed to repeated mild head injuries, are at greater risk of exhibiting postconcussive sequelae.

The effects of repeated mild concussive head injury on professional rugby players were examined. Data were collected for rugby players (n=26) and cricket player controls (n=21) using a comprehensive neuropsychological test battery comprising five modalities (Verbal Memory, Visual Memory, Verbal Fluency, Visuoperccptual Tracking and Hand Motor Dexterity) and a self-report Postconcussive Symptomology Questionnaire. Group statistical comparisons of the percentage of individuals with deficit were carried out for (i) rugby versus cricket; (ii) rugby forwards versus rugby backs; and (iii) rugby forwards versus cricket. Rugby players performed significantly poorer than controls on SA W AIS Digit Symbol Substitution subtest and on the Trail Making Test. On Digits Forward and Digit Symbol Incidental Recall, the results approached significance with the rugby players showing a tendency toward impairment on these tests. Rugby players exhibited impairment in areas of visuoperceptual tracking, speed of information processing and attention, and there are tendencies of impairment in verbal and/or visual memory. Results obtained on the self-report questionnaire strongly reinforced cognitive test results and a significant proportion of rugby players reported difficulties with sustained attention, memory and lowered frustration tolerance as well as symptoms of anxiety and depression. It was consistently noted that players in the more full contact positions (rugby forwards) were most susceptible to impairment, confirming that these players, who are exposed to repeated mild head injuries, are at greater risk of exhibiting postconcussive sequelae / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

sustained multiple concussions may be at risk of cumulative impairment. The role of neuropsychological testing in the management of sports-related concussion is a contentious and challenging issue which has gained credibility given the lack of clear and well-established guidelines pertaining to the diagnosis, assessment and return-to-play decisions following concussion. Despite various traditional paper and pencil tests being shown to be effective indicators of postconcussive neuropsychological dysfunction, testing has not been widely implemented, due to time- and labour-demands. ImPACT, a computer-based neuropsychological assessment instrument, has been recognised as a valid and reliable tool in the monitoring of athletes' symptoms and neurocognitive functioning preseason and postconcussion. As a part of larger-scale concussion research conducted on top-team university rugby players, this is an in-depth case study conducted on a 20-year old participant with a history of multiple concussions, who was referred following a concussion sustained during the season. The objectives of the study were: (i) to determine the sensitivity of ImPACT versus WAIS-III Digit Span and Trail Making Test during the acute postconcussive phase; and (ii) to examine the sensitivity of ImPACT versus a comprehensive battery of neuropsychological tests to possible residual deficits as a result of the multiple concussions. ImPACT was determined to be more sensitive to acute postconcussive impairment following concussion than Digit Span and Trail Making Test. Furthermore, the ImPACT preseason baseline scores appear to be sensitive to neurocognitive dysfunction, possibly due to cumulative concussive injuries.

The present study comprises part of an ongoing research study investigating the effects 0 f cumulative mild head injuries 0 n Rugby Union p layers. The aim 0 f t he study was to ascertain whether there are neuropsychological effects of cumulative mild head injuries sustained during the rugby-playing careers of senior schoolboy rugby players. Participants were top-level rugby players from high schools in Grahamstown and Cape Town (n = 79) and non-contact sport controls of top-level field hockey players from the same schools (n = 58). Group mean comparisons across a battery of neuropsychological tests were carried out between the Total Rugby versus the Total Field Hockey group, and the Rugby Forwards versus the Rugby Backs group. Comparisons between Total Rugby versus Total Field Hockey revealed impaired performance by the rugby players on two tests of visuoperceptual tracking, namely Digit Symbol Substitution and Trail Making Test (Part A). For Rugby Forwards versus Rugby Backs, there were no consistent differences to support the expectation that forwards would perform worse than backs. Forwards performed more poorly than backs on WMS Associate Learning Subtest - Hard (Delayed Recall), whereas backs performed more poorly than forwards on Digits Backwards. This suggests that some individuals in the cohort were starting to exhibit verbal memory deficit, albeit not clearly in association with forward positional play. Overall, results of the present study provide tentative support for the hypothesis that school level rugby players are more susceptible to the effects of cumulative concussive and sub-concussive head injuries than are non-contact sport controls. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

M.A. / A review of existing relevant literature and research confirms that there is not always unanimity about the diagnosis and classification of the Post-concussion syndrome (PCS). This controversy arising from the diagnosis results in the failure to inform, prepare and equip the patient and his family adequately for the effects of PCS. This influences the treatment and eventual rehabilitation of a patient who has a light head injury. It is, therefore, essential that the medical field, over the whole spectrum of medical disciplines, should fully understand PCS and the patient, and should also provide the patient's support system with the necessary information with regard to the effects of PCS. This will, in truth, affect the rehabilitation of this patient. An investigation of the literature showed that most light head injuries are the result of road accidents, followed by industrial and factory accidents. Other types of head injuries and alcohol abuse play a further role in the appearance and degree of seriousness of light head injuries. The effect of PCS symptoms range from physical discomforts such as headaches to more emotional problems such as depression, fatigue, anxiety and concentration problems. Primary symptoms fade with the passing of time while secondary symptoms increase after the first few months after the head injury. The experience of PCS symptoms can be influenced by different factors such as pre-trauma personality traits, accident neurosis and compensations. It is postulated that the experience of typical PCS symptoms can be mediated by sufficient understanding, knowledge and realistic expectations on the part of the light head injured patient. The aim of the study was to address the problem of insufficient information provided to patients suffering from PCS regarding the symptoms they are likely to suffer. This was done by creating a post-trauma information program consisting of an attractive and multicoloured booklet with easy access to various issues such as explanation of terminology, the neurology of concussion, likely symptoms, prognosis and recovery time. The booklet was complemented with a casette recording of relevant issues, presented in different voices, with a calming musical background. The patients who were selected to participate in the evaluation of the program had all presented at the 1 Military Hospital over a period of 18 months with firmly diagnosed PCS based on scores obtained on the Galveston Orientation and Amnesia Test (GOAT) and the Glasgow Coma Scale (GCS). A total of 81 white, male subjects were selected. All the subjects complied with certain criteria such as Afrikaans or English language proficiency, falling within a particular age group (16 - 35 years) and with no prior neurological or psychiatric disease. The 81 patients were randomly divided into groups according to the Solomon fourgroup design. Pre tests were administered to the two experimental groups. The pre tests consisted of four subscales of the Profile of Mood States (POMS) and four subscales of the Personal, Home, Social and Formal Relations Questionnaire (PHSF). The validities and reliabilities of these scales are wel documented. The four selected POMS subscales were: Tension-anxiety Depression-dejection Anger-hostility Fatigue-inertia The four selected PHSF subscales were: Self-esteem Self-control Health Formal Relations One experimental and one control group now received the intervention program.

Neurocognitive and symptom profiles of concussed and nonconcussed adult provincial rugby union players were investigated over one rugby season, including early season (baseline), intermittent postconcussion, and end of season testing. In a non-equivalent quasi-experimental design, nonconcussed (n = 54) and concussed (n = 17) rugby groups were compared with demographically equivalent noncontact sport controls (n = 37, and n = 17, respectively). Measures included the ImPACT cognitive and symptom composites, and the WMS-III Visual Reproduction and Verbal Paired Associates subtests. The independent and dependent comparative analyses in respect of both nonconcussed and concussed groups, provided cross-validation of poorer acute and/or chronic neuropsychological outcomes for the rugby groups on the ImPACT Reaction Time, Visual Motor Speed, Impulse Control and Symptom composites, and the WMS-III Verbal Paired Associates. The finding of significantly poorer scores on Verbal Paired Associates up to 24 days post concussion for the rugby players versus controls, was longer than the 7 – 10 day recovery period frequently cited in the literature. The overall implication of the study is that even in a group with high cognitive reserve such as these provincial level athletes, there may be prolonged acute recovery, as well as permanent deleterious neuropsychological consequences of cumulative concussive injury in association with a sport such as rugby. Accordingly, the move towards careful individualised postconcussion monitoring of neurocognitive functioning is endorsed, including early identification of any significant permanent reductions in cognitive reserve. Sensitivity of the ImPACT test might be enhanced via inclusion of a verbal associate learning task.