Differences in social participation between individuals who do and do not attend brain injury drop-in centres: A preliminary study

Organizational characteristics of Brain Injury Clubhouse Model programs

OBJECTIVE

We provide an overview of the Clubhouse Model and the history and development of Brain Injury Clubhouses. We describe organizational-level characteristics associated with eight Brain Injury Clubhouses to address gaps in the literature and inform future studies or program development.

METHODS

A electronic survey, the Clubhouse Profile Questionnaire (CPQ) was tailored for Brain Injury Clubhouses. The CPQ gathers program-level data that can be used to identify active ingredients of Clubhouses, understand best practices, examine, and evaluate program characteristics. The brain injury version of the CPQ was administered to a sample of eight Clubhouses affiliated with the International Brain Injury Clubhouse Association as part of a project designed to gather data on Clubhouse program characteristics and describe sociodemographic characteristics of people served by Brain Injury Clubhouses.

RESULTS

CPQ data from eight Brain Injury Clubhouses was analyzed. Brain Injury Clubhouse programs in this sample served approximately 17 members per day. There was wide variability in the size, funding and funding mechanisms, and length of operation of Brain Injury Clubhouses in this study.

CONCLUSIONS

Findings suggest that Brain Injury Clubhouses offer a wide range of services and supports. Additional research on the impact of Brain Injury Clubhouses is needed.

Recovering social participation - experience with a relational group intervention for traumatic brain injury patients

BACKGROUND

Traumatic brain injuries often result in impaired social functioning that may cause uncertainty, isolation, and precipitation of significant stress in social situations. Involvement in directed group treatment helps participants to develop new capabilities for feeling relationally connected, improving verbal and nonverbal communication skills, as well as building the capacity for empathic intersubjectivity. We suggest that group intervention to improve communication and social skills may provide an efficient and effective way for a patient to return to successful social participation.

OBJECTIVE

The purpose of this paper is to describe and discuss the principles of a clinical group intervention for increasing the social participation of persons with traumatic brain injury.

METHODS

Since 2000, several intervention periods, each with 10-20 group meetings, including some individual sessions for guidance, have been carried out under our direction in Finland. The intervention periods include education, reflection, and practical experiential exercises and can be multidisciplinary with both speech-language pathologists and neuropsychologists providing oversight and direction. The main goal of the described group interventions is to support community participation and social reintegration. In this article, we describe guiding principles and provide examples of the clinical group interventions drawn from our experience.

CONCLUSION

As determined by clinical observations and patient reports, the group intervention for social participation has proven to be beneficial. The participants report gaining more understanding of and insight into social situations, nonverbal and verbal communication, as well as affective interactive experience. Practicing social skills in a group situation is inherently self-motivating and encourages a constructive, positive impetus toward greater social participation. Based on our experience with this approach, it appears that this experiential form of group intervention is an effective bridge between structured cognitive-communication rehabilitation and successful real-life social participation.

Developing a model of long-term social rehabilitation after traumatic brain injury: the case of the head forward centre

Background: Social isolation and inactivity are highly problematic long-term consequences of Traumatic Brain Injury. They are rarely addressed by rehabilitation programmes, which focus on early phases of recovery. Day centres, or "drop-in" peer support groups, have emerged as an informal solution to social rehabilitation needs. However, there is a lack of knowledge regarding the therapeutic ingredients of these services.Methods: Twelve survivors of Traumatic Brain Injury that attended a social rehabilitation service (Head Forward Centre, UK; HFC), were interviewed to explore the meanings attached to the service and its activities. Thematic analysis was used to describe emerging themes and build a model of social rehabilitation.Results: Four therapeutic functions were attached to HFC: (a) HFC as a safe and predictable milieu; (b) HFC as a space where identity can be reconstructed; (c) HFC as a place where survivors can remain cognitive and socially active; (d) HFC as a network of continuous support.Conclusion: A model of long-term social rehabilitation should consider both psychological and practical/functional ingredients. Such a model can help informal rehabilitation services reflect upon their goals and activities, as well as articulate therapeutic actions along the rehabilitation path. The conceptualization of these four therapeutic ingredients in holistic rehabilitation models is described, and contrasted with its use in long-term social rehabilitation.IMPLICATIONS FOR REHABILITATIONSocial isolation and inactivity are important problems in the long-term rehabilitation of people with TBI. Both problems can be addressed by social rehabilitation services (day centres and peer support groups).Participation in social rehabilitation can promote a sense of normality and belongingness, which contribute to the long-term process of identity reconstruction.Social rehabilitation can help maintaining people with TBI cognitive and socially active, as well as developing a network of continuous support.

The Intensive Cognitive-Communication Rehabilitation Program for Young Adults With Acquired Brain Injury

Purpose This study investigated the effects of an intensive cognitive-communication rehabilitation (ICCR) program for young individuals with chronic acquired brain injury. Method ICCR included classroom lectures; metacognitive instruction, modeling, and application; technology skills training; and individual cognitive-linguistic therapy. Four individuals participated in the intensive program (6 hr with 1-hr lunch break × 4 days × 12 weeks of treatment): 3 participants completed 3 consecutive semesters, and 1 participant completed 1 semester. Two controls did not receive treatment and completed assessments before and after the 12-week treatment interval only. Results All 4 experimental participants demonstrated significant improvements on at least 1 standardized cognitive-linguistic measure, whereas controls did not. Furthermore, time point significantly predicted participants' scores on 2 of the 4 standardized outcome measures, indicating that as duration in ICCR increased, scores also increased. Participants who completed multiple semesters of ICCR also improved in their therapy and personal goals, classroom behavior, life participation, and quality of life. Conclusion After ICCR, participants showed gains in their cognitive-linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside the classroom and in their overall well-being. There is a gap between the large population of young adults with acquired brain injury who wish to return to higher education and a lack of rehabilitation programs supporting reentry into academic environments; ICCR is a first step in reducing that gap.

Picture This: Exploring the Lived Experience of High-Functioning Stroke Survivors Using Photovoice

An increasing number of high-functioning stroke survivors are present with minimal functional impairments and are often discharged with reduced access to community reintegration. Our objectives were to explore the lived experience of high-functioning stroke survivors and to identify gaps in community and rehabilitation services. Photovoice was used with five high-functioning stroke survivors to photo-document their experiences. A modified inductive thematic analysis was used, and meanings behind the photographs were elicited through four focus group sessions followed by photography exhibitions. Five themes emerged: lack of understanding and consideration for persons with disability, emotional and behavioral impacts after stroke, self-reliance and dependence on others, importance of appropriate and accessible services, and financial determinants of quality of life. By including service users' voices; investing in adapted, community-based programs; and providing educational programs for creating attitudinal change among service providers, the polarization between who can and cannot access services will be reduced.