As a result of medical advancement and cultural patterns of Western society, traumatic head injury is increasingly a problem for the injured, their families, medical and social services professionals, and the community at large. Head trauma is remarkable because of the complex nature of the residual disabilities which include long lasting cognitive and emotional problems, social isolation, and family disruption. The purpose of this study was to re-examine the phenomenon of recovery after mild to moderate head injury using an ethnographic research approach. The data were based on the experiences of 21 disabled and their families in the community setting. The disabled represented a range of stages of recovery and severity of disability. The data was collected using three field work strategies: extensive semi-structured interviews, participant observation, and non-academic document review. After collection the data was subjected to thematic and content analysis, that resulted in the selection of themes that characterized the experiences for the head injured and their families. The themes for the head injured informants were: dead days, loneliness, and forgetting. The family members' experiences were represented in the themes: responsibility, vulnerability, tough love, gender differences, and reactions to the experience. Next the data were interpreted using five theoretical concepts from cultural anthropology: liminality, personhood, social labelling, sick role and double bind. In addition, the reflexive influence of the investigator on the research process was addressed. The trustworthiness of the ethnography was assessed in terms of credibility, transferability, dependability and confirmability. Several variables were found to be important to the long term outcome of head injury. These variables were: family directed therapy, double bind communication patterns, and lifelong recovery. Two other factors were found to be critical for the recovery of the head injured. These were economic disincentives to the return to employment and the importance of the social and family environment. In the final section the research and policy implications of the study were discussed in relation to management and service provisions.

Several recent studies have revealed that high caliber European professional soccer players often have diminished levels of neurological functioning, yet no study has been able to identify the specific aspect of soccer participation responsible for these decreases. In an effort to identify a source of mild traumatic brain injury present in everyday participation in soccer, this study investigated whether a single bout of heading a soccer ball would have acute detrimental, measurable effects on sensorimotor and neurocognitive functioning. We hypothesized that subjects would exhibit significant changes in postural stability, memory, and concentration immediately after an acute bout of repeated heading a soccer ball. Additionally, we evaluated the protective effect(s) associated with wearing a mouthguard while performing the acute bout of heading. Twenty-eight elite level soccer players (mean age, 20.9 �� 2.5 yrs) were randomly assigned to one of three experimental groups: Headers with mouthguard (n=10), Headers with no mouthguard (n=10), and Control (n=8). Subjects in the two treatment groups performed 12 headers of soccer balls projected at 40 km/hr from an electric soccer ball-launching machine. Postural stability was evaluated using a Biodex Stability System, while memory and concentration were assessed using Wechsler Digit Span (WDS) tests (digits forward and digits backward) in a 3 x 2 factorial ANOVA design (��=0.05). There were no significant main effects or interactions among the three measures of postural stability scores in the three groups (p>0.05). The WDS Forward group means ranged from 10.4 �� 1.8 to 13.5 �� 1.2 while the WDS Backward means ranged from 6.4 �� 1.1 to 7.7 �� 3.0, but were not different among the groups (p>0.05). We concluded that a single bout of 12 soccer headers approximating the number of headers performed during a typical NCAA Division I-A soccer practice did not produce significant deficits in postural stability, memory, or concentration. While our findings are similar to several recent studies, we suggest that more sensitive measurement tools such as ImPACT neurocognitive testing and functional magnetic resonance imaging be utilized to determine the effects of acute as well as chronic exposure to headers in soccer players. / Graduation date: 2003

published_or_final_version / Surgery / Master / Master of Surgery

No description available.

Clinical neuropsychologists who assess patients following mild closed head injury (CHI) are often asked to offer an opinion whether there is evidence of malingering. Factors that impact the ability of a person to intentionally portray impairment are quite important since mis-diagnosis of malingering can result in delayed treatment. In this study knowledge of the sequelae of mild CHI was provided to normal college students in an effort to change reporting of symptoms and influence the type of malingering strategy used when completing the Neuropsychological Symptom Inventory (NSI). Subjects were randomly assigned to either a prior knowledge malingering group (PK;N=57), no prior knowledge malingering group (NPK;N=58), or control group (CON;N=61). The results showed that PK subjects endorsed more general and attention/concentration symptoms than NPK or CON subjects. The results also showed PK subjects were as likely to be detected by the NSI lie scale as NPK subjects. Thus, the NSI lie scale demonstrated sensitivity to malingering despite subjects having brief instruction about mild CHI. Also, having prior knowledge did not result in significantly different strategies when completing the NSI. Instead, both malingering groups reportedly used exaggeration and attempted to be consistent as frequent strategies. / Department of Educational Psychology

The effects of repeated mild concussive head injury on professional rugby players were examined. Data were collected for rugby players (n=26) and cricket player controls (n=21) using a comprehensive neuropsychological test battery comprising five modalities (Verbal Memory, Visual Memory, Verbal Fluency, Visuoperceptual Tracking and Hand Motor Dexterity) and a self-report Postconcussive Symptomology Questionnaire. Group statistical comparisons of the percentage of individuals with deficit were carried out for (i) rugby versus cricket; (ii) rugby forwards versus rugby backs; and (iii) rugby forwards versus cricket. Rugby players performed significantly poorer than controls on SA W AIS Digit Symbol Substitution subtest and on the Trail Making Test. On Digits Forward and Digit Symbol Incidental Recall, the results approached significance with the rugby players showing a tendency toward impairment on these tests. Rugby players exhibited impairment in areas of visuoperceptual tracking, speed of information processing and attention, and there are tendencies of impairment in verbal and/or visual memory. Results obtained on the self-report questionnaire strongly reinforced cognitive test results and a significant proportion of rugby players reported difficulties with sustained attention, memory and lowered frustration tolerance as well as symptoms of anxiety and depression. It was consistently noted that players in the more full contact positions (rugby forwards) were most susceptible to impairment, confirming that these players, who are exposed to repeated mild head injuries, are at greater risk of exhibiting postconcussive sequelae.

The effects of repeated mild concussive head injury on professional rugby players were examined. Data were collected for rugby players (n=26) and cricket player controls (n=21) using a comprehensive neuropsychological test battery comprising five modalities (Verbal Memory, Visual Memory, Verbal Fluency, Visuoperccptual Tracking and Hand Motor Dexterity) and a self-report Postconcussive Symptomology Questionnaire. Group statistical comparisons of the percentage of individuals with deficit were carried out for (i) rugby versus cricket; (ii) rugby forwards versus rugby backs; and (iii) rugby forwards versus cricket. Rugby players performed significantly poorer than controls on SA W AIS Digit Symbol Substitution subtest and on the Trail Making Test. On Digits Forward and Digit Symbol Incidental Recall, the results approached significance with the rugby players showing a tendency toward impairment on these tests. Rugby players exhibited impairment in areas of visuoperceptual tracking, speed of information processing and attention, and there are tendencies of impairment in verbal and/or visual memory. Results obtained on the self-report questionnaire strongly reinforced cognitive test results and a significant proportion of rugby players reported difficulties with sustained attention, memory and lowered frustration tolerance as well as symptoms of anxiety and depression. It was consistently noted that players in the more full contact positions (rugby forwards) were most susceptible to impairment, confirming that these players, who are exposed to repeated mild head injuries, are at greater risk of exhibiting postconcussive sequelae / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Considerable interest has been expressed regarding the issue of recovery of language following head injury in childhood. The two questions most frequently addressed are: 1) Do children recover linguistic abilities faster and better than adults after suffering a head Injury? 2) Is the linguistic disorder, if evident, mainly syntactic or lexical in nature? We have examined 8 children from 6;10-17; 0 who suffered traumatic head injury and who are in varying stages of recovery. Each child has been matched with a normal child of the same age. Despite reports of complete recovery from childhood aphasia, our results indicate persistent word finding problems, with otherwise normal language abilities. There was no correlation between severity of deficit and age at injury or length of coma. / Medicine, Faculty of / Audiology and Speech Sciences, School of / Graduate

Social Skills Training for Head Injured Adults Research has demonstrated numerous personality and behavioral disturbances resulting from head injury (Lezak,1978). It is these changes rather than the physical disabilities that create the stress, in the long term for the relatives of the head injured (MeKinley,1981). Therefore, social skills training is a important part of intervention with this population. This study evaluates a social skills training program "Stacking the Deck" (Braunling-McMorrow et al 1986) which has been modified to include structured learning assignments. This is a single case evaluation (A - Baseline, B - Treatment) with replication. The subjects are four males with severe head injuries, ages 19,22,34,and 36. Social skills were described as requiring an action or reaction within six skill areas: compliments, social interaction, politeness, criticism, social confrontation, and questions/answers. Measures include the baseline developed in the "Stacking the Deck" program, Staff Questionnaire on Social Behavior (Spence,1979) and the Social Skills Assessment Chart (Spence,1980). Results indicate that this is an effective program for social skills training with the adult head injured population. / Arts, Faculty of / Social Work, School of / Graduate

The purpose of this study was to examine the impact of brain injury upon the family of the brain-injured patient. Although some research into the psychosocial sequelae following head injury and the direct and indirect effects of severe head-injury upon the family have been conducted, these studies have largely been of a quantitative nature. For this reason, and with a view to expanding upon the existing findings, the present study was qualitative in nature in order to gain an in-depth understanding of relatives' experience of living with and caring for a severely head-injured family member. In addition, ways in which family members coped with the impact of the brain injury were elicited. Participants were caregivers to 11 severely head-injured patients who were representative of a range of socio-economic groupings and racial classifications. Severity of head injury was controlled for and participants were interviewed two or more years after the head injury had occurred. Demographic and injury related data were elicited by means of a questionnaire. Thereafter, data was collected by means of in-depth semi-structured interviews. A number of indices were developed based on a qualitative and descriptive analysis of the data. The study found that the mam source of distress experienced by caregivers related to emotional rather than physical symptomatology. All types of family relationships were profoundly affected by the patient's brain injury, although the caregiver's relationship with the patient appeared most vulnerable. Formal sources of support were considered inadequate and most caregivers relied heavily on emotional support, particularly from an intimate source. Coping responses were dependent upon coping resources available. Families of brain-injured patients who were racially and socio-economically disadvantaged were subjected to additional stress related to the unavailability of services and the randomness with which services that were available were dispensed. Rehabilitation services appeared to be failing to meet the needs of "brain-injured families" (Brooks, 1984) as they concentrated on the patient's physical handicap rather than emotional sequelae of the head injury.