The study sought to determine whether there is evidence for the presence of residual (chronic) deleterious effects on cognition due to repetitive mild traumatic brain injury in top team university level rugby players, using ImPACT 3.0, Trail Making Test (TMT) and Digit Span. The initial sample of 48 participants was divided into groups; Rugby (n = 30) and Controls (n = 18), Rugby Forwards (n = 14) and Rugby Backs (n = 16). A reduced sample (N = 31) comprised of Rugby (n = 20) and Controls (n = 11), Rugby Forwards (n = 9) and Rugby Backs (n = 11). Comparative subgroups were equivalent for estimated IQ but not for age and educational level in the full sample; in the reduced sample there was equivalence for all three variables of age, education and estimated IQ. All cognitive test measures were subjected to independent t-test analyses between groups at the pre- and post-season, and dependent t-test analyses for Rugby and Controls at pre- versus post-season. Overall, the results implicated the presence of deleterious effects of concussive events on Rugby players in the areas of speed of information processing, working memory and impulse control. Significant practice effects were found on the TMT and Digit Span for controls, but not on ImPACT 3.0, supporting the use of this computer-based programme in the sports management context.

The present study comprises the second phase of a larger and ongoing research study investigating the brain damage effects of cumulative mild head injury in rugby. The purpose of this study was to determine whether cumulative mild head injury sustained in the game of rugby would cause brain injury as evidenced by impaired performance on sensitive neuropsychological tests. Participants were Springbok professional rugby players (n = 26), Under 21 rugby players (n = 19), and a non-contact sport control of national hockey players (n = 21). Comparisons of performance were carried out across a spectrum of neuropsychological tests for the three rugby groups (Total Rugby, Springbok Rugby, and Under 21 Rugby) versus the performance of the non-contact sport control group (Hockey Control), as well as comparisons of performance f9r the subgroups of Rugby Forwards versus Rugby Backs. Comparisons revealed a consistent pattern of poorer performance across all rugby groups relative to the performance of the controls on tests highly sensitive to the effects of diffuse brain damage. Within rugby group comparisons (Forwards versus Backs) showed significantly poorer performance for Total Rugby Forwards and Springbok Rugby Forwards relative to the performance of the respective Total Rugby Backs and Springbok Rugby Backs on sensitive, as well as on somewhat less sensitive, neuropsychological tests. The performance of Under 21 Rugby Forwards relative to Under 21 Rugby Backs demonstrated similar trends. Brain reserve capacity theory was used as a conceptual basis for discussing the implications of these findings.

The present study comprises part of an ongoing research study investigating the effects 0 f cumulative mild head injuries 0 n Rugby Union p layers. The aim 0 f t he study was to ascertain whether there are neuropsychological effects of cumulative mild head injuries sustained during the rugby-playing careers of senior schoolboy rugby players. Participants were top-level rugby players from high schools in Grahamstown and Cape Town (n = 79) and non-contact sport controls of top-level field hockey players from the same schools (n = 58). Group mean comparisons across a battery of neuropsychological tests were carried out between the Total Rugby versus the Total Field Hockey group, and the Rugby Forwards versus the Rugby Backs group. Comparisons between Total Rugby versus Total Field Hockey revealed impaired performance by the rugby players on two tests of visuoperceptual tracking, namely Digit Symbol Substitution and Trail Making Test (Part A). For Rugby Forwards versus Rugby Backs, there were no consistent differences to support the expectation that forwards would perform worse than backs. Forwards performed more poorly than backs on WMS Associate Learning Subtest - Hard (Delayed Recall), whereas backs performed more poorly than forwards on Digits Backwards. This suggests that some individuals in the cohort were starting to exhibit verbal memory deficit, albeit not clearly in association with forward positional play. Overall, results of the present study provide tentative support for the hypothesis that school level rugby players are more susceptible to the effects of cumulative concussive and sub-concussive head injuries than are non-contact sport controls. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Thesis (MMED. (Forensic Medicine)) --University of Limpopo, 2019 / Traumatic intracranial haemorrhages are common, carry a high mortality rate and are therefore commonly known in the practice of forensic pathology as unnatural deaths. Studies have demonstrated a significant decrease in mortality rate among patients who received surgical interventions compared to patients who were treated medically. Missed or mis-diagnoses, which may be apparent during an autopsy procedure, present possible missed treatment opportunities. Aim/objective and methods The study investigated the discrepancy rate and discrepancy pattern of diagnosis between antemortem brain computed tomography (CT) scan findings and autopsy findings in deceased patients with traumatic intracranial haemorrhage (TIH). A quantitative retrospective descriptive study was conducted based on bodies presented with TIH at Pietersburg Hospital Forensic Pathology Department. A total of consecutive 85 cases with antemortem CT (ACT) scan findings were compared to autopsy findings using percentage agreement and Cohen’s kappa statistics. Results and conclusion There was a fair overall agreement (k=0.38) with overall discrepancy rate of 24.74%, ranging from 9.41% to 34.12% for individual TIH between ACT scan and autopsy findings. Subarachnoid haemorrhage had the lowest agreement between the ACT scan and autopsy findings for TIH. Patient and doctor factors associated with the discrepancies were assessed. Those associated factors, if addressed, may have a positive impact on patient outcome. As far as the debate on non-invasive autopsy procedure is concerned, as a result of existing discrepancy rate, we conclude that ACT should not be used alone in the determination of cause of death but may be used in conjunction with autopsy findings.

This study investigated the use of biofeedback as part of stress-management training program with head injured adults. The single cases examined were four males with head injuries of moderate severity who were in the post-acute stages of recovery. Treatment involved bi-weekly relaxation training, using EMG biofeedback in combination with deep breathing, autogenic training and/or imagery. Individual subject response to relaxation training was examined during treatment sessions, as was the frequency of stress-related symptomatology outside of sessions, and overall functional adaptation. While all subjects showed evidence of relaxation during treatment sessions, such factors as the nature of the functional disturbance and personal motivation appear to be related to the degree of carryover to the external environment.

Health professionals as well as families are being confronted with long-term care and caregiver issues that accompany the increasing incidence of individuals surviving traumatic brain injury. A sample of parents and brain-injured offspring from 20 families served as informants. The purpose of this study was to identify a qualitatively generated theory describing the parent's experience following a brain-injured child's return to the home setting. An exploratory qualitative design using grounded theory methodology was used during data collection and analysis. All the brain-injured offspring had survived a moderate-to-severe traumatic brain injury; were living with at least one parent; and were ages 17 to 34. A three-phase theory, Investing in the Comeback, was generated using grounded theory methodology. The theory's three stages, centering on fostering independence and seeking stability, describe the work of the parent living with a brain-injured offspring. The first phase, Centering On, involves the parent's focusing attention and behavior primarily on the brain-injured offspring. During Fostering Independence, the second phase, the parent initiates and maintains efforts to promote the offspring's resumption of independent functioning. The final phase, Seeking Stability, consists of the parent working to establish a regime that maintains the brain-injured offspring's optimal performance, while minimizing the strain on other family members. Theoretical sampling guided the identification of categories, properties, conditions, and consequences of each phase. Four quantitative measures supplied descriptions of sample characteristics and included demographics, cognitive deficit ratings of the child by the parent and the investigator, and the parent's perception of the family's functioning.

In the present study, an anger management treatment program was compared to a pseudo-social skills training program (self-help group) and waiting list control group to determine its effectiveness in reducing irritable/angry behavior in head injured subjects. Subjects consisted of 28 adults with previous head injury trauma who had difficulty with excessive irritability and anger. Subjects averaged 35.4 years of age and had an average of 8.9 years post head injury. Treatment consisted of 10 group sessions over a five week period. Anger management training was designed to teach subjects self management skills aimed at reducing the frequency of angry acting out behavior. Training methods included role playing, relaxation training, assertiveness training and cognitive restructuring. The pseudo-social skills training group was a self-help group designed to encourage discussion of irritability problems without teaching specific coping techniques. To assure some degree of homogeneity in cognitive abilities among subjects, minimum eligibility scores were required on five subtests of the Wechsler Adult Intelligence Scale - Revised and the Peabody Picture Vocabulary Test. Dependent measures were pre and posttreatment scores obtained from five categories of the Katz Adjustment Scale - Relative form: belligerence, negativity, general psychopathology, social obstreperousness, and social role functioning. In addition, pre and posttreatment recordings of observed angry/irritable behavior in the subjects were obtained from a significant other. Results failed to reveal statistically significant differences on the dependent measures between the three study groups. In addition, analysis failed to reveal any significant variables that predicted outcome. It is evident that much more organized research is needed to further investigate the possibilities of treatment for various problems encountered by those with head injuries.

Thesis (M. A. (Psychology)) --University of Limpopo, 2017 / This study investigated the perceptions of African families of TBI. Caregivers and TBI victims were given the opportunity to talk about their TBI perceptions. The study revealed that people’s knowledge of TBI is not good. This is proven by the way in which the participants understood and explained the conditions the victims found themselves in, after the accidents and how their family members are. Findings reveal that culture does play a vital role in the perceptions of African people. The study illustrates that the perceptions are culturally-rooted. The study interviewed five individuals (n=5) with TBI and a total of nine caregivers (n=9) were interviewed. A total of fourteen (n=14) participants were interviewed. The study reveals that the causes of TBI were attributed a number of things. According to the participants TBI is caused by witchcraft, the will of God and ancestors. The study also helped highlight the beliefs and the cultural system of Africans. It also explained the reality of an African. The Afrocentric theory helped shape the study as it helped in explaining the importance of an Africans’ view. The Afrocentric theory postulates that Africans have a different reality from that of Westerns and it has been proven by the findings. Although the participants were told about TBI by the doctors, they still had their own explanations and attributions to the problem.

Context: Concussion is a major sports medicine concern that is currently under scrutinisation worldwide. Well-publicised cases of careers ending due to multiple concussions, and the potential for permanent, disabling neurocognitive deficits have raised concerns and encouraged further research to take place. Objectives: This study aimed to investigate subjects exposed to mild head injuries with the aim of determining if neuro logical sequelae are detectable. The objectives of this study were to evaluate changes in neuropsychological performance over a period of playing rugby for one full season, which extended over nine months. This study investigated the relationship between concussion history and neuropsychological performance relating to the possible cumulative effects of concussion. Neuropsychological functioning in recently concussed athletes was compared with that of non-injured (control) athletes to detect whether neurological sequelae were present. Investigation into the relationship between post-concussion symptoms and neuropsychological performance was evaluated. The position of play was analysed to see if there were any measurable differences m neuropsychological performance present between forward and backline players. Design, Setting, and Participants: 35 club rugby players and 35 non-contact sports athletes were assessed over a period of 9 months. Both groups underwent pre-season baseline testing and post-season testing. A comprehensive battery of reliable and valid neuropsychological tests was used to assess these subjects, with particular focus on the following 5 areas of cognition: planning, visuo spatial and constructional ability; attention and concentration; memory; verbal fluency and speed of information processing. Results: The data showed that significant differences occurred in rugby players participating regularly in the sport over one full season in terms of changes in neuropsychological test performance in a range of cognitive domains, including planning, visual spatial and constructional ability, attention and concentration, memory and verbal fluency. Numerous significant relationships were found between certain Post Concussion Symptom Scale (PCSS) scores and poor neuropsychological performance, which were considered indicative of subtle effects of sub-concussive injuries and mild head injury (MHI). Surprisingly, following the assessment of concussed players during the season, the data did not show any reliable significant declines in cognitive performance compared to their baseline testing. However, mean scores of the concussed group did show a trend of decreased neuropsychological performance in almost every cognitive domain following the concussive injury. The data did not show any significant relationship between a history of three or more previous concussions and neuropsychological performance. Furthermore, no significant differences in neuropsychological performance between backline and forward players were evident. Conclusion: This research demonstrates that concussion can present serious consequences for athletes and warrants the attention it has received. This present study gives a clear description of the potential negative consequences of playing rugby, which are evident by looking at the change in scores between pre- and post-season testing and poorer performance in most neuropsychological measures following a concussive injury. Although this study dealt mainly with 'normal' players, the results shown here are a cause for concern. What has become evident is that the player need not be exposed to severe concussion in order to experience some form of cognitive impairments. Even if these impairments are minimal, they are however still present and have the potential of accumulating, which could lead to disastrous permanent deficits. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2008

Studies of sustained-attention retraining following brain injury are reviewed, and found to have produced inconclusive results. The reason for this, it is suggested, is that a standard operational analysis of attention has not been applied, as evidenced by considerable inconsistency in the dependent measures and treatment methods used from study to study. The present study addresses this concern by applying well established principles of operant conditioning to the analysis and remediation of attention deficits. After briefly reviewing the variety of task parameters in the attention literature, noting ambiguities inherent in the various conceptualizations of attention, it is decided to train vigilance task performance, a relatively unambiguous and uncontroversial operational definition of sustained attention. Both the principle of immediacy, of reinforcement (feedback of correct and incorrect on each trial) and shaping (gradual increase of speed demands contingent on increased performance accuracy) are employed. The issue of generalization is deemed central to concerns of treatment efficacy, and is explored by administration of alternate versions of the same basic vigilance task. Results show that training with immediate reinforcement and speed-shaping produced better acquisition of the trained task than delayed feedback and invariant speed of stimulus presentation. Furthermore, gains resulting from training were essentially limited to the task on which training was conducted, with little evidence for generalization to like tasks employing different stimuli. These results are discussed in terms of the applicability of the construct of sustained attention to head injury rehabilitation. / Graduate