M.A. / A review of existing relevant literature and research confirms that there is not always unanimity about the diagnosis and classification of the Post-concussion syndrome (PCS). This controversy arising from the diagnosis results in the failure to inform, prepare and equip the patient and his family adequately for the effects of PCS. This influences the treatment and eventual rehabilitation of a patient who has a light head injury. It is, therefore, essential that the medical field, over the whole spectrum of medical disciplines, should fully understand PCS and the patient, and should also provide the patient's support system with the necessary information with regard to the effects of PCS. This will, in truth, affect the rehabilitation of this patient. An investigation of the literature showed that most light head injuries are the result of road accidents, followed by industrial and factory accidents. Other types of head injuries and alcohol abuse play a further role in the appearance and degree of seriousness of light head injuries. The effect of PCS symptoms range from physical discomforts such as headaches to more emotional problems such as depression, fatigue, anxiety and concentration problems. Primary symptoms fade with the passing of time while secondary symptoms increase after the first few months after the head injury. The experience of PCS symptoms can be influenced by different factors such as pre-trauma personality traits, accident neurosis and compensations. It is postulated that the experience of typical PCS symptoms can be mediated by sufficient understanding, knowledge and realistic expectations on the part of the light head injured patient. The aim of the study was to address the problem of insufficient information provided to patients suffering from PCS regarding the symptoms they are likely to suffer. This was done by creating a post-trauma information program consisting of an attractive and multicoloured booklet with easy access to various issues such as explanation of terminology, the neurology of concussion, likely symptoms, prognosis and recovery time. The booklet was complemented with a casette recording of relevant issues, presented in different voices, with a calming musical background. The patients who were selected to participate in the evaluation of the program had all presented at the 1 Military Hospital over a period of 18 months with firmly diagnosed PCS based on scores obtained on the Galveston Orientation and Amnesia Test (GOAT) and the Glasgow Coma Scale (GCS). A total of 81 white, male subjects were selected. All the subjects complied with certain criteria such as Afrikaans or English language proficiency, falling within a particular age group (16 - 35 years) and with no prior neurological or psychiatric disease. The 81 patients were randomly divided into groups according to the Solomon fourgroup design. Pre tests were administered to the two experimental groups. The pre tests consisted of four subscales of the Profile of Mood States (POMS) and four subscales of the Personal, Home, Social and Formal Relations Questionnaire (PHSF). The validities and reliabilities of these scales are wel documented. The four selected POMS subscales were: Tension-anxiety Depression-dejection Anger-hostility Fatigue-inertia The four selected PHSF subscales were: Self-esteem Self-control Health Formal Relations One experimental and one control group now received the intervention program.

Background: The hippocampus and corpus callosum have been shown to be vulnerable in head injury. Various neuroimaging modalities and quantitative measurement techniques have been employed to investigate pathological changes in these structures. Cognitive and behavioural deficiencies have also been well documented in head injury. Aims: The aim of this research project was to investigate structural changes in the hippocampus and corpus callosum. Two different quantitative methods were used to measure physical changes and neuropsychological assessment was performed to determine cognitive and behavioural deficit. It was also intended to investigate the relationship between structural change and neuropsychology at 1 and 6 months post injury. Method: Forty-seven patients with head injury (ranging from mild to severe) had undergone a battery of neuropsychological tests and an MRI scan at 1 and 6 months post injury. T1-weighted MRI scans were obtained and analysis of hippocampus and corpus callosum was performed using region-of-interest techniques and voxel-based morphometry which also included comparison to 18 healthy volunteers. The patients completed neuropsychological assessment at 1 and 6 months post injury and data obtained was analysed with respect to each assessment and with structural data to determine cognitive decline and correlation with neuroanatomy. Results: Voxel-based morphometry illustrated reduced whole scan signal differences between patients and controls and changes in patients between 1 and 6 months post injury. Reduced grey matter concentration was also found using voxel-based morphometry and segmented images between patients and controls. A number of neuropsychological aspects were related to injury severity and correlations with neuroanatomy were present. Voxel-based morphometry provided a greater number of associations than region-of-interest analysis. No longitudinal changes were found in the hippocampus or corpus callosum using region-of-interest methodology or voxel-based morphometry. Conclusions: Decreased grey matter concentration identified with voxel-based morphometry illustrated that structural deficit was present in the head injured patients and does not change between 1 and 6 months. Voxel-based morphometry appears more sensitive for detecting structural changes after head injury than region- of-interest methods. Although the majority of patients had suffered mild head injury, cognitive and neurobehavioural deficits were evidenced by a substantial number of patients reporting increased anxiety and depression levels. Also, the findings of relationships between reduced grey matter concentration and cognitive test scores are indicative of the effects of diffuse brain damage in the patient group.

M.A. / This investigation aims to address and explore the experience of sibling head injury which appears to have been largely neglected in research. It seeks those themes, emotions and thoughts which are central and significant to the sibling's experience. it explores the manner in which the event of sibling head injury is incorporated into the adolescent's emerging identity, sense of self and understanding of the world. Overall, this research aims to provide some understanding of what the experience of living with a head-injured sibling entails and the personal meaning it holds for adolescent siblings. The existential-phenomenological system of inquiry is employed as a mode of research in an effort to study this experience of adolescent siblings of head-injured persons. Siblings are understood as beings-in-the-world who coconstitute their realities and interpret and act upon their own existence. Qualitative access to this subjective realm or individual lifeworld of siblings, is attempted through a qualitative design, where rich data is collected through in-depth, open-ended interviews which facilitate unique and personal descriptions. Eight siblings of an adolescent or young adult age, were sourced through Headway and interviewed for the purpose of this study. The 'Adolescent Coping Scale' was administered to gain further qualitative information which could be incorporated into a greater understanding of sibling coping under such circumstances. Interviews were recorded and transcribed verbatim, providing the database from which intraindividual analyses and discussions were conducted on each participant. Only three of the original eight participants were selected for the purposes of in-depth analysis and final inclusion in the study, for reasons of manageability and research size. These participants were selected on the basis of their rich and varied descriptions. The analyses rendered an understanding of each sibling's perceptions, cognitive conflicts and emotional experience, while an inter-individual analysis of the accounts permitted an exploration of contrasting themes and emerging patterns. An integration of the research data revealed the complexity and ambiguities inherent in the sibling experience of head injury, and the long-term nature of such a phenomenon. This phenomenon was found to be characterised by much change and feelings of loss, by a pervasive sense of helplessness accompanied by anger and depression, by feelings of abandonment and of being alone in their experience. Such themes confirmed many of those explicated in the literature review. However, the research findings also suggest a sense of being overwhelmed by threatening emotions, a strong reliance on avoidance coping, and a specific complexity inherent in the sibling experience, which creates a challenging experience which is long-term and for some, may be perceived as getting worse over time. The value of this research lies primarily in the neuropsychological field of family interventions and rehabilitation. It is hoped that the in-depth description of the experience of ado!escent siblings of head injury, presented here, can promote a greater understanding of this experience, and facilitate the establishment of appropriate interventions which focus on the provision of much-needed education and support. It is also hoped that this understanding can assist in raising awareness of the stressful and long-term nature of such a phenomenon, in schools and universities, among peers, facilitators, counsellors - those who have daily contact with adolescents. It is proposed that future research explores those aspects of the sibling experience which mediate its nature, dynamics and severity. Studies investigating the role played by race, culture and religion, gender and age, as well as those which focus on the long-term consequences of such a phenomenon, are likely to facilitate a deeper and more in-depth understanding of the experience of sibling head injury.

Neurocognitive and symptom profiles of concussed and nonconcussed adult provincial rugby union players were investigated over one rugby season, including early season (baseline), intermittent postconcussion, and end of season testing. In a non-equivalent quasi-experimental design, nonconcussed (n = 54) and concussed (n = 17) rugby groups were compared with demographically equivalent noncontact sport controls (n = 37, and n = 17, respectively). Measures included the ImPACT cognitive and symptom composites, and the WMS-III Visual Reproduction and Verbal Paired Associates subtests. The independent and dependent comparative analyses in respect of both nonconcussed and concussed groups, provided cross-validation of poorer acute and/or chronic neuropsychological outcomes for the rugby groups on the ImPACT Reaction Time, Visual Motor Speed, Impulse Control and Symptom composites, and the WMS-III Verbal Paired Associates. The finding of significantly poorer scores on Verbal Paired Associates up to 24 days post concussion for the rugby players versus controls, was longer than the 7 – 10 day recovery period frequently cited in the literature. The overall implication of the study is that even in a group with high cognitive reserve such as these provincial level athletes, there may be prolonged acute recovery, as well as permanent deleterious neuropsychological consequences of cumulative concussive injury in association with a sport such as rugby. Accordingly, the move towards careful individualised postconcussion monitoring of neurocognitive functioning is endorsed, including early identification of any significant permanent reductions in cognitive reserve. Sensitivity of the ImPACT test might be enhanced via inclusion of a verbal associate learning task.

There is a high incidence of head injury in children, yet few studies have systematically studied cognitive outcome. This study was designed as a survey to (a) establish the nature of intellectual and neuropsychological deficits that occur after head injuries of differing severity in children aged 6 to 14 years, (b) establish the nature of recovery curves in the first year after injury, and (c) determine which medical and psychosocial factors are associated with poor cognitive outcome and which functions show persisting impairment. From 1134 children admitted with head injury to Red Cross and Groote Schuur Hospitals during a 2-year period, a consecutive sample of all those who had post-traumatic amnesia (PTA) over 1 hour, a compound depressed or basal skull fracture, a seizure, or any evidence of neurological involvement, was collected (n=388). Further requirements that they should be between 6 and 14 years, English or Afrikaans speaking, and have no history of significant cerebral pathology or mental retardation, reduced the sample to 123 children. Severity groups were formed according to the length of PTA: 56 moderates (PTA less than 1 day), 40 severes (PTA 1 to 7 days), and 28 very severes (PTA more than 7 days). They were matched for age, sex, socioeconomic status and ethnic group with 46 controls who had traumatic injury not involving the head. Detailed accident, medical and psychosocial data were collected. The children were assessed on a battery of tests covering intelligence, language, motor speed, visuographic and memory functions, as soon as they were out of PTA (Tl), 3 months later (T2), and at 1-year post-injury (T3). The 4 groups are compared at each interval on Tukey' s studentized range test and the extent of recovery within and between the groups is compared by repeated measures analysis of variance.

Indiana University-Purdue University Indianapolis (IUPUI) / Grounded theory analysis, informed by a socio-cultural lens, was applied to the narratives of eighteen motorcycle riders in order to understand, from the rider’s perspective, receptivity to warning messages regarding motorcycle helmet use. This study relied upon narrative analysis to identify patterns in communication that surround motorcycle riders’ experiences. Socio-cultural cues identified importance in the process of interest development in motorcycle riding, search for information regarding motorcycle riding, response to danger within the motorcycle riding experience, and attitude toward protection messages. Narratives specific to danger, or experiences of motorcycle accidents were analyzed for comparison with fear appeal theory. Special focus was applied to Terror Management Theory (TMT) and applied to the communication surrounding the real experiences of motorcycle accident and the perceived threat of danger while motorcycle riding. Communication evidencing relational influence was examined for examples of socially constructed interpretation of social identity and an individual rider's perspective of their lifeworld. The analysis revealed evidence of the TMT concept of burying or denying thoughts of danger. The TMT concept of lifeworld influence on behavior was evidenced in riders who did not accept warning messages involving helmet use. Examples of attitude and behavior change where present in two study participants’ narratives that described experience of severe injury and also the death of a friend. The riders cited these occurrences as experiences that inhibited their previous behavior of placing thoughts of motorcycle injury and death in the back of mind. Although small in number, this participant group offered multiple categorizations of rider descriptions. The narratives offered distinction in time of life when riding interest developed. As well, motorcycle training facilities were often noted as a source of communication from which riders obtained influence on their future behaviors. From this information insight was gained to offer suggestions for future research on time of message delivery. Riders who develop interest in riding as adults represent a category on which to focus preliminary educational messages. Individuals who have not yet developed an interest in motorcycle riding may benefit from societal cues that demonstrate safe riding behavior. Future research in mass media appeals focused on motorcycle riders are suggested, as is development of educational programs for delivery to high school audiences.