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Sohlberg MM, O'Neil-Pirozzi TM, Ness B, Meulenbroek P, Byom L, Lemoncello R. Moving Beyond Rapport: The Importance of Active Facilitation of Therapeutic Alliance in Adult Acquired Brain Injury Rehabilitation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-10. [PMID: 39320322 DOI: 10.1044/2024_ajslp-23-00495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
PURPOSE Therapeutic alliance (TA) is critical to rehabilitation outcomes for adults with acquired brain injuries (ABIs). The purpose of this viewpoint article is to review factors that contribute to TA and to suggest ways speech-language pathologists (SLPs) can integrate these factors into their ABI rehabilitation practice. METHOD We evaluated literature describing client and clinician factors shown to affect-or not affect-TA in ABI rehabilitation and mapped findings onto suggested practices that SLPs may use to actively promote TA with their clients. Informed by our findings and TA frameworks, we integrated findings into a novel clinician self-reflection tool: the Therapeutic Alliance Reflection Checklist. CONCLUSIONS TA is a key ingredient in ABI rehabilitation. We contend that SLPs can, and should, actively facilitate TA with clients; the self-reflection checklist can assist. We advocate for continued TA research and improved measurement across rehabilitation settings. We further contend that training in active TA-promoting skills is a critical component of speech-language pathology education.
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Affiliation(s)
- McKay Moore Sohlberg
- Department of Communication Disorders and Sciences, University of Oregon, Eugene
| | - Therese M O'Neil-Pirozzi
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
- Spaulding-Harvard Traumatic Brain Injury Model System, Charlestown, MA
| | - Bryan Ness
- Department of Communication Sciences and Disorders, California Baptist University, Riverside
| | - Peter Meulenbroek
- Department of Communication Sciences and Disorders, Radford University, VA
| | - Lindsey Byom
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Rik Lemoncello
- Department of Speech & Hearing Sciences, Portland State University, OR
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2
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Jackson K, Newbury-Birch D. Patient reported experiences of community rehabilitation and/or support services for people with long term neurological conditions: a narrative review of quantitative studies. Disabil Rehabil 2024; 46:4068-4085. [PMID: 37905706 DOI: 10.1080/09638288.2023.2266369] [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: 12/13/2022] [Revised: 09/01/2023] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES 1. To identify validated quantitative Patient Reported Experience Measures (PREM's) being used in Community Rehabilitation and/or Support services for people with long term neurological conditions (PwLTNC). 2. To explore how data from quantitative PREM's adds to research on patient experiences of Community Rehabilitation and Support for PwLTNC. METHOD Eight data bases were searched for peer reviewed studies (2005-2021) which met inclusion criteria. Data extraction and quality assessment for sixteen studies was performed by two reviewers. Narrative synthesis was conducted. RESULTS Eleven validated PREM's were identified which captured data for 15,831 PwLTNC. PREM scores indicated positive and negative experiences for people with Multiple Sclerosis (n = 13,123), Parkinson's Disease (n = 2215) and Acquired Brain Injury (n = 493). Negative experiences related to Picker Institute Principles: 1 (accessibility); 3 (coordination/continuity); 4 (involvement/support for family and carers); 5 (information provision), 6 (Involvement in decision making) and 7 (empathy and emotional support). CONCLUSION Quantitative PREM's provide evidence of process quality and person-centred care within community rehabilitation and support services across large data sets of heterogeneous neurological conditions and geographical locations. Quality improvement initiatives for people with MS, PD and ABI should target processes relating to Picker Institute Principles 1,3,4,5,6, and 7.
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Affiliation(s)
- Katherine Jackson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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3
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McCabe C, Sica A, Fortune DG. Awareness through relationships in individuals undergoing rehabilitation following acquired brain injury. Neuropsychol Rehabil 2024; 34:1005-1033. [PMID: 37903181 DOI: 10.1080/09602011.2023.2273578] [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: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023]
Abstract
AIM This cross-sectional study investigated the association between self-awareness and quality of therapeutic relationships following acquired brain injury (ABI) while controlling for the potential impact of cognitive problems. It also aimed to investigate attachment as a potential moderator. METHOD 83 adults with ABI were recruited alongside a key member of their community neurorehabilitation team. The Scale to Assess Therapeutic Relationships (STAR) was used to measure therapeutic relationship quality and attachment was measured using the Experiences in Close Relationships - Relationship Structure (ECR-RS) questionnaire. Awareness was measured using the Patient Competency Rating Scale (PCRS) and the Mayo-Portland Adaptability Inventory (MPAI-4) provided a measure of cognitive problems. The MPAI-4 also provided an additional measure of awareness. RESULTS A significant association between self-awareness and therapeutic relationships was found in some regression models such that higher-quality relationships were associated with better awareness, after controlling for the impact of cognitive problems. Neither childhood parental attachment nor participants' attachment towards their rehabilitation staff were moderators. CONCLUSION The observed associations between awareness in clients and therapeutic relationships with rehabilitation staff may have importance for rehabilitation in this context. Results highlight the value of continuing to prioritize the therapeutic relational environment in ABI rehabilitation and research.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Co Dublin, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Miller LR, Divers R, Reed C, Cherry J, Patrick A, Calamia M. Value-consistent rehabilitation is associated with long-term psychological flexibility and quality of life after traumatic brain injury. Neuropsychol Rehabil 2024; 34:955-973. [PMID: 37708399 DOI: 10.1080/09602011.2023.2256964] [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: 02/22/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
Meaningful steps have been taken toward using holistic approaches in outpatient rehabilitation for traumatic brain injury (TBI) (i.e., treating the whole individual); however, research and practice continue to disproportionately focus on adapting to physical and cognitive changes. Research suggests treatment focusing on individual values may be important for psychological adjustment after TBI. The current study sought to explore individual values across multiple life domains in those with TBI as well as what values outpatient rehabilitation was helpful for, and to examine discrepancies between these factors (i.e., value-consistent rehabilitation) in relation to important long-term treatment outcomes. 215 adults with a history of TBI who had participated in outpatient rehabilitation completed online surveys assessing how consistent outpatient rehabilitation was with individual values, psychological flexibility, and quality of life. The life domains with the greatest discrepancies between individual importance and rehabilitation helpfulness were spirituality, intimate relations, and family relations. Greater value-consistent rehabilitation was associated with higher levels of psychological flexibility and quality of life beyond demographics and injury characteristics. Our findings provide further support in favour of holistic, client-centred approaches that are facilitated by neurological rehabilitation programs.
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Affiliation(s)
- Luke R Miller
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Ross Divers
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Christopher Reed
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Jared Cherry
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Abihail Patrick
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
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Montag LT, Bisson EJ, Duggan S, Gregory T, Murphy G, Gilron I, Wilson R, Salomons TV. Patient Expectations and Therapeutic Alliance Affect Pain Reduction Following Lidocaine Infusion in an Interdisciplinary Chronic Pain Clinic. THE JOURNAL OF PAIN 2024; 25:104443. [PMID: 38056545 DOI: 10.1016/j.jpain.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
Pain experience is affected by both ascending nociceptive signals and descending modulation. Expectations can affect pain experience and augment treatment-induced analgesia through descending inhibitory modulation of pain. This open-label, prospective cohort study examined the association between participant expectation ratings and pain reduction in adult participants with chronic pain receiving an intravenous lidocaine infusion. We aimed to explore whether: 1) participants' expectations of treatment efficacy were associated with pain reduction over 8 weeks after infusion; and 2) participants' therapeutic alliance was associated with expectations and/or pain reduction. We recruited 70 participants with chronic pain scheduled for lidocaine infusion. Study measures included pain intensity (pre-treatment, post-treatment, and daily for 8 weeks), treatment expectations (EXPECT), and therapeutic alliance (Trust in Physician and Working Alliance Inventory-Short Revised). Baseline treatment expectations were significantly correlated with pain reduction (r = .42, P < .01). Therapeutic alliance was significantly correlated with expectations (r = .27, P < .05) and pain reduction (r = .38, P < .01). This study quantifies the contribution of: 1) treatment expectations; and 2) therapeutic alliance to the magnitude of lidocaine-induced pain reduction. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes. PERSPECTIVE: This study evaluates the relationship between pain reduction and ratings of: 1) treatment expectations; and 2) therapeutic alliance following an intravenous lidocaine infusion. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes.
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Affiliation(s)
- Landon T Montag
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| | - Etienne J Bisson
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Scott Duggan
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
| | - Thomas Gregory
- Kingston Orthopaedic Pain Institute, Kingston, Canada; Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Canada
| | - Greg Murphy
- Kingston Orthopaedic Pain Institute, Kingston, Canada
| | - Ian Gilron
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada; School of Policy Studies, Queen's University, Kingston, Canada; Providence Care Hospital, Kingston, Canada
| | - Rosemary Wilson
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; School of Nursing, Queen's University, Kingston, Canada
| | - Tim V Salomons
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Department of Psychology, Queen's University, Kingston, Canada
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Vaucheret Paz E, Giacchino M, Leist M, Chirila C, Petracca L, Agosta G. Telerehabilitation of subjects with neurodevelopmental disorders during confinement due to COVID-19. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2024; 53:149-157. [PMID: 39127543 DOI: 10.1016/j.rcpeng.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/25/2021] [Accepted: 03/07/2022] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Social distancing measures due to the COVID-19 pandemic prevented many children with neurodevelopmental disorders from accessing face-to-face treatments. Telerehabilitation grew at this time as an alternative therapeutic tool. In this study we analysed remote cognitive rehabilitation in neurodevelopmental disorders. METHODS This was a prospective, quasi-experimental (before-after) study that included 22 patients (mean age 9.41 years) with neurodevelopmental disorders who had telerehabilitation for over six months. RESULTS After six months of telerehabilitation, a statistically significant improvement was found with a large effect size in these areas: attention (sustained, selective and divided), executive functions (verbal and visual working memory, categorisation, processing speed), visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia) and language (comprehensive and expressive). On the Weiss Functional Impairment Scale, all areas (family, learning and school, self-concept, activities of daily living, risk activities) improved with statistical significance. We found a positive correlation between the number of sessions and the improvement observed in executive functions (visual working memory, processing speed), attention (sustained attention, divided attention) and visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia). We did not find statistical significance between the family structure and the number of sessions carried out. A high degree of perception of improvement and satisfaction was observed in the parents. CONCLUSIONS Telerehabilitation is a safe alternative tool which, although it does not replace face-to-face therapy, can achieve significant cognitive and functional improvements in children with neurodevelopmental disorders.
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Affiliation(s)
- Esteban Vaucheret Paz
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Mariana Giacchino
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Leist
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Chirila
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luciana Petracca
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermos Agosta
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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McCabe C, Sica A, Doody N, Fortune DG. Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM). Neuropsychol Rehabil 2024; 34:335-361. [PMID: 36908086 DOI: 10.1080/09602011.2023.2186437] [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: 08/22/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized. METHOD Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach. RESULTS Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35). CONCLUSION Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Dublin, Ireland
| | - Niamh Doody
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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8
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Nedergård H, Sandlund M, Häger CK, Palmcrantz S. Users' experiences of intensive robotic-assisted gait training post-stroke - "a push forward or feeling pushed around?". Disabil Rehabil 2023; 45:3861-3868. [PMID: 36342771 DOI: 10.1080/09638288.2022.2140848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. MATERIALS AND METHODS Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis. RESULTS Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended. CONCLUSIONS The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments. IMPLICATIONS FOR REHABILITATIONWhen provided in a suitable context, the mental and physical challenges of intensive robotic-assisted gait training can be both inspiring and motivating.Support and engagement along with informative feedback from therapists are suggested crucial for motivation.Intensive task-specific gait training may preferably be performed in an enriched environment and combined with other physiotherapy treatments to stimulate engagement.
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Affiliation(s)
- Heidi Nedergård
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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O'Donnell K, Healy A, Burke T, Staines A, McGettrick G, Kwasky A, O'Halloran P, Corrigan C. Traumatic brain injury epidemiology and rehabilitation in Ireland: a protocol paper. HRB Open Res 2022; 4:66. [PMID: 37854498 PMCID: PMC10579856 DOI: 10.12688/hrbopenres.13209.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 10/20/2023] Open
Abstract
Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, a dearth of research means that we neither know the number of people affected by TBI, nor have the required data to improve neuro-rehabilitation services. This is a study protocol to examine the epidemiology and pathways through rehabilitation for a cohort of TBI survivors in the Republic of Ireland. Aims: 1. To document the epidemiological data of TBIs in Ireland. 2. To explore the pathway of TBI survivors through rehabilitation/health services. 3. To document the experiences of those providing care for TBI survivors in Ireland Methods: This is a quantitative cohort study. Existing routine datasets will be used to report epidemiological data. Participants with moderate or severe TBI will be recruited through two brain injury service providers, two acute hospitals that provide neurosurgical services, and the National Rehabilitation Hospital. Participants with TBI will be surveyed on two separate occasions, to explore their use of health and rehabilitation services. Those providing care or support to TBI survivors will be surveyed, on one occasion. Additionally, data from the medical records of TBI survivors will be extracted to capture key information about their TBI, such as mechanism of injury, severity, hospitalisation and follow-up. TBI survivors' use of health care will be followed prospectively for six months. Expected outcomes: The epidemiological data of TBI in Ireland will be documented. Data on survivors' experiences of how rehabilitation services are accessed, and any barriers encountered with rehabilitation/health services will be reported. The experiences of those providing care or support for TBI survivors will be captured. It is expected that the outcomes of the study will support advocacy efforts toward the redevelopment of neuro-rehabilitation services in the Republic of Ireland.
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Affiliation(s)
- Kate O'Donnell
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Andrea Healy
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Teresa Burke
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Grainne McGettrick
- Research and Policy Management, Acquired Brain Injury Ireland, Dun Laoghaire, Co Dublin, Ireland
| | - Andrea Kwasky
- College of Health Professions and McAuley School of Nursing, University of Detroit Mercy, Detroit, Michigan, USA
| | - Philip O'Halloran
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Neurosurgery, The Royal London Hospital, London, UK
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Vaucheret Paz E, Giacchino M, Leist M, Chirilla C, Petracca L, Agosta G. [Telerehabilitation of Subjects with Neurodevelopmental Disorders During Confinement due to COVID-19]. REVISTA COLOMBIANA DE PSIQUIATRIA 2022:S0034-7450(22)00028-2. [PMID: 35600217 PMCID: PMC9112035 DOI: 10.1016/j.rcp.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/07/2022] [Indexed: 06/15/2023]
Abstract
Introduction Social distancing measures due to the COVID-19 pandemic prevented many children with neurodevelopmental disorders from accessing face-to-face treatments. Telerehabilitation grew at this time as an alternative therapeutic tool. In this study we analysed remote cognitive rehabilitation in neurodevelopmental disorders. Methods This was a prospective, quasi-experimental (before-after) study that included 22 patients (mean age 9.41 years) with neurodevelopmental disorders who had telerehabilitation for over six months. Results After six months of telerehabilitation, a statistically significant improvement was found with a large effect size in these areas: attention (sustained, selective and divided), executive functions (verbal and visual working memory, categorisation, processing speed), visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia) and language (comprehensive and expressive). On the Weiss Functional Impairment Scale, all areas (family, learning and school, self-concept, activities of daily living, risk activities) improved with statistical significance. We found a positive correlation between the number of sessions and the improvement observed in executive functions (visual working memory, processing speed), attention (sustained attention, divided attention) and visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia). We did not find statistical significance between the family structure and the number of sessions carried out. A high degree of perception of improvement and satisfaction was observed in the parents. Conclusions Telerehabilitation is a safe alternative tool which, although it does not replace face-to-face therapy, can achieve significant cognitive and functional improvements in children with neurodevelopmental disorders.
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Affiliation(s)
- Esteban Vaucheret Paz
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Giacchino
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Leist
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Chirilla
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luciana Petracca
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Agosta
- Servicio de Neurología Infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Bergquist TF, Moessner AM, Mandrekar J, Ransom JE, Dernbach NL, Kendall KS, Brown AW. CONNECT: A pragmatic clinical trial testing a remotely provided linkage to service coordination after hospitalization for TBI. Brain Inj 2022; 36:147-155. [PMID: 35192438 DOI: 10.1080/02699052.2022.2042601] [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: 11/02/2022]
Abstract
OBJECTIVE To test whether a complex behavioral intervention delivered remotely to connect individuals to clinical resources after hospitalization for TBI improved their quality of life. DESIGN/METHODS Community-based randomized pragmatic clinical trial. Main measures TBI-QOL, Activity Measure for Post-Acute Care (AM-PAC), Clinical Satisfaction and Competency Rating Scale. RESULTS 332 individuals ≥18 years-old hospitalized for TBI in four upper Midwest states were randomized to Remote (n = 166) and Usual Care (n = 166) groups. The groups were equivalent and representative of their state population's racial and ethnic composition, age, and proportion living in rural communities. There were no significant differences within or between experimental groups over the study period in TBI-QOL t-scores. There was a significant improvement in AM-PAC Daily Activities within the Remote group and a significant between-group improvement in clinical satisfaction for the Remote group. CONCLUSION Enrolling a representative, regional community-based sample of individuals with TBI can be successful, and delivering a customized complex behavioral intervention remotely is feasible. The overall lack of intervention effectiveness was likely due to enrolling individuals without pre-identified clinical needs, initiating intervention after the immediate post-acute phase when needs are often highest, inability to provide direct clinical care remotely, and potential lack of outcome measure responsiveness in our sample.
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Affiliation(s)
- Thomas F Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anne M Moessner
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay Mandrekar
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanine E Ransom
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicole L Dernbach
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn S Kendall
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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It takes two to tango: The therapeutic alliance in community brain injury rehabilitation. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
A positive therapeutic (or working) alliance has been associated with better outcomes for clients in the psychotherapeutic and traumatic brain injury (TBI) rehabilitation literature. The aim of this pilot study was to gain an understanding of the therapeutic alliance in community rehabilitation from the perspectives of adults with TBI and their close others who have completed a community rehabilitation programme.
Method:
This study used a constructivist, qualitative methodology which applied grounded theory analysis techniques. Using purposeful sampling, three pairs of participants (adults with TBI and close others) who had finished a community rehabilitation programme completed separate in-depth interviews which were transcribed verbatim and progressively analysed using a process of constant comparison.
Results:
A preliminary framework illustrating participants’ experience of a therapeutic alliance was generated, comprising three interconnected themes: being recognised as an individual, working together and feeling personally connected. All participants viewed being able to work together as important in their experience of community rehabilitation and described features that helped and hindered the alliance.
Conclusion:
These pilot study results demonstrate the importance of the therapeutic alliance to the rehabilitation experience of individuals with TBI and those close to them.
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Torres A, Diaz P, Freund R, Baker TN, Baker AZ, Peluso P. Therapeutic alliance in vocational rehabilitation counseling: Assessing client factors and functioning. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The therapeutic relationship is often acknowledged as one of the most significant factors in clinical process that influences client outcomes. OBJECTIVE: While considerable research has been conducted on the therapeutic relationship in psychotherapy, there is a paucity of research on the impact of the therapeutic relationship in vocational rehabilitation counseling settings. METHODS: This study explored the relationship between areas of client functioning (individual, interpersonal, social, and overall) and the therapeutic alliance among clients who receive services from the State vocational rehabilitation agency. RESULTS: In this study, younger clients (ages between 16 to 29) reported stronger therapeutic alliance. CONCLUSION: The findings of this study suggested that clients’ perceived individual, interpersonal and overall functioning have a significant positive relationship with the task and bond components of therapeutic relationship.
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Affiliation(s)
- Ayse Torres
- Florida Atlantic University, Boca Raton, FL, USA
| | | | - Robert Freund
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | | | - Paul Peluso
- Florida Atlantic University, Boca Raton, FL, USA
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14
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O'Donnell K, Healy A, Burke T, Staines A, McGettrick G, Kwasky A, O'Halloran P, Corrigan C. Traumatic brain injury epidemiology and rehabilitation in Ireland: a protocol paper. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13209.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, a dearth of research on TBI means that we neither know the number of people affected by this injury, nor have the information required to improve neuro-rehabilitation services. Aims: This is the protocol for a study that will examine pathways through rehabilitation for survivors of TBI in the Republic of Ireland. The experiences of family members providing care or support to a person with TBI will also be explored. Additionally, the study will estimate the incidence and prevalence of TBI in Ireland. Epidemiological data and information on how people with TBI access rehabilitation and health services will support advocacy efforts towards the redevelopment of neuro-rehabilitation services. Methods: The research is a mixed method, observational cohort study design. Participants with moderate to severe TBI will be recruited through two brain injury service providers, two acute hospitals that provide neurosurgical services, and the National Rehabilitation Hospital. Questionnaires will be administered to participants with TBI on two separate occasions, six months apart, and to family members providing care or support to an individual with TBI, on one occasion. Data from the medical records of participants will be abstracted to capture key information about their brain injury. TBI survivor participants’ use of health care will be followed prospectively for six months. Expected outcomes: The study will outline participants’ pathways through rehabilitation in Ireland, to understand how rehabilitation services are accessed, and the barriers to accessing these services. The incidence and prevalence of TBI in Ireland will be estimated. Experiences of family members providing care or support to an individual with TBI will be detailed. The outcomes of the study will support ongoing efforts to improve care for TBI survivors in Ireland and to redevelop neuro-rehabilitation services.
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15
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Cummins C, Payne D, Kayes NM. Governing neurorehabilitation. Disabil Rehabil 2021; 44:4921-4928. [PMID: 33989096 DOI: 10.1080/09638288.2021.1918771] [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 Person centred approaches to rehabilitation are promoted as an ethical means of addressing paternalistic power relations in clinician dominated medical encounters and improving outcomes. However, they fail to account for the complex nature of power. We sought alternative ways to explain the use of power in health service provision. METHODS A poststructural discourse analysis using the view of power offered by Michel Foucault was undertaken. Foucault's concept of governmentality is useful to explain the way health services deploy technologies of power to achieve objectives of the state. Governmentality refers to not just political structures but all the strategies and procedures for directing human behaviour. RESULTS Our investigation uncovered a web of strategic relationships operating that were both potentially productive and problematic and illuminate how client centred approaches in neurorehabilitation intertwines its subjects in strategic power relationships that involve webs of obligations and responsibilities. CONCLUSION The client-professional relationship promoted in neurorehabilitation as a moral way to practice can be a tool for mastery of one over the other, and assist the client to achieve their desired ends, but also has the potential to marginalise others who are unable to shape themselves into the desired ideal client.Implications for rehabilitationThis analysis shows how power is subtle and productive in that it produces knowledge and roles for both clients and practitioners.It demonstrates how neurorehabilitation's disciplinary practices assist the client to achieve their recovery goals.It reveals how certain clients might be marginalised when they cannot shape themselves into the ideal rehabilitation client.As a final point we hope that by being aware of how power works in neurorehabilitation, practitioners can become aware of opportunities for challenging disciplinary practices that do not serve the best interest of the client.
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Affiliation(s)
- Christine Cummins
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Payne
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.,Centre for Midwifery and Women's Health Research, Auckland University of Technology, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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16
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Rowlands L, Coetzer R, Turnbull OH. Building the bond: Predictors of the alliance in neurorehabilitation. NeuroRehabilitation 2020; 46:271-285. [PMID: 32310195 DOI: 10.3233/nre-193005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurorehabilitation services are often delivered through group psycho-education programmes. However, little is known about the therapeutic process at work during such sessions. The present study is the first to gain insight into the therapeutic alliance, during a seven-session group programme. In addition, cognitive, emotional, and demographic predictors of the alliance, and participants' feelings towards their group members, were investigated, together with predictors of patient engagement. METHODS Forty-five participants with an acquired brain injury completed a series of questionnaires, and neuropsychological assessment, following group psycho-education. The group facilitator completed a parallel therapeutic alliance questionnaire, and rated participants' engagement. RESULTS Results demonstrated that a strong alliance can be formed in seven group sessions. Notably, no demographic or cognitive factors appear to pose a barrier to developing a therapeutic alliance, nor to group attraction. CONCLUSION High levels of depression, however, may be a challenge, and clinicians may need to tailor their clinical skills to ensure a good therapeutic relationship with such patients. To promote engagement, clinicians may also need to provide additional support to patients with lower levels of education, working memory, and episodic memory impairment.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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17
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Hall MS, Podlog L, Newton M, Galli N, Fritz J, Butner J, Greviskes L, Hammer C. Patient and practitioner perspectives of psychological need support in physical therapy. Physiother Theory Pract 2020; 38:670-685. [PMID: 32627632 DOI: 10.1080/09593985.2020.1780654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine strategies utilized by physical therapists that contributed to patient perceptions of basic psychological needs support articulated within Self-Determination Theory (SDT). METHODS Semi-structured interviews were conducted with physical therapists (n = 9) and physical therapy patients (n = 9) undergoing rehabilitation for a variety of musculoskeletal injuries. RESULTS Both patients and practitioners articulated the value of specific competence (e.g. matching rehabilitation challenges with patient abilities) and autonomy support strategies (e.g. active decision-making). Interestingly, both patients and therapists emphasized the salience of relatedness need support, a finding indicative of the potential importance of this need in a rehabilitation environment. The possibility that relatedness need support may be of equal - or potentially greater - importance than the other two needs in a rehabilitation setting, is however, antithetical to SDT contentions. Whether the primacy of relatedness need support is an artifact of the sample used in the current study or a reflection of a broader rehabilitation trend, is uncertain and remains a topic for further investigation. CONCLUSIONS Understanding the strategies physical therapists use to support patients' psychological needs may have substantial implications for patient motivation and rehabilitation adherence, such as, improved psychological well-being, enhanced function, and increased adherence to physical therapists' recommendations.
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Affiliation(s)
- Morgan S Hall
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Leslie Podlog
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Maria Newton
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Nick Galli
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Jonathan Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Lindsey Greviskes
- Department of Health, Physical Education, Recreation, and Coaching, University of Wisconsin-Whitewater, Whitewater, WI, USA
| | - Chris Hammer
- Athletics Department, Davis & Elkins College, Elkins, WV, USA
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18
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Stagg K, Douglas J, Iacono T. The perspectives of allied health clinicians on the working alliance with people with stroke-related communication impairment. Neuropsychol Rehabil 2020; 31:1390-1409. [PMID: 32546084 DOI: 10.1080/09602011.2020.1778491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The processes by which working alliances develop in stroke rehabilitation are not well understood. The aim of this study was to explore the ways in which experienced allied health clinicians establish and maintain alliances with people with stroke-related communication impairment, and to identify factors that may influence the strength of these alliances. In-depth interviews were completed with 11 clinicians from the disciplines of occupational therapy, speech-language pathology and physiotherapy. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory. Participants described processes that were captured by the themes of enabling interaction, being responsive, building relational capital and building credibility. Practices that supported communication and emphasized responding, both within an interaction and over time, aligned with examples of strong alliances. Professional credibility and relational practices such as everyday conversations and the use of humour were viewed as important. Difficulty accessing a shared mode of communication due to stroke-related communication impairment altered relational processes and influenced perceptions of the alliance, although examples of strong alliances were present. In this study, reflections on challenging alliances highlighted potentially helpful practices. A responsive approach to rehabilitation, supported by reflective practice, may assist clinicians to better navigate their working alliances with this population.
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Affiliation(s)
- Kellie Stagg
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia.,Summer Foundation, Melbourne, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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19
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Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors. J Int Neuropsychol Soc 2020; 26:97-107. [PMID: 31983372 DOI: 10.1017/s1355617719000791] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI). METHODS The audio recordings of 177 CBT-ABI sessions representing 31 therapist-client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework. RESULTS Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms. CONCLUSIONS CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.
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20
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Lawton M, Conroy P, Sage K, Haddock G. Aphasia and stroke therapeutic alliance measure (A-STAM): Development and preliminary psychometric evaluation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:459-469. [PMID: 31416382 DOI: 10.1080/17549507.2019.1648551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary evidence of the measure's psychometric properties. Method: Statements were generated from the: (1) therapeutic alliance literature, (2) qualitative interviews with stakeholders, and (3) Q methodological insights with people with aphasia (PWA) (n = 455). A representative sample of statements was identified from the data set (n = 57) and reviewed by expert panels (professionals and PWA), culminating in a 42-item clinician and patient version of the aphasia and stroke therapeutic alliance measure (A-STAM). Reliability and validity of both the clinician and patient versions of A-STAM were investigated with 34 Clinician-patient dyads engaging in therapy. Result: Internal consistency and test-retest reliability were excellent for both clinician (α = 92; ICC = 0.93) and patient versions of A-STAM (α = 0.92; ICC = 0.97). In both versions, scores correlated highly with psychotherapeutic measures of therapeutic alliance, indicative of good construct validity (rs = 0.75; rs = 0.77). Conclusion: The findings establish the preliminary reliability and validity of A-STAM and support further investigation into the measure's psychometric properties in larger samples.
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Affiliation(s)
- Michelle Lawton
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester , Manchester , UK
| | - Paul Conroy
- Faculty of Health and Wellbeing, Centre for Health and Social Care Research, Sheffield Hallam University , Sheffield , UK
| | - Karen Sage
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine & Health, The University of Manchester , Manchester , UK
| | - Gillian Haddock
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester , Manchester , UK
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21
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Bishop M, Kayes N, McPherson K. Understanding the therapeutic alliance in stroke rehabilitation. Disabil Rehabil 2019; 43:1074-1083. [PMID: 31433673 DOI: 10.1080/09638288.2019.1651909] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The quality of the therapeutic alliance between a client and their clinician is thought to play an important role in healthcare but there is limited research about this concept in stroke rehabilitation. This study explored the core components of a therapeutic alliance and the factors perceived to impact on its development in a stroke rehabilitation unit. METHODS Interpretive description methodology was used to gather and synthesise participants' experiences of their therapeutic relationships. Ten individual client interviews and one clinician focus group were conducted. Data was were analysed using conventional content analysis. RESULTS A therapeutic alliance appeared to consist of three overlapping core components: a personal connection, a professional collaboration, and family collaboration. Clients valued these components to different degrees and priorities could change over time. Alliance breakdowns were perceived to stem from a clinician's incorrect assumptions about their client's relationship preferences or lack of responsiveness to their needs. Recovery of the alliance seemed to depend on the strength of the pre-existing relationship and steps taken to repair it. CONCLUSIONS Establishing and maintaining a therapeutic alliance appears to be an individualised and complex process. A clinician's ability to use their personal attributes therapeutically, and professional skills flexibly, appeared integral to relationship quality.IMPLICATIONS FOR REHABILITATIONDeveloping therapeutic relationships requires a person-centred and sometimes family/whānau-centred approach.The judicious use of self-disclosure may achieve emotional proximity and yet maintain professional boundaries.Maintaining relationship health requires a proactive approach to detect and manage relationship disruptions.
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Affiliation(s)
- Megan Bishop
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.,School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Kathryn McPherson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.,Health Research Council of New Zealand, Auckland, New Zealand
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22
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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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23
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Araujo AC, Filho RN, Oliveira CB, Ferreira PH, Pinto RZ. Measurement properties of the Brazilian version of the Working Alliance Inventory (patient and therapist short-forms) and Session Rating Scale for low back pain. J Back Musculoskelet Rehabil 2018; 30:879-887. [PMID: 28282795 DOI: 10.3233/bmr-160563] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the low back pain (LBP) field, therapeutic alliance is considered a non-specific factor of interventions associated with improvements in clinical outcomes. However, there is a paucity of studies aimed to evaluate measurement properties of tools used to objectively quantify the alliance between therapist and patients, such as the Working Alliance Inventory (WAI) and Session Rating Scale (SRS). OBJECTIVE To translate and cross-culturally adapt the short-form version of WAI - therapist and SRS into Brazilian Portuguese; to investigate the measurement properties, of the WAI-Patient, WAI-Therapist and SRS in patients with LBP and their physical therapists, respectively. METHODS One hundred patients with LBP and 18 physical therapists were recruited from physical therapy clinics in Brazil. Therapeutic alliance measures were collected at the initial assessment, prior to the second session, and at 2-month follow-up. The measurement properties investigated were reproducibility, internal consistency, ceiling/floor effects and responsiveness. RESULTS Although WAI-Patient, WAI-Therapist and SRS were considered to have acceptable test-retest reliability (ICC2,1 > 0.70), these questionnaires showed problems with other measurement properties. WAI-Patient showed problems with internal consistency (i.e. Cronbach's alpha < 0.70 for all subscales). Presence of ceiling effect (i.e. > 15% of participants with the maximum score) and poor internal responsiveness were found for the WAI-Patient (Effect size = 0.15; 84% CI: 0.04 to 0.29) and for the SRS (Effect size = 0.05; 84% CI: -0.22 to 0.11). The WAI-Therapist revealed slightly better measurement properties. CONCLUSION We identified psychometric limitations with most measurement properties of the WAI questionnaires and SRS. Future studies are needed to refine these tools.
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Affiliation(s)
- Amanda Costa Araujo
- Physiotherapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Rúben Negrão Filho
- Physiotherapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Crystian B Oliveira
- Physiotherapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Rafael Z Pinto
- Physiotherapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, São Paulo, Brazil
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Stagg K, Douglas J, Iacono T. A scoping review of the working alliance in acquired brain injury rehabilitation. Disabil Rehabil 2017; 41:489-497. [DOI: 10.1080/09638288.2017.1396366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kellie Stagg
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
- Summer Foundation, Melbourne, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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25
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D’Cruz K, Douglas J, Serry T. Personal narrative approaches in rehabilitation following traumatic brain injury: A synthesis of qualitative research. Neuropsychol Rehabil 2017; 29:985-1004. [DOI: 10.1080/09602011.2017.1361844] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kate D’Cruz
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
- Summer Foundation, Melbourne, Australia
| | - Tanya Serry
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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26
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Swinnen E, Lefeber N, Willaert W, De Neef F, Bruyndonckx L, Spooren A, Michielsen M, Ramon T, Kerckhofs E. Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists. Top Stroke Rehabil 2016; 24:299-308. [PMID: 27996894 DOI: 10.1080/10749357.2016.1266750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the development of efficacious driven gait orthoses (DGO), it is an added value to consider patients' and therapists' perspectives concerning robot-assisted gait training (RAGT). A better understanding of these issues may improve the process of care and outcome. OBJECTIVES This study aimed to examine stroke patients' motivation and expectations of RAGT, and therapists' expectations and perspectives on the usability of RAGT. Additionally, the differences in expectations between stroke patients and their therapists were analyzed. METHODS A cross sectional, multi-center, three-group trial was conducted. Included were (1) stroke patients who have experience with RAGT (i.e. the stroke user group), (2) stroke patients who have no experience with RAGT (i.e. the stroke non-user group), and (3) therapists who have experience with RAGT (i.e. the therapist user group). The Intrinsic Motivation Inventory (IMI), Credibility/Expectancy Questionnaire (CEQ), and Usefulness, Satisfaction and Ease of Use Questionnaire (USE) were used. Descriptive statistics and non-parametric Kruskal-Wallis tests were conducted. RESULTS In total, 46 subjects were assessed (stroke user group: n = 23, stroke non-user group: n = 14, therapist user group: n = 9). IMI subscale scores ranged from 42 to 88%. Mean credibility and expectancy ranged from 80 to 85% and 57 to 72%, respectively, with no significant differences between groups. USE subscale scores ranged from 61 to 72%. CONCLUSIONS Stroke user group patients seem quite motivated to train with the DGO and both patients and therapists reasonably believe that this training could improve gait functioning. Therapists are moderately satisfied with the usability of the DGO, but there is room for improvement with respect to usefulness and ease of use.
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Affiliation(s)
- Eva Swinnen
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nina Lefeber
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ward Willaert
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Fallon De Neef
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lyn Bruyndonckx
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Annemie Spooren
- d Centre of Expertise - Care in Innovation , PXL University College , Hasselt , Belgium.,e Faculty of Medicine and Life Sciences, REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute , Hasselt University , Hasselt , Belgium
| | - Marc Michielsen
- f St. Ursula Rehabilitation Centre , Jessa Hospital , Herk-de-Stad , Belgium
| | - Tine Ramon
- g AZ Delta Hospital , Roeselare , Belgium
| | - Eric Kerckhofs
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
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27
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Therapeutic Alliances in Stroke Rehabilitation: A Meta-Ethnography. Arch Phys Med Rehabil 2016; 97:1979-1993. [PMID: 27137094 DOI: 10.1016/j.apmr.2016.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/24/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To synthesize qualitative studies exploring patients' and professionals' perspectives and experiences of developing and maintaining therapeutic alliances in stroke rehabilitation. DATA SOURCES A systematic literature search was conducted using the following electronic databases: PsycINFO, CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, and ComDisDome from inception to May 2014. This was supplemented by hand searching, reference tracking, generic web searching, and e-mail contact with experts. STUDY SELECTION Qualitative peer reviewed articles reporting experiences or perceptions of the patient or professional in relation to therapeutic alliance construction and maintenance in stroke rehabilitation were selected for inclusion. After a process of exclusion, 17 publications were included in the synthesis. DATA EXTRACTION All text identified in the results and discussion sections of the selected studies were extracted verbatim for analysis in a qualitative software program. Studies were critically appraised independently by 2 reviewers. DATA SYNTHESIS Articles were synthesized using a technique of meta-ethnography. Four overarching themes emerged from the process of reciprocal translation: (1) the professional-patient relationship: degree of connectedness; (2) asymmetrical contributions; (3) the process of collaboration: finding the middle ground; and (4) system drivers. CONCLUSIONS The findings from the meta-ethnography suggest that the balance of power between the patient and professional is asymmetrically distributed in the construction of the alliance. However, given that none of the studies included in the review addressed therapeutic alliance as a primary research area, further research is required to develop a conceptual framework relevant to stroke rehabilitation, in order to determine how this construct contributes to treatment efficacy.
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Brett CE, Sykes C, Pires-Yfantouda R. Interventions to increase engagement with rehabilitation in adults with acquired brain injury: A systematic review. Neuropsychol Rehabil 2015; 27:959-982. [DOI: 10.1080/09602011.2015.1090459] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Caroline Elizabeth Brett
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, City University London, London, UK
| | | | - Renata Pires-Yfantouda
- Department of Psychology, City University London, London, UK
- South London and the Maudsley NHS Trust, Liaison Psychiatry for Guy's and St Thomas's Hospital, London, UK
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Greenwood A, Theadom A, Kersten P, McPherson KM. Exploring researchers' experiences of working with people with acquired brain injury. Brain Inj 2015; 29:592-600. [PMID: 25790259 DOI: 10.3109/02699052.2014.1002422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to investigate the challenges and positive experiences of researchers who work with people who have experienced an acquired brain injury and their families. METHODS People who were currently or had previously worked as a researcher in the field of acquired brain injury (using either quantitative or qualitative methods) were invited to participate in a focus group or individual interview about their experiences. An expert reference group meeting was held to discuss strategies that could be implemented to enhance the researcher experience based on the interview data. RESULTS A total of 19 researchers who worked across four different research teams took part in the study. Six inter-connected themes were identified: researcher motivation, meaning and fulfillment; human connection; knowing and understanding the role; complexity of brain injury in the research context; the research process; and state of the researcher. A number of recommendations for supporting researchers more effectively were identified. DISCUSSION Researchers described a number of positive aspects as well as tensions they encountered in their role. The findings highlight the need to ensure researchers are supported effectively to ensure the quality of research studies in the field of brain injury.
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Affiliation(s)
- Andrea Greenwood
- Person Centred Research Centre, Health and Rehabilitation Institute and
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Bergquist TF, Yutsis M, Sullan MJ. Satisfaction with Cognitive Rehabilitation Delivered via the Internet in Persons with Acquired Brain Injury. Int J Telerehabil 2015; 6:39-50. [PMID: 25945228 PMCID: PMC4353005 DOI: 10.5195/ijt.2014.6142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We examined the level of satisfaction with cognitive rehabilitation delivered via the Internet in persons with moderate to severe acquired brain injury (ABI). Fifteen adults with moderate to severe ABI were randomized to 30 days of Internet-based active treatment (AT) or to a wait list (WL) group, and crossed over to the opposite condition after 30 sessions. Both caregivers and participants were assessed at three time points during the study. This study focused on participant satisfaction with receiving treatment in this manner. Though the results of this study showed no significant treatment effect, the vast majority of participants (>87%) were satisfied with treatment. Treatment satisfaction accounted for 25% of additional variance in predicting lower family ratings of mood difficulties after final assessment (p<.03). Greater satisfaction with treatment was positively correlated with greater employment rate after treatment (r=.63, p=.02), as well as lower family ratings of memory and mood difficulties after final assessment (r=−.59, p=.03; r=−.58, p=.03,). Results suggest that treatment satisfaction in persons with ABI is related to less activity limitations, and maintaining employment after cognitive rehabilitation delivered via the Internet.
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Affiliation(s)
- Thomas F Bergquist
- DEPARTMENT OF PSYCHIATRY & PSYCHOLOGY, MAYO CLINIC COLLEGE OF MEDICINE, ROCHESTER, MN, USA ; DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION, MAYO CLINIC COLLEGE OF MEDICINE, ROCHESTER, MN, USA
| | - Maya Yutsis
- DEPARTMENT OF PSYCHOLOGY, VA PALO ALTO HEALTHCARE SYSTEM, PALO ALTO, CA, USA
| | - Molly J Sullan
- DEPARTMENT OF CLINICAL AND HEALTH PSYCHOLOGY UNIVERSITY OF FLORIDA, GAINESVILLE, FL, USA
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Abstract
IMPORTANCE Persistent pain is highly prevalent, costly, and frequently disabling in later life. OBJECTIVE To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. EVIDENCE ACQUISITION Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. FINDINGS Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended-emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. CONCLUSIONS AND RELEVANCE Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.
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Affiliation(s)
- Una E Makris
- Department of Internal Medicine, Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, Texas2Department of Medicine, Division of Rheumatology, Veterans Administration Medical Center, Dallas, Texas
| | - Robert C Abrams
- Department of Psychiatry, Weill Cornell Medical College, New York, New York4Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Barry Gurland
- Stroud Center, Columbia University, New York, New York
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
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Rosti-Otajärvi E, Mäntynen A, Koivisto K, Huhtala H, Hämäläinen P. Predictors and impact of the working alliance in the neuropsychological rehabilitation of patients with multiple sclerosis. J Neurol Sci 2014; 338:156-61. [DOI: 10.1016/j.jns.2013.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/22/2013] [Accepted: 12/24/2013] [Indexed: 01/28/2023]
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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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Self-Awareness and Health-Related Quality of Life After Traumatic Brain Injury. J Head Trauma Rehabil 2013; 28:464-72. [DOI: 10.1097/htr.0b013e318263977d] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Block CK, West SE. Psychotherapeutic treatment of survivors of traumatic brain injury: Review of the literature and special considerations. Brain Inj 2013; 27:775-88. [DOI: 10.3109/02699052.2013.775487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of patients with chronic low back pain (LBP) has not been previously investigated. OBJECTIVE The purpose of this study was to investigate whether the therapeutic alliance between physical therapists and patients with chronic LBP predicts clinical outcomes. DESIGN This was a retrospective observational study nested within a randomized controlled trial. METHODS One hundred eighty-two patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate whether the alliance was a predictor of outcome or moderated the effect of treatment. RESULTS The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for 2 of 3 treatment contrasts (general exercise versus motor control exercise, spinal manipulative therapy versus motor control exercise). There was no treatment effect modification when outcome was measured with function, pain, and disability measures. LIMITATIONS Therapeutic alliance was measured at the second treatment session, which might have biased the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks. CONCLUSIONS Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.
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Hufford BJ, Williams MK, Malec JF, Cravotta D. Use of behavioural contracting to increase adherence with rehabilitation treatments on an inpatient brain injury unit: A case report. Brain Inj 2012; 26:1743-9. [DOI: 10.3109/02699052.2012.698791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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O'Callaghan A, McAllister L, Wilson L. Insight vs readiness: factors affecting engagement in therapy from the perspectives of adults with TBI and their significant others. Brain Inj 2012; 26:1599-610. [PMID: 22738228 DOI: 10.3109/02699052.2012.698788] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Adults sustain significant, often irreversible impairments following brain injury. The process they go through coming to terms with these impairments can seriously interfere with their readiness to engage in rehabilitation. AIM This study aimed to look beyond the development of self-awareness and insight in order to explore the concept of readiness as it relates to clients' experiences of engaging with therapy. METHOD Sixteen in-depth interviews were conducted with 14 adults with a moderate-severe traumatic brain injury (TBI) and nine of their significant others. These participants were asked to speak about the continuum of care they experienced and the factors that effected their engagement with care. RESULTS The results of this study indicated that participants believed their ability to engage in therapy was related to the degree to which they were aware of and accepted their impairments and motivated to engage in rehabilitation. Participants reported that the rate and degree to which they developed awareness varied according to the type of impairments they experienced (i.e. physical vs cognitive). Participants also stated that one way to augment their awareness was to compare their new vs old selves and to compare their recovery to those of others with a similar impairment. Finally, participants reported that it was important to be able to access services when they had accepted their impairment and were ready to engage in therapy. CONCLUSION The clinical implications for considering the degree of awareness of impairments and readiness for engagement in care of an adult with a moderate-severe TBI are discussed in relation to future services planning.
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Kayes NM, McPherson KM. Human technologies in rehabilitation: ‘Who’ and ‘How’ we are with our clients. Disabil Rehabil 2012; 34:1907-11. [DOI: 10.3109/09638288.2012.670044] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schönberger M, Ponsford J, Reutens D, Beare R, Clarke D, O'Sullivan R. The relationship between mood disorders and MRI findings following traumatic brain injury. Brain Inj 2011; 25:543-50. [PMID: 21534732 DOI: 10.3109/02699052.2011.565013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND High rates of depression have been reported in individuals with traumatic brain injury (TBI). The purpose of the current study was to investigate the relationship between structural MRI findings and the development of novel cases of post-injury depression in this population METHODS The study has a cross-sectional design. Assessments were conducted on average 2.2 years post-injury. Participants were 54 individuals (76% male, mean age 35 years, median PTA duration 16 days) who had sustained a TBI. Depression was assessed with the Structured Clinical Interview for DSM-IV (SCID-IV). Structural MRI scans were performed with a 1.5 Tesla machine. RESULTS The presence of lesions in the frontal, temporal, parietal and the sublobar regions was not related to depression. However, an imbalance of left vs right frontal and parietal viable brain volumes was related to the development of depression. DISCUSSION These findings are in support of Heller's model of emotion processing, but should be replicated using larger samples. Potential clinical implications are discussed in the manuscript.
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Affiliation(s)
- Michael Schönberger
- Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Germany.
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Radomski MV. More Than Good Intentions: Advancing Adherence to Therapy Recommendations. Am J Occup Ther 2011; 65:471-7. [DOI: 10.5014/ajot.2011.000885] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Clinical Scientist, Sister Kenny Research Center, 800 East 28th Street, Minneapolis, MN 55407;
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Hawthorne G, Kaye A, Gruen R, Houseman D, Bauer I. Traumatic brain injury and quality of life: Initial Australian validation of the QOLIBRI. J Clin Neurosci 2011; 18:197-202. [DOI: 10.1016/j.jocn.2010.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/14/2010] [Indexed: 10/18/2022]
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Abstract
Rehabilitation professionals have become increasingly aware that traumatic brain injury has a long-term adverse impact on family members as well as on survivors. Family members often have a critical supporting role in the recovery process, and researchers have identified a relationship between caregiver well-being and survivor outcome. Drawing from the fields of family therapy, cognitive-behavioral therapy, and individual psychotherapy, this article provides information to help clinicians effectively serve families. First, historically important and widely cited publications are reviewed and their implications for practice are discussed. Recommendations for developing successful therapeutic alliances are provided along with a rationale for their importance. Descriptions of common challenges and issues faced by families are presented along with corresponding therapeutic goals. Intervention principles and strategies, selectively chosen to help family members achieve therapeutic goals, are discussed. The article concludes with a presentation of ideas to help practitioners and systems of care more effectively help family members adjust and live fulfilling lives.
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Medley AR, Powell T. Motivational Interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review. Neuropsychol Rehabil 2010; 20:481-508. [DOI: 10.1080/09602010903529610] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Phys Ther 2010; 90:1099-110. [PMID: 20576715 DOI: 10.2522/ptj.20090245] [Citation(s) in RCA: 350] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The working alliance, or collaborative bond, between client and psychotherapist has been found to be related to outcome in psychotherapy. PURPOSE The purpose of this study was to investigate whether the working alliance is related to outcome in physical rehabilitation settings. DATA SOURCES A sensitive search of 6 databases identified a total of 1,600 titles. STUDY SELECTION Prospective studies of patients undergoing physical rehabilitation were selected for this systematic review. DATA EXTRACTION For each included study, descriptive data regarding participants, interventions, and measures of alliance and outcome-as well as correlation data for alliance and outcomes-were extracted. DATA SYNTHESIS Thirteen studies including patients with brain injury, musculoskeletal conditions, cardiac conditions, or multiple pathologies were retrieved. Various outcomes were measured, including pain, disability, quality of life, depression, adherence, and satisfaction with treatment. The alliance was most commonly measured with the Working Alliance Inventory, which was rated by both patient and therapist during the third or fourth treatment session. The results indicate that the alliance is positively associated with: (1) treatment adherence in patients with brain injury and patients with multiple pathologies seeking physical therapy, (2) depressive symptoms in patients with cardiac conditions and those with brain injury, (3) treatment satisfaction in patients with musculoskeletal conditions, and (4) physical function in geriatric patients and those with chronic low back pain. LIMITATIONS Among homogenous studies, there were insufficient reported data to allow pooling of results. CONCLUSIONS From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.
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Hawthorne G, Gruen RL, Kaye AH. Traumatic brain injury and long-term quality of life: findings from an Australian study. J Neurotrauma 2010; 26:1623-33. [PMID: 19317590 DOI: 10.1089/neu.2008.0735] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent calls have been made for the inclusion of health-related quality of life (HRQoL) in traumatic brain injury studies. This study reports the impact of TBI on traditional measures (general health, depression, social isolation, labor force participation), self-assessed health function status using the SF-36 version 2 (SF-36V2), and self-assessed health preference using two generic utility instruments, the assessment of quality of life (AQoL) and the SF6D. A random sample of TBI cases (n = 66) was drawn from a trauma registry and matched (gender, age, education, and relationship status) with non-trauma-exposed cases from a population health survey. All participants were interviewed and the two cohorts compared. When compared with matched comparators, TBI cases experienced worse general health, elevated probabilities of depression, social isolation, and worse labor force participation rates. The TBI-cohort reported worse health status on the SF-36V2. The most affected areas were social function, role emotion, and mental health (effect sizes -0.70 to -0.86). The reported utility values indicative of a HRQoL between 13 and 24% worse than their non-TBI contemporaries (effect sizes -0.80 to -0.81). The findings suggest that TBI has long-term consequences across all aspects of peoples' lives, and that these consequences can be self-assessed using generic instruments. The challenge is to provide and evaluate long-term services targeted at the life areas that those with TBI find particularly difficult.
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Affiliation(s)
- Graeme Hawthorne
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
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Schönberger M, Humle F, Teasdale TW. The relationship between clients’ cognitive functioning and the therapeutic working alliance in post-acute brain injury rehabilitation. Brain Inj 2009; 21:825-36. [PMID: 17676440 DOI: 10.1080/02699050701499433] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the impact of brain-injured patients' cognitive abilities on their working alliance (WA) with their therapist in post-acute rehabilitation. DESIGN Cognitive tests were administered to brain-injured individuals at the beginning of post-acute, holistic brain-injury rehabilitation. Clients as well as their primary therapists rated their mutual WA at four time points throughout a 14-week rehabilitation programme. Subjects consisted of 86 clients as well as their primary therapists. Clients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10). MEASURES (1) Neuropsychological tests of attention, memory and higher cognitive functions; (2) the Working Alliance Inventory, client and therapist short form. RESULTS Overall, the relationships between cognitive tests and WA ratings were weak. The tests of attention, memory and higher cortical functions were differentially related to clients' and therapists' view of their mutual WA at the different stages of their collaborative work. DISCUSSION AND CONCLUSION Clients' cognitive profile affects clients' and therapists' view of their WA in different ways. The weakness of the correlations between cognitive tests and WA ratings may indicate that a good WA is achievable also with clients with severe cognitive difficulties.
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Wilson C, Huston T, Koval J, Gordon SA, Schwebel A, Gassaway J. SCIRehab Project series: the psychology taxonomy. J Spinal Cord Med 2009; 32:319-28. [PMID: 19810633 PMCID: PMC2718824 DOI: 10.1080/10790268.2009.11760785] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT The integration of psychologists as members of the rehabilitation team has occurred in conjunction with the evolution and adoption of interdisciplinary teams as the standard of care in spinal cord injury (SCI) rehabilitation. Although the value of psychological services during rehabilitation is endorsed widely, specific interventions and their association with patient outcomes have not been examined adequately. OBJECTIVE To address this shortcoming, psychologists from 6 SCI centers collaborated to develop a psychology intervention taxonomy and documentation framework. METHODS Utilizing an interactive process, the lead psychologists from 6 centers compiled an inclusive list of patient characteristics assessed and interventions delivered in routine psychological practice at the participating rehabilitation facilities. These were systematically grouped, defined, and compared. RESULTS The resulting taxonomy became the basis of a documentation framework utilized by psychologists for the study. The psychology taxonomy includes 4 major clinical categories (assessment, psychotherapeutic interventions, psychoeducational interventions, and consultation) with 5 to 10 specific activities in each category. CONCLUSIONS Examination of psychological interventions and their potential association with positive outcomes for persons who sustain SCI requires the development of a taxonomy. Results of these efforts illustrate similarities and differences in psychological practice among SCI centers and offer the opportunity to blend research and clinical practice in an innovative approach to evidence-based practice improvement. The established taxonomy provides a basic framework for future studies on the effect of psychological interventions.
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Affiliation(s)
- Catherine Wilson
- 1Rehabilitation Institute of Chicago, Chicago, Illinois; 2Craig Hospital, Englewood, Colorado; 3Shepherd Center, Atlanta, Georgia; 4National Rehabilitation Hospital, Washington, DC; 5Carolinas Rehabilitation, Charlotte, North Carolina; 6Institute for Clinical/Outcomes Research, Salt Lake City, Utah
| | - Toby Huston
- 1Rehabilitation Institute of Chicago, Chicago, Illinois; 2Craig Hospital, Englewood, Colorado; 3Shepherd Center, Atlanta, Georgia; 4National Rehabilitation Hospital, Washington, DC; 5Carolinas Rehabilitation, Charlotte, North Carolina; 6Institute for Clinical/Outcomes Research, Salt Lake City, Utah
| | - Jill Koval
- 1Rehabilitation Institute of Chicago, Chicago, Illinois; 2Craig Hospital, Englewood, Colorado; 3Shepherd Center, Atlanta, Georgia; 4National Rehabilitation Hospital, Washington, DC; 5Carolinas Rehabilitation, Charlotte, North Carolina; 6Institute for Clinical/Outcomes Research, Salt Lake City, Utah
| | - Samuel A Gordon
- 1Rehabilitation Institute of Chicago, Chicago, Illinois; 2Craig Hospital, Englewood, Colorado; 3Shepherd Center, Atlanta, Georgia; 4National Rehabilitation Hospital, Washington, DC; 5Carolinas Rehabilitation, Charlotte, North Carolina; 6Institute for Clinical/Outcomes Research, Salt Lake City, Utah
| | - Andrea Schwebel
- 1Rehabilitation Institute of Chicago, Chicago, Illinois; 2Craig Hospital, Englewood, Colorado; 3Shepherd Center, Atlanta, Georgia; 4National Rehabilitation Hospital, Washington, DC; 5Carolinas Rehabilitation, Charlotte, North Carolina; 6Institute for Clinical/Outcomes Research, Salt Lake City, Utah
| | - Julie Gassaway
- 1Rehabilitation Institute of Chicago, Chicago, Illinois; 2Craig Hospital, Englewood, Colorado; 3Shepherd Center, Atlanta, Georgia; 4National Rehabilitation Hospital, Washington, DC; 5Carolinas Rehabilitation, Charlotte, North Carolina; 6Institute for Clinical/Outcomes Research, Salt Lake City, Utah
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Holm S, Schönberger M, Poulsen I, Caetano C. Patients' and relatives' experience of difficulties following severe traumatic brain injury: The sub-acute stage. Neuropsychol Rehabil 2009; 19:444-60. [DOI: 10.1080/09602010802296402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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