1
|
Anderson V, Hearps SJC, Catroppa C, Beauchamp MH, Ryan NP. What predicts persisting social impairment following pediatric traumatic brain injury: contribution of a biopsychosocial approach. Psychol Med 2023; 53:3568-3579. [PMID: 35189999 PMCID: PMC10277758 DOI: 10.1017/s0033291722000186] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychosocial deficits, such as emotional, behavioral and social problems, reflect the most common and disabling consequences of pediatric traumatic brain injury (TBI). Their causes and recovery likely differ from physical and cognitive skills, due to disruption to developing brain networks and the influence of the child's environment. Despite increasing recognition of post-injury behavioral and social problems, there exists a paucity of research regarding the incidence of social impairment, and factors predicting risk and resilience in the social domain over time since injury. METHODS Using a prospective, longitudinal design, and a bio-psychosocial framework, we studied children with TBI (n = 107) at baseline (pre-injury function), 6 months, 1 and 2-years post-injury. We assessed intellectual ability, attention/executive function, social cognition, social communication and socio-emotional function. Children underwent structural magnetic resonance imaging (MRI) at 2-8 weeks post-injury. Parents rated their child's socio-emotional function and their own mental health, family function and perceived burden. RESULTS We distinguished five social recovery profiles, characterized by a complex interplay between environment and pre- and post-TBI factors, with injury factors playing a lesser role. Resilience in social competence was linked to intact family and parent function, intact pre-injury adaptive abilities, post-TBI cognition and social participation. Vulnerability in the social domain was related to poor pre- and post-injury adaptive abilities, greater behavioral concerns, and poorer pre- and post-injury parent health and family function. CONCLUSIONS We identified five distinct social recovery trajectories post-child-TBI, each characterized by a unique biopsychosocial profile, highlighting the importance of comprehensive social assessment and understanding of factors contributing to social impairment, to target resources and interventions to children at highest risk.
Collapse
Affiliation(s)
- Vicki Anderson
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Stephen J. C. Hearps
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- University of Melbourne, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Miriam H. Beauchamp
- University of Montreal, P.O. Box 6128, Center-ville branch, Montreal, QC, H3C 317, Canada
- St Justine Hospital, Avenue Ellendale, Montreal, QC, Canada
| | - Nicholas P. Ryan
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
- Deakin University, 221 Burwood Highway, Burwood, Australia
| |
Collapse
|
2
|
Catroppa C, Sood NT, Morrison E, Kenardy J, Lah S, McKinlay A, Ryan N, Crowe L, Soo C, Godfrey C, Anderson V. The Australian and New Zealand brain injury lifespan cohort protocol: Leveraging common data elements to characterise longitudinal outcome and recovery. BMJ Open 2023; 13:e067712. [PMID: 36657763 PMCID: PMC9853218 DOI: 10.1136/bmjopen-2022-067712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Cognitive, behavioural, academic, mental health and social impairments are common following paediatric traumatic brain injury (TBI). However, studies are often reliant on small samples of children drawn from narrow age bands, and employ highly variable methodologies, which make it challenging to generalise existing research findings and understand the lifetime history of TBI. METHOD AND ANALYSIS This study will synthesise common data sets from national (Victoria, New South Wales, Queensland) and international (New Zealand) collaborators, such that common data elements from multiple cohorts recruited from these four sites will be extracted and harmonised. Participant-level harmonised data will then be pooled to create a single integrated data set of participants including common cognitive, social, academic and mental health outcome variables. The large sample size (n=1816), consisting of participants with mild, moderate and severe TBI, will provide statistical power to answer important questions that cannot be addressed by small, individual cohorts. Complex statistical modelling, such as generalised estimation equation, multilevel and latent growth models, will be conducted. ETHICS AND DISSEMINATION Ethics approval was granted by the Human Research Ethics Committee (HREC) of the Royal Children's Hospital (RCH), Melbourne (HREC Reference Number 2019.168). The approved study protocol will be used for all study-related procedures. Findings will be translated into clinical practice, inform policy decisions, guide the appropriate allocation of limited healthcare resources and support the implementation of individualised care.
Collapse
Affiliation(s)
- Cathy Catroppa
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Nikita Tuli Sood
- Brain and Mind, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elle Morrison
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justin Kenardy
- The University of Queensland, Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Suncica Lah
- The University of Sydney, Sydney, New South Wales, Australia
| | | | - Nicholas Ryan
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Louise Crowe
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Cheryl Soo
- Applied Medical Research, Ingham Institute, Liverpool, New South Wales, Australia
| | - Celia Godfrey
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Fisher A, Bellon M, Lawn S, Lennon S, Sohlberg M. Family-directed approach to brain injury (FAB) model: a preliminary framework to guide family-directed intervention for individuals with brain injury. Disabil Rehabil 2017; 41:854-860. [PMID: 29171308 DOI: 10.1080/09638288.2017.1407966] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This article proposes a theoretical framework to help professionals include family as active members in brain injury rehabilitation. A trend towards greater family involvement has lead to the development of family-collaboration models. However, current models appear to focus on information sharing rather than increasing the capability of family members. This article introduces a family-directed approach to brain injury model, which provides a theoretical framework for supporting family as facilitators of change. METHODS Family-collaboration models and literature regarding family experiences following brain injury and support needs are reviewed to identify the driving forces behind family engagement in rehabilitation, including effective professional-family relationships, and important factors in the delivery of education underpinned by evidence-based practices. RESULTS The family-directed approach to brain injury model is based on principles of hope, family expertise, education/skill building, and family-directed intervention. CONCLUSIONS The family-directed approach to brain injury model provides a theoretical framework for educating and training family members as facilitators in the management process: promoting competence rather than dependency on service systems. Guiding recommendations encourage professionals to reflect on the importance of their therapeutic relationships and their capacity to positively impact rehabilitation outcomes beyond the technical aspects of health care and treatment. Implications for Rehabilitation Training family members as facilitators in the rehabilitation process is suggested to reduce dependency on the service system, address families' unmet support needs, and to optimize rehabilitation outcomes for individuals with brain injury. The family-directed approach to brain injury model is proposed to guide the increased involvement of family as active members in the rehabilitation team and to define potential active ingredients in this process.
Collapse
Affiliation(s)
- Alinka Fisher
- a Disability and Community Inclusion, College of Nursing and Health Sciences , Flinders University , Adelaide , Australia
| | - Michelle Bellon
- a Disability and Community Inclusion, College of Nursing and Health Sciences , Flinders University , Adelaide , Australia
| | - Sharon Lawn
- b Department of Psychiatry , Flinders University , Adelaide , Australia
| | - Sheila Lennon
- c Discipline of Physiotherapy , Flinders University , Adelaide , Australia
| | - McKay Sohlberg
- d Communication Disorders & Sciences , University of Oregon , Eugene, OR, USA
| |
Collapse
|
5
|
Masalha W, Auslander G. Coping strategies used by parents of children with traumatic brain injury: A cross-sectional study of Palestinians and Israelis. SOCIAL WORK IN HEALTH CARE 2017; 56:964-983. [PMID: 28762891 DOI: 10.1080/00981389.2017.1353568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined the use and helpfulness of coping strategies and patterns among parents of children with traumatic brain injury (TBI). Participants were 122 Arab-Israeli, Jewish-Israeli, and Palestinian parents of 65 children with TBI following their discharge from pediatric rehabilitation hospital. Family-focused strategies were highly prevalent and most helpful among both mothers and fathers. Jewish mothers reported that support coping pattern (but not medical or family) was more helpful than did Arab-Israeli and Palestinian mothers. The findings highlight the need to promote effective coping among mothers of children with TBI with low levels of income and education and underscore the need for continuous long-term professional support to parents of children with TBI after hospital discharge.
Collapse
Affiliation(s)
| | - Gail Auslander
- b Zena Harman Professor of Social Work, School of Social Work & Social Welfare , Hebrew University of Jerusalem , Jerusalem , Israel
| |
Collapse
|
6
|
T. Woods D, Catroppa C, Godfrey C, A. Anderson V. Long-term maintenance of treatment effects following intervention for families with children who have acquired brain injury. ACTA ACUST UNITED AC 2014. [DOI: 10.1108/scn-01-2014-0001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Where no psychosocial or interventional support is provided, children with acquired brain injury (ABI) are at significant risk of serious long-term behavioural and social difficulties. The purpose of this paper is to report the six- and 18-month long-term treatment effects of a family centred behavioural intervention to help families manage and prevent challenging behaviours in children following ABI.
Design/methodology/approach
– In total, 31 parents were followed up at three time points (post-intervention, 6 and 18 months) after participating in an ABI adapted manualised “Signposts for Building Better Behaviour” programme (Hudson et al., 2003).
Findings
– Attrition rates were highest amongst families caring for a child with mild ABI. The maintenance of treatment effects were detailed for those families who reported a reduction in challenging behaviour immediately post-intervention. There were no significant elevations in challenging child behaviour, maladaptive parenting, or family dysfunction for any participants over the long-term follow-up. Irrespective of injury severity, parents reported high levels of satisfaction and efficacy in the parenting role at 18 months post-intervention.
Originality/value
– “Signposts” has further demonstrated its clinical viability by meeting the needs of parents who have a child with ABI in both the short- and longer-term.
Collapse
|