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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

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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.

Decision-making, accepted to be an important part of executive function, is inherent in all complex human experiences requiring intact brain functioning. Three different types of decision making have been identified: actor-centred, emotion-based and veridical decisionmaking. All require goal-setting, planning and execution, which are often impaired after sustaining an acquired brain injury (ABI). The Cognitive Reserve Hypothesis (CRH) holds that a larger brain belonging to an individual with a higher IQ and better education will be more resilient to injury. The principal aim of this study was to investigate performance differences in neuropsychological tests of decision-making between individuals with ABI from different socioeconomic status (SES). It was hypothesised that ABI would exacerbate differences in decisionmaking performance between individuals from a higher SES and those from low SES in terms of the CRH. Participants (n=25) had all sustained an ABI. Actor-centred, emotion-based and veridical decision-making were investigated using the Tinker Toy Test (TTT), the Iowa Gambling Task (IGT) and the Berg Card Sorting Task (BCST) respectively. Participants were asked to complete an SES Questionnaire. The independent variables were markers of SES: Race, Level of Education, Quality of Education, and Quality of Medical Care at time of injury. Differences in quality of education were significant for the BCST, suggesting that a poor quality of education has a negative impact on veridical decision-making after ABI. Poor education (a marker of low SES) does not provide the same buffering effect for insults to the brain in the event of an ABI as does superior education (a marker of high SES).

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.

A Masters Dissertation submitted to the Department of Speech Pathology and Audiology School of Human and Community Development, Faculty of Humanities University of Witwatersrand Johannesburg, in fulfillment of the requirements for the degree Master of Arts in Speech Pathology, November 2017 / Background: Traumatic Brain Injury (TBI) is a serious public health problem worldwide. It is a major cause of death among younger adults and is a leading cause of lifelong disability in persons who survive it. There are a large number of young adults living with life-long disabilities as a result of traumatic brain injury worldwide, with higher numbers existing in South Africa. Whilst previous research internationally has examined issues of community integration and difficulties experienced by persons with traumatic brain injury and their significant others or caregivers, a paucity of research of this nature exists in South Africa. This study intended to explore whether a gap in clinical practice exists with regard to aspects of intervention and support, underpinned by an ambiguous definition of community integration for survivors of traumatic brain injury and their significant others Method: The main aim of the study was to explore existing feelings of community integration and active participation in patients with traumatic brain injury who have been discharged from rehabilitation services in private practice in Johannesburg, South Africa. In this study, the sample comprised of 10 survivors of TBI and 10 significant others (SOs). The objectives were to describe and compare participants and significant others’ or caregivers experience of community integration and factors that influenced the perceptions by each (i.e. the patient and the caregiver) as well as to document barriers and facilitators to community integration and active participation within the, familial, social and work context. Lastly the study aimed to determine if the qualitative analysis of formal assessment measures (FIM and CIQ-R) match perceptions of persons with TBI with regard to Community Integration (Landrum et al., 1995). Results: Across various areas of comparison, participants who scored higher in the CIQ-Rand FIM measures, often expressed more subtle difficulties or challenges that landed up going undetected and ultimately contributed to their personal feelings of poorer community integration. Various studies, including the current study reveal that significant others have many unmet needs in terms of what they know and what they should expect with regard to handling their loved one with a TBI. Implications: This research has highlighted the fact that our South African context is lacking with regard to ongoing management of individuals surviving TBI, with reduced funding available for outpatient therapies, a lack of post discharge programmes and a general lack of education and information given to family members of TBI survivors upon discharge. As such this should be a major focus of health care providers in the future. This research revealed many subtleties that impact perceptions of community integration but go undetected by formal measures. Such subtleties could be used to direct specialised programmes, which should be made available to TBI survivors post discharge from rehabilitation services. Keywords: traumatic brain injury; community integration; rehabilitation; functional outcomes; private practice, developing countries, community resources, south Africa / XL2018