No description available.

The study investigated the long-term neuropsychological effects of repetitive mild traumatic brain injury (MTBI) due to participation in a contact sport amongst South African final year male high school athletes (N=189). The sample was divided by sports affiliation (Contact n = 115; Non-Contact n = 74) and concussion history (2+ Concussion n = 43; 0 Concussion n = 108). Comparative subgroups were statistically equivalent for age, education and estimated IQ (P > 0.05), with the Contact sport groups having markedly higher incidences of concussion than controls (p < 0.000). Measures included the ImPACT Verbal and Visual Memory, Visuomotor Speed and Reaction Time Composites, Digit Symbol Substitution and Digit Symbol Incidental Recall (immediate and delayed), the ImPACT Symptom Scale and a Post-concussion Symptom (PCS) questionnaire. Independent t-tests on cognitive measures at pre-and post-season revealed a predominant trend of Contact and 2+ Concussion groups performing worse, although only ImPACT Reaction Time at pre-season reached significance (p = 0.014). PCS comparisons revealed an overwhelming tendency of enhanced symptoms for Contact and 2+ Concussion groups with total scores being significantly different in most instances at pre-and post-season. Fatigue and aggression were the symptoms most pervasively high for the Contact and 2+ Concussion groups. Dependent t-test analyses at pre- versus post-season, revealed significant practice effects for the Contact group, not in evidence for controls on ImPACT Visual Motor Speed and Digit Symbol Incidental Recall-Delayed. Overall the results imply the possible presence of lingering neurocognitive and symptomatic concussion sequelae amongst South African final year high school participants of a contact sport. The indications gain potency when understood against the background of (i) Brain Reserve Capacity threshold theory, and (ii) the known risk of Type II error in group MTBI research, that might result in under-emphasis of subtle effects and miscalculation of cost-benefit risks. Clinical implications, and the need for prospective case-based research to ratify the results of this predominantly cross-sectional study, are discussed.

This exploratory study was designed to discover the culture of living with a head injured spouse. Using the ethnographic approach, five spouses of head injured survivors were interviewed. Analysis of data yielded five domains of meaning: concerns as a result of role transition, social isolation, loss, future and coping. Two cultural themes emerged as "no one understands" and a "wish list." Implications for nursing practice include increasing awareness of health care professionals regarding perceptions and needs of spouses of head injured survivors.

The capacity of Raven's Standard Progressive Matrices (SPM) and the Booklet Category Test (BCT) to discriminate between groups of brain-injured, simulated malingering, and normal participants was investigated in this study. Exploratory analyses were also conducted to examine the differences between groups categorized as sophisticated and naive fakers. Clinical decision rules and discriminant function analyses were utilized to identify malingerers. Clinical decision rules ranged in hit rates from 41% to 78%, in sensitivity from 2% to 100%, and in specificity from 86% to 100%. Discriminant functions ranged in hit rates from 81% to 86%, in sensitivity from 68% to 73% and in specificity from 82% to 87%. Overall, the least helpful detection method examined was below chance responding on either measure, while the most efficient was gross errors for SPM.

A dissertation submitted to the Faculty of Arts, University of the Witwatersrand, in partial fulfilment of the requirements of the degree of Master of Arts / The study reviews the literature concerning mild head injury and post concussion symptoms. It then investigates the applicability of international findings to South African patients. Three groups of subjects are compared: mildly injured, noninjured, and instructed malingerers. The study establishes base rates of postconcussive symptoms in the noninjured subjects, scores on tests of cognitive ability among the noninjured subjects, expectations regarding postconcussive sequelae among the noninjured subjects, the perceptions of injured subjects of their preand postmorbid status, and relationships between subjectively experienced symptoms and cognitive deficits am.ong injured subjects. Injured subgroups are examined to investigate pre-, peri-, and post-injury factors associated with development of postconcussive complaints. No differences in cognitive performance were found between the injured and noninjured groups. Time since injury did not affect cognitive performance, apart from on a copy task. It was found that injured subjects reported lower pre-injury levels of incidence of symptoms than those reported by noninjured subjects. No differences were found between post-injury reporting of postconcussive complaints and those symptoms reported by noninjured controls. Some postconcussive symptoms were nevertheless found to correlate with certain measures of cognitive performance. Instructed malingerers responded differently noninjured injured and not injured subjects, reporting fewer pre-injury complaints and mere post-injury complaints. They also performed more poorly on several cognitive measures. Test scores that effectively identified malingerers were then re-examined, and cut-off rates suggested for differentiating malingerers from genuinely injured subjects. / Andrew Chakane 2018

This study surveyed school-based speech language pathologists regarding their expectations for children returning to school after suffering a traumatic brain injury. Limited literature exists discussing the coordination procedures that should occur between hospital and school personnel. The survey was developed based on the existing literature and was sent to school-based speech language pathologists in the state of Indiana. A total of 38% of the surveys were completed and returned. Results of the surveys found that many of the coordination procedures in the literature were not consistently being followed. Participants who reported having experience with this population in the schools seemed more aware of the procedures that should be followed, based on their answers to the survey questions. It can be concluded, based on the results of the surveys, that increased knowledge and experience of school personnel about the effects, implications, and needs of students with traumatic brain injury would benefit children returning to the school environment after sustaining this type of injury. / Department of Speech Pathology & Audiology

This study investigates the effects of cumulative concussive and subconcussive mild head injury on the cognitive functioning of professional rugby players. A comprehensive battery of neuropsychological tests was administered to 26 professional rugby players and a noncontact sport control group of 21 professional cricket players. The test performances of the rugby players were compared to those of the cricket players. Within the rugby group, forward and backline players were compared. An analysis of mean score differences between the rugby and cricket group failed to support the presence of brain damage effects in the rugby group. However, there was significantly increased variability of scores for the rugby players compared with the cricket players on tests particularly sensitive to cognitive deficit associated with mild head injury. This invalidates the null indications of average effects, indicating that a notable proportion of rugby players’ performances were falling off relative to the rest of the rugby players on tests vulnerable to the cognitive effects of diffuse brain damage. Mean score comparisons within the rugby group indicated that it was the subgroup of forward players, in particular, whose test performances revealed deficits suggestive of cerebral damage. Specifically, deficits were found in working memory, visuoperceptual tracking, verbal memory and visual memory, a pattern of deficits commensurate with cumulative mild head injury. The theoretical perspectives of Satz’s (1997) Brain Reserve Capacity Theory and Jordan’s (1997) ‘Shuttle’ model of variability are drawn upon in order to elucidate research findings and suggestions for future research are provided.

sustained multiple concussions may be at risk of cumulative impairment. The role of neuropsychological testing in the management of sports-related concussion is a contentious and challenging issue which has gained credibility given the lack of clear and well-established guidelines pertaining to the diagnosis, assessment and return-to-play decisions following concussion. Despite various traditional paper and pencil tests being shown to be effective indicators of postconcussive neuropsychological dysfunction, testing has not been widely implemented, due to time- and labour-demands. ImPACT, a computer-based neuropsychological assessment instrument, has been recognised as a valid and reliable tool in the monitoring of athletes' symptoms and neurocognitive functioning preseason and postconcussion. As a part of larger-scale concussion research conducted on top-team university rugby players, this is an in-depth case study conducted on a 20-year old participant with a history of multiple concussions, who was referred following a concussion sustained during the season. The objectives of the study were: (i) to determine the sensitivity of ImPACT versus WAIS-III Digit Span and Trail Making Test during the acute postconcussive phase; and (ii) to examine the sensitivity of ImPACT versus a comprehensive battery of neuropsychological tests to possible residual deficits as a result of the multiple concussions. ImPACT was determined to be more sensitive to acute postconcussive impairment following concussion than Digit Span and Trail Making Test. Furthermore, the ImPACT preseason baseline scores appear to be sensitive to neurocognitive dysfunction, possibly due to cumulative concussive injuries.

Neuropsychological testing is recognised as one of the cornerstones of concussion evaluation, contributing significantly to both an understanding of the injury as well as management of the recovery process. Despite the high incidence of concussion at school level, traditional paper-and-pencil neuropsychological testing has generally been absent from school concussion management programmes, largely due to time and cost constraints. Now, the recent development of computerised neuropsychological testing is providing the opportunity for including neurocognitive assessment in this process. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a valid and reliable instrument of this type and normed on 13 - 18 year old North American high school athletes, as well as adult groups. The current recommendation is that athletes are baselined preseason in order to provide an individualised comparative level against which to monitor recovery and provide return-to-play recommendations. This in itself is quite a cumbersome process, thus the present study set out to ascertain whether baseline testing of all athletes is necessary, or whether the use of US or SA normative data alone would provide an appropriate standard against which to interpret the postinjury scores. From a leading South African rugby playing school, the 1st and 2nd rugby teams, (16 - 18 years) were baselined using ImPACT. Three athletes, who were subsequently referred with concussion during the rugby season, were followed up with serial testing on ImPACT. An analysis of the follow up scores was conducted to chart the athletes' recovery process, in relation to the athletes own baseline scores (using US and SA reliable change indices) and age appropriate US and SA normative ranges. The relative utility of individual baselines scores versus these normative ranges was then critically evaluated. It was concluded that a combination of both baseline and normative data provided optimal management of the athlete, with the methods complementing each other in the interpretation of post-injury results. Overall, the SA normative ranges seemed to provide slightly better management guidelines than the US normative ranges when used with this sample of South African high school athletes.

The aim of this study was to investigate the effect of cumulative mild head injury on the cognitive functioning of professional rugby players. A comprehensive battery of neuropsychological tests was administered to 26 professional rugby players and to a comparison group of 21 professional cricket players. The group test results of the rugby, cricket, rugby forwards and rugby backline players were each compared with established normative data. Generally, the comparison of the rugby and cricket mean scores relative to the normative data did not reveal significant differences on tests known to be sensitive to the effects of mild head injury. However, the comparison of variability for each of the rugby and cricket playing groups relative to variability for the normative data, revealed a pattern of increased variability among the rugby players. This implies a bimodal distribution in which a significant number of rugby players were performing poorly across these tests whereas a significant proportion were not. This variability effect was accounted for by further mean score comparisons which revealed that, as a group, it was the forward players whose performances were disproportionately poor on tests sensitive to the effects of mild head injury. The implications of these results are developed theoretically within the context of brain reserve capacity theory and suggestions for future research are provided.