Sex and Gender Issues for Individuals With Acquired Brain Injury During COVID-19: A Commentary

The feasibility, acceptability, and effectiveness of the multimodal, community-based LoveYourBrain Retreat program for people with traumatic brain injury and caregivers

PURPOSE

To evaluate the feasibility, acceptability, and effectiveness of the LoveYourBrain Retreat program using a pre-post, retrospective, concurrent triangulation mixed methods study.

MATERIALS AND METHODS

A 5-day, multimodal, residential Retreat intervention was designed to improve quality of life among traumatic brain injury (TBI) survivors and caregivers through mindfulness, movement, nutrition, art, and community-building. Eligibility included being a TBI survivor (>2 years post-injury) or caregiver, 18+ years old, independently mobile, able to communicate verbally, and a first-time participant. Self-reported quantitative and qualitative data were collected via electronic surveys pre- and post-retreat, analyzed separately, then combined. Paired t-tests assessed mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and NIH TBI/Neuro-QOL Resilience, Cognition, Positive Affect/Wellbeing, and Emotional/Behavioral Dysregulation scales. We assessed feasibility using sample characteristics and program frequency and retention, and acceptability using quality ratings. Content analysis explored perceived benefits and improvements.

RESULTS

68 People-53 with TBI and 15 caregivers-participated in one of three LoveYourBrain Retreats. Significant improvements were found in QOLIBRI-OS (6.91, 95%CI 1.88-11.94), Resilience (2.14, 95%CI 0.50-3.78), Cognition (2.81, 95%CI 0.79-4.83), and Emotional/Behavioral Dysregulation (2.84, 95%CI 0.14-5.54) among TBI survivors (n = 41). Mean satisfaction was 9.6/10 (SD = 0.64). Content analysis revealed community connection, reframing TBI experience, self-regulation, and self-care themes.

CONCLUSIONS

The LoveYourBrain Retreat is feasible, acceptable, and may be effective complementary rehabilitation to improve QOL among TBI survivors.

Impact of the COVID-19 pandemic on community-based brain injury associations across Canada: a cross-sectional survey study

Background

The COVID-19 pandemic created new difficulties for people living with brain injury, their families, and caregivers while amplifying the challenges of community-based associations that support them. We aimed to understand the effects of the pandemic on clients who live with brain injury, as well as on the provision of community brain injury services/programs in Canada.

Methods

Online cross-sectional survey conducted in January 2022. Representatives of brain injury associations across Canada completed the 31 open- and closed-ended questions about meeting clients' needs, addressing public health guidelines, and sustaining the association. Data were analyzed using descriptive statistics (close-ended questions) and qualitative content analysis (open-ended questions).

Results

Of the 45 key representatives from associations in Pacific/Western (40%), Central (56%), and Atlantic Canada (4%), the majority were paid executive directors (67%). Participants reported that the most frequent psychosocial challenges experienced by their clients during the pandemic were social isolation (98%), loneliness (96%), and anxiety (93%). To alleviate these challenges, associations implemented wellness checks and psychosocial support. Most respondents (91%) affirmed that clients faced multiple technological barriers, such as a lack of technological knowledge and financial resources for devices and/or internet. In the open-ended questions, twenty-nine (64%) associations reported providing clients with devices, technology training, and assistance. Regarding public health measures, thirty (67%) respondents reported that clients had challenges understanding and/or following public health guidelines. Forty-two associations (93%) provided tailored information to help clients understand and comply with public health measures. Although associations (67%) received pandemic-related funding from the Canadian government they still struggled with the association's sustainability. Thirty-four (76%) lost funding or financial resources that prevented them from delivering programs or required the use of reserve funds to continue to do so. Only 56% reported receiving sufficient funding to address additional COVID-19-related expenses.

Conclusion

Although the pandemic added further challenges to the sustainability of brain injury associations across Canada, they quickly adapted services/programs to respond to the increasing and varied needs of clients, while complying with protective measures. To ensure community associations' survival it is essential to aptly recognize the vital role played by these associations within the brain injury care continuum.

Community in the pandemic: experiences and strategies by people with acquired brain injury and their families during COVID-19

PURPOSE

This study explored the experiences of people with acquired brain injury and their families during the COVID-19 pandemic, focusing on how they maintained their communities and sense of belonging, the strategies they found helpful, and advice they have for improving service provision and community connectedness.

METHODS

Semi structured interviews with pictorial mapping were conducted with ten adults with ABI and six of their family members. Participants responded to recruitment information circulated by a state-wide ABI peer support network in South Australia.

RESULTS

Four primary themes were identified from the findings: (1) disruptions to routine; (2) social isolation; (3) using technology; and (4) strategies for staying safe and keeping well. Results are discussed using a social and urban geography lens and a conceptual framework of belonging to explore the experiences of people with ABI and their communities.

CONCLUSIONS

The study reinforces the role of robust peer/support networks to stay connected, stay well and support others. Government, health services and community groups must provide clear and accessible information and supports, and regularly reach out to ensure the safety and wellbeing of people with ABI and their families during the pandemic.IMPLICATIONS FOR REHABILITATIONPeople with acquired brain injury and their families experienced increased challenges to maintaining contact with their communities during the COVID-19 pandemic.The main challenges were disruptions to routine, social isolation, and use of technology for health, therapy and social contact.Strategies to support people with ABI to maintain connections, stay engaged, and access technology and information to stay safe and well during lock-down are presented.

Employment and accommodation needs and the effect of COVID-19 on men and women with traumatic brain injury

BACKGROUND

Traumatic brain injury (TBI) impacts an individual's workforce involvement post-injury. Support services and workplace accommodations that can help with work re-integration post-TBI may differ based on a person's sex and gender. The added impact of COVID-19 remains under-explored.

OBJECTIVE

We aimed to investigate the support services and workplace accommodation needs and the impact of COVID-19 on work and mental health for persons with TBI, considering sex and gender.

METHODS

A cross-sectional online survey was distributed. Descriptive and regression analyses were applied to uncover sex and gender differences, along with content analysis for open-ended responses.

RESULTS

Thirty-two persons with TBI (62% women, 38% men) participated. Physiotherapy, occupational therapy, and counselling services were indicated as the most needed services by women and men. Modified hours/days and modified/different duties were the most needed workplace accommodations. Mental challenges impacting well-being was a highlighted concern for both men and women. Women scored poorer on the daily activity domain of the Quality of Life after Brain Injury - Overall Scale (p = 0.02). Assistance with daily activities was highlighted by women for a successful transition to work, including housekeeping and caregiving. Men were more likely than women to experience change in employment status because of COVID-19 (p = 0.02). Further, a higher percentage of men expressed concern about the inability to pay for living accommodations, losing their job, and not having future job prospects.

CONCLUSION

Findings reveal important differences between men and women when transitioning to work post-TBI and emphasize the need for sex and gender considerations.

A Scoping Review of Barriers and Facilitators Affecting the Lives of People With Disabilities During COVID-19

Purpose

This scoping review aimed to identify the barriers and facilitators to everyday activities and social participation of people with a disability (PWD) during the first wave of the COVID-19 pandemic.

Methods

The search terms (disability and COVID-19) were used in four databases: CINAHL, Medline (Ovid), EMBASE and Web of Science. The search conducted from January 2019 to September 22, 2020, identified 465 peer reviewed articles and abstracts and were screened in Covidence software. Studies were included if they had the terms “COVID-19” and “disability,” were published in English, and specifically examined how COVID-19 impacted the daily lives of PWD. Exclusion criteria included: disability as a symptom or result of COVID-19, the health outcomes when PWD acquired COVID-19, disability leave for someone who is sick and the risk of acquiring the disease for PWD. 74 articles met the inclusion criteria and were analyzed via data charting. Charting began with existing barriers and facilitators identified by the World Health Organization and new barriers and facilitators, that emerged from the texts were added during this process.

Results

The barriers that emerged included: access to information, ease of communication, financial impacts, mental health impacts, access to essential services, physical safety, educational challenges, and changes to care and rehabilitation. Significant facilitators included: changes to care and rehabilitation, new innovations, social and familial support and inclusive policy measures.

Conclusion

COVID-19 exacerbated existing challenges in the lives of PWD and raised new quality of life concerns. Findings also demonstrate that policy makers, health care professionals and others continually support PWD in times of crisis.

Addressing the Shadow Pandemic: COVID-19 Related Impacts, Barriers, Needs, and Priorities to Healthcare and Support for Women Survivors of Intimate Partner Violence and Brain Injury

BACKGROUND

Intimate partner violence (IPV) affects one in three women and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face, and neck, the intersection of IPV and traumatic brain injury (TBI) remains largely unrecognized. This paper reports on COVID-19-related impacts, barriers, needs, and priorities to healthcare and support services for women survivors of IPV-TBI.

METHODS

Using a participatory research model, we engaged 30 stakeholders in virtual meetings drawn from an IPV-TBI Knowledge to Practice (K2P) Network including women survivors, service providers, researchers, and decision makers. Data was gathered through small group breakout sessions facilitated by the research team using semi-structured discussion guides. Sessions were recorded, transcribed verbatim transcripts, and analysed using thematic analysis techniques. Stakeholders were given the opportunity to contribute to the analysis and knowledge transfer through member checking activities. Ethics approval was obtained through the University of Toronto.

RESULTS

COVID-19 has increased rates and severity of IPV and barriers to services and help-seeking. These effects are exacerbated by infrastructure difficulties in rural and remote areas, including limited access to services. Implications of virtual care such as safety, privacy, and usability require careful consideration. Requests from survivors for peer support have increased significantly, indicating more formalized and better-supported peer roles are needed. An overwhelming lack of awareness of the intersection of IPV-TBI continues. Increasing education and awareness among healthcare and IPV service providers, survivors, and the public remains a priority.

CONCLUSIONS

The COVID-19 pandemic has intensified IPV-TBI, increased challenges for women survivors, and accentuated the continued lack of IPV-TBI awareness. Key recommendations for healthcare and rehabilitation to address this priority are discussed.

The Shadow Pandemic: A Qualitative Exploration of the Impacts of COVID-19 on Service Providers and Women Survivors of Intimate Partner Violence and Brain Injury

BACKGROUND

Intimate partner violence (IPV) affects up to 1 in 3 women over their lifetime and has intensified during the COVID-19 pandemic. Although most injuries are to the head, face, and neck, the intersection of IPV and brain injury (BI) remains largely unrecognized. This article reports on unexplored COVID-19-related impacts on service providers and women survivors of IPV/BI.

OBJECTIVES

To explore the impact of the COVID-19 pandemic on survivors and service providers.

PARTICIPANTS

Purposeful sampling through the team's national Knowledge-to-Practice (K2P) network and snowball sampling were used to recruit 24 participants across 4 categories: survivors, executive directors/managers of organizations serving survivors, direct service providers, and employer/union representatives.

DESIGN

This project used a qualitative, participatory approach using semistructured individual or group interviews. Interviews were conducted via videoconferencing, audio-recorded, and transcribed. Transcripts were thematically analyzed by the research team to identify themes.

FINDINGS

COVID-19 has increased rates and severity of IPV and barriers to services in terms of both provision and uptake. Three main themes emerged: (1) implications for women survivors of IPV/BI; (2) implications for service delivery and service providers supporting women survivors of IPV/BI; and (3) key priorities. Increased risk, complex challenges to mental health, and the impact on employment were discussed. Adaptability and flexibility of service delivery were identified as significant issues, and increased outreach and adaptation of technology-based services were noted as key priorities.

CONCLUSIONS

The COVID-19 pandemic has intensified IPV/BI, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/BI awareness. Recommendations for service delivery and uptake are discussed.

COVID-19-induced surge in the severity of gender-based violence might increase the risk for acquired brain injuries

While initial reports have emphasized a global rise in the frequency of intimate partner violence following COVID-19, emerging data are now showing a concerning surge in the severity of COVID-19-induced physical intimate partner violence. One of the most dangerous, frequent, yet hidden consequences of severe physical intimate partner violence is acquired brain injury, including repetitive mild traumatic brain injury and hypoxic brain injury. Although the increase in high-risk physical abuse during COVID-19 is gaining recognition, what still remains absent is the urgent discussion on intimate partner violence-related acquired brain injury during these times. The potential analogous surge in intimate partner violence-related acquired brain injury may have implications for both healthcare providers and healthcare actions/policies as repeated brain injuries have been associated with residual functional deficits and chronic disability. In addition, even in the pre-pandemic times, intimate partner violence-related acquired brain injury is likely unrecognized and/or misclassified due to overlap in symptoms with other comorbid disorders. This review aimed to raise awareness about intimate partner violence-related acquired brain injury within the context of COVID-19. Health actions and policies that should be considered as part of the pandemic response to minimize adverse outcomes associated with intimate partner violence-related acquired brain injury have also been discussed.