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Tomlin L, Smidt A, Bogart E. Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38558515 DOI: 10.1111/1460-6984.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. AIMS The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. METHODS AND PROCEDURES A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. OUTCOMES AND RESULTS The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. CONCLUSIONS AND IMPLICATIONS The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. WHAT THIS PAPER ADDS What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.
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Affiliation(s)
| | - Andy Smidt
- The University of Sydney, Sydney, Australia
- Southern Cross University, Lismore, Australia
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Omar SA, Zulkefly NS, Mukhtar F. The Effectiveness of Brain Injury Family Intervention in Improving the Psychological Well-Being of Caregivers of Patients With Traumatic Brain Injury: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53692. [PMID: 38483466 PMCID: PMC10979341 DOI: 10.2196/53692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Globally, traumatic brain injury (TBI) is recognized as one of the most significant contributors to mortality and disability. Most of the patients who have experienced TBI will be discharged home and reunited with their families or primary caregivers. The degree of severity of their reliance on caregivers varies. Therefore, the task of delivering essential care to the patients becomes demanding for the caregivers. A significant proportion of caregivers expressed considerable burden, distress, and discontentment with their lives. Therefore, it is critical to comprehend the dynamic of TBI and caregivers to optimize patient care, rehabilitation, and administration. The effectiveness of the Brain Injury Family Intervention (BIFI) program tailored for caregivers of patients with TBI has been widely proven in Western countries. However, the impact is less clear among caregivers of patients with TBI in Malaysia. OBJECTIVE This study aims to assess the effectiveness of BIFI in reducing emotional distress and burden of care, fulfilling the needs, and increasing the life satisfaction of caregivers of patients with TBI at government hospitals in Malaysia. METHODS This is a 2-arm, single-blinded, randomized controlled trial. It will be conducted at Hospital Rehabilitasi Cheras and Hospital Sungai Buloh. In total, 100 caregivers of patients with TBI attending the neurorehabilitation unit will be randomized equally to the intervention and control groups. The intervention group will undergo the BIFI program, whereas the control group will receive standard treatment. Caregivers aged ≥18 years, caring for patients who have completed >3 months after the injury, are eligible to participate. The BIFI program will be scheduled for 5 sessions as recommended by the developer of the module. Each session will take approximately 90 to 120 minutes. The participants are required to attend all 5 sessions. A total of 5 weeks is needed for each group to complete the program. Self-reported questionnaires (ie, Beck Depression Inventory, Positive and Negative Affect Schedule, Caregiver Strain Index, Satisfaction With Life Scale, and Family Needs Questionnaire) will be collected at baseline, immediately after the intervention program, at 3-month follow-up, and at 6-month follow-up. The primary end point is the caregivers' emotional distress. RESULTS The participant recruitment process began in January 2019 and was completed in December 2020. In total, 100 participants were enrolled in this study, of whom 70 (70%) caregivers are women and 30 (30%) are men. We are currently at the final stage of data analysis. The results of this study are expected to be published in 2024. Ethics approval has been obtained. CONCLUSIONS It is expected that the psychological well-being of the intervention group will be better compared with that of the control group after the intervention at 3-month follow-up and at 6-month follow-up. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20180809040746N1; https://irct.behdasht.gov.ir/trial/33286. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/53692.
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Affiliation(s)
- Siti Aminah Omar
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nor Sheereen Zulkefly
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Hanafy S, Quilico E, Haag H(L, Khoo Y(B, Munce S, Lindsay S, Colantonio A, Mollayeva T. An educational intervention to promote a culture of gender equity among persons with traumatic brain injury and caregivers: A pilot study. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1160850. [PMID: 37180573 PMCID: PMC10169667 DOI: 10.3389/fresc.2023.1160850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
Background Traumatic brain injury (TBI) outcomes are dependent on patients' biological sex (e.g., hormone levels) and sociocultural gender (e.g., norms, responsibilities). Informal caregivers additionally experience disruptions to identity and roles post-TBI. However, information on this topic remains largely unavailable to patients and caregivers. Purpose This study aimed to determine the effectiveness of a one-time educational intervention on sex and gender influences in TBI for patients and informal caregivers. Materials and methods We conducted a pilot pre-test/post-test randomized control-group design study. Groups (i.e., passive, active and control) consisted a total of 16 persons with TBI and caregivers (75% persons with TBI, 63% women). Individual and group learning gains, and group-average normalized gain, were computed for three learning domains: knowledge, attitude, and skill. An intervention with an average normalized gain of ≥30% was considered effective. Educational intervention evaluation and qualitative comments post-participation were summarized. Results The passive group demonstrated the highest average normalized gain across the three learning domains, including 100% for knowledge, 40% and 61% for attitude, and 37% for skill. The remaining groups did not reach an average normalized gain of ≥30%, except for the attitude domain of the control group (33% and 32%). Two key categories were identified qualitatively: (1) gendered self-expectations post-injury and (2) implications of gender stereotypes in rehabilitation, including the need for rehabilitation treatment to look beyond sex and gender. The post-participation educational session evaluation conveyed high appraisal of content, organization, and usability of the intervention. Conclusion A one-time passive educational intervention on sex and gender in TBI may improve knowledge, attitude, and skill on the topic of sex and gender among adults with TBI and caregivers. Obtaining knowledge and skill on sex and gender effects in TBI can potentially help persons with TBI and caregivers adapt to changes in roles and behaviours post-injury.
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Affiliation(s)
- Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Enrico Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Halina (Lin) Haag
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Yuelee (Ben) Khoo
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Lindsay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
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Hwang JHA, Fraser EE, Downing MG, Ponsford JL. A qualitative study on the attitudes and approaches of Australian clinicians in addressing sexuality after acquired brain injury. Disabil Rehabil 2022; 44:8294-8302. [PMID: 34951561 DOI: 10.1080/09638288.2021.2012605] [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: 01/19/2023]
Abstract
PURPOSE Studies indicate that up to 50% of survivors of acquired brain injury (ABI) experience persistent changes in sexuality. However, research on clinicians' perspectives in addressing sexuality issues post-ABI is limited. This study explored the attitudes and approaches, barriers and facilitators, and training preferences of Australian clinicians in addressing sexuality in individuals post-ABI. METHOD Purposive sampling was used to recruit 20 Australian multi-disciplinary clinicians from a related survey study. Semi-structured interviews were conducted and qualitatively analysed using thematic analysis. RESULTS Three broad themes were identified: ABI results in multi-faceted changes in sexuality; there is a fundamental discomfort in talking about sexuality; and, strategies proposed by clinicians may help to improve sexuality support. Participants also provided suggestions for sexuality training, which they believed should start at university. CONCLUSION Most clinicians are aware of sexuality issues post-ABI but fail to adequately address sexuality in individuals post-ABI due to personal levels of discomfort, perpetuated by institutional factors. Therefore, participants believe that changes made at individual and institutional levels may increase sexuality support for individuals with ABI. However, further research on the causes and treatment of sexual problems and patient perspectives is required to provide the evidence-based guidelines and training programs that clinicians require.Implications for rehabilitationUp to half of individuals experience changes in sexuality after ABI that restrict quality of life and relationships.The consequences of ABI and their impacts on sexuality are understood by Australian clinicians but remain largely unaddressed due to individual discomfort, perpetuated by institutional factors.This study suggests that professional training targeted towards understanding, assessing and treating sexuality issues post-ABI may help to reduce the discomfort.Adjustments should also be made at individual, policy and procedural levels to ensure that sexuality is addressed within rehabilitation post-ABI.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elinor E Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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van den Broek B, Rijnen S, Stiekema A, van Heugten C, Bus B. Factors related to the quality and stability of partner relationships after traumatic brain injury: A systematic literature review. Arch Phys Med Rehabil 2022; 103:2219-2231.e9. [PMID: 35395254 DOI: 10.1016/j.apmr.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The latest literature review on partner relationships following traumatic brain injury (TBI), conducted a decade ago, discussed solely quantitative work and noted significant knowledge gaps. The current review updates and expands on this work by providing an overview of the current state of knowledge on factors related to relationship quality and stability following TBI. DATA SOURCES CINAHL, Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on April 23, 2020, for literature on factors associated with 1)relationship quality and 2)relationship stability following TBI. STUDY SELECTION English quantitative and qualitative studies investigating factors associated with relationship quality and/or stability following TBI were included. Two reviewers independently assessed eligibility. If consensus was not reached, a third reviewer's conclusion was decisive. Forty-three studies were included. DATA EXTRACTION Information regarding study objectives and characteristics, participant demographics, (in)dependent variables, and main findings was extracted. Study quality was rated using the JBI Checklist for Analytical Cross Sectional Studies and/or the CASP Checklist for Qualitative Research. Both were performed by the lead reviewer and checked by the second reviewer. DATA SYNTHESIS Thirty-eight factors related to relationship quality and/or stability were identified, covering injury characteristics (e.g., severity), body functions (e.g., personality changes), activities (e.g., communication), participation (e.g., social dependence), environment (e.g., children), and personal factors (e.g., coping strategies). CONCLUSIONS Relationship quality and stability following TBI are found to be related to a multitude of factors, including newly identified factors such as personality changes and dependence. Future research may wish to quantitatively investigate factors thus far only identified in qualitative research, explore possible positive effects of TBI on relationships, study the experiences of same-sex couples, and include the perspectives of both partners with and without the injury.
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Affiliation(s)
- Brenda van den Broek
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands; School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands.
| | - Sophie Rijnen
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Annemarie Stiekema
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Caroline van Heugten
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Boudewijn Bus
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
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How does a narrative understanding of change in families post brain injury help us to humanise our professional practice? BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
In this paper, we critically explore the discourse of change post brain injury and challenge the dominant discourse of negative change, which alone leaves little room for other perspectives to exist. These negative changes pose a considerable risk to the well-being of families who may benefit from engaging in richer accounts making room for a more coherent and connected sense of self and family post-injury. We explore how narrative approaches provide opportunities for all practitioners to expand their professional scripts and support families to move towards a future which is not dominated by a discourse of loss. While loss and negative change is an important and very real consequence, of brain injury, focusing purely on stories of loss is life limiting for family members and can cause psychological distress. The life thread model is offered as a visible tool for all practitioners to engage with and use while working with families, providing a concrete focus for reflection and discussion of narratives relating to change which otherwise can feel quite abstract in everyday practice. We argue that one way we can humanise our professional practice is to support all practitioners to engage in a narrative understanding of family change following ABI.
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Whiffin CJ, Gracey F, Ellis-Hill C. The experience of families following traumatic brain injury in adult populations: A meta-synthesis of narrative structures. Int J Nurs Stud 2021; 123:104043. [PMID: 34388366 DOI: 10.1016/j.ijnurstu.2021.104043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely. OBJECTIVE To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research. DESIGN This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy. DATA SOURCES In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed. REVIEW METHODS Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis. RESULTS Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing. CONCLUSIONS The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI.
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Affiliation(s)
- Charlotte Jane Whiffin
- College of Health, Psychology and Social Care, University of Derby, Kedleston Road, Derby DE22 1GB, United Kingdom.
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Royal London House R110, Christchurch Road, Bournemouth BH1 3LT, United Kingdom.
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Yasmin N, Riley GA. Are spousal partner perceptions of continuity and discontinuity within the relationship linked to the symptoms of acquired brain injury? Disabil Rehabil 2021; 44:4249-4256. [PMID: 33736554 DOI: 10.1080/09638288.2021.1900410] [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: 10/21/2022]
Abstract
PURPOSE Some partners experience their relationship with a person with brain injury as the continuation of a loving pre-injury relationship (continuity), but others feel that the pre-injury relationship has been lost and replaced with something very different (discontinuity). This study provided a quantitative test of claims arising from qualitative research that certain symptoms of the injury might contribute to the experience of discontinuity - specifically, lack of emotional warmth, reduced social interaction and aggression. METHODS Fifty-three partners providing care to someone with brain injury completed questionnaires assessing continuity/discontinuity and a range of symptoms (emotional warmth, conversational ability, aggression, depression, somatic complaints, cognition, communication, aggression, and physical disability). RESULTS Discontinuity was significantly correlated with all symptom variables except physical disability but, in a multiple regression, only the measures of emotional warmth, conversation, aggression, and depression made a significant unique contribution. CONCLUSIONS Discontinuity has been linked with relationship dissatisfaction and dysfunction, greater burden and distress, and a less person-centred approach to the provision of care. Identifying which symptoms contribute to discontinuity may enable partners to be more effectively supported in terms of how they make sense of and react to those symptoms, so that a greater sense of continuity may be retained.Implications for rehabilitationIn a marriage/partnership after brain injury, some people struggle to maintain the loving relationship they shared with the person with the brain injury before the injury. This has an impact on the psychological wellbeing of the couple and on the quality of care provided.Certain symptoms of the brain injury may make it more difficult to maintain the loving pre-injury relationship.These include aggression, depression, a lack of emotional warmth within the relationship, and more general difficulties in making conversation.Caregivers dealing with these symptoms may need extra support in making sense of, and coming to terms with, these changes.
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Affiliation(s)
- Natasha Yasmin
- Centre for Applied Psychology. University of Birmingham, Birmingham, UK
| | - Gerard A Riley
- Centre for Applied Psychology. University of Birmingham, Birmingham, UK
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Moniz T, Costella J, Golafshani M, Watling C, Lingard L. Bringing narratives from physicians, patients and caregivers together: a scoping review of published research. MEDICAL HUMANITIES 2021; 47:27-37. [PMID: 30737250 DOI: 10.1136/medhum-2017-011424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
Patients and family caregivers tell different stories about their illness and care experiences than their physicians do. Better understanding of the relationships among these narratives could offer insight into intersections and disconnections in patient, caregiver and physician perceptions of illness and care. Such understanding could support enhanced patient-centred care in medical education and practice. Narrative writing is increasingly common among physicians, patients and caregivers and uniquely positioned to reveal matters of concern to these groups. We conducted a scoping review to identify literature in which first-person narratives from more than one group (physicians, patients and/or caregivers) were considered as 'data'. A search strategy involving nine databases located 6337 citations. Two reviewers independently screened titles and abstracts. Full-text screening followed (n=82), along with handsearching of grey literature and bibliographies. Of these, 22 met inclusion criteria. Most pieces analysed narratives by patients and caregivers (n=13), followed by patients, caregivers and physicians (n=7) and patients and physicians (n=2). Only nine pieces compared perspectives among any of these groups. The rest combined narratives for analysis, largely patient and caregiver stories (n=12). Most of the 22 papers used descriptive content analysis to derive themes. Themes of humanity, identity, agency and communication intersect between groups but often manifest in unique ways. What is absent, however, is a more interpretive narrative analysis of structure, orientation and characterisation within these narratives, which may reveal even more than their content. This scoping review offers a cautionary tale of lost potential. Many narratives are gathered and analysed but usually only thematically and rarely comparatively. We call for researchers to explore the potential of comparative analysis and the power of narrative inquiry in the field. Comparative narrative analysis may enrich understanding of how differences between perspectives come to be and what they mean for the experience of illness and care.
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Affiliation(s)
- Tracy Moniz
- Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - John Costella
- Allyn & Betty Taylor Library, Natural Science Centre, Western University, London, Ontario, Canada
| | - Maryam Golafshani
- Centre for the Study of Theory and Criticism, Western University, London, Ontario, Canada
| | - Chris Watling
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Hammond FM, Davis CS, Hirsch MA, Snow JM, Kropf ME, Schur L, Kruse D, Ball AM. Qualitative Examination of Voting Empowerment and Participation Among People Living With Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 102:1091-1101. [PMID: 33493439 DOI: 10.1016/j.apmr.2020.12.016] [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: 11/26/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine political participation after traumatic brain injury (TBI). DESIGN Qualitative, participatory research via interviews and observations. Each participant was interviewed to discuss their experience of voting in 2007 or 2008. Data were coded using Grounded Theory to develop themes, metacodes, and theories. SETTING Community. PARTICIPANTS A total of 57 individuals with history of TBI and 28 family members (N=85). MAIN OUTCOME MEASURES Not applicable. RESULTS Four themes emerged from the data: (1) people with TBI have barriers to voting; (2) the voting process can be improved for people with TBI; (3) voting is the responsibility of members of society; and (4) voting is one way we have a voice in society. CONCLUSIONS The data support the importance of voting as an American right regardless of the presence of disability. While persons with TBI report voting represents their freedom and voice, there may be barriers that can threaten or limit their voice.
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Affiliation(s)
- Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana; Rehabilitation Hospital of Indiana, Indianapolis, Indiana; Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Atrium Health, Charlotte, North Carolina.
| | - Christine S Davis
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Atrium Health, Charlotte, North Carolina; Department of Communication Studies, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Mark A Hirsch
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Atrium Health, Charlotte, North Carolina
| | - Julia M Snow
- Department of Communication Studies, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Martha E Kropf
- Department of Political Science & Public Administration, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Lisa Schur
- Rutgers University, School of Management and Labor Relations, New Brunswick, New Jersey
| | - Douglas Kruse
- Rutgers University, School of Management and Labor Relations, New Brunswick, New Jersey
| | - Andrew M Ball
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Atrium Health, Charlotte, North Carolina; NxtGen Institute, Atlanta, Georgia; Myopain Seminars, Bethesda, Maryland
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Lond BJ, Williamson IR. Acceptance, grief and adaptation amongst caregivers of partners with acquired brain injury: an interpretative phenomenological enquiry. Disabil Rehabil 2020; 44:2285-2294. [PMID: 33044883 DOI: 10.1080/09638288.2020.1829104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Families provide vital support to relatives with brain injury yet shoulder significant stress and anxiety with little help threatening family cohesion and rehabilitative outcomes. This paper analyses the accounts of people caring for a long-term partner with brain injury to identify coping mechanisms and support systems that enhanced well-being. Materials and method: This study used semi-structured interviews with eight participants and interpretative phenomenological analysis. Results: Three themes are reported-"moving through denial toward acceptance"; "confronting and managing ambiguous loss"; and "becoming an expert carer". Theme one describes participants' struggles to accept the longevity of brain injury and use of strenuous care practices to deny or fight disability; this proved counterproductive and was later remedied by individuals embracing change and making adaptations. Theme two reports how participants split their partners' identities -before and after brain injury- to help grieve for the marital relationships they lost. Theme three looks at participants' development of self-reliant attitudes to caregiving due to perceived limited state help, while embracing peer support that enhanced information and emotion-based coping. Conclusions: Findings support therapeutic practices that help family members confront the permanence of brain injury, and target feelings of complex and unresolved grief. Future research proposals are discussed.IMPLICATIONS FOR REHABILITATION:Caregivers typically provide considerable rehabilitative support to spouses living with Acquired Brain Injury to manage the physical and psychosocial burdens of long-term disability.Therapeutic interventions should reconcile notions of hope and acceptance in order to help carers confront the permanence of brain injury and develop sustainable care practices.We recommend that interventions address feelings of unresolved grief and ambiguous loss and develop tailored support for caregivers which targets pertinent psychological concerns.
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Affiliation(s)
- Benjamin J Lond
- Division of Psychology, De Montfort University, Leicester, UK
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12
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A Social Blow: The Role of Interpersonal Relationships in Mild Traumatic Brain Injury. PSYCHOSOMATICS 2020; 61:518-526. [DOI: 10.1016/j.psym.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/22/2022]
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13
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Hanafy S, Amodio V, Haag HL, Colquhoun H, Lewko J, Quilico E, Riopelle R, Archambault P, Colantonio A, Lindsay S, Mollayeva T. Is it prime time for sex and gender considerations in traumatic brain injury? Perspectives of rehabilitation care professionals. Disabil Rehabil 2020; 44:684-692. [PMID: 32574090 DOI: 10.1080/09638288.2020.1774670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose: The purpose of this study was to explore rehabilitation clinicians' understanding of how sex and gender facilitate or hinder care provided to patients with traumatic brain injury (TBI).Materials and methods: Sixteen clinicians from various specialities, attending to patients with TBI from a large rehabilitation hospital in Ontario, Canada, were recruited using purposive sampling. Data was collected through semi-structured interviews and thematic analysis was used to identify reoccurring themes.Results: Three themes that facilitate or hinder care of TBI patients were identified: (1) knowledge and evidence; (2) gender and other aspects of recovery; and (3) family caregiving. Lack of education about the topic and inconsistent scientific evidence limited clinicians' attention to sex and gender topics. Social, financial, and cultural characteristics of patients were considered to be more relevant than their sex and gender. The gendered nature of caregiving and its burden on caregivers' health were acknowledged.Conclusions: Currently, attention to topics of sex and gender as they may influence patients' recovery is limited. However, clinicians are willing to be educated on these topics to enhance rehabilitation care. Further research on the gendered nature of interactions between patient, clinician, and family caregiver during recovery is warranted.IMPLICATIONS FOR REHABILITATIONSex and gender matter for patients undergoing recovery for their traumatic brain injury; however, clinical attention to this topic is limited.Based on the clinicians' perceptions, resources that address patients' psychosocial vulnerabilities should be prioritized (e.g., unequal access to care, financial status, cultural diversity etc.).Clinicians highlighted that psychosocial vulnerability and patients' life roles, before and after injury, are sex and gender specific.Guidelines about sex and gender influences in traumatic brain injury rehabilitation have the potential to enhance clinical practice.
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Affiliation(s)
- Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Acquired Brain Injury Research Laboratory, University of Toronto, Toronto, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Vanessa Amodio
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Acquired Brain Injury Research Laboratory, University of Toronto, Toronto, Canada
| | - Halina Lin Haag
- Acquired Brain Injury Research Laboratory, University of Toronto, Toronto, Canada.,Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - John Lewko
- Centre for Research in Human Development, Laurentian University, Sudbury, Canada
| | - Enrico Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Acquired Brain Injury Research Laboratory, University of Toronto, Toronto, Canada
| | | | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Acquired Brain Injury Research Laboratory, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Tatyana Mollayeva
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Acquired Brain Injury Research Laboratory, University of Toronto, Toronto, Canada
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14
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Tsur N, Haller CS. Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms. FAMILY PROCESS 2020; 59:666-680. [PMID: 31013369 DOI: 10.1111/famp.12454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients' close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives' physical health was predicted by relatives' PTS symptoms (Slope=-1.76; p = .043), and mental health was predicted by both patients' (Slope=-2.77; p = .034) and relatives' (Slope=-6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients' PTS symptoms (Slope=-.25; p< .001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Chiara S Haller
- Department of Psychology, Harvard University, Cambridge, MA
- Division of Public Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA
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15
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Yasmin N, Keeble HS, Riley GA. Development and psychometric evaluation of the Birmingham Relationship Continuity Measure for acquired brain injury. Brain Inj 2020; 34:1089-1099. [DOI: 10.1080/02699052.2020.1767304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Natasha Yasmin
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Gerard A. Riley
- School of Psychology, University of Birmingham, Birmingham, UK
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16
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O’Keeffe F, Dunne J, Nolan M, Cogley C, Davenport J. “The things that people can’t see” The impact of TBI on relationships: an interpretative phenomenological analysis. Brain Inj 2020; 34:496-507. [DOI: 10.1080/02699052.2020.1725641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Fiadhnait O’Keeffe
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
- Department of Clinical Psychology, National Rehabilitation Hospital, Dun Laoghaire, Co Dublin, Ireland
- Department of Psychology, St Vincent’s University Hospital, Dublin 4, Ireland
- School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Johann Dunne
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Maeve Nolan
- Department of Clinical Psychology, National Rehabilitation Hospital, Dun Laoghaire, Co Dublin, Ireland
| | - Clodagh Cogley
- Department of Psychology, St Vincent’s University Hospital, Dublin 4, Ireland
| | - John Davenport
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
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17
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O’Shea A, Frawley P, Leahy JW, Nguyen HD. A Critical Appraisal of Sexuality and Relationships Programs for People with Acquired Brain Injury. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09616-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Buckland S, Kaminskiy E, Bright P. Individual and family experiences of loss after acquired brain injury: A multi-method investigation. Neuropsychol Rehabil 2020; 31:531-551. [PMID: 31902308 DOI: 10.1080/09602011.2019.1708415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
After a person experiences an acquired brain injury (ABI), there can be grieving for what has been lost. Little is known about the loss felt by relatives of people with ABI. This study investigates concepts of loss among individuals with ABI and their families. Forty participants, recruited from a brain injury charity client pool, took part in a semi-structured interview. Of the participants, 17 were in dyadic relationships (53% spouses, 41% parent/child and 6% sibling relationships). They also completed the Brain Injury Grief Inventory (BIGI; Coetzer, B. R., Vaughan, F. L., & Ruddle, J. A. (2003). The Brain Injury Grief Inventory. Unpublished Manuscript. North Wales Brain Injury Service, Conwy & Denbighshire NHS Trust) as a quantitative measure of loss after ABI. Five main themes emerged from the interviews: loss of person; loss of relationships; loss of activity/ability; loss of future; unclear loss. There were distinct differences qualitatively between individuals and relatives and only two dyads experienced similar loss, but there were no significant differences in loss as measured quantitatively by the BIGI. The differences between relatives' loss and individuals with ABIs' loss are discussed. This research suggests that it is important when supporting families to consider individual experiences, because even though the loss originates from the same injury, the loss as experienced may substantially differ among those affected by it.
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Affiliation(s)
- S Buckland
- Division of Psychology, Anglia Ruskin University, Cambridge, UK
| | - E Kaminskiy
- Division of Psychology, Anglia Ruskin University, Cambridge, UK
| | - P Bright
- Division of Psychology, Anglia Ruskin University, Cambridge, UK
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19
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Jellema S, van Erp S, Nijhuis-van der Sanden MWG, van der Sande R, Steultjens EMJ. Activity resumption after acquired brain injury: the influence of the social network as described by social workers. Disabil Rehabil 2019; 43:1137-1144. [PMID: 31429344 DOI: 10.1080/09638288.2019.1652855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To understand how the social network of patients with acquired brain injury facilitates or hinders resumption of their activities, such as social and leisure activities, and how this affects patients' well-being and quality of life. METHODS Thematic analysis was applied to 70 narratives about family members, friends, neighbors and colleagues helping or hindering patients in resuming their activities. The narratives were derived from social workers with extensive experience with brain-injured patients and their social networks. RESULTS The narratives show that an available, understanding and well-informed network enhances activity resumption by being inclusive and encouraging patients to develop their skills. This is in line with earlier studies based on patients' experiences. Whereas the patient-based studies emphasize that being unsupportive or overprotective hinders patients from resuming their activities, this study also shows that preventing patients from meeting others or placing too-high demands results in activity loss, social isolation and reduced well-being and quality of life. CONCLUSIONS Several social network factors play a role in activity resumption, well-being, and quality of life of after brain injury. Early after the brain injury, rehabilitation professionals should work with patients' family members, friends, and others and educate them about how to provide adequate support.IMPLICATIONS FOR REHABILITATIONSince the patient's social network is an important determinant of activity resumption, rehabilitation professionals should analyze its features soon after brain injury, such as whether patients have an understanding network that encourages them and includes them in their activities.Since especially close network members tend to be protective of or place high demands on the patient, rehabilitation professionals should explain to them the importance of activity resumption for the patient's wellbeing and the adverse effects of being overprotective or over-demanding.Rehabilitation professionals should include other network members, such as friends or colleagues, in the rehabilitation process and educate them about how to support patients in resuming their activities.
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Affiliation(s)
- Sandra Jellema
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands.,Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Sabine van Erp
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, The Netherlands.,Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob van der Sande
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Esther M J Steultjens
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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20
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Sexuality Re-education Program Logic Model for People with Traumatic Brain Injury (TBI): Synthesis via Scoping Literature Review. SEXUALITY AND DISABILITY 2018. [DOI: 10.1007/s11195-018-09556-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Pozzebon M, Douglas J, Ames D. Facing the Challenges of Primary Progressive Aphasia: The Spousal Perspective. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2292-2312. [PMID: 30208478 DOI: 10.1044/2018_jslhr-l-17-0492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Primary progressive aphasia (PPA) is a cognitive-neurodegenerative disorder. Little is known about the personal impact PPA has on those living with this condition, particularly from a spousal perspective. The aim of this qualitative study was to gain an understanding of the personal experiences of spouses living with a partner diagnosed with variant forms of PPA. METHOD Thirteen spouses whose partners were diagnosed with PPA participated in 1:1 semistructured, in-depth interviews to explore their lived experiences of this illness. Using a constructivist grounded theory approach, analysis moved through a process of data-driven open and focused coding for the identification of emergent categories, themes, and subthemes that captured the challenges faced by spouses while supporting their partners. RESULTS A constructivist grounded theory analysis of the interview data revealed an overarching theme of "facing the challenges of PPA" that captured the experience spouses encountered when living with a partner diagnosed with PPA. Four interdependent and overlapping themes that sat within this overarching theme included acknowledging disconnect in the spousal relationship, living the decline, readjusting sense of self, and getting on with living. Each of these core themes revealed how spouses dealt with the ongoing and evolving challenges of PPA, particularly concerning changing relational dynamics with their partner and adjusting their own self-conceptualization. CONCLUSIONS Greater understanding of the spousal experiences of PPA is crucial to the development of intervention to help sustain spouses' emotional and relational connections with their partner.
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Affiliation(s)
- Margaret Pozzebon
- La Trobe University, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Victoria, Australia
| | - Jacinta Douglas
- La Trobe University, Melbourne, Victoria, Australia
- Summer Foundation, Melbourne, Victoria, Australia
| | - David Ames
- University of Melbourne, Victoria, Australia
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22
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Backhaus S, Neumann D, Parrott D, Hammond FM, Brownson C, Malec J. Investigation of a New Couples Intervention for Individuals With Brain Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 100:195-204.e1. [PMID: 30195986 DOI: 10.1016/j.apmr.2018.08.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to (1) examine the efficacy of a treatment to enhance a couple's relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples' satisfaction with this type of intervention. DESIGN Randomized waitlist-controlled trial. SETTING Midwestern outpatient brain injury rehabilitation center. PARTICIPANTS Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group. INTERVENTIONS The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman's theoretical framework for couples adjusted for individuals with brain injury. MAIN OUTCOME MEASURES The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person's partner at 3 time points: baseline, immediate postintervention, 3-month follow-up. RESULTS The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable. CONCLUSIONS Results suggest this intervention can improve couples' dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed.
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Affiliation(s)
- Samantha Backhaus
- Rehabilitation Hospital of Indiana, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN.
| | - Dawn Neumann
- Rehabilitation Hospital of Indiana, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN
| | - Devan Parrott
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Flora M Hammond
- Rehabilitation Hospital of Indiana, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN
| | | | - James Malec
- Rehabilitation Hospital of Indiana, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN
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23
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Kinnunen L, Niemelä M, Hakko H, Miettunen J, Merikukka M, Karttunen V, Ristikari T, Gissler M, Räsänen S. Psychiatric diagnoses of children affected by their parents’ traumatic brain injury: the 1987 Finnish Birth Cohort study. Brain Inj 2018; 32:933-940. [DOI: 10.1080/02699052.2018.1470331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lotta Kinnunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mika Niemelä
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marko Merikukka
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Vesa Karttunen
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Tiina Ristikari
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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24
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MacQueen R, Fisher P, Williams D. A qualitative investigation of masculine identity after traumatic brain injury. Neuropsychol Rehabil 2018; 30:298-314. [DOI: 10.1080/09602011.2018.1466714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ruth MacQueen
- Norwich Medical School, University of East Anglia, Norwich, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Paul Fisher
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
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25
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“So that's the way it is for me — always being left out.” Acquired Pragmatic Language Impairment and Social Functioning following Traumatic Brain Injury. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our ability to interact appropriately in everyday interpersonal situations is fundamental to successful social integration. Impaired pragmatic competence correlates significantly and substantially with indices of social function across several domains for adults with acquired neurological disorders. In particular, evidence supports the negative impact of pragmatic impairments on the development and maintenance of relationships and community integration more generally.Pragmatic language competence sits in a complex, multifactorial space characterised by interacting associations with cognitive and psychological functions and social and environmental parameters. This complexity is evident in much of the research seeking to unravel the nature and magnitude of interactions between pragmatic language competence and social outcomes in adults with acquired neurological disorders.Over recent years our understanding of the impact of pragmatic impairments on social outcome has benefited substantially from inclusion of the insider's perspective in our research evidence base. Indeed, a methodological inclusion of constructivist paradigms has enabled the development of a rich understanding of the devastating social impact of impaired pragmatic competence.The aim of this paper is to review pragmatic language impairment in the context of traumatic brain injury (TBI) and detail its impact on social functioning from the perspectives of people with TBI and their intimate partners/spouses and friends. With these perspectives as background, the paper concludes with consideration of therapeutic developments and a brief look at a novel intervention designed to reduce the negative impact of pragmatic deficits and improve functional language use following TBI.
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26
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Villa D, Riley GA. Partners’ experiences of relationship continuity in acquired brain injury. COGENT PSYCHOLOGY 2017. [DOI: 10.1080/23311908.2017.1380891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Darrelle Villa
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Gerard A. Riley
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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27
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Psychosocial Aspects of Pragmatic Disorders. PERSPECTIVES IN PRAGMATICS, PHILOSOPHY & PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-47489-2_23] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Salas CE, Casassus M, Rowlands L, Pimm S, Flanagan DAJ. “Relating through sameness”: a qualitative study of friendship and social isolation in chronic traumatic brain injury. Neuropsychol Rehabil 2016; 28:1161-1178. [DOI: 10.1080/09602011.2016.1247730] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christian E. Salas
- Facultad de Psicología, Laboratorio Neurociencia Cognitiva y Social, Universidad Diego Portales, Santiago, Chile
- Head Forward Centre, Manchester, UK
- School of Psychology, Bangor University, Bangor, Wales, UK
| | - Martin Casassus
- Head Forward Centre, Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | | | - Steve Pimm
- Rehabilitation Without Walls, Milton Keynes, UK
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29
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Riley GA. The partner's experience of traumatic brain injury and its recovery. Concussion 2016; 1:CNC18. [PMID: 30202560 PMCID: PMC6094063 DOI: 10.2217/cnc-2016-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gerard A Riley
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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30
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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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How Partners Experience Personality Change After Traumatic Brain Injury – Its Impact on Their Emotions and their Relationship. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: The aim of this qualitative study was to explore how spouses/partners experience social, emotional and behavioural changes in persons following traumatic brain injury (TBI), with a particular focus on their emotional impact and the effect on the couple relationship.Method: Interpretative phenomenological analysis (IPA) of interview data explored five women's experiences of these changes in their partners following TBI.Results: Themes describe the direct emotional impact of living with the changes as well as the emotional impact of attempts to manage and make sense of the changes (identity change, managing the changes and making sense of the changes). The impact on the couple relationship is described under the themes of feeling love and receiving love. Changes led three of the participants to experience their partner as having been replaced by a new person; they actively disliked this new person; they felt unable to love the new person in the same way as the old person; and their love was defined in terms of a caring relationship, rather than a spousal relationship.Conclusions: The study provides insight into why social, emotional and behavioural changes might be so consistently associated with reduced emotional wellbeing and lower levels of relationship quality and satisfaction.
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Family Support Needs Following Acquired Brain Injury Across Metropolitan and Regional/Remote South Australia. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aims:To identify and compare, family support needs following an acquired brain injury (ABI) in metropolitan and regional/remote areas in order to inform the development of a state-wide family peer support network.Design:Mixed methods design including postal survey and focus groups.Results:The survey was completed by 194 family members who provide support to an adult with ABI. Focus groups included 43 participants (29 family members, 14 people with ABI). Thematic analysis of open-ended survey responses and focus group transcripts revealed 15 areas of needed support. Although all themes were identified by both geographic groups, regional/remote participants commented more frequently on the need for coordinated, accessible and tailored services. A strong focus was placed on the need for counselling and emotional support, as well as family support groups from both major city and regional/remote participants. Each support was reviewed to identify those which could be augmented through peer-supports, including: emotional support; family support groups; ABI information; family social activities; help to navigate the system; early supports (within the first year of ABI); and self-advocacy training.Conclusions:Results highlight a need for ongoing supports for the entire family following ABI in both metropolitan and regional/remote regions of SA (South Australia). Support themes can inform the development of family-centred services, including the role of peer-support networks.
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Kratz AL, Sander AM, Brickell TA, Lange RT, Carlozzi NE. Traumatic brain injury caregivers: A qualitative analysis of spouse and parent perspectives on quality of life. Neuropsychol Rehabil 2015; 27:16-37. [PMID: 26052805 DOI: 10.1080/09602011.2015.1051056] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this qualitative study was to examine how family caregivers of individuals with traumatic brain injury (TBI) describe their quality of life in the context of their caregiving role. Fifty-two caregivers of adults with moderate or severe TBI (n = 31 parents, n = 21 partners/spouses; 77% female; mean age = 57.96 years, range = 34-78 years) were recruited from three data collection sites to participate in focus groups. Thematic content analysis was used to identify two main meta-themes: Caregiver Role Demands and Changes in Person with TBI. Prominent sub-themes indicated that caregivers are (1) overburdened with responsibilities, (2) lack personal time and time for self-care, (3) feel that their life is interrupted or lost, (4) grieve the loss of the person with TBI, and (5) endorse anger, guilt, anxiety, and sadness. Caregivers identified a number of service needs. A number of sub-themes were perceived differently by partner versus parent caregivers. The day-to-day responsibilities of being a caregiver as well as the changes in the person with the TBI present a variety of challenges and sources of distress for caregivers. Although services that address instrumental as well as emotional needs of caregivers may benefit caregivers in general, the service needs of parent and partner caregivers may differ.
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Affiliation(s)
- Anna L Kratz
- a Department of Physical Medicine & Rehabilitation , University of Michigan , Ann Arbor , MI , USA
| | - Angelle M Sander
- b Department of Physical Medicine & Rehabilitation , Baylor College of Medicine , Houston , TX , USA.,c TIRR Memorial Hermann's Brain Injury Research Center , Houston , TX , USA.,d Department of Physical Medicine & Rehabilitation , Harris Health System , Houston , TX , USA
| | - Tracey A Brickell
- e Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , USA.,f Department of Psychiatry , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Rael T Lange
- e Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , USA.,g Department of Psychiatry , University of British Columbia , Vancouver , Canada
| | - Noelle E Carlozzi
- a Department of Physical Medicine & Rehabilitation , University of Michigan , Ann Arbor , MI , USA
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Knox L, Douglas JM, Bigby C. ‘The biggest thing is trying to live for two people’: Spousal experiences of supporting decision-making participation for partners with TBI. Brain Inj 2015; 29:745-57. [DOI: 10.3109/02699052.2015.1004753] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lucy Knox
- Department of Human Communication Sciences, La Trobe University, Victoria, Australia,
| | - Jacinta M. Douglas
- Department of Human Communication Sciences, La Trobe University, Victoria, Australia,
- Summer Foundation, Victoria, Australia, and
| | - Christine Bigby
- Department of Social Work and Social Policy, La Trobe University, Victoria, Australia
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