Closed head injuries are common occurrences in North America. Subsequent to a closed head injury (CHI), there are a number of symptoms which are commonly seen, one of which is fatigue. No studies were found which specifically address the issue of fatigue following CHI. Much remains unknown about this symptom, such as the percentage of individuals who experience fatigue as a problem after a CHI, the relationship between the degree of fatigue experienced and the severity of the injury, and the length of time that this problem persists following the injury. The present study explores and describes the problem of fatigue in a population of individuals following a CHI. In this study, 28 individuals who had experienced a CHI (14 with minor injuries and 14 with severe injuries) were each paired with a control subject who had not had a CHI and who was matched to the CHI subject in terms of age, sex, and personality characteristics. All subjects were asked to complete two brief questionnaires, two computerized tasks, and two self-report measures. All 28 subject pairs completed the first four measures and 22 of the pairs completed and returned the last two. The results showed a highly significant difference between the CHI and control groups on all measures. There were no differences between the CHI subgroups (minor end severe) on any of the measures, nor was there a relationship found between length of post traumatic amnesia or length of time post-injury and any of the measures, There was an interaction between the results on the measure of depression and four of the other five variables Further analysis demonstrated differences between the CHI and control groups on all measures after the depression scores were taken into account. These results indicate that fatigue is a serious, long lasting problem for this groups of individuals who have experienced a CHI. Suggestions for future research and for treatment are discussed. / Graduate

The present study is part of a larger and ongoing research initiative investigating the cumulative cognitive effects of mild head injury in rugby union and focused specifically on high school rugby players. A comprehensive battery of neuropsychological tests was administered to top team high school rugby players (n = 47), and a non-contact sport control group of top team high school hockey players (n = 34). Direct comparisons of group mean scores and standard deviations across each neuropsychological test were carried out for the Total Rugby group versus the Total Hockey group as well as for the subgroups Rugby Forwards versus Rugby Backs. A correlational analysis was conducted to ascertain whether a relationship exists between the number of mild head injuries reported by the players and their cognitive test performance. Results of the group comparisons of means and variability on WMS Paired Associate Learning Hard Pairs - Delayed Recall provides tentative indications of the initial stages of diffuse damage associated with mild head injury in the rugby group and provides some evidence for impairment of verbal learning and memory in the Rugby Forwards group. The correlational analysis revealed no significant relationship between number of reported mild head injuries and cognitive performance. The findings and possible latent effects of the multiple mild head injuries reported by the rugby players are discussed in terms of brain reserve capacity theory and suggestions for future research are provided.

The purpose of this study was to examine the coping styles, beliefs, and symptoms of head-injured adults during long term recovery. Twenty-eight head-injured and thirty-two control subjects suffering from non-neurological illnesses or injuries participated. Subjects completed the Ways of Coping Questionnaire and two questionnaires developed for this study: the "Why Me?" Questionnaire assessed subjects' causal attributions and beliefs about responsibility and the Head-Injury Symptom List provided self-report of the severity of symptoms of head-injury. The coping and belief profiles of the two groups were compared. Head-injured subjects were more likely to place responsibility for their injury on others and to undertake personal efforts to effect their recovery. Various relations between injury attributions and coping styles were obtained. Among both head-injured and control subjects those who endorsed beliefs of retribution were more likely to cope by wishing they could change their situation. Responses to the Head-Injury Symptom List identified tiredness as the most pervasive symptom. Greater symptomatology was related both to a coping style characterized by lack of ability or willingness to engage in social activity or to seek social support and to beliefs that the injury had occurred to serve a meaningful purpose. Consistent with these quantitative results, interviews with head-injured subjects revealed themes of both loss and enhancement. A majority compared their recovery favorably with that of other individuals. In support of cognitive coping theory, this research demonstrates the feasibility of studying the coping capacities of head-injured individuals and shows that they have distinctive coping styles and beliefs which are related to each other. This knowledge should aid those trying to support the recovery of head-injured individuals by adding to the framework upon which interventions are based.

published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Nursing

The present study attempts to further define the neuropsychological characteristics associated with mild, moderate, and severe closed head injuries (CHI). The Dean-Woodcock Neuropsychological Assessment System (D-WNAS), a new neuropsychological battery, was administered to 119 CHI patients. The scores of the cognitive portion of the D-WNAS were then analyzed via cluster analysis in an attempt to further delineate neuropsychological impairment into more specific classifications occurring within types of brain trauma.Results suggested that the cognitive portion of the D-WNAS was effective in separating 4 subtypes within CHI, which are best interpreted as "profiles" or characteristics associated with "levels" of impairment. These levels of impairment were characterized by distinctly different subtest profiles, and were labeled as mild/high functioning, mild, moderate, and severe. The highest performing group, mild/high functioning, showed no neuropsychological deficits. The most severely impaired group was characterized by many deficits in short-term memory, visual stimuli, new learning, processing speed, visual-spatial abilities, abstract reasoning, attention/concentration, and remote memory tasks. A multivariate analysis showed that educational level was significant in differentiating between the subtypes and suggested that, depending on the severity of injury, educational level might also protect individuals from obtaining a poorer prognosis.From this investigation, the cognitive portion of the D-WNAS appears to offer valuable utility in identifying CHI patients and in further classifying their varied neuropsychological characteristics. Implications for diagnosing and differentiating between different levels or profiles of CHI was discussed. / Department of Educational Psychology

This study investigates the effects of cumulative mild head injury on the cognitive functioning of elite rugby players. A comprehensive battery of neuropsychological tests was administered to top national (Springbok) rugby players (n=26), national Under 21 rugby players (n= 19), and a non-contact sport control group of national hockey players (n=21). The test results of the Total Rugby group (Springbok Rugby and Under 21 Rugby players), the Under 21 Rugby group, the hockey controls, and the Total Rugby and Under 21 Rugby forward and backline players respectively, were each compared with established normative data. Results showed significant differences in the direction of a poorer performance relative to the norms for the Total Rugby and Under 21 Rugby groups, and for the Total Rugby Forwards and Under 21 Rugby Forwards, on tests sensitive to the effects of diffuse brain damage. On the other hand, the Hockey Control group and the Total Rugby Backs and Under 21 Rugby Backs tended to perform within the normal range or better than the norm on some tests. These results confirm the hypothesis that rugby players, and the forward players in particular, are at risk of adverse cognitive effects consequent on cumulative mild head injury. The theoretical implications are that the aggregate effects of multiple exposures to mild head injuries in the rugby players served to reduce their brain reserve capacities and acted as a threshold-lowering influence associated with symptom onset.

This study investigates the cumulative effects of concussive and subconcussive mild head injury on the cognitive functioning of schoolboy rugby players. A comprehensive battery of neuropsychological tests and a self-report postconcussive questionnaire were administered to top level schoolboy rugby players (n=47), and a non-contact sport control group of top level schoolboy hockey players (n=34). Group comparisons of the percentage of individuals with cognitive deficit were carried out between i) the schoolboy rugby and the schoolboy hockey players, ii) the rugby forward and the rugby backline players; iii) the rugby forward and the schoolboy hockey players and, iv) the rugby backline and the schoolboy hockey players. Results on the neuropsychological test battery did not provide any substantial evidence of a higher level of neuropsychological impairment in the rugby players relative to the control group, or in the rugby forward players relative to the rugby backline players. Results obtained on the postconcussive symptom questionnaire provided tentative indications that the rugby players do report a greater frequency of postconcussive symptomatology. The symptoms most frequently reported were being easily angered, memory problems, clumsy speech and sleep difficulties. It was hypothesized that the absence of cognitive impairment in the schoolboy rugby players compared with that noted for professional players was due to their younger age, relatively high IQ and education level and a less intensive level of physical participation in the sport, and hence less accumulated exposure to the game, thereby decreasing their exposure to mild head injuries. From a theoretical perspective, these pre-existing conditions were considered to act as protective factors against reductions in brain reserve capacity and concomitant susceptibility to the onset of neuropsychological dysfunction.

This study investigated the cumulative effect of mild head injuries on rugby players. A comprehensive battery of neuropsychological tests was administered and subjects completed a self-report postconcussive symptom questionnaire. Data were collected for the two rugby groups, Springbok rugby players (n = 26) and Under 21 rugby players (n = 19), and for the control group, national hockey players (n = 21). Group comparisons of the percentage of individuals with deficit or self-reported symptomatology were made between: (i) the contact sport groups and the control group; (ii) the forwards and the backs within each rugby group and the rugby forwards and the control group; and (iii) the Springbok and Under 21 rugby players. Broadly speaking, comparative results on the neuropsychological tests and the self-reported postconcussive symptoms clearly distinguished between contact sport players and non-contact sport players and indicated the presence of diffuse brain damage in the contact sport players. There was also clear evidence of positional variation within the rugby groups, with the forwards (more full contact positions) most susceptible to impairment. Neuropsychological test results revealed deficit in information processing speed, attention and concentration, mental flexibility, visual memory and verbal new learning. The most significant neuropsychiatric complaints were reported in the areas of memory, social contact, sensitivity to noise, lowered frustration tolerance, anxiety and worry, and depression. The most sensitive neuropsychological test used in the present study was the Digit Symbol Substitution test. This test clearly distinguished contact sport players from non-contact sport players, and forwards from backs.

The objective of the study was to investigate the cumulative neurocognitive effects of repetitive concussive and subconcussive events in club level Rugby Union (hereafter rugby) during the course of one rugby season, in a combined group and individualized case-based approach. Amateur adult club level rugby players (n = 20) were compared with a non-contact control group (n = 22) of equivalent age, years of education and estimated IQ (p = > .05, in all instances), although the two groups were clearly differentiated on the basis of a history of reported concussions (p = < .05). Video analyses documented the tackling maneuvers observed amongst the players during all matches across the rugby season revealing a sobering average of more than a thousand tackles per player, excluding any contact practice sessions. Five rugby players (n = 5) who were observed to have a head jarring event were also isolated for individualized postconcussive follow-up analysis of their neurocognitive profiles. Measures included the ImPACT Verbal and Visual Memory, Visual Motor Speed and Reaction Time composites and the Purdue Pegboard. Independent and dependent statistical analyses were employed to compare the rugby versus control group neurocognitive test profiles at and between the three test intervals. Correlational analyses explored the association between concussion, tackling and neurocognitive test outcomes. Descriptive comparisons of individual neurocognitive test scores with normative data were employed for the case analyses. Taken together, the results implicated vulnerability amongst club rugby players on the motor and speeded tasks, with less robust indications on the memory tasks. While limited in terms of its small sample size, it is considered that the outcome of the study was rendered more robust by virtue of being methodologically multifaceted with heuristic implications for future research studies in the area. The novel inclusion of tackling data as well as fine-tuned case analyses, were of particular relevance in that regard. The results add to a growing body of literature that implicates deleterious neurocognitive effects in participants of a sport such as rugby due to repetitive head jarring incidents that are intrinsic to the game.