The study sought to determine whether there is evidence for the presence of residual (chronic) deleterious effects on cognition due to repetitive mild traumatic brain injury in top team university level rugby players, using ImPACT 3.0, Trail Making Test (TMT) and Digit Span. The initial sample of 48 participants was divided into groups; Rugby (n = 30) and Controls (n = 18), Rugby Forwards (n = 14) and Rugby Backs (n = 16). A reduced sample (N = 31) comprised of Rugby (n = 20) and Controls (n = 11), Rugby Forwards (n = 9) and Rugby Backs (n = 11). Comparative subgroups were equivalent for estimated IQ but not for age and educational level in the full sample; in the reduced sample there was equivalence for all three variables of age, education and estimated IQ. All cognitive test measures were subjected to independent t-test analyses between groups at the pre- and post-season, and dependent t-test analyses for Rugby and Controls at pre- versus post-season. Overall, the results implicated the presence of deleterious effects of concussive events on Rugby players in the areas of speed of information processing, working memory and impulse control. Significant practice effects were found on the TMT and Digit Span for controls, but not on ImPACT 3.0, supporting the use of this computer-based programme in the sports management context.

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 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

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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.

The number of informal carers in the UK is rising, yet the dynamics of care within informal care relationships remain poorly understood. The present research examined adaptation of informal care relationships affected by Acquired Brain Injury. The research addresses four pairs of questions: (1a) Are there any disagreements and/or misunderstandings between carers and people with Acquired Brain Injury (PwABI) regarding carer identity? (1b) How can the pattern of divergences be explained? (2a) Are there any disagreements and/or misunderstandings between carers and PwABI regarding PwABI identity? (2b) How can the pattern of divergences be explained? (3a) What strategies do carers and PwABI use in collaboration on a joint task? (3b) Is the type of input provided by carers on the joint task comparable to scaffolding as described in the child development literature? (4a) What happens when carers and PwABI collaborate to fill in the Disability Living Allowance (DLA) claim form? (4b) Why do carers see more disability than PwABI when filling in the DLA form? Four mixed-method data sets were used to answer these questions: (1) numerical ratings given by PwABI and carers to map out convergences and divergences (2) videos of discussions between participants and researcher during rating tasks (3) videos of carers and PwABI engaging in a joint task - planning inviting a friend or relative round for a meal and (4) videos of carers and PwABI filling in part of the DLA claim form. All data was collected from the same 28 PwABI/carer dyads who were two or more years post injury. Chapter 4 addresses questions 1a and 1b. Carers’ and PwABIs’ perspective ratings revealed a number of disagreements regarding carer identity. Carers perceived themselves negatively compared to their partners’ view of them. Regarding question 1b, carers feel negatively about themselves due to difficulties in the transition to the role of ‘carer’. They experience a lack of recognition for this caring role as a result of concealing the burden of care. Carers require more long term support from health services to help them achieve recognition for their role, such as facilitating attendance at support groups. Chapter 5 addresses questions 2a and 2b. Carers’ and PwABIs’ perspective ratings revealed only one disagreement and corresponding misunderstanding regarding PwABI identity. Regarding question 2b, alignment was found between the perspectives of carers and PwABI regarding PwABI due to the relational rating method used. It is carer identity which is the source of most divergences of perspective, not PwABI identity as commonly assumed. Using a relational rating method shows promise as a tool to explore perspectives as it treats all viewpoints as equal and avoids pathologising the perspective of PwABI. Chapter 6 addresses questions 3a and 3b. Analysis of strategies shows that completing a joint task is a collaborative process. Carers direct the background of the task but PwABI are in charge of the foreground, making task decisions. However, carers dominate the process and control where and how PwABI contribute. Regarding question 3b, the interaction meets the criteria for scaffolding in the strategies chosen and the flexibility of collaboration. However, removal of supports is often an unrealistic goal, leading to frustration in carers. Examination of processes of collaboration has elucidated the strategies used by carers and PwABI and can enhance theoretical discussion of the applicability of the scaffolding metaphor for a cognitively impaired adult sample. Chapter 7 address questions 4a and 4b. Disagreements were frequent when completing the DLA form. Contestations were almost exclusively in the direction of carers seeing greater disability than PwABI. Regarding question 4b, carers see greater disability due to the communication required to complete the form. Dyads are forced to confront disability, a pattern of interaction they avoid in everyday life. Carers marginalise PwABI point of view and position themselves as ‘expert’ on the PwABI. Differences in frames of reference regarding audience, aim and scope lead carers to maximise the disability and PwABI to minimise this. The impact of completing complex forms on relationships and identity needs to be considered during development of disability benefit assessment methods. A relational approach which studies both halves of informal care partnerships simultaneously allows us to go beyond outcomes of ABI and affords a greater understanding of processes of adaptation.

[Truncated abstract] Controlled and automatic processing are broad categories, and how best to measure these constructs and their impact on functioning after mild traumatic brain injury (TBI) remains uncertain. The purpose of this thesis was to examine automatic and controlled processing aspects of attention after mild TBI using the Paced Auditory Serial Addition Task (PASAT) and event-related potentials (ERPs). The PASAT is one of the most frequently used tests to evaluate attentional functioning. It has been demonstrated to be a measure sensitive to both acute and longer-term effects of mild TBI, presumably due to demands for rapid processing and executive attentional control. ERPs provide a noninvasive neurophysiological index of sensory processing and cognitive functions and have demonstrated sensitivity to even minor cognitive dysfunction. The parameters provided by this functional technique may be those most likely to distinguish individuals with mild TBI from controls. Initially, it was hypothesized that successful novice PASAT performance requires the engagement of executive attention to establish novel controlled information processing strategies. Ten individuals who had suffered a mild TBI an average of 15.20 months previously were therefore expected to demonstrate processing abnormalities on the PASAT, relative to 10 healthy matched controls. Although the mild TBI group reported significant intensification of subjective symptoms since their injury, compared to controls, the mild TBI group provided a similar amount of correct PASAT responses. ... In the first experiment a visual search task consisting of an automatic detection and a controlled search condition was developed. In the second experiment the search task was performed concurrently with the PASAT task in a dual-task paradigm. In the mild TBI group, prior failure to establish more efficient forms of information processing with practice was found to significantly interfere with simultaneous performance of the PASAT task and the attention demanding condition of the search task. The pattern of impaired performance was considered to reflect a reduction in processing resources rather than a deficit in resource allocation. Dual-task performance in the control group was not associated with a large interference effect. In general, the results of this thesis suggest that individuals with mild TBI are impaired in their ability to progress from the stage of effortful controlled information processing to a stage of more efficient, automatic processing, and thus suffer a subtle attentional deficit. Following mild TBI, performance levels equivalent to controls may only be achieved with an abnormal expenditure of cognitive effort. As a result of the neuropathologic consequences of injury, individuals who have sustained a mild TBI are less able to benefit from practice, experience difficulty coping with simultaneous performance of secondary task, and are susceptible to distressing subjective symptomatology.

A study was conducted on the self-reported symptoms of Mild Traumatic Brain Injury sustained in Rugby Union at the pre- and post-season stages. A full sample of 30 rugby players at Rhodes University was compared to 27 non-contact sport controls. A reduced sample of 20 rugby players and 9 control participants provided improved control for education and IQ and was compared. Measures included the WAIS-III Vocabulary and Picture Completion Sub-tests to estimate IQ level, the symptom checklist on a widely used computer-based program (ImPACT), and a paper and pencil self-report 31-Item Post-Concussion Symptom Questionnaire. Independent and Dependent T-Test comparisons were conducted on the full and reduced samples. The symptoms reported by the rugby group appeared to be more pronounced on both the ImPACT Symptom Scale and the 31-Item Post-Concussion Symptom Questionnaire when compared to the control group at both the pre-and post-season stages. It was concluded that the rugby players demonstrated evidence to support the hypothesis of having sustained more previous concussions and reporting more symptoms at the pre-season stage when compared to comtrol participants. No prevalent changes for either the rugby or control groups were seen in dependent comparisons from pre-to post-season.