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Gelech J, Bayly M, Desjardins M. Constructing robust selves after brain injury: positive identity work among members of a female self-help group. Neuropsychol Rehabil 2017; 29:456-476. [PMID: 28393594 DOI: 10.1080/09602011.2017.1308872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite common experiences of identity damage, decline, and deterioration, many brain injury survivors succeed in reconstructing robust identities in the wake of injury. Yet, while this accomplishment greatly benefits survivors' quality of life, little is known about how positive identity work might be facilitated or enhanced in therapeutic institutions. Drawing on data from a women's self-help group, we argue that an egalitarian, reflective, strength-focused, and gender-segregated environment can provide female ABI (acquired brain injury) survivors with a fertile scene for identity enhancement and offer unique opportunities for collective identity development. Sociolinguistic interactional analysis revealed four types of positive identity work undertaken within the group: constructing competent selves; tempering the threat of loss and impairment; resisting infantilisation and delegitimisation; and asserting a collective gender identity. This identity work was facilitated by specific programme attributes and activities and contributed to the global project of decentring disability and destigmatising impairments and losses. We call for increased attention to identity issues in brain injury rehabilitation and argue that gender-segregated programming can provide a unique space for female survivors to construct empowering individual and collective identities after injury.
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Affiliation(s)
- Jan Gelech
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
| | - Melanie Bayly
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
| | - Michel Desjardins
- a Department of Psychology , University of Saskatchewan , Saskatoon , Canada
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102
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Mitrushina M, Tomaszewski R. Psychometric properties of the HI-FI problem checklist in a sample of adults with neurological and neuropsychiatric disorders: factors contributing to life satisfaction after long-term disability. Disabil Rehabil 2017; 39:608-618. [DOI: 10.3109/09638288.2016.1152609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Maura Mitrushina
- Department of Psychology, California State University, Northridge, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Robert Tomaszewski
- Department of Psychology, California State University, Northridge, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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103
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Graff HJ, Christensen U, Poulsen I, Egerod I. Patient perspectives on navigating the field of traumatic brain injury rehabilitation: a qualitative thematic analysis. Disabil Rehabil 2017; 40:926-934. [DOI: 10.1080/09638288.2017.1280542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Heidi J. Graff
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Trauma Center and Acute Admission, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Rigshospitalet, Clinic of Neurorehabilitation, TBI Unit, University of Copenhagen, Hvidovre, Denmark
| | - Ingrid Egerod
- Trauma Center and Acute Admission, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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104
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Lapadatu I, Morris R. The relationship between stroke survivors' perceived identity and mood, self-esteem and quality of life. Neuropsychol Rehabil 2017; 29:199-213. [PMID: 28075218 DOI: 10.1080/09602011.2016.1272468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To examine change in identity after stroke and to elucidate its relationship with mood and quality of life. To test Higgins' theory of the impact of identity (self-discrepancy) on anxiety and depression. To examine the role of self-esteem in mediating the relationship between identity and outcomes. METHOD Sixty-five community-living first-time stroke survivors, mean age 61.58 and time since stroke 5.60 years, were recruited from stroke charities. A cross-sectional study used the Head Injury Semantic Differential Scale, the Hospital Anxiety and Depression Scale, the Rosenberg Self-Esteem Scale, the Stroke-Specific Quality of Life Questionnaire (adapted) and the Barthel Index. RESULTS Identity was rated more negatively after stroke than before (t(64) = 6.46, p < .00). Greater discrepancy in identity was associated with anxiety (r = .38, p < .00), depression (r = .59, p < .00), self-esteem (r = -.48, p < .00) and quality of life (r = -.54, p < .00). Overall positivity of identity after stroke predicted outcomes even better than discrepancy. The association between discrepancy and mood and quality of life was mediated by self-esteem (β = .30, p < .01; β = -.24, p < .01, respectively). Specific types of discrepancy defined by Higgins did not show differential relationships with anxiety and depression as predicted. CONCLUSIONS Identity changes after stroke and identity and self-esteem are associated with important outcomes for stroke survivors.
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Affiliation(s)
- Irina Lapadatu
- a Clinical Psychology, School of Psychology , Cardiff University , Cardiff , UK.,b Cardiff and Vale University Health Board , Cardiff , UK
| | - Reg Morris
- a Clinical Psychology, School of Psychology , Cardiff University , Cardiff , UK.,b Cardiff and Vale University Health Board , Cardiff , UK
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105
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Fadyl JK, Channon A, Theadom A, McPherson KM. Optimising qualitative longitudinal analysis: Insights from a study of traumatic brain injury recovery and adaptation. Nurs Inq 2016; 24. [PMID: 27905155 DOI: 10.1111/nin.12170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 01/11/2023]
Abstract
Knowledge about aspects that influence recovery and adaptation in the postacute phase of disabling health events is key to understanding how best to provide appropriate rehabilitation and health services. Qualitative longitudinal research makes it possible to look for patterns, key time points and critical moments that could be vital for interventions and supports. However, strategies that support robust data management and analysis for longitudinal qualitative research in health-care are not well documented in the literature. This article reviews three challenges encountered in a large longitudinal qualitative descriptive study about experiences of recovery and adaptation after traumatic brain injury in New Zealand, and the strategies and technologies used to address them. These were (i) tracking coding and analysis decisions during an extended analysis period; (ii) navigating interpretations over time and in response to new data; and (iii) exploiting data volume and complexity. Concept mapping during coding review, a considered combination of information technologies, employing both cross-sectional and narrative analysis, and an expectation that subanalyses would be required for key topics helped us manage the study in a way that facilitated useful and novel insights. These strategies could be applied in other qualitative longitudinal studies in healthcare inquiry to optimise data analysis and stimulate important insights.
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Affiliation(s)
- Joanna K Fadyl
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Alexis Channon
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.,National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Kathryn M McPherson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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106
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Salas CE, Casassus M, Rowlands L, Pimm S, Flanagan DAJ. “Relating through sameness”: a qualitative study of friendship and social isolation in chronic traumatic brain injury. Neuropsychol Rehabil 2016; 28:1161-1178. [DOI: 10.1080/09602011.2016.1247730] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christian E. Salas
- Facultad de Psicología, Laboratorio Neurociencia Cognitiva y Social, Universidad Diego Portales, Santiago, Chile
- Head Forward Centre, Manchester, UK
- School of Psychology, Bangor University, Bangor, Wales, UK
| | - Martin Casassus
- Head Forward Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | | | - Steve Pimm
- Rehabilitation Without Walls, Milton Keynes, UK
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107
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Snell DL, Martin R, Surgenor LJ, Siegert RJ, Hay-Smith EJC. What’s wrong with me? seeking a coherent understanding of recovery after mild traumatic brain injury. Disabil Rehabil 2016; 39:1968-1975. [DOI: 10.1080/09638288.2016.1213895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Deborah L. Snell
- Concussion Clinic, Burwood Hospital, Christchurch, New Zealand
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Rachelle Martin
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
| | - Lois J. Surgenor
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard J. Siegert
- Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand
| | - E. Jean C. Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
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108
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Abrahamson V, Jensen J, Springett K, Sakel M. Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community: a qualitative study. Disabil Rehabil 2016; 39:1683-1694. [PMID: 27557977 DOI: 10.1080/09638288.2016.1211755] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the experiences of individuals who have had a severe traumatic brain injury (TBI) and their carers in the first month post-discharge from in-patient rehabilitation into living in the community. METHOD Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers. RESULTS Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future. CONCLUSIONS Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead - this dissonance adds to anxiety. The study's findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.
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Affiliation(s)
- Vanessa Abrahamson
- a Senior Lecturer, Canterbury Christ Church University , Canterbury , Kent , UK
| | - Jan Jensen
- b School of Allied Health Professions , Canterbury Christ Church University , Canterbury , Kent , UK
| | - Kate Springett
- c Head of School of Allied Health Professions , Canterbury Christ Church University , Canterbury , Kent , UK
| | - Mohamed Sakel
- d East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital , Canterbury , Kent , UK
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109
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Knox L, Douglas JM, Bigby C. “I’ve never been a yes person”: Decision-making participation and self-conceptualization after severe traumatic brain injury. Disabil Rehabil 2016; 39:2250-2260. [DOI: 10.1080/09638288.2016.1219925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lucy Knox
- Living with Disability Research Center, La Trobe University, Victoria, Australia
- Summer Foundation, Victoria, Australia
| | - Jacinta M. Douglas
- Living with Disability Research Center, La Trobe University, Victoria, Australia
- Summer Foundation, Victoria, Australia
| | - Christine Bigby
- Living with Disability Research Center, La Trobe University, Victoria, Australia
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110
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Harrison AL, Hunter EG, Thomas H, Bordy P, Stokes E, Kitzman P. Living with traumatic brain injury in a rural setting: supports and barriers across the continuum of care. Disabil Rehabil 2016; 39:2071-2080. [PMID: 27549899 DOI: 10.1080/09638288.2016.1217081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) is prevalent in Kentucky and comes with a high cost in care and quality of life for individuals and caregivers affected. Many people living with the condition of TBI have unmet needs. Research among people living with TBI in rural areas is limited. The purposes of this study were to (1) increase understanding of the lived experience of people with TBI and caregivers in rural regions of Kentucky across the continuum of their care and (2) provide their perspectives on barriers and facilitators of optimal function and well-being. METHODS A qualitative descriptive interview study was conducted by a multidisciplinary team. Content analysis was completed with data-derived coding and iterative modifications to analysis, coalescing codes into categories and themes. RESULTS Thirteen people with TBI and six caregivers participated in the interview. Categories that emerged in analysis included the experiences under each locus of care; themes included relationships, functional competence, and participation in meaningful activity. CONCLUSION Relationships represented both barriers and facilitators of well-being. Major unmet needs persisted in terms of medical problems, support for caregivers, community linkages, and participation in meaningful activities. Recommendations are made regarding avenues for addressing unmet needs. Implications for Rehabilitation People with TBI are living with chronic conditions and may need intensive rehabilitation after the injury and intermittent rehabilitation throughout life to develop and maintain functional competence. Rehabilitation providers need to understand the unique aspects of the rural home environment to which a patient will be discharged (e.g., mountainous terrain, lack of transportation, dimensions of home) and communicate with rural providers directly. Rehabilitation providers need additional focus on improving patient's and caregiver's abilities to advocate for themselves. Patients with TBI should be referred to vocational rehabilitation as soon as possible to make the transition to meaningful activity at home more of a possibility.
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Affiliation(s)
- Anne L Harrison
- a Department of Rehabilitation Sciences , Kentucky Appalachian Rural Rehabilitation Network (KARRN), College of Health Sciences, University of Kentucky , Lexington , KY , USA
| | - Elizabeth G Hunter
- b The Graduate Center for Gerontology, College of Public Health, University of Kentucky , Lexington , KY , USA
| | - Heather Thomas
- c Kentucky Outpatient Rehabilitation Therapy , Lebanon , Kentucky , USA
| | - Paige Bordy
- d Pediatric Rehabilitation and Development Outpatient Pavilion, Advocate Children's Hospital , Oak Lawn , IL , USA
| | | | - Patrick Kitzman
- a Department of Rehabilitation Sciences , Kentucky Appalachian Rural Rehabilitation Network (KARRN), College of Health Sciences, University of Kentucky , Lexington , KY , USA
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111
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Weddell RA, Wood RL. Exploration of correlates of self-reported personality change after moderate-severe traumatic brain injury. Brain Inj 2016; 30:1362-1371. [PMID: 27541376 DOI: 10.1080/02699052.2016.1195921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Individuals with traumatic brain injury (TBI) often express concern that their personality has changed. Factors generating that conclusion are rarely explored quantitatively. Accordingly, this study examines neurobehavioural correlates of self-reported personality change. METHODS Seventy-one participants and informants were interviewed M = 57.9 (SD = 46.9) months after a moderate-severe TBI. The degree of self-reported personality change was correlated with scores on measures of general cognitive functioning, executive functioning, olfaction, social-emotional behaviour, emotional distress and the Expressed Emotion close informants directed towards them. RESULTS As expected, self-reported personality change correlated with dysexecutive symptoms and depression. Although anosmia (a putative index of ventral frontal damage) correlated with reduced self-reported emotional recognition and empathy, against prediction, the latter measures did not correlate with self-reported personality change. Neither were the predicted positive correlations found between high Expressed Emotion (criticism and emotional over-involvement) and self-reported personality change. DISCUSSION These findings are discussed in the context of previous work. A need to replicate and extend the present findings is suggested. A strategy to further clarify the relationships perceived personality change have with (a) self-reported change in specific behaviours and (b) identity change is advocated. Implications for intervention are suggested.
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Affiliation(s)
- Rodger A Weddell
- a Neuropsychology Department , Morriston Hospital , Swansea , UK.,b Brain Injury Research Group , Swansea University , Swansea , UK
| | - Rodger L Wood
- b Brain Injury Research Group , Swansea University , Swansea , UK
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112
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Wright MM, Medved M, Woodgate RL, Roger K, Sullivan D. Narratives of acquired brain injury patients: Their experience of healthcare relationships and medical decision-making. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17538068.2016.1186337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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113
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Koller K, Woods L, Engel L, Bottari C, Dawson DR, Nalder E. Loss of Financial Management Independence After Brain Injury: Survivors’ Experiences. Am J Occup Ther 2016; 70:7003180070p1-8. [DOI: 10.5014/ajot.2016.020198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. This pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence.
METHOD. Using a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis.
RESULTS. Three themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM.
CONCLUSION. This study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients’ experiences when supporting them through a change in independence.
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Affiliation(s)
- Kathryn Koller
- Kathryn Koller, MScOT, is Occupational Therapist, St. John’s Rehabilitation Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lindsay Woods
- Lindsay Woods, MScOT, is Occupational Therapist, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Lisa Engel
- Lisa Engel, MScOT, is PhD candidate, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada, and Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Carolina Bottari
- Carolina Bottari, PhD, is Assistant Professor, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Deirdre R. Dawson
- Deirdre R. Dawson, PhD, OT Reg (Ont), is Associate Professor, Rehabilitation Sciences Institute and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, and Senior Scientist, Rotman Resarch Institute, Baycrest, Toronto, Ontario, Canada;
| | - Emily Nalder
- Emily Nalder, PhD, is March of Dimes Paul J. J. Martin Early Career Professor, Department of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada, and Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
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114
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Sveen U, Søberg HL, Østensjø S. Biographical disruption, adjustment and reconstruction of everyday occupations and work participation after mild traumatic brain injury. A focus group study. Disabil Rehabil 2016; 38:2296-304. [DOI: 10.3109/09638288.2015.1129445] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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115
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Frostad Liaset I, Lorås H. Perceived factors in return to work after acquired brain injury: A qualitative meta-synthesis. Scand J Occup Ther 2016; 23:446-57. [DOI: 10.3109/11038128.2016.1152294] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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117
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D’Cruz K, Unsworth C, Roberts K, Morarty J, Turner-Stokes L, Wellington-Boyd A, Matchado J, Lannin NA. Engaging patients with moderate to severe acquired brain injury in goal setting. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.1.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate D’Cruz
- Lecturer, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
| | - Carolyn Unsworth
- Professor, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
| | - Karen Roberts
- Occupational therapist, Alfred Health, Melbourne, Australia
| | - Jacqui Morarty
- Manager, ABI Community and Transitional Living Service, Alfred Health, Melbourne, Australia
| | - Lynne Turner-Stokes
- Herbert Dunhill Professor of Rehabilitation, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London and Director, Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK
| | - Anna Wellington-Boyd
- Clinical support and development leader–acute social work, Alfred Health, Melbourne, Australia
| | - Joanne Matchado
- Social worker–acute neurosurgery, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Associate professor in occupational therapy, La Trobe University, Melbourne, Australia
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Snell DL, Macleod ADS, Anderson T. Post-Concussion Syndrome after a Mild Traumatic Brain Injury: A Minefield for Clinical Practice. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jbbs.2016.66023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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119
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Pearce G, Pinnock H, Epiphaniou E, Parke HL, Heavey E, Griffiths CJ, Greenhalgh T, Sheikh A, Taylor SJC. Experiences of Self-Management Support Following a Stroke: A Meta-Review of Qualitative Systematic Reviews. PLoS One 2015; 10:e0141803. [PMID: 26657458 PMCID: PMC4682853 DOI: 10.1371/journal.pone.0141803] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/13/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Supporting self-management in stroke patients improves psychological and functional outcomes but evidence on how to achieve this is sparse. We aimed to synthesise evidence from systematic reviews of qualitative studies in an overarching meta-review to inform the delivery and development of self-management support interventions. METHODS We systematically searched eight electronic databases including MEDLINE, EMBASE and CINAHL for qualitative systematic reviews (published January 1993 to June 2012). We included studies exploring patients', carers' or health care professionals' experiences relevant to self-management support following a stroke, including studies describing the lived experience of surviving a stroke. We meta-synthesised the included review findings using a meta-ethnographic framework. RESULTS Seven reviews, reporting 130 unique studies, were included. Themes emerging from the reviews were pertinent, consistent and showed data saturation; though explicit mention of self-management support was rare. Our meta-review highlighted the devastating impact of stroke on patients' self-image; the varying needs for self-management support across the trajectory of recovery; the need for psychological and emotional support throughout recovery particularly when physical recovery plateaus; the considerable information needs of patients and carers which also vary across the trajectory of recovery; the importance of good patient-professional communication; the potential benefits of goal-setting and action-planning; and the need for social support which might be met by groups for stroke survivors. CONCLUSIONS The observed data saturation suggests that, currently, no further qualitative research simply describing the lived experience of stroke is needed; we propose that it would be more useful to focus on qualitative research informing self-management support interventions and their implementation. Our findings demonstrate both the on-going importance of self-management support and the evolving priorities throughout the stages of recovery following a stroke. The challenge now is to ensure these findings inform routine practice and the development of interventions to support self-management amongst stroke survivors.
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Affiliation(s)
- Gemma Pearce
- Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, United Kingdom
| | - Hilary Pinnock
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Eleni Epiphaniou
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Hannah L. Parke
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Emily Heavey
- Social Policy Research Unit, University of York, York, United Kingdom
| | - Christopher J. Griffiths
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, Medical Sciences division, University of Oxford, Oxford, United Kingdom
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Stephanie J. C. Taylor
- multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- * E-mail:
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Mansfield E, Stergiou-Kita M, Cassidy JD, Bayley M, Mantis S, Kristman V, Kirsh B, Gomez M, Jeschke MG, Vartanian O, Moody J, Colantonio A. Return-to-work challenges following a work-related mild TBI: The injured worker perspective. Brain Inj 2015; 29:1362-9. [PMID: 26287754 DOI: 10.3109/02699052.2015.1053524] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To explore how individuals with work-related mild traumatic brain injury (wrMTBI) experience return-to-work (RTW) processes when returning to the workplace where the injury occurred. DESIGN RTW experiences were explored using in-depth interviews and an inductive analytic approach. Qualitative analysis guided by the research question moved through phases of line-by-line and thematic coding through which categories and the interaction between categories emerged. PARTICIPANTS Twelve workers diagnosed with a wrMTBI reported on their RTW experiences following wrMTBIs that occurred 3-5 years prior to the time of the interview. MAIN OUTCOMES AND RESULTS Participants perceived employer and workers' compensation factors as profoundly influencing their RTW experiences. Participants consistently reported that employers and workers' compensation representatives had an inadequate understanding of wrMTBI sequelae. Six of 12 participants were re-injured following their wrMTBI, with three of these injuries occurring at work. CONCLUSION Employers, co-workers and workers' compensation representatives should be aware of wrMTBI sequelae so injured workers can receive appropriate supports and both stigmatization and re-injury can be mitigated. Greater attention to the structural and social elements of workplace and compensation environments could inform strategies to break down barriers to successful return-to-work following a wrMTBI.
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Affiliation(s)
| | - Mary Stergiou-Kita
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada .,c Institute for Work & Health , Toronto , ON , Canada
| | | | - Mark Bayley
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
| | - Steve Mantis
- e Ontario Network of Injured Workers' Groups , Kaministiquia , ON , Canada
| | - Vicki Kristman
- a University of Toronto , Toronto , ON , Canada .,c Institute for Work & Health , Toronto , ON , Canada .,f Lakehead University , Thunder Bay , ON , Canada
| | | | | | - Mark G Jeschke
- a University of Toronto , Toronto , ON , Canada .,g Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto , ON , Canada .,h Sunnybrook Research Institute , Toronto , ON , Canada , and
| | | | - Joel Moody
- i Electrical Safety Authority , Mississauga , ON , Canada
| | - Angela Colantonio
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
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Ellis-Hill C, Gracey F, Thomas S, Lamont-Robinson C, Thomas PW, Marques EMR, Grant M, Nunn S, Cant RPI, Galvin KT, Reynolds F, Jenkinson DF. 'HeART of Stroke (HoS)', a community-based Arts for Health group intervention to support self-confidence and psychological well-being following a stroke: protocol for a randomised controlled feasibility study. BMJ Open 2015; 5:e008888. [PMID: 26243555 PMCID: PMC4538255 DOI: 10.1136/bmjopen-2015-008888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/23/2015] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Over 152,000 people in the UK have strokes annually and a third experience residual disability. Low mood also affects a third of stroke survivors; yet psychological support is poor. While Arts for Health interventions have been shown to improve well-being in people with mild-to-moderate depression post-stroke, their role in helping people regain sense of self, well-being and confidence has yet to be evaluated. The main aim of this study is to explore the feasibility of conducting a pragmatic multicentre randomised controlled trial to assess the effectiveness and cost-effectiveness of an Arts for Health group intervention ('HeART of Stroke' (HoS)) for stroke survivors. HoS is a 10-session artist-facilitated group intervention held in the community over 14 weeks. It offers a non-judgemental, supportive environment for people to explore sense of self, potentially enhancing well-being and confidence. METHODS AND ANALYSIS Sixty-four people, up to 2 years post-stroke, recruited via secondary care research staff or community stroke/rehabilitation teams in two UK centres will be randomised to either HoS plus usual care or usual care only. Self-reported outcomes, measured at baseline and approximately 5 months postrandomisation, will include stroke-related, well-being, mood, self-esteem, quality of life and process measures. Analyses will focus on estimating key feasibility parameters (eg, rates of recruitment, retention, intervention attendance). We will develop outcome and resource use data collection methods to inform an effectiveness and cost-effectiveness analysis in the future trial. Interviews, with a sample of participants, will explore the acceptability of the intervention and study processes, as well as experiences of the HoS group. ETHICS AND DISSEMINATION National Health Service (NHS), Research and Development and University ethical approvals have been obtained. Two peer-reviewed journal publications are planned plus one service user led publication. Findings will be disseminated at key national conferences, local stakeholder events and via institutional websites. TRIAL REGISTRATION NUMBER ISRCTN99728983.
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Affiliation(s)
- Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Fergus Gracey
- Department of Clinical Psychology, University of East Anglia, Norwich, UK
- Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Sarah Thomas
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | | | - Peter W Thomas
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Elsa M R Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mary Grant
- Stroke Research, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Dorset, UK
| | - Samantha Nunn
- Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Robin P I Cant
- Service User (formerly of Canterbury Christ Church University), Kent, UK
| | - Kathleen T Galvin
- Faculty of Health and Social Care, University of Hull, Hull, Yorkshire, UK
| | - Frances Reynolds
- College of Health and Life Sciences, Brunel University London, UK
| | - Damian F Jenkinson
- Stroke Unit, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Dorset, UK
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Schmid AA, Miller KK, Van Puymbroeck M, Schalk N. Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury. Disabil Rehabil 2015. [PMID: 26208245 DOI: 10.3109/09638288.2015.1062927] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this mixed-methods case study was to investigate whether an 8-week 1:1 yoga program was feasible and beneficial to people with traumatic brain injury (TBI). METHOD This was a mixed-methods case study of one-to-one yoga for people with TBI included three people. We completed assessments before and after the 8-week yoga intervention and included measures of balance, balance confidence, pain, range of motion, strength and mobility. Qualitative interviews were included at the post-assessment. We include a percent change calculation and salient quotes that represent the perceived impact of the yoga intervention. RESULTS All participants completed the yoga intervention and all demonstrated improvements in physical outcome measures. For the group, balance increased by 36%, balance confidence by 39%, lower extremity strength by 100% and endurance by 105%. Qualitative data support the use of yoga to improve multiple aspects of physical functioning, one participant stated: "I mean it's rocked my world. It's changed my life. I mean all the different aspects. I mean physically, emotionally, mentally, it's given me you know my life back…". CONCLUSIONS Yoga, delivered in a one-to-one setting, appears to be feasible and beneficial to people with chronic TBI. IMPLICATIONS FOR REHABILITATION Chronic traumatic brain injury (TBI) leads to many aspects of physical functioning impairment. Yoga delivered in a one-to-one setting may be feasible and beneficial for people with chronic TBI.
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Affiliation(s)
- Arlene A Schmid
- a Department of Occupational Therapy , College of Health and Human Sciences, Colorado State University , Fort Collins , CO , USA
| | - Kristine K Miller
- b Department of Physical Therapy , Indiana University School of Health and Rehabilitation Sciences , Indianapolis , IN , USA .,c Health Services Research and Development (HSR&D), Center on Implementing Evidence-Based Practice, Roudebush Veterans Administration (VA) Medical Center , Indianapolis , IN , USA
| | - Marieke Van Puymbroeck
- d Department of Parks , Recreation and Tourism Management, College of Health and Human Development, Clemson University , Clemson , SC , USA , and
| | - Nancy Schalk
- e Heartland Yoga Therapy , Indianapolis , IN , USA
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D’Cruz K, Howie L, Lentin P. Client-centred practice: Perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2015; 23:30-8. [DOI: 10.3109/11038128.2015.1057521] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Kleij R, Coster N, Verbiest M, van Assema P, Paulussen T, Reis R, Crone M. Implementation of intersectoral community approaches targeting childhood obesity: a systematic review. Obes Rev 2015; 16:454-72. [PMID: 25824957 DOI: 10.1111/obr.12273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/19/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
The implementation of intersectoral community approaches targeting childhood obesity (IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies.
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Affiliation(s)
- R van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
| | - N Coster
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - M Verbiest
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - P van Assema
- Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,TNO Leiden, Leiden, The Netherlands
| | - R Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
| | - M Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
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Douglas J. Elizabeth Usher Memorial Lecture: Placing therapy in the context of the self and social connection. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:199-210. [PMID: 25833073 DOI: 10.3109/17549507.2015.1016113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The concept of self influences the choice of goals and helps to make sense of lives. Essentially, self-concept is a dynamic internal representation of the individual. This representation shapes behaviour and how information about oneself is processed. The self-story is developed and validated through social interactions and shaped continuously through life experiences. METHOD The focus of this paper is the client's perspective of self and how one can actively use that perspective to plan therapy, particularly in the case of individuals with acquired brain injury (ABI). The paper draws upon the results of a number of research projects constructed around two primary aims: (1) to represent the perspectives of clients and their close others and (2) to maximize social connection through the delivery of effective communication intervention. RESULT A model of self, derived from in-depth qualitative exploration of the experiences of people with ABI, is presented as a framework to guide collaborative therapy. The model depicts the multidimensional and cyclical nature of self- conceptualization supported by factors that facilitate social connection. CONCLUSION Communication is crucial to maintaining social ties and communication breakdown is a significant predictor of participation. A new intervention that effectively improves coping with communication breakdown is presented.
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Affiliation(s)
- Jacinta Douglas
- College of Science, Health and Engineering, La Trobe University , Victoria , Australia ; Summer Foundation , Victoria , Australia
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Brunner M, Hemsley B, Palmer S, Dann S, Togher L. Review of the literature on the use of social media by people with traumatic brain injury (TBI). Disabil Rehabil 2015; 37:1511-21. [DOI: 10.3109/09638288.2015.1045992] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jesus TS, Silva IL. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehabil 2015; 30:315-28. [DOI: 10.1177/0269215515585133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/12/2015] [Indexed: 12/20/2022]
Abstract
Background: There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Methods: Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. Results: After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. Discussion: This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, Universidad Miguel Hernández, Elche, Spain
- Universidade Fernando Pessoa, Oporto, Portugal
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128
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Dillahunt-Aspillaga C, Becker M, Haynes D, Ehlke S, Jorgensen-Smith T, Sosinski M, Austin A. Predictors of behavioural health service use and associated expenditures: Individuals with TBI in Pinellas County. Brain Inj 2015; 29:644-50. [DOI: 10.3109/02699052.2014.1002005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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129
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Greenwood A, Theadom A, Kersten P, McPherson KM. Exploring researchers' experiences of working with people with acquired brain injury. Brain Inj 2015; 29:592-600. [PMID: 25790259 DOI: 10.3109/02699052.2014.1002422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to investigate the challenges and positive experiences of researchers who work with people who have experienced an acquired brain injury and their families. METHODS People who were currently or had previously worked as a researcher in the field of acquired brain injury (using either quantitative or qualitative methods) were invited to participate in a focus group or individual interview about their experiences. An expert reference group meeting was held to discuss strategies that could be implemented to enhance the researcher experience based on the interview data. RESULTS A total of 19 researchers who worked across four different research teams took part in the study. Six inter-connected themes were identified: researcher motivation, meaning and fulfillment; human connection; knowing and understanding the role; complexity of brain injury in the research context; the research process; and state of the researcher. A number of recommendations for supporting researchers more effectively were identified. DISCUSSION Researchers described a number of positive aspects as well as tensions they encountered in their role. The findings highlight the need to ensure researchers are supported effectively to ensure the quality of research studies in the field of brain injury.
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Affiliation(s)
- Andrea Greenwood
- Person Centred Research Centre, Health and Rehabilitation Institute and
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Sivertsen M, Normann B. Embodiment and self in reorientation to everyday life following severe traumatic brain injury. Physiother Theory Pract 2014; 31:153-9. [PMID: 25431992 DOI: 10.3109/09593985.2014.986350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
People with severe traumatic brain injury (sTBI) are often young and need long-term follow-up as many suffer complex motor, sensory, perceptual and cognitive impairments. This paper aims to introduce phenomenological notions of embodiment and self as a framework to help understand how people with sTBI experience reorientation to everyday life, and to inform clinical practice in neurological physiotherapy. The impairments caused by the sTBI may lead to a sense of alienation of one's own body and changes in operative intentionality and in turn disrupt the reorganization of self, identity, everyday life and integration/co-construction of meaning with others. Applying a first-person conception of the body may extend insights into the importance of an adapted and individualized approach to strengthen the sensory, perceptual and motor body functions, which underpin the pre-reflective and reflective aspects of the self. It seems important to integrate these aspects, while also paying attention to optimizing co-construction of meaning for the person with sTBI in the treatment context. This requires understanding the patient as an experiencing and expressive body, a lived body (body-as-subject) and not just the body-as-object as is favored in more traditional frameworks of physiotherapy.
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Affiliation(s)
- Marianne Sivertsen
- Department of Physiotherapy, Nordland Hospital Trust , Bodø , Norway and
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131
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Martin R, Levack WMM, Sinnott KA. Life goals and social identity in people with severe acquired brain injury: an interpretative phenomenological analysis. Disabil Rehabil 2014; 37:1234-41. [DOI: 10.3109/09638288.2014.961653] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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132
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Thomas EJ, Levack WMM, Taylor WJ. Self-Reflective Meaning Making in Troubled Times: Change in Self-Identity After Traumatic Brain Injury. QUALITATIVE HEALTH RESEARCH 2014; 24:1033-1047. [PMID: 25015780 DOI: 10.1177/1049732314542809] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Our aim with this article is to clarify the concept of change in self-identity following traumatic brain injury (TBI). We used concept analysis methodology-predominantly concept clarification. We identified 110 articles using a systematic literature search, and used critical appraisal, content analysis, and analytical questioning to explore attributes and boundaries. A reported change in self-identity is the ultimate expression of a variety of cognitive, psychological, and social sequelae of TBI. We present an integrative model of this process, identifying three potential levels of change: (a) component parts (egocentric self, sociocentric self, and "identity as shared with others"); (b) integral processes (self-awareness and expression via meaningful occupation and narratives); and (c) whole-system disruption. Change in self-identity after TBI is a highly individualistic process. The driver of this process is "self-reflective meaning making," giving a purpose and direction in life, providing motivation and goals for future behavior.
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133
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Kersten P, McCambridge A, M. Kayes N, Theadom A, McPherson KM. Bridging the gap between goal intentions and actions: a systematic review in patient populations. Disabil Rehabil 2014; 37:563-70. [DOI: 10.3109/09638288.2014.935874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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134
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Freeman A, Adams M, Ashworth F. An exploration of the experience of self in the social world for men following traumatic brain injury. Neuropsychol Rehabil 2014; 25:189-215. [DOI: 10.1080/09602011.2014.917686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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135
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Levack WMM, Boland P, Taylor WJ, Siegert RJ, Kayes NM, Fadyl JK, McPherson KM. Establishing a person-centred framework of self-identity after traumatic brain injury: a grounded theory study to inform measure development. BMJ Open 2014; 4:e004630. [PMID: 24833684 PMCID: PMC4024597 DOI: 10.1136/bmjopen-2013-004630] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To develop a theoretically sound, client-derived framework to underpin development of a measure reflecting the impact of traumatic brain injury (TBI) on a person's self-identity. DESIGN Grounded theory, based on transcription of audio recordings from focus group meetings with people who have experienced TBI, analysed with constant comparative methods. SETTING 8 different urban and rural communities in New Zealand. PARTICIPANTS 49 people (34 men, 15 women), 6 months to 36 years after mild-to-severe TBI. RESULTS The central concept emerging from the data was that of desiring to be or having lost a sense of being an integrated and valued person. The three main subthemes were: (1) having a coherent, satisfying and complete sense of oneself, (2) respect, validation and acceptance by others and (3) having a valued place in the world. CONCLUSIONS This study reinforces the notion that change in self-identity is an important aspect of life after TBI, and provides information on what this concept means to people with TBI. In order to scientifically evaluate relationships between self-identity and other aspects of health (eg, depression, quality of life), and to test the effect of interventions to address problems with self-identity after TBI, a quantitative tool for evaluation of this construct is required. Themes from this research provide a foundation for the development of a measure of self-identity grounded in the language and experience of people with TBI.
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Affiliation(s)
- William M M Levack
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Pauline Boland
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - William J Taylor
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Richard J Siegert
- Department of Psychology, Faculty of Health and Environmental Sciences, AUT University, Wellington, New Zealand
- Division of Rehabilitation and Occupation Studies, Person Centred Research Centre, AUT University, Auckland, New Zealand
| | - Nicola M Kayes
- Division of Rehabilitation and Occupation Studies, Person Centred Research Centre, AUT University, Auckland, New Zealand
| | - Joanna K Fadyl
- Division of Rehabilitation and Occupation Studies, Person Centred Research Centre, AUT University, Auckland, New Zealand
| | - Kathryn M McPherson
- Division of Rehabilitation and Occupation Studies, Person Centred Research Centre, AUT University, Auckland, New Zealand
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136
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Couchman G, McMahon G, Kelly A, Ponsford J. A new kind of normal: Qualitative accounts of Multifamily Group Therapy for acquired brain injury. Neuropsychol Rehabil 2014; 24:809-32. [DOI: 10.1080/09602011.2014.912957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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137
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Schönberger M, Ponsford J, McKay A, Wong D, Spitz G, Harrington H, Mealings M. Development and predictors of psychological adjustment during the course of community-based rehabilitation of traumatic brain injury: A preliminary study. Neuropsychol Rehabil 2014; 24:202-19. [DOI: 10.1080/09602011.2013.878252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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138
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Babbage DR. Open and abundant data is the future of rehabilitation and research. Arch Phys Med Rehabil 2013; 95:795-8. [PMID: 24380830 DOI: 10.1016/j.apmr.2013.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 01/14/2023]
Abstract
Development of our current research practices has been driven by a number of assumptions and from operating within practical constraints. Technological change is beginning to remove many of these limits, although our research and practice has so far only gradually and partially evolved in response. The U.S. federal government is now mandating open data repositories for research that it funds. Policy changes regarding open data repositories and an increasing abundance of data arising from both research and practice provide the opportunity to revisit some assumptions. With abundant sources of data that may increasingly be collected automatically during rehabilitation, it seems fundamentally flawed that the resolution of the primary quantitative analysis approaches widely understood in our field is so limited by the need to contain the risk of false positives. Identification of more sophisticated approaches to our data, which may well already exist in the statistical literature, is a high priority.
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Affiliation(s)
- Duncan R Babbage
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.
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139
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Lennon A, Bramham J, Carroll À, McElligott J, Carton S, Waldron B, Fortune D, Burke T, Fitzhenry M, Benson C. A qualitative exploration of how individuals reconstruct their sense of self following acquired brain injury in comparison with spinal cord injury. Brain Inj 2013; 28:27-37. [DOI: 10.3109/02699052.2013.848378] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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140
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Gendreau A, de la Sablonnière R. The cognitive process of identity reconstruction after the onset of a neurological disability. Disabil Rehabil 2013; 36:1608-17. [PMID: 24286233 DOI: 10.3109/09638288.2013.859749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Rehabilitation professionals and researchers underscore the impact of an acquired disability on identity. However, the cognitive process by which identity is transformed is understudied. The present study aims to explore the cognitive process by which personal identity is reconstructed following disability onset. METHODS A template organizing style of interpretation was used to perform a qualitative analysis based on the Cognitive-Developmental Model of Social Identity Integration (CDMSII) using interview data from 10 participants with traumatic brain injury or traumatic spinal cord injury. RESULTS As suggested by the CDMSII, following the accident, participants initially tend to emphasize distinctions between their pre- and post-injury conditions. Eventually, individuals are able to create cognitive connections between pre-injury self-knowledge and how they understand their new condition. Finally, in the last stage of the identity integration process, the various identity components are recognized as part of the self. Organizing data based on the three stages of this theory was found to resonate with participants and aided the comprehension of how every stage in the identity reconstruction process is intertwined with the need for continuity through life. CONCLUSIONS The CDMSII offers a useful heuristic for understanding long-term identity reconstruction and the present research emphasizes the importance of a sense of continuity following disability onset.
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Affiliation(s)
- Anne Gendreau
- Department of Psychology, Université du Québec à Montréal , Montréal, QC , Canada and
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Wood H, Cupitt C, Lavender T. The Experience of Cognitive Impairment in People with Psychosis. Clin Psychol Psychother 2013; 22:193-207. [PMID: 24281753 DOI: 10.1002/cpp.1878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 09/21/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022]
Abstract
Cognitive impairment has been widely studied in people with psychosis. However, research is lacking into the subjective experience of cognitive impairment, its impact and ways in which individuals cope. This study aimed to provide an account of the experience of cognitive impairment in people with a diagnosis of schizophrenia, including what difficulties people experience, how these difficulties are understood, how people respond to these difficulties and how they perceive others' views of these difficulties. A semi-structured interview was carried out with eight participants with a diagnosis of schizophrenia focusing on participants' experiences of difficulties with cognitive functioning. Interpretative phenomenological analysis was used to analyse interview transcripts. Experience of cognitive impairment was understood in terms of six master themes: impaired controlled thinking, physical sensations and impaired movement, explanations for the impairment and comparisons to the past, managing the impairment, how others see the impairment and anticipating the future. This study is the first rigorous qualitative study of the subjective experience of cognitive impairment in people with psychosis, and it provides greater context for empirical findings. The results have significant implications for clinical psychology, including education about cognitive difficulties and the importance of cognitive functioning to formulation. New areas for research include coping strategies in relation to functioning and future perspectives, ascertaining staff understanding of cognitive impairment, and reflective conversation style as an intervention for metacognitive difficulties. Key Practitioner Message Difficulties with cognitive functioning should be considered in clinical practitioners' formulations of clients' difficulties in the context of psychosis. Services should consider providing service user and carer education about cognitive impairment in psychosis. Staff may need further training in order to support people with psychosis who have difficulties with cognitive functioning.
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Affiliation(s)
- Helen Wood
- Canterbury Christ Church University, Applied Psychology, Tunbridge Wells, UK
| | - Caroline Cupitt
- Bexley Assertive Outreach Team, Oxleas NHS Foundation Trust, Erith, UK
| | - Tony Lavender
- Canterbury Christ Church University, Applied Psychology, Tunbridge Wells, UK
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142
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Levack WMM. The role of qualitative metasynthesis in evidence-based physical therapy. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- William M M Levack
- Rehabilitation Teaching & Research UnitDepartment of Medicine, University of Otago, Wellington, New Zealand
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143
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McPherson KM, Kayes NM. Qualitative research: its practical contribution to physiotherapy. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Kathryn M McPherson
- Person Centred Research CentreHealth and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Nicola M Kayes
- Person Centred Research CentreHealth and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
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144
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Nalder E, Fleming J, Cornwell P, Shields C, Foster M. Reflections on life: experiences of individuals with brain injury during the transition from hospital to home. Brain Inj 2013; 27:1294-303. [PMID: 23924357 DOI: 10.3109/02699052.2013.823560] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The transition from hospital to home has been described as a distinct rehabilitation phase for individuals with brain injury. As most research to date has quantitatively measured outcomes or used a sample with mixed brain injury diagnoses, less is known about the experience of transition following traumatic brain injury (TBI). AIMS This study aimed to examine the lived experiences of individuals with TBI during the first 6 months following discharge from hospital. DESIGN A qualitative investigation was conducted with 16 individuals with TBI using semi-structured interviews. DATA ANALYSIS Data were analysed thematically using a Framework approach. RESULTS Transition experiences were characterized by a desire to return to normality and a changed perspective on life, by accepting change or altering priorities. The process of transition was dynamic as individuals experienced the dominant themes in cyclical patterns. CONCLUSIONS Research has highlighted the significant adjustment for individuals with TBI, particularly in relation to identity change, appraisal and coping. The themes of wanting normality and changing life perspective which were dominant in the current study highlight the significance of the transition phase in the process of adjustment and that transition is characterized by adapting to a new normality.
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Affiliation(s)
- Emily Nalder
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
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145
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Jourdan C, Bosserelle V, Azerad S, Ghout I, Bayen E, Aegerter P, Weiss JJ, Mateo J, Lescot T, Vigué B, Tazarourte K, Pradat-Diehl P, Azouvi P. Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): Results from the PariS-TBI study. Brain Inj 2013; 27:1000-7. [DOI: 10.3109/02699052.2013.794971] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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146
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Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2013; 36:457-63. [DOI: 10.3109/09638288.2013.797515] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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147
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Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2013.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Deficits in attention, processing speed and executive functioning are among the most commonly reported and functionally limiting cognitive impairments among individuals with TBI. Changes in mood can exacerbate cognitive deficits and reduce life quality. Contemporary hierarchical models of cognitive functioning suggest that attention/arousal processes underlie and support higher-order functions. Building on decades of clinical research, a synergistic, integrative approach to neurorehabilitation is described, which combines bottom-up and top-town cognitive interventions in addition to psychotherapeutic interventions for mood. This approach is intended to address directly impairments in both foundational (i.e., attention) and higher-order (i.e., executive functions) processes. Executive dysfunction is addressed in a top-down fashion through the application of a series of problem-solving and emotional regulation modules that teach and integrate strategies that can be generalised across situations with practice. Attention, arousal and information processing are necessary prerequisites of successful higher-order thinking, attention skills, and are addressed in a bottom-up fashion through intensive individualised attention and processing training tasks. Combining top-down and bottom-up approaches within a comprehensive day-treatment programme can effect a synergistic improvement of overall functioning.
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148
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Douglas JM. Conceptualizing self and maintaining social connection following severe traumatic brain injury. Brain Inj 2012; 27:60-74. [DOI: 10.3109/02699052.2012.722254] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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149
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Younger stroke survivors' experiences of family life in a long-term perspective: a narrative hermeneutic phenomenological study. Nurs Res Pract 2012; 2012:948791. [PMID: 23304485 PMCID: PMC3530179 DOI: 10.1155/2012/948791] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 11/19/2012] [Indexed: 11/24/2022] Open
Abstract
The psychosocial consequences following a stroke are known to be challenging, influencing the stroke survivors' ability to participate in and carry out the taken-for-granted roles and activities in family life. This study explored how living with the consequences of stroke impacted on family life in the late recovery phase, that is, six months or more after stroke onset. Twenty-two stroke survivors aged 20–61 years were interviewed in-depth six months to nine years after stroke onset. The interviews were analyzed applying a narrative, hermeneutic phenomenological approach. The findings revealed challenges that varied with time, from an initial struggle to suffice in and balance the relationships and roles within the family early after the stroke, towards a more resigned attitude later on in the stroke trajectory. The struggles are summarized in two main themes: “struggling to reenter the family” and “screaming for acceptance.” Nonestablished people living with stroke and stroke survivors in parental roles seem to be particularly vulnerable. Being provided with opportunities to narrate their experiences to interested and qualified persons outside the home context might be helpful to prevent psychosocial problems.
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150
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Armstrong J, McPherson K, Nayar S. External Memory Aid Training after Traumatic Brain Injury: ‘Making it Real’. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13548955545459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: A number of options exist for the rehabilitation of memory after traumatic brain injury, and research suggests that the use of external memory aids is one of the best approaches. Unfortunately, there is very little evidence to guide therapists in training clients to use external memory aids and to ensure the sustainable use of the aids long term. Method: Grounded theory methodology was used to explore the question of how occupational therapists train clients to use external memory aids after a traumatic brain injury. Semi-structured interviews, with eight occupational therapists working in neurological rehabilitation, were conducted until data collection reached a saturation point. The data were analysed following the constant comparative method proposed by Strauss and Corbin. Findings: Analysis revealed four overlapping processes: developing client insight, getting client buy-in, getting others on board and making it real. Making it real emerged as the core process that encompassed and ran through the other three. It emphasised the need for occupational therapists to use meaningful, functional activities in order to establish an aid that fitted the client's real life. Conclusion: The processes uncovered by this study give occupational therapists working in the field of brain injury rehabilitation guidance for clinical practice.
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Affiliation(s)
- Jonathan Armstrong
- Occupational Therapist, ABI Rehabilitation New Zealand Ltd, Waitakere, Auckland, New Zealand
| | - Kathryn McPherson
- Professor, School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand
| | - Shoba Nayar
- Senior Lecturer — Community Health Development, School of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand
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