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Item Clarifying perceptions of cognitive functioning in normal aging and after mild traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand(Massey University, 2021) Watts, Dominika A.The cognitive symptoms reported more than 3 months after a mild traumatic brain injury (mTBI) are often found to have no association with objective cognitive functioning as evaluated by formal assessment measures. They are believed to relate more to physical symptoms such as pain or fatigue, psychological factors such as affective distress, and misattributions regarding the causes of ongoing subjective difficulties. This is similar to normal aging where for similar reasons, subjective complaints of worsening of cognitive function are also often not supported by objective assessment. The present research aimed to explore factors which have been suggested in the literature as potentially contributing to the development of subjective cognitive complaints (SCCs) in both populations. These factors included level of awareness of age-related change in cognition, affective distress, processing speed (PS), cognitive reserve (CR), and use of compensatory strategies. The present research consisted of two parts. In Part A, secondary analyses of two databases were conducted to inform development of a survey and model in Part B. The results supported inclusion of CR, PS, and compensatory strategies in the survey, and indicated the need for inclusion of a measure of psychological stress. Part B consisted of two studies which examined the hypothesized model of factors that influence reporting of SCCs. Data from a total of 659 individuals recruited from the New Zealand population was split into two groups - normal aging (n=436) and mTBI (n=223). Structural equation modelling (SEM) was employed to assess the relationships between the identified factors and SCCs in each of these groups. The results provided support for the hypothesized model in that this model explained 47.6% of variance in reporting of SCCs in normal aging, and 62.5% of variance in reporting of SCCs in mTBI. Psychoeducation-based interventions, compensatory strategy training, and in some instances individual psychological assessment and therapy are recommended as potentially helpful in reducing the reporting of SCCs.Item The use of mobile phones to compensate for organisational and memory impairment in people with acquired brain injury : a dissertation presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2008) Mackie, CornèObjectives: To investigate the extent to which people with memory difficulties use cognitive aids, and to compare this with that of the general population. Relationships between current memory aid use, age, and such factors as insight into functional difficulties, and pre-injury use of memory aids were examined. To investigate the usefulness of mobile phones in compensation for memory impairment following TBI; To investigate the impact of the type of memory impairment (encoding vs. retrieval), level of insight, and familiarity with technology on the use of mobile phones as cognitive aids. Design: Study One - Survey; Study Two - Repeated Single-case ABAB-design Participants: Study One - A group of 29 participants with memory difficulties due to traumatic brain injury (TBI), and an age-matched control group of 33 participants. Study Two - Six participants were selected from people with TBI in New Zealand. Inclusion criteria were a history of TBI, being over 16-years-old, and both self-reported and formally assessed memory difficulties. Measures: Memory Aids Questionnaire; Patient Competency Rating Scale; Shapiro Control Inventory; Task completion forms. Results: Study One - People with TBI and controls tended to use a similar number and type of aids. Electronic memory aids (EMAs) were viewed as more effective in assisting with remembering, but were used less frequently than non-EMAs. This study found that age may impact on the type of aids used. Study Two - All six participants showed statistically significant improvements in the number of tasks remembered while using the phone vs. not using any aids at all. When comparing the phone and the use of traditional aids, five participants showed statistically significant improvements and one performed worse. These results were maintained at one-month follow-up. While the use of mobile phones to assist with remembering is efficacious in some cases, it is not suitable for use with all individuals.Item The psychosocial consequences of severe head injury from the perspective of relatives who care for head-injured persons in the community : a cross-sectional case study approach : a thesis presented in partial fulfilment of the requirements for the degree or Master of Arts in Psychology at Massey University(Massey University, 1989) Cannon, Margaret AnnThe primary aim of this research was to gain insight into the "world" of carers of head-injured persons in the community, identify their major areas of stress, and explore support needs. A cross-sectional multiple case study design was chosen. The patient sample had all experienced severe to extremely severe head injuries. They were not interviewed. Semi-structured interviews were conducted with eleven carers of the head-injured persons, all but one being a relative of the patient. A verbally-administered questionnaire was used during the interviews to ensure that standardised questions were asked of all respondents. Many of the questionnaire items were closed, but others were partially or fully open-ended. The questions addressed: historical information, changes in the patient, changes in overall life-style, changes in relationships, carers' personal and practical support needs, and their perceptions of the future. A single quantitative analogue rating scale was used to measure levels of respondents' reported distress. Respondents were encouraged to provide comments freely during the interviews. The obtained data was systematically presented in the form of group frequencies and occasional measures of central tendency. This data was supplemented by eleven individual case studies. The main patterns and themes were apparent in the grouped data, but the individual case studies permitted examination of both common and unique responses within a "real life" context. There was thus across-study and within-study investigation. The approach to the research was exploratory and descriptive. No hypotheses were held but some expectations were indicated in the existing literature. The present study found similarities with previous research in that psychosocial changes in the patient were reported more frequently by carers than broadly physical changes, reported stress levels were generally high, and there were complaints by respondents about lack of head injury information, and lack of family counselling. The most notable differences were that respondents in this study considered that (in terms of reported frequencies) communication, conversation and interactional changes in the patients, together with patients' social restrictions/isolation, were the most distressing changes for the carers. A major area of reported distress by respondents in this study related to insensitivity by others towards the patient. However, a number of positive, optimistic comments were made by respondents. Practical support needs were generally met, as were personal support needs in the form of confidantes and friends. The methodological limitations of the present study were discussed, and theoretical and practical implications examined. Suggestions were made for further research.Item Indicators and predictors of return to work or education following traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology(Massey University, 1998) Cassin, Olivia MThe leading cause of brain damage in previously healthy young adults, many of whom are of working age, is traumatic brain injury (TBI). Research to date generally agrees that TBI can lead to unemployment. However, knowledge about the determinants of return to work following TBI in the New Zealand context is minimal. This is remarkable given that failure to return to work following TBI is associated with tremendous costs. These include economic implications such as contribution to the economy through work Vs the necessity of financial support through government and community funding (i.e. invalids benefits or long-term care facilities). Furthermore, work affects an individual's self-concept; it represents a major social role, offering self-esteem, social contact and social support. Therefore, a need exists to understand various predictors and indicators and their influence on a client's ability to return to work or education following TBI. The present study was divided into two parts. Part one, was a retrospective analysis of a pre-existing database. In this part, the predictors: pre-injury employment status, job classification at TBI, age at TBI, years of post primary education at TBI, ethnicity, substance abuse after TBI and motor impairments, significantly influenced return to work/education and non return to work/education following TBI. The predictors: age at time of assessment, gender, substance abuse prior to TBI, injury severity, epilepsy, visual difficulties, hearing difficulties and speech difficulties, however, did not. In addition, the indicators: verbal IQ, verbal memory, attention, information processing speed and executive functioning, significantly influenced return to work/education and non return to work/education following TBI, however, the indicators: performance IQ, full scale IQ and visual memory did not. Part two of the present study was a planned analysis. In this part, the predictors: pre-injury job classification, pre-injury job stability, tertiary qualifications and alcohol use after TBI, significantly influenced a persons job classification following TBI and/or the number of hours they were able to work per week following TBI. However, the predictors: pre-injury employment status, age, years of post primary education, ethnicity, gender, substance use before TBI, criminal offending, injury severity, early post trauma sequelae, did not. In addition, the indicators; attention, services of a General Practitioner, the length of time a General Practitioners service was received, cognitive ability and activities of daily living as reported by a relative or close other, significantly influenced a persons job classification following TBI and/or the number of hours they were able to work per week following TBI. However, the remaining cognitive sequelae, rehabilitation information, emotional, behavioural sequelae, participant and relative/close other reports, did not. Qualitative information was also provided by the participant and a relative or close other and the results presented. In conclusion, the findings of both parts of the present study are discussed in relation to the findings of previous research, together with recommendations for future research.Item Putting a human face to severe traumatic brain injury research : a review of neuropsychological rehabilitation, obsessive-compulsive disorder and caregiver burden with respect to the case of BP : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 2003) Blackler, Dion JThe following thesis is a review of several issues relating to severe brain injury. The theories and research literature were also paired with the case study of a young man who had suffered a severe TBI three years ago, and the outcomes and rehabilitation that he has faced since and continued to face. The case study and theory can be read separately, but it is together that they may help to put a human face on the TBI literature. Rehabilitation principles and theories are described in order to present a picture of an ideal rehabilitation plan, and then contrasted by the case study to demonstrate the difficulties that are inherent in severe TBI. Despite careful adherence to rehabilitation principles, the rehabilitation process remains difficult and lengthy. The research literature regarding obsessive-compulsive disorder and TBI are discussed in reference to aspects of the current case study and impulse control disorders in general. The caregiver burden research literature, particularly with regard to that of TBI, is also reviewed, with reference again to the current case study. A plea is made for more flexible, functionally-relevant rehabilitation models, that attempt to take into account the true complexities involved in severe TBI rehabilitation. The use of case studies in future TBI research, along with the larger-sampled empirical studies, may aid our understanding of TBI and its rehabilitation from a more human real-life perspective.Item Outcome measures in brain injury rehabilitation : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 2004) Robinson, Christina MaryBrain injury rehabilitation services require competent measures of outcome to monitor the progress made by individuals in their care. The FIM + FAM is the measure most widely used for this purpose. However, research suggests that this measure contains a number of limitations and does not adequately assess the activity limitations and participation restrictions experienced by individuals who have suffered brain injuries. The current study examined five outcome measures (BICRO-39, MPAI-4, R-CHART, CIQ, and DRS) for their suitability as possible replacement measures at Cavit ABI in Wellington and Auckland. Ten participants with brain injuries (eight males, two females; seven with TBI, three with injuries due to stroke) were administered six different outcome measures by therapists at Cavit ABI centres in Wellington and Auckland on admission and again at six weeks into the rehabilitation programme. Outcome measures were examined in relation to a set of specified criteria, and feedback regarding the performance of each outcome measure was collected from each therapist using a staff questionnaire. The results of the study show that there does not seem to be one adequate outcome measure currently available for use within post-acute brain injury rehabilitation settings Although the FIM + FAM was found to contain a number of strengths particularly in assessing physical independence, the MPAI-4 was found to be more useful in identifying goals related to activity limitations and participation restrictions, which was the key area of focus.Item Pre- and post-accident employment and employment-related factors following traumatic brain injury : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 1999) Alit, TiinaA total of forty individuals, from three rehabilitation centres in the Auckland area, participated in an exploratory study on return to work following traumatic brain injury. All of the participants were employed in some capacity prior to their injuries. Eleven of these individuals had not returned to work, and twenty-seven individuals had returned to work post-injury. Twelve of the latter group did not sustain their employment. Data analyses revealed that groups of participants did not differ significantly with respect to self-assessments of pre-injury job satisfaction, job performance, and job importance. However, with respect to post-injury job importance, significant differences were found between individuals who were not employed, those who unsuccessfully returned to work, and those who were currently employed post-injury. Single individuals had higher ratings of post-injury job performance, than partnered individuals. The majority of participants considered emotional support from families important for a successful return to work. Conversely, functional support from employers was considered important by more participants than emotional support. Nine employers of the individuals with traumatic brain injury who were surveyed completed employers questionnaires. The implications of the survey results for the coordination and planning of rehabilitation programmes are explored.Item Persistent symptoms after a traumatic brain injury and their relationship to the psychological impact of the trauma and to PTSD : a thesis presented in partial fulfilment of the requirements for the degree Master of Arts in Psychology at Massey University(Massey University, 1997) Wishart, IanThe post-concussive syndrome (PCS) is the term used to describe the persisting and troublesome symptoms and complaints after a traumatic brain injury. Uncertainty exists about the cause of these symptoms, but usually the early symptoms are held to have their origin in the physical brain damage while the late-onset and persisting ones are thought to be caused by psychological factors. Previous studies indicate that head injured persons complain of more symptoms when they retained consciousness during the injury and when the injury was caused by someone else, especially if it was an assault. Such findings suggest that not only are psychological factors pertinent to the outcome of a head injury but that factors relating to the subjective impact of the traumatic event causing the injury may play a role. Because post-traumatic stress disorder (PTSD) is also a possible outcome of such an injury, it seems possible, if not likely, to confuse the two disorders, especially since they also share many symptoms in common. This study was intended to clarify the prevalence of symptoms of PCS and PTSD in persons who had suffered a brain injury more than three months previously, and to examine how these symptoms interact and whether different aspects of the subjective impact predicted either PCS or PTSD. The study was in two sections, Part 1 examining the records of 195 subjects, and results supported previous research showing that mild head injured subjects and those who had been assaulted, experienced more symptoms than those with injuries of greater severity or head injuries from other causes. Part 2 was developed to investigate these findings more fully and used 18 subjects who were administered questionnaires on PCS and PTSD symptoms and on the psychological (subjective) impact of the head injury trauma. Results showed that there was a trend for the subjective impact of the trauma to be associated with PCS and there was a significant association between the subjective impact and PTSD. It appeared that PTSD symptoms were acting as a confounding factor for the diagnosis of PCS after a traumatic brain injury with a high subjective impact. Another finding of this study was that, although subjects with memory of the trauma generally experienced more PTSD symptoms than those with no memory of it, there were several subjects who could not remember the trauma but who had a high number of intrusive PTSD symptoms. This contradicts the usual view that PTSD and amnesia for the trauma are incompatible.Item Incidence, epidemiology and outcomes of mild traumatic brain injury in clients referred to the Massey University Concussion Clinic : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 2005) Taylor, Julia Margaret AlexandraThe primary objectives of the present study were: (a) to gain a comprehensive understanding of the epidemiological and demographic variables associated with Mild Traumatic Brain Injury in New Zealand, (b) to investigate the relationship between history of head injury and risk and recovery from future head injuries, (c) to investigate the outcomes of assessment and treatment after Concussion Clinic attendance, and (d) to evaluate the quality of service provided by the Massey University Concussion Clinic. Data was gained in two stages which involved firstly a review of the cover sheets of clients referred to the Concussion Clinic and secondly, the circulation of a questionnaire and a standardised measure of client satisfaction with services (the Service Satisfaction Survey – 30). Results indicated that the epidemiological and demographic variables associated with concussion found in our New Zealand sample mirror those trends identified in the international literature. With regards to evaluation of the Concussion Clinic, clients were generally satisfied with the services they received. However, clients did identify some aspects of the service which could be improved. This study demonstrated the need for an increase in the amount of available literature concerning the incidence and outcomes of Mild Traumatic Brain Injury in New Zealand. It also reinforced the need for ongoing evaluation as means of monitoring service delivery and client satisfaction in health care settings.Item The effects of traumatic brain injury on logical memory : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in psychology at Massey University(Massey University, 1994) Harris, Joanna LeeThe Logical Memory subtest of the Wechsler Memory Scale - Revised was administered to 80 subjects with mild to severe traumatic brain-injury (TBI) and 49 Control subjects. Quantitatively TBI subjects scored significantly below Control subjects and forgot more between the immediate and delayed testing. TBI clients also recalled more of Story B than Story A, as did all the male subjects. Female subjects performed better than the male subjects overall, TBI males scored as well as Control males which was unexpected. When the order of presentation was reversed for random Control subjects results show that performance was better for the first story presented. After the LM passages were modifying to eliminate various Americanisms, the Control subjects randomly selected performed better on the NZ version, although these results were not significant. When the demographic variables of the TBI and Control groups were compared the only significant differences were between the 21 - 30 year old subjects and the Pakeha subjects. Qualitative analysis was attempted in order to introduce a new domain of research and suggestions for improved scoring criteria. The evidence suggest that TBI subjects tend to focus on isolated details, have difficulty remembering proper nouns, and have more bizarre intrusion errors than Control subjects. Control subjects were more inclined to translate the stories into their own words and remember more of the overall gist.