D.Litt. et. Phil. / Head injury is the major cause of death for individuals under 35 years old in the United States of America, and a similar picture exists in South Africa. A major cause of traumatic brain injury is motor vehicle accidents. In addition, the advances in modem medical technology increase the chances for survival, for example, sophisticated medical diagnostic techniques such as computerised tomography (CT), and magnetic resonance imaging (MRI). Advances in emergency trauma and neurosurgical procedures have also increased the number of survivors following a head injury. The symptoms resulting from head injury include disturbed physical, cognitive, psychological and behavioural functioning. Long-term management of these symptoms is usually required. A body of evidence exists that demonstrates the value of rehabilitation during the first year of recovery from traumatic brain injury. Head injury cases often result in litigation in that the injured person may be entitled to compensation for the injuries sustained. Considerable forensic debate exists around the issue of whether the victim's symptoms are attributable to organic brain damage, or whether they reflect a pre-existing functional psychological state of psychiatric illness, or personality disorder. Further still, the individual may be 'malingering' or faking postconcussion symptoms of headache, dizziness, fatigue, memory deficit, impaired concentration, irritability, anxiety, insomnia, concern about bodily functions, and hypersensitivity to light and noise. Alternatively, a common diagnosis is traumatic neurosis with a psychogenic basis, and in the context of litigation is referred to as "compensation neurosis". Specifically, the issue of contention revolves around concussion, and mild or minor head injuries. This study proposed that both neuropathophysiological and psychosocial symptoms occur in the event of a traumatic brain injury. This view supports the traditional model that pain or the sequelae of head injury are not affected by compensation. Therefore, the objective of the study was that follow-up assessment after compensation pay-outs should produce similar results to the assessment results obtained during the litigation process. The hypotheses of the study were essentially confirmed. The neuropsychological error scores produced in the assessments during litigation, and two-to-four years after the completion of litigation were similar. However, similar to other studies, variations were evident. Four exceptions were demonstrated in that significant improvement was evident with regard to shotterm verbal memory delayed recall for paragraphs, and for immediate recall (without and after interference) in verbal memory for a word list. These improvements therefore pertain to verbal memory. The fourth improvement occurred with respect to manual dexterity and visual-motor work speed, although the improvement may be peripheral or primary (neurological). Further findings included that no gender differences were evident in the neuropsychological posttest scores. It was confirmed that individuals with a good Glasgow Outcome Scale rating showed less posttraumatic amnesia, a shorter time since injury, less additional injuries, and a lower compensation sum. It was also supported that individuals with a good Glasgow Outcome Scale rating showed less impairment on neuropsychological indices. However, an exception was that individuals with a moderate Glasgow Outcome Scale rating showed improvement on the neuropsychological index measuring immediate concentration, visual scanning, and visual-motor work speed. The qualitative data or psychosocial measures of severity and outcome produced a similar picture that the majority of subjects maintained their pretest status although some exceptions were evident. Within the medico-legal domain it was shown that, in general, concordance of severity was high amongst the medical experts for the plaintiffs and the defendents. However, their prognoses were indicated to be less accurate, and whilst their consistency in documenting diagnoses in the reports of the subjects was adequate, they were found to be inconsistent in documenting severity ratings and prognoses. It was suggested that improvements may be attributed to neurophysiological differences, non-participation in a rehabilitation programme, the interference and delay of rehabilitation, increased psychological reactions associated with litigation, and mechanisms of secondary gain which may by attributed to the other players, such as the family, the attorneys, the medical experts, among others, and not only to the individual or victim.

Magister Scientiae (Physiotherapy) - MSc(Physio) / HIV and AIDS are now being considered as a chronic disease. As people live longer the possibility of physical disability increases. This study aimed to investigate the nature of physical disability among HIV/AIDS adults cared for by the Makeni home-based carers in Lusaka, Zambia. Disability was measured based on the World Health Organisation International Classification of Functioning, Disability and Health. This study demonstrated that mostly mild impairments and mild to moderate activity limitations and participation restrictions exists among patients in the Makeni home-based care programme. This study concluded that physiotherapists and other health professionals will have to be more involved in the community home-based programs that are suited for people living with HIV/AIDS so that they are also provided with clinical assessments and rehabilitation services. / South Africa

Cette recherche traite de la participation des patients à la sécurité des soins en radiothérapie, qui se définit comme les actions mises en œuvre par les patients pour réduire la probabilité d’erreurs médicales et/ou pour atténuer les effets des erreurs lorsqu’elles surviennent effectivement. La sécurité des patients en radiothérapie est devenue une priorité centrale pour les politiques publiques suite aux accidents récents survenus à Épinal, Toulouse ou Grenoble pour les plus emblématiques. Dans ce contexte, la participation des patients peut être un moyen d'amélioration de la sécurité des soins. L’objectif général de cette étude est de comprendre la dynamique constructive des capabilités des patients dans la coproduction d’un soin sûr et efficace. Les capabilités des patients se définissent comme les contributions réelles faites par ces derniers et visant à assurer la sécurité et l'efficacité des soins.L'étude est menée dans les services de radiothérapie d’un hôpital et d'un centre de lutte contre le cancer. Plusieurs méthodes ont été combinées pour analyser l'activité de travail des manipulateurs, des patients et de l’activité conjointe entre ces deux partenaires : des observations des séances de traitement, des entretiens semi- directifs avec des manipulateurs et des patients, des auto- et allo -confrontations avec des manipulateurs et des entretiens d'explicitation avec des patients.Les résultats décrivent les contributions effectives mises en œuvre par les patients, et montrent que la coopération du patient agit comme une barrière de sécurité supplémentaire qui renforce la sécurité et l'efficacité du traitement. L'environnement et la durée de radiothérapie (traitement répétitif sur plusieurs semaines) sont des ressources externes qui fournissent une opportunité créative pour le patient d’apprendre de la situation et de l'évaluer en observant ce qui se passe. L'étude s’attache également à analyser les facteurs qui permettent (facteurs dits « positifs ») ou au contraire empêchent (facteurs dits « négatifs ») de convertir les capacités des patients en capabilités, c’est-à-dire en contributions effectives. Les facteurs de conversion positifs sont relatifs aux patients (connaissance des risques associés aux soins, motivation personnelle), au collectif manipulateur-patient (objectif commun, synchronisation cognitive, synchronisation opératoire) et aux manipulateurs (construction d’une relation de confiance, encouragement et renforcement positif). Cependant, les capabilités des patients ne sont pas toujours optimisées et les fortes pressions temporelles rencontrées par les manipulateurs dans leur pratique peuvent empêcher leur développement.Cette étude a permis de montrer qu’il y a une volonté conjointe des professionnels et des patients d’aller ensemble vers une meilleure coopération. Elle montre également que la coopération du patient est une nécessité qui reste encore méconnue et sous-exploitée, alors qu’elle permettrait probablement de réduire le nombre de situations et des comportements à risques des patients. Cette participation active, si elle ne doit en aucun cas être exigée et être une source d’anxiété supplémentaire pour le patient, mérite d’être développée et encouragée. / This research deals with patient participation to patient safety, which can be defined as the actions taken by patients to reduce the likelihood of medical errors and / or mitigate the effects of errors when they do occur. Patient safety in radiotherapy has become a central priority for public policies further to the recent accidents arisen at Épinal, Toulouse and Grenoble for the most symbolic. In this context, patient participation may be a way of improvement of patient safety. The general objective of this study is to understand the constructive dynamics of patient capabilities in the co-production of a safe and effective care. Patient capabilities are defined as the actual contributions made by patients to ensure the safety and effective of care.The study was conducted in the radiotherapy departments of a public hospital and of a cancer center. Several methods have been combined to analyze the work activity of radiographers, of patients and of joint activity between the two partners : observations of treatment sessions, semi-structured interviews with manipulators and patients, self- and allo-confrontations with radiographers and elicitation interviews with patients.The results describe the actual contributions carried out by patients and show that patient cooperation acts as an additional safety barrier for patient safety. The environment of care and the duration of radiotherapy (repetitive and long treatment) constitute external resources, which provide a creative opportunity for the patient to learn from the situation and to evaluate it by observing what happens. The study also attempts to analyze the factors that allow ("positive" factors) or prevent ("negative" factors) patient capacities to become capabilities, i.e. actual contributions. The positive conversion factors are relative to the patients (knowledge of risks associated to care, personal motivation), to the collective (common objective, cognitive synchronization, operative synchronization) and to radiographers (construction of a trust relationship, encouragement and positive strengthening). However, patient capabilities are not always optimized and the strong work-related temporal pressures can prevent their development.This study highlights that there is a common will of professionals and patients to go together towards a better cooperation. It also shows that patient cooperation is a necessity that remains still unknown and underexploited, while it would likely reduce the number of risky situations and patients’ risky behaviors. Even if this active participation should not be required and be an additional source of anxiety for the patient, it should be developed and encouraged.

MCur / Department of Advanced Nursing Science

Thesis (MA)--Stellenbosch University, 2015 / ENGLISH ABSTRACT : Worldwide there are various reports on the prevalence of depression in patients diagnosed with brain tumours. In South Africa, psychological research in relation to psychiatric symptoms among patients with brain tumours is lacking. The aims of this study were to determine the incidence of depression in patients diagnosed with brain tumours and to clarify our understanding of the relationship between depression and tumour localisation, histopathological type of tumour, and participant characteristics. The study sample consisted of 35 patients (11 males and 24 females) aged between 21 and 64 years with a solitary primary brain tumour. The patients were treated at the neurosurgery clinics located at Tygerberg Hospital in the Western Cape and Universitas Hospital in the Free State between mid-2010 and 2013. The major histological subgroup consisted of meningiomas (47%), glioblastomas (22%), astrocytomas (19%), gliomas (9%) and epidiomas (3%). The tumour distribution was as follows: 52% in the left hemisphere, 37% in the right hemisphere, and 11 % in the midline. The psychiatric symptoms of the patients were assessed before treatment by the Beck Depression Inventory and Mini International Neuropsychiatric Interview. In addition, the patients’ neuropsychological functions were evaluated by a short neuropsychological test battery (Mini Mental State Examination, Trail Making Test (Part A), Letter Number Sequencing subtest, Hopkins Verbal Learning Test – Revised, and Brief Visuospatial Memory Test – Revised). Results from the quantitative data, showed the prevalence of mild depression was 26% for men and 43% for women. Overall 37% of the total sample had depressive symptoms. No significant relationship was found between depression and tumour location or between the various neuropsychological characteristics and neurological symptoms and tumour location. The study showed that depression is a common symptom in patients diagnosed with brain tumours and therefore depression symptoms have to be recognised and treated by psycho-educating the patients and their families, pharmacotherapy, or psychotherapy as soon as possible. However, due to the relatively small sample size, the results are of limited generalisability. / AFRIKAANSE OPSOMMING : Wêreldwyd is daar verskeie verslae oor die voorkoms van depressie in pasiënte gediagnoseer met breingewasse. In Suid-Afrika is daar ’n tekort aan sielkundige navorsing met betrekking tot psigiatriese simptome by pasiënte. Die doel van hierdie studie was om die voorkoms van depressie te bepaal in pasiënte gediagnoseer met breingewasse en om duidelikheid te kry oor die verband tussen depressie en die ligging van breingewasse, histopatologiese tipe gewas en karakter eienskappe van die deelnemers. Die steekproef van die studie het bestaan uit 35 pasiënte (11 mans en 24 vroue) tussen die ouderdomme 21 en 64 jaar met ‘n soliede breingewas. Die pasiënte is behandel by die neurochirurgiese klinieke by Tygerberg Hospitaal in die Wes-Kaap en by Universitas Hospitaal in die Vrystaat vanaf middel 2010 tot 2013. Die mees algemene histologiese subgroep het bestaan uit meningiome (47%), glioblastomas (22%), astrocytomas (19%), gliomas (9%) en epidiomas (3%). Die verspreiding van die gewasse was soos volg: 52% in die linkerhemisfeer, 37% in die regterhemisfeer en 11% in die middel. Die psigiatriese simptome van die pasiënte is voor behandeling geëvalueer met behulp van die Beck Depression Inventory en die Mini International Neuropsychiatric Interview. Bykomend is die pasiënte se neurosielkundige funksies geëvalueer met behulp van ‘n neurosielkundige toetsbattery (Mini Mental State Examination, Trail Making Test (Part A), Letter Number Sequencing subtest, Hopkins Verbal Learning Test – Revised en Brief Visuospatial Memory Test – Revised). Die resultate van die kwantitatiewe data het getoon die voorkoms van matige depressie was 26% vir mans en 43% vir vroue. In geheel het 37% van die totale steekproef depressiewe simptome getoon. Daar was geen beduidende verhouding tussen depressie en die ligging van die gewas of tussen die verskeie neurosielkundige eienskappe en die ligging van die gewas nie. Die studie het getoon dat depressie ’n algemene simptoom is in pasiënte gediagnoseer met breingewasse en daarom moet depressiewe simptome herken en so gou as moontlik behandel word deur psigo-opvoeding van die pasiënte en hul familie, farmakoterapie of psigoterapie. As gevolg van die relatiewe klein steekproef grootte het die resultate ’n beperkte veralgemeenbaarheid.

Psychology / (D. Litt et Phil.(Psychology ))

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009. / Introduction Decreased hip extension in the paretic leg is a common impairment after stroke. Gluteal taping was introduced as a technique that helped in increasing hip extension of the paretic leg, and step length in the unaffected leg. The aim of this study was to further investigate the effect of gluteal taping on other temporal spatial and kinematic parameters using a 3D motion analysis system (Moven System). Methods The study was conducted in two phases. Phase 1 entailed examining the intra trial reliability of the Moven System, where eight subjects were recruited and tested twice at their normal pace of walking, and twice again at their maximum speed. Phase 2 involved studying the effect of gluteal taping on temporal spatial and kinematic parameters. Thirty subjects participated and were tested under three taping conditions (no tape, therapeutic tape, and placebo tape), while walking at their self selected walking speed. Intra-class correlation coefficient ICC determined around 95% confidence intervals was used to examine the intra trial reliability of the Moven System. Repeated measures-ANOVA was used to study the temporal spatial, and kinematic variables during the three taping conditions. Results The Moven showed moderate to excellent reliability in measuring the gait variables including temporal spatial parameters and sagittal kinematic parameters in addition to the lateral pelvic tilt. Taping caused significant increase in hip extension and reduction in knee flexion at terminal stance for the paretic leg. There was a trend toward better hip flexion at terminal stance, and a mild trend toward more planter flexion at terminal stance. Both treatment and placebo tapes caused an increase in the step lengths of either leg, and a significant increase in gait velocity and cadence. Conclusion Gluteal taping may be beneficial in producing important clinical effects post stroke, and can be used as an adjunct strategy during gait rehabilitation. Further research is needed to understand the mechanism of how taping produces effects, and to further explore its effect on kinetic and muscle activation variables.

This thesis was concerned with the psychological adjustment of 67 end-stage cancer patients, and three psychosocial variables considered to influence that adjustment: emotional support from spouse, positive meaning, and working models of attachment. Furthermore, this thesis was also concerned with the psychological adjustment of the patients' spouses, and the influence of emotional support from patient and working models of attachment on their adjustment. It was hypothesised that each of these psychosocial variables would directly influence the psychological adjustment of patients and spouses, measured using the negative affectivity scale of the Positive and Negative Affect Scale (PANAS). Furthermore, it was hypothesised that emotional support would influence positive meaning, and working models of attachment would influence both emotional support and positive meaning. Variables were measured via paper and pencil self-report inventories, with the exception of positive meaning, where verbal responses to an open question were coded. Univariate analyses indicated an association between patients' and spouses' emotional support provided by one another and their psychological adjustment. Univariate results also showed that patients' positive meaning was related to patients' psychological adjustment, and that patients' working models of attachment involving higher levels of attachment anxiety were associated with patients' poorer psychological adjustment. All these individual associations remained statistically significant after three control variables related to the patients' physical condition were taken into account. In addition, univariate analyses indicated that attachment was associated with emotional support, and that emotional support was associated with positive meaning. Following univariate analyses, variables were integrated into one model for patients and another for spouses using path analyses. Results were generally consistent with the prior sets of analyses. However, patients' working models of attachment involving higher levels of attachment anxiety no longer had a direct effect on patients' psychological adjustment to statistically significant levels. Rather, the influence of the working models of attachment on patients' psychological adjustment was mediated by emotional support. In addition, patients' positive meaning no longer had a significant direct effect on patients' psychological adjustment. The insignificant path coefficients between attachment anxiety and psychological adjustment, and between positive meaning and psychological adjustment, were attributed to the large amount of variance in negative affect due to emotional support. In summary, this research indicates that emotional support given and received between patients and spouses is important to the psychological adjustment of each party. Furthermore, emotional support influences patients' ability to construe positive meaning in their illness, although positive meaning does not appear to be as critical to the psychological adjustment of patients as emotional support. Working models of attachment influence the psychological adjustment of patients primarily through their influence on emotional support.

Social support is likely to play an especially important role in coping with a cancer diagnosis as it presents a unique set of stressors to the individual. The purpose of this study was to examine biological sex differences in the perceived availability of three modes of social support (emotional, instrumental, and informational), source of support (friends vs. family), and social support seeking behavior in a population of cancer patients. The sample included 71 men and 71 women who had been diagnosed with cancer within two years of the start of the study. No significant sex differences were found in social support seeking; however, results revealed that women perceived greater availability of emotional support as well as greater support from friends on all modes of social support than did men. Implications of these findings and future directions for research are discussed. / Department of Counseling Psychology and Guidance Services

Psychology / (D. Litt et Phil.(Psychology ))