Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (p. 125-137).

Thesis (M.A.)--Miami University, Dept. of Psychology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 42-51).

This study investigates the effects of cumulative mild head injury on the cognitive functioning of elite rugby players. A comprehensive battery of neuropsychological tests was administered to top national (Springbok) rugby players (n=26), national Under 21 rugby players (n= 19), and a non-contact sport control group of national hockey players (n=21). The test results of the Total Rugby group (Springbok Rugby and Under 21 Rugby players), the Under 21 Rugby group, the hockey controls, and the Total Rugby and Under 21 Rugby forward and backline players respectively, were each compared with established normative data. Results showed significant differences in the direction of a poorer performance relative to the norms for the Total Rugby and Under 21 Rugby groups, and for the Total Rugby Forwards and Under 21 Rugby Forwards, on tests sensitive to the effects of diffuse brain damage. On the other hand, the Hockey Control group and the Total Rugby Backs and Under 21 Rugby Backs tended to perform within the normal range or better than the norm on some tests. These results confirm the hypothesis that rugby players, and the forward players in particular, are at risk of adverse cognitive effects consequent on cumulative mild head injury. The theoretical implications are that the aggregate effects of multiple exposures to mild head injuries in the rugby players served to reduce their brain reserve capacities and acted as a threshold-lowering influence associated with symptom onset.

This study investigates the cumulative effects of concussive and subconcussive mild head injury on the cognitive functioning of schoolboy rugby players. A comprehensive battery of neuropsychological tests and a self-report postconcussive questionnaire were administered to top level schoolboy rugby players (n=47), and a non-contact sport control group of top level schoolboy hockey players (n=34). Group comparisons of the percentage of individuals with cognitive deficit were carried out between i) the schoolboy rugby and the schoolboy hockey players, ii) the rugby forward and the rugby backline players; iii) the rugby forward and the schoolboy hockey players and, iv) the rugby backline and the schoolboy hockey players. Results on the neuropsychological test battery did not provide any substantial evidence of a higher level of neuropsychological impairment in the rugby players relative to the control group, or in the rugby forward players relative to the rugby backline players. Results obtained on the postconcussive symptom questionnaire provided tentative indications that the rugby players do report a greater frequency of postconcussive symptomatology. The symptoms most frequently reported were being easily angered, memory problems, clumsy speech and sleep difficulties. It was hypothesized that the absence of cognitive impairment in the schoolboy rugby players compared with that noted for professional players was due to their younger age, relatively high IQ and education level and a less intensive level of physical participation in the sport, and hence less accumulated exposure to the game, thereby decreasing their exposure to mild head injuries. From a theoretical perspective, these pre-existing conditions were considered to act as protective factors against reductions in brain reserve capacity and concomitant susceptibility to the onset of neuropsychological dysfunction.

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 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.

This study investigated the use of biofeedback as part of stress-management training program with head injured adults. The single cases examined were four males with head injuries of moderate severity who were in the post-acute stages of recovery. Treatment involved bi-weekly relaxation training, using EMG biofeedback in combination with deep breathing, autogenic training and/or imagery. Individual subject response to relaxation training was examined during treatment sessions, as was the frequency of stress-related symptomatology outside of sessions, and overall functional adaptation. While all subjects showed evidence of relaxation during treatment sessions, such factors as the nature of the functional disturbance and personal motivation appear to be related to the degree of carryover to the external environment.

This dissertation approaches the work of South African/Botswanan novelist Bessie Head, especially the novel A Question of Power, as positioned within the critical framework of the postcolonial paradigm, the genius of which accommodates both African and African American literature without recourse to racial essentialism. A central problematic of postcolonial literary criticism is the ideological stance postcolonial authors adopt with respect to the ideology of the metropolis, whether on the one hand the stances they adopt are collusive, or on the other oppositional. A key contested concept is that of universality, which has been widely regarded as a witting or unwitting tool of the metropolis, having the effect of denigrating the colonial subject. It is my thesis that Bessie Head, neither entirely collusive nor oppositional, advocates an Africanist universality that paradoxically eliminates the bias implicit in metropolitan universality.

Background: Cerebrovascular injury (CVI) is a potentially devastating complication of gunshot wounds to the head (GSWH), with yet unclear incidence and prognostic implications. Few studies have also attempted to define CVI risk factors and their role in patient outcomes. We aimed to describe 10 years of CVI from GSWH and characterize these injury patterns. Methods: Single-institution data from 2009 to 2019 were queried to identify patients presenting with dural-penetrating GSWH. Patient records were reviewed for GSWH characteristics, CVI patterns, management, and follow-up. Results: Overall, 63 of 297 patients with GSWH underwent computed tomography angiography (CTA) with 44.4% showing CVI. The middle cerebral artery (22.2%), dural venous sinuses (15.9%), and internal carotid artery (14.3%) were most frequently injured. Arterial occlusion was the most prominent injury type (22.2%) followed by sinus thrombosis (15.9%). One fifth of patients underwent delayed repeat CTA, with 20.1% showing new/previously unrecognized CVI. Bihemispheric bullet tracts were associated with CVI occurrence (P = 0.001) and mortality (P = 0.034). Dissection injuries (P = 0.013), injuries to the vertebrobasilar system (P = 0.036), or the presence of ≥2 concurrent CVIs (P = 0.024) were associated with increased risk of mortality. Of patients with CVI on initial CTA, 30% died within the first 24 hours. Conclusions: CVI was found in 44.4% of patients who underwent CTA. Dissection and vertebrobasilar injuries are associated with the highest mortality. CTA should be considered in any potentially survivable GSWH. Longitudinal study with consistent CTA use is necessary to determine the true prevalence of CVI and optimize the use of imaging modalities.