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Background: Despite evidence of the efficacy of activities of daily living (ADL) retraining during post-traumatic amnesia (PTA) following traumatic brain injury (TBI), utilisation of this intervention in practice is unclear. Utilising an implementation science framework, the Consolidated Framework for Implementation Research, this study explored efforts to translate ADL retraining during PTA into the clinical practice of occupational therapists (OTs) working in TBI rehabilitation settings across Australia. Methods: Participants were 44 OTs who attended a day-long training workshop that included knowledge and skill-based content regarding ADL retraining during PTA. Baseline and post-training ratings were completed including evaluation of workshop utility, and skill and knowledge-based competencies relevant to the intervention. Approximately 2 years later, nine trained OTs and two administrators were interviewed to explore the results of implementing the intervention. Results: Overall, the training workshop was rated as being helpful and OT ratings of confidence (P < 0.001) and competencies (P < 0.001) significantly improved from baseline to post-workshop. At follow-up, thematic analysis of interviews identified themes related to implementing the intervention as it pertains to patients in PTA, OTs delivering the intervention and the organisational context. Various facilitators and barriers to translation were identified. Participants indicated a positive view of the clinical use of the intervention and development of their knowledge and skills, with the intervention benefiting those in PTA. Despite this, factors such as time, resourcing, team training, and rehabilitation-setting processes posed significant barriers. Conclusion: Multiple barriers were identified in implementation of ADL retraining during PTA and require consideration to facilitate translation and promote best practice. Despite evidence supporting skills retraining during post-traumatic amnesia (PTA) following traumatic brain injury (TBI), utilisation of this intervention in clinical practice in Australia is unclear. Following training in the intervention, occupational therapists reported improved confidence and competencies, and 2 years later, a key facilitator of implementing the intervention into clinical practice was the benefit to the patients. Despite this, barriers such as time and resourcing require consideration to facilitate best-practice rehabilitation for individuals in PTA. This article belongs to the Collection Clinical Implementation to Optimise Outcomes. [ABSTRACT FROM AUTHOR]

It is uncertain whether therapy delivered during posttraumatic amnesia (PTA) following traumatic brain injury can be effective due to risk of agitation and poor learning capacity. This study used goal attainment scaling (GAS) to assess gains in activities of daily living (ADL) retraining during PTA. Occupational therapists' perspectives on goal setting and therapy delivery were also explored qualitatively. Forty-nine rehabilitation inpatients were provided with manualised ADL retraining following errorless and procedural learning principles during PTA. From 104 GAS goals, 90% were achieved at PTA emergence. GAS T-scores changed significantly (p < .001) from baseline (M = 26.94, SD = 4.90) to post-intervention (M = 61.44, SD = 11.45). Mean post-intervention T-scores correlated significantly (p < .001) with change in Functional Independence Measure scores. The four therapists reported that GAS was unfamiliar and time-consuming initially, although it aided goal-directed therapy and measurement of patient performance. Application of manualised skill retraining using errorless and procedural learning techniques was described as novel and challenging, but providing valuable structure. The intervention reportedly promoted therapeutic alliance, skill-building and meaningful time-use without elevating agitation, but fatigue impeded therapy. Overall, GAS captured positive individual change following ADL retraining during PTA and therapists indicated that the intervention and use of GAS was generally beneficial and feasible within clinical practice. [ABSTRACT FROM AUTHOR]

Primary objective: Family caregivers play an important role in managing challenging behaviours after TBI. The aims of this study were to understand how family caregivers of individuals with TBI perceive challenging behaviours and their impact on the TBI individual's community integration and family functioning. Research design: A qualitative research design was employed to capture the lived experience of family caregivers of individuals with TBI. Methods and procedures: Face-to-face interviews were conducted on six female family caregivers of individuals with severe TBI (sustained an average of 17 years earlier) and long-standing challenging behaviours. Main outcomes and results: The results revealed that family caregivers adopted a broader definition of challenging behaviour than that used by professionals and these behaviours impacted on the community integration of the individual with TBI, most notably leading to poor social relationships. Challenging behaviours were viewed as a key source of distress and burden for family caregivers and they used many different strategies to manage the behaviours. Conclusion: Greater understanding of challenging behaviours from the perspectives of family caregivers may help provide more effective support and interventions to improve quality-of-life for individuals with challenging behaviours after TBI and their families. [ABSTRACT FROM AUTHOR]