A Multidisciplinary Social Communication and Coping Skills Group Intervention for Adults with Acquired Brain Injury (ABI): A Pilot Feasibility Study in an Inpatient Setting

Family members' and friends' reports after standard and intensive group treatment for social communication difficulties following acquired brain injury - a mixed method approach

OBJECTIVE

To examine family members/friends' perception of change following standard and intensive group interactive structured treatment (GIST) for persons with social communication difficulties (SCDs).

METHODS

A parallel mixed methods design combining data from questionnaires, the Goal Attainment Scale, and interviews.

PARTICIPANTS

Forty-nine adult (>18 years) family members/friends (69.4% female) of persons with SCDs and acquired brain injury (ABI) (cohabitating partner, 53.1%; other relatives, 30.6%; friends, 16.3%).

INTERVENTION

Standard GIST consisted of 12 weekly outpatient sessions (2.5 h). Intensive GIST consisted of 4 weeks of inpatient rehabilitation (2 × 3 days/week, 2 × 4 days/week). Both treatments included 3- and 6-month follow-ups.

MAIN OUTCOME MEASURES

Quantitative measures (n = 49) included the following informant reports: Latrobe Communication Questionnaire (LCQ), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Behavior Rating Inventory for Executive Functions-Adult version (BRIEF-A), and Goal Attainment Scale. The qualitative measure (n=9) was an interview performed at 6-month follow-up.

RESULTS

Converging results were found, suggesting a perceived positive change over time for both standard and intensive GIST, with no substantial differences reported between the treatments.

CONCLUSIONS

Family members/friends reported improved social communication skills of the persons with SCDs following standard and intensive GIST. However, the integration of data showed the complexity of assessing SCDs and the need for further investigation.

A systematic review of interventions for adults with social communication impairments due to an acquired brain injury: Significant other reports

Purpose: To determine the most effective intervention for adults with social communication impairments due to an Acquired Brain Injury (ABI), using standardised outcome measures completed by significant others.Method: A systematic literature review was conducted. Four electronic databases relevant to the field of speech-language pathology or brain injury were searched: Medline, CINAHL, AMED and Embase. Grey literature, reference lists and citation indexes were also hand searched for additional research. Studies that met the broad inclusion and exclusion criteria were initially screened to determine articles for full text reviews by two independent reviewers. Reviewers independently extracted data from full-text reviews using a data extraction form and performed bias analysis using the Downs and Black quality checklist (Downs, S.H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology & Community Health, 52, 377-384.). Studies were categorised using a five-phase model of evidence (Robey, R.R., & Schultz, M.C. (1998). A model for conducting clinical-outcome research: An adaptation of the standard protocol for use in aphasiology. Aphasiology, 12, 787-810.).Result: 681 articles were identified after duplicates were removed. 15 articles were reviewed for full-text analysis. Six studies were ultimately included in the review. Of these, three were randomised controlled trials and three others were not. Four studies delivered intervention solely to the individual with an ABI, one to the communication partner only, and one delivered intervention both to the individual and their communication partner. Intervention programmes ranged from four to 12 weeks and from 12 to 48 hours total contact time. The reviews studies were heterogeneous, which made comparisons difficult. Risk of bias was also present to varying degrees in all studies. The current level of evidence has focussed on efficacy of treatments and effectiveness of treatment is not yet established.Conclusion: The current level of evidence is not yet established to make clear clinical guidelines on which interventions are most effective, based on significant others' reports. Further research is required, incorporating more rigorous study designs and larger sample sizes to enable accurate conclusions to be drawn.

A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury

Psychological distress is common in persons with traumatic brain injury (TBI) but treatments remain underdeveloped. This randomized controlled trial of Acceptance and Commitment Therapy (ACT) was designed to address this gap. Ninety-three persons with medically-documented complicated mild to severe TBI, normal-to-mildly impaired memory, and clinically significant psychological distress in the chronic phase of recovery were randomized to receive eight weeks of ACT (manualized with adaptations to address TBI-related cognitive impairments) or a single session of needs assessment, brief counseling/education, and referral. The ACT group showed significantly greater reduction of psychological distress (Brief Symptom Inventory 18) and demonstrated improvements in psychological flexibility and commitment to action (Acceptance and Action Questionnaire-II (AAQ-II) scores). The number of treatment responders (post-treatment BSI 18 GSI T scores <63) was larger in the ACT group than in the control group. Entry of AAQ-II scores into the model of between-group differences in BSI 18 GSI T scores indicated that core ACT processes explained the variance in treatment group outcomes. Provision of ACT reduces psychological distress in persons with TBI in the chronic phase of recovery when adaptations are made to accommodate TBI-related cognitive impairments. Additional clinical trials with a structurally equivalent control group are needed.

Patient perceptions of participation in group-based rehabilitation in an inpatient brain injury rehabilitation setting

OBJECTIVES

The use of groups is common in healthcare. There is a paucity of research which captures patient experiences of group participation. The aims of this study were to explore the perceptions and experiences of people with traumatic brain injury (TBI) about their participation in inpatient occupational therapy rehabilitation groups.

METHOD

A phenomenological approach guided the study. Patients with a TBI who were participating in an inpatient occupational therapy group program were recruited. Data were collected through semi-structured interviews and analysed using content analysis.

RESULTS

Fifteen participants consented to the study. Three themes emerged from the data; 1) feeling normal, comfortable and connected; 2) learning by doing, seeing and sharing and; 3) practicalities of groups. Participants highlighted that groups facilitated opportunities to practice skills and prepared them for the real world. Opportunities for interaction and support were also emphasised as positive by participants.

CONCLUSION

Perceptions of patients about participation in groups were generally positive, and as such a consumer-focused approach to healthcare would support the use of occupational therapy groups in TBI rehabilitation.

PRACTICE IMPLICATIONS

Recommendations from the perspectives of patients include consideration of the selection of group participants, and meeting individual needs and goals within a group setting.

Interventions to enhance coping after traumatic brain injury: A systematic review

Background/Aims:

The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions.

Methods:

Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were searched. Titles and abstracts were independently screened by two of the authors and selected for inclusion. The full text of all potentially relevant studies were retrieved and assessed for eligibility, reporting and methodological quality, and risk of bias.

Findings:

Eight included studies were very heterogeneous in terms of study design, type of intervention, the population studied and instruments used to evaluate coping. All studies were judged to have a moderately high risk of bias. Six studies used cognitive behavioural therapy-based interventions. Two interventions (a peer-mentoring programme and cognitive behavioural therapy combined with motivational interviewing) showed significant treatment effects on maladaptive coping. Two cognitive behavioural therapy-based group programmes improved adaptive coping, but increases were either not sustained over time or no longer significant when compared to an active control.

Conclusions:

There is insufficient evidence to support practice recommendations strongly. Targeting specific subgroups of people who have experienced traumatic brain injury might allow the development of more effective coping interventions. Further, a more unified concept of coping in traumatic brain injury needs to be articulated allowing larger scale evaluations.

Effectiveness of Interventions to Improve Occupational Performance for People With Psychosocial, Behavioral, and Emotional Impairments After Brain Injury: A Systematic Review

OBJECTIVE

This systematic review evaluates the effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury (TBI).

METHOD

Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched. Of the 1,512 articles initially identified, 35 met the inclusion criteria.

RESULTS

Six types of interventions were identified: (1) education, (2) peer mentoring, (3) goal-directed therapy, (4) physical activity, (5) skills training, and (6) cognitive-behavioral therapy (CBT). Strong evidence from well-conducted research supports the use of CBT in individual and group settings. Moderate evidence supports goal-directed interventions, aquatic exercise, and functional skills training. Limited evidence supports peer mentoring, aerobic exercise, educational interventions, and various skills training.

CONCLUSION

An increasing body of evidence supports specific interventions to improve occupational performance and participation for people with psychosocial, behavioral, or emotional impairments after TBI.