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Hendryckx C, Couture M, Gosselin N, Nalder E, Gagnon-Roy M, Thibault G, Bottari C. A window into the reality of families living long term with challenging behaviours after a TBI. Neuropsychol Rehabil 2024:1-32. [PMID: 38781592 DOI: 10.1080/09602011.2024.2354402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
Challenging behaviours are a long-term burden for people with traumatic brain injury (TBI) and their families. Families frequently shoulder the responsibility alone, but little is known about the strategies they use to manage these behaviours. This study aimed to 1) identify the coping strategies used by people with TBI living in the community and their family caregivers to manage challenging behaviours; and 2) describe the similarities and differences between strategies used by people with TBI and caregivers. In this qualitative descriptive design, individual semi-structured interviews were conducted with adults with TBI and their caregivers and were inductively analyzed. The sample included 10 dyads and two triads, totalling 12 caregivers (8 women) and 14 individuals with TBI (6 women; 21.71 ± 10.84 years post-injury). Participants' strategies were proactive (prevention), reactive (response), or retroactive (aftercare). Most strategies were described by caregivers. Some of them were effective and lasting, others not, reflecting how they adapted their approaches over time. Families put in place various strategies in their life's journey, such as giving feedback or adapting the environment. Despite these strategies supporting long-term community living, the need for ongoing support is underscored, as crises may still occur, impacting families' quality of life.
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Affiliation(s)
- Charlotte Hendryckx
- Department of Psychology, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Cœur de Montréal, CIUSSS NIM Research Center, Montreal, Canada
| | - Mélanie Couture
- Centre for research and expertise in social gerontology (CREGÉS), CIUSSS West-Central Montreal, Côte Saint-Luc, Canada
- École de travail social, Faculté des lettres et sciences humaines, Université de Sherbrooke, Sherbrooke, Canada
| | - Nadia Gosselin
- Department of Psychology, Université de Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Cœur de Montréal, CIUSSS NIM Research Center, Montreal, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mireille Gagnon-Roy
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Occupational Therapy program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Geneviève Thibault
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Service québécois d'expertise en troubles graves du comportement (SQETGC), CIUSSS MCQ, Montréal, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Occupational Therapy program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
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Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
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Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Hendryckx C, Nalder E, Drake E, Leclaire É, Pituch E, Gouin-Vallerand C, Wang RH, Poulin V, Paquet V, Bottari C. Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions. J Rehabil Assist Technol Eng 2023; 10:20556683231191975. [PMID: 37614442 PMCID: PMC10443634 DOI: 10.1177/20556683231191975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Challenging behaviours are one of the most serious sequelae after a traumatic brain injury (TBI). These chronic behaviours must be managed to reduce the associated burden for caregivers, and people with TBI. Though technology-based interventions have shown potential for managing challenging behaviours, no review has synthesised evidence of technology aided behaviour management in the TBI population. The objective of this scoping review was to explore what technology-based interventions are being used to manage challenging behaviours in people with TBI. Two independent reviewers analysed 3505 studies conducted between 2000 and 2023. Studies were selected from five databases using search strategies developed in collaboration with a university librarian. Sixteen studies were selected. Most studies used biofeedback and mobile applications, primarily targeting emotional dysregulation. These technologies were tested in a variety of settings. Two interventions involved both people with TBI and their family caregivers. This review found that technology-based interventions have the potential to support behavioural management, though research and technology development is at an early stage. Future research is needed to further develop technology-based interventions that target diverse challenging behaviours, and to document their effectiveness and acceptability for use by people with TBI and their families.
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Affiliation(s)
- Charlotte Hendryckx
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Research Center from CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, QC, Canada
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Emma Drake
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Éliane Leclaire
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Evelina Pituch
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Charles Gouin-Vallerand
- Centre de Recherche Createch sur les Organisations Intelligentes, Université de Sherbrooke, Sherbrooke, QC, Canada
- DOMUS Laboratory, Université de Sherbrooke, Sherbrooke, QC, Canada
- University of Sherbrooke, Sherbrooke, QC, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Valérie Poulin
- Department Of Occupational therapy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, QC, Canada
| | - Virginie Paquet
- Bibliothèque Marguerite-D’Youville, Université de Montréal, Montréal, QC, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
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Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
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