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Avramović P, Rietdijk R, Kenny B, Power E, Togher L. Developing a Digital Health Intervention for Conversation Skills After Brain Injury (convers-ABI-lity) Using a Collaborative Approach: Mixed Methods Study. J Med Internet Res 2023; 25:e45240. [PMID: 37556179 PMCID: PMC10448295 DOI: 10.2196/45240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND People with acquired brain injury (ABI) experience communication breakdown in everyday interactions many years after injury, negatively impacting social and vocational relationships. Communication partner training (CPT) is a recommended intervention approach in communication rehabilitation after ABI. Access to long-term services is essential, both in rural and remote locations. Digital health has potential to overcome the challenges of travel and improve cost efficiencies, processes, and clinical outcomes. OBJECTIVE We aimed to collaboratively develop a novel, multimodal web-based CPT intervention (convers-ABI-lity) with key stakeholders and evaluate its feasibility for improving conversation skills after brain injury. METHODS This mixed methods study consisted of 3 key stages guided by the Integrate, Design, Assess, and Share (IDEAS) framework for developing effective digital health interventions. Stage 1 included the integration of current end-user needs and perspectives with key treatment and theoretical components of existing evidence-based interventions, TBI Express and TBIconneCT. Stage 2 included the iterative design of convers-ABI-lity with feedback from end-user interviews (n=22) analyzed using content analysis. Participants were individuals with ABI, family members, health professionals, and paid support workers. Stage 3 included the evaluation of the feasibility through a proof-of-concept study (n=3). A total of 3 dyads (a person with ABI and their communication partner [CP]) completed 7 weeks of convers-ABI-lity, guided by a clinician. The outcome measures included blinded ratings of conversation samples and self-report measures. We analyzed postintervention participant interviews using content analysis to inform further intervention refinement and development. RESULTS Collaborative and iterative design and development during stages 1 and 2 resulted in the development of convers-ABI-lity. Results in stage 3 indicated positive changes in the blinded ratings of conversation samples for the participants with traumatic brain injury and their CPs. Statistically reliable positive changes were also observed in the self-report measures of social communication skills and quality of life. Intervention participants endorsed aspects of convers-ABI-lity, such as its complementary nature, self-guided web-based modules, clinician sessions, engaging content, and novel features. They reported the intervention to be relevant to their personal experience with cognitive-communication disorders. CONCLUSIONS This study presents the outcome of using the IDEAS framework to guide the development of a web-based multimodal CPT intervention with input from key stakeholders. The results indicate promising outcomes for improving the conversation skills of people with ABI and their CPs. Further evaluation of intervention effectiveness and efficacy using a larger sample size is required.
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Affiliation(s)
- Petra Avramović
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Rachael Rietdijk
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Emma Power
- Discipline of Speech Pathology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Lloyd O, Ownsworth T, Zimmer-Gembeck MJ, Fleming J, Shum DHK. Measuring domain-specific deficits in self-awareness in children and adolescents with acquired brain injury: Component analysis of the Paediatric Awareness Questionnaire. Neuropsychol Rehabil 2021; 32:1814-1834. [PMID: 33980136 DOI: 10.1080/09602011.2021.1926290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-awareness has been found to vary across different functional domains for adults with acquired brain injury (ABI); however, domain-specific self-awareness is yet to be investigated following paediatric ABI. This study aimed to validate the Paediatric Awareness Questionnaire (PAQ) as a multi-domain measure of self-awareness and to investigate domain-specific self-awareness in children with ABI. One hundred and ninety-seven children and adolescents (8-16 years, M = 12.44, SD = 2.62) with mixed causes of ABI (70% with traumatic brain injury) and their parents (n = 197) were recruited through consecutive rehabilitation appointments and completed the PAQ. The 37 items of the parent version of the PAQ were subjected to a principal component analysis with varimax rotation. A five-component solution (29 items) explained 64% of the variance in the PAQ items. Components revealed five domains of self-awareness: socio-emotional functioning, activities of daily living (ADLs), cognition, physical functioning, and communication. Internal consistency of the components ranged from acceptable to excellent (α = .70-.95). The analysis identified that children had poorer self-awareness of cognitive functioning than socio-emotional functioning, ADLs, and communication skills. Overall, the findings identify five components (i.e., functional domains) of self-awareness and provide some support that self-awareness varies across domains following paediatric ABI.
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Affiliation(s)
- Owen Lloyd
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Melanie J Zimmer-Gembeck
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - David H K Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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3
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Hoepner JK, Sievert A, Guenther K. Joint Video Self-Modeling for Persons With Traumatic Brain Injury and Their Partners: A Case Series. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:863-882. [PMID: 33784468 DOI: 10.1044/2021_ajslp-20-00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Individuals with traumatic brain injury (TBI) experience impairments to self-regulation and social communication that strain relationships. Video self-modeling (VSM) provides visible and audible, tangible evidence of what they do well and what could improve. Conducting such training in the context of authentic exchanges with their everyday partners may support positive change in social communication. The present investigation sought to evaluate indices of improved social communication. Method A mixed-methods design was employed for this case series investigation. Quantitative measures include pre- and postoutcomes on goal attainment scales (GASs) and measures of conversational effectiveness. Qualitative measures include responsiveness to video-supported prompts, conversational behaviors, and metacognitive statements. Results Participants perceived gains on GAS of 3-4 SDs, as well as perceived improvements on the La Trobe Communication Questionnaire. Those gains were validated by gains on the adapted Measure of Participation in Conversation and Measure of Skill in Supported Conversation. Individuals with TBI and their partners reached consensus on most goals and postintervention La Trobe Communication Questionnaire ratings. Participants made accurate judgments about their behaviors at a high rate, given video review. Conversational behaviors and use of metacognitive statements varied across participants and conversational contexts. Field notes and session transcripts provide evidence that both dyads increased internalization of VSM goals and purpose. Conclusions Joint VSM shows promise as a method for eliciting accurate self-assessments among individuals with TBI and their close partners. Both dyads perceived positive gains in interactions within and outside their dyads. Furthermore, joint VSM and GAS appear to improve self-awareness and internalization of VSM goals and purpose.
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Affiliation(s)
- Jerry K Hoepner
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
| | - Alexis Sievert
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
| | - Kaitlin Guenther
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
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Lloyd O, Ownsworth T, Fleming J, Jackson M, Zimmer-Gembeck M. Impaired Self-Awareness after Pediatric Traumatic Brain Injury: Protective Factor or Liability? J Neurotrauma 2021; 38:616-627. [PMID: 33107366 DOI: 10.1089/neu.2020.7191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children and adolescents with traumatic brain injury (TBI) can experience impaired self-awareness, or difficulty in accurately perceiving their personal abilities. This study aimed to identify the neuro-developmental and socio-environmental factors associated with self-awareness impairment and determine how self-awareness is associated with psychosocial functioning. Parents and their children age 8-16 years with TBI (n = 107, 65.4% male, mean [M] age = 12.66 years, standard deviation [SD] = 2.6 years) were consecutively recruited from an outpatient clinic over a 4-year period. Children completed the Paediatric Awareness Questionnaire (PAQ) to report their functional abilities, and the Beck Youth Inventories to report their self-concept, and anxiety and depression symptoms. Parents completed the PAQ and measures of family functioning, parenting style, and children's emotional and behavioral problems. Self-awareness impairments were defined as more negative parent-child discrepancy scores on the PAQ. Younger age at injury, more severe injury, and more family dysfunction were significantly associated with poorer self-awareness. Poorer self-awareness was associated with worse parent-rated child adaptive functioning and emotional and behavioral problems. However, poorer self-awareness was also significantly associated with more positive self-concept and fewer symptoms of depression and anxiety as rated by children. Overall, impaired self-awareness seems to be both a liability and a benefit depending on the reporter (parent or child) and outcome of interest (adaptive function/behavior or self-concept/mood).
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Affiliation(s)
- Owen Lloyd
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Megan Jackson
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
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Rubin E, Klonoff P, Perumparaichallai RK. Does self-awareness influence caregiver burden? NeuroRehabilitation 2020; 46:511-518. [DOI: 10.3233/nre-203093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Evan Rubin
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- Bryn Mawr Rehab Psychology Associates, Main Line Health Care, Malvern, PA, USA
| | - Pamela Klonoff
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
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Arango-Lasprilla JC, Zeldovich M, Olabarrieta-Landa L, Forslund MV, Núñez-Fernández S, von Steinbuechel N, Howe EI, Røe C, Andelic N. Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe. J Clin Med 2020; 9:jcm9062007. [PMID: 32604823 PMCID: PMC7355447 DOI: 10.3390/jcm9062007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.
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Affiliation(s)
- Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE Basque Foundation for Science, 48013 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Correspondence: (J.C.A.-L.); (M.Z.); Tel.: +34-946-006-000 (J.C.A.-L.) (ext. 7963); +49-551-398-195 (M.Z.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany;
- Correspondence: (J.C.A.-L.); (M.Z.); Tel.: +34-946-006-000 (J.C.A.-L.) (ext. 7963); +49-551-398-195 (M.Z.)
| | | | - Marit Vindal Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
| | | | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany;
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (M.V.F.); (E.I.H.); (C.R.); (N.A.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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7
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Elbourn E, Kenny B, Power E, Togher L. Psychosocial Outcomes of Severe Traumatic Brain Injury in Relation to Discourse Recovery: A Longitudinal Study up to 1 Year Post-Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1463-1478. [PMID: 31487472 DOI: 10.1044/2019_ajslp-18-0204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The interrelationship between psychosocial outcomes and discourse after severe traumatic brain injury remains largely unknown. This study examines outcomes relating to work, relationships, and independence within the context of discourse recovery across the 1st year post-injury. Method An inception cohort comprising 57 participants with severe traumatic brain injury was assessed at 3, 6, 9, and 12 months post-injury. Outcomes were measured with the Sydney Psychosocial Reintegration Scale-2 (Tate et al., 2012; Tate, Simpson, Loo, & Lane-Brown, 2011), and discourse was evaluated with Main Concept Analysis of a narrative retell. Correlation and linear regression analyses were utilized. Results Significant correlations were found between psychosocial outcomes reported by relatives and discourse performance across the 1st year. The 6-month discourse scores significantly predicted the 12-month psychosocial outcomes reported by relatives. Initial discourse severity and recovery pattern also informed outcomes. Conclusions Discourse disorders have a strong relationship with everyday outcomes relating to work, relationships, and independence as reported by relatives. Six months post-injury is a beneficial time for assessment, education, and service planning. Age, years of education, and aphasia may mediate recovery and outcomes. A clinical decision tree is offered to support goal setting. Supplemental Material https://doi.org/10.23641/asha.9755444.
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Affiliation(s)
- Elise Elbourn
- Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia
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8
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Donnelly KZ, Baker K, Pierce R, St Ivany AR, Barr PJ, Bruce ML. A retrospective study on the acceptability, feasibility, and effectiveness of LoveYourBrain Yoga for people with traumatic brain injury and caregivers. Disabil Rehabil 2019; 43:1764-1775. [PMID: 31577456 DOI: 10.1080/09638288.2019.1672109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To conduct a mixed methods, pre-post, retrospective study on the feasibility, acceptability, and effectiveness of the LoveYourBrain Yoga program. MATERIALS AND METHODS People were eligible if they were a traumatic brain injury survivor or caregiver, age 15-70, ambulatory, and capable of gentle exercise and group discussion. We analyzed attendance, satisfaction, and mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and four TBI-QOL/Neuro-QOL scales. Content analysis explored perceptions of benefits and areas of improvement. RESULTS 1563 people (82.0%) participated ≥1 class in 156 programs across 18 states and 3 Canadian provinces. Mean satisfaction was 9.3 out of 10 (SD 1.0). Mixed effects linear regression found significant improvements in QOLIBRI-OS (B 9.70, 95% CI: 8.51, 10.90), Resilience (B 1.30, 95% CI: 0.60, 2.06), Positive Affect and Well-being (B 1.49, 95% CI: 1.14, 1.84), and Cognition (B 1.48, 95% CI: 0.78, 2.18) among traumatic brain injury survivors (n = 705). No improvement was found in Emotional and Behavioral Dysregulation, however, content analysis revealed better ability to regulate anxiety, anger, stress, and impulsivity. Caregivers perceived improvements in physical and psychological health. CONCLUSIONS LoveYourBrain Yoga is feasible and acceptable and may be an effective mode of community-based rehabilitation.IMPLICATIONS FOR REHABILITATIONPeople with traumatic brain injury and their caregivers often experience poor quality of life and difficulty accessing community-based rehabilitation services.Yoga is a holistic, mind-body therapy with many benefits to quality of life, yet is largely inaccessible to people affected by traumatic brain injury in community settings.Participants in LoveYourBrain Yoga, a six-session, community-based yoga with psychoeducation program in 18 states and 3 Canadian provinces, experienced significant improvements in quality of life, resilience, cognition, and positive affect.LoveYourBrain Yoga is feasible and acceptable when implemented on a large scale and may be an effective mode of, or adjunct to, community-based rehabilitation.
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Affiliation(s)
- Kyla Z Donnelly
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.,The LoveYourBrain Foundation, Windsor, VT, USA
| | - Kim Baker
- The LoveYourBrain Foundation, Windsor, VT, USA
| | | | - Amanda R St Ivany
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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9
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Zelencich L, Kazantzis N, Wong D, McKenzie D, Downing M, Ponsford J. Predictors of working alliance in cognitive behaviour therapy adapted for traumatic brain injury. Neuropsychol Rehabil 2019; 30:1682-1700. [PMID: 30990370 DOI: 10.1080/09602011.2019.1600554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive Behaviour Therapy (CBT) has the strongest preliminary support for treatment of depression and anxiety following traumatic brain injury (TBI). TBI associated cognitive impairments may pose an obstacle to development of a strong working alliance, on which therapeutic gains depend. The current study examined the association of demographic (i.e., gender, age at study entry, years of education and premorbid IQ) and injury-related (i.e., years since injury, post-trauma amnesia duration, memory and executive functioning test performance) variables with alliance in CBT adapted for TBI (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions from 31 participants were assessed with an observer version of the Working Alliance Inventory at nine time-points. Multi-level mixed model regressions showed that participants and therapists maintained a relatively strong alliance across all sessions. Pre-intervention symptom severity was considered as a confounder variable and was found to have no statistically significant influence on the models. None of the demographic variables were significantly associated with alliance scores. More years since injury was associated with a stronger alliance. These findings demonstrate that TBI associated cognitive impairments do not necessarily pose an obstacle to development and maintenance of a strong working alliance, which is more likely to develop with more time post-brain injury.
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Affiliation(s)
- Leah Zelencich
- School of Psychological Sciences, Cognitive Behaviour Therapy Research Unit, Monash University, Clayton, Australia
| | - Nikolaos Kazantzis
- School of Psychological Sciences, Cognitive Behaviour Therapy Research Unit, Monash University, Clayton, Australia
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dean McKenzie
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Marina Downing
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
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Hurst FG, Ownsworth T, Beadle E, Shum DHK, Fleming J. Domain-specific deficits in self-awareness and relationship to psychosocial outcomes after severe traumatic brain injury. Disabil Rehabil 2018; 42:651-659. [DOI: 10.1080/09638288.2018.1504993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Felicity G. Hurst
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Elizabeth Beadle
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David H. K. Shum
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Neuropsychology and Applied Cognitive Neuroscience Laboratory CAS Key Laboratory of Mental Health, Institute of Psychology Chinese Academy of Sciences, Griffith University, Beijing, China
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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11
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Hoepner JK, Olson SE. Joint Video Self-Modeling as a Conversational Intervention for an Individual with Traumatic Brain Injury and His Everyday Partner: A Pilot Investigation. ACTA ACUST UNITED AC 2018. [DOI: 10.21849/cacd.2018.00262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Sunderaraman P, Cosentino S. Integrating the Constructs of Anosognosia and Metacognition: a Review of Recent Findings in Dementia. Curr Neurol Neurosci Rep 2017; 17:27. [PMID: 28283961 DOI: 10.1007/s11910-017-0734-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the predominant theoretical models of awareness and summarize both traditional and emerging approaches to assessing awareness from clinical and meta-cognitive perspectives. In this review, we focus primarily on findings from recent studies in anosognosia and meta-cognition in the context of neurodegenerative disease with special emphasis on Alzheimer's disease and frontotemporal dementia. Emerging trends in the study of awareness, including examination of the longitudinal course of anosognosia, and investigation of the neural substrates underlying meta-cognitive abilities are addressed. Finally, the practical importance of studying and assessing awareness from both theoretical and clinical angles is emphasized.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease, Columbia University Medical Center, New York, NY, USA.,Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY, 10032, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease, Columbia University Medical Center, New York, NY, USA. .,Aging Brain, G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA. .,Department of Neurology, Columbia University Medical Center, New York, NY, USA. .,Taub Institute, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY, 10032, USA.
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FitzGerald MCC, O'Keeffe F, Carton S, Coen RF, Kelly S, Dockree P. Rehabilitation of emergent awareness of errors post traumatic brain injury: A pilot intervention. Neuropsychol Rehabil 2017; 29:821-843. [PMID: 28728461 DOI: 10.1080/09602011.2017.1336102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Impaired awareness of errors is common following traumatic brain injury (TBI) and can be a barrier to successful rehabilitation. The objective of this study was to develop and evaluate a computer-based intervention programme aimed at improving error awareness in individuals with TBI. A further aim was to explore its effects on metacognitive awareness and variability of performance. Participants were 11 individuals with TBI and impaired error awareness who performed a sustained attention task twice-weekly for four weeks. The intervention consisted of audio-visual feedback-on-errors during the sustained attention task. Six participants received audio-visual feedback-on-error, five did not receive feedback. Emergent and metacognitive awareness were measured pre- and post-intervention. Between-groups comparisons of emergent awareness from pre- to post-intervention showed that audio-visual feedback-on-error improved emergent awareness compared to no feedback-on-error. Some changes in metacognitive awareness of executive behaviours as a result of feedback were observed. Audio-visual feedback-on-error improved emergent awareness in individuals with TBI following a four-week/eight-session intervention. This improvement was not observed in the no-feedback group. This pilot intervention is not a stand-alone treatment but it has potential to be usefully incorporated into cognitive or clinical rehabilitation programmes to improve emergent awareness.
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Affiliation(s)
- Mary C C FitzGerald
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland.,b Psychology Department , Trinity College Dublin , Dublin , Ireland
| | - Fiadhnait O'Keeffe
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland
| | - Simone Carton
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland
| | | | - Simon Kelly
- d School of Electrical and Electronic Engineering , University College Dublin , Dublin , Ireland
| | - Paul Dockree
- b Psychology Department , Trinity College Dublin , Dublin , Ireland
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14
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Psychosocial Aspects of Pragmatic Disorders. PERSPECTIVES IN PRAGMATICS, PHILOSOPHY & PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-47489-2_23] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Douglas JM, Bracy CA, Snow PC. Return to Work and Social Communication Ability Following Severe Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:511-520. [PMID: 27124205 DOI: 10.1044/2015_jslhr-l-15-0025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 11/05/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Return to competitive employment presents a major challenge to adults who survive traumatic brain injury (TBI). This study was undertaken to better understand factors that shape employment outcome by comparing the communication profiles and self-awareness of communication deficits of adults who return to and maintain employment with those who do not. METHOD Forty-six dyads (46 adults with TBI, 46 relatives) were recruited into 2 groups based on the current employment status (employed or unemployed) of participants with TBI. Groups did not differ in regard to sex, age, education, preinjury employment, injury severity, or time postinjury. The La Trobe Communication Questionnaire (Douglas, O'Flaherty, & Snow, 2000) was used to measure communication. Group comparisons on La Trobe Communication Questionnaire scores were analyzed by using mixed 2 × 2 analysis of variance (between factor: employment status; within factor: source of perception). RESULTS Analysis yielded a significant group main effect (p = .002) and a significant interaction (p = .004). The employed group reported less frequent difficulties (self and relatives). Consistent with the interaction, unemployed participants perceived themselves to have less frequent difficulties than their relatives perceived, whereas employed participants reported more frequent difficulties than their relatives. CONCLUSION Communication outcome and awareness of communication deficits play an important role in reintegration to the workplace following TBI.
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Al Banna M, Redha NA, Abdulla F, Nair B, Donnellan C. Metacognitive function poststroke: a review of definition and assessment. J Neurol Neurosurg Psychiatry 2016; 87:161-6. [PMID: 25995488 DOI: 10.1136/jnnp-2015-310305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/26/2015] [Indexed: 11/03/2022]
Abstract
Metacognition is the conscious knowledge individuals have about their own cognitive capacities and the regulation of these activities through self-monitoring. The aim of this review was to identify the definitions and assessment tools used to examine metacognition in relation to stroke studies. A computer database search was conducted using MEDLINE, CINAHL, PsycINFO, Cochrane Reviews, Scopus and Web of Science. A total of 1412 publications were retrieved from the initial database search. Following the removal of unrelated articles, 34 articles remained eligible. 5 studies examined metacognition in relation to cognitive and/or emotional functioning, 4 examined the concept in relation to memory, while others investigated its relationship to driving, employment or restrictions in daily living. 12 studies examined metacognitive function exclusively in stroke. Only 1 study examined metacognition in the acute phase of stroke. 7 studies adhered to the standard definition of metacognition in line with the neuropsychological literature. The main assessment tools utilised included the Self-Regulation and Skills Interview (SRSI), the Self-Awareness of Deficits Interview (SADI), the Awareness Questionnaire (AQ) and the Patient Competency Rating Scale (PCRS). Assessment of metacognition has tended to focus on traumatic and other acquired brain injury in comparison to stroke. The majority of the studies that examined metacognition in stroke did not assess patients in the acute phase. The heterogeneity of assessment tools was in keeping with the variation in the definition of metacognition. The emergence of a standard metacognitive assessment tool may have important implications for future rehabilitative programmes.
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Affiliation(s)
- Mona Al Banna
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Noor Abdulla Redha
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Fatema Abdulla
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Manama, Bahrain
| | - Bindhu Nair
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Claire Donnellan
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Smeets SMJ, Vink M, Ponds RWHM, Winkens I, van Heugten CM. Changes in impaired self-awareness after acquired brain injury in patients following intensive neuropsychological rehabilitation. Neuropsychol Rehabil 2015; 27:116-132. [PMID: 26282626 DOI: 10.1080/09602011.2015.1077144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this study was to investigate changes in self-awareness impairments in outpatients with acquired brain injury (ABI) and the effects these changes have on rehabilitation. Participants were 78 patients with ABI (8.3 years post-injury) who followed an intensive outpatient neuropsychological rehabilitation programme. This longitudinal study comprised pre (T1) and post (T2) measurements and a one-year follow-up (T3). Thirty-eight patients completed the study. The main outcome domains were self-awareness, depressive symptoms, psychological and physical dysfunction, and health-related quality of life (HRQoL). Patients were divided into three awareness groups: underestimation, accurate estimation, and overestimation of competencies. Most patients who underestimated their competencies at the start of treatment accurately estimated their competencies directly after treatment (9 out of 11 patients). These patients also exhibited the largest treatment effects regarding depressive symptoms, psychological and physical dysfunction, and HRQoL. Most patients with impaired self-awareness (i.e., overestimation of competencies) at the start of treatment continued to overestimate their competencies after treatment (10 out of 14 patients). These patients exhibited a significant decrease in depressive symptoms but no other treatment effects. The results indicate that changes in outcome are related to changes in awareness, which underline the importance of taking into account different awareness groups with respect to treatment effects.
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Affiliation(s)
- Sanne M J Smeets
- a School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , The Netherlands
| | - Martie Vink
- b Amsterdam Rehabilitation Research Center , Amsterdam , The Netherlands
| | - Rudolf W H M Ponds
- a School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , The Netherlands.,c Department of Psychiatry and Psychology , Maastricht University Medical Center (MUMC), Maastricht and Adelante, Rehabilitation Center , Hoensbroek , The Netherlands
| | - Ieke Winkens
- a School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , The Netherlands
| | - Caroline M van Heugten
- a School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , The Netherlands.,d Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology , Maastricht University , Maastricht , The Netherlands
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Whiting DL, Deane FP, Simpson GK, McLeod HJ, Ciarrochi J. Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review. Neuropsychol Rehabil 2015; 27:263-299. [PMID: 26156228 DOI: 10.1080/09602011.2015.1062115] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper provides a selective review of cognitive and psychological flexibility in the context of treatment for psychological distress after traumatic brain injury, with a focus on acceptance-based therapies. Cognitive flexibility is a component of executive function that is referred to mostly in the context of neuropsychological research and practice. Psychological flexibility, from a clinical psychology perspective, is linked to health and well-being and is an identified treatment outcome for therapies such as acceptance and commitment therapy (ACT). There are a number of overlaps between the constructs. They both manifest in the ability to change behaviour (either a thought or an action) in response to environmental change, with similarities in neural substrate and mental processes. Impairments in both show a strong association with psychopathology. People with a traumatic brain injury (TBI) often suffer impairments in their cognitive flexibility as a result of damage to areas controlling executive processes but have a positive response to therapies that promote psychological flexibility. Overall, psychological flexibility appears a more overarching construct and cognitive flexibility may be a subcomponent of it but not necessarily a pre-requisite. Further research into therapies which claim to improve psychological flexibility, such as ACT, needs to be undertaken in TBI populations in order to clarify its utility in this group.
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Affiliation(s)
- Diane L Whiting
- a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Liverpool , Australia.,b School of Psychology , University of Wollongong , Wollongong , Australia.,d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia
| | - Frank P Deane
- b School of Psychology , University of Wollongong , Wollongong , Australia
| | - Grahame K Simpson
- a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Liverpool , Australia.,c John Walsh Centre for Rehabilitation Research , University of Sydney , Sydney , Australia.,d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia
| | - Hamish J McLeod
- e Institute of Health and Well-being , University of Glasgow , Glasgow , Scotland
| | - Joseph Ciarrochi
- f Institute of Positive Psychology & Education , Australian Catholic University , Strathfield , Australia
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Richardson C, McKay A, Ponsford JL. The trajectory of awareness across the first year after traumatic brain injury: The role of biopsychosocial factors. Brain Inj 2014; 28:1711-20. [DOI: 10.3109/02699052.2014.954270] [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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Richardson C, McKay A, Ponsford JL. Does feedback influence awareness following traumatic brain injury? Neuropsychol Rehabil 2014; 25:233-53. [DOI: 10.1080/09602011.2014.936878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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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Kuenemund A, Zwick S, Doering BK, Conrad N, Rief W, Exner C. Decline in attainability of communion and agency life goals over 2 years following acquired brain injury and the impact on subjective well-being. Neuropsychol Rehabil 2013; 23:678-97. [DOI: 10.1080/09602011.2013.801779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stergiou-Kita M, Dawson D, Rappolt S. Inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury: a systematic and evidence-based approach. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:166-181. [PMID: 21968612 DOI: 10.1007/s10926-011-9332-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION This paper introduces an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. This guideline aims to explicate the processes and factors relevant to vocational evaluation to assist evaluators (i.e. health care teams, individuals and employers) in collaboratively determining if clients are able to work and to make recommendations for work entry, re-entry or vocational planning. METHODS Methods in the Canadian Medical Association's (CMA) Handbook on Clinical Practice Guideline and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were utilized to ensure rigour. Steps in the CMA handbook were followed and included: (1) identifying the guideline's objective and questions; (2) systematic literature review; (3) study selection and quality appraisal; (4) development of clear recommendations by key stakeholders; (5) guideline pilot testing and endorsement. RESULTS The resulting guideline includes 17 key recommendations within the seven domains: (1) evaluation purpose and rationale; (2) initial intake process; (3) assessment of the personal domain; (4) assessment of the environment; (5) assessment of occupational/job requirements; (6) analysis and synthesis; (7) evaluation recommendations. CONCLUSIONS The guideline may be useful to individually practicing clinicians, health care teams, employers and individuals with TBI. Future research will formally examine the success of the guideline's implementation.
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Affiliation(s)
- Mary Stergiou-Kita
- Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Ave., Toronto, ON M5G 1V7, Canada.
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Stergiou-Kita M, Rappolt S, Dawson D. Towards developing a guideline for vocational evaluation following traumatic brain injury: the qualitative synthesis of clients’ perspectives. Disabil Rehabil 2011; 34:179-88. [DOI: 10.3109/09638288.2011.591881] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stergiou-Kita M, Dawson DR, Rappolt SG. An integrated review of the processes and factors relevant to vocational evaluation following traumatic brain injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:374-394. [PMID: 21258849 DOI: 10.1007/s10926-010-9282-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION In order to develop the evidence base for a clinical practice guideline (CPG) for vocational evaluation following traumatic brain injury (TBI), we undertook a review to identify the key processes evaluators should follow and the key factors they should consider when completing a vocational evaluation. METHODS Processes outlined in the Cochrane Handbook of Systematic Review guided our processes and included: development of review questions, search strategies and selection criteria; quality appraisal; extraction, analysis and data synthesis; drawing conclusions. Four data bases (i.e. Medline; PsychInfo; Embase; The Cochrane Library of Systematic Reviews) were searched for descriptive articles, quantitative and qualitative studies, and nine websites were searched for CPGs (e.g. Scottish Intercollegiate Guideline Network; US National Guideline Clearinghouse; New Zealand Guideline Group). Two reviewers independently appraised methodological quality. Data were extracted into evidence tables which included: study purpose; location; participants; design/method; themes; findings; relevant processes and factors. Directed content analysis was utilized to analyze and synthesize the descriptive process evidence. A constant comparative method was employed to compare study findings in relation to factors associated with successful employment. RESULTS Results from process and factors syntheses are integrated into the Evidence-based Framework for Vocational Evaluation Following TBI. This framework identifies seven key processes in a vocational evaluation, including: (1) identification of the evaluation purpose and rationale; (2) intake process; (3) assessment of the person; (4) assessment of the environment; (5) assessment of the occupation/job requirements; (6) analysis and synthesis of assessment results; (7) development of evaluation recommendations. Relevant factors are integrated into each key process. CONCLUSIONS This framework outlines the key information evaluators should gather, the domains of the person, environment and occupation they should assess, and elements of rigour they should consider when completing a vocational evaluation and making recommendations for work re-entry following a TBI.
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Affiliation(s)
- Mary Stergiou-Kita
- Department of Rehabilitation Science, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
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Juengst S, Skidmore E, Pramuka M, McCue M, Becker J. Factors contributing to impaired self-awareness of cognitive functioning in an HIV positive and at-risk population. Disabil Rehabil 2011; 34:19-25. [PMID: 21870997 DOI: 10.3109/09638288.2011.587088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association between self-awareness of cognitive impairment and age, selected mood disorders, and type and severity of cognitive impairment in a sample of individuals with HIV/AIDS and at risk for HIV. METHOD 75 subjects, 52 HIV+ and 23 at risk for HIV completed a psychosocial interview, the Patient's Assessment of Own Functioning (PAOF) questionnaire, and a battery of neuropsychological tests. Based upon the differences between their clinical impairment and self-reported impairment, subjects were classified as being "Underestimators", "Good Awareness", or "Impaired Awareness" with regard to self-awareness. RESULTS Those with more severe cognitive impairment were less aware than those with normal or borderline cognitive impairment. A one-way ANOVA suggested that the Impaired Awareness group differed significantly from the Underestimators on the Rey Figure Immediate and Delayed Recall tasks, and from both the Underestimators and Good Awarenesss groups on the Digit Symbol Substitution Task. There were significant differences among all awareness groups on the test of Simple Reaction Time. Furthermore there is some suggestion that age may contribute to impaired self-awareness. The role of HIV in self-awareness remains unclear, as both, individuals with HIV and at risk, demonstrated impaired self-awareness. CONCLUSIONS Overall, impaired awareness was associated with poorer test performance, suggesting a relationship between awareness and sustained complex attention and visual spatial processing. This research has implications for understanding factors contributing to poor awareness among individuals with cognitive impairment.
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Affiliation(s)
- Shannon Juengst
- Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
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Stergiou-Kita M, Yantzi A, Wan J. The personal and workplace factors relevant to work readiness evaluation following acquired brain injury: occupational therapists' perceptions. Brain Inj 2010; 24:948-58. [PMID: 20545450 DOI: 10.3109/02699052.2010.491495] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined the personal and workplace/environmental factors perceived most relevant to work readiness evaluations following acquired brain injury. RESEARCH DESIGN Using a qualitative secondary analysis design 'indicators of success' and 'risks of failure', identified as relevant in a primary study of occupational therapists' evaluation practices, were explored further. METHOD Data collected in the primary study, e.g. interviews, practice surveys, evaluation protocols, were re-analysed. Surveys and protocols were used to define participant and practice context characteristics. Interviews were coded, by three investigators, using a constructivist grounded theory approach. RESULTS Four themes emerged describing relevant personal client attributes: (1) motivation; (2) physical and functional independence; (3) cognitive abilities; and (4) use of compensatory strategies and feedback. Four themes emerged describing relevant workplace factors: (1) workplace demands; (2) employer risks and burden; (3) risks associated with information sharing; and (4) financial implications associated with return to work. CONCLUSIONS Findings suggest that work readiness needs to be viewed as both a client and a workplace issue. Findings are translated into questions for rehabilitation professionals to guide evaluations of work readiness. Recommendations for future research include investigating how professionals weigh factors in their decision-making and exploring strategies relevant from a workplace perspective.
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Affiliation(s)
- Mary Stergiou-Kita
- Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Ave., Toronto, Ontario, Canada.
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The contribution of injury severity, executive and implicit functions to awareness of deficits after traumatic brain injury (TBI). J Int Neuropsychol Soc 2010; 16:1089-98. [PMID: 20735889 DOI: 10.1017/s1355617710000925] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deficits in self-awareness are commonly seen after Traumatic Brain Injury (TBI) and adversely affect rehabilitative efforts, independence and quality of life (Ponsford, 2004). Awareness models predict that executive and implicit functions are important cognitive components of awareness though the putative relationship between implicit and awareness processes has not been subject to empirical investigation (Crosson et al., 1989; Ownsworth, Clare, & Morris, 2006; Toglia & Kirk, 2000). Severity of injury, also thought to be a crucial determinant of awareness outcome post-insult, is under-explored in awareness studies (Sherer, Boake, Levin, Silver, Ringholz, & Walter, 1998). The present study measured the contribution of injury severity, IQ, mood state, executive and implicit functions to awareness in head-injured patients assigned to moderate/severe head-injured groups using several awareness, executive, and implicit measures. Severe injuries resulted in greater impairments across most awareness, executive and implicit measures compared with moderate injuries, although deficits were still seen in the moderate group. Hierarchical regression results showed that severity of injury, IQ, mood state, executive and implicit functions made significant unique contributions to selective aspects of awareness. Future models of awareness should account for both implicit and executive contributions to awareness and the possibility that both are vulnerable to disruption after neuropathology.
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Anderson RL, Doble SE, Merritt BK, Kottorp A. Assessment of Awareness of Disability Measures among Persons with Acquired Brain Injury. The Canadian Journal of Occupational Therapy 2010; 77:22-9. [DOI: 10.2182/cjot.2010.77.1.4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background. Limited self-awareness of disabilities can compromise individuals' occupational performance. Purpose. The Assessment of Awareness of Disability (AAD) provides occupational therapists with a standardized methodology for measuring clients' self-awareness when performing activities of daily living (ADL). This is the first study that formally examines the stability of the AAD measures. Methods. The AAD was administered twice to 15 participants with acquired brain injury (ABI) within one or two days. One participant's data were excluded because significant changes in his ADL process abilities were detected. Two criteria were used to examine the stability of the remaining 14 participants' AAD measures: standardized diference Z-scores and a difference of 0.65 logits. Findings. All 14 participants' AAD measures were stable on the basis of their Z-scores; 13 participants' measures were stable based on the 0.65 logit difference. Implications. Occupational therapists can have confidence that the AAD generates stable measures when administered to adults with ABI.
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Ownsworth T, Shum D. Relationship between executive functions and productivity outcomes following stroke. Disabil Rehabil 2009; 30:531-40. [PMID: 17852299 DOI: 10.1080/09638280701355694] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Stroke occurs in many individuals of working age and can considerably disrupt their capacity for employment and other productive activities. Few studies have examined the relationship between loss of productivity and cognitive impairment, particularly deficits in executive function. The present study examined whether performance on tests of executive function is related to employment and productivity at 12-months follow-up. METHOD Twenty-seven individuals (mean age = 47.3 years, SD = 10.7) on average 2.1 years (SD = 1.6) post-stroke were recruited from hospital and community rehabilitation services and administered a theory-driven battery of executive function tests (i.e. Health and Safety sub-test, FAS Test, Five-Point test, Key Search Test and Tinkertoy Test). A 12-month follow-up assessment of employment outcome ('employed' or 'unemployed') and productivity (measured by the Sydney Psychosocial Reintegration Scale) was conducted. RESULTS A series of between-group comparisons identified that a measure of purposive behaviour and self-regulation (i.e. the Tinkertoy Test) best distinguished between the employed and unemployed groups (p < 0.01) irrespective of time since injury and neglect. Level of post-stroke productivity was significantly correlated with measures of planning (p < 0.05), self-monitoring (p < 0.01) and self-regulation (p < 0.05), as well as time since injury (p < 0.05) and functional status (p < 0.01). CONCLUSIONS These findings highlight the importance of routinely assessing executive functions to guide cognitive rehabilitation interventions following stroke.
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Affiliation(s)
- Tamara Ownsworth
- Applied Cognitive Neuroscience Research Centre and School of Psychology, Griffith University, Australia.
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Coetzer R. Holistic neuro-rehabilitation in the community: is identity a key issue? Neuropsychol Rehabil 2009; 18:766-83. [PMID: 18654932 DOI: 10.1080/09602010701860266] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many people experience identity change after brain injury. Impaired self-awareness after acquired brain injury is also common and can, along with other factors, affect the identity change a person may experience. Holistic rehabilitation programmes attempt to address both cognitive and emotional difficulties and specifically problems of self-awareness after brain injury. Does identity change require longer-term rehabilitation interventions? This paper describes a community-based neuro-rehabilitation service that has incorporated some principles from more traditional holistic programmes with a view to providing long-term, low-intensity brain injury rehabilitation. Specific reference is made to problems of identity and how these may be addressed during long-term psychotherapeutic follow-up. The potential relevance of the total duration of rehabilitation input rather than simply the number of sessions when working with adjustment and identity change after brain injury in community settings is discussed. The service model is compared to more traditional holistic rehabilitation programmes. A case study and early outcome data are presented to illustrate some of these points and to provide more information about the nature of the programme.
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Affiliation(s)
- Rudi Coetzer
- North Wales Brain Injury Service, Colwyn Bay, Wales, and Bangor University, Wales.
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Hart T, Seignourel PJ, Sherer M. A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury. Neuropsychol Rehabil 2009; 19:161-76. [DOI: 10.1080/09602010802188393] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ownsworth TL, Turpin M, Andrew B, Fleming J. Participant perspectives on an individualised self-awareness intervention following stroke: A qualitative case study. Neuropsychol Rehabil 2008; 18:692-712. [DOI: 10.1080/09602010701595136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Turner BJ, Ownsworth TL, Turpin M, Fleming JM, Griffin J. Self-identified goals and the ability to set realistic goals following acquired brain injury: A classification framework. Aust Occup Ther J 2008; 55:96-107. [DOI: 10.1111/j.1440-1630.2007.00660.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ownsworth T, Clare L. The association between awareness deficits and rehabilitation outcome following acquired brain injury. Clin Psychol Rev 2006; 26:783-95. [PMID: 16814436 DOI: 10.1016/j.cpr.2006.05.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 04/18/2006] [Accepted: 05/08/2006] [Indexed: 11/28/2022]
Abstract
The relationship between awareness of deficits and rehabilitation outcome following acquired brain injury (ABI) has yet to be established. The aim of the present review was to examine empirical evidence concerning the issue of whether awareness of deficits is necessary for rehabilitation gains and provide guidelines to assist clinical decision-making. The search strategy entailed identification of longitudinal group outcome studies with individuals who had experienced ABI of varying aetiology published between 1980 and 2006 in which awareness of deficits was systematically measured from the outset of rehabilitation and examined in relation to post-intervention functional outcomes. Eligible studies were evaluated against indicators of methodological quality. The review yielded 12 empirical studies, of which four indicated that individuals with greater awareness of deficits achieve more favorable rehabilitation outcomes and six provided partial support for this association. Two studies failed to support this view. Overall, the key issues requiring consideration when forming opinions and developing interventions for individuals with awareness deficits include the following: (a) how awareness is conceptualized and determined; (b) the perceived impact of poor self-awareness and possible adverse effects of targeting awareness; (c) biopsychosocial factors underlying awareness deficits; (d) the clients' goals and expectations in the intervention; and (e) the scope, intensity and resources of the rehabilitation context. Clinical recommendations are made regarding the circumstances in which it might be optimal to target the development of awareness in the context of rehabilitation.
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Affiliation(s)
- Tamara Ownsworth
- School of Psychology, Griffith University, Mt Gravatt Campus, Nathan 4111, Australia.
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