Participation in communication activities following traumatic brain injury: A time use diary study

Differentiating Use of Facial Expression between Individuals with and without Traumatic Brain Injury Using Affectiva Software: A Pilot Study

This study investigated the feasibility of using an automated facial coding engine, Affectiva (integrated in iMotions, version 8.2), for evaluating facial expression after traumatic brain injury (TBI). An observational cross-sectional study was conducted based on facial expression data from videos of participants with TBI and control participants. The aims were to compare TBI and control groups, and identify confounding factors affecting the data analysis. Video samples of two narrative tasks (personal event and story retell) from ten participants with severe TBI and ten control participants without TBI were analyzed using Affectiva. Automated data on participants' engagement, smile and brow furrow were compared statistically between and within groups. Qualitative notes for each sample were also recorded. Affectiva detected a higher percentage of time of engagement for TBI participants than for control participants on both tasks. There was also a higher percentage of time of smiling for TBI participants in one task. Within groups, there were no significant differences between the two narrative tasks. Affectiva provides standardized data about facial expression and may be sensitive to detecting change in the use of facial expression after TBI. This study also identified factors to avoid during videorecording to ensure high quality samples for future research.

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review

BACKGROUND

More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions.

OBJECTIVE

This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success.

METHODS

From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool.

RESULTS

We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses.

CONCLUSIONS

Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1177/20552076211035988.

Implementation of online psychosocial interventions for people with neurological conditions and their caregivers: A systematic review protocol

Background

As the burden of neurological conditions increases globally, online psychosocial interventions offer a potentially scalable solution to enabling healthcare access. However, their successful development and implementation require research into electronic healthcare implementation specifically.

Methods

Using a search strategy combining the concepts of implementation, electronic healthcare, psychosocial interventions and neurological conditions, we will conduct comprehensive electronic searches for primary implementation evidence in MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, SpeechBITE and NeuroBITE databases. Included studies will be analysed according to the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework, appraised using the Mixed-Methods Appraisal Tool and evaluated for theoretical underpinning in implementation science, with hybrid studies of effectiveness-implementation research classified according to the type of hybrid design.

Discussion

This review will be the first to use a theoretical underpinning in the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework to evaluate strengths and gaps in existing implementation research into online psychosocial interventions for people with neurological conditions and/or their caregivers. The results may be useful to provide direction and recommendations for future clinical implementation and research into online psychosocial interventions for people with neurological conditions and/or their caregivers.

Systematic review registration

PROSPERO 2020: CRD42020186387.

How is right hemisphere communication disorder disabling? Evidence from response mobilizing actions in conversation

Aim: Assessment and intervention strategies for communication disorders caused by right hemisphere stroke are at an early stage of development. There is also little evidence on how right hemisphere communication disorder is disabling for everyday life. This study explores how a woman with conversational problems following right hemisphere stroke participated in everyday conversation with family members.Method: One hour of triadic conversation was recorded and analyzed using the descriptive qualitative methodology of conversation analysis. It focused on attempts by the woman with right hemisphere stroke to direct conversation with "response mobilizing" communicative acts, i.e., communicative acts that set out clear expectations about who should speak, and how they should respond.Results: Seventy-eight communicative acts produced by the woman with right hemisphere communication disorder were divided into five groupings based on how her conversation partners addressed them. Around half of her response mobilizing communicative acts received unsupportive responses from her conversation partners, including minimal acknowledgements, explicit rejections, and ignoring responses.Conclusion: The findings of this study provide novel insight into the ways that right hemisphere communication disorder affects routine communication, and the nature of the disability it causes. This information will support the future development of evidence-based speech pathology assessment and intervention for right hemisphere stroke.IMPLICATIONS FOR REHABILITATIONRight hemisphere stroke can have complex implications for communication, but little is known about how they manifest in daily life.Familiar communication partners may deal with troublesome communicative acts in conversation by preventing them from developing, which may be useful information for speech pathology assessment.Speech pathologists should consider sampling everyday conversation because it can provide insight into the ways that communication disorders caused by right hemisphere stroke restrict participation in daily life.

Activity resumption after acquired brain injury: the influence of the social network as described by social workers

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.

Protocol for a clinical trial of telehealth-based social communication skills training for people with traumatic brain injury and their communication partners

Background: A previous clinical trial of training communication partners of people with traumatic brain injury (TBI) demonstrated positive outcomes [Togher, Power, McDonald, Tate, & Rietdijk (2009). Brain Impairment, 10(2), 188-204]. Adapting communication partner training for delivery via telehealth could improve access to this intervention.

Objectives: To compare outcomes across in-person communication partner training, telehealth communication partner training and a control group

Method: Protocol for a partially randomised controlled trial. People with moderate-severe TBI will be allocated to either an in-person or telehealth-based training program. Comparison data will be drawn from the original trial control group, which was recruited using the same eligibility criteria as this protocol. Outcomes after training will be compared between the in-person training group, the telehealth training group and the historical control group.

Discussion: This protocol uses specific design features with the aim of maximising the study’s power, including a partially randomised allocation process and a historical control group. The results will inform about the feasibility and effectiveness of delivering TBI rehabilitation via telehealth.

Trial registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615001024538.

Rett syndrome: Teenagers' and young adults' activities, usage of time and responses during an ordinary week - a diary study

Background: Little is known about the everyday life of individuals with Rett syndrome.Aim/Objective: To describe ten participants' (teenagers/young adults) activities during a period of seven days, the time-use, where and with whom the activities were performed and the participants' responses in the form of visible/audible reactions during activities.Material and method: A time-geographic self-administered diary was filled in by 63 informants (parents/support staff) and analysed using the software, DAILY LIFE 2011.Results/Findings: The most frequently reported activities were hygiene/toilet, moving around indoors, eating and getting dressed. Most time was spent in sleeping, daily care, medical health care and travel/transportation. Little time remained for receptive activities, daytime rest, physical, social/creative, communication, school/daily work and domestic chore activities, especially for the young adults. Most time was spent with staff, thereafter with families and the least time was spent with friends. The most reported response was "interested", and "opposed" was the least reported.Conclusions: Daily and medical health care activities were time consuming. Improved communication between all parties may increase participation and well-being and provide solutions for handling unpleasant activities and sedentary time.Significance: A more varied range of activities may improve the everyday life for individuals with Rett syndrome.

Do executive function and theory of mind predict pragmatic abilities following traumatic brain injury? An analysis of sincere, deceitful and ironic communicative acts

Quality of life and social integration are strongly influenced by the ability to communicate and previous research has shown that pragmatic ability can be specifically impaired in individuals with traumatic brain injury (TBI). In addition, TBI usually results in damage to the frontotemporal lobes with a consequent impairment of cognitive functions, i.e., attention, memory, executive function (EF) and theory of mind (ToM). The role of the underlying cognitive deficits in determining the communicative-pragmatic difficulties of an individual with TBI is not yet completely clear. This study examined the relationship between the ability to understand and produce various kinds of communicative acts, (i.e., sincere, deceitful and ironic) and the above-mentioned cognitive and ToM abilities following TBI. Thirty-five individuals with TBI and thirty-five healthy controls were given tasks assessing their ability to comprehend and produce sincere, deceitful and ironic communicative acts belonging to the linguistic and extralinguistic scales of the Assessment Battery for Communication (ABaCo), together with a series of EF and ToM tasks. The results showed that, when compared to healthy individuals, participants with TBI performed poorly overall in the comprehension and production of all the pragmatic phenomena investigated, (i.e., sincere, deceitful and ironic communicative acts), and they also exhibited impaired performance at the level of all the cognitive functions examined. Individuals with TBI also showed a decreasing trend in performance in dealing with sincere, deceitful and ironic communicative acts, on both the comprehension and production subscales of the linguistic and extralinguistic scales. Furthermore, a hierarchical regression analysis revealed that - in patients with TBI but not in the controls - EF had a significant effect on the comprehension of linguistic and extralinguistic irony only, while the percentage of explained variance increased with the inclusion of theory of mind. Indeed, ToM had a significant role in determining patients' performance in the extralinguistic production of sincere and deceitful communicative acts, linguistic and extralinguistic comprehension of deceit and the linguistic production of irony. However, with regard to the performance of patients with TBI in the various pragmatic tasks investigated, (i.e., sincere, deceitful and ironic communicative acts), EF was able to explain the pattern of patients' scores in the linguistic and extralinguistic comprehension but not in production ability. Furthermore, ToM seemed not to be able to explain the decreasing trend in the performance of patients in managing the various kinds of communicative acts investigated.