1
|
Ponsford J, Trevena-Peters J, Janzen S, Harnett A, Marshall S, Patsakos E, Kua A, McIntyre A, Teasell R, Wiseman-Hakes C, Velikonja D, Bayley MT, McKay A. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part I: Posttraumatic Amnesia. J Head Trauma Rehabil 2023; 38:24-37. [PMID: 36594857 DOI: 10.1097/htr.0000000000000840] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Posttraumatic amnesia (PTA) is a common occurrence following moderate to severe traumatic brain injury (TBI) and emergence from coma. It is characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention and frequently, agitation. Clinicians and family need guidelines to support management practices during this phase. METHODS An international team of researchers and clinicians (known as INCOG) met to update the INCOG guidelines for assessment and management of PTA. Previous recommendations and audit criteria were updated on the basis of review of the literature from 2014. RESULTS Six management recommendations were made: 1 based on level A evidence, 2 on level B, and 3 on level C evidence. Since the first version of INCOG (2014), 3 recommendations were added: the remainder were modified. INCOG 2022 recommends that individuals should be assessed daily for PTA, using a validated tool (Westmead PTA Scale), until PTA resolution. To date, no cognitive or pharmacological treatments are known to reduce PTA duration. Agitation and confusion may be minimized by a variety of environmental adaptations including maintaining a quiet, safe, and consistent environment. The use of neuroleptic medications and benzodiazepines for agitation should be minimized and their impact on agitation and cognition monitored using standardized tools. Physical therapy and standardized activities of daily living training using procedural and errorless learning principles can be effective, but delivery should be tailored to concurrent levels of cognition, agitation, and fatigue. CONCLUSIONS Stronger recommendations regarding assessment of PTA duration and effectiveness of activities of daily living training have been made. Evidence regarding optimal pharmacological and nonpharmacological management of confusion and agitation during PTA remains limited, with further research needed. These guidelines aim to enhance evidence-based care and maximize consistency of PTA management.
Collapse
Affiliation(s)
- Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University Melbourne, Australia (Drs Ponsford, Trevena-Peters, and McKay); Epworth HealthCare, Melbourne, Australia (Drs Ponsford and McKay); Lawson Health Research Institute, Parkwood Institute, London, Ontario, Canada (Mss Janzen, Harnett, and McIntyre and Dr Teasell); The Ottawa Hospital Rehabilitation Center, University of Ottawa, Bruyere Research Institute, Ottawa, Ontario, Canada (Dr Marshall); KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada (Mss Patsakos and Kua and Dr Wiseman-Hakes); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada (Dr Teasell); Speech Language Pathology Program, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada (Dr Wiseman-Hakes); Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Velikonja); and Neuro Rehabilitation Program, KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (Dr Bayley)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Lithopoulos A, Bayley M, Curran D, Fischer L, Knee C, Lauzon J, Nevison M, Velikonja D, Marshall S. Protocol for a living systematic review for the management of concussion in adults. BMJ Open 2022; 12:e061282. [PMID: 35835532 PMCID: PMC9289038 DOI: 10.1136/bmjopen-2022-061282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Concussion/mild traumatic brain injury (mTBI) often presents initially with disabling symptoms that resolve, but for an unfortunate minority some of these symptoms may become prolonged. Although research into diagnosis and interventions for concussion is increasing, study quality overall remains low. A living systematic review that is updated as evidence becomes available is the ideal research activity to inform a living guideline targeting clinicians and patients. The purpose of this paper is to present the protocol of an ongoing living systematic review for the management of adult concussion that will inform living guidelines building off the Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms: third Edition. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines were followed in the reporting of this systematic review protocol. We are including English peer-reviewed observational studies, trials, qualitative studies, systematic reviews and clinical practice guidelines related to diagnosis/assessment or treatment of adult concussion. Future searches will be conducted at minimum every 6 months using the following databases: MEDLINE ALL, EMBASE, Cochrane, PsycInfo and CINAHL. The data are managed in the Covidence website. Screening, data extraction and risk-of-bias assessments are being done through multiple raters working independently. Multiple validated tools are being used to assess risk of bias, and the tool applied matches the document or study design (eg, Downs and Black Scale for healthcare interventions). Many concussion experts in various clinical disciplines from across North America have volunteered to examine the evidence in order to make recommendations for the living guidelines. ETHICS AND DISSEMINATION No ethical approval is necessary because primary data are not collected. The results will be disseminated through peer-reviewed publications and on the living guidelines website once built. PROSPERO REGISTRATION NUMBER CRD42022301786.
Collapse
Affiliation(s)
- Alexander Lithopoulos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mark Bayley
- Hull-Ellis Concussion Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Dorothyann Curran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lisa Fischer
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Knee
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Julia Lauzon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Margaret Nevison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Diana Velikonja
- Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Shawn Marshall
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
- Physical Medicine and Rehabilitation, Bruyere Continuing Care, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Panday J, Velikonja D, Moll SE, Harris JE. Experiences of inpatient rehabilitation from the perspective of persons with acquired brain injury. Disabil Rehabil 2021; 44:5539-5548. [PMID: 34166176 DOI: 10.1080/09638288.2021.1938706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Perspectives of individuals with acquired brain injury (ABI) regarding inpatient rehabilitation experiences can inform patient-centered care; however, these voices are under-represented in the literature. PURPOSE To explore the experiences, needs, and preferences of patients from an ABI inpatient rehabilitation program in Ontario. METHODS Using an interpretive description approach, we interviewed 12 participants and analyzed the transcripts inductively to generate themes. FINDINGS We identified three major themes: (1) Life Rerouted - participants felt their lives diverted due to ABI, with rehabilitation seen as a way to return to pre-injury life, (2) Autonomy within Rehab highlighted the perceived importance of personal autonomy in decision-making within rehabilitation, and (3) Life (and Recovery) Go On reflected an ongoing recovery process after discharge - leading to mixed emotions. An overall message, "re-establishing personal identity is important to the recovery process," reflected theories of biographical disruption and relational autonomy. IMPLICATIONS Our findings provide a patient perspective for clinicians and administrators to consider. We found that ABI was significantly disruptive to personal identity - resulting in tensions in autonomy while attempting to reclaim a sense of identity. We suggest counseling services and strategies supporting post-injury adjustment, along with ways for rehabilitation professionals to enhance patient autonomy where possible.Implications for rehabilitationSustaining an ABI can significantly disrupt personal identity and sense of autonomy - especially as persons occupy the role of "patient" while in inpatient rehabilitation.Psychological support is recommended to address the impacts of ABI on patients' sense of identity, as well as on family members.Strategies of support might include, providing formal psychotherapy, as well as creating opportunities for patients and family members to discuss the changes they are experiencing, and to establish their personal narratives (e.g., through writing or art) or peer mentorship programs between discharged and current patients.Clinicians can enhance patient autonomy by increasing opportunities for communication with patients about choice; educating patients and family members on the rehabilitation team's decision-making process, and other methods that increase communication and provide consistent up-to-date information to patients and their family members.
Collapse
Affiliation(s)
- Janelle Panday
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, Hamilton, Canada.,Department of Psychology and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sandra E Moll
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, Hamilton, Canada
| |
Collapse
|
4
|
Abstract
Background: In acquired brain injury (ABI) populations, low motivation to engage in rehabilitation is associated with poor rehabilitation outcomes. Motivation in ABI is thought to be influenced by internal and external factors. This is consistent with Self-determination Theory, which posits that motivation is intrinsic and extrinsic. This paper discusses the benefit of using Self-determination Theory to guide measurement of motivation in ABI. Methods: Using a narrative review of the Self-determination Theory literature and clinical rehabilitation research, this paper discusses the unique role intrinsic and extrinsic motivation has in healthcare settings and the importance of understanding both when providing rehabilitation in ABI. Results: Based on the extant literature, it is possible that two independently developed measures of motivation for ABI populations, the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self and the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, may assess intrinsic and extrinsic motivation, respectively. Conclusion: Intrinsic and extrinsic motivation in ABI may be two equally important but independent factors that could provide a comprehensive understanding of motivation in individuals with ABI. This increased understanding could help facilitate behavioural approaches in rehabilitation. Implications for Rehabilitation Conceptualization of motivation in ABI would benefit from drawing upon Self-determination Theory. External factors of motivation such as the therapeutic environment or social support should be carefully considered in rehabilitation in order to increase engagement. Assessing motivation as a dual rather than a global construct may provide more precise information about the extent to which a patient is motivated.
Collapse
Affiliation(s)
- Andrea Kusec
- a School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , Canada
| | - Diana Velikonja
- b Hamilton Health Sciences , Acquired Brain Injury Program , Hamilton , Canada.,c Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine , McMaster University , Hamilton , Canada
| | - Carol DeMatteo
- a School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , Canada
| | - Jocelyn E Harris
- a School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , Canada
| |
Collapse
|
5
|
Kusec A, DeMatteo C, Velikonja D, Harris JE. Psychometric properties of measures of motivation and engagement after acquired brain injury. Rehabil Psychol 2018; 63:92-103. [DOI: 10.1037/rep0000186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Levac DE, Glegg SMN, Sveistrup H, Colquhoun H, Miller P, Finestone H, DePaul V, Harris JE, Velikonja D. Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation. PLoS One 2016; 11:e0168311. [PMID: 27992492 PMCID: PMC5167266 DOI: 10.1371/journal.pone.0168311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. METHOD A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. RESULTS The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. CONCLUSION The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
Collapse
Affiliation(s)
- Danielle E. Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Stephanie M. N. Glegg
- Therapy Department, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hillel Finestone
- Physiatry, Élisabeth Bruyère Hospital and Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Jocelyn E. Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Velikonja
- Regional Rehabilitation Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
7
|
Velikonja D, Oakes J, Brum C, Sachdeva M. Assessing the validity of Task Analysis as a quantitative tool to measure the efficacy of rehabilitation in brain injury. Brain Inj 2016; 31:68-74. [DOI: 10.1080/02699052.2016.1212090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diana Velikonja
- Hamilton Health Sciences Acquired Brain Injury Program, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jill Oakes
- Hamilton Health Sciences Acquired Brain Injury Program, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christine Brum
- Hamilton Health Sciences Acquired Brain Injury Program, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Muskaan Sachdeva
- McMaster University Health Sciences Program, Hamilton, Ontario, Canada
| |
Collapse
|
8
|
Levac D, Glegg SMN, Sveistrup H, Colquhoun H, Miller PA, Finestone H, DePaul V, Harris JE, Velikonja D. A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation. BMC Health Serv Res 2016; 16:557. [PMID: 27716179 PMCID: PMC5052802 DOI: 10.1186/s12913-016-1807-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/30/2016] [Indexed: 12/20/2022] Open
Abstract
Background Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1807-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Danielle Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Stephanie M N Glegg
- Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees (A121), Ottawa, ON, K1S 5S9, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave Toronto, Ontario, M5G 1V7, Canada
| | - Patricia A Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. West, Hamilton, ON, L8S 1C7, Canada
| | - Hillel Finestone
- Bruyere Research Institute, Élisabeth Bruyère Hospital, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3 N6, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, IAHS Building Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, 300 Wellington St. North, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster Univerity, 12 Main Street West, Hamilton, ON, l8S 1C7, Canada
| |
Collapse
|
9
|
Toor GK, Harris JE, Escobar M, Yoshida K, Velikonja D, Rizoli S, Cusimano M, Cullen N, Sokoloff S, Colantonio A. Long-Term Health Service Outcomes Among Women With Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:S54-63. [DOI: 10.1016/j.apmr.2015.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/12/2015] [Accepted: 02/14/2015] [Indexed: 10/24/2022]
|
10
|
Glegg SMN, Holsti L, Stanton S, Hanna S, Velikonja D, Ansley B, Sartor D, Brum C. Evaluating change in virtual reality adoption for brain injury rehabilitation following knowledge translation. Disabil Rehabil Assist Technol 2016; 12:217-226. [PMID: 28508725 DOI: 10.3109/17483107.2015.1111944] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the impact of knowledge translation (KT) on factors influencing virtual reality (VR) adoption and to identify support needs of therapists. HYPOTHESES Intervention will be associated with improvements in therapists' perceived ease of use and self-efficacy, and an associated increase in intentions to use VR. METHOD Single group mixed-methods pre-test-post-test evaluation of convenience sample of physical, occupational and rehabilitation therapists (n=37) from two brain injury rehabilitation centres. ADOPT-VR administered pre/post KT intervention, consisting of interactive education, clinical manual, technical and clinical support. RESULTS Increases in perceived ease of use (p=0.000) and self-efficacy (p=0.001), but not behavioural intention to use VR (p=0.158) were found following KT, along with decreases in the frequency of perceived barriers. Post-test changes in the frequency and nature of perceived facilitators and barriers were evident, with increased emphasis on peer influence, organisational-level supports and client factors. Additional support needs were related to clinical reasoning, treatment programme development, technology selection and troubleshooting. CONCLUSIONS KT strategies hold potential for targeting therapists' perceptions of low self-efficacy and ease of use of this technology. Changes in perceived barriers, facilitators and support needs at post-test demonstrated support for repeated evaluation and multi-phased training initiatives to address therapists' needs over time. Implications for Rehabilitation Therapists' learning and support needs in integrating virtual reality extend beyond technical proficiency to include clinical decision-making and application competencies spanning the entire rehabilitation process. Phased, multi-faceted strategies may be valuable in addressing therapists' changing needs as they progress from novice to experienced virtual reality users. The ADOPT-VR is a sensitive measure to re-evaluate the personal, social, environmental, technology-specific and system-level factors influencing virtual reality adoption over time.
Collapse
Affiliation(s)
- Stephanie M N Glegg
- a Sunny Hill Health Centre for Children , Vancouver , BC , Canada.,b Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada
| | - Liisa Holsti
- b Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada
| | - Sue Stanton
- b Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada
| | - Steven Hanna
- c Department of Clinical Epidemiology & Biostatistics, and Department of Rehabilitation Science , McMaster University , Hamilton , ON , Canada
| | - Diana Velikonja
- d Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine , McMaster University , Hamilton , ON , Canada
| | | | | | | |
Collapse
|
11
|
Glegg SMN, Holsti L, Stanton S, Hanna S, Velikonja D, Ansley B, Sartor D, Brum C. Using virtual reality in clinical practice: A multi-site exploratory study. NeuroRehabilitation 2015; 35:563-77. [PMID: 25238866 DOI: 10.3233/nre-141152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Virtual reality (VR) is a relatively new treatment tool with emerging evidence supporting its use in neurorehabilitation, although no information exists about how therapists use VR clinically. OBJECTIVE This study's purpose was to document current practice in GestureTek VR use for inpatient acquired brain injury (ABI) rehabilitation as a benchmark for clinicians integrating the approach into practice, and to inform future research to improve its clinical applicability. METHODS As part of a larger study examining barriers and facilitators to VR use, participating therapists at two rehabilitation centres documented descriptive data about client demographics and VR treatment programme characteristics for 29 ABI clients on their caseloads over eight months. RESULTS Differences between the clinical population and published research samples were apparent. Treatment characteristics and several outcomes of interest paralleled those in the literature; however, novel outcome areas were identified as research gaps. By study's end, more than half of clients' VR programmes had been discontinued, for reasons consistent with documented barriers to VR use. CONCLUSIONS These findings can help bridge the knowledge-to-action gap by informing the design of research that has high clinical relevance, and by providing a point of reference for clinicians incorporating VR into their practices.
Collapse
Affiliation(s)
- Stephanie M N Glegg
- Sunny Hill Health Centre for Children, Vancouver, BC, Canada Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Liisa Holsti
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Sue Stanton
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Steven Hanna
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Diana Velikonja
- Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | |
Collapse
|
12
|
Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L, Ouchterlony D, Weegar K. Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Inj 2015; 29:688-700. [DOI: 10.3109/02699052.2015.1004755] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Shawn Marshall
- Ottawa Hospital Research Institute, Ottawa, ON, Canada,
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada,
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,
- Department of Medicine, University of Toronto, Toronto, ON, Canada,
| | - Scott McCullagh
- Hamilton Health Sciences, Hamilton, ON, Canada,
- Department of Pscyhiatry, McMaster University, Hamilton, ON, Canada,
| | - Diana Velikonja
- Hamilton Health Sciences, Hamilton, ON, Canada,
- Department of Pscyhiatry, McMaster University, Hamilton, ON, Canada,
| | | | | | - Kelly Weegar
- Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| |
Collapse
|
13
|
Ponsford J, Janzen S, McIntyre A, Bayley M, Velikonja D, Tate R. INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part I. J Head Trauma Rehabil 2014; 29:307-20. [DOI: 10.1097/htr.0000000000000074] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Glegg SMN, Holsti L, Velikonja D, Ansley B, Brum C, Sartor D. Factors influencing therapists' adoption of virtual reality for brain injury rehabilitation. Cyberpsychol Behav Soc Netw 2014; 16:385-401. [PMID: 23713844 DOI: 10.1089/cyber.2013.1506] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Virtual reality (VR) is an important emerging technology that is increasingly being introduced in health centers as a rehabilitation intervention. Quantitative research is needed to identify the factors influencing therapists' adoption of VR for brain injury rehabilitation, including barriers and facilitators to VR use, in order to inform successful implementation strategies. A measure based on the decomposed theory of planned behavior (DTPB) was developed and administered to 42 therapists; early psychometric properties are reported. Mean or median composite scores and correlations were calculated for each DTPB construct. Overall, therapists had positive attitudes toward VR, perceived it as being useful, and had positive intentions to use it more in the future. The self-efficacy composite yielded the lowest scores. The most significant barrier to adoption was time, while social influences and knowledge were the primary facilitators. Future research will explore the impact of knowledge translation interventions on these mediators of VR adoption.
Collapse
|
15
|
Velikonja D, Warriner EM, Coulson S, Brum C. The relationship between coping styles and affective/behavioural symptoms among individuals with an acquired brain injury. Brain Inj 2013; 27:158-68. [DOI: 10.3109/02699052.2012.729289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Diana Velikonja
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Erin M. Warriner
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | | | | |
Collapse
|
16
|
Colantonio A, Mar W, Escobar M, Yoshida K, Velikonja D, Rizoli S, Cusimano M, Cullen N. Women's health outcomes after traumatic brain injury. J Womens Health (Larchmt) 2012; 19:1109-16. [PMID: 20469963 DOI: 10.1089/jwh.2009.1740] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major public health problem, yet little is known about how this injury may affect long-term outcomes unique to women. This research examined the health outcomes relevant to premenopausal women 5-12 years after injury. METHODS This was a retrospective cohort study at eight participating acute care/rehabilitation facilities. Participants were consecutive eligible women with moderate to severe TBI. A follow-up interview assessed menstrual functioning, fertility, and pregnancy experiences before and after injury as well as cervical cancer screening. Demographic variables, self-rated general and mental health, and functional limitations were also collected. Injury-related information was abstracted from health records. Female control participants recruited were matched on age, education, and geographic location. RESULTS Of the 104 women with TBI (W-TBI), 46% experienced amenorrhea with duration of up to 60 months. Cycles became irregular for 68% of W-TBI after the injury. These findings were significantly different from those of controls. Among W-TBI, menstrual disturbances were associated with injury severity. No differences were shown between W-TBI and controls with respect to fertility, although significantly fewer W-TBI had one or more live births, and they reported more difficulties in the postpartum period than controls. W-TBI were less likely to have regular Pap smears and reported lower mental health, self-rated health, and function. CONCLUSIONS These findings inform prognosis after TBI for women and provide evidence for long-term monitoring of health outcomes and increased support after childbirth. More research is needed in this area, particularly with respect to the neuroendocrine system.
Collapse
Affiliation(s)
- Angela Colantonio
- University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario M5G 1V7, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Can Fam Physician 2012; 58:257-e140. [PMID: 22518895 PMCID: PMC3303645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To outline new guidelines for the management of mild traumatic brain injury (MTBI) and persistent postconcussive symptoms (PPCS) in order to provide information and direction to physicians managing patients’ recovery from MTBI. QUALITY OF EVIDENCE A search for existing clinical practice guidelines addressing MTBI and a systematic review of the literature evaluating treatment of PPCS were conducted. Because little guidance on the management of PPCS was found within the traumatic brain injury field, a second search was completed for clinical practice guidelines and systematic reviews that addressed management of these common symptoms in the general population. Health care professionals representing a range of disciplines from across Canada and abroad were brought together at an expert consensus conference to review the existing guidelines and evidence and to attempt to develop a comprehensive guideline for the management of MTBI and PPCS. MAIN MESSAGE A modified Delphi process was used to create 71 recommendations that address the diagnosis and management of MTBI and PPCS. In addition, numerous resources and tools were included in the guideline to aid in the implementation of the recommendations. CONCLUSION A clinical practice guideline was developed to aid health care professionals in implementing evidencebased, best-practice care for the challenging population of individuals who experience PPCS following MTBI.
Collapse
Affiliation(s)
- Shawn Marshall
- Acquired Brain Injury Rehabilitation Program, Ottawa Hospital Rehabilitation Centre, Ontario.
| | | | | | | | | |
Collapse
|
18
|
Berrigan L, Marshall S, McCullagh S, Velikonja D, Bayley M. Quality of clinical practice guidelines for persons who have sustained mild traumatic brain injury. Brain Inj 2011; 25:742-51. [DOI: 10.3109/02699052.2011.580317] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Abstract
This study examined patterns of emotional and behavioural sequelae in 300 individuals who sustained a traumatic brain injury (TBI). Participants were obtained through the Adult Acquired Brain Injury Program at Chedoke Hospital in Hamilton, Ontario, based on the following inclusionary criteria: (1) single incident of TBI; (2) no history of additional neurological diseases; (3) time postinjury < or =8.5 years; (4) WAIS-R FSIQ >85 and/or estimated reading skills above grade 5 level; and (5) valid Minnesota Multiphasic Personality Inventory (MMPI) profiles (i.e., F<90, L<66, and K<66). MMPI profiles of these individuals, in randomly split samples of 150 per group, were subjected to a three-step cluster analytic approach. A six-cluster solution was adequately replicated across samples and across clustering techniques. The identified subtypes included profiles indicative of: (1) no concerns or normal functioning; (2) mild somatic and pain concerns; (3) mild internalizing difficulties; (4) marked disinhibition and externalizing behavioural difficulties; (5) marked internalizing difficulties; and (6) marked somatic, internalizing, and externalizing behavioural disturbances. Members of the Externalized subtype were significantly younger in age than those in the other five subtypes, and more likely to be single than those in the Internalized subtype. Individuals in the Internalized subtype tended to be married, have longer times postaccident, and lower WAIS-R Verbal Intelligence Quotients than those comprising the Normal subtype.
Collapse
Affiliation(s)
- Erin M Warriner
- Department of Psychology, University of Windsor, Windsor, Ont., Canada.
| | | | | | | |
Collapse
|
20
|
Velikonja D, Warriner E, Brum C. Profiles of emotional and behavioral sequelae following acquired brain injury: Cluster analysis of the Personality Assessment Inventory. J Clin Exp Neuropsychol 2009; 32:610-21. [DOI: 10.1080/13803390903401302] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diana Velikonja
- a McMaster University, DeGroote School of Medicine, Hamilton Health Sciences , Hamilton, Ontario, Canada
| | - Erin Warriner
- a McMaster University, DeGroote School of Medicine, Hamilton Health Sciences , Hamilton, Ontario, Canada
| | - Christine Brum
- a McMaster University, DeGroote School of Medicine, Hamilton Health Sciences , Hamilton, Ontario, Canada
| |
Collapse
|
21
|
Barreca S, Velikonja D, Brown L, Williams L, Davis L, Sigouin CS. Evaluation of the effectiveness of two clinical training procedures to elicit yes/no responses from patients with a severe acquired brain injury: a randomized single-subject design. Brain Inj 2009; 17:1065-75. [PMID: 14555365 DOI: 10.1080/0269905031000110535] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PRIMARY OBJECTIVE Thirteen (10 males) participants with severe acquired brain injuries (ABI) were randomly assigned to two treatments, A or B (ABAB, BABA) in a crossover study to determine which treatment approach elicited more consistent and reliable yes/no responses. RESEARCH DESIGN Treatment A consisted of an enriched stimulus environment, collaborative multidisciplinary interventions and additional yes/no response training, while Treatment B consisted of the standard hospital environment and interventions. MAIN OUTCOMES An ANOVA showed no order effect (AB vs BA; p=0.60), but a trend (A vs B;p=0.07) towards statistical significance for increased responsiveness with treatment A. Inter-raterreliability (n=10) ranged from fair-to-good, intra class correlation (ICC) 0.51; 95% confidence interval (CI) (0.29-0.93). Post-hoc analyses showed statistically significant increased responsiveness for four participants with treatment A (p<0.001). CONCLUSION Evidence is provided that enhanced communication strategies can improve responsiveness in a sub-group of participants with severe acquired brain injuries.
Collapse
Affiliation(s)
- Susan Barreca
- Adult Specialized Rehabilitation Services, Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
22
|
Blake G, Velikonja D, Pepper V, Jilderda I, Georgiou G. Evaluating an in-school injury prevention programme's effect on children's helmet wearing habits. Brain Inj 2008; 22:501-7. [PMID: 18465391 DOI: 10.1080/02699050802070752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To evaluate the effectiveness of the Bikes, Blades and Boards (BB&B) programme. It was hypothesized that children who participated in the BB&B programme would demonstrate greater knowledge of how to wear their helmets safely than a control group who did not participate in the programme and retain their skills when assessed 1 year later. RESEARCH DESIGN Single blind cluster randomized design. METHODS AND PROCEDURES Twelve classes of grade 2 students (n = 162) participated; six classes were assigned to an experimental or control group. A blinded research assistant, taking 3-5 minutes per child, completed the Helmet Checklist with each group on two occasions and scores of the experimental group (post-BB&B programme) were compared to the control group. The experimental group was reassessed using the Helmet Checklist, 1 year later. EXPERIMENTAL INTERVENTIONS The BB&B programme consisted of a presentation, bicycle helmet checklist, demonstration and individual practice and feedback. MAIN OUTCOMES AND RESULTS Children in the experimental group showed a better knowledge of how to wear their helmets safely compared to the control group (F = 51.84, CI = 9.11-9.71) and retained this knowledge 1 year after participating in the BB&B programme. CONCLUSIONS The BB&B programme is effective in teaching grade 2 children how to wear their helmets correctly, which is knowledge they retain for at least 1 year.
Collapse
Affiliation(s)
- Gary Blake
- Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | | | | | | | | |
Collapse
|
23
|
Abstract
Traumatic brain injuries (TBI) are frequently accompanied by psychiatric disturbances, which can include striking to relatively minor alterations in personality, behavior, and emotional regulation. The persistence of these neurobehavioral syndromes often leads to deleterious effects on recovery and rehabilitation outcomes. A recent surge of studies has emerged in the past several years to quantify the extent of psychiatric disorders in TBI and to describe differential clinical presentations. Various pre- and post-injury factors also have been hypothesized to contribute to the development and maintenance of psychiatric symptoms in survivors of brain injuries. The identification of high-risk individuals with distinct neuropathophysiological and psychosocial features permits the development of multidisciplinary and tailored approaches to the assessment, prevention, and management of the negative effects of personality and behavioral changes in TBI. This article summarizes the most recent research in these areas and highlights the gaps that need to be filled in subsequent future.
Collapse
Affiliation(s)
- Erin M Warriner
- McMaster University Medical Centre, Room 3G-30, Hamilton Health Sciences, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.
| | | |
Collapse
|
24
|
Nicholson IR, Velikonja D, Bisnaire L. Hospital psychology in Canada: issues and strategies. Healthc Manage Forum 2004; 17:30-5. [PMID: 15320446 DOI: 10.1016/s0840-4704(10)60325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Psychology has long been an important component of the services provided in Canadian hospitals. Most major centres' interdisciplinary teams include a number of psychologists. Nonetheless, recent restructurings have resulted in substantial negative consequences to hospital psychology staff and to their accessibility by patients. This article outlines the impact of recent changes on the recruitment and retention of hospital psychologists and offers recommendations for organizational changes to assist in overcoming these problems.
Collapse
Affiliation(s)
- Ian R Nicholson
- London Health Sciences Centre and University of Western Ontario
| | | | | |
Collapse
|
25
|
Morrison-Stewart SL, Velikonja D, Corning WC, Williamson P. Aberrant interhemispheric alpha coherence on electroencephalography in schizophrenic patients during activation tasks. Psychol Med 1996; 26:605-612. [PMID: 8733218 DOI: 10.1017/s0033291700035674] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Thirty schizophrenic patients (20 medicated, 10 off medication) were compared with 30 normal controls subjects matched for age, sex, handedness and intelligence. During the performance of a frontal activation task, normal subjects showed increased interhemispheric coherence between anterior brain regions. Schizophrenic patients did not show the same amount of bilateral anterior activation. During the performance of right hemisphere cognitive activation tasks, normal subjects and medicated schizophrenic patients showed significantly reduced bilateral interhemispheric coherence patterns, while the drug-free schizophrenic patients showed a trend towards this same pattern. It is suggested that these findings provide additional evidence for an aberrant functional organization of the brain in schizophrenia.
Collapse
|
26
|
Abstract
It has been proposed that it is possible to selectively activate the cerebral hemispheres, thereby enhancing lateralized cognitive abilities. A proposed method of achieving selective activation is by altering nasal congestion/decongestion (nasal cycle), which is believed to effect a contralateral change in hemispheric activation through the autonomic nervous system (ANS). This hypothesis was tested in 4 right-handed male and 6 right-handed female undergraduate students. Subjects were untrained in specific breathing techniques but were aware of the experimental hypothesis. Four 1 min samples of EEG were recorded in each of 4 experimental conditions in which nasal decongestion was altered by having subjects lie in the lateral recumbent position and occluding the contralateral nare. Cortical activation and laterality were examined using ratios of the low beta (12-18 Hz) and high alpha (10-12 Hz) bandwidths relative to each other and between hemispheres. Repeated measures ANOVAs showed non-significant changes in the alpha and beta bandwidths across the 4 experimental conditions. Although changes in hemispheric activation have been postulated for all subjects, this study does not support such changes in subjects untrained in breathing techniques.
Collapse
Affiliation(s)
- D Velikonja
- Department of Psychology, University of Waterloo, Ont. Canada
| | | | | |
Collapse
|