As a result of medical advancement and cultural patterns of Western society, traumatic head injury is increasingly a problem for the injured, their families, medical and social services professionals, and the community at large. Head trauma is remarkable because of the complex nature of the residual disabilities which include long lasting cognitive and emotional problems, social isolation, and family disruption. The purpose of this study was to re-examine the phenomenon of recovery after mild to moderate head injury using an ethnographic research approach. The data were based on the experiences of 21 disabled and their families in the community setting. The disabled represented a range of stages of recovery and severity of disability. The data was collected using three field work strategies: extensive semi-structured interviews, participant observation, and non-academic document review. After collection the data was subjected to thematic and content analysis, that resulted in the selection of themes that characterized the experiences for the head injured and their families. The themes for the head injured informants were: dead days, loneliness, and forgetting. The family members' experiences were represented in the themes: responsibility, vulnerability, tough love, gender differences, and reactions to the experience. Next the data were interpreted using five theoretical concepts from cultural anthropology: liminality, personhood, social labelling, sick role and double bind. In addition, the reflexive influence of the investigator on the research process was addressed. The trustworthiness of the ethnography was assessed in terms of credibility, transferability, dependability and confirmability. Several variables were found to be important to the long term outcome of head injury. These variables were: family directed therapy, double bind communication patterns, and lifelong recovery. Two other factors were found to be critical for the recovery of the head injured. These were economic disincentives to the return to employment and the importance of the social and family environment. In the final section the research and policy implications of the study were discussed in relation to management and service provisions.

This study investigated the relationship between the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Stanford-Binet Intelligence Scale: Fourth Edition (SBIV) in a brain-damaged adult sample. The sample in this study was composed of 30 adult patients at two residential treatment programs who completed comprehensive psychological evaluations between August, 1986 and November, 1987. Each patient was administered both the WAIS-R and the SBIV as part of these evaluations. Data gathered in this study was submitted to Pearson product moment correlational statistical procedures. Significant correlations were found in the following pairs of summary scores: the SBIV Test Composite Standard Age Score (SAS) and the WAIS-R Full Scale IQ; the SBIV Abstract/Visual Reasoning Area SAS and the WAIS-R Performance IQ; the SBIV Quantitative Reasoning Area SAS and the WAIS-R Verbal Scale IQ; the SBIV Verbal Reasoning Area SAS and the WAIS-R Verbal Scale IQ; the SBIV Short-Term Memory Area SAS and the WAIS-R Verbal Scale IQ; and the SBIV Short-Term Memory Area SAS and the WAIS-R Full Scale IQ. Significant correlations were also found in the following pairs of individual subtest results: the SBIV and WAIS-R Vocabulary subtests; the SBIV Memory for Digits subtest and the WAIS-R Digit Span subtest; the SBIV Pattern Analysis subtest and the WAIS-R Block Design subtest; and the SBIV Paper Folding and Cutting subtest and the WAIS-R Picture Arrangement subtest. Directions for future research were also suggested upon review of the subtest correlation matrix and the descriptive statistics of data generated.

Ph.D (Industrial Psychology) / Brain injuries often occur suddenly and without warning, and from that instant, a normal life can be changed. Traumatic Brain Injury (TBI) may result in significant impairment of an individual’s physical, cognitive and psychosocial functioning. Although there is a fair amount of research on the concept of brain damage and the consequent effects on the family and return to work (RTW) prospects, there is far less information available on the actual assessment of workplace capability or workplace potential following the head injury incident. This is important, since the concept of work or job value has been well documented. Employment is far more than just a job; it not only provides for basic sustenance needs and decent living conditions, but also allows someone to fit into the world, create relationships, use talents and skills, learn, grow and build, and develop a sense of identity and belonging. While the value of work is well-documented, the statistics regarding unemployment following a head injury are concerning. It is estimated that approximately 1.5 million Americans sustain head injuries each year, with the majority of these people being under the age of 35 and in their prime years of vocational productivity. A baseline figure of 2% of the American population is currently living with disabilities as a result of head injuries. In South Africa, the rate of occurrence seems to be even more alarming, with published rates of 89,000 cases for 2009. In 2001, this was a baseline figure of 5% of the population living with disabilities resulting from head injuries. Various sources put the occurrence of head injuries in South Africa at 1.5 to 3.5 times higher than the estimated global rate. The negative impact of this on the individual, the family, community and economy is clear.

To date, no research exists examining criterion-related validity of alternate, computerized forms of the Category Test. The intent of this study was to address criterion-related validity of three full forms of the Category Test. In that, the goal was to examine equivalency of each version in their ability to differentiate brain-injured from non-brain-injured individuals. Forty-nine (N = 49) healthy adults and 45 (N = 45) brain-injured adults were tested using three versions of the Category Test, the BDI, and the WAIS-R NI. ANOVA indicated no significant differences between versions of the Category Test or an interaction between Category Test version and group membership on the total error score. MANOVA performed between versions of the Category Test and Subtest error scores indicated significant differences between versions on Subtest 3 and Subtest 6. Group membership (brain-injured v. non-brain-injured) produced a significant main effect on all subtests of the Category Test except Subtest 2. Several exploratory analyses were performed examining the relationship between neuropsychological impairment, group membership based on Category Test error scores, and the WAIS-R NI. Clinical applications, such as the use of serial testing to index neurorehabilitation gains, were discussed.

Emotion regulation is an ability that humans engage in throughout their lives. Disruption in this ability due to brain injury can have devastating consequences on the ability to function adaptively in complex environments. It has been observed that damage involving certain areas of the prefrontal cortex (PFC), including the ventromedial PFC (VMPFC), can result in long-lasting impairments in real-world emotional and behavioral functioning. However, the specific areas of the PFC that are critical for the ability to regulate emotion have not been identified. The primary aims of this project were to identify areas of the PFC that are important for the regulation of emotion, and to determine the degree to which impairments in emotion regulation may contribute to real-world dysfunction following damage to the PFC. To address these aims, emotional regulation and real-world functioning were examined in a sample of patients with focal PFC lesions. Damage involving the VMPFC appeared to have limited impact on the ability to voluntarily regulate emotion. It was also observed that damage to PFC regions outside the VMPFC was associated with reduced ability to overcome distraction by salient emotional stimuli, compared to VMPFC damage. However, analyses of lesion volume showed that more extensive damage involving the VMPFC was associated with greater emotional distraction, suggesting one form of emotional dysregulation that may result from damage to the VMPFC. In addition, it was found that brain damage in general was associated with impairments in real-world functioning, though PFC damage was not associated with more striking impairments compared to damage outside the PFC. These findings suggest that damage involving certain PFC regions can disrupt the ability to effectively regulate emotion. The results from this project also suggest that laboratory measures of emotion regulation may help in predicting real-world dysfunction following brain damage.

The purpose of this study was to examine and compare inferential abilities on a reading comprehension task in two groups of adults who had suffered cerebrovascular accidents (CVA). Sixteen subjects with a CVA to the right hemisphere of the brain were compared to an equal number of left hemisphere damaged subjects. Subjects were selected after they had demonstrated an adequate level of functioning on the Short Porch Index of Communicative Ability (SPICA), a test which measures communicative efficiency, to perform the tasks required in this study. All subjects were administered the revised version of the Nelson Reading Skills Test (NRST). On the NRST, test questions can be grouped into three categories representing literal, translational and high levels of inference. Subjects were presented five reading paragraphs. They were asked to answer thirty-three questions pertaining to the reading material by pointing to the correct answer out of four choices. Subjects were allowed to refer back to the paragraphs when trying to answer the questions. Results revealed total NRST performance to be significantly better for RBD subjects. RBD subjects also performed significantly better than LBD subjects on translational inference items. The research data did not reflect the expected error pattern with most errors on questions requiring high inferential abilities followed by translational items and fewest errors on literal inferences for either group of subjects.

This study explores the processes and conditions surrounding long-term care decision-making and care management after traumatic brain injury. Grounded theory methodology and methods were used. Semi-structured interviews were conducted with a total of 51 participants in New South Wales, Australia. A grounded theory of care management was developed through constant comparison of data and cases and identified a social problem, a core social process, strategies, conditions and consequences. The basic social problem was the need for ongoing care, a problem which the person with brain injury and others managed collectively. Together, they determined an appropriate care location or living situation, configuration of carers and level of care. This study provides a framework for understanding preferred ways of living with care after brain injury. Increased autonomy was a desired outcome. Living alone and spending time alone were associated with increased autonomy and increased risk. A series of strategies and processes are suggested that allow professionals and family carers to gradually increase risk, and share responsibility for risk management. The findings have implications for health professional and legal practice, education, research and policy. / Doctor of Philosophy (PhD)

The aim of the thesis was to evaluate the effectiveness of static hand splints for the prevention of muscle contracture during early rehabilitation following acquired brain impairment. Three studies were undertaken and are reported in the research. The aim of the first study was to appraise the existing research on the effects of hand splinting for adults with hemiplegia following acquired brain impairment. The aim of the second study was to evaluate the effectiveness of static hand splints which position the wrists and fingers in the common ‘functional position’ when provided in conjunction with a rehabilitation program which included daily motor training and prolonged stretches. The aim of the final study was to evaluate the effectiveness of two hand splinting positions, the ‘functional position’ and a position of wrist and finger extension, in comparison to a control group that did not receive prolonged stretches. Findings indicate that splinting the hand in the ‘functional’ position or in a position of greater wrist extension did not prevent contracture following acquired brain impairment over the course of the study periods (4 weeks with follow up at 4 and 6 weeks in studies 2 and 3 respectively). / Doctor of Philosophy (PhD)

Traumatic brain injury (TBI) is frequently associated with both cognitive and behavioural executive dysfunction. Assessment of executive dysfunction has traditionally been measured using tests that were not based on theory and this has been postulated as one reason why there are poor predictive relationships between performance on traditional executive tasks and functional outcome following TBI. Baddeley�s (1996) working memory model may offer a theoretical basis with which to design new executive measures and possibly improve prediction of outcome. Baddeley�s theory has made recent advances in identifying core central executive (CE) processes that are likely to be relevant to TBI. The research presented in the thesis used Baddeley�s proposed coordinative sub function of the CE (and it related dual tasking measure) to assess: (a) whether this theoretically based dual tasking test would be sensitive to TBI injury status and show a significant relationship with functional outcome, (b) whether the theoretically based test would be more sensitive to the above relationships than executive measures that have been traditionally available, and (c) whether more ecologically relevant dual tasks could be developed that reflect the coordinative construct and improve predictive relationships between task performance and real life functional ability. This study found that Baddeley�s Dual Task Test (DTT) measure was sensitive to TBI injury and was related to functional outcome following injury. A questionnaire assessing everyday dual tasking ability was developed as was an in vivo conversation and motor based dual task. The dual tasking questionnaire reflected Baddeley�s coordinative construct, however, applications to an in vivo conversation and motor based dual task were less successful. These ecologically relevant tasks showed a relationship between language dysfluencies and dual tasking and identified avoidance of dual tasking in everyday settings as an important predictor of functional outcome following injury. Overall the DTT and the dual tasking questionnaire showed greater injury sensitivity and stronger relationships with outcome than three executive measures traditionally used in clinical practice. Regression analysis confirmed that the dual based tasks were helpful in predicting a variety of outcomes following TBI, and implications for rehabilitation planning are discussed. Further increases in the predictive power of the dual tasking construct are likely to be achieved when mechanisms of action involved in both laboratory-based and real-life dual tasking are identified. Findings from the current study suggest a range of mechanisms could be involved in dual tasks and these are discussed.

Although it is well established that persons with traumatic brain injury (TBI) experience word retrieval difficulties, the underlying cause of these deficits is not known. Difficulties with word retrieval have negative social implications as they can impact on the ability to converse with others. The overarching goal of this dissertation was to determine the underlying cause of problems with word retrieval after TBI. To test word retrieval in this dissertation, participants were given a series of word fluency tasks and the speed of word generation was measured. In addition to measuring interresponse times, procedures used by Rohrer, Wixted, Salmon and Butters (1995) were also followed. This involved the calculation of parameter estimates to investigate whether slowed retrieval or degraded semantic stores were responsible for the patients� word retrieval difficulties. One parameter (N) was a measure of the total number of retrievable words and the second parameter (tau) was an estimate of mean latency. Study 1 was designed to trial the procedure and equipment adopted throughout this dissertation to analyse speech. University students were presented with categories on a computer screen and asked to generate as many exemplars as possible in 60 seconds. A PowerLab Chart sound system was used to measure the time that each word was generated. The results of Study 1 showed that the methodology of previous research could be replicated using the PowerLab Chart sound system. In Study 2, persons with postconcussion syndrome (PCS) and matched controls were given two word fluency tasks. Results showed that on both tasks patients recalled fewer words, had longer pauses between words, and took significantly longer to generate their first word than controls. Also, patients had a significantly reduced N relative to controls, but there was no difference in tau between patients and controls. Given that the participants had not finished responding and that parameter estimates require responses to be exhausted, Study 3 was designed to replicate the findings of Study 2 using an extended recall period. In Study 3, patients with PCS and matched controls completed a series of word fluency tasks and were given extended periods of time to generate words. Results showed that the patients obtained significantly fewer words on two of the tasks, but no evidence of slowed retrieval was found. There was also no difference in the estimates of N and tau between patients and controls. As the patients in Study 3 sustained more minor injuries than those in Study 2, Study 4 tested patients with severe TBI. In Study 4, patients with severe TBI and matched controls were given a series of word fluency tasks. Results showed that the patients generated fewer words and experienced slowed retrieval. Again, there was no difference in the estimates of N and tau between patients and controls. The results of Study 4 confirmed the hypothesis that slowed word retrieval is a consequence of TBI. Taken together, the results of this dissertation show that an underlying slowness of processing is the primary cause of problems with word retrieval in persons with TBI.