Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

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.

One of the consequences of traumatic brain injury is the postconcussion syndrome. The symptoms in this syndrome include headache, dizziness, poor memory, poor concentration, easy fatigue, drowsiness, irritability, sensitivity to light, sensitivity to noise, low alcohol tolerance, visual problems, auditory problems, nausea, vomiting, anxiety, and depression. Several factor analytic studies have shown that these symptoms load onto cognitive and noncognitive factors (Bohnen, Twijnstra, & Jolles, 1992). The aim of this study was to determine whether patients who report different symptoms also evidence differences in cognitive deficits, as indexed by reaction time. For this purpose 106 subjects (mean age 25.92 years; SD=6.05) of both sexes were tested on 8 reaction time tasks adapted from Shum, McFarland, Bain, and Humphreys (1990). There were 54 traumatic brain injury patients (mean age 26.40 years; SD=6.23) drawn from three Pretoria hospitals. They were heterogeneous with respect to diagnosis and severity of injury. For the controls (N=52), the mean age was 25.43 years (SD=5.88). The eight reaction time tasks constituted 4 task variables, each with 21evels. From these tasks, 36 reaction time indexes were derived. The indexes were classified into 4 groups, viz., reaction time (RT), movement time (MT), total reaction time (TT), and subtraction scores (SB, the difference between the 2 levels for each task variable). RT reflects the decision component and MT reflects the response execution component of reaction time. Partial correlation coefficients for all symptoms (p0,01) showed that some symptoms were most frequently associated with RT whilst others were most frequently associated with MT. On factor analysis with varimax rotation, symptoms loaded predominantly with SB scores. Symptoms also loaded with different task variablseuiggesting that they correlated with deficits on different stages of information processing. Taking into account possible methodological constraints that were discussed, these results confirm that different symptoms within the postconcussion syndrome correlate with different cognitive deficits. The correlations between symptoms and indices of reaction time are moderated by the characteristics of the symptoms (frequency & intensity), and the duration since injury. These findings have significance for understanding the aetiology of the postconcussion symptoms and for planning treatment. / Psychology / Ph. D. (Psychology)

A dissertation submitted to the Faculty of Arts, University of the Witwatersrand, in partial fulfilment of the requirements of the degree of Master of Arts / The study reviews the literature concerning mild head injury and post concussion symptoms. It then investigates the applicability of international findings to South African patients. Three groups of subjects are compared: mildly injured, noninjured, and instructed malingerers. The study establishes base rates of postconcussive symptoms in the noninjured subjects, scores on tests of cognitive ability among the noninjured subjects, expectations regarding postconcussive sequelae among the noninjured subjects, the perceptions of injured subjects of their preand postmorbid status, and relationships between subjectively experienced symptoms and cognitive deficits am.ong injured subjects. Injured subgroups are examined to investigate pre-, peri-, and post-injury factors associated with development of postconcussive complaints. No differences in cognitive performance were found between the injured and noninjured groups. Time since injury did not affect cognitive performance, apart from on a copy task. It was found that injured subjects reported lower pre-injury levels of incidence of symptoms than those reported by noninjured subjects. No differences were found between post-injury reporting of postconcussive complaints and those symptoms reported by noninjured controls. Some postconcussive symptoms were nevertheless found to correlate with certain measures of cognitive performance. Instructed malingerers responded differently noninjured injured and not injured subjects, reporting fewer pre-injury complaints and mere post-injury complaints. They also performed more poorly on several cognitive measures. Test scores that effectively identified malingerers were then re-examined, and cut-off rates suggested for differentiating malingerers from genuinely injured subjects. / Andrew Chakane 2018

Mild traumatic brain injuries (MTBI) are the leading type of head injuries with appreciable risque of sequelae leading to functional and psychological deficits. Although mild traumatic brain injuries are frequently underdiagnosed by conventional imaging modalities, rapidly evolving techniques such as diffusion tensor imaging (DTI) reveal subtle changes in white matter integrity as a result of head trauma and play an important role in refining diagnosis, therapeutic interventions and management of MTBI. In this dissertation we use diffusion tensor imaging to detect the microstructural changes induced by axonal injuries and to monitor their evolution during the recovery process. DTI data were previously acquired from 11 subjects, football players of age 19-23 years (median age 20 years). Three players had suffered a mild traumatic brain injury during the season and underwent scanning within 24 hours after the injury with follow-ups after one and two weeks. A set of diffusion indices, such as fractional anisotropy, axial, radial and mean diffusivity were derived from the diffusion tensor. Changes in diffusion indices in concussed subjects were analyzed based on two different approaches: whole brain analysis, using tract-based spatial statistics (TBSS) and region of interest analysis (ROI). In both approaches we use a voxelwise analysis to examine group differences in diffusion indices between five controls and three concussed subjects for all DTI scans. Additional statistical analysis was performed between control groups consisting of five and three non-injured players. Both analyses demonstrated that the MTBI group reveals increase in fractional anisotropy and decreases in transversal and mean diffusivity in cortical and subcortical areas within 24 hours after the injury. / No changes were detected in TBSS analysis for the follow-up data sets. Furthermore, our ROI approach revealed multiples regions with significantly different voxels, non-uniformly distributed throughout the brain, for all diffusion indices in all three scans. Three of the diffusion indices fractional anisotropy, mean and transversal diffusivity showed higher vulnerability to head trauma in subcortical and cortical areas than in regions in the lower brain. Recovery of white matter pathways occured at different locations in the brain at one and two weeks after head trauma. Strong recovery was observed in mean and transversal diffusivity in subcortical areas that correspond to the corticospinal tract. No recovery was found for fractional anisotropy and axial diffusivity in the same region. Also, decreases in fractional anisotropy and increases in transversal and axial diffusivity were observed in the spleninum of the corpus callosum. As voxelwise analysis performed on DTI data revealed white matter regions, which exhibit changes in diffusion parameters in the concussed group for all three scans, we conclude that diffusion tensor imaging is a powerful technique for early detection of axonal injuries and may serve as an important tool for monitoring microstructural changes during the recovery process. / by Angelica Hotiu. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

In recent years there has been considerable interest and research examining psychological distress resulting from athletic injuries, as well as coping strategies for an enhanced recovery. The purpose of this study was to examine the psychological effects of sport related concussions and to determine if participation in support groups can reduce these psychological side effects. Participants included concussed male and female varsity or comparable elite level athletes who were placed in either a control or an experimental group. All subjects completed the Profile of Mood States and the Post Concussion Rating Scale. Participants in the experimental group received three support group intervention sessions, while those in the control group received no intervention. Data was analyzed using descriptive statistics. It was revealed that participants in the experimental group improved their mood state. In addition to the impact of support groups on concussed athletes, factors influencing their moods were also identified including the concussion history of the athletes, the stage of rehabilitation, gender, and number of concussion symptoms.

Mild head injury or concussion accounts for as many as 90% of all traumatic brain injuries and can sometime result in long-lasting and disabling post-concussion symptoms (PCS), even in the absence of detectable structural damage to the brain by morphological imaging. To date, the nature of persistent PCS following mild head injury remains poorly understood as objective and scientifically valid diagnostic tools are practically absent. This, in turn, likely accounts for missed diagnoses, prevents accurate assessment of the severity of the injury and creates difficulties for achieving proper patient management. / This dissertation describes 4 functional magnetic resonance imaging (fMRI) studies designed to establish whether there is a pathological basis to persistent PCS following cerebral concussion in male athletes. Study 1 was intended to evaluate the feasibility of using fMRI to detect changes in brain activation following concussion. The results showed that concussed athletes displayed reduced prefrontal activities compared to a healthy control group when performing a working memory task. In Study 2, we examined the relationship between self-reported PCS and the pattern of brain activity measured by fMRI. The severity of self-reported PCS was found to be associated with blood oxygen level dependent (BOLD) activation patterns in the region of interest: the higher the PCS score the lower the BOLD signal. In Study 3, we used serial fMRI approach to investigate brain activation pattern in the course of injury recovery. The results showed that symptom resolution was accompanied by a return to normal BOLD response patterns. Study 4 was designed to investigate the nature of depression, a common PCS, following concussion. Concussed athletes with depression showed less activation in the dorsolateral prefrontal cortex, and attenuated deactivation in the medial prefrontal region, consistent with functional neuroimaging findings in major depression. Again, depression severity correlated with the strength of the fMRI signal in the region of interests. / Taken together, these results demonstrate the value of functional MRI in the evaluation of cerebral concussion, and provide evidence of an underlying pathology in persistent PCS following concussion.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Cornell University, May, 2007. / Vita. Includes bibliographical references (leaves 162-189).

Disputats, Umeå universitet, 2006. / Härtill 3 uppsatser.