SciELO - Scientific Electronic Library Online

 
vol.15 issue1Sexual risk behaviour amongst young people in the Vhembe district of the Limpopo province, South AfricaThe health care needs of the physically disabled patient in a home-based care environment: Implications for the training of ancillary health care workers author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Health SA Gesondheid (Online)

On-line version ISSN 1025-9848

Health SA Gesondheid (Online) vol.15 n.1 Cape Town  2010

 

ORIGINAL RESEARCH

 

The effects of fatigue and the post-concussion syndrome on executive functioning in traumatic brain injury and healthy comparisons

 

 

Jessica D. Fry; Kirston Greenop; Enid Schutte

Department of Psychology, University of the Witwatersrand, South Africa

Correspondence

 

 


ABSTRACT

In this study, behavioural manifestations of compromised executive control, including perseveration and reduced inductive reasoning, on the Wisconsin Card Sorting Test (WCST) were investigated. Performance was affected by fatigue in both a head-injured and matched population, which has implications for health care professionals involved in rehabilitation and assessment. A fatigue condition was manipulated for 15 moderate to severe traumatic brain injury (TBI) individuals through the course of a three-hour neuropsychological testing session. A comparison sample of 15 participants in a group of 'no history of TBI' was fatigued through the same approach. All fatigued participants (with and without TBI) displayed trends towards increased levels of perseveration and reduced inductive reasoning on the WCST. Thus, the effects of fatigue on high-level functioning are pervasive even when not head-injured. This finding supports the sub-optimal performance in cognitive skills, specifically in executive control, that is often found in fatigued people. These findings are relevant for the manner in which rehabilitation interventions and medico-legal assessments are structured. Importantly, the order of tests, their interpretation and rest sessions should be clearly indicated and interpreted in assessment reports and rehabilitation sessions.

Keywords: behavioural manifestations; head injury; perseveration; rehabilitation efforts; Wisconsin Card Sorting Test


OPSOMMING

In hierdie studie is gedragsmanifestering in individue met gekompromitteerde uitvoerende funksionering, met inbegrip van perseverasie en verminderde induktiewe redenering, op die Wisconsin-kaartsorteringstoets (WCST), bestudeer. Die waarneming dat prestasie deur uitputting beïnvloed word in sowel normale populasies as dié met kopbeserings het implikasies vir gesondheidsorgpersoneel wat by rehabilitasie en assessering betrokke is. 'n Uitputtingstoestand is gemanipuleer vir 15 matig ernstige individue met traumatiese kopbeserings (TKB) vir die duur van 'n drie uur lange toetssessie. 'n Vergelykingsmonster van 15 deelnemers met geen geskiedenis van kopbeserings is deur dieselfde metodologie uitgeput. Alle uitgeputte deelnemers (met en sonder TKB) het 'n neiging na verhoogde vlakke van perseverasie en verminderde induktiewe redenering op die WCST getoon. Die impak van uitputting op hoëvlak-funksionering is dus verreikend, selfs in gevalle waar geen kopbesering opgedoen is nie. Die bevinding ondersteun suboptimale prestasie in kognitiewe vaardighede, en spesifiek in uitvoerende beheer, wat dikwels onder uitgeputte mense gevind word. Hierdie bevindinge is van belang vir die manier waarop rehabilitasie-intervensies en regsgeneeskundige assesserings gestruktureer word. Die volgorde van toetse, die interpretasie daarvan en die rusperiodes moet duidelik in assesseringsverslae en rehabilitasiesessies aangetoon en geïnterpreteer word.


 

 

“Full text available only in PDF format”

 

 

REFERENCES

Aaronson, L., Teel, C., Cassmeyer, V., Neuberger, G., Pallikkathayil, L. & Pierce, J., 1999, 'Defining and measuring fatigue', Image: The Journal of Nursing Scholarship 31, 45-50.         [ Links ]

Alexander, M.P., 1995, 'Mild traumatic brain injury: Pathophysiology, natural history, and clinical management', Neurology 45, 1253-1260.         [ Links ]

Anderson, S., Damasio, H., Jones, R. & Tranel, D., 1991, 'Wisconsin Card Sorting Test performance as a measure of frontal lobe damage', Journal of Clinical and Experimental Neuropsychology 13, 99-122.         [ Links ]

Bartlett, F., 1943, 'Fatigue following highly skilled work', Proceedings of the Royal Society of London. Series B: Biological Sciences 131(864), 247-257.         [ Links ]

Belmont, A., Agar, N., Hugeron, C., Gallais, B. & Azouvi, P., 2006, 'Fatigue and traumatic brain injury', Annals of Physical and Rehabilitation Medicine 49(6), 370-374.         [ Links ]

Berg, E., 1948, 'A simple objective technique for measuring flexibility in thinking', The Journal of General Psychology, 39, 15-22, viewed 2008, from http://www.ncbi.lm.nih.gov/pubmed/1889466        [ Links ]

Bohnen, N., Wijnen, G., Twijnstra, A., Van Zutphen, W. & Jolles, J., 1995, 'The constellation of late post-traumatic symptoms of mild head injury patients', Neurorehabilitation and Neural Repair 9(1), 33-39, viewed 2008, from http://www.nnr.sagepub.com/cgi/content        [ Links ]

Boone, K., Ghaffarian, S., Lesser, I., Hill-Gutierrez, E. & Berman, N., 1993, 'Wisconsin Card Sorting Test performance in healthy, older adults: Relationship to age, sex, education and IQ', Journal of Clinical Psychology 49, 54-60.         [ Links ]

Braver, T., Barch, D., Keys, B., Carter, C., Cohen, J., Kaye, J., 2001, 'Context processing in older adults: Evidence for a theory relating cognitive control to neurobiology in healthy aging', Journal of Experimental Psychology: General 130(4), 746-763.         [ Links ]

Broadbent, D., 1979, 'Is a fatigue test now possible?' Ergonomics 22(12), 1277-1290.         [ Links ]

Cazalis, F., Azouvi, P., Sirigu, A., Agar, N. & Burnod, Y., 2001, 'Script knowledge after severe traumatic brain injury', Journal of the International Neuropsychological Society 7(7), 795-804.         [ Links ]

Chan, R., 2001, 'Base rate of postconcussion symptoms among normal people and its neuropsychological correlates', Clinical Rehabilitation 15(3), 266-273.         [ Links ]

Duley, J., Wilkins, J., Hamby, S., Hopkins, D., Burwell, R. & Barry, N., 1992, 'Explicit scoring criteria for the Rey-Osterrieth and the Taylor Complex Figures', The Clinical Neuropsychologist 7(1), 29-38.         [ Links ]

Duncan, J., Emslie, H., Williams, P., Johnson, R. & Freer, C., 1996, 'Intelligence and the frontal lobe: The organisation of goal-directed behaviour', Cognitive Psychology 30(3), 257-303.         [ Links ]

Golden, C., 1978, Stroop Color and Word Test: A manual for clinical and experimental uses, Skoelting, Chicago, Ill.         [ Links ]

Grant, D. & Berg, E., 1948, 'A behavioural analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem', Journal of Experimental Psychology 38(4), 404-411.         [ Links ]

Heaton, R., 1981, Wisconsin Card Sorting Test Manual, University of Colorado, Odessa.         [ Links ]

Heaton, R., Chelune, G., Kay, G., Talley, J. & Curtis, G., 1993, Wisconsin Card Sorting Test manual: Revised and expanded, Psychological Assessment Resources, Odessa.         [ Links ]

Hockey, G.R., 1997, 'Compensatory control in the regulation of human performance under stress and high workload: A cognitive-energetic framework', Biological Psychology 45, 73-93.         [ Links ]

Holding, D., 1983, 'Fatigue', in R. Hockey (ed.), Stress and fatigue in human performance, pp. 145-164, Wiley, Durham.         [ Links ]

Howell, D.C., 2004, Fundamental Statistics for the Behavioural Sciences, 5th edn., Brooks/Cole, California.         [ Links ]

Iverson, G. & Lange, R., 2003, 'Examination of postconcussion-like symptoms in a healthy sample', Applied Neuropsychology 10(3), 137-144.         [ Links ]

Jagoda, A. & Riggio, S., 2005, 'Mild traumatic brain injury and the post-concussive syndrome', Emergency Medicine Clinics of North America 18(2), 355-363.         [ Links ]

Kimberg, D. & Farah, M., 1993, 'A unified account of cognitive impairments following frontal lobe damage: The role of working memory in complex organised behaviour', Journal of Experimental Psychology: General 122(4), 411-428.         [ Links ]

LaChapelle, D. & Finlayson, M., 1998, 'An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls', Brain Injury 12(8) 649-659.         [ Links ]

Lee, K., Hicks, G. & Nino-Murcia, G., 1991, 'Validity and reliability of a scale to assess fatigue', Psychiatry Research 36, 291-298.         [ Links ]

Lezak, M., Howieson, D.B. & Loring, D.W., 2004, Neuropsychological Assessment, 4th edn., Oxford University Press, New York.         [ Links ]

Lorist, M., 1998, 'Caffeine and information processing in man, in J. Snel & M. Lorist, (eds.), Nicotine, caffeine, and social drinking: Behaviour and brain function, Harwood Academic Publishers, Amsterdam.         [ Links ]

Mazaux, J., Masson, F., Levin, H., Alaoui, P., Maurette, P. & Barat, M., 1997, 'Long-term neuropsychological outcome and loss of social autonomy after traumatic brain injury', Archives of Physical Medicine and Rehabilitation 78(12), 1316-1320.         [ Links ]

Meijman, T., 2000, 'The theory of the stop-emotion: On the functionality of fatigue', in D. Pogorski & W. Karwowski (eds.), Ergonomics and safety for global business quality and production, pp. 45-50, CIOP, Warsaw.         [ Links ]

Milner, B., 1963, 'Effects of different brain lesions on card sorting: The role of the frontal lobes', Archives of Neurology 9(1), 90-100.         [ Links ]

Monsell, S., & Driver, J., 2000, 'Control of cognitive processes: Attention and performance, XVIII', The MIT Press, Cambridge.         [ Links ]

Norman, D., & Shallice, T., 1986, 'Attention to action: Willed and automatic control of behaviour', in R. Davidson, G. Swartz & D. Shapiro (eds.), Consciousness and self-regulation: Advances in theory and research, vol. 4, pp. 1-18, Plenum Press, New York.         [ Links ]

Olver, J., Ponsford, J. & Curran, C., 1996, 'Outcome following traumatic brain injury: A comparison between 2 and 5 years after injury', Brain Injury 10(11), 841-848.         [ Links ]

Ponsford, J. & Kinsella, G., 1992, 'Attentional deficits following severe closed head injury', Journal of Clinical Experimental Neuropsychology 14(5), 822-838.         [ Links ]

Rosnow, R. & Rosenthal, R., 1996, Beginning behavioural research: A conceptual primer, Prentice-Hall, New Jersey.         [ Links ]

Sanders, A.F., 1998, Elements of human performance: Reaction processes and attention in human skill, Lawrence Erlbaum, London.         [ Links ]

Schmidt, M., 1996, Rey Auditory Verbal Learning Test: A handbook, Western Psychological. Services, Los Angeles.         [ Links ]

Smith, D., Meaney, D. & Shull, W., 2003, 'Diffuse axonal injury in head trauma', Journal of Head Trauma Rehabilitation 18, 307-316.         [ Links ]

Tucker, D.M., & Williamson, P.A., 1984, 'Asymmetric neural control systems in human self-regulation', Psychological Review 91, 185-215.         [ Links ]

Van der Linden, D., Frese, M. & Meijman, T., 2003, 'Mental fatigue and the control of cognitive processes: Effects on perseveration and planning', Acta Psychologica 113, 45-65.         [ Links ]

Van der Linden, D., Frese, M. & Sonnentag, S., 2003, 'The impact of mental fatigue on exploration in a complex computer task: Rigidity and loss of systematic strategies', Human Factors: The Journal of Human Factors and Ergonomics Society 45(3), 483-494, viewed 2 March 2008, from doi: 10.1518/hfes.45.3.27256        [ Links ]

Van der Naalt, J., Van Zomeren, A., Sluiter, W. & Minderhoud, J., 1999, 'One year outcome in mild to moderate head injury: The predictive value of acute injury characteristics related to complaints and return to work', Journal of Neurology, Neurosurgery and Psychiatry 66(2), 207-213.         [ Links ]

Wang, Y., Chan, R. & Deng, Y., 2006, 'Examination of postconcussion-like symptoms in healthy university students: Relationships to subjective and objective neuropsychological function performance', Archives of Clinical Neuropsychology 21, 339-347.         [ Links ]

War Department, Adjunct General's Office Trail, 1944, Army Individual Test Battery: Manual of direction and scoring, Washington DC.         [ Links ]

Wechsler, D., 1981, WAIS-R manual, The Psychological Corporation, New York.         [ Links ]

Wechsler, D., 1987, Wechsler Memory Scale: Revised manual, The Psychological Corporation, San Antonio.         [ Links ]

Wechsler, D., 1997, Wechsler Adult Intelligence Scale-III, The Psychological Corporation, San Antonio.         [ Links ]

Zillmer, E.A. & Spiers, M.V., 2001, Principles of neuropsychology, Wadsworth/Thomson Learning, California.         [ Links ]

 

 

Correspondence:
Jessica Fry
Department of Psychology
School of Human and Community Development, University of the Witwatersrand
Private Bag X3
Johannesburg 2050
South Africa
email: jessica.fry@hotmail.com

Received: 18 Feb. 2010
Accepted: 08 June 2010
Published: 09 Nov. 2010

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License