Materials and methods: Educational professionals from all schools in the state of Victoria, Australia, were invited to participate in an online cross-sectional survey consisting of 20 questions assessing knowledge of concussion and 30 questions examining knowledge of traumatic brain injury (n?=?364).
Results: On average, participants correctly answered 16/20 (80%) questions about concussion and 24.3/30 (81%) about traumatic brain injuries. Participants who had previously taught a child with a brain injury demonstrated greater knowledge of traumatic brain injury, but not concussion, than those who had not. There were no differences in knowledge of concussion or brain injury between participants who had and had not attended a briefing session about concussion. Misconceptions displayed by educators predominantly related to the ongoing effects and impact of both concussion and traumatic brain injury, including effects on emotion, cognition, and social behaviour, as well as the increased risk of multiple injuries following an initial brain injury. When participants’ responses to the brain injury questionnaire were compared with results reported by Farmer and Johnson-Gerard in 1997 using the same questionnaire, many of the same misconceptions were evident in the two samples of educational professionals.
Conclusions: Although educators demonstrated reasonable understanding of concussion and brain injury, some gaps in knowledge were apparent. Providing educational professionals with further training and professional development regarding childhood brain injuries would enhance their preparedness to manage students with these injuries in the school environment.
- Implications for Rehabilitation
Mild to moderate brain injuries are relatively common among school-aged children, and educators may be required to manage and support students with these injuries in the school environment.
This study shows that educators generally have a good understanding of the symptoms and immediate effects of brain injuries, but have gaps in knowledge regarding the potential socioemotional, behavioural, and cognitive difficulties and vulnerabilities to multiple injuries that may be present during recovery.
Pre-service training and professional development may increase educators’ understanding and capacity to accommodate the needs of students with brain injuries.
Methods: An electronic search was conducted from 1987 to 24 October 2017. Studies were included if they met the following criteria: (1) full text, peer reviewed, and written in English, (2) original research, (3) diagnosed concussion or mild traumatic brain injury, (4) described the evaluation of an intervention, (5) the outcome was a concussion impairment, and (6) the mean/median age was under 19. Quality assessment using the Down’s and Black criteria was conducted.
Results: Twenty-six studies published between 2001 and 2017 were identified. Interventions included rest, active rehabilitation, exercise, vestibular, oculomotor, cervicospinal therapy, education, early intervention, telephone counselling, mobile health application, Web-based Self-Management program, multimodal physical therapy, cognitive behavioural therapy, transcranial direct current stimulation, and acupuncture. The quality assessments ranged from poor to good.
Conclusions: The literature describing interventions following concussion in children is scarce. While both positive and negative results were obtained, there were methodological concerns in most studies limiting the ability to draw conclusions. Interventions incorporating aerobic exercise show promise as a concussion management strategy.
- Implications for rehabilitation
Few studies have examined rehabilitation interventions for youth following concussion.
Research ranging from rest to exercise highlights the uncertainty of the field.
Low quality research limits the generalizability of results.
The use of physical activity appears to be an emerging area of interest.
Individualised, aerobic exercise should be used as part of clinical management.
Methods: A literature review was performed to investigate the incidence and prevalence of torture and traumatic brain injury in displaced and fleeing populations. Impacts of traumatic brain injury and residency status on outcomes in these individuals were also examined.
Results: The incidence and prevalence of torture and traumatic brain injury among refugees and asylum seekers is significant. These populations may access healthcare systems differently than other groups and as a result may experience a unique health-related outcomes following traumatic brain injury.
Conclusions: This information should sensitize healthcare providers to a potential history of traumatic brain injury sustained by patients/clients who are refugees or asylum seekers and may serve to guide some clinical encounters.
- Implications for rehabilitation
Traumatic brain injuries are commonly sustained by refugees and asylum seekers.
Cultural factors may complicate how refugees and asylum seekers understand, report, and manage these injuries.
The above may be worsened by cognitive, emotional, and behavioral changes following traumatic brain injury.
Rehabilitation providers should be aware of potential traumatic brain injury history during encounters with refugee and asylum seeker populations, especially if a history of torture is suspected.
Method: The Community Integration Questionnaire-Revised was administered to a sample of 88 adults with traumatic brain injury and to a control sample matched by gender, age and education. Participants with traumatic brain injury were divided into four subgroups according to injury severity.
Results: The internal consistency of the Community Integration Questionnaire-Revised was satisfactory. The differences between the group with traumatic brain injury and the control group were statistically significant for the overall Community Integration Questionnaire-Revised score, as well as for all the subscales apart from the Home Integration subscale. The community Integration Questionnaire-Revised score varied significantly for subgroups with different severity of traumatic brain injury.
Conclusions: The results show that the Croatian translation of the Community Integration Questionnaire-Revised is useful in assessing participation in adults with traumatic brain injury and confirm previous findings that severity of injury predicts community integration. Results of the new Electronic Social Networking scale indicate that persons who are more active on electronic social networks report better results for other domains of community integration, especially social activities.
- Implications for rehabilitation
The Croatian translation of the Community Integration Questionnaire-Revised is a valid tool for long-term assessment of participation in various domains in persons with moderate to severe traumatic brain injury
Persons with traumatic brain injury who are more active in the use of electronic social networking are also more integrated into social and productivity domains.
Targeted training in the use of new technologies could enhance participation after traumatic brain injury.
Methods: A scoping review was conducted of four electronic databases of peer-reviewed literature from the databases earliest records to June 2017. Articles were included if the study population was mild traumatic brain injury/concussion and a vision rehabilitation intervention was tested. Two independent reviewers screened articles for inclusion, extracted data, and identified themes.
Results: The initial search identified 3111 records. Following exclusions, 22 articles were included in the final review. Nine studies evaluated optical devices, such as corrective spectacles, contact lenses, prisms, or binasal occlusion. Two studies assessed vision therapy. Ten studies examined vision therapy using optical devices. One study investigated hyperbaric oxygen therapy. Optometrists performed these interventions in most of the studies. Future research should address quality appraisal of this literature, interventions that include older adult and pediatric populations, and interdisciplinary interventions.
Conclusions: There are promising interventions for vision deficits following mild traumatic brain injury. However, there are multiple gaps in the literature that should be addressed by future research.
- Implications for Rehabilitation
Mild traumatic brain injury may result in visual deficits that can contribute to poor concentration, headaches, fatigue, problems reading, difficulties engaging in meaningful daily activities, and overall reduced quality of life.
Promising interventions for vision rehabilitation following mild traumatic brain injury include the use of optical devices (e.g., prism glasses), vision or oculomotor therapy (e.g., targeted exercises to train eye movements), and a combination of optical devices and vision therapy.
Rehabilitation Professionals (e.g., optometrists, occupational therapists, physiotherapists) have an important role in screening for vision impairments, recommending referrals appropriately to vision specialists, and/or assessing and treating functional vision deficits in individuals with mild traumatic brain injury.
Methods: This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n?=?11) and their family members (n?=?10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n?=?7). We developed and assessed the Content Validity Index of the BASTβ.
Results: The BASTβ initial items (n?=?77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BASTβ included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n?=?23) and four open-ended questions about environmental factors. The BASTβ had a high Content Validity Index of 89.3%.
Conclusion: The BASTβ is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST.
- Implications for Rehabilitation
Behavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury.
Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term.
The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries.
The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.
Study design: Cross-sectional.
Methods: Forty eight participants with traumatic brain injury (Age M?=?40.50 SD?=?14.62, 77% male, post-traumatic amnesia days M?=?28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures.
Results: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills.
Conclusions: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs.
- Implications for rehabilitation
Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries.
Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres.
Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury.
Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.
Methods: Interpretative phenomenological analysis was employed to collect and analyze data from six semi-structured interviews with participants regarding their experiences of living in nursing homes.
Results: Two themes were identified, including “Corporeal prison of acquired brain injury: broken selves” and “Existential prison of the nursing home: stagnated lives”. Results illustrated that young adults with acquired brain injury can experience aged care as an existential prison in which their lives feel at a standstill. This experience was characterized by feelings of not belonging in a terminal environment, confinement, disempowerment, emptiness and hope for greater autonomy through rehabilitation.
Conclusion: It is hoped that this study will provide relevant professionals, services and policy-makers with insight into the challenges and needs of young adults with brain injury facing these circumstances.
- Implications for rehabilitation
This study supports the contention that more home-like and age-appropriate residential rehabilitation services for young adults with acquired brain injury are needed.
As development of alternative accommodation is a lengthy process, the study findings suggest that the interim implementation of rehabilitative care in nursing homes should be considered.
Taken together with existing research, it is proposed that nursing home staff may require training to deliver evidence-based rehabilitative interventions to those with brain injury.
The present findings add support to the call for systemic change in Ireland, to clarify the acquired brain injury care pathway and establish integrated rehabilitation services.
Methods: This study employed first-wave data for 1993 participants from the Panel Study of Workers’ Compensation Insurance. A two-step cluster analysis was conducted to profile pre-injury job characteristics, including monthly wages, length of service, company size, contract type, and working hours. For each subsample selected by the characteristics of the independent variables, multinomial logistic regression analyses were performed to predict the odds ratio for being unemployed or working in a new firm versus returning to the pre-injury job, depending on cluster membership.
Results: Two clusters were identified with pre-injury job characteristics. Workers in the unstable employment cluster were more likely than were workers in the stable employment cluster to be unemployed or work in a new firm rather than return to the pre-injury job; this held for all socio-demographic and injury-related characteristics.
Conclusions: Our results showed a need to develop differential RTW strategies for injured workers in insecure jobs at the time of injury.
- Implications for rehabilitation
Policymakers and rehabilitation practitioners need to take into account not only socio-demographic or injury-related characteristics but also working conditions at the time of injury when designing return-to-work programs for injured workers in South Korea.
Injured employees in poor working conditions are relatively more vulnerable in the return-to-work process and deserve special attention and supports from the Korean government.
The Korean government needs to review return-to-work policies for injured workers in unstable employment environment in the context of employment relationships rather than individual characteristics.
- Implications for rehabilitation
College-aged students with mild traumatic brain injury report unique preferences for no- and high-tech cognitive aids; however, similar patterns emerge relating to preferred system characteristics.
Facilitating several trial periods prior to selection and implementation of external cognitive supports for individuals with mild traumatic brain injury is essential given the preference changes that occur post-trial.
Implementing a three-phase external cognitive aid selection process appears beneficial for young adults with mild brain injuries.
Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study.
Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions.
Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury.
- Implications for Rehabilitation
People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts.
Research supports problem solving skills training following brain injury.
Assistive technology for cognition (smartphones, selected apps) offers a means of
supporting problem solving for this population.
This project demonstrated the feasibility of a web-based programme to address this need.
Method: Systematic searches on the Internet for relevant websites were conducted using five search engines, and through consultation of the lists of resources published on websites of traumatic brain injury organizations. Two team members assessed eligibility of the websites. To be included, they had to provide information related to management of cognitive difficulties following moderate to severe traumatic brain injury, to be in English or French and available free of charge. Two reviewers evaluated each website according to: (1) its readability using Flesch–Kincaid Grade Level; (2) the quality of its content using a checklist of eight recommendations for managing memory, attention and executive function problems; (3) its usability (e.g., clear design) and reliability (e.g., currency of information) using the Minervation Validation Instrument for Health Care Web Sites.
Results: Of the 38 websites included, 10 provide specific tips for families that cover several domains of cognitive function, including memory, attention and executive function. The most frequent recommendations focused on the use of environmental supports for memory problems (n?=?33 websites). The readability of information is below the recommended grade 7 for only nine of the websites. All sites show acceptable usability, but their quality is variable in terms of reliability of the information.
Conclusions: This review provides useful information for selecting online resources to educate families about the management of cognitive difficulties following moderate to severe traumatic brain injury, as a complement to information and training provided by the rehabilitation team.
- Implications for rehabilitation
This review describes standardized criteria for the evaluation of the content, readability, reliability and usability of websites for family education post-TBI.
Given the variability in the content, the readability and the reliability of websites providing information for families about the management of cognitive difficulties post-TBI, careful attention to the selection of appropriate resources is required.
Findings from this review may facilitate clinicians’ identification of relevant websites to educate families about the management of cognitive difficulties post-TBI, as a complement to other information and training from the rehabilitation team.
Methods: Semi-structured interviews informed by organismic valuing theory of growth through adversity were conducted with 14 elite paratriathletes (eight male, six female). To increase the likelihood that participants had experienced posttraumatic growth, a short form of the Posttraumatic Growth Inventory was completed prior to interview participation. Interview data were analyzed using directed content analysis.
Results: Although the initial response to disability was largely negative, paratriathlon experiences were reported to be a mechanism through which growth was facilitated. In particular, participants suggested that social, competence, empowerment, and identity development processes were instrumental in facilitating posttraumatic growth.
Conclusions: Analysis identified themes largely consistent with the main tenets of organismic valuing theory of growth through adversity, supporting its utility in understanding response to a traumatic event and subsequent growth. These findings also suggest that para sport may be an efficacious means for promoting posttraumatic growth, especially for individuals with severe initial reactions to their disability. Lastly, findings suggest that fostering perceptions of competence, autonomy, and social connection may promote posttraumatic growth.
- Implications for Rehabilitation
Acquiring a physical disability may have a detrimental impact on the satisfaction of an individual’s fundamental psychological needs.
In order to foster posttraumatic growth, the para sport environment should allow for participants to feel competent, autonomous, and to have meaningful interactions with fellow athletes and coaches.
Para sport may be particularly beneficial for individuals with previous sporting backgrounds and for those with severe initial reactions to their disability.
- Implications for rehabilitation
Investigating resiliency processes can move the traumatic brain injury field beyond examining individual traits and protective factors, to transactional processes that influence participation experiences and opportunities over time.
The Traumatic Brain Injury Resiliency Model can be used to frame the targets and desired outcomes of rehabilitation interventions, such as self-regulatory processes or environmental supports known to enhance resiliency.
Studying resiliency will help to shift the paradigms of traumatic brain injury research, and rehabilitation practice, to a focus on life experiences and adaptation, helping individuals, clinicians, and families consider processes of positive change, rather than focusing solely on adversity.
Methods: A rigorous scoping review method was used to select and analyze empirical studies published between the years 1988 and 2016 in order to systematically map research findings about fathers’ affective, behavioral, and cognitive involvement.
Results: Fifty-four (n?=?54) studies (quantitative n?=?47 and qualitative n?=?7) met inclusion criteria associated with three levels of review. Four main trends emerged: (a) paternal “stress” is a main concept of interest; (b) comparison of mothers and fathers on affective and cognitive involvement; (c) lack of a focus on fathers’ behavioral involvement, and (d) the absence of research designs that allow for examination of fathers’ unique perspectives.
Conclusions: Fathers are generally underrepresented in research in the context of childhood neurodisability. While there is a lack of depth in this area of research, granular analyses revealed important and unique differences about fathers’ parenting experiences. Recommendations for research and practice are provided.
- Implications for rehabilitation
Fathers are underrepresented in the parenting in childhood neurodisability literature.
Fathers who report feeling competent in parenting and connected to their child also report less parenting distress and more satisfaction in their couple relationship and family environment.
Rehabilitation and allied health professionals should include fathers in parenting/family assessments.
Manifestation of distress may differ among family members. Rehabilitation and allied health professionals should offer individualized care that is attuned to the needs of all family members.
Materials and methods: Five hundred and eight individuals with moderate-to-severe traumatic brain injury were administered the Disability Rating Scale. The sample was randomly divided into two groups. An exploratory factor analysis was conducted on Group 1, and a confirmatory factor analysis on Group 2. Regressions were performed to determine the predictive ability of the factors.
Results: The exploratory factor analysis generated a three-factor structure, explaining 82.1% of the variance. Factor 1, comprising three disability items (feeding, toileting, and grooming), accounted for 58.4% of the variance. Factor 2, comprising three impairment items (eye opening, communication ability, and motor response), accounted for 14.8% of the variance. Factor 3, comprising two handicap items (level of functioning and employability), accounted for 8.9% of the variance. The three-factor solution was confirmed by confirmatory factor analysis. Regressions revealed the impairment factor at admission and the disability factor at discharge accounted for unique variance in predicting functional outcomes at one year post-injury.
Conclusion: Each factor of the Disability Rating Scale may independently serve as a clinically useful outcome predictor after traumatic brain injury.
- Implications for rehabilitation
The Disability Rating Scale is a measure used in brain injury rehabilitation that generates a total score indicating level of disability.
This study confirmed a three-factor structure and showed that the individual factor scores provide unique information in predicting rehabilitation outcomes at one year post-injury.
Materials and methods: Qualitative and quantitative studies were identified through searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Libraries. The literature search was limited to humans, of English and Scandinavian languages and publication year between 1980 and 2017. Study quality was assessed for all the included studies and extracted data were synthesized using narrative analysis.
Results: Of 4235 records identified through literature search, eleven were included in the analyses. Results from the qualitative studies illustrated multiple physical, behavioral, emotional, and cognitive manifestations of trauma. Four out of five quantitative studies showed that various types of potentially traumatic events were significantly associated with mental health adversities (p?<?0.05). The prevalence of post-traumatic mental disorders was 4–21.2% for depression, 0.9% for dysthymia, and 32% for substance misuse. The quality of the reviewed studies was considered low to moderate.
Conclusion: Traumatic experiences appear to have a great impact on the mental health in people with visual impairment (VI) and these results highlight their need for mental health care. Future studies with higher methodological rigor are recommended.
- Implications for rehabilitation
Visual impairment entails a greater susceptibility to some types of potentially traumatic events, especially threats in everyday life. This calls for a greater emphasis on safe community environments and universal design in public spaces.
In rehabilitation after serious accidents or potentially traumatic events, professionals working with people with vision impairment should be aware of the different manifestations of post-traumatic stress responses and that some stress responses may cause additional disability.
The high prevalence of traumatic events and their impact on mental health in individuals with visual impairments highlights a need of mental health care.
- Key points
Task shifting between different levels of health care is a relevant and legitimate strategy for planning and policy.
GPs in Norway report adverse events related to task shifting from specialist colleagues without proper resource allocation.
Patient safety may be put at risk by hazardous delay, overdiagnosis, endangered accountability and potential malpractice.
Planning and implementation of task shifting must involve all system levels and relevant stakeholders to ensure patient safety.
Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines.
Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin “ultra”, beyond, to “habilitare”, make fit. The resulting term, “ultrabilitate”, commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning.
Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas.
- Implications for rehabilitation
Despite significant progress, rehabilitation limits some people with disabilities.
Modern health systems still benchmark therapy for rehabilitation against “normal” or species-typical standards to aid recovery.
“Ultrabilitation”, meaning “beyond fitness”, promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery.
Biological, social and technological conditions are needed to support ultrabilitation.
Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth.