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Examining the drawing process used to complete the Rey-Osterrieth Complex Figure Task in individuals with mild traumatic brain injury

Newman, M. L. (2022). Examining the drawing process used to complete the Rey-Osterrieth Complex Figure Task in individuals with mild traumatic brain injury. (Unpublished Doctoral thesis, City, University of London)


Mild traumatic brain injury (mTBI) accounts for 65-90% of all brain injuries. Whilst the majority make a full recovery within three months, 2-24% report persisting symptoms beyond this window, sometimes for years. This may result in a diagnosis of Post-Concussion Syndrome (PCS). However, a long-standing debate questions the cause of these symptoms, arguing there is a lack of evidence of tissue damage or cognitive deficit. Symptoms are attributed to other factors such as low intelligence, mental health or malingering. Supporters of PCS having an organic basis have highlighted limitations in the tools used to measure cognition and behaviour. New neuroimaging technology illustrates organic damage occurs at a substructural and metabolic level not identified in earlier techniques. Further, the research design and statistical analysis has been criticised. Research has indicated that researchers and clinicians should be focusing on how individuals with mTBI completed tasks, not on what they achieve. The Rey-Osterrieth Complex Figure tasks offers a solution to observe how individuals perceive and problem-solve complex visual information.

A mixed-methods approach within a clinical neuropsychological framework was used to examine whether observations of drawing process used to complete the Rey-Osterrieth Complex Figure task can support a diagnosis of PCS. Drawing process scores from both non-mTBI and mTBI populations were used to validate a novel scoring system of four constructs, and to identify if drawing process measurements were predictors of postconcussive symptoms and behavioural challenges. Thematic analysis was also used to analyse examine in greater detail the challenges experienced following mTBI, and to consider how cognitive performance correlates with subjective reports of these challenges.

Results indicated observations of drawing process were strong predictors of subjective reporting of persisting symptoms and behavioural challenges post-mTBI. Examination of drawing process constructs alongside other neuropsychological measures indicated that reduced inhibitory control and cognitive flexibility underpins persisting symptoms and, in particular, cognitive fatigue. The theme of Effort and Energy indicated that fatigue was a significant long-term challenge following mTBI, supporting theoretical models that increased cognitive effort underpins cognitive fatigue. Analysis showed that mental health was also a strong predictor of symptoms and challenges. However, the nature of how this is experienced by individuals with mTBI illustrated different sources for these psychological challenges – concluding that mental health is a moderator of cognitive dysfunction following mTBI, rather than the cause.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: School of Health & Psychological Sciences > Psychology
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Newman Thesis 2022_Redacted PDF-A.pdf] Text - Accepted Version
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