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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

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.

Thesis (Ph. D.)--University of Newcastle, 2004. / School of Social Sciences. Includes bibliographical references (leaves 269-292). Also available online.

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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).

Abstract not available