The number of informal carers in the UK is rising, yet the dynamics of care within informal care relationships remain poorly understood. The present research examined adaptation of informal care relationships affected by Acquired Brain Injury. The research addresses four pairs of questions: (1a) Are there any disagreements and/or misunderstandings between carers and people with Acquired Brain Injury (PwABI) regarding carer identity? (1b) How can the pattern of divergences be explained? (2a) Are there any disagreements and/or misunderstandings between carers and PwABI regarding PwABI identity? (2b) How can the pattern of divergences be explained? (3a) What strategies do carers and PwABI use in collaboration on a joint task? (3b) Is the type of input provided by carers on the joint task comparable to scaffolding as described in the child development literature? (4a) What happens when carers and PwABI collaborate to fill in the Disability Living Allowance (DLA) claim form? (4b) Why do carers see more disability than PwABI when filling in the DLA form? Four mixed-method data sets were used to answer these questions: (1) numerical ratings given by PwABI and carers to map out convergences and divergences (2) videos of discussions between participants and researcher during rating tasks (3) videos of carers and PwABI engaging in a joint task - planning inviting a friend or relative round for a meal and (4) videos of carers and PwABI filling in part of the DLA claim form. All data was collected from the same 28 PwABI/carer dyads who were two or more years post injury. Chapter 4 addresses questions 1a and 1b. Carers’ and PwABIs’ perspective ratings revealed a number of disagreements regarding carer identity. Carers perceived themselves negatively compared to their partners’ view of them. Regarding question 1b, carers feel negatively about themselves due to difficulties in the transition to the role of ‘carer’. They experience a lack of recognition for this caring role as a result of concealing the burden of care. Carers require more long term support from health services to help them achieve recognition for their role, such as facilitating attendance at support groups. Chapter 5 addresses questions 2a and 2b. Carers’ and PwABIs’ perspective ratings revealed only one disagreement and corresponding misunderstanding regarding PwABI identity. Regarding question 2b, alignment was found between the perspectives of carers and PwABI regarding PwABI due to the relational rating method used. It is carer identity which is the source of most divergences of perspective, not PwABI identity as commonly assumed. Using a relational rating method shows promise as a tool to explore perspectives as it treats all viewpoints as equal and avoids pathologising the perspective of PwABI. Chapter 6 addresses questions 3a and 3b. Analysis of strategies shows that completing a joint task is a collaborative process. Carers direct the background of the task but PwABI are in charge of the foreground, making task decisions. However, carers dominate the process and control where and how PwABI contribute. Regarding question 3b, the interaction meets the criteria for scaffolding in the strategies chosen and the flexibility of collaboration. However, removal of supports is often an unrealistic goal, leading to frustration in carers. Examination of processes of collaboration has elucidated the strategies used by carers and PwABI and can enhance theoretical discussion of the applicability of the scaffolding metaphor for a cognitively impaired adult sample. Chapter 7 address questions 4a and 4b. Disagreements were frequent when completing the DLA form. Contestations were almost exclusively in the direction of carers seeing greater disability than PwABI. Regarding question 4b, carers see greater disability due to the communication required to complete the form. Dyads are forced to confront disability, a pattern of interaction they avoid in everyday life. Carers marginalise PwABI point of view and position themselves as ‘expert’ on the PwABI. Differences in frames of reference regarding audience, aim and scope lead carers to maximise the disability and PwABI to minimise this. The impact of completing complex forms on relationships and identity needs to be considered during development of disability benefit assessment methods. A relational approach which studies both halves of informal care partnerships simultaneously allows us to go beyond outcomes of ABI and affords a greater understanding of processes of adaptation.

Early cortical injury has been attributed to the consequential effects of various factors, such as alcohol, drug addiction, smoking, and inadequate nutrient intakes during periods of pregnancy and lactation, or delivery of infants by forceps, and premature deliveries. These are only a few examples of circumstances, or "injury", that may result in disorders ranging from mild learning difficulties to aggressive behaviour. Injury to the cortex during the early years of development has been know to result in poor behavioural outcome into adulthood. Presently, the most common form of treatment includes a pharmacological agent, which may be accompanied with behavioral modification therapies supported by families. As an alternative form of therapy towards the treatment of early cortical injury, choline and a vitamin and mineral supplement (EM Power+) were used to determine the possibilities of nutrition intervention in an animal model. The injuries were incurred by aspiration lesion at days three, (Exp.1) and four, (Exp.2) and lesions were localized to the midline medial frontal cortex in some rats, while a different group of rats received lesions in the posterior parietal cortex. The pre-and postnatal choline treated animals showed favorable results for the medial frontal lesions, and the postnatal vitamin supplement treated animals showed favorable results for treatment in both medial frontal and posterior parietal lesions. All animals were tested in adulthood indicating that nutrition intervention is very beneficial for alleviating some of the functional deficits commonly seen from early cortical injury. / xiv, 191 leaves : ill. ; 28 cm.

Traumatic brain injury (TBI) results in over 50,000 deaths and 80,000 disabilities each year. Current treatment strategies aim to alleviate acute disturbances, but are not able to address the chronic disorders associated with TBI. Neural transplantation is one potential treatment that will provide multifaceted sustained therapy to degenerating injured tissue. Transplantation of multipotent neural stem cells (NSCs) has been shown to enhance functional recovery in TBI models; however, poor cell survival and integration with host tissue potentially restrict the efficacy of such transplants. This limitation may be due to the absence of inherent NSC pro-survival cues (e.g., cell-ECM interactions). Furthermore, the neural injury environment presents cell death factors to transplanted NSCs. It is hypothesized that a 3-D scaffold presenting specific CNS adhesive moieties will enhance donor cell survival and promote differentiation and migration. This project encompassed material development and in vitro characterization. Results highlighted the importance of ligand tethering chemistry and density and also the mechanical integrity of cell scaffold systems. Furthermore, the developed scaffold provides a controlled microenvironment to assess the influence of LN on NSC survival, migration, and differentiation. Lastly, co-delivering NSC with the MC-LN tissue engineered scaffold into a mechanically injured neural co-culture test-bed or in vivo TBI model confirmed the importance of ECM cues for NSC survival and migration, respectively.

[Truncated abstract] Controlled and automatic processing are broad categories, and how best to measure these constructs and their impact on functioning after mild traumatic brain injury (TBI) remains uncertain. The purpose of this thesis was to examine automatic and controlled processing aspects of attention after mild TBI using the Paced Auditory Serial Addition Task (PASAT) and event-related potentials (ERPs). The PASAT is one of the most frequently used tests to evaluate attentional functioning. It has been demonstrated to be a measure sensitive to both acute and longer-term effects of mild TBI, presumably due to demands for rapid processing and executive attentional control. ERPs provide a noninvasive neurophysiological index of sensory processing and cognitive functions and have demonstrated sensitivity to even minor cognitive dysfunction. The parameters provided by this functional technique may be those most likely to distinguish individuals with mild TBI from controls. Initially, it was hypothesized that successful novice PASAT performance requires the engagement of executive attention to establish novel controlled information processing strategies. Ten individuals who had suffered a mild TBI an average of 15.20 months previously were therefore expected to demonstrate processing abnormalities on the PASAT, relative to 10 healthy matched controls. Although the mild TBI group reported significant intensification of subjective symptoms since their injury, compared to controls, the mild TBI group provided a similar amount of correct PASAT responses. ... In the first experiment a visual search task consisting of an automatic detection and a controlled search condition was developed. In the second experiment the search task was performed concurrently with the PASAT task in a dual-task paradigm. In the mild TBI group, prior failure to establish more efficient forms of information processing with practice was found to significantly interfere with simultaneous performance of the PASAT task and the attention demanding condition of the search task. The pattern of impaired performance was considered to reflect a reduction in processing resources rather than a deficit in resource allocation. Dual-task performance in the control group was not associated with a large interference effect. In general, the results of this thesis suggest that individuals with mild TBI are impaired in their ability to progress from the stage of effortful controlled information processing to a stage of more efficient, automatic processing, and thus suffer a subtle attentional deficit. Following mild TBI, performance levels equivalent to controls may only be achieved with an abnormal expenditure of cognitive effort. As a result of the neuropathologic consequences of injury, individuals who have sustained a mild TBI are less able to benefit from practice, experience difficulty coping with simultaneous performance of secondary task, and are susceptible to distressing subjective symptomatology.

This autoethnography explores the phenomenon of marriage after traumatic brain injury (TBI). Capturing as its data, through a series of audio-recorded conversations and journal entries, the first-hand, co-constructed experiences of a married couple, it provides an ‘insider’ and as such, intimate perspective on life together following such an unexpected, disruptive and life-altering event. Situated within ‘a systemic constructionist’ epistemology, it spotlights, in particular, the relational aspects of the post-TBI marriage unfolding over time, rather than just the individual perspectives of each spouse at a single point in time - as most existing studies on the topic do. As a qualitative study, it made allowance for the collection and use of rich, nuanced data so as to do some justice to the complex nature of the topic being studied. David Reiss’ explanatory theory on ‘crisis and the development of the family paradigm’ was applied deductively during the carrying out of a thematic analysis of the data, with the intention of bringing new insights to the understanding of the phenomenon of the post-TBI marriage. Data were also analysed inductively, in that themes emerging from the data itself were also used. A discussion based on the findings of the data analysis was proffered. Based on these findings, recommendations on what issues therapists working from within a family-systems orientation might focus their attention on were made. A recommendation for TBI couples to receive support from early intervention and follow-up services was also made, along with identifying the consequent need for research first to be done on developing and implementing such a service / Psychology / M.A. (Psychology)

Indiana University-Purdue University Indianapolis (IUPUI) / Traumatic brain injury (TBI) has emerged as a major cause of morbidity among U.S. soldiers who have served in Iraq and Afghanistan. Even mild TBI (mTBI) can result in cognitive impairments that can impact how veterans experience such things as physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration. The purpose of this study was to develop a comprehensive self-management intervention for veterans with mTBI to facilitate their community reintegration upon returning from deployment to combat zones. This study was conducted in two Phases. Phase I entailed collecting qualitative data regarding needs, concerns, strategies used, and advice given by eight veterans with mTBI, guided by a conceptual model derived from Ferrans’ and colleagues’ health-related quality of life model and the TBI literature. Six key categories and predominant themes emerged providing further support for the model (cognitive impairments, physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration). Guided by the conceptual model, a mTBI Veteran Needs and Concerns Checklist and 14 algorithms making up the VETeranS Compensate, Adapt, REintegrate (VETSCARE) intervention were developed. Phase II entailed obtaining review of the mTBI Veteran Needs and Concerns Checklist and the 14 VETSCARE algorithms from six TBI experts. On a scale of 1 to 5, with 5 being strongly agree, expert ratings provided moderate evidence of content validity for the checklist (3.33), and for the 14 algorithms (problem relevance 3.92, accuracy 3.73, feasibility 3.80, acceptability 3.84). The average overall expert rating for the VETSCARE intervention was 3.82. The checklist and the 14 algorithms are being revised based on specific comments provided by the experts. Once revised, the mTBI Veteran Needs and Concerns Checklist and the VETSCARE intervention will be tested for feasibility in a future pilot study with veterans with mTBI who have recently returned from combat zones in Iraq and Afghanistan.

This research study consisted of an examination of the role played by the educational psychologist in the emotional and social rehabilitation of the TBI adolescent. A survey of the literature reveals that traumatic brain injury during adolescence negatively impacts on their adaptation, development and functioning after the acute phase of the rehabilitation process. In order to study this phenomenon, a psycho-educational perspective was utilised. An in-depth qualitative study was undertaken by means of a case study design. The two cases being presented offers the reader insight into the cases pre-morbid functioning, the accident and its aftermath, the specific traumatic brain injuries, the emotional and social problems encountered by these adolescents as well as the psychotherapeutic interventions applied by the educational psychologist in the rehabilitation process of the cases under investigation. The conclusions reached from this investigation were that traumatic brain injury during the developmental phase of adolescence, negatively impacts on the emotional and social well being of these adolescents, and that the educational psychologist plays a valuable role in the emotional and social rehabilitation of these adolescents. / Educational Studies / M. Ed. (Guidance and Counselling)

This research study consisted of an examination of the role played by the educational psychologist in the emotional and social rehabilitation of the TBI adolescent. A survey of the literature reveals that traumatic brain injury during adolescence negatively impacts on their adaptation, development and functioning after the acute phase of the rehabilitation process. In order to study this phenomenon, a psycho-educational perspective was utilised. An in-depth qualitative study was undertaken by means of a case study design. The two cases being presented offers the reader insight into the cases pre-morbid functioning, the accident and its aftermath, the specific traumatic brain injuries, the emotional and social problems encountered by these adolescents as well as the psychotherapeutic interventions applied by the educational psychologist in the rehabilitation process of the cases under investigation. The conclusions reached from this investigation were that traumatic brain injury during the developmental phase of adolescence, negatively impacts on the emotional and social well being of these adolescents, and that the educational psychologist plays a valuable role in the emotional and social rehabilitation of these adolescents. / Educational Studies / M. Ed. (Guidance and Counselling)

The recent breakthroughs in the research of brain trauma as it relates to athletics has revealed never before seen damage linked with football participation. Known as chronic traumatic encephalopathy (CTE), it is caused by activities inherent to the sport of football. School sponsored football has been granted immunity through case law and legislation in Texas. Recent research however indicates a different type of injury than those that school districts have been protected of liability from. This will provide a challenge to the immunity school districts have enjoyed regarding football. One route to abrogation of immunity is the state created danger provision established by the Supreme Court. The Fifth Circuit Court whose jurisdiction includes Texas has yet to officially adopt the state created danger theory. This research examined legal precedent to determine the challenge CTE may present the various layers of immunity surrounding school sponsored football in Texas.

Text in Afrikaans / In this study an instrument is suggested for implementation by the Educational Psychologist to design a support programme, aimed at handling family members' stress where a child has sustained a brain injury. Attention was paid to the phenomenon "brain injured child" to ascertain demands and needs (physical, cognitive, psychological and emotional). Specific note was taken of the toll on each family member in their observance, experience, assistance and giving· meaning to the child. Reference was made to existing support programmes for such family members from the acute care phase to the final acceptance and readjustment of the family. With this study the need for a continuous support programme and the contents of such a programme was addressed. Using these guidelines the Educational Psychologist will be able to prepare the family for the stress possibilities in dealing with the brain injured child. / Met hierdie studie is 'n instrument daargestel vir die ontwerp van 'n hulpverleningsprogram vir gebruik deur die Opvoedkundige Sielkundige. Hierdie hulpprogram het as doel, die hantering van stres, deur die gesin van 'n kind, wat 'n breinbesering opgedoen het. In die studie is aandag gegee aan die tipiese gedrag wat oor die algemeen van 'n breinbeseerde kind verwag kan word. Daar is ook gepoog om te bepaal hoe elke lid van die gesin die breinbeseerde kind beleef, aan hom betekenis gee, en hom probeer help ten opsigte van die eise (fisiek en emosioneel) wat hy stel. Verder is daar gekyk na bestaande hulpverlening (gerig op die hantering van stres) aan die gesinslede van 'n breinbeseerde kind vanaf die akute versorgingsfase tot en met die aanpassing en herorganisering van die gesin. Met hierdie studie is 'n behoefte aan 'n kontinue hulpverleningsprogram en die inhoud van so 'n program by gesinslede aangespreek. Aan die hand van die riglyne sal die Opvoedkundige Sielkundige 'n gesin kan voorberei op die stres wat hulle ten opsigte van die hantering van 'n breinbeseerde kind te wagte kan wees. / Psychology of Education / M. Ed. (Voorligting)