Measures routinely used to assess the severity and outcome of closed head injury, that is the Glasgow Coma Scale (GCS) and the duration of post-traumatic amnesia (PTA), are of limited use in the case of mild closed head injury (MCHI). The present study investigated the sensitivity of a proposed alternative measure, the Glasgow Coma Scale-Extended (GCS-E), which is a combination of GCS and PTA measures. Twenty subjects who sustai1ed MCHI were assessed with a brief battery of neuropsychological tesrs, six months after the injury. Correlations between the neuropsych1 logical measures and GCS, duration of PTA and the GCS-E were not significant, possibly because of methodological limitations. Although statistical methods do not support the notion that the GCS-E is mere sensitive than currently used measures in detecting the consequem es of MCHI, some support is obtained from qualitative observations. / Psychology / M.A. (Psychology)

Orientadora: Roberta Gonçalves da Silva / Co-orientador: Paula Cristina Cola / Banca: Célia Maria Giacheti / Banca: Rodrigo Bazan / Resumo: O sistema nervoso central representa bilateralmente o controle neuromotor da deglutição, sendo que o córtex cerebral aciona a fase oral e faríngea da deglutição. Embora os achados da deglutição orofaríngea e a localização da lesão no Acidente Vascular Encefálico (AVE) já tenham sido estudados, ainda são necessárias investigações que envolvam a lateralidade da lesão cortical e as alterações na biomecânica da deglutição. Esta pesquisa teve por objetivo analisar a relação entre o início da resposta faríngea (IRF) e a lateralidade da lesão cerebral no indivíduo após Acidente Vascular Encefálico com disfagia orofaríngea em distintas consistências de alimento e idade. Para esta pesquisa foram analisados 90 exames de videofluoroscopia de deglutição, sendo que 73 foram selecionados, contemplando todos os critérios de inclusão e exclusão da pesquisa. Estes 73 exames de videofluoroscopia de deglutição eram de indivíduos pós-AVE hemisférico unilateral e isquêmico com diagnóstico neurológico confirmado por exames médicos clínicos e de neuroimagem. Os indivíduos foram divididos em dois grupos, de acordo com o lado da lesão cortical, sendo que o grupo 1 (G1) foi composto de 39 indivíduos com lesão cortical esquerda e o grupo 2 (G2) de 34 indivíduos com lesão cortical direita. Os exames de G1 e G2 foram analisados na consistência de alimento pastosa fina e líquida. Para verificar o IRF os exames foram analisados por meio de software específico computadorizado e por dois juízes treinados no procedimento. Para a análise do nível de concordância do IRF entre os julgadores foi realizado o teste Índice de Correlação Intraclasses (ICC). Após o ICC, o tempo do IRF utilizado neste estudo foi a média estatística realizada entre a análise dos julgadores. Posteriormente, foi utilizado o teste Mann-Whitney para comparar os grupos G1 e G2 com o IRF. Os resultados... / Abstract: The central nervous system represent bilaterally of the neuromotor control of swallowing, and the cerebral cortex triggers the oral and pharyngeal phases. Although the findings of oropharyngeal swallowing and location of the lesion in stroke have been studied, it is still necessary investigations involving the lateralization of cortical damage and changes in swallowing. The aimed of this research was to verify the relationship between pharyngeal swallow response (PSR) with the lateralization of brain injury in individual after stroke with oropharyngeal dysphagia in different food consistencies and age. For this study were analyzed 90 videofluoroscopic swallow studies, and 73 were selected, covering all the criteria for inclusion and exclusion of research. These 73 videofluoroscopic swallow studies were of individuals post unilateral hemispheric ischemic stroke with neurological diagnosis confirmed by clinical medical or neuroimaging examinations. They were divided into two groups, according to the lateralization of the cortical lesion, and the group 1 (G1) was composed of 39 individuals with left cortical lesion and group 2 (G2) of 34 patients with right cortical injury. The examinations of G1 and G2 were analyzed in the puree and thin liquid consistencies. To check the PSR, the exams were analyzed using computerized specific software and two judges trained in the procedure. For the analysis of the PSR was carried out agreement between the judges in the intraclass correlation test (ICT). After the ICT, the time of the PSR used in this study was the average statistical analysis performed between the judges. Subsequently, was used the Mann-Whitney test to compare the groups G1 and G2 with the PSR. The results showed no statistical difference in the comparison between the G1 and G2 for the value of PSR in both consistencies and age group studied. Therefore, we concluded that there was no ... / Mestre

Orientador: Maria Irma Hadler Coudry / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-10T00:31:25Z (GMT). No. of bitstreams: 1 Andrade_MaraLuciaFabriciode_D.pdf: 1055214 bytes, checksum: 4121348d1883f5aad48038053d466759 (MD5) Previous issue date: 2007 / Resumo: Nosso objetivo principal, neste trabalho, é buscar conhecer quais as inter-relações que podemos estabelecer entre o funcionamento da linguagem e da atenção, tomando por base indícios presentes na fala de sujeitos cérebro-lesados. Como fundamentação teórica, tomamos por base uma Neurolingüística discursivamente orientada (abreviada como ND). Na ND o indivíduo é visto em relação ao seu meio, ou seja, social e historicamente, conforme a perspectiva luriana. Também na ND não se considera o indivíduo como ¿amostra¿ de uma população, mas sim como um sujeito, com uma história de vida e que vive em sociedade, o que se reflete na metodologia do dado-achado. A atenção, conforme perspectiva luriana, diz respeito ao caráter direcional e à seletividade dos processos mentais, sendo parte de um sistema funcional complexo, no qual atenção e linguagem se inter-relacionam entre si e com demais processos psíquicos. Para essa investigação utilizamos transcrições e découpages de sessões do Centro de Convivência de Afásicos - Grupo II (CCA-IEL/Unicamp) que compõem o Banco de Dados em Neurolingüística (BDN), vinculado ao Projeto Integrado em Neurolingüística (CNPq 521773/95-4). O estudo foi realizado com cinco sujeitos cérebro-lesados por diversas etiologias. A análise, de natureza qualitativa, é voltada para o levantamento e descrição de diferentes aspectos envolvidos nas inter-relações entre linguagem e atenção. Consideramos, conforme teorias lurianas e vigostskianas, que a atenção se desenvolve nos períodos iniciais da vida, socialmente e pela via da linguagem, mas, tendo em vista a reorganização do processo inicial, a atenção do sujeito se reconstrói. A presente tese tem como hipótese que a atenção, após a reorganização do processo inicial, estaria fortemente envolvida no trabalho lingüístico, o que, em relação à linguagem, resultaria em uma mútua constitutividade: a linguagem constitui a atenção e esta se volta para a linguagem. No capítulo três, a análise e discussão gira em torno de cada um dos cinco sujeitos e em torno de temas relacionados à seletividade, aos sistemas de referência e à especularidade. A hipótese da mútua constitutividade nos guiou na análise dos dados e a partir dela chegamos a três outras hipóteses mais específicas, uma para cada conjunto de dados. Essas hipóteses evidenciam o trabalho com a linguagem pela via da atenção, ou seja, a atenção se voltando para a linguagem. No capítulo quatro, ainda com base na hipótese da mútua constitutividade, retomamos o caso de JS para analisar determinadas falas em que ele se refere a si mesmo como se fosse outra pessoa. Trabalhando com a hipótese de que essas falas se apresentam como uma ¿linguagem interior¿, neste caso, o que estaria em evidência é a linguagem constituindo a atenção. As relações entre linguagem e atenção não podem se limitar, acreditamos nós, às fronteiras do ¿patológico¿. O estudo com sujeitos cérebro-lesados pode conduzir a certas especificidades, mas os vários casos aqui trazidos, apesar de se constituírem de forma singular expressam alguns fenômenos da linguagem comuns a todos os sujeitos falantes. Terminamos este trabalho considerando que o estudo das relações entre linguagem e atenção, tal como o desenvolvemos permite estabelecer uma correlação entre o lingüístico e o psicológico, e, levantar, entre outros, aspectos que contribuem para desnudar todo um trabalho com a linguagem / Abstract: The main scope of this work is to know which relations can be established between the language and attention, with the basic signals presented in the speaking of those with injured brain. A basic guided Neurolinguistic (ND) was used as a theoric fundamentation. In the ND, the person is analyzed in relation to his social and historic life as the Lurian perspective. Also, in the ND the individual is not considered as a sample of the population as the statistics based in experimental tests but as an individual with a life story, reflecting on the methodology of the case. The attention, as a Lurian perspective, has a direct character and selective of mental process, being part of a complex functional system in which the attention and language are self related and also related to psycho process. Transcriptions and selections of sections of the Aphasics Acquaintanceship Center ¿ Group II (CCA-IEL/Unicamp) from the Neurolinguistic Data Bank (NDB/Integrated Project of Neuron Linguistic/CNPq 521773/95-4) were used. As we consider Luria and Vigostski theories that states that the attention starts its development in the first period of life, socially and speaking as well. However, when we consider the reorganization of the attention of the individual, it can be reconstructed.. This work studies the hypothesis that the attention, after the reorganization of the initial process, would be strongly involved in the linguistics task, which would result in a mutual constitutively: the language focus attention and attention turns back to the language. On chapter three, the analysis and discussion was based in each of the five individuals and on related themes to selectivity, reference system and specularity. The hypothesis of the mutual constitutionality guided us in the data analysis and following this hypothesis we reached three specific hypotheses being each one for each complete data. These hypotheses focus the work with the language through attention specifically linked to the language. On chapter four which still includes the hypothesis of the mutual constructivist, and we focused the case of JS to analyse some of his speaking, where he refers to himself on the third person and are directed for himself. Working with the hypothesis that theses talking show an ¿interior language¿, in this case we focus the language bringing attention. The relations between the language and attention cannot be delimited only to the pathologic aspect. The work with injured brain individuals may conduct to some specific cases, but the many cases presented in this study, although been singular cases, we can say that they express some of the language phenomena that may be common to all speaking individuals. We finish this work considering that the study of the relations between language and attention, as we considered here, permitted us to stablish a relationship between the linguistic and psyclological aspects and to focus, among others subjects, the aspects that may contribute to clarify all the work of the language / Doutorado / Doutor em Linguística

Background: Alcohol Related Brain Damage (ARBD) is an umbrella term used to describe the range of effects that long-term consumption of alcohol can have on the structure and function of the brain. Despite the increasing prevalence of ARBD, there is a lack of research in this area, and as a result, there are no current guidelines and few services available for the treatment of this condition. There is therefore a need to increase the evidence base in this area, which will assist in the understanding, and ultimately treatment, of ARBD. Aims: This thesis consists of two parts. The first is a systematic review journal article which asks the question: “What is the impact of alcohol-abuse on memory function within the first three weeks of alcohol withdrawal?” The second part is a qualitative research project which aims to develop a grounded theory regarding the patient experience of ARBD, identifying and highlighting themes and concepts that are central to the experience. Methods: For the systematic review, four databases were searched. Studies that were included in the review had to have participants with alcohol-dependence; abstinence of less than or equal to three weeks; and to have undergone some form of neuropsychological assessment of memory function. Data from 15 articles were extracted and assessed for quality. For the qualitative study, participants (n=10) were interviewed regarding their experiences of ARBD and the data was then analysed using grounded theory methodology. Results: The results of the systematic review were somewhat ambiguous with some studies reporting impairments in verbal and visual memory, while other studies found no impairments. Episodic memory deficits were present in all studies reviewed. The results of the qualitative study propose a tentative model which describes “transformation through adaptation”. This model hypothesises that successful negotiation of the journey through ARBD hinges on the adaptations that need to be made in order to progress towards transformation. The model is understood in the framework of a number of phases, “Being diagnosed with ARBD, “Focusing on abstinence”, “Taking ownership of life with ARBD” and “Creating a valuable life”, all of which exist within a framework of being supported by specialist services. Conclusions and implications: The systematic review demonstrated some support for deficits in visual and episodic memory within the first three weeks of abstinence, while it appeared that verbal memory was relatively preserved. The heterogeneity of the studies, coupled with the methodological variability, meant that all conclusions need to be considered as tentative, and be interpreted with caution. The main difficulties with interpretation were to do with the confounding factors often found within this client group. The results reinforce the concept of tailored treatment programmes for individuals due to the large variability of the effect of alcohol (and other factors). The qualitative study proposes a model that shows how adaptation appears to play a key role in the successful negotiation of a diagnosis of ARBD. The study describes a series of categories that can be used as a framework to identify and support the changes that are necessary for recovery and reintegration. The value in this study is that the results are directly attributable to individuals who have been diagnosed, and are now successfully living, with ARBD.

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.

This study examined the effectiveness of cautioning and education on simulating a mild traumatic brain injury on several neuropsychological measures. The measures used included the Word Memory Test (WMT), Wechsler Adult Intelligence Scales® - Third Edition (WAIS®-III), Wechsler Memory Scales®-3rd Edition instrument (WMS®-III), 16-item version of the Rey Memory Test, and a self-report symptom checklist. Five experimental groups were used including clinical and non-clinical controls, as well as three simulation groups. The design and implementation of this study also attempted to correct several methodological short comings of prior research by increasing the incentives for participants, expanding the generalizability of findings and examining research compliance and participant self-perception through debriefing. Discriminant analysis was utilized to determine if specific functions existed that would correctly classify and distinguish each experimental group. Several discriminant functions had at least moderate canonical correlations and good classification accuracy. Results also include utility estimates given projected varying base rates of malingering.

The issue of effortful patient performance has been an area of clinical interest in individuals with minor traumatic brain injury (mTBI). Clinical attention to this area has increased largely because of an increase in the number of worker's compensation claims, injury-related lawsuits and/or insanity defense pleas. As patients are presented with the opportunity for secondary gain, the issue of optimum performance on neuropsychological measures becomes salient. In addition to neurocognitive deficits, there are psychological characteristics associated with mTBI including depression, emotional disturbance, personality changes, and other psychopathology. This study utilized the MSVT, a set of standard neuropsychological instruments, and the Minnesota Multiphasic Inventory-2 (MMPI-2) to investigate the relationships between effort, psychological characteristics, and neuropsychological functioning in individuals with minor traumatic brain injuries. The first objective of this study was to determine which psychological factors were related to effort in mTBI. The second objective was to determine if there were differences between groups that performed poorly on effort testing and groups that performed adequately on effort testing, based on relevant psychological characteristics. The results of the analyses supported the first hypothesis. Hysteria was inversely related to effort, and Mania was positively related to effort on one of five measures of effort. The second hypothesis was not supported.

This project represents one of the foundation steps to a collaboration between the Department of Human Physiology, University of Pretoria and the Nuclear Medicine Department at Steve Biko Academic hospital. Following the initial discovery of the surprising effect zolpidem has on patients in persistent vegetative states in 1999 by Dr H.W. Nel - namely that zolpidem administration results in a significant qualitative increase in brain function, to the extent that patients were able to once again communicate and respond appropriately to their surroundings - much data has been collected by both Dr Nel as well as the Nuclear Medicine Department of Steve Biko Hospital. Over the course of twelve years SPECT scans have been carried out on patients of various pathologies both before and after a course of zolpidem. To this day, both assessment and follow up of these and new patients is still being done by the Nuclear Medicine Department and Dr Nel. As this vast collection of data grows it has become increasingly daunting for a single research team to consolidate all this information into a usable form and an outside team has been deemed necessary to facilitate this process. The primary goal of this study was to quantify the neurological perfusion changes following zolpidem administration within responder patients. This was achieved through reprocessing and semi-quantification of the existing SPECT scan records held by the Pretoria Academic Hospital. Within the group of responder patients (n = 29), 22 patients (~76%) presented a significant increase in perfusion within at least one lesion with a range of 4.5 - 46.1% (mean = 11.9%). In opposition to this finding non-responsive lesion perfusion decreased with a significant mean change of -14.5%. For both sets the p-value was determined to be <0.01. Of all lesions measured (n = 85) 32% displayed increased perfusion after zolpidem administration, whereas 30.6% presented with a perfusion decrease. It was determined that only one lesion is required to respond to zolpidem in a positive manner to facilitate positive functional improvements with a given patient. In a small minority of patients post-zolpidem functional improvements seems to be connected to wide-spread cortical changes as opposed to singular lesional improvements. This study provides further evidence of zolpidem’s paradoxical action in a subset of brain damaged individuals. Unique quantification of results allows for additional insight and provides further understanding the physiological changes associated with zolpidem administration. / Dissertation (MSc)--University of Pretoria, 2014. / tm2015 / Physiology / MSc / Unrestricted

BACKGROUND- Motor vehicle crashes pose a serious public health problem. Many serious crashes are due to faulty driving by unfit operators, including several categories of neurological patients. Unfortunately, there seems to be little agreement among health professionals, driving experts, and state government on how to advise these individuals. REVIEW SUMMARY- This article reviews the question of driving in neurological patients. Decisions on driver fitness should be based on empirical observations of performance and not on criteria of age or medical diagnosis, which alone are unreliable predictors. Relevant data can be collected either on a road test or off-road, using different probes of vision and cognition, in the setting of a Department of Motor Vehicles office or medical clinic. The use of a driving simulator is also feasible. The predictive value of these performance assessments is a topic of active research. CONCLUSION- Understanding how performance data from off-road and on-road observations correlate with real-life crash risk is a key step toward developing safe, fair, and accurate means of predicting driver fitness. One potential benefit is the prevention of injury, and another is the preservation of mobility and independence of individuals whose licenses are being unduly revoked because of old age or illness.

The frequency and duration of six coverbal behaviors were examined in two experimental groups and one control group. Conversational samples of ten aphasic subjects, ten right hemisphere damaged (RHD) subjects, and ten matched, non-brain damaged (NBD) control subjects were scored for frequency and duration of eye contact, head nod, head shake, head tilt, smile and eyebrow raise. Only the frequency of smile was found to differ significantly; the RHD subjects smiled less often than either of the other two groups.