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    Enabling face-name recognition after brain injury using mobile technology : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, New Zealand
    (Massey University, 2013) Howard, Philip Martin
    Acquired brain injury (ABI) is a term that encompasses a wide range of mechanisms that cause damage to the brain, however in New Zealand the most common causes of ABI are traumatic brain injury (TBI) and stroke. One of the most commonly reported and enduring difficulties from TBI and stroke is in memory function, however research also indicates that these brain injuries also negatively impact affective functioning, as well as social and interpersonal relationships. Although recovery from brain injury can to some degree be predicted from measures of injury severity, the course of recovery can be aided by cognitive rehabilitation. One of the most effective types of cognitive rehabilitation for prospective memory difficulties is the use of external compensatory strategies using electronic devices such as mobile phones. However, no studies could be found which have investigated the use of mobile phones in supporting those who have face-name memory difficulties following ABI. These face-naming difficulties have been associated with increased social isolation and reduced wellbeing in survivors; therefore finding an effective intervention is an important goal. The present study included the development of an iPhone application to act as an external compensatory device to support face-naming. Three hypotheses were tested through a single-case research design: (1) that the device would be effective in improving participants’ face-naming, (2) that improved face-naming ability would result in improved social interactions, and (3) improved face-naming would result in improved wellbeing. The results clearly indicated that the face-name application produced improvement in functional face naming across all participants, and participants also reported that they found the application helpful. Approximately half of the participants showed improvement in aspects of social interaction thought due to the intervention, but fewer than half showed improvements on measures of wellbeing. A significant correlation was found between how often the application was used, and changes in wellbeing. Recommendations for future research are discussed, as are implications for practice.
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    Tuku iho, he tapu te upoko = From our ancestors, the head is sacred : Indigenous theory building and therapeutic framework development for Māori children and adolescents with traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Wellington, New Zealand
    (Massey University, 2012) Elder, Hinemoa
    International research shows „minority‟ culture and indigeneity are risk factors for traumatic brain injury (TBI) and for differential responses by rehabilitation services. New Zealand epidemiological studies align with those findings showing that Māori tamariki (children) and taiohi (adolescents) are significantly over represented in TBI populations with poorer outcomes, including higher mortality rates. This study asked two questions. Firstly, what do Māori people say about tamariki and taiohi TBI in the context of the Māori cultural belief that the head is the most sacred part of the body? Secondly, how could this information be used to build theory and inform a framework to address the rehabilitation needs of this group? Eighteen marae wānanga (culture specific fora in traditional meeting houses) were held in urban, rural and remote locations. Participation in these marae wānanga established an overt collective Māori cultural orientation at the entry point of the study. This collective view meant that marae themselves were considered as respondents. Data were analysed using Rangahau Kaupapa Māori (Māori indigenous research methods) and informed by elements of grounded theory. The central aspect of the theory proposes that TBI not only injures anatomical structures and physiology but also injures wairua. Wairua is defined here as a uniquely Māori dimension of wellbeing characterised by profound connection with all elements of the universe. The wairua injury means culturally determined interventions are both indicated and expected. The cultural knowledge required to address the wairua injury is housed within whakapapa (genealogy). This knowledge is activated by a cascade of events. The wairua theory in mokopuna TBI thereby provides a guide to intervention. The interventional framework underpinned by this theoretical position is called Te Waka Oranga. This framework uses the metaphor of a waka, a traditional Māori sailing vessel, preparing for journeys, in the process of moving across the ocean and finally arriving at it‟s destination. In this way this framework provides a Māori space where both Māori and clinical world views and their respective interventions can co-exist and be jointly monitored. This framework is therefore a practical tool that clarifies the interface where the two world views of the whānau and clinicians meet, suggesting opportunity for improved outcomes. This is the first study to propose and operationalise an indigenous theoretical construct for Māori child and adolescent TBI rehabilitation. Methods including noho puku, whanaungatanga, kaitiakitanga and centrifugal thinking were employed in novel ways. Future application of this work includes non-accidental traumatic brain injury, youth forensic populations, incarcerated groups and virtual rehabilitation.
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    Coping in caregivers of family members with traumatic brain injury and the effects on the caregivers' quality of life : 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, 2012) Klum, Maren Annette
    Traumatic Brain Injury (TBI) not only affects the patient but also the family, which is a vital part of the rehabilitation process. Utilising the stress, appraisal, and coping theory developed by Lazarus and Folkman (1984) this study investigated coping in caregivers of a family member with TBI in New Zealand. Most previous research has focused only on psychological morbidity as an outcome measure. However, multiple areas of a caregiver’s life can be affected and a variety of factors can play a role in how caregivers cope. Quality of Life (QoL) is a multidimensional construct that allows for an assessment in physical, psychological, social, and environmental domains. In addition, changes in coping strategies over time were investigated. The hypothesis that emotion-focused coping was related to higher levels of depression and problem-focused coping to lower levels of depression and anxiety was supported. Against expectations, seeking social support was related to higher levels of anxiety. Further findings showed that depression and anxiety were negatively related to QoL and was lower in all domains than in the general population. Emotion-focused coping was negatively related to psychological and environmental QoL, and problem-focused coping was positively related to environmental QoL. In addition, the coping subscales showed a variety of relationships to psychological distress and individual QoL domains. This underlined the importance of investigating individual coping strategies as well as using the multidimensional construct of QoL as an outcome measure. Finally, emotion-focused coping was used most frequently by caregivers in the early years following injury and problem-focused coping most frequently in the later years. The findings are of both clinical and theoretical importance because they add to the understanding of coping in caregivers, how specific coping strategies are related to psychological distress and QoL, and how they change over time. The discussion considers these findings and how they make an important contribution to caregiving research in this population.