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Câmara-Costa H, Bayen E, Francillette L, Toure H, Meyer P, Laurence W, Dellatolas G, Chevignard M. Parental report of levels of care and needs 7-years after severe childhood traumatic brain injury: Results of the traumatisme grave de l'Enfant (TGE) cohort study. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:152-164. [PMID: 36353798 DOI: 10.1080/21622965.2022.2142792] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigated parental reports of the level of care and needs 7-years following severe childhood traumatic brain injury (TBI), and the factors associated with this outcome. From the 65 children (0-15 years) consecutively admitted to the Parisian regional TBI reference intensive care unit following severe TBI, included in this prospective longitudinal study, 39 patients [M(SD) age at injury = 7.5 years (4.6) and assessment 15.3(4.4)] were followed 7-years post-injury and matched with a control group composed of typically developing participants (n = 34) matched by age, sex and parental education level. We used the Care and Need Scale (CANS) and its Pediatric version (PCANS) to assess the primary outcome 7-years post-injury. Concurrent measures included overall level of disability, and parent- and/or self-reported questionnaires assessing executive functioning, behavior, quality of life, fatigue, participation and caregivers' burden. The level of care and needs was significantly higher in the TBI group than in the control group, the difference being significant with the CANS only. PCANS scores were extremely variable in the control group. High level of dependency was associated with initial TBI severity (higher coma duration and initial Injury Severity Score), higher levels of behavioral problems, executive function deficits, fatigue, and lower participation levels. Caregivers' burden was strongly associated with the CANS. The CANS provides a simple and reliable measure of the support needed long-term after childhood TBI, in accordance with previous studies. The PCANS scores were not significantly different between the TBI and the control groups, which seems to illustrate the difficulty to assess accurately mild-to-moderate deficits of functional independence/adaptive behavior in children based exclusively on parental reports.
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Affiliation(s)
- Hugo Câmara-Costa
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Paris, France
- Sorbonne Université, GRC 24, Handicap Moteur et Cognitif et Réadaptation - HaMCre, Paris, France
| | - Eléonore Bayen
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Paris, France
- Sorbonne Université, GRC 24, Handicap Moteur et Cognitif et Réadaptation - HaMCre, Paris, France
- Department of Physical Rehabilitation Medicine, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Leila Francillette
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Paris, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Brain Injury, Outreach Team for Children and Adolescents with Acquired Brain Injury; Saint Maurice Hospitals, Saint Maurice, France
| | - Philippe Meyer
- Assistance Publique des Hôpitaux de Paris (APHP), Centre - Université de Paris, Paris, France
| | - Watier Laurence
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM. UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24, Handicap Moteur et Cognitif et Réadaptation - HaMCre, Paris, France
| | - Mathilde Chevignard
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Paris, France
- Sorbonne Université, GRC 24, Handicap Moteur et Cognitif et Réadaptation - HaMCre, Paris, France
- Rehabilitation Department for Children with Acquired Brain Injury, Outreach Team for Children and Adolescents with Acquired Brain Injury; Saint Maurice Hospitals, Saint Maurice, France
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Silva MA, Finn JA, Dillahunt-Aspillaga C, Cotner BA, Stevens LF, Nakase-Richardson R. Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study. Disabil Rehabil 2021; 44:4474-4484. [PMID: 33756089 DOI: 10.1080/09638288.2021.1900930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery. MATERIALS AND METHODS RNS items were generated following a literature review (January - March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015-2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented. RESULTS Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8-9, and number of unmet needs was 1-2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS. CONCLUSION The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.Implications for rehabilitationVeterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.
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Affiliation(s)
- Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jacob A Finn
- Extended Care and Rehabilitation (EC&R) Patient Service Line, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Bridget A Cotner
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Lillian F Stevens
- Mental Health Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,TBI Center of Excellence (TBICoE), James A. Haley Veterans' Hospital, Tampa, FL, USA
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Verdugo MA, Aguayo V, Arias VB, García-Domínguez L. A Systematic Review of the Assessment of Support Needs in People with Intellectual and Developmental Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9494. [PMID: 33352974 PMCID: PMC7766556 DOI: 10.3390/ijerph17249494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023]
Abstract
An evaluation of support needs is fundamental to the provision of services to people with intellectual and developmental disabilities. Services should be organized by considering the support that people need to improve their quality of life and enforce their rights as citizens. This systematic review is conducted to analyze the rigor and usefulness of the available standardized tools for assessing support needs, as well as the uses of their results. Several databases were consulted, including Web of Sciences, Scopus, PubMed, ProQuest Central, PsycInfo, ERIC, and CINAHL, and the 86 documents that met the review criteria were organized into four sections: (a) measurement tools, (b) descriptive/correlational studies, (c) predictive studies, and (d) interventions. The results showed that age, level of intellectual disability, adaptive behavior skills, the number and type of associated disabilities, and medical and behavioral needs affected the support needs of people with disabilities. Quality of life outcomes have been predicted by the individual's support needs, explaining a significant percentage of their variability. The findings are useful in guiding assessments and planning interventions. Further research should address the effectiveness of specific support strategies and the development of social policies and indicators for inclusion that involve assessing support needs.
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Affiliation(s)
| | - Virginia Aguayo
- Institute on Community Integration, University of Salamanca, 37005 Salamanca, Spain; (M.A.V.); (V.B.A.); (L.G.-D.)
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Burden and Preparedness amongst Informal Caregivers of Adults with Moderate to Severe Traumatic Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176386. [PMID: 32887272 PMCID: PMC7503757 DOI: 10.3390/ijerph17176386] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/23/2023]
Abstract
This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role.
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Tate RL, Lane-Brown AT, Myles BM, Cameron ID. A longitudinal study of support needs after severe traumatic brain injury. Brain Inj 2020; 34:991-1000. [DOI: 10.1080/02699052.2020.1764101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Robyn L Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Bridget M Myles
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Abstract
Objective: Difficulty applying cognitive strategies during task performance is a hallmark feature of brain injury. This study aimed to develop a cognitive strategy profile of people living in a transitional living unit for people with brain injury.Research design: Prospective, longitudinal study (n = 16)Method: Cognitive strategy application was assessed using the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis. Functional measures were also administered. Data were examined using Rasch analysis (FACETS 3.71.4) and relationships between variables were analyzed.Results: Rasch analysis of PRPP data generated a hierarchy of cognitive strategies: from the most complex executive processing strategies to the simplest perceptual and recall strategies. The functional profile revealed a more impaired group of clients than has been previously reported in similar residential programs. Cognitive strategy use (PRPP Total score) was correlated with functional independence (r = .61), the performance of instrumental activities of daily living (r = .45), and community participation (r = -.63).Conclusions: The PRPP System enabled assessment of cognitive strategy difficulties and generation of individual profiles that allowed for individualized intervention planning. More efficient and effective application of cognitive strategies was related to the improved functional performance of everyday tasks and activities, greater independence and community participation.
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Affiliation(s)
- Melissa Therese Nott
- Occupational Therapy, School of Community Health, Charles Sturt University, Albury, Australia
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Ownsworth T, Fleming J, Tate R, Beadle E, Griffin J, Kendall M, Schmidt J, Lane-Brown A, Chevignard M, Shum DHK. Do People With Severe Traumatic Brain Injury Benefit From Making Errors? A Randomized Controlled Trial of Error-Based and Errorless Learning. Neurorehabil Neural Repair 2017; 31:1072-1082. [DOI: 10.1177/1545968317740635] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Errorless learning (ELL) and error-based learning (EBL) are commonly used approaches to rehabilitation for people with traumatic brain injury (TBI). However, it is unknown whether making errors is beneficial in the learning process to promote skills generalization after severe TBI. Objective. To compare the efficacy of ELL and EBL for improving skills generalization, self-awareness, behavioral competency, and psychosocial functioning after severe TBI. Method. A total of 54 adults (79% male; mean age = 38.0 years, SD = 13.4) with severe TBI were randomly allocated to ELL or EBL and received 8 × 1.5-hour therapy sessions that involved meal preparation and other goal-directed activities. The primary outcome was total errors on the Cooking Task (near-transfer). Secondary outcome measures included the Zoo Map Test (far-transfer), Awareness Questionnaire, Patient Competency Rating Scale, Sydney Psychosocial Reintegration Scale, and Care and Needs Scale. Results. Controlling for baseline performance and years of education, participants in the EBL group made significantly fewer errors at postintervention (mean = 36.25; 95% CI = 32.5-40.0) than ELL participants (mean = 42.57; 95% CI = 38.8-46.3). EBL participants also demonstrated greater self-awareness and behavioral competency at postintervention than ELL participants ( P < .05). There were no significant differences on other secondary outcomes ( P > .05), or at the 6-month follow-up assessment. Conclusion. EBL was found to be more effective than ELL for enhancing skills generalization on a task related to training and improving self-awareness and behavioral competency.
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Affiliation(s)
| | | | | | | | | | - Melissa Kendall
- Acquired Brain Injury Outreach Service, Brisbane, Australia
- Griffith University Division of Rehabilitation, Metro South Health, Brisbane, Australia
| | - Julia Schmidt
- University of British Columbia, Vancouver, Canada
- La Trobe University, Melbourne, Australia
| | | | - Mathilde Chevignard
- Hôpitaux de Saint Maurice, Saint Maurice, France
- Sorbonne Universités, Paris, France
- GRC-UPMC n°18 Handicap Cognitif et Réadaptation (HanCRe), Paris, France
| | - David H. K. Shum
- Griffith University, Mt Gravatt, Australia
- Chinese Academy of Sciences, Beijing, China
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Fleming J, Ownsworth T, Doig E, Hutton L, Griffin J, Kendall M, Shum DHK. The efficacy of prospective memory rehabilitation plus metacognitive skills training for adults with traumatic brain injury: study protocol for a randomized controlled trial. Trials 2017; 18:3. [PMID: 28057075 PMCID: PMC5217156 DOI: 10.1186/s13063-016-1758-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/15/2016] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Impairment of prospective memory (PM) is common following traumatic brain injury (TBI) and negatively impacts on independent living. Compensatory approaches to PM rehabilitation have been found to minimize the impact of PM impairment in adults with TBI; however, poor self-awareness after TBI poses a major barrier to the generalization of compensatory strategies in daily life. Metacognitive skills training (MST) is a cognitive rehabilitation approach that aims to facilitate the development of self-awareness in adults with TBI. This paper describes the protocol of a study that aims to evaluate the efficacy of a MST approach to compensatory PM rehabilitation for improving everyday PM performance and psychosocial outcomes after TBI. METHODS/DESIGN This randomized controlled trial has three treatment groups: compensatory training plus metacognitive skills training (COMP-MST), compensatory training only (COMP), and waitlist control. Participants in the COMP-MST and COMP groups will complete a 6-week intervention consisting of six 2-h weekly training sessions. Each 1.5-h session will involve compensatory strategy training and 0.5 h will incorporate either MST (COMP-MST group) or filler activity as an active control (COMP group). Participants in the waitlist group receive care as usual for 6 weeks, followed by the COMP-MST intervention. Based on the sample size estimate, 90 participants with moderate to severe TBI will be randomized into the three groups using a stratified sampling approach. The primary outcomes include measures of PM performance in everyday life and level of psychosocial reintegration. Secondary outcomes include measures of PM function on psychometric testing, strategy use, self-awareness, and level of support needs following TBI. Blinded assessments will be conducted pre and post intervention, and at 3-month and 6-month follow-ups. DISCUSSION This study seeks to determine the efficacy of COMP-MST for improving and maintaining everyday PM performance and level of psychosocial integration in adults with moderate to severe TBI. The findings will advance theoretical understanding of the role of self-awareness in compensatory PM rehabilitation and skills generalization. COMP-MST has the potential to reduce the cost of rehabilitation and lifestyle support following TBI because the intervention could enhance generalization success and lifelong application of PM compensatory strategies. TRIAL REGISTRATION New Zealand Clinical Trials Registry, ACTRN12615000996561 . Registered on 23 September 2015; retrospectively registered 2 months after commencement.
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Affiliation(s)
- Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Tamara Ownsworth
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith Health Institute, Griffith University, Mount Gravatt, QLD Australia
| | - Emmah Doig
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072 QLD Australia
| | - Lauren Hutton
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith Health Institute, Griffith University, Mount Gravatt, QLD Australia
| | - Janelle Griffin
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Melissa Kendall
- Acquired Brain Injury Outreach Service, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, QLD Australia
- Menzies Health Institute Queensland and School of Human Services and Social Work, Griffith University, Meadowbrook, QLD Australia
| | - David H. K. Shum
- Menzies Health Institute Queensland and School of Applied Psychology, Griffith Health Institute, Griffith University, Mount Gravatt, QLD Australia
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Nott MT, Baguley IJ, Heriseanu R, Weber G, Middleton JW, Meares S, Batchelor J, Jones A, Boyle CL, Chilko S. Effects of concomitant spinal cord injury and brain injury on medical and functional outcomes and community participation. Top Spinal Cord Inj Rehabil 2014; 20:225-35. [PMID: 25484568 DOI: 10.1310/sci2003-225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There are limited data on the interactions between concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) in terms of medical, psychological, functional, and community outcomes. OBJECTIVE To investigate the hypothesis that in addition to SCI-associated sensory-motor impairments, people with dual diagnosis would experience additional TBI-associated cognitive impairments that would have a negative impact on community reintegration. METHODS Cross-sectional, case-matched study comparing a consecutive sample of participants with dual diagnosis (n = 30) to an SCI group (n = 30) and TBI group (n = 30). Participants who were on average 3.6 years postrehabilitation discharge were interviewed using a battery of standardized outcome measures. RESULTS Length of rehabilitation stay was significantly longer in SCI and dual diagnosis participants. Fatigue, pain, sexual dysfunction, depression, and sleep disturbances were frequently reported by all groups. Similar levels of anxiety and depression were reported by participants in all groups, however TBI participants reported higher stress levels. All groups achieved mean FIM scores > 100. The dual diagnosis and SCI groups received more daily care and support than TBI participants. Similar levels of community reintegration were achieved by all groups with a high level of productive engagement in work, study, or volunteer activities. CONCLUSIONS The findings of this study do not support the hypotheses. Postrehabilitation functioning was better than anticipated in adults with dual diagnosis. The contribution of rehabilitation factors, such as longer admission time to develop compensatory techniques and strategies for adaptation in the community, may have contributed to these positive findings.
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Affiliation(s)
- Melissa T Nott
- School of Community Health, Charles Sturt University , Albury, NSW , Australia
| | - Ian J Baguley
- Brain Injury Rehabilitation Service , Westmead Hospital, Sydney, NSW , Australia
| | - Roxana Heriseanu
- Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Sydney, NSW , Australia
| | - Gerard Weber
- Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Sydney, NSW , Australia
| | | | - Sue Meares
- Department of Psychology, Macquarie University , Sydney, NSW , Australia
| | - Jennifer Batchelor
- Department of Psychology, Macquarie University , Sydney, NSW , Australia
| | - Andrew Jones
- Concord Centre for Mental Health, Concord Hospital , Sydney, NSW , Australia
| | - Claire L Boyle
- Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Sydney, NSW , Australia
| | - Stephanie Chilko
- Occupational Therapy Department, Balmain Hospital , Sydney, NSW , Australia
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Ownsworth T, Fleming J, Tate R, Shum DHK, Griffin J, Schmidt J, Lane-Brown A, Kendall M, Chevignard M. Comparison of error-based and errorless learning for people with severe traumatic brain injury: study protocol for a randomized control trial. Trials 2013; 14:369. [PMID: 24192067 PMCID: PMC4228339 DOI: 10.1186/1745-6215-14-369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/28/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Poor skills generalization poses a major barrier to successful outcomes of rehabilitation after traumatic brain injury (TBI). Error-based learning (EBL) is a relatively new intervention approach that aims to promote skills generalization by teaching people internal self-regulation skills, or how to anticipate, monitor and correct their own errors. This paper describes the protocol of a study that aims to compare the efficacy of EBL and errorless learning (ELL) for improving error self-regulation, behavioral competency, awareness of deficits and long-term outcomes after TBI. METHODS/DESIGN This randomized, controlled trial (RCT) has two arms (EBL and ELL); each arm entails 8 × 2 h training sessions conducted within the participants' homes. The first four sessions involve a meal preparation activity, and the final four sessions incorporate a multitasking errand activity. Based on a sample size estimate, 135 participants with severe TBI will be randomized into either the EBL or ELL condition. The primary outcome measure assesses error self-regulation skills on a task related to but distinct from training. Secondary outcomes include measures of self-monitoring and self-regulation, behavioral competency, awareness of deficits, role participation and supportive care needs. Assessments will be conducted at pre-intervention, post-intervention, and at 6-months post-intervention. DISCUSSION This study seeks to determine the efficacy and long-term impact of EBL for training internal self-regulation strategies following severe TBI. In doing so, the study will advance theoretical understanding of the role of errors in task learning and skills generalization. EBL has the potential to reduce the length and costs of rehabilitation and lifestyle support because the techniques could enhance generalization success and lifelong application of strategies after TBI. TRIAL REGISTRATION ACTRN12613000585729.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology and Behavioural Basis of Health Program, Griffith Health Institute, Griffith University, Mt Gravatt 4122, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Princess Alexandra Hospital, Wooloongabba, Australia
| | - Robyn Tate
- Rehabilitation Studies Unit, University of Sydney, Sydney, Australia
- Brain Injury Unit, Royal Rehabilitation Centre, Sydney, Australia
| | - David HK Shum
- School of Applied Psychology and Behavioural Basis of Health Program, Griffith Health Institute, Griffith University, Mt Gravatt 4122, Australia
| | | | - Julia Schmidt
- Brain Injury Unit, Royal Rehabilitation Centre, Sydney, Australia
- Australian Catholic University Sydney, Brisbane, Australia
| | - Amanda Lane-Brown
- Rehabilitation Studies Unit, University of Sydney, Sydney, Australia
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia
| | | | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Brain Injury (INR-A), Hôpitaux de Saint Maurice, Saint Maurice, France
- ER6, Université Pierre at Marie Curie, Paris 6, France
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Community-Based Rehabilitation Following Brain Injury: Comparison of a Transitional Living Program and a Home-Based Program. BRAIN IMPAIR 2012. [DOI: 10.1017/brimp.2012.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and aims: Community-based rehabilitation programs for people with a brain injury are diverse. Comparative program evaluation is required to identify optimal type, intensity and duration of programs. The aim of this study was to compare the effectiveness of two community-based rehabilitation programs using a set of standardised outcome measures.Methods: The study used a quantitative, multicentre, longitudinal design. Persons with severe traumatic brain injury (TBI,n= 39) and acquired brain impairment (n= 2) were recruited from two residential, transitional living programs (TLU;n= 21) and two home-based community rehabilitation programs (CR;n= 20). Participants were assessed via interview at program entry, 2 months and 6 months later using a broad range of standardised measures. The quantity and types of intervention provided to study participants were recorded. Results: No significant differences were identified between the TLU and CR groups at baseline or 6-month follow-up. Two significant group-by-time interactions were identified on the Community Integration Questionnaire (CIQ). First, the CR group had significantly greater changes in productivity (p= .003;d= 1.0) compared to the TLU group over time; by contrast, the TLU group showed significantly greater improvements in social integration (p= .007;d= .86). The TLU participants received up to five times more intervention than the CR participants. This finding is significant considering the similar levels of improvement in function made by both TLU and CR participants.Conclusions: Both TLU and CR groups improved on a range of measures. The TLU group however, received significantly more face-to-face interventions. Further examination of the relationship between participant contextual factors, such as coping style and self-esteem, and impairments such as challenging behaviour and decreased self-awareness, of people attending TLU and CR programs is required.
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