Factors influencing return to work experienced by people with acquired brain injury: a qualitative research study

Purpose.?To describe the factors experienced by adults with moderate-to-severe acquired brain injury (ABI) as either limiting or facilitating during the process of return to work (RTW) in order to give an advice about the vocational rehabilitation process.

Methods.?A qualitative study was performed. Twelve adults who were working before acquiring traumatic or non-traumatic brain injury (2–3 years earlier) participated. The experiences were gathered by semi-structured interviews. The International Classification of Functioning, Disability and Health was used as a theoretical framework for the interviews and the analysis.

Results.?The most common limiting factor was tiredness. The most common facilitating factors were the will to RTW, the ongoing recovery and the knowledge and support of the employer, colleagues, occupational physician and occupational specialist.

Conclusions.?Different aspects were experienced as being important during the process of RTW after ABI. These aspects should be kept in mind during the process of RTW to make the outcome as successful as possible. It is advised to pay special attention to the recovery opportunities of an individual, to inform the employer, colleagues, occupation physician and the occupational specialist about ABI, and to support people with ABI for long time periods. An important role can be played by the rehabilitation centre.     

The use of standard calendar software by individuals with acquired brain injury and cognitive complaints: a mixed methods study

Purpose: To explore the actual use of standard calendar software by people with acquired brain injury (ABI) and healthy individuals. Method: Mixed methods design with qualitative and quantitative analyses of the respondents’ use of calendar software. Fifteen individuals with ABI and 15 healthy participants were enrolled. Participants were asked to execute five consecutive tasks using standard calendar software, which resembled everyday use of an electronic calendar. Results: The core processes “task execution” and “information processing” were influenced by internal factors (cognitive and emotional processes and fatigue) as well as environmental factors (software features and distractions). Results obtained by qualitative and quantitative methods showed similar reaction patterns in both groups. However, ABI patients had more cognitive problems and showed stronger emotions during task performance than healthy participants. Healthy participants were more successful and needed less time and mental effort to perform a task. Conclusions: Although ABI patients were able to use standard calendar software, they became upset more easily, needed more effort, became tired sooner and more suddenly. Strategies to support ABI patients in the use of calendar software are suggested from multi-disciplinary perspectives.

Implications for Rehabilitation

• A user-centred approach is necessary when designing dedicated calendar software for acquired brain injury (ABI) patients with cognitive deficits.

• Training ABI patients in the use of assistive technology should focus on the influence of person-related factors such as cognitive and emotional processes and fatigue and environmental factors such as software features and distractions.

• In order to conceive and realize user-centred solutions for AT use in cognitive rehabilitation, a strong multi-disciplinary input is necessary.

     

Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community: a qualitative study

Purpose: To explore the experiences of individuals who have had a severe traumatic brain injury (TBI) and their carers in the first month post-discharge from in-patient rehabilitation into living in the community.

Method: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers.

Results: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future.

Conclusions: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services.

• Implications for Rehabilitation

• Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer.

• Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety.

• The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors.

• A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.

     

How assistive devices affect activities of daily living and cognitive functions of people with brain injury: a meta-analysis

Purpose: This study aims to systematically evaluate and synthesize the literature on the effects of assistive technology devices on the activities of daily living and cognitive functions of people with brain injury.

Methods: Eight randomized controlled trials were selected from online databases pertaining to the scientific use of AT devices for people with brain injury. The Jadad scale was used to analyse the subjects qualitatively, and Comprehensive Meta-Analysis 2.0 was used to test the statistical heterogeneity, effect size, sensitivity and publication bias of each of the selected studies.

Results: All selected studies were assigned a score of three on the Jadad scale, which could classify them as high-quality studies. The total number of participants in the studies was 385. The effect size of activities of daily living was 0.72, which is a medium effect size and that of cognitive function was 0.30, which is a small effect size.

Conclusion: Assistive devices are effective in improving the activities of daily living and relatively less effective in enhancing the cognitive function of people with brain injury. This meta-analysis is evidence that assistive devices could be an effective intervention method for people with brain injury.

• Implications for Rehabilitation

• The purpose of this study is to demonstrate the effectiveness of this approach and to generalize the use of assistive devices. We aim to provide a basis for popularizing assistive devices as a therapeutic intervention method.

     

Using electronic aids to daily living after acquired brain injury: A study of the learning process and the usability

Purpose. The purpose was to study the ability of persons with memory impairments after acquired brain injury to learn how to and use electronic aids to daily living (EADL) and to describe changes in function and quality of life.

Method. Eight participants stayed in two apartments equipped with a set of basic and advanced EADL for either 4 or 6 months during an intervention time of 2 years. The teaching and learning method was influenced by certain principles of errorless learning. Ability to learn to use EADL was measured by structured observations. Function and quality of life were assessed with self-rating questionnaires.

Results. Results indicate that the participants learned to use EADL in their everyday activities. They perceived that EADL were very useful and easy to learn. Occupational performance and satisfaction with occupational performance and quality of life was improved.

Conclusion. The results indicate that EADL may play an important role in facilitating everyday activities and improve satisfaction with occupational performance and quality of life for people with memory impairments. The study indicates the importance of adjusting technology to the user's needs and calls for more consideration for human – technology interaction factors.     

Risk assessment and management for providers of community-based rehabilitation to people with acquired brain injury: Health professionals' perspectives

Purpose.?This study aimed to explore health professionals' perspectives regarding the presence, assessment and management of risks when providing community-based rehabilitation (CBR) to clients with acquired brain injury (ABI).

Method.?A qualitative approach using semi-structured interviews of health professionals working in CBR.

Results.?The main themes were: (1) risk assessment in CBR settings is an informal, unstructured, complex, multi-phase and cyclical process extending over a period of time; (2) structured and standardised risk assessments were not considered ideal for use in CBR services catering for people with ABI; (3) CBR services face numerous challenges in providing effective risk assessment and management; (4) the risks encountered by health professionals in CBR settings are not always predictable or preventable; and (5) CBR risk management focuses on implementing a range of practical strategies.

Conclusions.?A flexible risk assessment process supported by a range of practical risk management strategies to minimise and manage potential risks is advocated by health professionals working in CBR services for people with ABI. There is a need for more research into the effectiveness of current risk assessment and management strategies for CBR services.     

Exploring the use of the Cognitive Orientation to daily Occupational Performance approach (CO-OP) with children with executive functions deficits after severe acquired brain injury: A single case experimental design study

Children with acquired brain injury (ABI) often have cognitive and behavioral impairments that affect participation in everyday activities. Among them, executive function (EF) deficits are frequent. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance. Few studies have examined the effectiveness of CO-OP in children with EF deficits after ABI. Objectives: to assess whether the use of CO-OP could be of interest in children with EF deficits after ABI, to improve their occupational performance, their executive functioning in everyday life and their cognitive processes constituting EF. Methods. This was a single case experimental study with multiple baselines across individuals and behaviors. We included 2 children at least 6 months after severe ABI. The children received 14 individual sessions of the CO-OP intervention. Each child set 3 goals by using the Canadian Occupational Performance Measure; 2 goals were trained and the third was a control goal. The achievement of the goals was measured by using repeated measures of Goal Attainment Scales (GASs). Ecological assessments of EF included the Children's Cooking Task and parent and teacher ratings of the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire. Results: both children improved their performance on both trained goals (and, to a lesser extent, on untrained goals). We found significant improvement on tests of EF and on the BRIEF questionnaire, reflecting executive functioning in everyday life, at home and at school. Conclusions: these results are encouraging and suggest the feasibility and effectiveness of CO-OP for children with EF deficits after ABI. They should be replicated in a larger number of cases. Trial registration: ClinicalTrials.gov (NCT04718688).     

Environmental barriers to participation and facilitators for use of three types of assistive technology devices

The aim was to compare the presence of environmental barriers to participation and facilitators for assistive technology (AT) use and study the relation between barriers and AT use in three different AT devices. A cross-sectional survey was conducted. Inclusion criteria were ≥one year of experience as a user of myoelectric prosthesis (MEP), powered mobility device (PMD), or assistive technology for cognition (ATC) and age 20-90 years. Overall, 156 participants answered the Swedish version of the Craig Hospital Inventory of Environmental Factors and a study-specific questionnaire on facilitating factors. Non-parametric tests were used for comparisons. Barriers to participation were lowest in MEP users (md=0.12; p>0.001), and highest in ATC users (md=1.56; p>0.001) with the least support for AT use (p>0.001 - p=0.048). A positive correlation between fewer barriers and higher use of MEP was seen (r=0.30, p=0.038). The greatest barriers to participation were Natural environment, Surroundings and Information, and the most support came from relatives and professionals. Support, training and education are vital in the use of AT. These factors may lead to a more sustained and prolonged use of AT and may enable increased participation. Future research should focus on interventions that meet the needs of people with cognitive disabilities.     

Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury

Purpose: The purpose of this mixed-methods case study was to investigate whether an 8-week 1:1 yoga program was feasible and beneficial to people with traumatic brain injury (TBI). Method: This was a mixed-methods case study of one-to-one yoga for people with TBI included three people. We completed assessments before and after the 8-week yoga intervention and included measures of balance, balance confidence, pain, range of motion, strength and mobility. Qualitative interviews were included at the post-assessment. We include a percent change calculation and salient quotes that represent the perceived impact of the yoga intervention. Results: All participants completed the yoga intervention and all demonstrated improvements in physical outcome measures. For the group, balance increased by 36%, balance confidence by 39%, lower extremity strength by 100% and endurance by 105%. Qualitative data support the use of yoga to improve multiple aspects of physical functioning, one participant stated: “I mean it’s rocked my world. It’s changed my life. I mean all the different aspects. I mean physically, emotionally, mentally, it’s given me you know my life back…”. Conclusions: Yoga, delivered in a one-to-one setting, appears to be feasible and beneficial to people with chronic TBI.

• Implications for Rehabilitation

• Chronic traumatic brain injury (TBI) leads to many aspects of physical functioning impairment.

• Yoga delivered in a one-to-one setting may be feasible and beneficial for people with chronic TBI.

     

A comparison of rural speech-language pathologists' and residents' access to and attitudes towards the use of technology for speech-language pathology service delivery

This paper reports results and implications of two related studies which investigated (a) access of residents and speech-language pathologists (SLPs) of rural Australia to information and communication technologies (ICT) and (b) their attitudes towards the use of ICT for delivery of speech-language pathology services. Both studies used mail out questionnaires, followed by interviews with a subset of those who completed the questionnaires. Data were obtained from 43 questionnaires from rural residents and 10 interviews with a subset of those residents, and from questionnaires returned by 49 SLPs and 4 interviews with a subset of those SLPs. Results show a mismatch between rural residents' and SLPs' access to and attitudes towards use of ICT for speech-language pathology service delivery. Rural residents had better access and more positive attitudes to the use of ICT for speech-language pathology service delivery than expected by SLPs. The results of this study have important implications for education and professional development of SLPs and for research into the use of ICT for telespeech-language pathology.     

Collaborating across sectors to provide early intervention for Aboriginal and Torres Strait Islander children with disability and their families: a qualitative study of provider perspectives

ABSTRACT

Aboriginal and Torres Strait Islander children experience a higher prevalence of disability than other Australian children. Early intervention from across the health, education, and social service sectors is vital for improving outcomes, but families face lack of coordination between services. This study aimed to inform improvements in service access for families of urban-dwelling Aboriginal children with disability through exploring providers’ perceptions of factors that influenced working together across sectors. Semi-structured interviews were conducted. Data analysis was informed by the general inductive approach and the Collaborative Practice to Enhance Patient Care Outcomes framework. Twenty-four providers participated. Interprofessional collaborative practice was influenced by interdependent interactional and organizational factors. Interactional factors fit within one of two dimensions: the ability of providers to share common goals and vision within a complex cross-sector service landscape, and influence of interpersonal relationships on their sense of belonging working in a cross-cultural space. Organizational factors also fit within one of two dimensions: the influence of governance in relation to its role in coordination and unlocking the strength of schools as service settings, and the need to formalize processes for effective interprofessional communication. Interprofessional collaborative practice was managed within the context of systemic factors relating to policy and funding. These findings demonstrate the complex interplay of factors related to the cross-sector involvement of providers in early intervention service provision. Consideration of these factors is required to facilitate collaborative cross-sector responses to improve service access for Aboriginal families.

Abbreviations: WHO: world health organization; ACCHS: aboriginal community controlled health service; GP: general practitioner; NDIS: national disability insurance scheme     

Everyday-like memory and its cognitive correlates in healthy older adults and in young patients with traumatic brain injury: a pilot study based on virtual reality

Abstract

Purpose State: A pilot-study with a comparison approach between aging and traumatic brain injury (TBI) is proposed to investigate everyday object memory patterns using a virtual HOMES test. Methods: Sixteen young controls, 15 older adults and 15 TBI patients underwent the HOMES test and traditional tests. Results: Older adults and TBI patients exhibited similar HOMES performances: poor recall, a greater recognition benefit, high false recognitions, but intact clustering and proactive interference effects. The age-related differences for HOMES measures were mainly mediated by executive functioning, while the HOMES performances in the TBI group were correlated with memory measures. Conclusion: The differential cognitive mediating effects for a similar everyday-like memory pattern are discussed by highlighting the need for more cautious interpretations of cognitive mechanisms behind similar behavioral patterns in different populations especially in clinical and rehabilitation settings.

• Implication for Rehabilitation

• Virtual reality might provide ecological scenarios to assess the multiple processes of everyday memory in elderly people as well as in TBI patients.

• A similar pattern of Everyday-like memory failures might result from different cognitive origins among different neuropsychological patients.

• The assessment of specific cognitive origins of Everyday-like memory impairments deserves consideration for drawing up relevant rehabilitative programs that match the specific cognitive needs of patients for performing everyday memory tasks.

     

Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury

Purpose: Rehabilitation professionals have little information concerning lower limb exoskeletons for people with paraplegia. This study has four objectives: (1) Outline the characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community for the Rewalk?, Mina, Indego®, Ekso? (previously known as the eLEGS?) and Rex®; (2) document functional mobility outcomes of using these exoskeletons; (3) document secondary skills and benefits achieved with these exoskeletons, safety, user satisfaction and applicability in the community; and (4) establish level of scientific evidence of the selected studies. Method: A systematic review of the literature (January 2004 to April 2014) was done using the databases PubMed, CINAHL and Embase and groups of keywords associated with “exoskeleton”, “lower limb” and “paraplegia”. Results: Seven articles were selected. Exoskeleton use is effective for walking in a laboratory but there are no training protocols to modify identified outcomes over the term usage (ReWalk?: 3 months, Mina: 2 months and Indego®: 1 session). Levels of evidence of selected papers are low. Conclusions: The applicability and effectiveness of lower limb exoskeletons as assistive devices in the community have not been demonstrated. More research is needed on walking performance with these exoskeletons compared to other mobility devices and other training contexts in the community.

• Implications for rehabilitation

• Characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community are addressed for the Rewalk?, Mina, Indego®, Ekso? and Rex® ReWalk?, Indego® and Mina lower limb exoskeletons are effective for walking in a laboratory for individuals with complete lower-level SCI.

• The ReWalk? has the best results for walking, with a maximum speed of 0.51 m/s after 45 sessions lasting 60 to 120 min; it is comparable to the average speed per day or per week in a manual wheelchair.

• The level of scientific evidence is low. Other studies are needed to provide more information about performance over the longer term when walking with an exoskeleton, compared to wheelchair mobility, the user’s usual locomotion, the use of different exoskeletons or the training context in which the exoskeleton is used.

     

Swedish District Nurses’ experiences on the use of information and communication technology for supporting people with serious chronic illness living at home – a case study

Scand J Caring Sci; 2010; 24; 259–265
Swedish District Nurses’ experiences on the use of information and communication technology for supporting people with serious chronic illness living at home – a case study The aim of this case study was to describe two District Nurses’ (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi‐structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.     

‘The group was the only therapy which supported my needs,because it helped me feel normal and I was able to speak out with a voice’: A qualitative study of an integrated group treatment for dual diagnosis service users within a community mental health setting

Whilst the evidence for the efficacy of treatment interventions for individuals with dual diagnosis has been developing in recent decades, little is known about individual perceptions and the personal benefits of attending integrated treatment programmes within this population group. A qualitative methodology, Interpretive phenomenological analysis, was used to investigate the experiences of individuals with a range of complex mental health and coexisting substance misuse problems who took part in a psychoeducational group (PEG) programme. This comprised of social support and therapeutic peer group relationship facilitation. Semi‐structured interviews were undertaken with 15 service users who successfully participated in this treatment programme. Findings identify the complexity of the therapeutic process and understanding of the treatment from the service users perspective. This included the importance of forming meaningful therapeutic relationships as an influential factor in countering a range of distressing and incompatible environmental and situational stressors, such as self‐regulatory control, self‐awareness of a need for change and the importance of integrated treatment in reducing the sense of stigma and exclusion linked with using mental health services. The study findings support the use of integrated treatment programmes in mental health services with a dual diagnosis population group.