This study investigates the effects of cumulative concussive and subconcussive mild head injury on the cognitive functioning of professional rugby players. A comprehensive battery of neuropsychological tests was administered to 26 professional rugby players and a noncontact sport control group of 21 professional cricket players. The test performances of the rugby players were compared to those of the cricket players. Within the rugby group, forward and backline players were compared. An analysis of mean score differences between the rugby and cricket group failed to support the presence of brain damage effects in the rugby group. However, there was significantly increased variability of scores for the rugby players compared with the cricket players on tests particularly sensitive to cognitive deficit associated with mild head injury. This invalidates the null indications of average effects, indicating that a notable proportion of rugby players’ performances were falling off relative to the rest of the rugby players on tests vulnerable to the cognitive effects of diffuse brain damage. Mean score comparisons within the rugby group indicated that it was the subgroup of forward players, in particular, whose test performances revealed deficits suggestive of cerebral damage. Specifically, deficits were found in working memory, visuoperceptual tracking, verbal memory and visual memory, a pattern of deficits commensurate with cumulative mild head injury. The theoretical perspectives of Satz’s (1997) Brain Reserve Capacity Theory and Jordan’s (1997) ‘Shuttle’ model of variability are drawn upon in order to elucidate research findings and suggestions for future research are provided.

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.

sustained multiple concussions may be at risk of cumulative impairment. The role of neuropsychological testing in the management of sports-related concussion is a contentious and challenging issue which has gained credibility given the lack of clear and well-established guidelines pertaining to the diagnosis, assessment and return-to-play decisions following concussion. Despite various traditional paper and pencil tests being shown to be effective indicators of postconcussive neuropsychological dysfunction, testing has not been widely implemented, due to time- and labour-demands. ImPACT, a computer-based neuropsychological assessment instrument, has been recognised as a valid and reliable tool in the monitoring of athletes' symptoms and neurocognitive functioning preseason and postconcussion. As a part of larger-scale concussion research conducted on top-team university rugby players, this is an in-depth case study conducted on a 20-year old participant with a history of multiple concussions, who was referred following a concussion sustained during the season. The objectives of the study were: (i) to determine the sensitivity of ImPACT versus WAIS-III Digit Span and Trail Making Test during the acute postconcussive phase; and (ii) to examine the sensitivity of ImPACT versus a comprehensive battery of neuropsychological tests to possible residual deficits as a result of the multiple concussions. ImPACT was determined to be more sensitive to acute postconcussive impairment following concussion than Digit Span and Trail Making Test. Furthermore, the ImPACT preseason baseline scores appear to be sensitive to neurocognitive dysfunction, possibly due to cumulative concussive injuries.

Essa dissertação teve como objetivo investigar as funções executivas em crianças e adolescentes com Transtorno do Espectro do Autismo (TEA). No primeiro estudo, foi feita uma revisão sistemática de publicações de 2001 a 2011, que avaliaram as funções executivas nessa amostra. No segundo estudo, foi feita uma comparação de desempenho de dois grupos de crianças e adolescentes, um grupo com diagnóstico de TEA (n=11) e um grupo controle com desenvolvimento típico (n=19), em tarefas de funções executivas e memória de trabalho. Concluiu-se que, embora o estudo de revisão tenha encontrado evidências de componentes executivos intactos (resolução de problemas, memória de trabalho) e disfuncionais (planejamento, flexibilidade, fluência verbal, inibição) nas amostras com TEA, o estudo empírico indicou desempenho inferior do grupo TEA em todas as tarefas de funções executivas e memória de trabalho, envolvendo componentes do controle inibitório, da flexibilidade cognitiva, do planejamento, de memória de trabalho e de fluência verbal. / This dissertation aimed to investigate executive function in children and adolescents with Autism Spectrum Disorders (ASD). In the first study, we performed a systematic review of publications from 2001 to 2011, which assessed executive function in this sample. In the second study, was done a performance comparison of two groups of children and adolescents, a group with ASD (n=11) and a control group with typical development (n=19), in tasks of executive function and working memory. It was concluded that, although the review study has found evidence of intact (problem-solving, working memory) and dysfunctional (planning, flexibility, verbal fluency, inhibition) executive components in samples with ASD, the empirical study indicated lower performance of executive function in ASD group, involving components of inhibitory control, cognitive flexibility, planning, working memory and verbal fluency.

Neuropsychologists are becoming increasingly aware that there is a complex interplay of cognitive, personality, and sociocultural factors that affect an individual's performance on neuropsychological tests. The current study investigated the effect of one aspect of the sociocultural environment, that is, quality of education, on performance on neuropsychological tests of executive function. The sample included 40 high school learners: Group A comprised learners with a high quality of education and Group B comprised learners with a low quality of education. Four tests of executive function were administered: the Verbal Fluency Test, the Design Fluency Test, the Stroop Test and the Wisconsin Card Sorting Test. Results indicated that quality of education significantly affected the participants' performance with Group A performing significantly better than Group B on all the tests of executive function. These findings have implications for the interpretation of neuropsychological test performance in cross-cultural research and practice. / Psychology / M.A. (Clinical Psychology)

Contexto. A impulsividade é um conceito formado a partir de diversas dimensões comportamentais. Desta forma a avaliação do comportamento impulsivo apresenta características complexas e distintas, que devem ser levadas em conta durante o processo de diagnóstico ou pesquisa. Objetivo. Este artigo de revisão apresenta os principais instrumentos de avaliação do comportamento impulsivo tanto em animais, quanto em humanos, relacionando as indicações e limitações de cada instrumento, assim como apontando referências de artigos empíricos que exemplificam cada protocolo. Método. Foram realizadas buscas nos sistemas Medline, PsycINFO e BVS/Bireme durante o período de 2007 a 2012. Resultados. Para humanos foram apontados quatro questionários e oito tarefas, e para animais foram apontadas seis tarefas. Entre os questionários a Escala de Impulsividade Barrat 11 se destaca, assim como a tarefa Delay Discounting, tanto para humanos quanto para animais. Conclusão. Estudos que utilizam instrumentos de modelos diferentes são sugeridos, assim como validação de escalas de impulsividade para diferentes populações brasileiras. / Background. The concept of impulsivity encompasses several behavioral dimensions. Therefore, the evaluation of impulsive behavior is quite complex and can vary greatly. Hence, such complexity should be considered during research or while establishing a diagnosis. Objectives. The objective of the present review article was to describe the main impulsive behavior assessment instruments both in animals and humans, including the indications and limitations of each instrument, and to suggest references of empirical articles that illustrate each protocol. Methods. The following databases were searched from 2007 to 2013: MEDLINE, PsycINFO and BVS/Bireme. Results. Our search retrieved four questionnaires and eight tasks for humans, and six tasks for animals. Among the most frequently used questionnaires and tasks, we found the Barratt Impulsiveness Scale-11 and the Delay Discounting Task, both for humans and animals. Conclusion. It is recommended that further research be undertaken using different models of instruments. In addition, impulsivity scales should be validated for different Brazilian populations.

Esta dissertação é composta por três estudos conduzidos de acordo com a abordagem da Neuropsicologia Cognitiva, a fim de compreender as habilidades e prejuízos na escrita de palavras/pseudopalavras de adultos com lesão cerebrovascular no hemisfério direito (LHD) e no hemisfério esquerdo (LHE), comparados a adultos neurologicamente saudáveis (controles). No primeiro estudo, comparou-se o desempenho dos grupos com LHE, LHD e controles em tarefas de linguagem oral e escrita e nos tipos de erros na tarefa Escrita Ditada em um instrumento de avaliação neuropsicológica breve. O grupo com LHE apresentou pior desempenho em todas as tarefas de linguagem oral e escrita (exceto em compreensão oral). Verificou-se que o grupo com LHE demonstrou déficits significativos nas habilidades linguísticas (rotas fonológica e lexical) e periféricas fundamentais para escrita de palavras, enquanto os casos com LHD destacaram-se por déficits no uso da rota lexical (Regularizações). No segundo estudo, descreveu-se o processo de construção de uma Tarefa de Escrita de Palavras/pseudopalavras controlada linguisticamente para avaliação das disgrafias em adultos. No terceiro estudo buscou-se analisar as habilidades de linguagem oral e escrita de adultos com LHE e LHD comparados a controles, analisar a associação entre características sociodemográficas e o desempenho em escrita ditada e distinguir o tipo de disgrafia adquirida dos casos com escores deficitários. Não foram encontradas diferenças significativas entre os perfis linguísticos dos grupos. Melhor desempenho na escrita de palavras mostrou estar associado com altos hábitos de leitura e escrita e maior escolaridade dos adultos. Verificaram-se características de disgrafias linguísticas (fonológica, lexical e mista) e periférificas em casos com LHE e LHD. A presente dissertação destaca a heterogeneidade dos déficits de escrita encontrados e ressalta a importância do controle das variáveis sociodemográficas no diagnóstico de disgrafia adquirida. / This dissertation consists of three studies conducted in accordance with the approach of Cognitive Neuropsychology, in order to understand the skills and damages in writing of words and pseudowords of adults with cerebrovascular lesions in the right hemisphere (LHD) and left hemisphere (LHE) compared to neurologically healthy adults (controls). The first study compared the performance of groups with LHE, LHD and controls on tasks of oral and written language and the types of errors in the task dictated writing in a brief neuropsychological assessment instrument. The LHE group showed worse performance on all tasks of oral and written language (except in oral comprehension). It was found that the group with LHE has demonstrated significant deficits in linguistic (phonological and lexical) and peripheral skills fundamental to writing of words, while cases with LHD highlighted for deficits in the use of the lexical route (Regularizations). In the second study, was presented the construction process of a words/pseudowords writing task linguistically controlled for evaluation of dysgraphias in adults. The third study aimed to examine the oral and writing language skills of adults with LHE and LHD compared to controls, examining the association between sociodemographic characteristics and performance on dictated written distinguish the type of acquired dysgraphia in the cases with deficient scores. There were no significant differences between the linguistic profiles of the groups. Best performance in writing of words was associated with higher reading and writing habits and higher education of adults. There were features linguistic (phonological, lexical and mixed) and peripherical dysgraphias in cases with LHE and LHD. This dissertation highlights the heterogeneity of deficits founded in the word writing and highlights the importance of controlling sociodemographic variables in the diagnosis of acquired dysgraphia.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Bipolar disorder (BD) is a severe psychiatric disorder, recurrent, characterized by mood swings and involves neurochemical, cognitive, psychological, functional, family and socioeconomic factors. The literature describes impairments in multiple cognitive domains in patients with BD, which may persist even during periods of euthymia. Executive functions involves cognitive sub-processes, among them self-regulation, mental flexibility, decision making, selective attention and inhibitory control. These functions are impaired in BD, but there is no consensus on the persistence of deficits in euthymia. It is understood that such impairments affect the daily life of the BD patients, and the way they deal with their treatment. In this research, we sought to understand the socio-demographic and clinical characteristics of 41 patients with BD in euthymia, aged between 25 and 60 years, assisted by the Mood Clinic of the Department of Psychiatry, University Hospital of Santa Maria, RS, Brazil, comparing them with a matched group of 41 healthy controls, in order to test for possible differences in executive functions performance, more specifically, mental flexibility and inhibitory control. This is an exploratory, descriptive and case-control study, where the following instruments were used to compare the groups: Wisconsin Card Sorting Test, Stroop Test, and Trail Making Test B. Ethical procedures required for research with human beings were followed. The social-demographic profile, of the group of patients with BD, showed a predominance of female gender, white ethnicity, average age 42.8 years, mean education of 9.4 years of schooling, low occupancy rate in the workplace, most without conjugal relationship, and low family incomes. In the clinical profile of BD patients, the main characteristics were: occurrence of first episode of BD between 21 and 40 years of age; illness duration between 16 and 30 years; at least one psychiatric hospitalization in 80,5% of the patients. There were statistically significant differences between groups in the variables perseverative errors and perseverative responses in WCST, time in TMT, Stroop3, number of errors in the Stroop task, indicating poorer performance of patients with BD, in euthymia, which suggests they present impairments relative to cognitive flexibility and inhibitory control. A marginally significant difference in WCST categories completed variable was observed. Based on the results it is concluded that social life, family and occupational background of BD patients is affected not only by the symptoms of the disease, but also by deficits in cognitive performance. So, it is necessary to take these aspects into account in order to provide a more comprehensive therapeutic approach to patients. / O Transtorno Bipolar (TB) é uma patologia psiquiátrica grave, recorrente, que se caracteriza por oscilações de humor e envolve aspectos neuroquímicos, cognitivos, psicológicos, funcionais, familiares e socioeconômicos. A literatura descreve prejuízos em vários domínios cognitivos em portadores de TB, que podem persistir mesmo nos períodos de eutimia. As funções executivas envolvem subprocessos cognitivos, entre eles, auto-regulação, flexibilidade mental, tomada de decisão, atenção seletiva e controle inibitório. Estas funções encontram-se prejudicadas no TB, contudo, não há um consenso sobre a persistência de déficits em eutimia. Entende-se que tais prejuízos interferem no cotidiano do portador e na maneira com que este lida com seu tratamento. Nesta pesquisa, buscou-se conhecer as características sócio-demográficas e clínicas de 41 portadores de TB, em eutimia, com idades entre 25 e 60 anos, atendidos pelo Ambulatório de Transtornos do Humor do Setor de Psiquiatria do Hospital Universitário de Santa Maria, RS. Esse grupo foi pareado a outro com 41 controles saudáveis, sendo comparadas suas funções executivas, mais especificamente, flexibilidade mental e controle inibitório. Trata-se de um estudo exploratório, descritivo e caso-controle, em que foram utilizados, para comparação dos grupos, o Wisconsin Card Sorting Test, o Stroop Test e o Trail Making Test B. Foram obedecidos os procedimentos éticos exigidos para pesquisas com seres humanos. O perfil sócio-demográfico do grupo de portadores de TB apontou predominância do gênero feminino, etnia branca, idade média de 42,8 anos; escolaridade média de 9,4 anos de estudo; baixo índice de ocupação laboral; maioria sem relação conjugal; e baixa renda familiar. No perfil clínico dos portadores de TB destacaram-se: a ocorrência do primeiro episódio de TB entre 21 e 40 anos; o tempo de duração da doença entre 16 e 30 anos; ao menos uma hospitalização psiquiátrica em 80,5% dos casos. Foram observadas diferenças estatisticamente significativas entre os grupos nas variáveis erros perseverativos e respostas perseverativas no WCST, tempo no TMT, Stroop3, número de erros na tarefa de Stroop, apontando pior desempenho dos portadores de TB, em eutimia, sugerindo prejuízos quanto à flexibilidade cognitiva e ao controle inibitório. Uma diferença marginalmente significativa na variável completar categorias do WCST, foi encontrada. Com base nos resultados, conclui-se que a vida social, familiar e ocupacional dos pacientes com TB é afetada, não somente pelos sintomas da doença, como também pelas falhas no desempenho cognitivo, sendo então necessário levar estes aspectos em consideração numa abordagem terapêutica mais abrangente oferecida ao paciente.

Neuropsychological testing is recognised as one of the cornerstones of concussion evaluation, contributing significantly to both an understanding of the injury as well as management of the recovery process. Despite the high incidence of concussion at school level, traditional paper-and-pencil neuropsychological testing has generally been absent from school concussion management programmes, largely due to time and cost constraints. Now, the recent development of computerised neuropsychological testing is providing the opportunity for including neurocognitive assessment in this process. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a valid and reliable instrument of this type and normed on 13 - 18 year old North American high school athletes, as well as adult groups. The current recommendation is that athletes are baselined preseason in order to provide an individualised comparative level against which to monitor recovery and provide return-to-play recommendations. This in itself is quite a cumbersome process, thus the present study set out to ascertain whether baseline testing of all athletes is necessary, or whether the use of US or SA normative data alone would provide an appropriate standard against which to interpret the postinjury scores. From a leading South African rugby playing school, the 1st and 2nd rugby teams, (16 - 18 years) were baselined using ImPACT. Three athletes, who were subsequently referred with concussion during the rugby season, were followed up with serial testing on ImPACT. An analysis of the follow up scores was conducted to chart the athletes' recovery process, in relation to the athletes own baseline scores (using US and SA reliable change indices) and age appropriate US and SA normative ranges. The relative utility of individual baselines scores versus these normative ranges was then critically evaluated. It was concluded that a combination of both baseline and normative data provided optimal management of the athlete, with the methods complementing each other in the interpretation of post-injury results. Overall, the SA normative ranges seemed to provide slightly better management guidelines than the US normative ranges when used with this sample of South African high school athletes.

The aim of this study was to investigate the effect of cumulative mild head injury on the cognitive functioning of professional rugby players. A comprehensive battery of neuropsychological tests was administered to 26 professional rugby players and to a comparison group of 21 professional cricket players. The group test results of the rugby, cricket, rugby forwards and rugby backline players were each compared with established normative data. Generally, the comparison of the rugby and cricket mean scores relative to the normative data did not reveal significant differences on tests known to be sensitive to the effects of mild head injury. However, the comparison of variability for each of the rugby and cricket playing groups relative to variability for the normative data, revealed a pattern of increased variability among the rugby players. This implies a bimodal distribution in which a significant number of rugby players were performing poorly across these tests whereas a significant proportion were not. This variability effect was accounted for by further mean score comparisons which revealed that, as a group, it was the forward players whose performances were disproportionately poor on tests sensitive to the effects of mild head injury. The implications of these results are developed theoretically within the context of brain reserve capacity theory and suggestions for future research are provided.