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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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Hendryckx C, Couture M, Gosselin N, Nalder E, Gagnon-Roy M, Thibault G, Bottari C. The dual reality of challenging behaviours: Overlapping and distinct perspectives of individuals with TBI and their caregivers. Neuropsychol Rehabil 2024; 34:485-509. [PMID: 37219424 DOI: 10.1080/09602011.2023.2212172] [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: 12/08/2022] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
Challenging behaviours significantly impact the lives of people with traumatic brain injury (TBI) and their family caregivers. However, these behaviours are rarely defined from the perspectives of both individuals, a necessary step to developing interventions targeting meaningful goals for individuals and caregivers. This study aimed to (1) explore and confirm the perspective of individuals with TBI living in the community and their family caregivers on behaviours they consider challenging and, (2) identify overlapping or distinct views on challenging behaviours. A qualitative descriptive design was used. Twelve caregivers (8 females; 59.67 ± 11.64 years old) and 14 participants with mild-severe TBI (6 females; 43.21 ± 10.98 years old; time post-injury: 21.71 ± 10.84 years) were interviewed (10 dyads and two triads). Data were analysed using inductive qualitative analysis. Challenging behaviours most frequently reported by all participants were aggressive/impulsive behaviours, inappropriate social behaviours, and behavioural manifestations of cognitive impairments. Overlapping perspectives were identified regarding aggressive behaviours. Distinctions exist as inappropriate social behaviours and cognitive difficulties were mainly reported by caregivers. Our results confirm that perspectives may vary between dyad members. Interventions should include dyad inputs to formulate goals that are significant to the person with TBI and their caregiver.
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Affiliation(s)
- Charlotte Hendryckx
- Department of Psychology, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Coeur de Montréal, Centre de recherche du CIUSSS NIM, 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-Coeur de Montréal, Centre de recherche du CIUSSS NIM, 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 Montréal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of RehabilitationUniversité de Montréal, Montreal, Canada
| | - Geneviève Thibault
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Service québécois d'expertise en troubles graves du comportement (SQETGC), CIUSSS MCQ, Montreal, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of RehabilitationUniversité de Montréal, Montreal, Canada
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Faccio E, Fonte C, Smania N, Neri J. (Re)constructing identity following acquired brain injury: The complex journey of recovery after stroke. Health Expect 2024; 27:e13874. [PMID: 37731198 PMCID: PMC10726149 DOI: 10.1111/hex.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION People with poststroke acquired brain injury (ABI) face a complex and often troubled identity reconstruction journey. The literature is rich with studies related to the psychological and neuropsychological components involved in rehabilitation, but it is lacking with respect to the investigation of the existential dimensions and the challenges associated with finding new senses and meanings for one's identity and future perspectives, body and interpersonal relationships. METHODS The aim of this study is to investigate the narrative processes of identity reconstruction after brain damage. Through a qualitative approach, 30 autobiographical narratives about self, body and the relationships with others were collected and analyzed. Semistructured interviews were used for the data collection. Narrative and positioning analysis were applied. RESULTS Four main positionings emerged: sanctioning a radical break with one's previous life; assuming a sense of salvation and compulsory as well as irreversible adaptation to the limitations associated with one's condition; feeling different and disabled; and considering new possibilities and active constructions of self-being in relationship with others. These results underline the narrative processes of construction of the injury and the identity and delineate possible resources and instruments to improve the clinical practice for health practitioners. They are also valuable for other professionals who deal with neurological services and rehabilitation, such as psychological counselling and support for persons who have experienced ABI and their families. PATIENT OR PUBLIC CONTRIBUTION This work resulted from a close collaboration between two universities and a hospital neurological rehabilitation department in the Veneto Region (Northern Italy). Three associations of people with stroke and their families living in the same area contributed to designing the research on the basis of the needs expressed by their members with the aim to identify strategies and devices to be implemented in the public service to improve the care pathway. They also participated in the interpretation of the data.
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Affiliation(s)
- Elena Faccio
- Department of Philosophy, Sociology, Education and Applied PsychologyUniversity of PaduaPaduaItaly
| | - Cristina Fonte
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Jessica Neri
- Department of Philosophy, Sociology, Education and Applied PsychologyUniversity of PaduaPaduaItaly
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Gagnon-Roy M, Bier N, Le Dorze G, Boulé-Riley S, Paquette G, Couture M, Bottari C. Cognitive assistance to support individuals with traumatic brain injury using a minimal and personalised approach: A conversion mixed methods study using video analysis. Aust Occup Ther J 2024; 71:35-51. [PMID: 37799014 DOI: 10.1111/1440-1630.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Individuals with traumatic brain injury (TBI) frequently need assistance to manage complex everyday activities. However, little is known about the types of cognitive assistance that can be used to facilitate optimal independence. A conversion mixed method study using video analysis was conducted to describe assistance provided by trained occupational therapists during three everyday tasks carried out in the participants' homes and surrounding environments. METHODS Forty-five people with moderate and severe TBI were tested by three occupational therapists using the Instrumental Activities of Daily Living Profile, an observation-based assessment that documents independence in complex everyday activities and the minimal assistance required to attain task goals. Using video analysis, difficulties experienced by the people with TBI during a meal preparation and grocery shopping task, and the cognitive assistance provided by the occupational therapists in response to these difficulties, were documented. Statistical analyses were also completed to identify the main difficulties and types of cognitive assistance provided during the evaluation, for the whole group and depending on their level of independence. RESULTS Nine types of cognitive assistance were used by occupational therapists, including implicit (stimulating thought processes), and more explicit assistance (cueing), to facilitate task performance. When needed, motivational assistance, which consisted of encouraging participants to think for themselves, was also used. Stimulating thought processes was mostly used to support goal formulation and planning, whereas cueing was used in numerous instances. Participants with lower levels of independence received more assistance of almost all types to support them. CONCLUSION Using these findings, training could be developed for caregivers and occupational therapists to support them in providing minimal and personalised cognitive assistance. Further research is needed to examine the extent to which all types of cognitive assistance are effective in helping various cognitive profiles of people with TBI attain optimal independence.
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Affiliation(s)
- Mireille Gagnon-Roy
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Nathalie Bier
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Guylaine Le Dorze
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- School of Speech-Language Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Boulé-Riley
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Guillaume Paquette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | | | - Carolina Bottari
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
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Pituch E, Cormier T, Gilbert V, Bottari C. Babycare Assistance Needs of Parents With Physical Disabilities: An Observational Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:25-36. [PMID: 37191385 PMCID: PMC10676028 DOI: 10.1177/15394492231172935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The assistance needs of parents with physical disabilities have been widely underexamined. This qualitative observational study described the assistance needs of parents with physical disabilities during the performance of in-home babycare activities. Thirty-one parents were assessed by trained occupational therapists using the Activities of Daily Living (ADL) Profile adapted for use with parents, an ecological performance-based assessment that considers executive functioning. Descriptive statistics of participants' demographics and parents' independence scores in babycare activities were calculated, and a qualitative content analysis of parents' assistance needs was performed using video recordings. At least one-fourth of parents experienced difficulties in all babycare activities, either affecting activity performance or requiring verbal or physical assistance. Assistance needs were also observed in all activity-related operations of the ADL Profile. It is necessary to develop specialized clinical services to address assistance needs and promote safe and easy parenting in parents with physical disabilities.
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Affiliation(s)
- Evelina Pituch
- Université de Montréal, Québec, Canada
- CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Québec, Canada
| | | | | | - Carolina Bottari
- Université de Montréal, Québec, Canada
- CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Québec, 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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Block H, Bellon M, Hunter SC, George S. Barriers and enablers to managing challenging behaviours after traumatic brain injury in the acute hospital setting: a qualitative study. BMC Health Serv Res 2023; 23:1266. [PMID: 37974214 PMCID: PMC10655469 DOI: 10.1186/s12913-023-10279-z] [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: 02/20/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Challenging behaviours after traumatic brain injury (TBI) in the acute setting are associated with risk of harm to the patient and staff, delays in commencing rehabilitation and increased length of hospital stay. Few guidelines exist to inform practice in acute settings, and specialist services providing multi-disciplinary expertise for TBI behaviour management are predominantly based in subacute inpatient services. This study aims to investigate acute and subacute staff perspectives of barriers and enablers to effectively managing challenging behaviours after TBI in acute hospital settings. METHODS Qualitative focus groups were conducted with 28 staff (17 from acute setting, 11 from subacute setting) across two sites who had experience working with patients with TBI. Data were analysed using inductive-deductive reflexive thematic analysis. Data were applied to the constructs of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to generate themes representing barriers and enablers to managing challenging behaviours after TBI in the acute hospital setting. RESULTS Four barriers and three enablers were identified. Barriers include (1) Difficulties with clinical decision making; (2) Concerns for risks to staff and patients; (3) Hospital environment; (4) Intensive resources are required. Enablers were (1) Experienced staff with practical skills; (2) Incorporating person-centred care; and (3) Supportive teams. CONCLUSION These findings can inform pre-implementation planning for future improvements to TBI behaviour management in acute hospital settings. Difficulties with clinical decision making, concerns for risks of injury, the hospital environment and lack of resources are major challenges. Implementation strategies developed to address barriers will need to be trialled, with multi-disciplinary team approaches, and tailored to the acute setting.
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Affiliation(s)
- Heather Block
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia.
- Division of Allied Health, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - Michelle Bellon
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Sarah C Hunter
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, Australia
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Strang JF, Anthony LG, Song A, Lai MC, Knauss M, Sadikova E, Graham E, Zaks Z, Wimms H, Willing L, Call D, Mancilla M, Shakin S, Vilain E, Kim DY, Maisashvili T, Khawaja A, Kenworthy L. In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:212-229. [PMID: 34121545 DOI: 10.1080/15374416.2021.1916940] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. METHOD This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs. RESULTS Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. CONCLUSIONS Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.
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Affiliation(s)
- John F Strang
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Laura G Anthony
- Department of Psychiatry, University of Colorado School of Medicine
- Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Amber Song
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
- Department of Psychiatry, The Hospital for Sick Children
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto
- Autism Research Centre, Department of Psychiatry, University of Cambridge
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine
| | - Megan Knauss
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Alliance of Community Health Plans
| | | | | | - Zosia Zaks
- Hussman Center for Adults with Autism, Towson University
| | - Harriette Wimms
- Youth Gender Care Services, The Village Family Support Center of Baltimore
| | - Laura Willing
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - David Call
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Michael Mancilla
- Youth Pride Clinic, Adolescent and Young Adult Medicine, Children's National Hospital
| | - Sara Shakin
- Department of Pediatrics, Sinai Hospital of Baltimore
| | - Eric Vilain
- Center for Genetic Medicine Research, Children's National Hospital
- Department of Genomics and Precision Medicine, George Washington University
- Epigenetics, Data, & Politics at Centre National de la Recherche Scientifique
| | - Da-Young Kim
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Tekla Maisashvili
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Ayesha Khawaja
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
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Riccardi JS, Vogel S, Ciccia AH. Preliminary findings on TBI knowledge of professionals working with justice-involved youth. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:45-55. [PMID: 35077241 DOI: 10.1080/21622965.2022.2027771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Professionals working with justice-involved youth (JIYs) play a critical role in identifying and providing supports and services related to traumatic brain injury (TBI). The aim of this study was to better understand the knowledge of TBI of professionals working with JIYs, a research priority identified by the National Conference of State Legislatures. Fifty employees of an urban juvenile court system completed an online survey about their TBI knowledge. Respondents scored an average of 77.31% correct, yet patterns emerged in item responses and based on participant characteristics that indicate opportunities for training and education on TBI. The results of this preliminary study provide foundational evidence on TBI knowledge of professionals working with JIYs, inform future TBI-related trainings and education provided to professionals working with JIYs, and inform other practices and policies related to JIYs with TBI.
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Affiliation(s)
- Jessica Salley Riccardi
- Communication Sciences, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Samantha Vogel
- Communication Sciences, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Angela H Ciccia
- Communication Sciences, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
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Transgender Youth Executive Functioning: Relationships with Anxiety Symptoms, Autism Spectrum Disorder, and Gender-Affirming Medical Treatment Status. Child Psychiatry Hum Dev 2022; 53:1252-1265. [PMID: 34146208 DOI: 10.1007/s10578-021-01195-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
Executive function (EF) underlies broad health and adaptive outcomes. For transgender youth, navigating gender discernment and gender affirmation demand EF. Yet, factors associated with transgender youth EF are unknown. We investigate hypothesized predictors of EF: over-represented conditions among transgender youth (anxiety and depression symptoms, autism spectrum disorder [ASD]) and gender-affirming care. One-hundred twenty-four transgender 11-21-year-olds participated. Parents/caregivers completed EF and mental health report measures. ASD diagnostics and gender-affirming medication histories were collected. 21 % of non-autistic and 69 % of autistic transgender youth had clinically elevated EF problems. Membership in the gender-affirming hormone treatment group was associated with better EF. ASD, anxiety symptoms, and membership in the long-duration pubertal suppression group were associated with poorer EF. Given the importance of EF skills for multiple outcomes, and the unique and additional EF demands specific to transgender youths' experiences, EF skill monitoring-and when appropriate, supports-should be considered for transgender youth.
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11
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Holth K, Gould KR, Hicks AJ, Analytis P, Feeney TJ, Ponsford JL. "I've never been positive … I am now": Participant perspectives of a Positive Behaviour Support intervention (PBS + PLUS) for community-living individuals with ABI and their close others. Neuropsychol Rehabil 2022; 32:2411-2428. [PMID: 34233578 DOI: 10.1080/09602011.2021.1947326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Challenging behaviours are common following moderate to severe acquired brain injury (ABI). These behaviours cause relationship and community participation difficulties and are a significant source of stress for many individuals with ABI and their close others (COs). A Positive Behaviour Support intervention, PBS + PLUS, was implemented to assist individuals with ABI to collaboratively build meaningful lives and self-regulate their behaviour. This study explored the perspectives of individuals with ABI and COs (family members, friends, and carers) who had completed an individualized 12-month PBS + PLUS intervention. Fifty-two individuals participated in semi-structured interviews, and a thematic analysis of interview transcripts identified the interrelated themes of Openness to Change, Embeddedness, Clinician Connection, and Preparedness for the Future. Participant perceptions of, and engagement with, PBS + PLUS were influenced by an attitude of openness to new ideas and by the intervention itself. Achieving contextual relevance allowed the intervention to become embedded in participants' lives, and the client-clinician relationship was central to participants' positive experiences. While most participants felt better equipped to cope with the future, some experienced difficulties transitioning to post-intervention life. These results suggest PBS + PLUS may assist individuals with ABI to lead meaningful lives and more confidently overcome behavioural challenges, while encouraging supportive and empowered COs.
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Affiliation(s)
- Kristian Holth
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - Kate Rachel Gould
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - Amelia J Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - Penelope Analytis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - Timothy J Feeney
- Belvedere Health Services and the Mill School, Winooski, Vermont, USA
| | - Jennie Louise Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
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12
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Block H, Hunter SC, Bellon M, George S. Implementing a behavior management approach in the hospital setting for individuals with challenging behaviors during acute traumatic brain injury. Brain Inj 2022; 36:1176-1186. [PMID: 35996950 DOI: 10.1080/02699052.2022.2110941] [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
PRIMARY OBJECTIVE This study aimed to determine if implementing a clinically pragmatic behavior management approach for challenging behaviors during acute TBI reduces use of restraints, security incidences, acute length of stay admission and cost, thereby improving progress to rehabilitation. RESEARCH DESIGN This pilot study involved a behavior management group (n = 27), compared with a historical control group (n = 74). METHOD AND PROCEDURES The behavior management group received care following the implementation of a behavior management approach for challenging behaviors during acute TBI at two hospitals in South Australia. MAIN OUTCOMES AND RESULTS Fidelity results demonstrated high level of adherence to the implemented behavior management approach. The behavior management group had significant lower use of mechanical restraints (p = 0.03), and significantly lower acute admission costs (p = 0.034). Trends in lower pharmacological restraint usage, lower acute hospital length of stay and time from admission to rehabilitation acceptance were recorded. CONCLUSIONS These pilot results contribute to improving quality of health care but methodological limitations make outcomes difficult to interpret as a direct result of the intervention. Future studies are required to investigate evidence-based behavior management interventions for acute TBI patients using more rigorous knowledge translation implementation designs.
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Affiliation(s)
- Heather Block
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Division of Allied Health, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Sarah C Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle Bellon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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13
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Duff MC, Morrow EL, Edwards M, McCurdy R, Clough S, Patel N, Walsh K, Covington NV. The Value of Patient Registries to Advance Basic and Translational Research in the Area of Traumatic Brain Injury. Front Behav Neurosci 2022; 16:846919. [PMID: 35548696 PMCID: PMC9082794 DOI: 10.3389/fnbeh.2022.846919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/29/2022] [Indexed: 01/16/2023] Open
Abstract
The number of individuals affected by traumatic brain injury (TBI) is growing globally. TBIs may cause a range of physical, cognitive, and psychiatric deficits that can negatively impact employment, academic attainment, community independence, and interpersonal relationships. Although there has been a significant decrease in the number of injury related deaths over the past several decades, there has been no corresponding reduction in injury related disability over the same time period. We propose that patient registries with large, representative samples and rich multidimensional and longitudinal data have tremendous value in advancing basic and translational research and in capturing, characterizing, and predicting individual differences in deficit profile and outcomes. Patient registries, together with recent theoretical and methodological advances in analytic approaches and neuroscience, provide powerful tools for brain injury research and for leveraging the heterogeneity that has traditionally been cited as a barrier inhibiting progress in treatment research and clinical practice. We report on our experiences, and challenges, in developing and maintaining our own patient registry. We conclude by pointing to some future opportunities for discovery that are afforded by a registry model.
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Affiliation(s)
- Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Meharry Medical College, Nashville, TN, United States
| | - Emily L. Morrow
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Malcolm Edwards
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Meharry Medical College, Nashville, TN, United States
| | - Ryan McCurdy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sharice Clough
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nirav Patel
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kimberly Walsh
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Natalie V. Covington
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, United States
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14
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Analytis P, Hicks AJ, Gould KR, Feeney TJ, Ponsford J. Clinical perspectives on delivering a Positive Behaviour Support intervention for challenging behaviours following acquired brain injury. Neuropsychol Rehabil 2021; 33:281-304. [PMID: 34904535 DOI: 10.1080/09602011.2021.2010574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Challenging behaviours are distressing sequelae for people with acquired brain injury (ABI) and their families. Positive Behaviour Support (PBS) is a collaborative approach focussing on improving quality of life for individuals with ABI presenting with challenging behaviours. This qualitative study explored clinicians' experiences of a 12-month intervention (PBS+PLUS) for adults with ABI and their family/carers. Semi-structured interviews were conducted with eight clinicians trained in neuropsychology (n = 5), occupational therapy (n = 3), speech pathology (n = 2), with two clinicians trained in two of these disciplines. Interviews were analysed through reflexive thematic analysis. Three themes were identified: Shifting clinical identity; Working as equals; Adapting to the environment. Participants experienced PBS+PLUS as a difficult approach to learn but one which enhanced overt client communication and comfort with their clinical fallibility. PBS+PLUS involved giving clients equal status in the clinician-client relationship which for some clients and families was challenging. Finally, PBS+PLUS was perceived as problematic to implement in some work settings (e.g., involving high staff turnover). Clinicians' recommendations for future implementation included thorough training and supervision and early setting of client expectations. With increasing interest in PBS to address challenging behaviours after ABI, these findings will guide PBS+PLUS translation for community clinicians.
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Affiliation(s)
- Penelope Analytis
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Timothy J Feeney
- Belvedere Health Services and the Mill School, Winooski, VT, USA
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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15
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Ciccia A, Lundine JP, O'Brien KH, Salley J, Krusen S, Wilson B, Kunz J, Haarbauer-Krupa J. Understanding Cognitive Communication Needs in Pediatric Traumatic Brain Injury: Issues Identified at the 2020 International Cognitive-Communication Disorders Conference. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:853-862. [PMID: 33621119 DOI: 10.1044/2020_ajslp-20-00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose In early 2020, the second International Cognitive-Communication Disorders Conference was held to provide an opportunity for researchers and clinician-scientists to discuss the most recent advances and pressing issues in the care of individuals with cognitive-communication disorders (CCDs). Presentations and discussions resulted in the identification of four areas in need of attention: (a) terminology, (b) training, (c) interdisciplinary teams, and (d) pediatrics. We will explore the four themes identified at ICCDC, specifically expanding on how terminology, training, and teams intersect in pediatric traumatic brain injury care. Additionally, we will provide two case studies to highlight the integration of these themes and suggest ways to advance clinical service provision across medical and educational settings for persons with CCDs through the lens of pediatrics. Conclusion While speech-language pathology has come a long way since the original discussion of CCD over 30 years ago, clinicians and researchers have ongoing opportunities to help advance the ways in which speech-language pathologists offer support to persons, specifically children, with CCDs and to continue to advance the profession.
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Affiliation(s)
- Angela Ciccia
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Jennifer P Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens
| | - Jessica Salley
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Sarah Krusen
- Bucks County Intermediate Unit 22, Doylestown, PA
| | | | - Jasmin Kunz
- Papillion La Vista Community Schools, Omaha, NE
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16
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Kelly G, Brown S, Gillett L, Descallar J, Simpson GK. Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series ( N = 24). Neuropsychol Rehabil 2020; 32:407-428. [PMID: 33081575 DOI: 10.1080/09602011.2020.1830807] [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: 10/23/2022]
Abstract
Inappropriate sexual behaviours (ISX) are challenging clinical sequelae of acquired brain injury (ABI). Limited evidence exists about treatment approaches, with few case studies published to date. This study reports an exploratory clinical trial of community-based behaviour support interventions as a treatment approach to ISX after ABI. From routine referrals to a state-wide service specializing in challenging behaviours after ABI, a cohort (n = 24) displaying ISXs were selected. The interventions addressed multiple behavioural domains, and used a variety of approaches including environmental change, psychoeducation, and specific behavioural techniques. These approaches targetted change in the person with ABI, support personnel, or other environmental domains. Behaviour data were collected using the Overt Behaviour Scale (OBS) at baseline, closure and follow-up. Visual inspection and multilevel models were used to analyse the data. For the sample as a whole, there was a significant decline in ISXs from baseline to closure that was maintained at follow-up. Results at an individual level are also presented. Specificity of the intervention was demonstrated by comparison with concurrent challenging behaviours (aggression, perseveration, absconding) which showed no significant change over the same three time points. The results demonstrate the potential efficacy of community-based behaviour support interventions in treating ISXs after ABI.
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Affiliation(s)
| | | | - Lauren Gillett
- Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, UNSW Australia, Liverpool, Australia
| | - Grahame K Simpson
- Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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17
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Oliver S, Gosden-Kaye EZ, Winkler D, Douglas JM. The outcomes of individualized housing for people with disability and complex needs: a scoping review. Disabil Rehabil 2020; 44:1141-1155. [PMID: 32645274 DOI: 10.1080/09638288.2020.1785023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Worldwide, disability systems are moving away from congregated living towards individualized models of housing. Individualized housing aims to provide choice regarding living arrangements and the option to live in houses in the community, just like people without disability. The purpose of this scoping review was to determine what is currently known about outcomes associated with individualized housing for adults with disability and complex needs. METHODS Five databases were systematically searched to find studies that reported on outcomes associated with individualized housing for adults (aged 18-65 years) with disability and complex needs. RESULTS Individualized housing was positively associated with human rights (i.e., self-determination, choice and autonomy) outcomes. Individualized housing also demonstrated favourable outcomes in regards to domestic tasks, social relationships, challenging behaviour and mood. However, outcomes regarding adaptive behaviour, self-care, scheduled activities and safety showed no difference, or less favourable results, when compared to group homes. CONCLUSIONS The literature indicates that individualized housing has favourable outcomes for people with disability, particularly for human rights. Quality formal and informal supports were identified as important for positive outcomes in individualized housing. Future research should use clear and consistent terminology and longitudinal research methods to investigate individualized housing outcomes for people with disability.Implications for rehabilitationIndividualized housing models can foster self-determination, choice and autonomy for adults with disability and complex needs.Having alignment between paid and informal support is important for positive outcomes of individualized housing arrangements.A more substantial evidence base regarding individualized housing outcomes, in particular long-term outcomes, and outcomes for people with an acquired disability, is required.
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Affiliation(s)
- Stacey Oliver
- Summer Foundation Ltd, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia
| | - Emily Z Gosden-Kaye
- Summer Foundation Ltd, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia
| | - Dianne Winkler
- Summer Foundation Ltd, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia
| | - Jacinta M Douglas
- Summer Foundation Ltd, Melbourne, Australia.,Living with Disability Research Centre, La Trobe University, Melbourne, Australia
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18
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‘We struggle and muddle.’ A qualitative study exploring community ABI therapists’ experiences of using, training in and implementing behaviour interventions. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractObjectives:Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life.Methods:Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts.Findings:The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB.Conclusions:The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.
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19
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Howell S, Beeke S, Pring T, Varley R. Measuring outcomes of a peer-led social communication skills intervention for adults with acquired brain injury: A pilot investigation. Neuropsychol Rehabil 2020; 31:1069-1090. [PMID: 32408795 DOI: 10.1080/09602011.2020.1760892] [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
Reduced social competence following severe acquired brain injury (ABI) is well-documented. This pilot study investigated a peer-led group intervention based on the claim that peer models may be a more effective mechanism for behaviour change than clinician-led approaches. Twelve participants with severe ABI were recruited from a post-acute neurorehabilitation setting and randomly assigned to either a peer-led intervention or a staff-led activity group (usual care) (Clinicaltrials.gov: NCT02211339). The groups met twice a week for 8 weeks. A peer was trained separately to facilitate interaction in the intervention group. Training comprised 16 individual sessions over 4 weeks. Group behaviour was measured twice at baseline, after intervention and at maintenance (4 weeks), using the Adapted Measure of Participation in Conversation (MPC) and the Interactional Network Tool (INT), a newly devised measure of group conversational interaction. Outcome measures showed differential sensitivity. The groups did not differ in baseline behaviour. Findings showed a significant improvement in the treated group on the MPC transaction scale post-intervention (p = .02). The intervention group showed more balanced interaction post-intervention on the INT and at follow-up. Findings show preliminary evidence of the advantage for peer-led groups. The INT shows promise as a method to detect a change in group communication behaviour.Trial registration: ClinicalTrials.gov identifier: NCT02211339.
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Affiliation(s)
- Susan Howell
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Tim Pring
- Division of Language and Communication Science, City, University of London, London, UK
| | - Rosemary Varley
- Division of Psychology and Language Sciences, University College London, London, UK
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20
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Evidence for the management of challenging behaviours in patients with acute traumatic brain injury or post-traumatic amnesia: An Umbrella Review. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractObjective:To synthesise the current best evidence on both pharmacological and non-pharmacological behaviour management interventions for adult patients in the acute hospital setting with traumatic brain injury (TBI) or post-traumatic amnesia (PTA).Data Sources:A comprehensive search of 10 electronic databases was completed.Study Selection:Systematic reviews (SRs) published in English before September 2018 were included. Initial search resulted in 4604 citations, 2916 for title and abstract screening with duplicates removed, and 2909 articles failed to meet the inclusion criteria leaving seven reviews for inclusion. Five reporting pharmacological management approaches, two reporting non-pharmacological management approaches, and one reporting both pharmacological and non-pharmacological management approaches.Data Extraction:Methodological quality was assessed independently by two reviewers using the Critical Appraisal Skills Programme Tool for SRs. Data were extracted from the studies based on the recommendations of the Joanna Briggs Institute (JBI) Methodology for JBI Umbrella Reviews.Data Synthesis:The SRs were of low-to-moderate quality overall. High-quality SRs were characterised by low numbers of studies and significant biases. The evidence relating to pharmacological interventions demonstrates low level and variable quality. The evidence relating to non-pharmacological interventions was limited and of low quality.Conclusions:The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours. More studies with rigorous methodologies are required to investigate the most suitable pharmacological and non-pharmacological behavioural interventions for the acute phase of TBI or PTA.
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21
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Understanding Australian Community ABI Therapists’ Preferences for Training in and Implementing Behaviour Interventions: A Focus on Positive Behaviour Support. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Individuals with acquired brain injury (ABI) may experience persistent and distressing challenging behaviours (CB), and therefore, effective delivery of behaviour interventions is crucial. This study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions with a focus on Positive Behaviour Support (PBS).Methods:A sample of Australian community ABI therapists (n = 136) completed an online survey about their experiences with behaviour interventions, including PBS. Data from open-ended questions were analysed using content analysis. Frequency and descriptive statistics were computed, and a multiple regression was performed to determine factors predicting readiness to learn and implement new behaviour interventions. Rank-based non-parametric tests were conducted to investigate the influence of clinical role on experiences with behaviour interventions and training preferences.Results:Consistent with PBS, participants indicated that the following were important in addressing CB: teamwork and collaboration, person-centred practice, working with antecedents, environmental modification, improving quality of life and skill-building. Despite a high level of desire and readiness, 80% of participants reported facing barriers to learning and implementing new behaviour interventions (e.g., lack of time). Participants’ confidence in using behaviour interventions (β = 0.31; p = 0.002) and the number of barriers faced (β = −0.30; p = 0.002) predicted their readiness to learn and implement new behaviour interventions. Confidence, duration of past training in behaviour interventions and preferred duration of future training did not differ based on clinical role.Conclusion:Implications for the development of training in behaviour interventions such as PBS and implementation into community practice are discussed.
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22
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Chia AA, Power E, Kenny B, Elbourn E, McDonald S, Tate R, MacWhinney B, Turkstra L, Holland A, Togher L. Patterns of early conversational recovery for people with traumatic brain injury and their communication partners. Brain Inj 2019; 33:690-698. [DOI: 10.1080/02699052.2019.1571632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- An An Chia
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- Discipline of Speech Pathology, UTS Graduate School of Health, University of Technology, Sydney, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Elise Elbourn
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Skye McDonald
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Tate
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lyn Turkstra
- Department of Communicative Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Audrey Holland
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
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23
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Fisher A, Bellon M, Lawn S, Lennon S. Brain injury, behaviour support, and family involvement: putting the pieces together and looking forward. Disabil Rehabil 2019; 42:1305-1315. [PMID: 30653928 DOI: 10.1080/09638288.2018.1522551] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: (1) to provide insight into the family's experience and support needs following acquired brain injury (ABI) specific to behavioural changes; (2) to provide an overview of empirically-based behaviour support approaches for individuals with ABI; and (3), to examine family involvement in implementing behavioural interventions.Methods: Review of the literature.Results: Family members experience significant distress resulting from neurobehavioural changes in relatives with ABI, and report unmet informational and practical support needs regarding this issue. The importance of utilising family expertise within the rehabilitation process is widely acknowledged, with the increasing involvement of family members being promoted. There is growing evidence supporting the use of positive behaviour support approaches for individuals with ABI in community settings, and evidence supporting the involvement of family within behavioural interventions.Conclusions: This review suggests the need to develop alternative support models that shift the focus towards building competence in everyday support people rather than dependency on the service system. A bottom-up approach is recommended, with the aim of addressing unmet support needs and increasing the competence of family members in supporting behaviour change in individuals with ABI. Recommendations are provided in informing an optimal community-based neurobehavioural support model. Implications for RehabilitationPositive behaviour support is recommended in supporting behavioural changes following brain injury, with family expertise utilised in this process.Evidence suggests that family members can be effectively trained in developing and implementing behaviour support strategies.Family involvement in behavioural interventions may address unmet support needs and increasing the competence of family members in supporting behavioural changes following brain injury.
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Affiliation(s)
- Alinka Fisher
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle Bellon
- Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Department of Psychiatry, Flinders University, Adelaide, Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, Flinders University, Adelaide, Australia
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24
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Tran S, Kenny B, Power E, Tate R, McDonald S, Heard R, Togher L. Cognitive-communication and psychosocial functioning 12 months after severe traumatic brain injury. Brain Inj 2018; 32:1700-1711. [DOI: 10.1080/02699052.2018.1537006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sarah Tran
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Belinda Kenny
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Emma Power
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Robyn Tate
- Rehabilitation Studies Unit, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of NSW, Sydney, Australia
| | - Rob Heard
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Abstract
The past 50 years have been a period of exciting progress in neuropsychological research on traumatic brain injury (TBI). Neuropsychologists and neuropsychological testing have played a critical role in these advances. This study looks back at three major scientific advances in research on TBI that have been critical in pushing the field forward over the past several decades: The advent of modern neuroimaging; the recognition of the importance of non-injury factors in determining recovery from TBI; and the growth of cognitive rehabilitation. Thanks to these advances, we now have a better understanding of the pathophysiology of TBI and how recovery from the injury is also shaped by pre-injury, comorbid, and contextual factors, and we also have increasing evidence that active interventions, including cognitive rehabilitation, can help to promote better outcomes. The study also peers ahead to discern two important directions that seem destined to influence research on TBI over the next 50 years: the development of large, multi-site observational studies and randomized controlled trials, bolstered by international research consortia and the adoption of common data elements; and attempts to translate research into health care and health policy by the application of rigorous methods drawn from implementation science. Future research shaped by these trends should provide critical evidence regarding the outcomes of TBI and its treatment, and should help to disseminate and implement the knowledge gained from research to the betterment of the quality of life of persons with TBI. (JINS, 2017, 23, 806-817).
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Hicks AJ, Gould KR, Hopwood M, Kenardy J, Krivonos I, Ponsford JL. Behaviours of concern following moderate to severe traumatic brain injury in individuals living in the community. Brain Inj 2017; 31:1312-1319. [DOI: 10.1080/02699052.2017.1317361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - K. R. Gould
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - M. Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J. Kenardy
- Recover Injury Research Centre and School of Psychology, University of Queensland, Brisbane, Australia
| | - I. Krivonos
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J. L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
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The Prevalence of Traumatic Brain Injury Among People With Co-Occurring Mental Health and Substance Use Disorders. J Head Trauma Rehabil 2017; 32:E65-E74. [DOI: 10.1097/htr.0000000000000249] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gould KR, Hicks AJ, Hopwood M, Kenardy J, Krivonos I, Warren N, Ponsford JL. The lived experience of behaviours of concern: A qualitative study of men with traumatic brain injury. Neuropsychol Rehabil 2017; 29:376-394. [PMID: 28391771 DOI: 10.1080/09602011.2017.1307767] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Behaviours of Concern (BoC) are a debilitating consequence of Traumatic Brain Injury (TBI). Whilst perspectives of clinicians, carers and family members on BoC have been previously explored, few qualitative studies have included individuals with TBI. The aim of this study was to explore the lived experience of BoC in individuals with TBI, their close others and clinicians. METHOD Eleven males with TBI and BoC were recruited and 25 semi-structured qualitative interviews were conducted (9 individuals with TBI, 9 close others, 7 clinicians). A six-phase thematic analysis approach was utilised. RESULTS Frequent and persistent BoC were reported and the key themes identified included the brain injury, control, environment, mood, identity, social relationships, and meaningful participation. Whilst the brain injury contributed to BoC in all cases, the way the other themes manifested and interacted was variable. CONCLUSIONS This study enriches our understanding of factors associated with BoC. Themes emerging from this study will inform interventions designed to reduce BoC and ultimately maximise quality of life for individuals with TBI and their families.
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Affiliation(s)
- Kate Rachel Gould
- a Monash-Epworth Rehabilitation Research Centre , Epworth Healthcare , Melbourne , Australia.,b Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Amelia J Hicks
- a Monash-Epworth Rehabilitation Research Centre , Epworth Healthcare , Melbourne , Australia.,b Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Malcolm Hopwood
- c Department of Psychiatry , University of Melbourne , Melbourne , Australia
| | - Justin Kenardy
- d Recover Injury Research Centre and School of Psychology , University of Queensland , Brisbane , Australia
| | - Iveta Krivonos
- c Department of Psychiatry , University of Melbourne , Melbourne , Australia
| | - Narelle Warren
- e School of Social Sciences, Faculty of Arts , Monash University , Melbourne , Australia
| | - Jennie L Ponsford
- a Monash-Epworth Rehabilitation Research Centre , Epworth Healthcare , Melbourne , Australia
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Identifying Current Practices and Supports in Behaviour Management Following ABI in South Australian Community Settings: A Delphi Study. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2016.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: To consider the strategies currently used by family care givers to manage challenging behaviour in the community following ABI, and to identify what supports are available that support family care givers in addressing this issue.Research design: Delphi study.Methods: Service providers (n = 8) and family care givers (n = 3) completed a three-round Delphi process with the aim of reaching consensus (75% agreement) regarding research objectives. Round 1 consisted of an open-ended questionnaire in which items were identified; these items were then rated in Round 2 and 3 using a Likert scale. Statistical aggregation then allowed for quantitative analysis.Results: The findings suggest a number of behaviour management approaches are being used by family care givers, including basic antecedent strategies, agreeing with the person's demands, and medication. Consensus was reached that only two services in SA provide specific support to family care givers regarding behaviour management in the community: Families4Families Inc. (a peer support network) and Private Specialists (e.g., [neuro]psychologists and [neuro]psychiatrists).Conclusions: Findings emphasise the need for more specialised services specific to educating and supporting family care givers in the management of challenging behaviours following ABI. These services should be accessible, centralised, and easy for family care givers to navigate.
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Elbourn E, Togher L, Kenny B, Power E. Strengthening the quality of longitudinal research into cognitive-communication recovery after traumatic brain injury: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:1-16. [PMID: 27315590 DOI: 10.1080/17549507.2016.1193896] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 04/23/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE (i) To systematically review longitudinal and prognostic studies relating to the trajectory of cognitive-communication recovery after TBI and (ii) to provide recommendations to strengthen future research. METHOD Thirteen health literature databases were accessed up until July 2014. MAIN MEASURES Articles were screened systematically against pre-determined inclusion and exclusion criteria. Quality reviews were performed on the selected articles using a modified Downs & Black Rating Scale. Two independent reviewers performed the reviews. RESULT Sixteen longitudinal and prognostic articles met the inclusion criteria. There was evidence of either maintenance or improvement of cognitive-communication skills during the first 3 years post-injury. However, the studies did not provide detailed recovery trajectories, by failing to evaluate numerous data points over time. No studies evaluated recovery beyond 3 years post-injury. Injury severity, lesion location, brain volume loss and conversation skills may predict specific cognitive-communication outcomes. There was high variability in study characteristics and measures. CONCLUSION There is currently scarce evidence regarding cognitive-communication recovery and prognosis. People with TBI may recover or maintain pre-morbid cognitive-communication skills during the early rehabilitation stage. Further research detailing the recovery trajectory with a view to evaluating predictive factors is strongly indicated. Guidelines for future research are provided.
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Affiliation(s)
- Elise Elbourn
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Leanne Togher
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Belinda Kenny
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Emma Power
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
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Kalapatapu RK, Giles GM. The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint? Disabil Rehabil 2016; 39:2261-2268. [PMID: 27636708 DOI: 10.1080/09638288.2016.1223757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. New data on interventions used in the RNA and on how the RNA interventions can be used with patients with acquired brain injury (ABI) who have differing levels of functional impairment are provided in this paper. METHOD The study was conducted over a 6-week period in a secure 65-bed program for individuals with ABI that is housed in two units of a skilled nursing facility (SNF). Implementation of the RNA was compared between two units that housed patients with differing levels of functional impairment (n = 65 adults). Since this was a hierarchical clustered dataset, Generalized Estimating Equations regression was used in the analyses. RESULTS RNA interventions used to manage the 495 aggressive incidents included the following: Aggression ignored, Closer observation, Talking to patient, Reassurance, Physical distraction, Isolation without seclusion, Immediate medication by mouth, Holding patient. Different interventions were implemented differentially by staff based on level of functional impairment and without use of seclusion or mechanical restraint. CONCLUSIONS The RNA can be used to non-aversively manage aggression in patients with brain injury and with differing levels of functional impairment. Programs adopting the RNA can potentially manage brain injury-related aggression without seclusion or mechanical restraint. Implications for Rehabilitation The Relational Neurobehavioral Approach (RNA) is a set of non-aversive intervention methods to manage individuals with brain injury-related aggression. RNA methods can be used to manage aggression in patients with brain injury who have differing levels of functional impairment. Successful implementation of the RNA may allow for the management of brain injury-related aggression without seclusion or mechanical restraint.
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Affiliation(s)
- Raj K Kalapatapu
- a Department of Psychiatry , University of California , San Francisco , CA , USA.,b Department of Psychiatry , San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA
| | - Gordon M Giles
- c Department of Occupational Therapy , Samuel Merritt University , Oakland , CA , USA.,d Crestwood Treatment Center , Fremont , CA , USA
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Curran C, Dorstyn D, Polychronis C, Denson L. Functional outcomes of community-based brain injury rehabilitation clients. Brain Inj 2016; 29:25-32. [PMID: 25180709 DOI: 10.3109/02699052.2014.948067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community-based rehabilitation can help to maximize function following acquired brain injury (ABI); however, data on treatment outcome is limited in quantity. OBJECTIVE To describe and evaluate client outcomes of an outpatient programme for adults with moderate-to-severe traumatic and non-traumatic ABI. METHODS Two phase design involving retrospective and longitudinal study of programme completers with ABI (n = 47). Changes in functioning were measured with the Mayo-Portland Inventory (MPAI-4), administered pre- and immediately post-rehabilitation and at 3 years follow-up. Self-ratings were supplemented with MPAI-4 data from significant others (n = 32) and staff (n = 32). RESULTS Injured individuals and informants reported improved physical and psychosocial functioning immediately following the completion of community rehabilitation, with medium-to-large and significant treatment gains noted on the MPAI-4 ability, adjustment and participation sub-scales (Cohen's d range = 0.31-1.10). A deterioration in individuals' adjustment was further reported at follow-up, although this was based on limited data. Issues with longer-term rehabilitation service provision were additionally noted. CONCLUSIONS The data support the need for continuity of care, including ongoing emotional support, to cater to the complex and dynamic needs of the ABI population. However, these results need to be considered in the context of a small sample size and quasi-experimental design.
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Affiliation(s)
- Christine Curran
- a School of Psychology, Faculty of Health Sciences, University of Adelaide , Adelaide , South Australia , Australia and
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33
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Togher L, McDonald S, Tate R, Rietdijk R, Power E. The effectiveness of social communication partner training for adults with severe chronic TBI and their families using a measure of perceived communication ability. NeuroRehabilitation 2016; 38:243-55. [DOI: 10.3233/nre-151316] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Leanne Togher
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Skye McDonald
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Robyn Tate
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Rachael Rietdijk
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Emma Power
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
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Raju B, Lukose S, Raj P, Reddy K. Clinically providing psycho-social care for caregivers in emergency and trauma care setting: Scope for medical and psychiatric social workers. Int J Crit Illn Inj Sci 2016; 6:206-210. [PMID: 28149828 PMCID: PMC5225766 DOI: 10.4103/2229-5151.195452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury is the leading cause of death and disability in young people. TBI is associated with increased mortality, morbidity, and socioeconomic loss, especially in developing countries such as India. It is creating damage to the psychosocial well–being of caregiver and their family members significantly. Caregivers’ informational, educational, psychosocial problems are still overlooked and unaddressed. Providing psychosocial interventions such as educating caregivers about TBI-related consequences, increasing social support, mobilization of resources for the needy, and dealing with psychological stress will be beneficial to reduce the caregiver burden. Medical and psychiatric social workers (MPSWs) have important role in providing psychosocial care and decreasing caregiver burden of TBI survivors. This case report highlights the role of MPSWs in the emergency and trauma care setting.
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Affiliation(s)
- Birudu Raju
- Department of Psychiatric Social Work, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Lukose
- Department of Psychiatric Social Work, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabu Raj
- Department of Psychiatric Social Work, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Krishna Reddy
- Department of Neuro-Surgery, Neuro-Surgery Unit, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Fisher CA, Brown A. Sensory modulation intervention and behaviour support modification for the treatment of severe aggression in Huntington's disease. A single case experimental design. Neuropsychol Rehabil 2015; 27:891-903. [DOI: 10.1080/09602011.2015.1091779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Caroline A. Fisher
- Brain Disorders Program, Austin Health, Melbourne, Australia
- Child and Youth Mental Health Service, Eastern Health, Melbourne, Australia
- Living Well Program, The Melbourne Clinic, Melbourne, Australia
| | - Anahita Brown
- Brain Disorders Program, Austin Health, Melbourne, Australia
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36
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Kenworthy L, Anthony LG, Naiman DQ, Cannon L, Wills MC, Luong-Tran C, Werner MA, Alexander KC, Strang J, Bal E, Sokoloff JL, Wallace GL. Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. J Child Psychol Psychiatry 2014; 55:374-83. [PMID: 24256459 PMCID: PMC4532389 DOI: 10.1111/jcpp.12161] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unstuck and On Target (UOT) is an executive function (EF) intervention for children with autism spectrum disorders (ASD) targeting insistence on sameness, flexibility, goal-setting, and planning through a cognitive-behavioral program of self-regulatory scripts, guided/faded practice, and visual/verbal cueing. UOT is contextually-based because it is implemented in school and at home, the contexts in which a child uses EF skills. METHODS To evaluate the effectiveness of UOT compared with a social skills intervention (SS), 3rd-5th graders with ASD (mean IQ = 108; UOT n = 47; SS n = 20) received interventions delivered by school staff in small group sessions. Students were matched for gender, age, race, IQ, ASD symptomotolgy, medication status, and parents' education. Interventions were matched for 'dose' of intervention and training. Measures of pre-post change included classroom observations, parent/teacher report, and direct child measures of problem-solving, EF, and social skills. Schools were randomized and evaluators, but not parents or teachers, were blinded to intervention type. RESULTS Interventions were administered with high fidelity. Children in both groups improved with intervention, but mean change scores from pre- to postintervention indicated significantly greater improvements for UOT than SS groups in: problem-solving, flexibility, and planning/organizing. Also, classroom observations revealed that participants in UOT made greater improvements than SS participants in their ability to follow rules, make transitions, and be flexible. Children in both groups made equivalent improvements in social skills. CONCLUSIONS These data support the effectiveness of the first contextually-based EF intervention for children with ASD. UOT improved classroom behavior, flexibility, and problem-solving in children with ASD. Individuals with variable background/training in ASD successfully implemented UOT in mainstream educational settings.
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Affiliation(s)
- Lauren Kenworthy
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA,The George Washington University School of Medicine, District of Columbia, USA
| | - Laura Gutermuth Anthony
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA,The George Washington University School of Medicine, District of Columbia, USA
| | - Daniel Q. Naiman
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lynn Cannon
- The Ivymount School, Rockville, Maryland, USA
| | - Meagan C. Wills
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | - Caroline Luong-Tran
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | | | | | - John Strang
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA,The George Washington University School of Medicine, District of Columbia, USA
| | - Elgiz Bal
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | - Jennifer L. Sokoloff
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | - Gregory L. Wallace
- Laboratory of Brain & Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Traumatic brain injury: unmet support needs of caregivers and families in Florida. PLoS One 2013; 8:e82896. [PMID: 24358236 PMCID: PMC3866264 DOI: 10.1371/journal.pone.0082896] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/07/2013] [Indexed: 11/20/2022] Open
Abstract
Sustaining a Traumatic Brain Injury results in familial strain due to the significant impact the injury has upon the role and function of individuals and their families at home and in the community. Using the Stress Process Model of Caregiving, a caregiver needs assessment survey was developed and conducted to better understand the needs of individuals with a Traumatic Brain Injury and their caregivers. Survey results indicate that caregivers experience many challenges including unmet needs in areas of relational supports such as maintaining relationships, long-term emotional and financial support for themselves and the survivor, and the need for a patient or caregiver advocate. Implications for future practice are presented.
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Hoepner JK, Turkstra LS. Video-based administration of the La Trobe Communication Questionnaire for adults with traumatic brain injury and their communication partners. Brain Inj 2013; 27:464-72. [DOI: 10.3109/02699052.2013.765600] [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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Abstract
Neurobehavioral disorders are composed of a large group of behavioral impairments seen in association with brain disease (e.g., stroke, multiple sclerosis, dementia, and neuro-oncological conditions), transient as well as permanent brain impairments (e.g., metabolic and toxic encephalopathies), and/or injury (e.g., trauma, hypoxia, and/or ischemia). The neurorehabilitative assessment and management of such disorders is often poorly addressed in the context of overall neurological, psychiatric, and rehabilitative care. Too often, more basic, yet critical, aspects of behavioral assessment and treatment are not addressed or only superficially addressed by evaluating clinicians. Physicians often overly rely on pharmacological interventions as initial and/or sole treatment approaches rather than taking a pragmatic biopsychosocial approach that focuses on holistic disease state management. This chapter provides readers with an overview of the common behavioral impairments associated with brain dysfunction due to disease, injury, or toxicity. Details regarding the nature of impairments such as localization-related syndromes, affective disorders and personality disorders, among others are expounded. Principles of neurobehavioral assessment and treatment are examined including general guidelines for eliciting a history and physical, behavioral analysis, and functional behavioral assessment. General treatment caveats are provided including discussion of impairment and disability adaptation, and creation of positive behavioral supports. The topic of pharmacological management of neurobehavioral disorders is covered in numerous other references including Chapter 33 of this text.
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Uruma G, Hashimoto K, Abo M. A new method for evaluation of mild traumatic brain injury with neuropsychological impairment using statistical imaging analysis for Tc-ECD SPECT. Ann Nucl Med 2012; 27:187-202. [PMID: 23255125 DOI: 10.1007/s12149-012-0674-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to identify specific brain lesions with regional perfusion abnormalities possibly associated with neuropsychological impairments (NPI), as sequela after mild traumatic brain injury (MTBI), using 99mTc-ethylcysteinate dimer single photon emission computed tomography (Tc-99m ECD SPECT) and its novel analytic software. METHODS We studied 23 patients with diffuse axonal injury with NPI group (Impaired-DAI), 26 with MTBI with NPI group (Impaired-MTBI) and 24 with MTBI without NPI group (Healthy-MTBI). In each subject, Tc-99m ECD SPECT images were analyzed by easy Z score imaging system (eZIS) and voxel-based stereotactic extraction estimation (vbSEE). Segmented into lobule levels, ROIs were set in 140 areas in whole brain, and relative regional low Tc-99m ECD uptake was computed as "extent" (rate of coordinates with Z score >2.0 in the ROI). Receiver operating characteristic analysis was performed using "extent" to discriminate the three groups. RESULTS The highest area under the curve (AUC) value for data of Impaired-DAI and Healthy-MTBI groups was obtained in ROI on the left anterior cingulate gyrus (LtACG), with AUC of 0.93, optimal "extent" cutoff value of 10.9%, sensitivity 87.0%, specificity 83.3%. The highest AUC value for data of Impaired-MTBI and Healthy-MTBI groups was also in the LtACG, with AUC of 0.87, optimal "extent" cutoff value of 9.2%, sensitivity 73.1%, specificity 83.3%. CONCLUSIONS Using two analytic software packages, eZIS and vbSEE, we identified specific lesions with low regional Tc-99m ECD uptake possibly associated with NPIs after MTBI. Especially, this trend was most marked in the left anterior cingulate gyrus in MTBI patients with NPIs and those with DAI. The optimal "extent" cutoff value, as a criterion for SPECT abnormality, might help the diagnosis of NPIs after MTBI.
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Affiliation(s)
- Go Uruma
- Department of Rehabilitation Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, Japan.
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McDonald S, Togher L, Tate R, Randall R, English T, Gowland A. A randomised controlled trial evaluating a brief intervention for deficits in recognising emotional prosody following severe ABI. Neuropsychol Rehabil 2012; 23:267-86. [PMID: 23215966 DOI: 10.1080/09602011.2012.751340] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many adults with acquired brain injuries, including traumatic brain injuries (TBI) have impaired emotion perception. Impaired perception of emotion in voice can occur independently to facial expression and represents a specific target for remediation. No research to date has addressed this. The current study used a randomised controlled trial to examine the efficacy of a short treatment (three x two-hour sessions) for improving the ability to recognise emotional prosody for people with acquired brain injury, mostly TBI. Ten participants were allocated to treatment and 10 to waitlist. All participants remained involved for the duration of the study in the groups to which they were allocated. There were no significant treatment effects for group, but analyses of individual performances indicated that six of the treated participants made demonstrable improvements on objective measures of prosody recognition. The reasons why some participants showed improvements while others did not, was not obvious. Improvements on objective lab-based measures did not generalise to relative reports of improvements in everyday communicative ability. Nor was there clear evidence of long-term effects. In conclusion, treatment of emotional prosody was effective in the short-term for half of the participants. Further research is required to determine what conditions are required to optimise generalisability and longer-term gains.
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Affiliation(s)
- S McDonald
- University of New South Wales, Sydney, Australia.
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Johnston JM, Foxx RM, Jacobson JW, Green G, Mulick JA. Positive behavior support and applied behavior analysis. THE BEHAVIOR ANALYST 2012; 29:51-74. [PMID: 22478452 DOI: 10.1007/bf03392117] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article reviews the origins and characteristics of the positive behavior support (PBS) movement and examines those features in the context of the field of applied behavior analysis (ABA). We raise a number of concerns about PBS as an approach to delivery of behavioral services and its impact on how ABA is viewed by those in human services. We also consider the features of PBS that have facilitated its broad dissemination and how ABA might benefit from emulating certain practices of the PBS movement.
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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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Togher L, Power E, Rietdijk R, McDonald S, Tate R. An exploration of participant experience of a communication training program for people with traumatic brain injury and their communication partners. Disabil Rehabil 2012; 34:1562-74. [PMID: 22360709 DOI: 10.3109/09638288.2012.656788] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the experiences of participants who attended communication training programs for people with traumatic brain injury (TBI) and their everyday communication partners (CP) as part of a non-randomised controlled trial. METHOD The participants were people with TBI and their CP, who were family members or carers of the people with TBI. Twenty-six participants (13 participants with TBI and 13 CP) completed the JOINT program, which involved participants with TBI and CP attending the program together. Fourteen participants with TBI completed the TBI SOLO training program, which did not involve the participation of a CP. Semi-structured videotaped interviews were completed by all participants at the end of the training. Using a six-step generic analysis procedure, data were categorised into topics and then subtopics to identify conceptually discrete units. RESULTS Participants described improvements in communication skills, the impact of improved communication skills, valuable components of the programs and components that needed changes. CONCLUSION The accounts of participants provided additional evidence for the effectiveness of the training programs, assisted with identifying helpful components of the training and demonstrated the usefulness of a qualitative research methodology as part of evaluating the outcomes of the clinical trial.
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Affiliation(s)
- Leanne Togher
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
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Palmisano B, Arco L. Changes in Functional Behaviour of Adults With Brain Injury and Spouse-Caregiver Burden With In-Home Neurobehavioural Intervention. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.24.1.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractA within-participant multiple baseline experiment evaluated effects of in-home neurobehavioural interventions on functional behaviour of 3 persons with brain injury, and their spouses' burden of care. The 6-week individualised interventions included in-home and telephone consultations. Measures consisted of functional behaviour of the injured persons, spouses' burden of care using the QRS-SF at preand postintervention and at 1 month follow-up, and social validity. Results show interventions were efficacious in improving functional behaviour, but effects on burden of care and social validity were mixed. One caregiver who presented with high levels of burden at preintervention reported reduced burden, while the other 2 who presented with low to moderate burden reported no changes.
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Abstract
AbstractThere has been a dramatic increase in recent years in the literature available on community integration among people with acquired brain injuries. At the same time, however, clinicians are calling for information that has utility in the complex environment of community practice. The study was a scoping review to address the question:What is known from the existing literature regarding the best ways to promote community integration in the postacute phase of brain injury recovery?From a preliminary pool of 925 studies identified by electronic searching of 5 databases in a 15-year time window, a final set of 30 was selected for further review, referring to 25 distinct programs. This scoping review has shown that there are 5 types of programs typically offered to survivors of brain injuries to assist with community integration: supported employment, traditional rehabilitation, environmental adaptation, support development and transitional living. These 5 approaches were primarily used to address 2 aspects of community integration: traditional rehabilitation was most commonly used to promote independent living, and supported employment was the most common approach used to promote productive occupation. Themes that emerged from the review were the need for highly individualised programming, in vivo approaches, tailored supports, early intervention and a focus on participation. Methodologically, the study represents an important acknowledgment of the valuable information that is available in the literature in descriptive and small sample research.
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Ylvisaker M, Feeney T, Capo M. Long-Term Community Supports for Individuals With Co-Occurring Disabilities After Traumatic Brain Injury: Cost Effectiveness and Project-Based Intervention. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.8.3.276] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractOutcome studies have established that successful community living is compromised in the population of individuals with traumatic brain injury and chronic behavioural difficulties along with a co-occurring diagnosis of substance abuse and/or mental health disorder. Two studies are presented. The first was aimed at describing long-term outcome of a sample of individuals (N = 51) served by the New York State Department of Health TBI Medicaid Waiver Program. Each of the participants was diagnosed with TBI plus either substance abuse or a mental health disorder, or both. Because of significant behavioural challenges, all of the participants were in a restrictive living setting the year before enrolment in the waiver program (e.g., nursing or correctional facility). Data on community living arrangement, self-reported community integration experiences, and costs are presented. Results indicate that most of the participants (41 of the 46 who were alive and living in state) continued to live in the community 8 to 9 years after commencement of community support services. The participants' community integration responses were generally positive and cost data demonstrate substantial savings to the state for this cohort. Comparing prewaiver costs in residential settings with most recent (2005) costs for community supports, there was an average daily cost savings of US$137 per person for the 1996 cohort and US$144 per person for the 1997 cohort. The second study explored the use of project-oriented interventions and supports in an agency that provides community support services to this dual diagnosis population. Project-oriented services are described as meeting many needs common to this dual-diagnosis population. Clinical staff (N = 11) and a sample of waiver participants (N = 7) were surveyed. Results suggest that the use of personally meaningful projects can become a clinical habit for staff and that projects are generally judged by participants to be a meaningful use of time, and significant in giving them an opportunity to play an expert role and to help others.
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Arco L, Bishop J. Single Participant Studies in Positive Behaviour Support for Parents of Individuals With Brain Injuries. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.10.3.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThree single participant studies examined effects of in-home parent-implemented Positive Behaviour Support (PBS) interventions on behaviour of individuals with brain injuries. Parental and independent observations of morning routine behaviour or problem behaviour (viz., noncompliance during meals or morning routines, yelling, kicking, swearing, and so on) were taken during baselines and PBS interventions, which consisted of person-centred functional assessments of behaviour, emphasis on changing behavioural antecedents, parent participation in assessing, treating, and evaluating behaviour change, and in-home parent coaching and support. Results show decreased problem behaviour or improved morning routine behaviour, which corroborate and add to the few studies that applied similar parent-implemented interventions. Future comparative studies between PBS and out-patient interventions are indicated.
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Togher L, McDonald S, Tate R, Power E, Rietdijk R. Training Communication Partners of People With Traumatic Brain Injury: Reporting the Protocol for a Clinical Trial. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.10.2.188] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article reports on the design of a three-arm, nonrandomised controlled trial of interventions targeting social communication skills following traumatic brain injury (TBI) in adult participants. People with severe TBI were allocated to one of the three groups: the TBI group, where only the person with TBI was trained, the JOINT group where both the everyday communication partner (ECP) and the person with TBI were trained together, and a delayed treatment control condition. The trial is comparing whether including everyday communication partners in the training process provide additional benefit when compared to training the person with TBI alone; and additionally, whether training the person with TBI alone is more effective than no training. A range of primary and secondary outcome measures will be used to evaluate outcomes. Publishing the protocol prior to the results of the trial being available has several important benefits (Godlee, 2001). The original hypotheses and intentions of the research are made explicit to ensure that the process of conducting this clinical trial is transparent to readers, and so that comments may be made before results are finalised. It provides the opportunity to outline a detailed description of this intervention and methodology, or to acknowledge changes to methodology, which may assist with eventual clinical application of the intervention. This article also informs the research community of the work that is underway to promote opportunities for collaboration and reduce unnecessary duplication of research. The protocol for this trial has previously been registered on Current Controlled Trials (http://www.controlled-trials.com/ISRCTN57815281).
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Togher L, Taylor C, Aird V, Grant S. The Impact of Varied Speaker Role and Communication Partner on the Communicative Interactions of a Person With Traumatic Brain Injury: A Single Case Study Using Systemic Functional Linguistics. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.7.3.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article presents preliminary findings on an investigation into the differences in communicative performance across varying speaking conditions, of an individual with a cognitive–linguistic impairment following traumatic brain injury (TBI). The article compares the communicative exchanges of an individual in a conversation with a therapist, a conversational dyad with a peer with TBI, and in a communication group task where they were interacting with other participants with TBI. The speaking conditions studied included an unstructured chat, the participant requesting information and the participant giving information. Results showed that the person with TBI responded to differences in communication partner and speaker role. He was best able to give information in the unstructured chat with the clinician and the information giving session in the group. Requesting was maximally facilitated in the information request condition with the clinician. Qualitatively, however, the most equal interactions occurred with the peer, with evidence of the person with TBI engaging in typical conversational strategies such as establishing common ground to facilitate topic development and co-constructing the discourse topics. These strategies did not occur in the clinician or group interactions, possibly due to power imbalance in the former and impaired cognitive–linguistic ability in the latter situation. Implications for clinical decision making regarding intervention strategies for patients with cognitive–communication deficits are discussed.
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