Aaro Toomela

Changes in coping strategies, social support, optimism and health-related quality of life following traumatic brain injury: A longitudinal study

Primary objective: To study longitudinal changes in psychological coping strategies, social support, life orientation and health-related quality of life in the late period after traumatic brain injury (TBI). Subjects: Thirty-one patients with TBI who were first investigated on average 2.3 years after injury and were prospectively followed on average 5.7 years later. Methods: Estonian versions of the COPE-D Test, the Brief Social Support Questionnaire, the Life Orientation Test and the RAND-36 questionnaire. Results: During the late follow-up period health-related quality of life and resuming work did not improve significantly. Persons with TBI reported an increase in seeking social/emotional support (p < 0.05), frequent use of avoidance-oriented styles and reduced use of task-oriented styles. This was accompanied by low social support and low satisfaction with support, both of which were associated with health-related quality of life and resuming work after TBI. Although the patients had become more optimistic (p < 0.05), this did not correlate with their health status and social well-being. Conclusions: This prospective study revealed maladaptive changes in the profile of coping strategies and an increase in optimism. As social support, satisfaction with support and health-related quality of life did not improve, then rehabilitation, social and psychological support are continuously needed.

Coping strategies, social support, life orientation and health-related quality of life following traumatic brain injury

Objective: To study coping strategies, social support and life orientation in patients following moderate and severe traumatic brain injury (TBI) in relation to health-related quality of life. Subjects: Eighty-five patients with moderate or severe TBI and 68 control persons. Methods: Estonian versions of the COPE-D test, the Brief Social Support Questionnaire, the Life Orientation Test and the RAND-36 questionnaire. Results: Persons with TBI reported using task-oriented and social/emotional support strategies less often and avoidance-oriented strategies more often than control persons (p < 0.05). The social support network, satisfaction with it and optimism as life orientation were lower in the patient group (p < 0.05). Task-oriented coping styles, satisfaction with social support and optimistic life orientation were associated with the majority of the domains of health-related quality of life and resuming work after TBI. Conclusions: To achieve effective rehabilitation and to enhance patients’ well-being, it is important to improve the quality and amount of social support network, as well as to support patients’ adequate coping efforts for promoting an active lifestyle.

Activity Theory Is a Dead End for Cultural-Historical Psychology

In this article, activity theory is analysed. Specific examples for the analysis are taken from Ratner’s (2000) article on emotions. It is concluded that activity theory in general and Ratner’s approach in particular are deficient at three different levels of analysis: from a general theoretical approach to the study of mind to specific details of how particular mental phenomena and their development are studied. Reasons are proposed for why activity theory in principle cannot solve those deficiencies. It is proposed that Vygotsky’s cultural-historical psychology may be more suitable for understanding the human mind and its genesis.

POSSIBLE INTERPRETATION OF SUBJECTIVE COMPLAINTS IN PATIENTS WITH SPONTANEOUS SUBARACHNOID HAEMORRHAGE

OBJECTIVE To analyse factors related to subjective non-cognitive and cognitive complaints in patients with spontaneous subarachnoid haemorrhage. SUBJECTS Twenty-seven patients with subarachnoid haemorrhage and 27 age-, sex- and education-matched healthy controls. METHODS A battery of cognitive tests measuring visuo-spatial abilities, verbal abilities, and fine-motor skill, Brief Social Support Questionnaire, and Life Orientation Scale were individually presented to all participants. RESULTS Cognitive complaints were related to low social support but not to cognitive performance. Complaints about headaches and dizziness were also related to decreased cognitive performance. Above-normal optimistic life-orientation was related to the absence of complaints in patients with subarachnoid haemorrhage. Healthy participants were best discriminated from patients with subarachnoid haemorrhage by less satisfactory social support system and decreased fine motor skills in the latter group. CONCLUSION Change in social support network may be an important resource for increasing quality of life in patients with subarachnoid haemorrhage not only through help provided by supporters but also indirectly, through increasing subjective well-being. The absence of subjective complaints in patients with subarachnoid haemorrhage is not necessarily related to better objective condition but rather to inadequately optimistic life orientation.

Drawing Development: Stages in the Representation of a Cube and a Cylinder

A new schema for defining developmental stages in the drawing of geometrical objects is proposed. In four studies, (N = 917, 1851, 673, and 437, respectively) children and adults drew cubes and cylinders. The data demonstrate that the proposed stages appear in an invariant order: 2-year-old children almost always draw Scribbles; Single Units appear at the age of 3 years, Differentiated Figures at the age of 4 years, and Integrated Wholes after the age of 7 years.

How Should Culture be Studied

What should be studied in order to understand culture depends on how culture is defined. Different definitions imply different methods and research questions. Sneddon (2003) suggests that, to understand culture, it is necessary to study cultural activities, tacit and explicit representations. I propose that Sneddons account is incomplete; there are more than only two kinds of representations that should be differentiated. In addition, there is no way to study representations without studying activities. Thus, it is necessary to understand what kinds of representations can be studied through different activities. I also draw attention to communication, which is not just another cultural activity, but rather a very special social-cultural activity through which limits of sensory-based information processing can be transcended.

Paradoxical facilitation of a free recall of nonwords in persons with traumatic brain injury.

Brain damage is usually associated with behavioral deficits. However, there is an increasing amount of evidence that lesions of some brain regions are associated with improvements instead of impairments of certain behaviors. We report the results of a study of free recall performance in subjects with traumatic brain injury. One-fourth of the subjects displayed above-normal performance in recall of nonwords. No such facilitation was found with nine lists of words.

What Characterizes Language That Can Be Internalized: A Reply to Tomasello:

Tomasello disagrees with my position that language is the only human artefact that potentiates internalization. Tomasellos position seems to imply that language can be only verbal. My position is that every object or behavioural act is a symbol if it has all of the following characteristics: symbol must be an object or phenomenon that can be directly perceived through sense organs; meaning of symbols must be shared by organisms; symbols must refer to objects, events or phenomena; it must be possible to use a symbol differently from its referents. Internalization is possible only by means of symbols with such characteristics.

Coping strategies in patients following subarachnoid haemorrhage

Objectives – To assess psychological coping strategies and their relationship with outcome in patients after primary subarachnoid haemorrhage (SAH). Patients and methods– In 51 unselected patients (24 males, 27 females; mean age 46 years) in an average 15.7±12.0 months after SAH usage of coping strategies were assessed by means of Estonian COPE‐D test with 15 four‐items scales and compared to those obtained from 51 age‐, sex‐ and education‐matched healthy persons. The data were analysed according to age, sex and education of the patients, initial severity of disease, localization of aneurysm and outcome characteristics. Results– Patients after SAH reported using social support strategy less than control persons (P<0.05) with a tendency of using acceptance‐oriented strategy. Task‐oriented coping styles were less used (P<0.05) by patients with severe initial state, who had more marked late disability and dependence in daily living. Healthy women used social support more than men; patients and control persons 50 years or older used task‐oriented strategies less than younger persons (P<0.05). Conclusion– The structure of coping strategies used by patients after SAH differs compared to healthy persons. The differences in using coping strategies are related to age of the patients, functional state and degree of adaptation after SAH.

Word meaning structure as a predictor of depression in Estonian defense forces.

This study examined psychological factors that predict the level of depression and the role of the dominant type of word meaning structure in the prediction of the level of depression. Native-born Estonian male recruits (N = 687), 18–28 years old, completed psychological tests assessing depression, dominant type of word meaning structure, cognitive ability, personality, self-esteem, coping style, and aggressiveness during the first month of their compulsory military service. The level of depression was assessed a second time about 4–5 months later. The study found that the level of depression could be predicted by a set of psychological factors. Both the accuracy of prediction and the list of psychological factors related to the prediction of depression depended on the dominant type of word meaning structure.