Browsing by Author "Schrieff-Elson, Leigh"

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    Exploring factors that influence academic and behavioural outcome and the specific role of premorbid functioning, in a sample of children with severe traumatic brain injury
    (2014) Dollman, Aimee; Schrieff-Elson, Leigh; Figaji, Anthony; Wolf, Pedro
    Children who have sustained severe traumatic brain injury (TBI) demonstrate a range of deficits in neurocognitive and behavioural domains (Anderson, Northam, Hendy, &Wrennall, 2001; Babikian & Asarnow, 2009; van’t Hooft, 2010). These impairments may have adverse effects on academic and behavioural outcomes and can therefore interfere with school re-entry, educational progress, and ultimately, quality of life of the injured child (Anderson & Yeates, 2010; Keenan & Bratton, 2006; Lallo & van As, 2004). Pre-injury characteristics may increase risk for, and play a role in, TBI outcome, however, many studies exclude children with known adverse premorbid functioning (Dennis et al., 2007; Farmer etal., 2002). There are also dearth of published studies incorporating a variety of factors affecting outcome (e.g., socio economic status (SES), age at injury, time since injury, premorbid functioning, family environment) as well as academic and/or behavioural outcome variables in the same study generally. The broad aim of the study was therefore to contribute to the existing pediatric TBI (pTBI) literature on outcomes and factors influencing outcomes. In this study, I focused on investigating both academic and behavioural outcomes in a group of South African children of school-going age who had sustained a severe TBI. This study includes two parts. For the first part of the study, the aim was to explore the relationship between commonly reported factors that influence outcome after TBI (premorbid functioning, age at injury, time since injury, family environment and SES), and academic and behavioural outcome. For the second part of the study, the aim was to investigate the specific role of premorbid functioning in academic and behavioural outcome. The sample included 27 children who had been admitted to Red Cross War Memorial Children’s Hospital (RXH) and received intracranial monitoring for closed severe TBI between 2006-2011, who were of school-going age at the time of the injury. In terms of part one of the study, the results show elevated problems with academic outcome, and behavioural and executive functioning in the sample. The results also show that in this sample, factors such as family environment and premorbid functioning are particularly important with regards outcome in the home environment; while factors such as age at injury, family environment and SES play more of a role within the classroom environment.
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    Implementation of an attention training program with children who have sustained traumatic brain injuries in South Africa
    (2015) Lanesman, Talia; Schrieff-Elson, Leigh
    Traumatic brain injury (TBI) is an international public health concern, particularly in lowand middle-income countries. Children who sustain TBIs typically have attentional difficulties, which disrupt the development and functioning of other cognitive, behavioural, and social skills. The aim of this research was to evaluate the efficacy and feasibility of implementing an attention-training program for children who have sustained moderate-tosevere TBI in South Africa, and to compare the efficacy of the program in two clinical samples: children with TBI and children with Attention Deficit Hyperactivity Disorder (ADHD). Fifteen children aged 6 to 8 who sustained TBIs at least a year before were recruited to form three groups: a TBI Intervention Group (n=5), a TBI Art Group (n=5) and a TBI Control Group (n=5). Five children who had been diagnosed with ADHD formed the ADHD Intervention Group. Children in the two Intervention Groups participated in the ‘Pay Attention!’ program (originally designed to assist children with ADHD) for 45 minutes twice a week for 12 weeks. All children underwent neuropsychological testing pre- and postintervention and behavioural data was collected from parents and teachers. Between- and within-group analyses showed that children in the TBI Intervention group did not show overall significant improvements in attention. However, children in the ADHD Intervention Group showed individual attentional improvements on measures of the CPT-II, as well as secondary gains in verbal memory. Nevertheless, implementing a cognitive rehabilitation intervention in South Africa is feasible and necessary, despite limited infrastructure and access to resources. Further research is required to better tailor interventions to the needs of children with TBIs.
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    Implementation of an attention training program with children with attention deficit hyperactivity disorder in South Africa
    (2015) Wilson, Abigail Gillian; Schrieff-Elson, Leigh
    Attention Deficit/Hyperactivity Disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness and tends to be the most commonly diagnosed childhood behavioural disorder. The aim of this study was to determine the feasibility of the Pay Attention! Intervention with a small group of children diagnosed with ADHD as compared to matched controls. The intervention focused on sustained, selective, alternating and divided attention. After a baseline evaluation, five children aged 6 to 8 years were assigned to receive bi-weekly Pay Attention! sessions for 12 weeks and five matched controls were assigned to a Test-only group. Participants completed an outcome evaluation approximately 12 weeks after their baseline evaluation, both of which included neuropsychological and behavioural (both parent and teacher) assessments. Results show that the intervention is feasible to administer and acceptable to participants. Although no significant treatment effects were found on the neuropsychological outcomes and for the teacher ratings of ADHD, there were however significant effects found on parent ratings of ADHD symptoms on the Child Behaviour Checklist and the Vineland Adaptive Behaviour Scale-II. These preliminary findings add to the growing body of literature on attention training interventions for children with ADHD. However, a randomised controlled trial is warranted to further investigate the specific use of the Pay Attention! intervention with this population in the South African context.
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    Investigating history of concussion and data from head impact telemetry (xPatch) in relation to neuropsychological outcomes in a sample of adult rugby players in Cape Town
    (2016) Stephen, Dale C; Schrieff-Elson, Leigh; Thomas, Kevin; Figaji, Anthony
    While Rugby Union has worldwide popularity, with over 5 million registered and nonregistered players participating every year, the game lends itself to a high incidence of concussion among players. Rugby players, more so than that recorded for any other contact sport, including American Football, are also more frequently exposed to head collisions not resulting in concussion (i.e., subconcussive head injuries). Despite some evidence for a potential association between such injuries and acute neurological and neuropsychological difficulties, which may at times persist among some players, overt symptoms still guide the initial on-field response for further concussion management to be initiated. The aim of this study was threefold: 1) to investigate the relationship between rugby players' history of concussion and neuropsychological outcomes, 2) to explore the use of a head impact telemetry (HIT) device in describing high-impact head collisions (and potentially subconcussive injuries), and 3) to explore the relationship between that HIT data and neuropsychological outcomes. Study 1 investigated differences between non-contact sport participants (n = 23) and rugby players with (Rugby Concussed; n = 31), and without a history of concussion (Rugby Not Concussed; n = 26) in a baseline cognitive assessment. Results showed that at the beginning of the rugby season there were no differences in cognitive abilities at a group level; a more severe concussion history was largely not associated with a poorer performance on these cognitive outcomes. Study 2 was a pilot study utilising the xPatch to objectively capture a rugby player's exposure to head impacts in an amateur rugby team (UCT IRL team; n = 8). Although the majority of impacts captured were of a 'mild' severity, there were many acceleration forces, particularly rotational accelerations, recorded above an injury threshold potentially implicated with concussion. Following from this, Study 3 used a prospective and repeated-measures design with the same UCT IRL team, to evaluate a means for investigating a player's neuropsychological vulnerability to high-impact subconcussive head injuries. Using correlational analyses, the Reliable Change Index (RCI) and head collision data from Study 2, there was a lack of evidence to indicate that player's increased exposure to repeated high-impact head collisions results in a generally poorer neuropsychological performance. However, a number of test practice effects are noted. Combined, these findings suggest that (a) identifying possible enduring neuropsychological difficulties retrospectively is limited, and issues such as test-practice effects and test sensitivity should be considered in future, preferably prospective studies, (b) rugby players are vulnerable to sustaining multiple high-impact subconcussive head injuries and the data suggests utility in including HIT like the xPatch, and (c) that implementing a multi-faceted protocol for monitoring rugby players' that negates a reliance on concussion diagnosis is necessary to better understanding individual recovery trajectories.
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    Rehabilitation of executive functioning following pediatric traumatic brain injury: evaluating a goal management training intervention
    (2015) Mahomed, Aqeela; Schrieff-Elson, Leigh
    Background and aims. Executive function (EF), defined as a set of interrelated skills and behavioural competencies required for independent, purposeful, goal-directed activity, are particularly susceptible to impairment following traumatic brain injury (TBI). Despite this knowledge, data concerning the rehabilitation of executive dysfunction in pediatric populations is lacking to date. A Goal Management Training (GMT) intervention, based on Duncan et al.’s (1996) theory of goal neglect, has been successfully implemented for the remediation of EF in adults. The current study adapted the GMT to a healthy South African sample and evaluated the efficacy in a pediatric TBI sample. Method. The study comprised of 3 parts. Part 1 involved the translation and adaptation of the pediatric GMT (pGMT) intervention so that it was suitable for use with South African children. This included the implementation of various health professionals’ evaluations of these adaptations. Part 2 involved evaluating the pGMT by implementing the programme with 3 healthy control participants. Lastly, Part 3 involved evaluating the efficacy of the revised pGMT with 3 children who had sustained a moderate to severe TBIs. For Parts 2 and 3 I employed a multiple case study approach. Data for parts 2 and 3 were analyzed using the Reliable Change Index (RCI; Jacobson & Truax, 1991) . The RCI distinguished between three levels of change, each at confidence levels of 68.2%, 95% and 99%. Outcomes were based on neuropsychological test outcomes, changes in everyday behaviour, self-report measures, and reports from parents and teachers. Results. Regarding the cognitive measures for the TBI group, all three participants did not show improvement on the same domains. Positive changes from pre- to post-intervention on a number of attention and executive function measures at confidence intervals of 68.26% to 99% were evident. Regarding the behavioural measures parents/guardians and/or teachers reported significant positive changes for all of the participants on at least one index at confidence intervals of 68.26% to 99%. In terms of real world generalization, only one participant’s teacher and parents commented on her improvements academically, behaviourally, and socially. No significant real world behavioural changes were reported for the other two participants. Results indicated that the adapted pGMT was successfully applied to the South African context for both healthy and TBI samples, although levels of success, in terms of post-intervention outcomes, varied with each TBI individual. Conclusions. These results suggest that the pGMT intervention could be an efficacious cognitive rehabilitation tool for the remediation of everyday behaviours associated 9 with executive dysfunction in South Africa. However, the variability in the results do not provide conclusive evidence at this stage. Individual, injury-related and familial factors need to be considered and may affect outcome. In addition, limitations such as the small sample size and uncontrolled confounding effects (e.g., practice or maturation effects) could also contribute to seemingly positive effects. Greater evidence from future, larger and more controlled studies, is required