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Versace J, Tazrin S, O'Connor E, Sekibo J, Morey E, Kasinopoulou A, O'Donoghue D, Simblett SK. The role of spirituality and identity formation in personal recovery from traumatic brain injury: A qualitative analysis through the personal experiences of survivors. Neuropsychol Rehabil 2024; 34:1110-1140. [PMID: 38006578 DOI: 10.1080/09602011.2023.2274624] [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: 04/17/2023] [Accepted: 10/04/2023] [Indexed: 11/27/2023]
Abstract
Traumatic brain injury (TBI) is a type of acquired brain injury (ABI) that happens when a sudden, external, physical assault damages the brain. TBI can cause long-term cognitive impairments and other lifestyle changes that may affect psychological wellbeing. Among the psychological challenges people recovering from TBI often face is the subjective loss of their pre-injury identity. Quantitative and qualitative research suggests that spirituality can play a positive role in recovery from TBI, increasing the quality of life and overall mental health. However, thus far, the research into this topic has not directly addressed the relationship between identity and spirituality after TBI. The present study sought to do this by thematically analyzing 22 public podcasts featuring interviews of people recovering from TBI telling their stories. The authors review the spiritual themes discussed in the podcasts and then propose a hypothesis about how, through a sense of connection to something self-transcendent, spirituality may enable people to test new meanings and identities, relatively free from the consequences of discrepancy in meaning and identity after TBI.
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Affiliation(s)
- J Versace
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Tazrin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E O'Connor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Sekibo
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Morey
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Kasinopoulou
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D O'Donoghue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S K Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Elbourn E, Brassel S, Steel J, Togher L. Perceptions of communication recovery following traumatic brain injury: A qualitative investigation across 2 years. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:463-482. [PMID: 36239151 DOI: 10.1111/1460-6984.12795] [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: 04/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exploring the perceptions of individuals with traumatic brain injury (TBI) towards their brain injury recovery across the continuum of care may offer insights to support engagement with rehabilitation services. Illness narratives are a potentially valuable avenue for examining perceptions of recovery that may influence engagement. AIMS The aim of this study is to explore the perspective of individuals with severe TBI towards their communication, brain injury and recovery experiences at 6 months, 1 year and 2 years post-injury. METHODS & PROCEDURES Discourse samples were obtained from 12 participants with severe TBI at 6 months, 1 year and 2 years following injury. A standardised protocol was used to elicit responses relating to perceptions of communication, the brain injury narrative, and perceptions of recovery facilitators. A thematic analysis of the discourse samples was completed. OUTCOMES & RESULTS Three overarching themes were identified: experiences of communication recovery are diverse (Theme 1), varied experiences of recovery and rehabilitation (Theme 2), and continuous and lifelong journey of recovery (Theme 3). Primary communication concerns included presence of anomia, dysarthria, conversational topic difficulties, impacts of fatigue and memory difficulties. Illness narratives revealed the importance of re-establishing a sense of self and the perceived importance of a strong social network post-injury. CONCLUSIONS & IMPLICATIONS The varied nature of communication challenges and recovery after TBI highlights the need for holistic, multidisciplinary support as well as inclusion of family and friends in the recovery process. Social communication intervention is a perceived priority area for individuals with TBI. Illness narratives may also play a valuable role in therapy and help to shape post-injury identity. Managing the impacts of fatigue on communication and encouraging individuals to take ownership over their recovery and treatment may also help to improve patient outcomes. Supporting individuals to construct positive brain injury narratives that reaffirm a sense of self and include perspectives of family and friends may offer a potential future avenue for rehabilitation. Tailored but flexible, team-based service delivery models for individuals with TBI that span from acute to long-term care are warranted. WHAT THIS STUDY ADDS?: What is already known on this subject Communication recovery from traumatic brain injury (TBI) is complex and multifaceted. The perceptions of individuals with TBI toward their communication recovery is largely unknown. To establish rehabilitation services that meet the needs of these individuals, we need to understand how they experience communication recovery. What this paper adds to existing knowledge Social communication interventions were perceived as a priority for intervention by individuals with TBI. Fatigue was identified as perceived barrier to communication recovery. Taking ownership over one's recovery process was revealed as a facilitator of recovery. Illness narratives were found to strengthen post-injury identity over time. What are the potential or actual clinical implications of this work? Speech pathologists should prioritise social communication interventions and fatigue management for communication. Facilitating ownership of the recovery process and offering long-term supports are key aspects of treatment. Supporting positive illness narratives as part of treatment may facilitate post-injury identity construction.
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Affiliation(s)
- Elise Elbourn
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sophie Brassel
- The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Steel
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, New South Wales, Australia
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3
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Ma H, Yuan X, Sun X, Lawson G, Wang Q. Seeing Your Stories: Visualization for Narrative Medicine. HEALTH DATA SCIENCE 2024; 4:0103. [PMID: 38486622 PMCID: PMC10880175 DOI: 10.34133/hds.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/29/2023] [Indexed: 03/17/2024]
Abstract
Importance: Narrative medicine (NM), in which patient stories play a crucial role in their diagnosis and treatment, can potentially support a more holistic approach to patient care than traditional scientific ones. However, there are some challenges in the implementation of narrative medicine, for example, differences in understanding illnesses between physicians and patients and physicians' increased workloads and overloaded schedules. This paper first presents a review to explore previous visualization research for narrative medicine to bridge the gap between visualization researchers and narrative medicine experts and explore further visualization opportunities. Highlights: The review is conducted from 2 perspectives: (a) the contexts and domains in which visualization has been explored for narrative medicine and (b) the forms and solutions applied in these studies. Four applied domains are defined, including understanding patients from narrative records, medical communication, medical conversation training in education, and psychotherapy and emotional wellness enhancement. Conclusions: A future work framework illustrates some opportunities for future research, including groups of specific directions and future points for the 4 domains and 3 technological exploration opportunities (combination of narrative and medical data visualization, task-audience-based visual storytelling, and user-centered interactive visualization). Specifically, 3 directions of future work in medical communication (asynchronous online physician-patient communication, synchronous face-to-face medical conversation, and medical knowledge dissemination) were concluded.
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Affiliation(s)
- Hua Ma
- Faculty of Science and Engineering,
University of Nottingham, Ningbo 315100, China
- Digital Art Department,
Art & Design Technology Institute, Suzhou 215104, China
| | - Xiaoru Yuan
- National Key Laboratory of General Artificial Intelligence and School of Intelligence Science and Technology,
Peking University, Beijing 100871, China
- Health Data Visualization and Visual Analytics Research Center, National Institute of Health Data Science at PKU, Beijing 100191, China
| | - Xu Sun
- Faculty of Science and Engineering,
University of Nottingham, Ningbo 315100, China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute,
University of Nottingham Ningbo China, Ningbo 315100, China
| | - Glyn Lawson
- Human Factors Research Group, Faculty of Engineering,
University of Nottingham, Nottingham NG7 2RD, UK
| | - Qingfeng Wang
- Nottingham University Business School China,
University of Nottingham, Ningbo 315100, China
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Stagg K, Douglas J, Iacono T. Living with stroke during the first year after onset: an instrumental case study exploring the processes that influence adjustment. Disabil Rehabil 2023; 45:3610-3619. [PMID: 36222354 DOI: 10.1080/09638288.2022.2131005] [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: 05/04/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of the study was to explore the experiences of an individual navigating life in the first year after stroke, with attention to the influence of health professionals on adjustment. METHOD In-depth interviews were completed at regular intervals with an individual in rural Australia. This longitudinal approach supported the exploration of views over time. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory methods. Findings are presented as an instrumental case study. RESULTS The experience of stroke was one of adjustment to a new reality and of an altered and evolving concept of self: captured within the themes of fragmentation, loss, and reconstruction. Self-efficacy emerged as a driver in the adjustment process. Interactions with health professionals influenced adjustment and impacted on conceptualisations of self and self-efficacy. CONCLUSIONS Adjustment to stroke necessitated a reconceptualization of self. Relationships and interactions with others emerged as potential facilitators. For health professionals working with people after stroke, knowledge of the adjustment process and attention to practices that affirm personhood and enhance self-efficacy have the potential to facilitate long term outcomes. Processes linked to adjustment are represented visually to guide conceptual understandings and facilitative actions. IMPLICATIONS FOR REHABILITATIONAll interactions with health professionals, including casual or ad hoc interactions, have the potential to influence adjustment after stroke.Health professionals who interact in ways that recognise personhood may have an especially positive influence on processes linked to adjustment.Giving time to listen to personal narratives and reflections may assist with sense-making and support the process of reconceptualising self after stroke.Through bidirectional sharing of experience and ideas, health professionals can facilitate the experience of self-efficacy.
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Affiliation(s)
- Kellie Stagg
- Living with Disability Research Centre, La Trobe University, Melbourne/Bendigo, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, La Trobe University, Melbourne/Bendigo, Australia
- Summer Foundation, Melbourne, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Melbourne/Bendigo, Australia
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Biel M, Haley KL. Motivation in Aphasia Treatment: Self-Determination Theory Applied to the FOURC Model. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1016-1036. [PMID: 36889681 DOI: 10.1044/2022_ajslp-22-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Although the importance of motivation to successful rehabilitation is frequently acknowledged in the aphasia literature, little evidence-based guidance has been provided on how to support it. The purpose of this tutorial is to introduce a well-validated theory of motivation, self-determination theory (SDT); explain its role as the foundation for the FOURC model of collaborative goal setting and treatment planning; and explain how it may be applied during rehabilitation to support the motivation of people with aphasia. METHOD We provide an overview of SDT, explore the link between motivation and psychological wellness, and discuss how psychological needs are addressed in SDT and the FOURC model. Concrete examples from aphasia therapy are used to illustrate main concepts. CONCLUSIONS SDT offers tangible guidance for supporting motivation and wellness. SDT-based practices support positive forms of motivation, which is one of the targets of FOURC. An understanding of SDT's theoretical foundation will help clinicians maximize the impact of collaborative goal setting and aphasia therapy more generally.
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Affiliation(s)
- Michael Biel
- Department of Communication Disorders and Sciences, California State University, Northridge
| | - Katarina L Haley
- Department of Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill
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6
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Nalder E, King G, Hunt AW, Hartman LR, Szigeti Z, Drake E, Shah R, Shahzad M, Resnick M, Pereira G, Lenton E. Indicators of life success from the perspective of individuals with traumatic brain injury: a scoping review. Disabil Rehabil 2023; 45:330-343. [PMID: 35037526 DOI: 10.1080/09638288.2021.2025274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose was to synthesize qualitative literature and identify indicators of life success (positive life outcomes and experiences) that can help in understanding resiliency in the context of traumatic brain injury (TBI). METHODS This scoping review involved searching nine online databases for population (TBI) and context (qualitative literature). Searches retrieved 42 852 articles and, after two-stage screening, 76 articles met the inclusion criteria of reporting indicators of life success from the perspective of individuals with TBI. RESULTS Most studies were conducted in North America, Australia, or Europe. Participants were people living with TBI (mild to severe), of all age ranges. Positive life experiences were organized within four domains: understanding of oneself and one's life, social relationships and interaction, doing (engagement in activities, sense of control and accomplishment), and hope for the future. CONCLUSIONS The positive life experiences reflect both processes and outcomes (indicators of success) and highlight the need for a multidimensional approach when seeking to understand resiliency following TBI. The transactional framework of life experiences can be applied in future TBI resiliency research to understand how individuals negotiate adversity through experiences promoting understanding of oneself and the world, social relationships, engagement in activity and hope. Implications for rehabilitationRehabilitation services should consider how to afford opportunities for engagement in activity, social interaction, meaning making (i.e., coming to new understandings), and hope.With respect to engaging in activity and social relationships, having social interaction, being understood, being active and productive, having autonomy, and having accomplishments, reflect important experiences to enable within rehabilitation services.Rehabilitation professionals should consider how providing opportunities for their clients to have positive life experiences may contribute toward an adaptive and empowered mindset.
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Affiliation(s)
- Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- March of Dimes Canada, East York, Canada
| | - Gillian King
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Bloorview Research Institute & Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Anne W Hunt
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Laura R Hartman
- Bloorview Research Institute & Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Zara Szigeti
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Bloorview Research Institute & Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Emma Drake
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Riya Shah
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Maryam Shahzad
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Myles Resnick
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Giles Pereira
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Erica Lenton
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
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Douglas J, D'Cruz K, Winkler D, Topping M, Bucolo C, Finis C. Development and preliminary evaluation of a novel participant-led video intervention to train disability support workers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2414-2425. [PMID: 35920613 PMCID: PMC10087932 DOI: 10.1111/hsc.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/10/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
This paper describes the development and preliminary evaluation of a novel participant-led video (PLV) intervention to support people with disability (PWD) and cognitive and communication impairments to communicate their needs and preferences to their disability support workers. The PLV intervention was designed following a scoping literature review and workshop with PWD and close others. Subsequently, it was piloted with five primary participants with acquired brain injury and cognitive and communication impairments, five close other supporters and five facilitators. An independent mixed methods evaluation of the pilot was conducted with participants, close others and facilitators. All pilot evaluation participants reported high levels of satisfaction with the PLV intervention (mean ratings: primary participants 4.5/5.0; supporters 5.0/5.0; facilitators 4.8/5.0). When primary participants and their supporters were asked to rate how likely they were to recommend the PLV intervention, responses were extremely positive with the mean rating exceeding eight on a 10-point scale. Qualitative analysis of interview data revealed the PLV to be a person-centred experience for primary participants that was structured around sense of self and included having a voice and taking control in directing their lives, personal growth through participation and feeling validated through the experience. The production and use of PLV training resources has much potential to improve the delivery of support and maximise support outcomes by enabling people with cognitive and communication impairments to have choice and control, set their own goals and direct their supports. Further research is required with a larger sample size and longitudinal evaluation of participant outcomes.
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Affiliation(s)
- Jacinta Douglas
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | - Kate D'Cruz
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | - Di Winkler
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
| | - Megan Topping
- La Trobe UniversityMelbourneVictoriaAustralia
- Summer FoundationMelbourneVictoriaAustralia
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8
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Candlish L, Fadyl JK, D'Cruz K. Storytelling as an intervention in traumatic brain injury rehabilitation: a scoping review. Disabil Rehabil 2022:1-15. [PMID: 35710308 DOI: 10.1080/09638288.2022.2084778] [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: 11/03/2022]
Abstract
PURPOSE Storytelling interventions are increasingly being proposed as a tool for rehabilitation after Traumatic Brain Injury (TBI). This review aimed to systematically map intervention details as described in the TBI rehabilitation/recovery literature to better understand why, when and how storytelling is being used in rehabilitation. METHODS The review team included a storyteller-performer with lived experience of severe TBI, and two academics. Literature searching followed a pre-defined protocol with systematic search strategies and inclusion/exclusion criteria developed through discussion and literature scoping. Included interventions described a deliberate process of creation and sharing of the story. FINDINGS Thirteen studies met inclusion criteria, describing eleven distinct interventions fitting into four categories: film production, visual art, written publication and song composition. Rationale for the interventions included identity reconstruction, emotional processing, sense-making, and community (re)engagement. Varying levels of specialist materials and facilities were utilized. Most required facilitation by professionals trained in specialist areas such as narrative, art or music therapy. CONCLUSION Intervention models suggest that storytelling is intended for self-identity reconstruction after TBI and that it can create socially acceptable ways to process difficult experiences and (re)connect with peers, clinicians, families, and communities. Larger-scale trials that test intervention efficacy in relation to documented outcomes are needed.IMPLICATIONS FOR REHABILITATIONStorytelling as part of traumatic brain injury rehabilitation is used to assist with self-identity reconstruction, emotional processing, and clinical issues such as communication and executive functioning.Categories of storytelling intervention include film, visual art, written work and song writing.Collaborative facilitation is key to this process for a traumatic brain injury population.
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Affiliation(s)
- Lethan Candlish
- Freelance Author and Storyteller-Performer, Bloomsburg, PA, USA
| | - Joanna K Fadyl
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Kate D'Cruz
- Summer Foundation Ltd, Melbourne, Australia.,Living With Disability Research Centre, La Trobe University, Melbourne, Australia
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Linnestad AM, Løvstad M, Groven KS, Howe EI, Fure SCR, Spjelkavik Ø, Sveen U. "Manoeuvring in uncharted waters - a balancing act": A qualitative exploration of treatment and improvement after mild traumatic brain injury. Neuropsychol Rehabil 2022; 33:592-612. [PMID: 35168477 DOI: 10.1080/09602011.2022.2034651] [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: 10/19/2022]
Abstract
Background: Individuals who have sustained mild traumatic brain injury (mTBI) with a protracted course of recovery may experience long-lasting somatic, cognitive, and emotional symptoms affecting activities of daily living. There is limited knowledge regarding individuals' lived experiences with treatments and advice provided.Purpose: To explore how individuals with mTBI describe and make sense of their injury, recovery process, and their experiences with various treatment approaches.Methods: Eight participants with mTBI were recruited from the intervention group in an ongoing randomized controlled trial regarding return-to-work. They were interviewed once after treatment delivery using a qualitative hermeneutical approach. Thematic analysis was applied, and findings are discussed in light of a salutogenic theory.Results: Participants expressed uncertainty regarding conflicting advice they received in the early phase of recovery. Three main themes were developed: (1) "Ambiguity and hope"; (2) "Uncertainty concerning activity and rest"; and (3) "To become the person I used to be vs. to become a new version of myself."Conclusion: The findings showed that the participants experienced both uncertainty and hope for further recovery. The recovery process is challenged by the variability of TBI symptoms that affects participation in everyday life, as well as the conflicting advice received by the participants.
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Affiliation(s)
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Karen Synne Groven
- Faculty of Health, VID Specialized University, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silje Christine Reistad Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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Larsson-Lund M, Pettersson A, Strandberg T. Team-based rehabilitation after traumatic brain injury: a qualitative synthesis of evidence of experiences of the rehabilitation process. J Rehabil Med 2022; 54:jrm00253. [PMID: 35019996 PMCID: PMC8862657 DOI: 10.2340/jrm.v53.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To synthesize and explore experiences of the rehabilitation process for adults with traumatic brain injury receiving team-based rehabilitation. DATA SOURCES A qualitative evidence synthesis was conducted according to the "Enhancing transparency in reporting the synthesis of qualitative research" (ENTREQ) Guidelines, of qualitative studies published in 5 databases in 2000-21. STUDY SELECTION AND DATA EXTRACTION Screening, selection of relevant studies, assessment of methodological limitations, systematic qualitative content analysis and assessment of confidence with Grading of Recommendations Assessment, Development, and Evaluation- Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) were carried out by independent researchers. DATA SYNTHESIS The 10 included studies revealed how people with traumatic brain injury perceived that they struggled on their own for a long time to adapt their daily life. They experienced that access to team-based rehabilitation was scarce and that the interventions offered were neither individually tailored nor coordinated. A respectful attitude from professionals and individually adapted information facilitated their rehabilitation process. CONCLUSION This qualitative evidence synthesis indicates areas for improvement and a need to develop person-centred team-based rehabilitation for adults with traumatic brain injury, in terms of accessibility, coordination, continuity, content and participation. Given the limited opportunities for team-based rehabilitation after hospital discharge, further research is needed to understand how rehabilitation can support the adaptation of everyday life.
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Affiliation(s)
- Maria Larsson-Lund
- Department of Health Science, Occupational Therapy, Luleå University of Technology, 971 87 Luleå, Sweden.
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11
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Humanising brain injury rehabilitation: a qualitative study examining humanising approaches to engagement in the context of a storytelling advocacy programme. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objectives:
Building upon the findings of an earlier study that explored the experience and impact of narrative storytelling following acquired brain injury (ABI), this study sought to examine the engagement of storytelling facilitators with storytellers.
Methods:
Transcripts of in-depth interviews conducted with six storytelling facilitators were analysed drawing upon content analysis. The analysis included a process of mapping previously analysed data (D’Cruz et al., 2020b) to a humanising values framework (Galvin & Todres, 2013; Todres et al., 2009).
Results:
The findings of this study provide insights into how facilitators engaged in humanising practice within the context of a storytelling advocacy programme. The facilitator participants ranged in years of facilitation experience from 1 to 11 years, with a mix of professional backgrounds, including health care (3), journalism (1) and community development (2). Analysed facilitator data mapped to each of the eight dimensions of the framework (insiderness, agency, uniqueness, togetherness, sense-making, personal journey, sense of place and embodiment), with a breadth of codes represented in each dimension, revealing the depth of humanisation.
Conclusions:
This study extends our understanding of approaches to engagement with adults living with ABI, demonstrating the humanising potential of storytelling. Furthermore, the findings help us to think about what it means to be human, guiding us to find ways to better partner with and support adults living with brain injury.
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How does a narrative understanding of change in families post brain injury help us to humanise our professional practice? BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
In this paper, we critically explore the discourse of change post brain injury and challenge the dominant discourse of negative change, which alone leaves little room for other perspectives to exist. These negative changes pose a considerable risk to the well-being of families who may benefit from engaging in richer accounts making room for a more coherent and connected sense of self and family post-injury. We explore how narrative approaches provide opportunities for all practitioners to expand their professional scripts and support families to move towards a future which is not dominated by a discourse of loss. While loss and negative change is an important and very real consequence, of brain injury, focusing purely on stories of loss is life limiting for family members and can cause psychological distress. The life thread model is offered as a visible tool for all practitioners to engage with and use while working with families, providing a concrete focus for reflection and discussion of narratives relating to change which otherwise can feel quite abstract in everyday practice. We argue that one way we can humanise our professional practice is to support all practitioners to engage in a narrative understanding of family change following ABI.
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Pedrotty M, Wong TS, Wilde EA, Bigler ED, Laatsch LK. Application of neuropsychology and imaging to brain injury and use of the integrative cognitive rehabilitation psychotherapy model. NeuroRehabilitation 2021; 49:307-327. [PMID: 34420990 DOI: 10.3233/nre-218028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND An early approach to cognitive rehabilitation therapy (CRT) was developed based on A. R. Luria's theory of brain function. Expanding upon this approach, the Integrative Cognitive Rehabilitation Psychotherapy model (ICRP) was advanced. OBJECTIVE To describe the ICRP approach to treatment of clients post brain injury and provide a comprehensive list of evaluation tools to determine the client's abilities and needs. Finally, to provide a link between CRT and functional imaging studies designed to improve rehabilitation efforts. METHODS History of cognitive rehabilitation and neuropsychological testing is reviewed and description of cognitive, academic, psychiatric, and substance abuse tools are provided. Cognitive and emotional treatment techniques are fully described. Additionally, a method of determining the client's stage of recovery and pertinent functional imaging studies is detailed. RESULTS Authors have been able to provide a set of tools and techniques to use in comprehensive treatment of clients with brain injury. CONCLUSIONS Inclusive treatment which is outlined in the ICRP model is optimal for the client's recovery and return to a full and satisfying life post brain injury. The model provides a framework for neuropsychologists to integrate issues that tend to co-occur in clients living with brain injury into a unified treatment plan.
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Affiliation(s)
- Mark Pedrotty
- Tingley Hospital Outpatient -UNM, Albuquerque, NM, USA
| | - Tiffanie S Wong
- Polytrauma Rehabilitation Center, Comprehensive Rehabilitation Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Stem Cognitive and Psychological Rehabilitation, Inc., Palo Alto, CA, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.,George E. Wahlen Veterans' Affairs Medical Center, Salt Lake City, UT, USA
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Linda K Laatsch
- Department of Neurology, University of Illinois, Chicago, IL, USA
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14
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Whiffin CJ, Gracey F, Ellis-Hill C. The experience of families following traumatic brain injury in adult populations: A meta-synthesis of narrative structures. Int J Nurs Stud 2021; 123:104043. [PMID: 34388366 DOI: 10.1016/j.ijnurstu.2021.104043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. OBJECTIVE To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. DESIGN This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy. DATA SOURCES In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. REVIEW METHODS Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. RESULTS Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. CONCLUSIONS The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI.
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Affiliation(s)
- Charlotte Jane Whiffin
- College of Health, Psychology and Social Care, University of Derby, Kedleston Road, Derby DE22 1GB, United Kingdom.
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Royal London House R110, Christchurch Road, Bournemouth BH1 3LT, United Kingdom.
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15
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Gombay N, Andrews GJ. Living with embodied vibrations: Sensory experiences following a traumatic brain injury. Soc Sci Med 2021; 284:114233. [PMID: 34325326 DOI: 10.1016/j.socscimed.2021.114233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/18/2020] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Based on autoethnography, this article adopts a (neuro)phenomenological lens to explore sensory experiences following a traumatic brain injury (TBI). Although focussing particularly on pain, vision, hearing, and somatic experiences connected with sleep, we also touch on how these are interwoven with other symptoms associated with TBIs. We use these experiences to enliven, and thereby enrich, clinical constructions and understandings of 'sensitivity' to light and to noise, as well as 'sleep disturbance'. We conclude with a discussion of how these sensory experiences can be understood in relation to embodied dynamics of vibration, oscillation, and (stochastic) resonance. The article closes with the suggestion that an embodied, sensorial, and phenomenologically informed analysis of the experiences of people with TBIs, particularly in relation, for example, to embodied sensations and perceptions of vibration, might provide novel insights for research and clinical practice.
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Affiliation(s)
- Nicole Gombay
- Département de Géographie, Université de Montréal, Complexe des Sciences, C. P. 6128, Succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
| | - Gavin J Andrews
- Department of Health Aging & Society, McMaster University, Canada
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16
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Allen N, Hevey D, Carton S, O'Keeffe F. Life is about "constant evolution": the experience of living with an acquired brain injury in individuals who report higher or lower posttraumatic growth. Disabil Rehabil 2021; 44:3479-3492. [PMID: 33459069 DOI: 10.1080/09638288.2020.1867654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the experience of living with an Acquired Brain Injury (ABI) in individuals who report higher or lower posttraumatic growth (PTG). METHOD A multi-method design was employed. Participant scores on the Posttraumatic Growth Inventory (PTGI) were used to identify groups for qualitative comparative analysis. Individual semi-structured interviews were conducted with fourteen individuals with ABI. Data were analysed thematically. RESULTS Four themes emerged. The first two themes: "In my mind I was fine" surviving in aftermath of acquiring a brain injury and The everyday as "derailing" capture the transition process from an initial rehabilitation state characterised by neuropsychological and avoidance coping, towards active rebuilding for PTG. Internal building blocks for PTG and Growing in the social world: "you need to have that social connection" elaborate on the internal (e.g., acceptance, integration of the pre and post-injury self) and external (e.g., social relationships) factors seen to facilitate or obstruct PTG. CONCLUSIONS Under certain conditions, individuals living with ABI may construe positive growth from their experiences. Practitioners can support PTG development by providing individual and family-based supports aimed at increasing acceptance, the integration of self, and social connection throughout all stages of ABI rehabilitation.IMPLICATIONS FOR REHABILITATIONInternal factors such as having a flexible and positive mindset and external factors such as one's social environment can affect how individuals living with an ABI construe positive growth.Individuals with ABI and their families require access to individualised longitudinal support for neuropsychological and social challenges that can result in increased distress and obstruct the development of PTG.Efforts to facilitate acceptance and support the integration of the pre and post-injury self through recognition of continuity of self and processing of new schematic beliefs can benefit PTG development.Rehabilitation providers should support individuals with ABI to develop or maintain a positive social identity within new or existing social groups.
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Affiliation(s)
- Niamh Allen
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Simone Carton
- National Rehabilitation Hospital, Dún Laoghaire, Dublin, Ireland
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17
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Jenkin T, Anderson V, D'Cruz K, Collins A, Muscara F, Scheinberg A, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The clinician perspective. Neuropsychol Rehabil 2020; 32:104-130. [PMID: 32811301 DOI: 10.1080/09602011.2020.1801470] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper explored clinicians' experiences of the goal setting process with children and adolescents with acquired brain injuries (ABI) and their families in paediatric neurorehabilitation. Semi-structured interviews were conducted with 13 clinicians, all members of an interdisciplinary paediatric rehabilitation service, who work with children and adolescents with ABI and their families. Interview transcripts and additional data were analysed using constructivist grounded theory methods. Three main themes and sub-themes were developed: (1) Seeing the bigger picture: Goals change over time; Families set bigger picture goals; Need-to-dos: Goals that the child/adolescent needs to achieve; and Want-to-dos: Goals that the child/adolescent wants to achieve; (2) Collaborating as a team: Everyone needs to be on the same page; Hearing the child's/adolescent's voice; and Parents as advocates; and (3) Recognizing and navigating challenges: Child-/adolescent- and family-related challenges and Time as a service-related challenge. Participants perceived the clinician's role during goal setting as that of an active collaborator, enabling children and adolescents with ABI and their families to generate meaningful goals. These findings demonstrate insights into goal setting in paediatric ABI neurorehabilitation from clinicians' perspectives, and highlight the importance of collaboration, flexibility and anticipation of challenges in facilitating children's, adolescents' and families' involvement in this process.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - Alana Collins
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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18
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Stenberg M, Stålnacke BM, Saveman BI. Family experiences up to seven years after a severe traumatic brain injury–family interviews. Disabil Rehabil 2020; 44:608-616. [DOI: 10.1080/09638288.2020.1774668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Maud Stenberg
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
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D’Cruz K, Douglas J, Serry T. Sharing stories of lived experience: A qualitative analysis of the intersection of experiences between storytellers with acquired brain injury and storytelling facilitators. Br J Occup Ther 2020. [DOI: 10.1177/0308022619898085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Narrative storytelling is a relational process. While interest in storytelling in brain injury rehabilitation is increasing, little attention has been directed to the interpersonal relationships experienced through storytelling. As part of a larger study exploring narrative storytelling, this paper reports on the intersection of experiences between those sharing their story and those listening to the story. Method A qualitative grounded theory approach informed all stages of the study. In-depth interviews were conducted with adult storytellers with severe acquired brain injury and facilitators of a storytelling advocacy programme. Findings Analysis of the intersection of data from 28 transcripts of interviews with eight storytellers and six facilitators was conducted. Two key relationships emerged to be central to the storytelling experience: (1) a collaborative partnership between the storytellers and the advocacy organisation, and (2) an intentional story-sharing relationship between the storytellers and facilitators. The advocacy context of helping others through story-sharing was central to the meaningfulness of the experience. Conclusion Narrative storytelling is a social relationship experience with much potential for building relationships in rehabilitation. Sharing stories of lived experience of disability presents an opportunity for meaningful occupational engagement, enabling social connectedness and contribution to society.
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Affiliation(s)
- Kate D’Cruz
- Discipline of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
- Summer Foundation, Box Hill, Australia
| | - Tanya Serry
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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20
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A Qualitative Study on the Transition Support Needs of Indigenous Australians Following Traumatic Brain Injury. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:A growing body of qualitative literature globally describes post-hospital experiences during early recovery from a traumatic brain injury. For Indigenous Australians, however, little published information is available. This study aimed to understand the lived experiences of Indigenous Australians during the 6 months post-discharge, identify the help and supports accessed during transition and understand the gaps in service provision or difficulties experienced.Methods and Procedure:Semi-structured interviews were conducted at 6 months after hospital discharge to gain an understanding of the needs and lived experiences of 11 Aboriginal and Torres Strait Islander Australians who had suffered traumatic brain injury in Queensland and Northern Territory, Australia. Data were analysed using thematic analysis.Results:Five major themes were identified within the data. These were labelled ‘hospital experiences’, ‘engaging with medical and community-based supports’, ‘health and wellbeing impacts from the injury’, ‘everyday living’ and ‘family adjustments post-injury’.Conclusions:While some of the transition experiences for Indigenous Australians were similar to those found in other populations, the transition period for Indigenous Australians is influenced by additional factors in hospital and during their recovery process. Lack of meaningful interaction with treating clinicians in hospital, challenges managing direct contact with multiple service providers and the injury-related psychological impacts are some of the factors that could prevent Indigenous Australians from receiving the supports they require to achieve their best possible health outcomes in the long term. A holistic approach to care, with an individualised, coordinated transition support, may reduce the risks for re-admission with further head injuries.
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The Potential of a Narrative and Creative Arts Approach to Enhance Transition Outcomes for Indigenous Australians Following Traumatic Brain Injury. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractBackground:Increasingly, narrative and creative arts approaches are being used to enhance recovery after traumatic brain injury (TBI). Narrative and arts-based approaches congruent with Indigenous storytelling may therefore provide benefit during the transition from hospital to home for some Indigenous TBI patients. This qualitative study explored the use and impact of this approach as part of a larger, longitudinal study of TBI transition with Indigenous Australians.Method:A combined narrative and arts-based approach was used with one Indigenous Australian artist to describe his transition experiences following TBI. Together with the researchers and filmmaking team, the artist was involved in aspects of the process. The artist contributed two paintings, detailing the story of his life and TBI. Based on the artworks, a film was co-created. Following the viewing of the film, impacts of the narrative and arts-based process were examined through semi-structured interviews with the artist, a service provider and a family member. Multiple sources of data were used in the final thematic analysis including transcripts of the interviews and filming, paintings (including storylines) and researcher notes.Results:Positive impacts from the process for the artist included positive challenge; healing and identity; understanding TBI and raising awareness.Discussion:This approach may enable the individual to take ownership over their transition story and to make sense of their life following TBI at a critical point in their recovery. A combined narrative and arts-based approach has potential as a culturally responsive rehabilitation tool for use with Indigenous Australians during the transition period following TBI.
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D’Cruz K, Douglas J, Serry T. Narrative storytelling as both an advocacy tool and a therapeutic process: Perspectives of adult storytellers with acquired brain injury. Neuropsychol Rehabil 2019; 30:1409-1429. [DOI: 10.1080/09602011.2019.1586733] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kate D’Cruz
- Department of Community and Clinical Allied Health, Discipline of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Department of Community and Clinical Allied Health, Discipline of Speech Pathology, 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, Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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