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Computerized cognitive retraining is a technique for remediation of the cognitive and behavioral changes which follow a traumatic brain injury. The technique utilizes specifically developed computer software which builds on the basic foundations of intellectual functioning. While the injured patient is the target of treatment, the method appeared to have an impact on the patient's family as well. Families of patients who participated in computerized cognitive retraining initially appeared to have fewer difficulties with anxiety, depression, and family problems. They also appeared to be more involved in the patient's treatment than were similar families who had not had this experience.The experiment evaluated the secondary psychological effects of computerized cognitive retraining on the brain injured patient's primary caretaker in the family. The dependent variables studied were perception of family involvement in patient treatment, anxiety, depression and perception of family problems.Subjects were recruited from the outpatient case load of the Psychology Department of Fort Sanders Regional Medical Center in Knoxville, Tennessee and from a local support group for families of patients who have experienced a traumatic brain injury. The injured patients and family members participated in the retraining technique. A total of seventeen patient/family member pairs participated in the study.Subjects participated in either the experimental or control treatments. The experimental group underwent five sessions of approximately one hour in length. The patient and family member worked together during the course of the retraining. Brief counseling followed each session. The treatment group used an Atari 800 computer and Bracy's "Foundations" cognitive retraining software package ( Psychological Software Services, Indianapolis, Indiana). The control group was a waiting list, minimum contact group, whose participation was limited to completion of the pre and posttest materials.Family members in both groups completed pre and posttesting packages. These included: a demographic questionnaire, the "Problem Solving Inventory" (Heppner, 1982a, 1982b), the "State/Trait Anxiety Inventory" (Speilberger, 1983), the "Beck Depression Inventory" (Beck, 1961), and the "Scale of Marriage Problems" (Swenson & Fiore, 1982).The experiment utilized Kerlinger's pretest-posttest control group design (Kerlinger, 1973). Patient/family pairs were randomly selected from the available subject pool. Control or experimental treatment groupings were assigned by stratified random sampling. Data were analyzed by the use of two way analysis of variance with repeated measures on one factor. Throughout the analysis, a level of R < .05 was required to infer statistical significance.The results of this experiment did not support the effectiveness of computerized cognitive retraining as a specific intervention method for the families of brain injured individuals. The findings revealed that there were no statistically significant differences between the control and treatment groups on measures of perception of family involvement, depression, or perception of family problems. The treatment group experienced a statistically significant increase in state anxiety following the experimental treatment. The validity, generalizability and implications for these findings were discussed in light of prior research.Recommendations for further research in the area of family response to computerized cognitive retraining include replication of the study with greater numbers of subjects and more sophisticated evaluation and treatment methodology. It is also suggested that future research address the patient's cognitive level, the utilization of varied retraining protocols specific to the patient's level of function, and premorbid psychosocial factors which may influence the process of cognitive remediation.

Typescript. / Thesis (Ph.D.)--University of Hawaii, 1985. / Bibliography: leaves 199-213. / Photocopy. / xi, 213 leaves, bound ill. 29 cm

The purpose of this study was to investigate the relationship between the Affective Facial Recognition Test (AFRT) and Facial Recognition Test (FRT) with a group of right and left hemisphere CVA patients and controls. In addition, the differences in abilities of right and left hemisphere CVA patients and controls to perform on these two tests was explored. The four null hypotheses were: (a) There will be no significant differences between right and left hemisphere damaged patients and controls on the AFRT, (b) There will be no significant differences between right and left hemisphere damaged patients and controls on the FRT, (c) There will be no significant relationship between the AFRT and FRT with right hemisphere damaged patients, and (d) There will be no significant relationship between the AFRT and FRT with left hemisphere damaged patients. Hypotheses one and two were statistically analyzed by using a One-Way Analysis of Variance and three and four by a Pearson Product Moment Correlation.Experimental group subjects were 16 right and 16 left hemisphere CVA volunteer patients obtained from Community Hospital, Indianapolis, Indiana. The control group was composed of 16 non-neurologically impaired subjects from the Muncie, Indiana area. All subjects were equated with respects to age, education, and post-injury. The subjects were randomly administered the AFRT, FRT, and Comprehension subtest of the WAIS-R. The Comprehension subtest was used as a screening device to insure that the patients understood what was expected of them during the testing. The testing, data analysis, and interpretation was completed between May, 1982 and February, 1984.All four hypotheses were rejected. Right and left hemisphere CVA patients and controls significantly differed in performance on the AFRT and FRT (r<.01). In short, right and left hemisphere CVA's were significantly impaired on the AFRT and FRT when compared with the controls. However, both experimental groups exhibited equal impairment on the two tests. This suggests that neither affective facial recognition nor facial recognition is hemispherically lateralized. Also, a higher relationship (r=.79) was found between the AFRT and FRT with right hemisphere patients as opposed to left (r=.65). This appears to indicate that both tests are measuring similar neurological functions and that the inability to match unfamiliar faces and affective faces may not be two separate disorders.

This study examines the validity of using a combination of two psychometric measures, an emotional adjustment measure, and functional assessment measures to predict vocational outcome in a traumatically brain injured population. Patients included 33 males and 11 females, with an average age of 32.3 years, and a stable work history over the past three years prior to injury. All had sustained a traumatic brain injury in the 12 months prior to initial testing, with a mean of 3.8 months since injury. Levels of severity of injury included 24 patients with severe injury, 12 patients with moderate injury, and 8 patients with mild injury. Patients completed the Logical Memory subtest (LM) of the Wechsler Memory Scale-Revised, Paced Auditory Serial Addition Test (PASAT), Beck Depression Inventory (BDI), and Personal Capacities Questionnaire (PCQ). A clinician working closely with the patient also completed the Functional Assessment Inventory (FAI) and the Behavior Checklist (BC) at the time of initial testing. Follow-up testing on available patients (n=16) was completed approximately six months after initial testing. Comparison of the functional assessment measures demonstrated that patients exhibited a decreased awareness of functional limitations relative to clinician's ratings, but identified an increased number of personal strengths. The present study demonstrates the first comparison of FAI and PCQ ratings in a TBI population, as well as the first available field research using the PCQ. Results also indicated that the only significant predictor on earned income after six months was the overall functional limitations score on the PCQ. The only significant difference in patients' test performance at six months with scores at initial testing was seen on the PASAT, which suggested that patients had a significant improvement in their speed of information processing after six months. In addition, comparison of patients from Canadian and American rehabilitation agencies, respectively, revealed no significant differences between patients at either initial testing or at follow-up. / Graduate

M.A. / With the advances achieved in medical technology in recent years, society is increasingly faced with the issue of determining how fit individuals are for reintegration in society following the event of traumatic brain injury. Together with Neurology and it's diagnostic capabilities, many other disciplines such as Neuropsychology, Physiotherapy and Occupational Therapy, to name but a few, have placed strong emphasis on the rehabilitation of individuals with brain damage, with a view to reintegrate them into society. Besides the physical rehabilitation which aims at normalizing the individual's physical health, issues such as psychological ,cognitive and social functioning have been the focus of a great body of research in recent years. Whereas in the past the prognosis for many such patients in respect of returning to a normal life style were discouraging, health workers are now more optimistic in most cases regarding the individuals' probability to achieve a higher level of functioning after recovery. In this context, the individuals' ability to function in society, their ability to be integrated into the family and working environment and competence to be active and valued members of society have thus become the new aims which the therapeutic team together with the patient strive to achieve. With this in mind, rehabilitation teams now place greater emphasis and effort on optimizing recovery in the areas of cognitive and emotional competence. Amongst these issues, the individuals' competence to make moral judgements and socially adequate decisions in everyday living is of the utmost importance. This impacts on their ability to abide by social rules and norms which will determine their competence and desirability as active members in the family, social and working environments. This is the main focus of the present study. The issue of moral judgement and behaviour is central to this discussion, and a delineation of what defines morality and moral judgement is mandatory. Contributions to this analysis were found in the writings of the various authors and schools of thought presented here, and each of them has dealt with the theme of morality, moral behaviour and judgement from a different theoretical perspective. Theorists such as Lawrence Kohlberg made a major contribution to the understanding of the development of moral judgement through his stage theory, which forms one of the cornerstones of the present study. The site and the severity of the brain injury is paramount to the prognosis for rehabilitation. The frontal lobes have been described as the structures responsible for the widest range of symptoms and seen as the seat of intellect, responsible for deviations in moral and emotional functioning. An overview of the frontal lobes and associated cognitive functions as well as behaviors observed as a result of injury to these structures is presented. The existential-phenomenological system of inquiry has been described by its proponents as the most adequate to investigate phenomena relating to human behaviour, when an understanding of the subjective experience of the individuals involved is desired. For this reason this methodology is used in the present study to facilitate a qualitative analysis of the experience of brain injury particularly in respect of possible alterations in moral judgement and behaviour following the accident. The present investigation is based on interviews with three subjects and their primary caretakers, who answered questions regarding moral dilemmas. These dilemmas aim at tapping the individual's underlying reasoning processes when faced with the decision of what is right and wrong. The analysis and integration of the data obtained through these interviews reveals a complex cluster of alterations in thought and behaviour, much in line with those expected from patients suffering traumatic injury of the frontal lobes. Although different behaviours were revealed by each participant in this study, they were generally in line with the alterations described in the literature resulting from injury to the described brain areas. The value of this study lies in projecting a clearer picture of the experience of brain injury from the point of view of the victims as well as the close family members. Furthermore, analysis of data obtained in this investigation highlights certain typical behaviors and responses observed in individuals with such brain injuries, as described in the literature presented here.

D.Litt. et. Phil. / Head injury is the major cause of death for individuals under 35 years old in the United States of America, and a similar picture exists in South Africa. A major cause of traumatic brain injury is motor vehicle accidents. In addition, the advances in modem medical technology increase the chances for survival, for example, sophisticated medical diagnostic techniques such as computerised tomography (CT), and magnetic resonance imaging (MRI). Advances in emergency trauma and neurosurgical procedures have also increased the number of survivors following a head injury. The symptoms resulting from head injury include disturbed physical, cognitive, psychological and behavioural functioning. Long-term management of these symptoms is usually required. A body of evidence exists that demonstrates the value of rehabilitation during the first year of recovery from traumatic brain injury. Head injury cases often result in litigation in that the injured person may be entitled to compensation for the injuries sustained. Considerable forensic debate exists around the issue of whether the victim's symptoms are attributable to organic brain damage, or whether they reflect a pre-existing functional psychological state of psychiatric illness, or personality disorder. Further still, the individual may be 'malingering' or faking postconcussion symptoms of headache, dizziness, fatigue, memory deficit, impaired concentration, irritability, anxiety, insomnia, concern about bodily functions, and hypersensitivity to light and noise. Alternatively, a common diagnosis is traumatic neurosis with a psychogenic basis, and in the context of litigation is referred to as "compensation neurosis". Specifically, the issue of contention revolves around concussion, and mild or minor head injuries. This study proposed that both neuropathophysiological and psychosocial symptoms occur in the event of a traumatic brain injury. This view supports the traditional model that pain or the sequelae of head injury are not affected by compensation. Therefore, the objective of the study was that follow-up assessment after compensation pay-outs should produce similar results to the assessment results obtained during the litigation process. The hypotheses of the study were essentially confirmed. The neuropsychological error scores produced in the assessments during litigation, and two-to-four years after the completion of litigation were similar. However, similar to other studies, variations were evident. Four exceptions were demonstrated in that significant improvement was evident with regard to shotterm verbal memory delayed recall for paragraphs, and for immediate recall (without and after interference) in verbal memory for a word list. These improvements therefore pertain to verbal memory. The fourth improvement occurred with respect to manual dexterity and visual-motor work speed, although the improvement may be peripheral or primary (neurological). Further findings included that no gender differences were evident in the neuropsychological posttest scores. It was confirmed that individuals with a good Glasgow Outcome Scale rating showed less posttraumatic amnesia, a shorter time since injury, less additional injuries, and a lower compensation sum. It was also supported that individuals with a good Glasgow Outcome Scale rating showed less impairment on neuropsychological indices. However, an exception was that individuals with a moderate Glasgow Outcome Scale rating showed improvement on the neuropsychological index measuring immediate concentration, visual scanning, and visual-motor work speed. The qualitative data or psychosocial measures of severity and outcome produced a similar picture that the majority of subjects maintained their pretest status although some exceptions were evident. Within the medico-legal domain it was shown that, in general, concordance of severity was high amongst the medical experts for the plaintiffs and the defendents. However, their prognoses were indicated to be less accurate, and whilst their consistency in documenting diagnoses in the reports of the subjects was adequate, they were found to be inconsistent in documenting severity ratings and prognoses. It was suggested that improvements may be attributed to neurophysiological differences, non-participation in a rehabilitation programme, the interference and delay of rehabilitation, increased psychological reactions associated with litigation, and mechanisms of secondary gain which may by attributed to the other players, such as the family, the attorneys, the medical experts, among others, and not only to the individual or victim.

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.

Maximizing recovery of function after brain injury is the goal for many neuroscientists and rehabilitation medicine professional alike. To further elucidate the neural mechanisms underlying compensatory changes in brain injury and to determine the possibility of enhancing these changes, three experiments are described. Experiment 1 looks at the effects of structured (skilled reaching) versus functional (enriched environment) training with and without FGF-2, a pharmacological intervention, as treatment paradigms for rehabilitation-induced recovery of function in cortical lesion adult rats. Experiment 2 examines the treatment effects of tactile stimulation to enhance motor abilities in postnatal day 4 rat pups sustaining cortical damage. Finally, experiment 3 explores changes in the cortical motor representation after cortical damage. Results indicate a marked improvement on behavioral testing combing FGF-2 and functional training. Tactile stimulation significantly enhances recovery of motor functions. Post-lesion cortical mapping reveals changes in the motor representation utilizing the adjacent posterior parietal cortex. / xv, 127 leaves : ill. ; 28 cm.

This study investigated the differences between right and left hemisphere brain damaged (BD) patients and controls in response to verbal and spatial-affective stimuli. The three null hypotheses explored in this study were: (a) Right hemisphere BD patients would not display significantly different arousal levels from controls in response to verbal and spatial-affective stimuli, (b) left hemisphere BD patients would not display significantly different arousal levels from controls in response to verbal and spatial-affective stimuli, and (c) left hemisphere BD patients would not display significantly different arousal levels from right hemisphere BD patients in response to verbal and spatial-affective stimuli. A One-Way Analysis of Variance was used to determine if differences in arousal existed between right and left hemisphere BD patients and controls. Planned comparisons (t-tests) were used in analyzing the hypotheses.A total of 48 subjects was used in this study. Experimental subjects were composed of 16 left and 16 right hemisphere BD patients from Community Hospital, Indianapolis, Indiana. Sixteen control subjects were obtained from the community of Muncie, Indiana. All subjects were volunteers. No significant differences were found between right and left hemisphere BD patients and controls with respect to age, education, and post injury.The instruments used in this study were a J & J electrodermal unit, the Affective Behavior Test, and the Comprehension subtest of the Wechsler Adult Intelligence Scale-Revised. All tests were individually administered while GSR recordings were obtained. Administration, scoring, computer analyses, and interpretation was completed between May 1982 and February 1984.All three null hypotheses were rejected. Right and left hemisphere BD patients' arousal levels in response to affective stimuli were significantly different from those of controls (p <.001). These results suggested that arousal levels in right and left hemisphere BD patients were lower than non-brain damaged individuals. Additionally, right hemisphere BD patients were found to have significantly lower arousal levels than left hemisphere BD patients (p<.01). In light of these findings, it was recommended that future research explore the value of increasing arousal levels for cerebrovascular accident patients in the rehabilitative process.