M.A. / Certain topics almost have an interdicted status surrounding them. Avoidance of the unknown is a common reaction displayed by people especially when it involves a condition that strips another of normality. One such topic is brain damage. This study was undertaken to provide an alternative method of viewing a condition that is known to affect many individuals. Brain damage may be acquired by anyone at any point in time as a result of the forces of nature, such as illnesses or intervention of mankind, such as motor vehicle accidents. It seems more valuable to research the issue and provide some resolve, than to ignore or avoid it. To ensure that a well-founded study was accomplished one dimension of daily living affected by head injuries, was focused upon. Re-employability of labourers following mild to moderate brain damage was the area selected for this study. To achieve this objective, a psychometric battery which assesses the capabilities of an unskilled or semiskilled labourer with brain damage, has been designed. In order to assess the validity of the battery, it was administered to two groups of individuals. The first group constituted 25 brain-damaged labourers and the second group consisted of 100 normal labourers. By comparing the performance of the two groups, it became possible to determine whether the battery was feasible as an instrument of skill disparity. The data accumulated by the study showed that the battery does have the capability of distinguishing between the groups. A significant result of this study is that there now appears to be a method of differentiating between the jobrelated skills retained by brain-damaged labourers as opposed to normal labourers. This infers that the instrument has the capacity to assess how close to normal the skill competencies of injured persons are. In this setting this invariably implies an evaluation of the reemployability status of a person. Brain-damaged individuals are thereby given some recourse to determine their future work prospects and are provided with some clarity on one dimension of their functioning.

Introduction: After a brain injury there are often long term consequences impacting on QoL. However, this is a complex issue influenced by many factors. As someone recovers and adjusts it is likely that the way in which they evaluate QoL will also change. The theory of response shift suggests people will change the way they evaluate QoL in the face of changes in their life. The aim of this thesis is to investigate what influences a QoL judgement; examining the possibility of response shift. Methods: Quantitative and qualitative methods were used in 4 studies. These were a cross-sectional design utilising an individualised QoL measure (SEIQoL-DW); a longitudinal study utilising a ‘then-test’ approach; a cross-sectional questionnaire study; and a qualitative study using Interpretative Phenomenological Analysis. Study 1 (Ch.3) Results: Correlations between the QoL measures confirm the validity of the SEIQoL-DW; however, correlations were generally stronger for the simpler Hadorn Scale. There was little overall change in mean QoL when current and retrospective judgements were compared. There was evidence for a change in what areas of life were considered most important to QoL following injury. Study 2 (Ch.4) Results: Improvements in reported QoL between baseline and follow-up were small. A then-test indicates that any effect of response shift is small, and non-significant in the current research. There was also little evidence for reprioritisation or re-conceptualisation. Examination of other factors associated with QoL suggest that brain-injury specific factors (BIGI, RBANS) play a role in predicting QoL. Study 3 (Ch.5) Results: QoL was reported as worse post-injury on both Hadorn’s scale and the QOLIBRI-OS; a difference that was more pronounced on the QOLIBRI-OS. Differences were also reported in the importance of different areas of functioning. Change in QoL as measured by the QOLIBRI-OS was significantly influenced by disability as measured by the GOSE, emotional and informational support, and upwards social comparison. Optimism as measured by the LOT, but not upwards social comparison was a significant predictor of change on Hadorn’s scale; GOSE and emotional and informational support remain significant predictors. The GOSE, emotional and informational support, emotional coping styles and optimism were significant predictors of current QoL on the QOLIBRI-OS; and emotional and informational support and optimism were significant predictors of QoL on Hadorn’s scale. Little evidence was found to suggest that the factors proposed in Sprangers and Schwartz’s (1999) model of response shift have predicted relationships with QoL. Two candidate variables were studied: optimism and social support. However neither showed the predicted pattern of relationships. Nonetheless the study supports previous work indicating an influence of optimism and social support on QoL, and indicates that these warrant further study. There were systematic difference between current and retrospective ratings of importance of domains. The level of importance given to the areas of life defined by the QOLIBRI-OS is higher after injury than before, with the exception of “personal and social life” for which there is no significant difference. The areas of life chosen to reflect that which is measured by the GOSE (“work”, “close relationships”, and “social and leisure activities”) are rated as less important with the exception of “close relationships”. These findings provide further support for the idea that QoL domains are re-evaluated after brain injury. Study 4: This was an in depth qualitative investigation of the experience of recovery and adjustment following TBI. Semi-structured interviews and Interpretative Phenomenological Analysis (IPA) were used. Interviews were conducted with 4 men who were 3, 7, 12, and 18 years post injury. Main Outcome and Results: Themes emerging from the analysis were ‘Change: In Self and World’; ‘Reaching a point of realisation’; ‘Support’; ‘Adjusting to change/Coping with day to day life’; and ‘Participation, Goals and Focus’. These themes cover how participants felt both they and their lives had changed as a consequence of their injury; ways they went about coping and adjusting to changes; the importance of support; and the significance of social integration and participation in feeling satisfied with life. Summary and Conclusions: These studies provide evidence for response shift in different ways. There is little evidence for recalibration but there is some indication that reprioritization or reconceptualization may take place. Changes in how important different areas of life are before and after injury suggest that participants are changing the way they view and make evaluations of QoL. Factors identified as being important to QoL judgements were disability, social support (emotional and informational support identified in the questionnaire study and support in the IPA), upwards social comparison, and optimism. The IPA study suggests that functional outcome and participation are important after TBI; while also identifying ways of coping and providing an insight into the experience of recovery from brain injury. The different QoL measures used provides both evidence for their validity, but also evidence for the different conceptualisations of QoL that are measured by different instruments. The findings have implications both for understanding the QoL of the individual and for research on QoL after TBI.

No description available.

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

A research report submitted in partial fulfilment of the requirements for the degree of Master of Arts in Social and Psychological Research to the Department of Psychology, School of Human and Community Development, The University of the Witwatersrand, Johannesburg, South Africa, 2017 / Introduction. The provision of appropriate long term care facilities for people with acquired brain injury is a portentous issue internationally. There is a global lack of long term care facilities for people with acquired brain injury and they are often placed in facilities for the physically disabled or the elderly. It is unclear whether these facilities are suitable and what effect they may have on well-being and social isolation. Aim. This interpretive phenomenological study explored how adults with acquired brain injury experience living in such long term care facilities. Additionally, it described how such living arrangements impact on social isolation, a particularly devastating psychosocial consequence of acquired brain injury. Method. One-on-one, semi-structured interviews were conducted with seven adults who had acquired a brain injury. Each participant had been living in a long term care facility for at least one year. They were asked questions related to their general lived experience as well as specific questions to explore their experience of social isolation. Findings. Thematic content analysis of the interview data led to the following five categories of themes: overall evaluations (guarded approval, and disapproval); general lived experience (autonomy, choice, freedom, burden, boredom, and basic needs); social isolation (loneliness, companionship, and belonging); sources of isolation (living with the disabled, different disability, age differences, pets, and facility setup); and sources of well-being (positivity, and meaning). The main findings were that the general lived experience of people with ABI was mainly negative. The facilities generally met only basic needs and seldom met higher level psychological needs. Social isolation was commonly reported among residents with ABI in long term care facilities and was linked to age differences and having a brain injury in a facility geared for people with other disabilities. The findings were understood in relation to Bronfenbrenner’s ecological systems theory and Maslow’s hierarchy of needs. Conclusions. The findings of this study contribute towards filling a theoretical gap in understanding the lived experience of people with ABI in long term care facilities and how this contributes to social isolation. The findings have potential value to family members of people with acquired brain injury considering various living arrangement options. They can also be useful for long term care facilities housing people with brain injury to make changes that may result in greater well-being of their residents. / MT 2018

Memory impairment is an outcome of Traumatic Brain Injury (TBI), and associated with lower levels of post-morbid adjustment. This research isolated the memory impairment of retrieval deficit, and examined the efficacy of cues and mnemonics in remediating the impairment. Thirty-three male and female TBI survivors, 18 to 71 years old, were pre-tested for attention (COPY), short-term memory (SD), long-term memory (LD) and recognition memory (RS) employing the Rey Osterrieth Complex Figure Test (CFT), and Subtest. Sixteen subjects demonstrating a retrieval deficit were administered the post-test, with even random assignment into four treatment conditions: a control group (CONTROL), a group administered cues (CUES), a group administered mnemonics {MNEM), and a group administered mnemonics and cues (BOTH) (n = 4). A MANOVA revealed a significant effect of TRIAL (p5.05), no significant effect of TREATMENT, and no interaction. A power analysis indicated the lack of TREATMENT effect could be the result of sample size. Post-hoc t tests revealed a difference across TRIAL for SD and LO in the two experimental conditions which utilized mnemonics. The sample was divided into two groups according to subjects' level of functioning (HIGH and LOW). A MANOVA showed main effects for LEVEL for SD and RS, for TRIAL for SD, LO, and RS, and a LEVEL by TRIAL interaction for COPY (R

Includes list of articles published or accepted for publication during the period of PhD candidature. / "July, 2004" / Includes bibliographical references (leaves 255-293) / xxviii, 293 leaves : ill., plates (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Pathology, 2004?

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Computers are used for diagnostic and training in the neuropsychological rehabilitation. PLANTEST is a program for the IBM-PC that was developed for diagnostic support. It implements a test that gives information about the reduced ability of brain-injured patients to make plans regarding a certain task.The presented thesis describes a knowledge-based system that can be used to develop new test versions for PLANTEST. The program is called SolvePT and it can prove the solubility of test material used in PLANTEST. It can also automatically generate new test material. The program uses an exhaustive forward-chaining, depth-first search and is implemented in Prolog. The datastructures and algorithm of the program as well as space and time requirements are discussed. / Department of Computer Science

Traumatic brain injury (TBI) represents a significant and growing type of disability in South Africa. Coping with the impact of traumatic brain injury is one of the most difficult tasks that can confront a family, and family members experience a wide range of needs as the injured person progresses through rehabilitation. In South Africa, research on family needs following traumatic brain injury has thus far been neglected and rehabilitation resources are sadly lacking. For this reason it is necessary to accumulate knowledge about these families’ needs so as to assist with the planning of future rehabilitation programmes. The study aimed to explore and describe the needs of a sample of families with adult traumatic brain injury individuals in the Eastern Cape utilizing the Family Needs Questionnaire (FNQ). The research approach followed could be described as descriptive and exploratory in nature and was conducted within a quantitative framework. A biographical questionnaire and the FNQ were administered to a heterogeneous sample of 32 family members, including significant others and primary caregivers, of 16 adult traumatically brain-injured individuals, who sustained the TBI one to three years previously, and who underwent rehabilitation treatment at a private rehabilitation hospital in Port Elizabeth. A non-probability, purposive, and convenient sampling method was used. Descriptive statistics were computed to determine the importance and the perceived fulfillment of the needs. The results of the present study indicated that all 40 needs were endorsed by at least half the sample as being important to very important. Furthermore, 52.50% of the needs were endorsed by more than two-thirds of the sample as being important to very important. The needs were rank-ordered according to their importance ratings and the 10 mostly rated as important or very important were identified. These 10 needs were endorsed by between 84.38% and 93.75% of the family members as being important to very important. Six of the important or very important needs related to health information, two to professional support, one to community support, and one to emotional support. The relation between various participant, traumatically brain-injured individual and brain injury characteristics and the 10 important or very important needs, as well as the 10 needs more frequently rated as met were investigated and found to either have a limited or varied relationship. The 10 needs most often rated as met were endorsed by between 43.75% and 56.25% of the family members. Six of the met needs related to health information, two to community support, one to instrumental support, and one to treatment decisions. The highest unmet need was endorsed by 46.88% of the participants and related to the need to discuss their feelings with someone who has gone through the same experience. Based on the findings of the present study, further research on family needs following traumatic brain injury is suggested. It is also recommended that the Family Needs Questionnaire be used to evaluate existing rehabilitation programmes so as to make suggestions as to how to improve them. The results of this study suggested that family members would benefit from receiving educational information material, as well as referrals to professionals for advice and support.