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Objective: This scoping review aimed to identify manualised programs and practice suggestions to support children's health literacy, behaviors and emotions after a parental acquired brain injury., Methods: A systematic search of five scientific databases (PsychINFO, MEDLINE, ProQuest, Scopus, Cochrane) and gray literature occurred. Inclusion criteria included: studies and gray literature published 1989 to 2023, in English, child populations with relationship to parental acquired brain injury, identifying manualised programs or practice suggestions via content analysis approach., Ethical Considerations: No data were collected from human participants. All included studies, where relevant, demonstrated consent and/or ethical processes., Results: Sixteen relevant studies and three gray literature resources ( n  = 19) were identified, including two studies that detailed manualised programs, and fifteen studies and two resource packs that included practice suggestions. Five common domains within practice suggestions were identified: systemic commitment ( n  = 17); family-centered approaches ( n  = 16); child-centered practices ( n  = 15); structured programs ( n  = 9); and peer support ( n  = 8)., Conclusions: More rigorous evaluation is required to test the potential benefits of manualised programs and practice suggestions. A systemic commitment at clinical and organizational levels to provide child and family-centered practices, structured programs, and access to peer support, early and throughout adult-health care settings, may help to meet the support needs of children.

Background: Acquired brain injury (ABI) often leads to persisting somatic, cognitive, and social impairments. Cognitive impairments of processing speed, sustained attention, and working memory are frequently reported and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of virtual reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR game is effective in training cognitive functions after ABI and to explore if the possible effects transfer into everyday functioning., Methods: One hundred participants (18-65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and a minimum of 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy, and severe mental illness will be excluded. Participants will be randomized into two parallel groups: (1) an intervention group playing a commercial VR game taxing processing speed, working memory, and sustained attention; (2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is 5 weeks. The VR group will be asked to train at home for 30 min 5 days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method., Discussion: This study will contribute to improve understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute to new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended., (© 2024. The Author(s).)

Background: Drowning is a leading cause of brain injury in children. Long-term outcome data for drowning survivors are sparse. This study reports neurocognitive outcomes for 154 children hospitalized following drowning., Methods: A survey for parent caregivers was distributed online. Likert scale items assessed 10 outcome variables in four domains: motor (three), perception (three), language (three), and social/emotional (one). Cluster analysis, outcome relative risk, and descriptive statistics were applied., Results: Of 208 surveys received, 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified three outcome groups: Mild (n = 39), Moderate (n = 75), and Severe (n = 40). Motor impairment with cognitive and perceptual sparing (deefferentation) was present in Moderate (P < 1 × 10 -26 ) and Severe (P < 1 × 10 -12 ) but absent in Mild. Locked-in state was endorsed in both Moderate (83%) and Severe (70%). The strongest predictor of good outcome (Mild) was hospitalization with no medical intervention (relative risk [RR] = 6.7). Responsivity on admission (RR = 4.2) or discharge (RR = 12.22) also predicted good outcome. In-hospital prognostication and counseling predicted outcome weakly (RR = 1.3) or not at all., Conclusions: Long-term outcomes in pediatric drowning ranged widely. Overall, motor impairments exceeded perceptual or cognitive (P < 1 × 10 -18 ), with "locked-in state" endorsed in most (93 of 154). The strongest predictors of good outcome were the lack of necessity for interventions and responsivity on admission or discharge. The eponym "Conrad syndrome" is proposed for locked-in state following nonfatal drowning in children., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier Inc.)

Background: Acquired brain injuries (ABI) represent neurological disorders that can arise after traumatic and non-traumatic events. In addition to the physical, emotional and cognitive challenges that patients face, these injuries can bring changes in the life of the patient and his or her family., Objective: This study aims to understand how the occurrence of an ABI condition can disrupt and reshape family functioning by examining certain dimensions such as role in the family, gender and age, which may have a major influence on family dynamics., Methods: We enrolled 86 caregivers of patients with ABI. Two experienced psychologists examined family functioning with Olso's Family Adaptability and Cohesion Rating Scale (FACES IV)., Results: The correlation between groups by generics showed a significant difference only for flexibility (p = 0.05). Specifically, flexibility was greater in male caregivers, particularly in sons. Most of the constructs defining family functioning, such as communication, remained unchanged despite the ABI event., Conclusion: This study provides an in-depth understanding of how families face the challenges posed by the ABI and the role caregivers play within the system.

Objective: This commentary seeks to evaluate existing knowledge about the relationship between brain injury (BI) and overdose (OD), to unify distant bodies of literature, and to enhance prevention and treatment for opioid OD among individuals with BI., Background: There is a hidden epidemic of undiagnosed BI in the United States. Due to lack of screening, the vast majority of BI sufferers do not know they have a BI. Not only are those with BI at elevated risk for opioid use, misuse, and opioid use disorder, but also they are at elevated risk for OD. Conversely, those with OUD and those who experienced an OD, are more likely to sustain BI. Key Findings/Conclusions: The existing literature suggests that primary strategies to reduce ABI (Acquired Brain Injury)/TBI (Traumatic Brain Injury) harms involve addressing: screening, stigma, racial disparities, and popular misconceptions about OD. The association between TBI and OD is an underexamined public health issue, exacerbated by the bidirectional nature of the relationship. Not only is TBI a risk factor for opioid OD; opioid OD was also found to be a major cause of ABI, which can have lifelong effects similar to Alzheimer's disease. Screening tools for BI were underutilized and inconsistently implemented across reviewed studies. Enhanced screening population wide is a promising intervention, complemented with expanded treatment and research. Black individuals face worse outcomes in BI and treatment outcomes. Anti-racist strategies must fight inequity while addressing social and structural drivers of overdose and BI within the opioid and opioid overdose crises.

In recent years, the prevalence of acquired brain injury (ABI) has been on the rise, leading to impaired gait functionality in affected individuals. Traditional gait exoskeletons are typically rigid and bilateral and lack adaptability. To address this, the STELO, a pioneering modular gait-assistive device, was developed. This device can be externally configured with joint modules to cater to the diverse impairments of each patient, aiming to enhance adaptability and efficiency. This study aims to assess the safety and usability of the initial functional modular prototype, STELO, in a sample of 14 ABI-diagnosed participants. Adverse events, device adjustment assistance and time, and gait performance were evaluated during three sessions of device use. The results revealed that STELO was safe, with no serious adverse events reported. The need for assistance and time required for device adjustment decreased progressively over the sessions. Although there was no significant improvement in walking speed observed after three sessions of using STELO, participants and therapists reported satisfactory levels of comfort and usability in questionnaires. Overall, this study demonstrates that the STELO modular device offers a safe and adaptable solution for individuals with ABI, with positive user and therapist feedback.

This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent's and young people's experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer-clinician relationship and the need to actively engage young people in goal setting.

Background: Returning to education (RtE) after an acquired brain injury (ABI) can be stressful for children/young people (CYP) and families. While much can be done to support RtE, there has been limited exploration of the lived experience of parents/carers about what can both help and hinder the process., Objective: The aim was to understand more about RtE from parents' perspectives to inform best practice and facilitate improvements in service delivery., Methods: A service evaluation explored parent/carer views about the RtE process and the support received from healthcare professionals at a regional centre in the UK. Questionnaires (n = 59) were sent to parents of patients treated for an ABI in the last two years., Results: 31 parents (response rate = 51%) completed the survey. Results highlight the many challenges of RtE. Thematic analysis of responses revealed six key themes: Parental mindset and growth; What do they need now?; Specialist support and information; Talk and share; Challenges of new and hidden needs; and Don't forget them!, Conclusion: Parents offer crucial insight into the challenges of the RtE process. Their feedback highlights important factors for service development and reminds professionals of the key components of an effective return.

Purpose: Maintaining work in the long term represents a major challenge for people with acquired brain injury (ABI) as evidenced by a high rate of premature labour market dropouts. The present study aimed to compile factors associated with working in the long term after sustaining an ABI., Materials and Methods: We carried out a scoping review synthesizing quantitative and qualitative research conducted between 2000 and 2021. Databases searched comprised PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science., Results: Ten quantitative and nine qualitative studies were included, all but one from high-resource countries. Quantitative research predominantly comprised longitudinal follow-ups on individuals' work status several years post ABI onset, showing an effect of injury-related and sociodemographic factors. Qualitative studies mostly dealt with work maintenance and revealed a key role of cognitive difficulties, psychological personal factors (e.g., adequate coping strategies) and environmental factors (e.g., flexible work schedules, supportive colleagues)., Conclusions: The factors identified in our review should receive particular attention in vocational integration and job retention programs to support work participation of people with ABI in the long term. There is a need for measures that regularly monitor and promote a good match between individuals and their work environment.Implications for RehabilitationPeople with acquired brain injury (ABI) often have long-lasting and invisible injury-related difficulties that hamper their labour market participation.Factors identified as positively associated with working in the long term, such as coping strategies and self-awareness, should be strengthened.Future interventions should educate affected persons, employers and health care professionals about long-lasting injury-related difficulties and promote a supportive work environment for people with ABI.Prolonged availability of vocational services could be beneficial for supporting work maintenance of people with ABI.

Predicting positive psychosocial outcomes following an Acquired Brain Injury (ABI) remains a challenge. Considerable research demonstrates that social group memberships can have positive effects on psychological well-being, particularly during life transitions. Social group memberships are argued to help people derive a sense of self. This prospective study examined if social group memberships (number of groups and connectedness with groups) could predict posttraumatic growth (PTG) in those affected by ABI. Thirty-six participants (10 females, M age  = 46.56, SD  = 11.46) engaged in community rehabilitation services completed measures at two time-points. Mediation analyses demonstrated that the number of new group memberships (groups formed post-injury) predicted greater PTG at time 2, via stronger connectedness with these new group memberships (controlling for initial PTG). The observed results suggest that a focus on developing and strengthening connections with new group memberships may promote positive adjustment after brain injury.

Purpose: To evaluate the current evidence on dating interventions, their theoretical underpinnings and effectiveness for adult neuro-atypical populations., Methods: A literature search was completed using CINAHL, Communication Source, PsycARTICLES, PsycINFO, SocINDEX, MEDLINE, Embase, AMED and EMB Reviews (all), for English-language, peer-reviewed studies into interventions for relationships or dating among adults with acquired brain injuries (ABI), learning disabilities or autistic spectrum disorder (ASD). Demographic data and intervention details were extracted for all included studies. Standard checklists were used for methodological quality and intervention description. Narrative synthesis for studies rating above poor quality., Results: A total of 11 studies (13 articles) were eligible, ABI ( n  = 6), learning disability ( n  = 4), ASD ( n  = 1). These comprised five comparison or control group studies, two pre-post studies and four case studies. The methodological quality was varied, but intervention descriptions were generally poor. While all studies reported positive outcomes, firm conclusions on their effectiveness are difficult due to the high number of before-after analyses and variation in content and outcome measures used., Conclusions: More high-quality studies are needed to assess the effectiveness of interventions. Also, greater consensus is needed on the key behaviors for dating and relationships and the measures to assess these.IMPLICATIONS FOR REHABILITATIONIntimate relationships are important to quality of life, but challenging for many people in neuro-atypical populations.There are a small number of researched interventions to support dating or marital relationships among adults with ABI, ASD or learning disabilities.Rehabilitation professionals should ask about dating and relationships and support people if this area is identified as important.Rehabilitation professionals should consider different interventions for dating skills and marital relationships.

This paper explored clinicians' experiences of the goal setting process with children and adolescents with acquired brain injuries (ABI) and their families in paediatric neurorehabilitation. Semi-structured interviews were conducted with 13 clinicians, all members of an interdisciplinary paediatric rehabilitation service, who work with children and adolescents with ABI and their families. Interview transcripts and additional data were analysed using constructivist grounded theory methods. Three main themes and sub-themes were developed: (1) Seeing the bigger picture: Goals change over time ; Families set bigger picture goals ; Need-to-dos: Goals that the child/adolescent needs to achieve ; and Want-to-dos: Goals that the child/adolescent wants to achieve ; (2) Collaborating as a team: Everyone needs to be on the same page ; Hearing the child's/adolescent's voice ; and Parents as advocates ; and (3) Recognizing and navigating challenges: Child-/adolescent- and family-related challenges and Time as a service-related challenge . Participants perceived the clinician's role during goal setting as that of an active collaborator, enabling children and adolescents with ABI and their families to generate meaningful goals. These findings demonstrate insights into goal setting in paediatric ABI neurorehabilitation from clinicians' perspectives, and highlight the importance of collaboration, flexibility and anticipation of challenges in facilitating children's, adolescents' and families' involvement in this process.

Primary Objective: To describe the clinical characteristics, self-reported outcomes in domains relating to activities of daily living and patterns of service engagement in the survivors of a moderate-to-severe acquired brain injury over seven years., Research Design: A longitudinal research design was used., Methods and Procedures: Thirty-two individuals who sustained a moderate-to-severe acquired brain injury completed a Sociodemographic and Support Questionnaire at one (t1) and seven years (t2) after completing a publicly funded inpatient neurorehabilitation program., Main Outcomes and Results: There were minimal changes in independent living, mobility, ability to maintain key relationships and in return to work in the interval between t1 and t2. Sixty-nine percent of participants engaged with two or more allied health professional services and 75% engaged with support services in the community over the seven years., Conclusions: There were minimal additional gains in outcomes relating to activities of daily-living and there was a high level of service need in the first decade postinjury. Young and middle-aged individuals who sustain an ABI may continue to live in the community for decades with some level of disability and may require ongoing access to services.

This study evaluated a computer-based prompting intervention for improving expository essay writing after acquired brain injury (ABI). Four undergraduate participants aged 18-21 with mild-moderate ABI and impaired fluid cognition at least 6 months post-injury reported difficulty with the writing process after injury. The study employed a non-concurrent multiple probe across participants, in a single-case design. Outcome measures included essay quality scores and number of revisions to writing counted then coded by type using a revision taxonomy. An inter-scorer agreement procedure was completed for quality scores for 50% of essays, with data indicating that agreement exceeded a goal of 85%. Visual analysis of results showed increased essay quality for all participants in intervention phase compared with baseline, maintained 1 week after. Statistical analyses showed statistically significant results for two of the four participants. The authors discuss external cuing for self-monitoring and tapping of existing writing knowledge as possible explanations for improvement. The study provides preliminary evidence that computer-based prompting has potential to improve writing quality for undergraduates with ABI.

Children's social competence is important for their general wellbeing and life satisfaction. Often it is an area identified as problematic for children brought to the attention of a psychologist, particularly for children with brain injuries. However, it can be difficult to pin down exactly where social difficulties lie, and therefore how best to help. The current article draws together the literature on social competence from brain injury and from more general developmental research. A hierarchical model is presented with three layers: social adjustment, social functioning, and social cognition. Additional factors likely to be relevant for children with brain injuries are noted. This framework can be used to guide psychologists' casework around social competence, aiming to provide a practical and coherent structure for assessment that can then support formulation, person centred planning, and tailored interventions.

Objective: To summarise the current research on the effectiveness of the Amsterdam Memory and Attention Training for Children (Amat-c)., Methods: A literature search was conducted to find articles published about the Amat-c, using PubMed, psychINFO, and PsychBITE databases. Relevant search terms included Amat-c, attention and memory, and childhood ABI., Results: Our literature search identified 7 articles that described 5 separate studies including 61 children in total (mostly TBI). Only one study had a control group. All results indicated positive effects on memory and attention, although in three of the studies, these results were not statistically tested. Positive results were generally maintained six months follow up., Conclusions: This review showed that the Amat-c is effective for treating attention and memory disturbances in children with ABI. However, evidence is limited and training material is outdated. We suggest that the Amat-c should be digitised and implemented in a school setting and further evaluated.

Primary Objective: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children., Design: The study was qualitative, using a thematic analysis approach., Methods and Procedure: Six children between 9-18 years of age, six parents (three with ABI) and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide., Results: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs., Conclusions: The results reveal an interaction between the child's experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child and the children's need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

Objective: The Sydney Psychosocial Reintegration Scale for Children (SPRS-C) assesses psychosocial functioning in children with acquired brain injury (ABI). This article aims to: (1) describe normative data for the parent-rated SPRS-C and, (2) evaluate the discriminant validity of the SPRS-C., Methods: For Aim 1, participants were parents of typically developing children (TDC) aged 5-14 years (N = 200). For Aim 2, participants with ABI were aged 5-14 years (n = 26). A matched group of TDC was sampled from the larger normative sample to serve as a control group (n = 26)., Results: For Aim 1, SPRS-C scores across the 10 age-bands were in the higher ranges. Correlation coefficients of SPRS-C total score with child's age and parent occupational skill level were not statistically significant. For Aim 2, SPRS-C scores for the ABI group were significantly lower than the control group., Conclusions: These data provide a guide for clinical interpretation of the SPRS-C for measuring psychosocial functioning in children with ABI.

Introduction: This study examined whether interarm differences in systolic blood pressure (IDSBP) ≥10 mm Hg were associated with the risk of incident dementia and subclinical brain injury., Methods: Between 1992 and 1998, 2063 participants of the Framingham Heart Study underwent assessment of IDSBP with results related to the 10-year risk of incident dementia including clinically characterized Alzheimer's disease. Secondary outcomes included markers of subclinical brain injury on magnetic resonance imaging., Results: High IDSBP were associated with a greater risk of incident dementia (hazard ratio [HR] 1.92; 95% confidence interval [CI], 1.09-3.40) and Alzheimer's disease (HR, 2.32; 95% CI, 1.29-4.18), but only in those who carried an apolipoprotein E (APOE) ε4 allele. IDSBP also predicted lower total brain volumes and more prevalent silent brain infarcts in those who were APOE ε4 positive., Discussion: High IDSBP were associated with an increased risk of dementia, including clinical Alzheimer's disease, and subclinical brain injury in those who were APOE ε4 positive., (Copyright © 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the perceived needs, obstacles to services, psychological distress and social problem-solving abilities of family members of persons with ABI at a post-acute community-based brain injury rehabilitation facility and offer suggestions for methods of assessment and providing support., Participants: Twenty-nine family members who did not provide daily care, but were involved in the care process., Design: Participants completed self-report questionnaires including the FNQ:R, SOS, DASS-21, WHO-QOL BREF and SPSI:R-S., Results: Participants reported informational and professional needs as most met and involvement in care, instrumental support and emotional support as most unmet. Most were satisfied with the amount of professional help and services and had confidence in the quality of care. Nearly half of the family members felt there were few ABI-related resources in the community and one third were unaware of good ABI treatment resources in their community. Psychosocial functioning was generally average., Conclusion: Family members who do not provide daily care are still impacted by the neurobehavioural changes that progress throughout the long-term, post-acute community phase. This study offers suggestions regarding an effective methodology for assessing family needs and recommends accessible and practical supports.

Background: This study assessed the use of medications during inpatient post-acute rehabilitation for acquired brain injury (ABI)., Materials and Methods: All inpatients with ABI undergoing post-acute rehabilitation in centres identified through the roster of the Italian Society for Rehabilitation Medicine were included. A designated physician in each centre collected information through a structured questionnaire. This study calculated (a) prevalence of medication use, (b) logistic regression Odds Ratio (OR), with 95% confidence interval (95% CI), of polypharmacy (≥ 6 medications)., Results: A total of 484 patients (median age = 52 years, 63.4% men, median time from acute event = 18.5 weeks) were included; 33.8% had Rancho Los Amigos Levels of Cognitive Functioning Scale (RLAS) score 1-2, 8.1% had a score of 7-8, of whom 92.0% received medications, 51.8% had a score of 6-10, of whom 83.9% had at least one psychotropic medication and 66.9% had two or more; 51.8% received anti-epileptics, 32.1% anti-depressants, 14.5% anti-psychotics, peaking in RLAS 4 (37.3%) and decreasing in RLAS 7-8. Polypharmacy was directly associated with age (55-64 years, OR = 2.1; 95% CI = 1.1-4.1; ≥ 65 years, OR = 1.7; 95% CI = 0.9-3.3), inversely with RLAS score (1-2 vs 7-8, OR = 4.3; 95% CI = 1.9-9.8)., Conclusion: Polypharmacy and concurrent use of psychotropic medications was common, raising concern about drug-drug interactions. Safety and effectiveness of medications should be monitored, particularly when used concurrently.

Objective: Transition back to school following paediatric acquired brain injury (ABI) is complex. It must be facilitated by healthcare and educational professionals, who need to work together to return affected students to learning. This qualitative systematic review synthesizes qualitative studies on clinicians' and educators' experiences of facilitating hospital-to-school transitions following ABI., Methods: A search was conducted using seven electronic databases (CINAHL, Cochrane, EMBASE, ERIC, HealthSTAR, MEDLINE, PsycINFO) and key resources were manually reviewed. Publications selected for inclusion had a sample of clinicians and/or educators who worked with children/youth with ABI and focused on hospital-to-school transition processes from the professionals' perspectives., Results: The initial search returned 4761 publications. Of those, 10 met the inclusion criteria. Six main themes emerged across those publications. Three related to transition barriers: (1) lack of training and education regarding transition processes; (2) lack of communication between stakeholders; and (3) lack of preparation for transition. The remaining three presented items that both facilitate and/or impede the transition process: (4) supports available; (5) linking agents; and (6) policies and procedures guiding transition., Conclusions: Clinicians and educators called for collaboration and communication to support students' transition back to school. Further inquiry into designated linking agents and policies that facilitate hospital-to-school transitions for students following ABI may address these lacking areas.

Background/aim: The ability to drive safely can be affected by an acquired brain injury. Following acquired brain injury, clients may experience driving disruptions, formal assessment, return to driving or permanent cessation. Health professionals may be involved in formal driving or component skills' assessment and rehabilitation, or interventions for continued community participation. Meeting the needs of clients related to driving remains a challenging area of clinical practice. The aim of this study was to investigate how driving issues are currently managed by acquired brain injury rehabilitation teams., Method: This study utilised a qualitative phenomenological approach to gain insight into the approaches undertaken by four rehabilitation teams working with clients post-acquired brain injury. Semi-structured, audiotaped interviews were conducted with 25 participants who had identified driving as part of their role., Results: Health professional participants described three major areas of clinical focus, describing strategies and challenges associated with each. These were as follows: 'Integrating driving goals into rehabilitation' which involved optimising timing and acknowledging the clients' focus on driving while enhancing driving and rehabilitation outcomes; 'Managing emotional responses' which required protecting therapeutic relationships and providing information, as well as responding to more extreme responses; and finally 'Managing unlicensed driving and meeting long-term needs', which participants identified as the most challenging aspect. Strategies involved using set procedures, building on knowledge of the client, supporting the family and exploring alternatives., Conclusion: The teams described a range of strategies used to address the challenges related to driving and driving cessation which can be applied to successfully manage this issue in acquired brain injury rehabilitation., (© 2014 Occupational Therapy Australia.)

Objective: To investigate current knowledge and application in practice of constraint-induced movement therapy (CIMT) by therapists within the United Kingdom., Design: An online 19-item survey., Setting: Neurological rehabilitation., Participants: Occupational therapists and physiotherapists (N=489) currently working or within 3 months of working with the adult acquired brain injury population were recruited from 2 specialist interest groups., Interventions: Database administrators of 2 specialist interest groups circulated an e-mail to all therapists on the database to invite them to complete the online survey., Main Outcome Measures: Not applicable., Results: Most therapists (62.9%, n=306) had not used CIMT. Those who had used it were only using 2 or 3 components of the core 7-component CIMT protocol. Therapists identified 2 main barriers to the implementation of CIMT: lack of resources (staffing; 20.7%, n=63) and lack of training (20%, n=61)., Conclusions: Adoption into practice remains limited. Despite a significant evidence base in support of CIMT, most therapists are not using CIMT in practice. This article indicates how concerns and barriers related to CIMT may be minimized to translate this robust intervention from research into clinical practice., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Self-awareness is a significant predictor of neurorehabilitation process and outcome and encompasses metacognitive knowledge and online awareness. The literature focuses primarily on intellectual awareness and research on online awareness is lacking., Objective: To examine online awareness for functional tasks, how it is affected by task experience and its relationships with neurogenic and psychogenic factors., Methods: Thirty six adults with ABI attending neurorehabilitation participated in this study. Online awareness was measured as the discrepancy between subjective ratings of performance and performance on functional tasks, as rated by experienced therapists. Participants' ratings were recorded before and immediately after task experience, as well as following a mediated review of task steps. The Impaired Self-Awareness scale (ISA) and the Denial of Disability scale (DD) rated neurogenic and psychogenic mechanisms of unawareness., Results: Results indicated significant differences between therapists' and participants' ratings before and after IADL task performance, and following mediation. Participants typically overestimated their functional independence and did not significantly change their ratings after task experience. Significant moderate to strong correlations were found between online awareness measures and both DD and ISA scales., Conclusions: Overestimation of functional independence is common in persons with ABI, is related to both neurogenic and psychogenic factors and is not significantly affected by single task experience. Further studies are required to examine the effect of theoretically driven awareness interventions in neurorehabilitation.

Fatigue is common following paediatric acquired brain injury (ABI) and can negatively impact quality of life. Despite this, there is limited understanding of how clinicians currently assess and manage fatigue in rehabilitation. This study explored how Australian rehabilitation clinicians recognize, assess, and manage fatigue following paediatric ABI. Using a qualitative research design, semi-structured interviews were conducted with 11 clinicians who work with children (0-18 years) with ABI in rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and sub-themes were developed: (1) Reaching a shared understanding: Identifying and understanding fatigue; Unpacking fatigue with children and their families; and (2) Using the shared understanding: Clinicians working collaboratively to manage fatigue; Planning for and supporting children and their family through transitions; Anticipating and problem-solving speedbumps. Participants reflected on the importance of reaching a shared understanding of fatigue within each child's unique context, requiring the collaborative effort of the child, family, school, and interdisciplinary rehabilitation team, to problem-solve and manage fatigue together over time. These findings provide insights into the processes of assessing and managing fatigue from rehabilitation clinicians’ perspectives and highlight the importance of a collaborative approach to support the individual needs of the child during their rehabilitation. [ABSTRACT FROM AUTHOR]

Background: There is a need for improved access to evidence-based interventions supporting the wellbeing of caregivers of adults with acquired brain injury (ABI). Remotely delivered interventions could address this need. The present systematic review sought to collate studies evaluating remotely delivered interventions designed to improve the wellbeing of caregivers of adults with an ABI, to summarise findings and to comment on the quality of this research. Methods: Systematic searches were conducted up until December 2023. Study characteristics, populations, interventions and outcomes were outlined, and papers were appraised on methodological quality. The review was pre-registered (PROSPERO: CRD42020189235). Results: Eleven studies meeting inclusion criteria were identified. Methodological quality was generally low to adequate. Most studies evaluated an intervention for caregivers of people with stroke, with a variety of types of interventions trialled. The majority of studies reported non-significant findings on wellbeing outcomes when compared to control conditions. Conclusions: There is limited evidence supporting a remotely delivered intervention to improve wellbeing outcomes for ABI caregivers. Specific recommendations are provided, including the development of a core set of outcomes and replication of findings over time, which can improve research into the development and evaluation of remote interventions for this population. Caring for someone with an acquired brain injury can impact negatively on wellbeing, and caregivers face a range of barriers to access services. This systematic review explored the evidence-base for supporting the psychological wellbeing of caregivers remotely. The literature was searched, and studies were summarised and evaluated on methodological quality. Eleven studies were found. In summary, there is currently little evidence supporting remote delivery to improve psychological wellbeing for this group. Recommendations for future research and intervention development are provided. [ABSTRACT FROM AUTHOR]

The International Classification of Impairment, Disabilities and Health by the World Health Organization had a profound influence on assessing and treating people with acquired brain injuries (ABI), which cause a movement from using impairment-based intervention to use therapies that focused on improving the participation and function of the individual's daily life. Although the first step of any therapy plan is to measure the damaged function of the related dimension, no available functional communication test for Persian-speaking people with ABI is available. Our purpose of this study was to provide a Functional Communication Test for Persian-speaking patients to measure the strengths and weakness of communication in dementia-free patients with ABI. In this cross-sectional study, the first version of the Persian Functional Communication Test (P-FUCT) was designed based on the structure of the most common functional communication tests such as ASHA-FACS and CADL. The content validity ratio (CVR) were determined. The final version of P-FUCT was administered on 30 dementia-free patients with ABI completed once by a clinician and once by the caregivers and the correlation between the scores was obtained. Concurrently, the P-WAB-1 was administered to assess the concurrent validity of the P-FUCT. The results indicated that P-FUCT has an acceptable level of internal consistency (alpha = 0.96), inter-rater 0.91 and intra-rater measurements 0.95 p < 0.05 with an adequate CVR of 0.71. The correlation between P-WAB-1 and P-FUCT scores completed by clinicians and the caregivers was r = 0/79 and r = 0/80. The P-FUCT is a valid and reliable assessment tool can be use for measuring the function communication ability of dementia-free patients with ABI. [ABSTRACT FROM AUTHOR]

Several studies have investigated biopsychosocial consequences after acquired brain injury (ABI) in the early rehabilitation phases. However, longitudinal studies are rare and few go beyond three years post-injury. The aim of the present study was to assess biopsychosocial challenges in a long term perspective and investigate which challenges remain after five years. With reference to the biopsychosocial model our study holds a special emphasis on the psychosocial aspects of it. Methods: Adults (N = 45) with moderate or severe ABI were evaluated at three time points: at discharge from hospitalization, 1-year post-injury, and 5-year follow-up. Data were derived from self-reported questionnaires: Major Depression Inventory, Quality of life, Impact on Participation and Autonomy Questionnaire and self-reports on work and marital status. Repeated measures ANOVAs were used for analysis. Results: Physical QOL and aspects of autonomy increased over time whereas social QOL decreased. Family roles were challenged at discharge and remained so at 1-year and 5-year follow-up, and the frequency of being married or in a relationship dropped. Level of depression did not change significantly over time, and one in four were still above clinical cut-off at the 5-year follow-up. Employment increased over time but remained less than half of the pre-injury level. Conclusion: Improvements in perceived physical function and autonomy are possible long after the injury, whereas social relations remain a challenge and signs of depression persist. [ABSTRACT FROM AUTHOR]

As part of a larger study exploring narrative storytelling, this paper focuses upon the experiences of eight adults with ABI who had participated in storytelling workshops facilitated by an advocacy organization. Following participation in the storytelling workshops, each storyteller was interviewed twice, with three shorter interviews conducted with one participant with significant communication challenges. In total, 25 interview transcripts (17 interviews plus eight transcripts of produced personal narratives) were analysed using constructivist grounded theory methods. Data analysis produced two main themes and sub-themes; (1) Sharing and helping (feeling heard & releasing emotions) and, (2) Re-visiting my story (reflecting and learning). The themes capture insights into the process of storytelling and reveal the therapeutic potential of narrative storytelling when coupled with an altruistic opportunity to help others through story sharing. This study contributes to an emerging area of research and practice supporting positive identity growth following ABI. The findings present substantial implications for goal setting and meaningful productive engagement in brain injury rehabilitation. [ABSTRACT FROM AUTHOR]

Ecological Momentary Assessment (EMA) promises to be a suitable method for capturing the dynamics in self-assessments through repeated measurements in naturalistic environments using common mobile devices. Therefore, EMA could increase the power of neuropsychological assessment by obtaining a more fine-grained picture of symptoms, limitations, and strengths in patients with an acquired brain injury (ABI) in real-life situations. The present study examined 15 patients with an ABI with cognitive and motor impairments. Following a semirandomized high-frequency sampling plan to assess EMA's feasibility and applicability, data were collected across 7 days. At eight prompts per day, patients were asked about their current activities, the social context they were in, their current mood, performance judgments of their own functional status, and the frequency of self-reflections. The average compliance rate was 71.6%. The fluctuations in patients' responses were measured in terms of variance distributions within simple (intercept only) three-level models and root mean square of successive difference values. They were sufficient, as shown, for example, by the mean within-person variability of 44.9% across all of the items studied. There were no significant correlations between patients' age, severity of depressive symptoms, or their level of functioning and their compliance with study participation or the variability of their responses. The results support the feasibility and applicability of EMA as an assessment technique in patients with an ABI. There are, however, limitations that should be considered when planning an assessment of brain-injured patients using EMA. [ABSTRACT FROM AUTHOR]

Research indicates that Acquired Brain Injury (ABI) is associated with significant and chronic impairment across multiple areas of functioning including physical, cognitive, emotional and behavioral domains. Whilst impairments associated with ABI can be ameliorated, cure is seldom possible. The emergence of positive psychology reflects a paradigm shift in health and wellbeing research, highlighting the role of character strengths, positive emotions, meaning, and resilience. Positive psychology interventions have been demonstrated to improve wellbeing in a variety of populations, although research investigating the impact of positive psychotherapy for people living with ABI are sparse. Here we characterize the experience of an 8-week positive psychotherapy intervention for 13 people living with ABI including four mentors and nine participants using thematic analysis of transcripts collected during mini-groups and one-to-one interviews. Six main themes were identified including empowerment, social opportunity, coping, cultivation of positive emotion, consolidation of skills and barriers. Results indicated that wellbeing can be promoted and improved in individuals with ABI. Recent theoretical developments in wellbeing science highlight scope to improve the intervention by connecting individuals to their communities and spending time in nature. [ABSTRACT FROM AUTHOR]

The ever-increasing cases of acquired brain injury (ABI), especially among young people, have prompted a rapid progress in research involving neurological disorders. One important path is the concept of relearning, which attempts to help people regain basic motor and cognitive skills lost due to illness or accident. The goals of relearning are twofold. First, there must exist a way to properly assess the necessities of an affected person, leading to a diagnosis, followed by a recommendation regarding the exercises, tests and tasks to perform; and second, there must be a way to confirm the results obtained from these recommendations in order to fine-tune and personalize the relearning process. This presents a challenge, as there is a deeply-rooted duality between the personalized and the generalized approach. In this work we propose a personalization algorithm based on the ant colony optimization (ACO), which is a bio-inspired meta-heuristic. As we show, the stochastic nature of ants has certain similarities to the human learning process. We combine the adaptive and exploratory capabilities of ACO systems to respond to rapidly changing environments and the ubiquitous human factor. Finally, we test the proposed solution extensively in various scenarios, achieving high quality results. [ABSTRACT FROM AUTHOR]

PURPOSE: Best practice guidelines for neurorehabilitation recommend coordinated rehabilitation programmes to ensure seamless service transitions and comprehensive rehabilitation practices. However, this recommendation for practice and the evidence informing its advancement is based on unexamined assumptions. Therefore, this study investigates bio-psycho-social outcomes and perceptions of a coordinated rehabilitation programme. METHOD: In a prospective, naturalistic mixed methods study, rehabilitation outcomes for 82 adults (18-66 years) with moderate to severe acquired brain injury were investigated. Clients who received the coordinated rehabilitation programme KORE (n = 27) were compared to clients from the same area who received standard rehabilitation prior to the implementation of the KORE programme (n = 37) and clients who received other coordinated efforts elsewhere (n = 18). The study employed quantitative data from standardized tests (Functional Independence Measure, Major Depression Inventory, Quality of life, and Impact on Participation and Autonomy Questionnaire, as well as information on return to work and qualitative interviews with clients (n = 82) and their relatives (n = 40). RESULTS: Outcomes did not improve from hospital discharge to two years later. Notably, physiological recovery had probably been achieved to the extent possible, but depression and reduced psychological well-being remained prevalent across groups. Qualitative interviews suggested several barriers to improvement, such as identity dilemmas and unmet needs for psychological support, while rehabilitation services focused on physical and practical training. CONCLUSION: Coordinated interventions do not guarantee comprehensive rehabilitation and better outcomes for clients with acquired brain injury. Psychological support seems to be important and largely unaddressed. [ABSTRACT FROM AUTHOR]

Aim: To describe the occurrence and causes of acquired brain injury (ABI), including traumatic brain injury (TBI) and non-traumatic brain injury (NTBI), among Dutch youth and estimate incidence rates from the data. Patients: Aged 1 month-24 years, hospital diagnosed with ABI in 2008 or 2009. Methods: In three major hospitals in the southwest region of the Netherlands patients with ABI were retrospectively identified by means of diagnosis codes and specific search terms. Results: One thousand eight hundred and ninety-two patients were included: 1476 with TBI and 416 with NTBI. Causes of TBI and NTBI varied among the age groups 0-4, 5-14 and 15-24 years, with accidents (in traffic or at home) being the most common cause of TBI and hypoxic-ischemic events for NTBI, in all groups. The estimated yearly incidence rates per 100 000 for mild-moderate-severe TBI were 271.2-15.4-2.3 (0-14 years) and 261.6-27.0-7.9 (15-24 years), for mild-moderate-severe NTBI they were 95.7-11.8-1.3 (0-14 years) and 73.8-6.1-1.6 (15-24 years), respectively. Conclusion: More than 15% of TBI and NTBI in children and youth is classified as moderate or severe, with causes of TBI and NTBI varying among age groups. Based on the occurrence of ABI in three hospitals, the estimated incidence of ABI in children and youth in the southwest region of the Netherlands is substantial. [ABSTRACT FROM AUTHOR]

Positive peer relationships are essential in healthy development. The prevalence of peer-relationship problems in children after acquired brain injury (ABI) has yet to be explored, although ABI does inevitably impact upon peer interactions. We aimed to explore how peer-relationships and emotional distress after ABI may differ from the levels reported by healthy children or mental health controls. Parents of 214 children (137 'healthy' children, 27 children using mental health services and 40 children with ABI) aged 9-15 years participated. A questionnaire measure of peer-relationship functioning and emotional distress was completed. Children with ABI experienced a greater degree of peer-relationship difficulties and emotional distress than healthy controls. No difference was found in reported peer relationship difficulties or emotional distress between ABI children and the children accessing mental health services. We conclude that emotional distress and co-occurring peer-relationship difficulties are as prevalent in a population of children after ABI as may be expected in a population of children under the care of mental health services, yet, unlike the latter group, appropriate intervention services are not commonly available. Interventions that aim to enhance peer relationships after childhood ABI may provide an essential resource to the benefit of outcome. [ABSTRACT FROM AUTHOR]

Objective: Recently, Bedell reported data from the US on functional changes during inpatient rehabilitation for children with ABI. Similar data for Australia is not available. The aim of this study was to measure functional outcomes of children admitted to rehabilitation in Victoria, Australia and to explore predictors of outcome to contribute to international benchmarking of paediatric services. Method: The Pediatric Evaluation of Disability Inventory (PEDI) was administered to 72 children (aged 8 months to 16 years) within 3 days of admission to rehabilitation and again in the 3 days prior to discharge to measure functional skills in self-care, mobility and social function. Outcome data for the three domains are described and baseline and injury characteristics explored as predictors of outcome using linear regression models. Results: Significant improvements in PEDI scores across all domains were demonstrated from admission to discharge. Older age at injury, higher baseline scores and being female were all predictive of better outcomes at discharge. Conclusions: Findings revealed that patterns of recovery in this sample were similar to those reported in previous studies. Continued use of the PEDI for inpatient rehabilitation is recommended to further investigate effects of injury type and the impact of therapy on outcome. [ABSTRACT FROM AUTHOR]

Information provision is an important resource for those living with acquired brain injury (ABI) and their families. Web-based health information services are now common additions to health service provision. Ideally, they should be easy to use and provide useful, relevant and accurate information. ABI injuries do not affect individuals in the same way, and survivors can have a wide range of abilities and impairments. Therefore, any informational resource intended for this group should take account of their needs and help to compensate for their limitations. This pilot study recruited a group of individuals with ABI (of a median Extended Glasgow Outcome Scale rating of “lower moderate disability”) who were clients of a UK National Health Service rehabilitation service and asked them to assess a specialised website provided by that service and hosted by their employing Primary Care Trust organisation. Participants completed a practical task and then gave their opinions on various aspects of website design, and content. They were also asked to suggest improvements and recommend additions. Overall the results were favourable. However, improvements in the legibility, layout and writing style were identified. There were also requests to add more information on the existing topics and add additional topics. The discussion also evaluates the utility of the methodology and the implications of the results for others considering constructing their own website. [ABSTRACT FROM AUTHOR]

Traumatic brain injury is a term used to group conditions caused by a disruption in normal brain function secondary to an external source. Traumatic brain injury can range from mild to severe. These patients can be symptomatic with subtle to major physiological changes unapparent upon imaging. Some of the more common symptoms of traumatic brain injury include loss of consciousness, loss of memory before or after the injury, an alteration in mental state at the time of the accident or a focal neurological deficit. Frequent visual symptoms associated with TBI include unexplained vision changes, photosensitivity, and motion hypersensitivity, as well as decreased visual processing speed, which can make this population difficult and time-consuming to examine. The patient's symptoms are often dismissed as psychological, secondary to the neurological disorders associated with the injury. This paper discusses modified examination procedures for symptomatic patients with traumatic brain injury. This paper has been written to encourage optometrists to become members of the rehabilitation team so that these patients can receive the comprehensive care necessary for maximal recovery. [ABSTRACT FROM AUTHOR]

Primary objectives: To identify the health and social care services used by young adults aged 18-25 years with acquired brain injury (ABI) and the costs of these supports. Research methods: A review of existing literature and databases and contact with academics and stakeholders working with people with ABI. Main outcomes and results: The likely care pathways of young adults with ABI were mapped over a notional 1-year period after presentation at hospital accident and emergency departments. Most young adults with ABI will use minimal health and social care support following injury but those with subsequent disabilities may cost the health and social care budget in excess of £47.2 million per year. Conclusion: Lack of available data mean the service use and cost estimates draw from a range of sources. However, the costs may under-estimate the true impact on budgets as incidence rates may be higher than identified and conservative values were selected for unit costs. The model estimates the cost of treatment and support as provided today, but high levels of unmet need remain. [ABSTRACT FROM AUTHOR]

Background: In Canada, allocation of rehabilitation services is often based on the assumption that families who have third party insurance funding are well served by the private sector system and are not in need of publicly funded rehabilitation services. However, there has been little research comparing the experiences of caregivers with and without access to third party insurance funding; data that could inform service planning and provision. Method: The current study compared the stresses, resources and psychological health of caregivers of children with Acquired Brain Injury (ABI) with and without third party funding. Results: Caregivers with third party funding (MVA) reported a similar level of stress in comparison to caregivers without funding (non-MVA); however there were differences in what these families perceived as stressful. Conclusions: Although results indicated significant psychological distress and depressive symptoms for both groups, parents in both groups reported high availability of and satisfaction with services, although they used very few services. Implications for clinical services are discussed. [ABSTRACT FROM AUTHOR]

Objective : To investigate through pilot exploration the relationships between depression, self-concept and perceived quality of life (QoL) in post-acute patients with acquired brain injury (ABI). Methods : Nineteen patients with ABI were administered the Beck Depression Inventory-II and the Quality of Life Inventory, along with the Tennessee Self-Concept Scale-2 and the Head Injury Semantic Differential Scale, measures of self-concept. The relationships between these measures were explored using correlational analyses. Results : Ratings of self-concept were correlated with perceived QoL, suggesting that poorer view of self was associated with lower subjective QoL. Additionally, depressive symptoms were associated with lower QoL ratings, consistent with previous research. Conclusions : These results suggest that intra-personal variables, such as self-concept and depression, impact the perceived QoL of the ABI survivor. Future research exploring the mediating effects of these variables on QoL may clarify this relationship and may aid in developing more effective interventions for these individuals. [ABSTRACT FROM AUTHOR]

This paper describes an intervention aimed at empowering parents of child survivors of acquired brain injury (ABI) in their interaction with teachers and other professionals involved in their child's education. The particular characteristics of the late morbidity of child ABI led to the design of an intervention in the form of a video and informational booklet that is the property of the family. Early response to the intervention has been extremely positive, although formal evaluation has been unexpectedly challenging. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of a behavioural intervention programme in reducing disruptive behaviours in children with brain injury. The behavioural package included programme rules, a token economy with response cost and mystery motivators. Participants were three male patients in an after-school programme at a rehabilitation hospital who were identified as having both a brain injury and disruptive behaviours in the classroom setting. Two control composites were formed, one with children who behaved appropriately and one with children who behaved in a disruptive manner. This study employed a multiple baseline design across individuals. The participants' disruptive behaviour decreased during the intervention phase by an average of 69%; the effect size of each participant's improvement was 'large'. The comparisons' disruptive behaviour was unchanged. This pronounced decrease in disruptive behaviours for the three participants was maintained in the follow-up phase. This short-term, easily implemented package altered important programme and social behaviours positively, were well received by children and staff and resulted in long-term improvements to behavioural deficits secondary to brain injury. These results are discussed in terms of theoretical disagreements, methodological issues and practical community-based interventions in brain-injured children. [ABSTRACT FROM AUTHOR]