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.

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.

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.

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.