A number of computerised tests have been especially developed to facilitate the medical management of the sports-related concussion. Probably the most widely used of these programmes is the ImPACT test that was developed in the USA and that is registered with the HPCSA for use in the South African context. A recent Afrikaans version of the test served as the basis of the present study with the following objectives: (i) to collect Afrikaans ImPACT normative data on a cohort of Afrikaans first language adolescent rugby players with Model C education for comparison with existing South African English first language adolescent rugby players with Private/Model C schooling, and (ii) to investigate the pre-versus postseason ImPACT neurocognitive test profiles of this cohort of Afrikaans first language adolescent rugby players versus equivalent noncontact sports controls. The results for Part 1 of the study generally demonstrate poorer performance in respect of the Afrikaans cohort, which is understood to be the result of poorer quality of education. The results for Part 2 demonstrated failure of the rugby group to benefit from practice on the ImPACT Visual Motor Speed composite score to the same extent as the control group. It is argued that this apparent cognitive vulnerability in the rugby group is due to lowered cognitive reserve capacity in association with long term exposure to concussive and sub-concussive injury.

The aim of the study was to obtain preliminary normative data for two tests of hand motor function (Successive Finger Tapping and Purdue Pegboard tests) and two tests of verbal fluency ("S"-Words-In-One-Minute and Words-In-One-Minute), administered in English, on a non-clinical sample of black, isiXhosa-speaking unskilled workers with a background of relatively disadvantaged former DET education (N = 33). The sample was equally distributed for gender; educational level was restricted to 11 - 12 years; age range was 18 - 40 years divided further into two age categories (18 - 29 and 30 - 40 years). Results of t-test comparative analyses revealed significant age effects on both trials of the Successive Finger Tapping test in the direction of the younger age group outperforming the older age group, and a marginal but consistent tendency towards poorer performance at an earlier age stage than proposed by the available literature, for the Purdue Pegboard, "S"Words- In-One-Minute and Words-In-One-Minute. Gender effects were only in evidence on the Purdue Pegboard in the direction of females outperforming males. A descriptive comparison of the norms acquired for the present study with available normative data for English first language speaking populations with higher levels and/ or relatively advantaged quality of education revealed consistently poorer performance for the present study. The findings highlight the effect of relatively low levels and/ or poor quality of education on both verbal and non-verbal neuropsychological test performance and confirm the need for demographically specific normative data.

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

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.

Malingering has become an increasing concern in neuropsychological assessment in recent years, and a wide range of tests have been designed and examined for the purpose of detecting malingering. Cut-off scores have been recommended for these tests in order to provide indications of malingering performances. However, the derived scores have been in respect of westernised populations of people with relatively high levels of education who speak English as their first language. Accordingly, the current study aimed to attain normative data and cut-off scores for four commonly employed neuropsychological tools, administered in English, on a population of black, South African, Xhosa-speaking people (N = 33), who attended a former DET-type school in the Eastern Cape, with a Grade 11-12 level of education, in the age range of 18 - 40 years. The targeted measures included the TOMM, the Rey-15 Item Memory Test, the Digit Span subtest of the WAIS-III, and the Trail Making Test. The obtained scores were poorer than the previously published cut-offs for at least one component of each of the tests investigated, except the TOMM. The fmdings of this study highlight the important role that the factors of culture, quality of education, and language play in neuropsychological test performance.

The Rey-Osterrieth Complex Figure Task (ROCFT) has been a standard in neuropsychological assessment for six decades. Many researchers have contributed administration procedures, additional scoring systems and normative data to improve its utility. Despite the abundance of research, the original 36-point scoring system still reigns among clinicians despite documented problems with ceiling and floor effects and poor discrimination between levels of impairment. This study is an attempt to provide a new method based upon item response theory that will allow clinicians to better describe the impairment levels of their patients. Through estimation of item characteristic curves, underlying traits can be estimated while taking into account varying levels of difficulty and discrimination within the set of individual items. The ultimate goal of the current research is identification of a subset of ROCFT items that can be examined in addition to total scores to provide an extra level of information for clinicians, particularly when they are faced with a need to discriminate severely and mildly impaired patients.

This study utilized the Medical Symptom Validity Test (MSVT) and a set of standard neuropsychological instruments to determine the underlying construct of the MSVT that accounts for effort in mild traumatic brain injury (mTBI) patients by comparing/contrasting mTBI with dementia and an analog simulation. The results indicate that a common underlying neurocognitive construct (memory) exists between mTBI and dementia patients, which may account for poor effort as measured by the MSVT. Other underlying factors emerged for both groups, though they did not point to a common construct. This finding suggests that the overall effect of brain injury in neurologically impaired groups also impacts effort performance as measured by the MSVT. Similarly impaired performance patterns also emerged between mTBI and dementia groups in sub-groups that failed effort measures. Thus, failed effort tests may be a function of more pronounced deficits in these groups, rather than a function of effort. Finally, although similar effort profiles were noted between mTBI and analog simulators, the analog group was unable to mimic the neurocognitive effects of mTBI.

Although many theorists have speculated that chronic pain may be linked to some sort of central neuropsychological integration deficit, a review of the current literature reveals no empirical support for this theory. This study attempts to assess the severity, if any, of neuropsychological deficits in chronic pain subjects by using a neuropsychological screen developed at the University of North Texas. Also, presented are studies of correlations between the UNT Neuropsych-screen and the MMPI. the Dallas Pain Questionnaire (DPQ), the Dallas Pain Drawing CDPD), and time since injury in order to assess any possible relationships. The subjects in this study consist of 100 volunteers. Of these subjects, 74 were patients of the Spinal and Chronic Pain Center at Medical Arts Hospital in Dallas, Texas and represented the clinical population. The remaining 26 subjects were staff volunteers from the hospital . The results of the study indicate significant differences between chronic pain subjects and non-pain subjects across many areas of neuropsychological functioning, as well as other significant correlations among many of the variables. The implications of this study are elaborated upon, in the discussion section, in detail along with limitations and future research directions.

Among the goals of neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional, and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions has long been a question of debate. The purpose of the present study was to determine the utility of various performance level indictors and lateralizing indicators from the McCarron-Dial System Neuropsychological Assessment Battery (MDS) in ascertaining the presence or absence of brain damage as well as location of lesion. Models used in the present study appear to provide increased classification accuracy compared to other studies utilizing the MDS. The MDS was also shown to be comparable to other well-known neuropsychological batteries, including the Halstead-Reitan Neuropsychological Test Battery (HRB) and the Luria-Nebraska Neuropsychological Battery (LNNB) with regard to distinguishing between those with brain damage and normal controls, and also localizing brain lesion. The results of this study offer clinicians parsimonious models to evaluate for presence of lesion and its location so this information may be used to make accurate, thorough diagnoses and appropriate treatment and rehabilitation recommendations.

The present study investigates the predictive accuracy of a key approach to interpretation of the verbal-spatialcognitive (VSC) and sensorimotor (SM) factors of the McCarron-Dial System (MDS). The subjects include 99 brain damaged and 30 normal adults. The following research questions are addressed: (a) Does the neuropsychological key classify brain damaged and non-brain damaged subjects at a level significantly above chance? (b) Among the brain damaged subjects, does the neuropsychological key identify right brain damage, left brain damage and diffuse brain damage at an accuracy level significantly above chance? (c) Is the neuropsychological key approach superior to the empirical model derived from discriminant function analysis in predictive accuracy? The neuropsychological key correctly classifies 90% of the cases as brain damaged and 90% of the cases as non-brain damaged, for a total of 89.9% predictive accuracy. The obtained Kappa coefficient of .74 is statistically significant. The key accurately classifies 71.4% of the brain damaged group as right damage, 70% as left damage, and 93.8% as diffuse damage, for a total predictive accuracy of 7 9.5%. The Kappa coefficient of .68 is statistically significant. Chi square analysis of the difference between the key approach and multiple discriminant function analysis reveals that no significant difference is present between the accuracy of the two approaches in differentiating between brain damaged and non-brain damaged, or in differentiating among left, right and diffuse brain damage. The results support the validity of a neuropsychological key approach to interpretation of the McCarron-Dial System, although cross-validation is indicated to confirm the stability of these results. Differences in sex, educational level and racial composition of the comparison groups may have affected the results obtained. Refinement of the key in future research and the addition of test instruments assessing memory, auditory processing, attention and emotional/behavioral variables are recommended.