The issue of effortful patient performance has been an area of clinical interest in individuals with minor traumatic brain injury (mTBI). Clinical attention to this area has increased largely because of an increase in the number of worker's compensation claims, injury-related lawsuits and/or insanity defense pleas. As patients are presented with the opportunity for secondary gain, the issue of optimum performance on neuropsychological measures becomes salient. In addition to neurocognitive deficits, there are psychological characteristics associated with mTBI including depression, emotional disturbance, personality changes, and other psychopathology. This study utilized the MSVT, a set of standard neuropsychological instruments, and the Minnesota Multiphasic Inventory-2 (MMPI-2) to investigate the relationships between effort, psychological characteristics, and neuropsychological functioning in individuals with minor traumatic brain injuries. The first objective of this study was to determine which psychological factors were related to effort in mTBI. The second objective was to determine if there were differences between groups that performed poorly on effort testing and groups that performed adequately on effort testing, based on relevant psychological characteristics. The results of the analyses supported the first hypothesis. Hysteria was inversely related to effort, and Mania was positively related to effort on one of five measures of effort. The second hypothesis was not supported.

In hierdie studie is daar gefokus op Tourettesindroomlyers se leefwereldstigting, met spesifieke verwysing na hulle kognitiewe funksionering. Tourettesindroom is 'n neuropsigiatriese versteuring wat gewoonlik tydens die kinderjare 'n aanvang neem en wat deur motoriese en/of vokale tics gekenmerk word. Tourettesindroomlyers kan 'n verskeidenheid aanverwante versteurings manifesteer, byvoorbeeld Obsessief-kompulsiewe Versteuring, Aandaggebrekversteuring, met of sander hiperaktiwiteit, fobies en ander affektiewe afwykings. Aangesien die werklike oorsake van T ourettesindroom steeds 'n onbekende faktor is, is die behandeling van hierdie chroniese toestand nie 'n gewaarborgde sukses nie. Dit wil voorkom asof die insidensie van Tourettesindroom, wat heelwat hoer onder manlikes as vroulikes is, hoer is as wat aanvanklik vermoed is. Al ses die fasette van menswees kan deur Tourettesindroomlyers negatief beleef word. Op fisiese gebied toon navorsing verskillende abnormaliteite in die brein, byvoorbeeld by die afskeiding van die neurosenders soos dopamien en serotonien, 'n reduksie in die volume van die basale ganglia, 'n kleiner linker globus pallidus en versteurings in die frontale lobbe, die corpus callosum en die basale ganglia se senuweebane. Hulle konatiewe faset kan oorheers word deur hulle ongemotiveerdheid op kognitiewe gebied. Die normatiewe faset word dikwels weens verslawende gedrag belemmer. Die Tourettesindroomlyers se sosialisering kan swak wees weens hulle gedragsprobleme. Hierdie navorsing bevestig vorige ondersoeke wereldwyd wat toon dat depressie, slaapprobleme, angsversteurings en die onvermoe om stres te hanteer by sommige Tourettesindroomlyers kan bydra tot uitputting wat hulle kognitiewe funksionering belemmer. Tourettesindroomlyers presteer op kognitiewe gebied 6f uitstekend 6f uiters swak. Groot uiteenlopendhede word in die neuropsigologiese gedrag van Tourettesindroomlyers gemanifesteer, met 'n vermindering in hulle uitvoerende kognitiewe funksionering weens tekorte in hulle kognitiewe prosesseringsvermoens. Dit het verarmende gevolge vir hulle kognitiewe inhoud, struktuur en uiteindelik kognitiewe produkte. Algemene en spesifieke leerprobleme is die gevolg. Dit is dus te begrype dat Tourettesindroomlyers se betrokkenheid, belewing en betekenisgewing by die skoolsituasie en leerstof negatief beleef kan word. Saam met hulle vernederende simptome, fluktuasie van hulle punte en belemmerde leefwereldstigting, is die logiese gevolg ontwrigte selfbeelde. Tourettesindroomlyers benodig daadwerklike ondersteuning in hulle selfaktualisering ten einde waardevolle mensepotensiaal vir SuidAfrika te behou. / The focus of this study is the life-world formation of Tourette syndrome sufferers, with specific reference to their cognitive functioning. Tourette syndrome is a neuropsychological disorder which usually has its inception during childhood and is characterised by motor and/or vocal tics. Tourette syndrome sufferers may also exhibit a variety of related disorders, for example Obsessive Compulsive Disorder, Attention Deficit Disorder, with or without hyperactivity, phobias and various affective disorders. The cause of Tourette syndrome is still unknown, therefore treatment cannot be guaranteed to be successful. The incidence of Tcurette syndrome is higher than was initially suspected and is more prevalent among men. Tourette syndrome sufferers can negatively experience all six facets of humanity. In the physical area research indicates various abnormalities in the brain, for example the secretion of neurotransmitters, a reduction in the volume of the basal ganglia, a smaller left globus pallidus and disorders in the frontal lobes, the corpus callosum and the nerve circuitry of the basal ganglia. The conative facet may be dominated by their lack of motivation in the cognitive area. The normative facet is often hampered due to addictive behaviour. Socialisation can be poor due to behaviour problems. This research confirms previous investigations world-wide which indicated that depression, sleep and anxiety disorders and the inability to handle stress contributes to exhaustion, which impedes cognitive functioning. In the cognitive area Tourette syndrome sufferers perform either extremely well or extremely poorly. There are great discrepancies in the neuropsychological behaviour of Tourette syndrome sufferers and a reduction in their executive cognitive functioning due to shortages in their cognitive processing abilities. This has impoverishing consequences for their cognitive content, structure and eventually cognitive products resulting in general and specific learning disabilities. It is therefore understandable that Tourette syndrorne sufferers' involvement with, experiences of and attribution of meaning to the school situation and study material are negatively influenced. Add their humiliating symptoms, fluctuation of marks and hampered life-world formation and the logical result is disrupted self-images. Tourette syndrome sufferers need crucial support in their self-actualisation in order to be able to offer South Africa worthy human potential. / Psychology of Education / D. Ed.(Sielkundige Opvoedkunde)

The main aim of this thesis was to explore the maintenance of personhood and self-image in dementia by way of facilitating collaborative communication between people with dementia and their caregivers/interaction partners. As such, the roles of the person with dementia and the interaction partner were examined in each study within the realms of the ‘Collaborative Personhood Model’. Findings of the first study highlighted strategies used by people with mild to severe dementia to maintain social interactions, to save-face and to maintain and project a sense of self-image in a reminiscence situation. The impact of introducing a family member as the interaction partner in a similar reminiscence-based situation using personal photographs was then explored. The findings of this study indicated that the personal nature of the photographs can create conflict between the person with dementia and her family member. Crucially, these studies illuminated the supportive role that the communication partner must adopt in order to successfully facilitate people with dementia to maximise their retained communication skills. Communication and sense of self was then examined in an individual with very severe dementia with some retained speech. The findings of this study illuminated the potential of imitation in communicating with people at this stage of the illness. These findings were then built upon by exploring the use of Intensive Interaction (II) in a person with very advanced dementia with no retained speech. Findings of this study indicated retained awareness of self and functional communication skills at very late stages of dementia. Finally, this study was expanded using a modified version of II (Adaptive Interaction) in a small group of individuals with very severe dementia with very little or no retained speech. These findings indicated an unprecedented desire and ability to communicate in people with such severe dementia. Taken as a whole, these studies highlighted the adaptive and collaborative role that the interaction partner must adopt in order to facilitate the maintenance of personhood and self-image in people with dementia. More specifically, the interaction partner must adjust to the communicative repertoire that is maintained at each stage of dementia and in each individual. The ‘Collaborative Personhood Model’ represents an attempt to explain how this might be achieved.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Psychology / Master / Master of Philosophy

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / abstract / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy