The purpose of this research was to investigate the efficacy of a 12 week isokinetic conditioning progam for the lower limbs in 12 young adults with acquired brain injury. There is strong evidence that young adults following ABI (Acquired Brain Injury) have on-going issues with physical impairments and functional limitations many years after their brain injury, and that these limitations are substantial and restrictive. As most therapy resources are available for early rehabilitation only, and these resources are mainly located in large cities, there are many people who are not receiving rehabilitation to support their on-going progress. / There is a paucity of studies investigating conditioning programs in young adults with ABI, and the effect of focusing treatment on the negative rather than the positive features of the Upper Neurone Syndrome (UMNS). The dose prescription for strengthening programs is uncertain, the effect of resistive exercise on tone is controversial and the changes following exercise on muscle strength, muscle power, functional abilities, and quality of life are largely unknown. / The research was in the form of a series of single case studies, with an A-B-A design. For each subject, a series of isokinetic (strength, power, tone) and mobility (gait speed and time to rise from a chair) baseline assessments and 6 subsequent assessments at 2-weekly intervals were performed. The last assessment was performed 4 weeks after cessation of the program to determine any carryover effect. The Short Form-36 questionnaire (SF-36) and semi-structured interviews were administered pre- and post- exercise to reflect the life satisfaction of subjects, and their perspective of any changes in response to the conditioning program. / The multiple isokinetic and mobility measures provided data for analysis of individual cases which were managed statistically, and for clinically significant change. Data was also analysed for the group. Group isokinetic and mobility measures were compared at pre-exercise, post-exercise and 4 weeks following cessation of the conditioning program using repeated measures analysis of variance. / The isokinetic exercise program, on a Kin Com dynamometer, consisted of nine sets of maximal contractions at velocities of 60 and 90 deg/s for unilateral knee flexors and extensors, and ankle plantarflexors and dorsiflexors. These sets were divided into three cycles of six reciprocal contractions. Subjects attended twice weekly for 12 weeks. / The conditioning program resulted in significant improvements in peak torque and power of ankle plantarflexors and peak torque of knee extensors for the group. In addition, functional improvements resulted, in particular fast walking activity, repeated chair rises and participation in activities the subjects valued. There was a carryover effect after the program ceased for some measures. There was no deleterious effect on tone in response to the exercise program. Quality of life of all subjects assessed by using the SF36 questionnaire improved in the area of physical functioning. Occupational status, vitality, self-esteem and optimism were further common themes of improvement obtained from interview data at the completion of the exercise program. / This study demonstrated that a 12 week intensive, resistive, conditioning program produced significant improvement in muscle performance in ankle plantarflexors, knee extensors, function, and participation in valued activities, as well as in feelings of well-being, in a group of ABI subjects. There were no adverse symptoms in response to the high intensity, high repetition exercise protocol at the ankle, indicating that the exercise protocol is suitable for strengthening ankle muscles in individuals following ABI who have a broad range of abilities. / Three subjects experienced knee pain and stiffness in response to the exercise program. These three TBI subjects, who had the highest functional mobility of the group, were able to develop higher torques when exercising, and, the twice weekly, maximal, isokinetic conditioning program might have been excessive for these subjects. The other nine subjects with moderate to severe muscle weakness of knee muscles did not suffer any adverse knee symptoms in response to the conditioning program, and demonstrated improvements in muscle performance of knee muscles. Therefore, when exercising knee muscles, a similar intensive protocol should only be utilized when the individuals have marked or moderate weakness of knee muscles. / These results indicate that a change in therapeutic approach is needed and that the focus for treatment should shift from the positive to the negative features of the UMNS. Rehabilitation of individuals following ABI should incorporate muscle conditioning programs for the lower limbs. Also, many individuals who are currently not receiving therapy may benefit from muscle strengthening exercises. It is important that further research is conducted to establish the most useful conditioning protocol for individuals following ABI. / Thesis (PhDPhysiotherapy)--University of South Australia, 2005.

The overall objective of this dissertation was to increase scientific understanding of brain reserve. Chapter 1 describes how brain reserve has come to be viewed in two distinct ways: differential expression of brain injury on the basis of individual differences in gross brain properties (neurological), or on the basis of lifespan patterns of complex mental activity (behavioural). Evidence in the Alzheimer???s disease and ageing literature has been extensive, yet with conflicting reports. In order to better evaluate this evidence, a systematic review of cohort studies is the focus of Chapter 2. Complex mental activity was found to be associated with reduced incidence of dementia and slowed rate of cognitive decline. Neurological brain reserve evidence was limited. A major task of this dissertation was to develop a more standard and complete behavioural brain reserve instrument. Chapter 3 relates the development of the Lifetime of Experiences Questionnaire (LEQ) in a group of 86 healthy elderly. The LEQ had adequate levels of internal consistency and reliability. In a validation test, higher LEQ scores were also found to predict attenuated cognitive decline over 18 months independent of covariates including premorbid IQ. Chapter 4 describes how both LEQ (as a measure of behavioural brain reserve) and intracranial volume (as a measure of neurological brain reserve) significantly predicted cognitive decline over three years in a sample of 70 aged subjects. Total LEQ was furthermore significantly correlated with hippocampal volume independent of intracranial volume, and this association mediated the relationship with cognitive decline. Behavioural brain reserve may therefore work by protecting individuals from hippocampal atrophy. The fifth chapter explores therapeutic and neurobiological aspects of behavioural brain reserve in a preliminary fashion. A randomized-control mental activity trial was run with 20 healthy elderly who received repeat magnetic resonance spectroscopy. Mental activity subjects were found to have selective and sustained upregulation of phosphocreatine metabolism in the hippocampal region, a finding of potential neuroprotective significance. Experience-dependent neuroplasticity is proposed as a unifying framework in the final chapter, allowing synthesis of the present findings and reconciliation of the neurological and behavioural approaches to brain reserve.

The overall objective of this dissertation was to increase scientific understanding of brain reserve. Chapter 1 describes how brain reserve has come to be viewed in two distinct ways: differential expression of brain injury on the basis of individual differences in gross brain properties (neurological), or on the basis of lifespan patterns of complex mental activity (behavioural). Evidence in the Alzheimer???s disease and ageing literature has been extensive, yet with conflicting reports. In order to better evaluate this evidence, a systematic review of cohort studies is the focus of Chapter 2. Complex mental activity was found to be associated with reduced incidence of dementia and slowed rate of cognitive decline. Neurological brain reserve evidence was limited. A major task of this dissertation was to develop a more standard and complete behavioural brain reserve instrument. Chapter 3 relates the development of the Lifetime of Experiences Questionnaire (LEQ) in a group of 86 healthy elderly. The LEQ had adequate levels of internal consistency and reliability. In a validation test, higher LEQ scores were also found to predict attenuated cognitive decline over 18 months independent of covariates including premorbid IQ. Chapter 4 describes how both LEQ (as a measure of behavioural brain reserve) and intracranial volume (as a measure of neurological brain reserve) significantly predicted cognitive decline over three years in a sample of 70 aged subjects. Total LEQ was furthermore significantly correlated with hippocampal volume independent of intracranial volume, and this association mediated the relationship with cognitive decline. Behavioural brain reserve may therefore work by protecting individuals from hippocampal atrophy. The fifth chapter explores therapeutic and neurobiological aspects of behavioural brain reserve in a preliminary fashion. A randomized-control mental activity trial was run with 20 healthy elderly who received repeat magnetic resonance spectroscopy. Mental activity subjects were found to have selective and sustained upregulation of phosphocreatine metabolism in the hippocampal region, a finding of potential neuroprotective significance. Experience-dependent neuroplasticity is proposed as a unifying framework in the final chapter, allowing synthesis of the present findings and reconciliation of the neurological and behavioural approaches to brain reserve.

The overall objective of this dissertation was to increase scientific understanding of brain reserve. Chapter 1 describes how brain reserve has come to be viewed in two distinct ways: differential expression of brain injury on the basis of individual differences in gross brain properties (neurological), or on the basis of lifespan patterns of complex mental activity (behavioural). Evidence in the Alzheimer???s disease and ageing literature has been extensive, yet with conflicting reports. In order to better evaluate this evidence, a systematic review of cohort studies is the focus of Chapter 2. Complex mental activity was found to be associated with reduced incidence of dementia and slowed rate of cognitive decline. Neurological brain reserve evidence was limited. A major task of this dissertation was to develop a more standard and complete behavioural brain reserve instrument. Chapter 3 relates the development of the Lifetime of Experiences Questionnaire (LEQ) in a group of 86 healthy elderly. The LEQ had adequate levels of internal consistency and reliability. In a validation test, higher LEQ scores were also found to predict attenuated cognitive decline over 18 months independent of covariates including premorbid IQ. Chapter 4 describes how both LEQ (as a measure of behavioural brain reserve) and intracranial volume (as a measure of neurological brain reserve) significantly predicted cognitive decline over three years in a sample of 70 aged subjects. Total LEQ was furthermore significantly correlated with hippocampal volume independent of intracranial volume, and this association mediated the relationship with cognitive decline. Behavioural brain reserve may therefore work by protecting individuals from hippocampal atrophy. The fifth chapter explores therapeutic and neurobiological aspects of behavioural brain reserve in a preliminary fashion. A randomized-control mental activity trial was run with 20 healthy elderly who received repeat magnetic resonance spectroscopy. Mental activity subjects were found to have selective and sustained upregulation of phosphocreatine metabolism in the hippocampal region, a finding of potential neuroprotective significance. Experience-dependent neuroplasticity is proposed as a unifying framework in the final chapter, allowing synthesis of the present findings and reconciliation of the neurological and behavioural approaches to brain reserve.

Thesis (PhD) - Swinburne University of Technology, Brain Sciences Institute, 2005. / Submitted for the degreee of Doctor of Philosophy, Brain Sciences Institute, Swinburne University of Technology - 2005. Typescript. Bibliography: p. 159-197.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

Thesis (Ph.D.)--University of Wollongong, 2004. / Typescript. Includes bibliographical references: leaf 130-154.

Thesis (M. Phil.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 66-73) Also available in print.

Thesis (Ph. D.)--University of Wisconsin, 1967. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliography.

Thesis (M. Communication Pathology)--University of Pretoria, 2006. / Summary in English and Afrikaans. Includes bibliographical references.