Massey Documents by Type

Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294

Browse

Has files: YesSubject: search.filters.subject.Traumatic brain injury

Search Results

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Affect recognition training after traumatic brain injury : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2013) Yim, Jackki Hoon Eng
    Impairment in facial affect recognition is prevalent after moderate to severe traumatic brain injury (TBI), and may underlie some problems in social functioning. Tentative work indicates that emotion recognition can improve with training, but the effectiveness of these programmes remains unclear. Little is known about whether broader cognitive deficits underlie facial affect recognition impairment. Less is known about baseline cognitive variables that predict treatment response and the relationship between changes in cognitive functioning and improvement in facial affect recognition after treatment. The present research formed part of a multi-centre randomised controlled trial examining the efficacy of two affect recognition training programmes designed to improve emotion recognition in adults with moderate to severe TBI. Study One reports outcome data from the main trial. Seventy people with TBI and facial affect recognition difficulties were randomly assigned to nine sessions of one of three treatments: Faces, focusing on facial affect recognition, Stories, determining emotions from social context, and a control group. Participants completed tests assessing cognition, emotion recognition, community integration, interpersonal behaviour and empathy, and informants completed interpersonal and social functioning measures. Participants were assessed five times: initial screening, pre- and post-treatment, and at three- and six-month follow-up. Significant improvement was seen in the Faces group on the primary facial affect recognition outcome measure (DANVA2-Adult Faces). These gains were sustained at six months. No significant differences between treatment groups and the control group were found on interpersonal and social functioning measures. Study Two had 75 participants with facial affect recognition difficulties and investigated the relationship between facial affect recognition impairment and cognitive functioning. Greater facial affect recognition failures were related particularly to working memory, processing speed, and nonverbal memory. No relationship was found with executive functioning. Study Three explored the relationship between baseline cognitive variables, changes in cognitive functioning, and long term treatment response. Only older age was predictive of a better long-term response to Faces treatment. Improvement of facial affect recognition was not mediated by changes in cognitive functioning. This research provides further evidence that retraining is possible for affect recognition difficulties after traumatic brain injury.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Development of systematic behavioural observation to quantify ongoing cognitive activity limitations after brain injury : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2010) Lewis, Mark
    One of the goals of cognitive rehabilitation following traumatic brain injury is to help people perform everyday tasks. However, options for the rigorous assessment of everyday cognitive effectiveness after rehabilitation are limited. Performance on neuropsychological tests is only moderately correlated with everyday functioning, while previous measures of everyday functioning include only fairly general estimates of overall cognitive functioning. The aim of the current study was to develop an ecologically valid measure that captured a number of subdomains of executive functioning, using systematic behavioural observation of an everyday task. The initial phase of the research involved identifying an everyday task that was sufficiently complex to ensure that executive functioning was utilised in the completion of the task. Participants with traumatic brain injury were then asked to prepare chocolate brownies, using a recipe provided, and a hot drink. Participants were allowed to use any compensatory strategy to help complete the task. Participant performance was directly observed by an examiner and videotaped for subsequent inter-rater reliability. Two independent raters assessed nine components of executive functioning. During this phase, the examiner manuals were modified improving inter-rater reliability. The final version of the measure was then trialled with participants with and without traumatic brain injury. Final inter-rater reliability indicated the approach had merit. Significant and moderate correlations were found between traditional measures of executive functioning and the everyday task. This study employed systematic behavioural observation to obtain fine-grained information regarding a person’s cognitive functioning. With further development, this approach may prove useful for targeting and monitoring specific functional difficulties during cognitive rehabilitation.
  • Thumbnail Image
    Item
    Efficacy of cognitive behavioural therapy for clients who have sustained a traumatic brain injury (TBI) : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2009) Christianson, Muriel Katherine
    While the focus of rehabilitation following traumatic brain injury (TBI) is often on management of physical and cognitive impairments, emotional and behavioural changes in the person with the injury may represent major hurdles in adjustment following injury. Mood, anxiety and adjustment disorders are common following TBI. A manualised cognitive behavioural therapy (CBT) treatment programme was developed that incorporated provision of education on consequences of TBI, used cognitive and behavioural strategies to recognise and manage emotional reactions to injury, and promoted achievement of personal goals. Participants were nine people with TBI referred to Massey University Psychology Clinic Wellington, for psychotherapy to assist in managing symptoms of psychological distress or adjustment difficulties following injury. Measures used included the Hospital Anxiety and Depression Scale (HADS) to monitor progress in reduction of symptoms of Anxiety and Depression; the Patient Competency Rating Scale (PCRS) to assess competency across areas of day-to-day living; and the Homework Rating Scale Second Edition (HRS-II) to assess the value of homework assignments for participants. Results were presented graphically in group format and in the form of individual case studies outlining progress in achieving individual goals. There was considerable variation in the responses of participants to treatment. When anxiety and depression were secondary to other referral issues such as fatigue and pain that remained high over treatment sessions, there was limited movement on HADS Anxiety and Depression scores. The small number of participants impacted on the ability to detect differences between Patient and Informant ratings on the PCRS or to demonstrate increased levels of awareness over treatment sessions. Consistent completion of Homework assignments proved difficult for participants. Factors that impacted on achievement of personal goals included ongoing levels of fatigue and pain, levels of personal expectation, interpersonal and organisational skills, insight into emotional reactions, and good family and social support. There is a part for a CBT approach in adjusting to changes following TBI, particularly in assisting with reassessing expectations following injury.