Jai Carmichael, Amelia J. Hicks, K. Gould, T. Feeney, Penelope Analytis, J. Ponsford
Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life.Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts.The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB.The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.
{"title":"‘We struggle and muddle.’ A qualitative study exploring community ABI therapists’ experiences of using, training in and implementing behaviour interventions","authors":"Jai Carmichael, Amelia J. Hicks, K. Gould, T. Feeney, Penelope Analytis, J. Ponsford","doi":"10.1017/brimp.2020.6","DOIUrl":"https://doi.org/10.1017/brimp.2020.6","url":null,"abstract":"Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life.Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts.The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB.The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"63 1","pages":"1-16"},"PeriodicalIF":0.8,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74407648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Block, Stacey George, S. Milanese, J. Dizon, H. Bowen-Salter, Felicity Jenkinson
To synthesise the current best evidence on both pharmacological and non-pharmacological behaviour management interventions for adult patients in the acute hospital setting with traumatic brain injury (TBI) or post-traumatic amnesia (PTA).A comprehensive search of 10 electronic databases was completed.Systematic reviews (SRs) published in English before September 2018 were included. Initial search resulted in 4604 citations, 2916 for title and abstract screening with duplicates removed, and 2909 articles failed to meet the inclusion criteria leaving seven reviews for inclusion. Five reporting pharmacological management approaches, two reporting non-pharmacological management approaches, and one reporting both pharmacological and non-pharmacological management approaches.Methodological quality was assessed independently by two reviewers using the Critical Appraisal Skills Programme Tool for SRs. Data were extracted from the studies based on the recommendations of the Joanna Briggs Institute (JBI) Methodology for JBI Umbrella Reviews.The SRs were of low-to-moderate quality overall. High-quality SRs were characterised by low numbers of studies and significant biases. The evidence relating to pharmacological interventions demonstrates low level and variable quality. The evidence relating to non-pharmacological interventions was limited and of low quality.The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours. More studies with rigorous methodologies are required to investigate the most suitable pharmacological and non-pharmacological behavioural interventions for the acute phase of TBI or PTA.
{"title":"Evidence for the management of challenging behaviours in patients with acute traumatic brain injury or post-traumatic amnesia: An Umbrella Review","authors":"H. Block, Stacey George, S. Milanese, J. Dizon, H. Bowen-Salter, Felicity Jenkinson","doi":"10.1017/brimp.2020.5","DOIUrl":"https://doi.org/10.1017/brimp.2020.5","url":null,"abstract":"To synthesise the current best evidence on both pharmacological and non-pharmacological behaviour management interventions for adult patients in the acute hospital setting with traumatic brain injury (TBI) or post-traumatic amnesia (PTA).A comprehensive search of 10 electronic databases was completed.Systematic reviews (SRs) published in English before September 2018 were included. Initial search resulted in 4604 citations, 2916 for title and abstract screening with duplicates removed, and 2909 articles failed to meet the inclusion criteria leaving seven reviews for inclusion. Five reporting pharmacological management approaches, two reporting non-pharmacological management approaches, and one reporting both pharmacological and non-pharmacological management approaches.Methodological quality was assessed independently by two reviewers using the Critical Appraisal Skills Programme Tool for SRs. Data were extracted from the studies based on the recommendations of the Joanna Briggs Institute (JBI) Methodology for JBI Umbrella Reviews.The SRs were of low-to-moderate quality overall. High-quality SRs were characterised by low numbers of studies and significant biases. The evidence relating to pharmacological interventions demonstrates low level and variable quality. The evidence relating to non-pharmacological interventions was limited and of low quality.The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours. More studies with rigorous methodologies are required to investigate the most suitable pharmacological and non-pharmacological behavioural interventions for the acute phase of TBI or PTA.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"13 1","pages":"1-19"},"PeriodicalIF":0.8,"publicationDate":"2020-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83031287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with severe stroke frequently present with substantial impairments but are often not prioritised for post-discharge rehabilitation. There is a need to determine where these patients are discharged to in order to facilitate appropriate allocation of post-discharge pathway resources.The present study aimed to describe the discharge pathways of patients with severe stroke and to identify predictors of discharge destination for these patients.A descriptive, retrospective design was utilised to determine the discharge destination for 770 patients with severe stroke in Queensland, Australia. Binomial logistic regression was used to determine the variables that predicted discharge destination.The results indicated that 58.44% of patients were discharged home (n = 450). Age, length of stay, discharge ward and geographical region emerged as significant predictors of discharge destination. The full model containing all predictors was statistically significant and, as a whole, explained 36.50% of the variance in discharge destination.These results highlight the importance of these variables in influencing the outcomes of patients with severe stroke, which may assist post-hospital discharge services in allocating resources for patients with severe stroke.
{"title":"Exploring discharge destination following severe stroke","authors":"W. Teoh, Emma Finch","doi":"10.1017/brimp.2020.4","DOIUrl":"https://doi.org/10.1017/brimp.2020.4","url":null,"abstract":"Patients with severe stroke frequently present with substantial impairments but are often not prioritised for post-discharge rehabilitation. There is a need to determine where these patients are discharged to in order to facilitate appropriate allocation of post-discharge pathway resources.The present study aimed to describe the discharge pathways of patients with severe stroke and to identify predictors of discharge destination for these patients.A descriptive, retrospective design was utilised to determine the discharge destination for 770 patients with severe stroke in Queensland, Australia. Binomial logistic regression was used to determine the variables that predicted discharge destination.The results indicated that 58.44% of patients were discharged home (n = 450). Age, length of stay, discharge ward and geographical region emerged as significant predictors of discharge destination. The full model containing all predictors was statistically significant and, as a whole, explained 36.50% of the variance in discharge destination.These results highlight the importance of these variables in influencing the outcomes of patients with severe stroke, which may assist post-hospital discharge services in allocating resources for patients with severe stroke.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"11 1","pages":"1-12"},"PeriodicalIF":0.8,"publicationDate":"2020-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83236882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Culph, L. Clemson, J. Scanlan, L. Craven, Y. Jeon, K. Laver
Abstract Aims: Implementation of novel interventions occurs within broad organisational contexts, which contain many relationships and moving parts. Efforts need to be made to understand these relationships as they are an important predictor of successful implementation. This study examines the relationships between health professionals involved in the implementation of an evidence-based community program for people with dementia and their carers in Australia, The Care of People with dementia in their Environments program. Methods: This study utilised mixed methods including in-depth interviews and organisational diagrams. Qualitative data from 28 interviews were collected from occupational therapists, nurses and their managers. Recruitment ensured a variety of different organisational contexts were represented. Thematic analysis was used to capture key emergent themes. Findings: The strongest relationships were usually between the occupational therapist and their manager. Strong trusting relationships with managers were instrumental in advocating for the need for reablement programs and the occupational therapy professional role in dementia care. Large teams of occupational therapists were seen to be beneficial in supporting each other in case complexities. Relationships between occupational therapists and nurses were often missing or perceived as weak relationships. A conducive physical environment contributed to stronger more collaborative relationships, where individuals were visible and therefore felt to be more approachable. Conclusion: Our study highlights the additional preparation work that is required of organisations to consider relationships in their strategies for implementation.
{"title":"Exploring relationships between health professionals through the implementation of a reablement program for people with dementia: A mixed methods study","authors":"Jennifer Culph, L. Clemson, J. Scanlan, L. Craven, Y. Jeon, K. Laver","doi":"10.1017/BrImp.2020.2","DOIUrl":"https://doi.org/10.1017/BrImp.2020.2","url":null,"abstract":"Abstract Aims: Implementation of novel interventions occurs within broad organisational contexts, which contain many relationships and moving parts. Efforts need to be made to understand these relationships as they are an important predictor of successful implementation. This study examines the relationships between health professionals involved in the implementation of an evidence-based community program for people with dementia and their carers in Australia, The Care of People with dementia in their Environments program. Methods: This study utilised mixed methods including in-depth interviews and organisational diagrams. Qualitative data from 28 interviews were collected from occupational therapists, nurses and their managers. Recruitment ensured a variety of different organisational contexts were represented. Thematic analysis was used to capture key emergent themes. Findings: The strongest relationships were usually between the occupational therapist and their manager. Strong trusting relationships with managers were instrumental in advocating for the need for reablement programs and the occupational therapy professional role in dementia care. Large teams of occupational therapists were seen to be beneficial in supporting each other in case complexities. Relationships between occupational therapists and nurses were often missing or perceived as weak relationships. A conducive physical environment contributed to stronger more collaborative relationships, where individuals were visible and therefore felt to be more approachable. Conclusion: Our study highlights the additional preparation work that is required of organisations to consider relationships in their strategies for implementation.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"10 1","pages":"286 - 298"},"PeriodicalIF":0.8,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86213510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim: To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management. Method: A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis. Results: Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation. Conclusion: There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.
{"title":"A survey of speech-language pathology treatment for non-progressive dysarthria in Australia","authors":"Narissa Gracia, A. Rumbach, Emma Finch","doi":"10.1017/BrImp.2020.3","DOIUrl":"https://doi.org/10.1017/BrImp.2020.3","url":null,"abstract":"Abstract Aim: To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management. Method: A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis. Results: Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation. Conclusion: There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"12 1","pages":"173 - 190"},"PeriodicalIF":0.8,"publicationDate":"2020-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91050583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: The interdependence between patient and caregivers’ health, which is when the patients’ and informal caregivers’ emotion, cognition and/or behavior affects that of the other person is well documented among dyads experiencing cancer and heart disease, but scant research has assessed interdependence among those with brain injuries or dementia and Latina/o populations. This study aimed to assess the interdependence of patient and caregiver depression, patient functional independence and caregiver burden among non-Latina/o and Latina/o and patients with brain injuries and dementia and their caregivers. Methods: Patients and caregiver dyads (n = 96) were recruited from a trauma hospital. Participants completed measures on patient and caregiver depression, patient functional independence and caregiver burden. Participants provided written informed consent. Patient inclusion criteria included: (1) diagnosis with a brain injury or dementia, (2) minimum age of 12, (3) community dwelling and (4) ability to verbally communicate and complete study measures. Caregivers were only included if they were informal, unpaid, family or a friend. Nonparametric Spearman’s Rho correlations were conducted to test the study hypotheses. Discussion: There was consistently a statistically significant positive relationship between caregiver depression and caregiver burden for all groups. For non-Latina/o patient and caregiver dementia dyads, there were associations between patient depression and caregiver depression. For non-Latina/o dementia dyads, functional ability was only associated with patient depression. For Latina/o patient and caregiver brain injury and dementia dyads, the only statistically significant relationship was between caregiver depression and caregiver burden. Health services should embrace family-focused mental health and respite interventions.
{"title":"Latina/o and non-latina/o brain injury and dementia patients’ and caregivers’ health: An actor/partner interdependence model","authors":"K. Linton","doi":"10.1017/BrImp.2020.1","DOIUrl":"https://doi.org/10.1017/BrImp.2020.1","url":null,"abstract":"Abstract Background: The interdependence between patient and caregivers’ health, which is when the patients’ and informal caregivers’ emotion, cognition and/or behavior affects that of the other person is well documented among dyads experiencing cancer and heart disease, but scant research has assessed interdependence among those with brain injuries or dementia and Latina/o populations. This study aimed to assess the interdependence of patient and caregiver depression, patient functional independence and caregiver burden among non-Latina/o and Latina/o and patients with brain injuries and dementia and their caregivers. Methods: Patients and caregiver dyads (n = 96) were recruited from a trauma hospital. Participants completed measures on patient and caregiver depression, patient functional independence and caregiver burden. Participants provided written informed consent. Patient inclusion criteria included: (1) diagnosis with a brain injury or dementia, (2) minimum age of 12, (3) community dwelling and (4) ability to verbally communicate and complete study measures. Caregivers were only included if they were informal, unpaid, family or a friend. Nonparametric Spearman’s Rho correlations were conducted to test the study hypotheses. Discussion: There was consistently a statistically significant positive relationship between caregiver depression and caregiver burden for all groups. For non-Latina/o patient and caregiver dementia dyads, there were associations between patient depression and caregiver depression. For non-Latina/o dementia dyads, functional ability was only associated with patient depression. For Latina/o patient and caregiver brain injury and dementia dyads, the only statistically significant relationship was between caregiver depression and caregiver burden. Health services should embrace family-focused mental health and respite interventions.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"20 1","pages":"237 - 246"},"PeriodicalIF":0.8,"publicationDate":"2020-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73692719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miia Rahja, Jennifer Culph, L. Clemson, Sally Day, K. Laver
Abstract Rationale: Evidence-based reablement programs for people with dementia and their caregivers are not routinely implemented in practice. These programs have been shown to be effective in delaying functional decline and improving caregiver wellbeing. Yet, little is known about the experiences of those participating in such programs. Aim: To describe experiences and outcomes of participating in a dementia reablement program, the Care of Persons with dementia in their Environments (COPE), in Australia. Methods: Purposeful sampling was used and semi-structured interviews were completed with people with dementia and their caregivers who received the COPE program in two different states in Australia. The interviews explored the participants’ experiences with the program as well as how they are managing after program completion. Thematic analysis was used to identify themes from the interviews. A Likert scale was used to rate the value of the program. Results: Ten dyads (person with dementia and/or their caregiver) were interviewed. Participation in the program was rated (mostly) very valuable. The ongoing collaboration between the therapist and caregiver was considered empowering. The program promoted participation in everyday activities for the person with dementia and appeared to give a ‘second chance’ to remain in their own homes and communities. Conclusion: Participation in reablement programs (such as the COPE program) has the potential to re-engage people with dementia in meaningful roles and activities in their chosen environments. A therapeutic relationship and individualized intervention approaches tailored to the participants’ needs and readiness foster positive experiences and confidence.
{"title":"A second chance: Experiences and outcomes of people with dementia and their families participating in a dementia reablement program","authors":"Miia Rahja, Jennifer Culph, L. Clemson, Sally Day, K. Laver","doi":"10.1017/BrImp.2019.34","DOIUrl":"https://doi.org/10.1017/BrImp.2019.34","url":null,"abstract":"Abstract Rationale: Evidence-based reablement programs for people with dementia and their caregivers are not routinely implemented in practice. These programs have been shown to be effective in delaying functional decline and improving caregiver wellbeing. Yet, little is known about the experiences of those participating in such programs. Aim: To describe experiences and outcomes of participating in a dementia reablement program, the Care of Persons with dementia in their Environments (COPE), in Australia. Methods: Purposeful sampling was used and semi-structured interviews were completed with people with dementia and their caregivers who received the COPE program in two different states in Australia. The interviews explored the participants’ experiences with the program as well as how they are managing after program completion. Thematic analysis was used to identify themes from the interviews. A Likert scale was used to rate the value of the program. Results: Ten dyads (person with dementia and/or their caregiver) were interviewed. Participation in the program was rated (mostly) very valuable. The ongoing collaboration between the therapist and caregiver was considered empowering. The program promoted participation in everyday activities for the person with dementia and appeared to give a ‘second chance’ to remain in their own homes and communities. Conclusion: Participation in reablement programs (such as the COPE program) has the potential to re-engage people with dementia in meaningful roles and activities in their chosen environments. A therapeutic relationship and individualized intervention approaches tailored to the participants’ needs and readiness foster positive experiences and confidence.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"45 1","pages":"274 - 285"},"PeriodicalIF":0.8,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77214580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Barker-Collo, A. Theadom, K. Jones, N. Starkey, Kris Fernando, M. Kahan, P. Prah, V. Feigin
Emerging data suggest that recovery from mild traumatic brain injury (mTBI) takes longer than previously thought. This paper examines trajectories for cognitive recovery up to 48 months post-mTBI, presenting these visually using a Sankey diagram and growth curve analysis.This sample (n = 301) represents adults (≥16 years) from a population-based Brain Injury Outcomes in the New Zealand Community study over a 4-year follow-up on the CNS-Vital Signs neuropsychological test. Data were collected within 2 weeks of injury, and then at 1, 6, 12 and 48 months post-injury.Significant improvement in cognitive functioning was seen up to 6 months post-injury. Using growth curve modelling, we found significant improvements in overall neurocognition from baseline to 6 months, on average participants improved one point per month (0.9; 95% CI 0.42–1.39) p < 0.001. No change in neurocognition was found within the time periods 6–12 months or 12–48 months. The Sankey highlighted that at each time point, a small proportion of participants remained unchanged or declined. Proportionally, few show any improvement after the first 6 months.Most individuals remained stable or improved over time to 6 months post-injury. Summary statistics are informative regarding overall trends, but can mask differing trajectories for recovery. The Sankey diagram indicates that not all improve, as well as the potential impact of individuals moving in and out of the study. The Sankey diagram also indicated the level of functioning of those most likely to withdraw, allowing targeting of retention strategies.
新出现的数据表明，从轻度创伤性脑损伤(mTBI)中恢复需要的时间比以前想象的要长。本文研究了mtbi后48个月的认知恢复轨迹，使用桑基图和生长曲线分析直观地展示了这些轨迹。该样本(n = 301)代表来自新西兰社区一项基于人群的脑损伤结局研究的成年人(≥16岁)，该研究对cns -生命体征神经心理测试进行了为期4年的随访。分别于伤后2周、1个月、6个月、12个月和48个月采集数据。损伤后6个月认知功能显著改善。使用生长曲线模型，我们发现从基线到6个月的整体神经认知有显著改善，参与者平均每月改善1点(0.9;95% CI 0.42-1.39) p < 0.001。在6-12个月或12-48个月的时间内，神经认知没有变化。桑基强调，在每个时间点，一小部分参与者保持不变或下降。按比例来看，在前6个月之后，几乎没有人表现出任何改善。大多数人在受伤后6个月保持稳定或有所改善。摘要统计数据对总体趋势提供了信息，但可能掩盖了复苏的不同轨迹。桑基图表明，并不是所有的人都有所改善，以及个人进入和离开研究的潜在影响。桑基图还显示了那些最有可能退出的人的功能水平，从而使保留率策略成为可能。
{"title":"Three methods for examining trajectories in neuropsychological performance across the first 4 years after mild Traumatic Brain Injury","authors":"S. Barker-Collo, A. Theadom, K. Jones, N. Starkey, Kris Fernando, M. Kahan, P. Prah, V. Feigin","doi":"10.1017/brimp.2019.31","DOIUrl":"https://doi.org/10.1017/brimp.2019.31","url":null,"abstract":"Emerging data suggest that recovery from mild traumatic brain injury (mTBI) takes longer than previously thought. This paper examines trajectories for cognitive recovery up to 48 months post-mTBI, presenting these visually using a Sankey diagram and growth curve analysis.This sample (n = 301) represents adults (≥16 years) from a population-based Brain Injury Outcomes in the New Zealand Community study over a 4-year follow-up on the CNS-Vital Signs neuropsychological test. Data were collected within 2 weeks of injury, and then at 1, 6, 12 and 48 months post-injury.Significant improvement in cognitive functioning was seen up to 6 months post-injury. Using growth curve modelling, we found significant improvements in overall neurocognition from baseline to 6 months, on average participants improved one point per month (0.9; 95% CI 0.42–1.39) p < 0.001. No change in neurocognition was found within the time periods 6–12 months or 12–48 months. The Sankey highlighted that at each time point, a small proportion of participants remained unchanged or declined. Proportionally, few show any improvement after the first 6 months.Most individuals remained stable or improved over time to 6 months post-injury. Summary statistics are informative regarding overall trends, but can mask differing trajectories for recovery. The Sankey diagram indicates that not all improve, as well as the potential impact of individuals moving in and out of the study. The Sankey diagram also indicated the level of functioning of those most likely to withdraw, allowing targeting of retention strategies.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"24 1","pages":"1-14"},"PeriodicalIF":0.8,"publicationDate":"2019-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78772118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: Positive Behaviour Support (PBS) may be an effective intervention for reducing challenging behaviours following acquired brain injury (ABI). However, it is not known whether community ABI therapists are currently using this intervention. Accordingly, this study was designed to determine the need for clinical translation. Method: Data were collected from community ABI therapists about their experiences with training in and delivering behaviour management interventions. Quantitative data were collected from 135 community ABI therapists from Australia who completed a purpose-designed online survey, while qualitative data were collected through semi-structured interviews (n= 13). Analysis of quantitative and qualitative data involved multiple regression and thematic analysis, respectively. Results: Consistent with PBS, participants emphasised the importance of working with the client’s support network and other therapists in order to share expertise. Although many participants identified using elements of PBS, most expressed a desire for (further) training in this intervention and behaviour management more generally. Approximately, 80% of participants indicated facing barriers to learning, and to implementing, new behaviour management interventions, with lack of time being the most common barrier. Number of barriers and confidence significantly predicted readiness to learn and implement new behaviour management interventions. Specific recommendations for training community ABI therapists in PBS will also be presented. Conclusions: The results suggest that community ABI therapists largely support the use of PBS but highlight a need for further clinical translation. The results will directly inform the development of a behaviour management training program tailored to therapists’ preferences and needs.
{"title":"ASSBI/NZRA AWARDS","authors":"","doi":"10.1017/BrImp.2019.29","DOIUrl":"https://doi.org/10.1017/BrImp.2019.29","url":null,"abstract":"Background and Aims: Positive Behaviour Support (PBS) may be an effective intervention for reducing challenging behaviours following acquired brain injury (ABI). However, it is not known whether community ABI therapists are currently using this intervention. Accordingly, this study was designed to determine the need for clinical translation. Method: Data were collected from community ABI therapists about their experiences with training in and delivering behaviour management interventions. Quantitative data were collected from 135 community ABI therapists from Australia who completed a purpose-designed online survey, while qualitative data were collected through semi-structured interviews (n= 13). Analysis of quantitative and qualitative data involved multiple regression and thematic analysis, respectively. Results: Consistent with PBS, participants emphasised the importance of working with the client’s support network and other therapists in order to share expertise. Although many participants identified using elements of PBS, most expressed a desire for (further) training in this intervention and behaviour management more generally. Approximately, 80% of participants indicated facing barriers to learning, and to implementing, new behaviour management interventions, with lack of time being the most common barrier. Number of barriers and confidence significantly predicted readiness to learn and implement new behaviour management interventions. Specific recommendations for training community ABI therapists in PBS will also be presented. Conclusions: The results suggest that community ABI therapists largely support the use of PBS but highlight a need for further clinical translation. The results will directly inform the development of a behaviour management training program tailored to therapists’ preferences and needs.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"12 1","pages":"289 - 376"},"PeriodicalIF":0.8,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81898399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Health outcome measurement is a growth industry. Thousands of behavioural assessment instruments, developed for neurological populations alone, are available for diagnosis, prediction and evaluation of interventions. The task of selecting the best instrument for the purpose at hand is thus a daunting one for the clinician and researcher. Fortunately, there are guides that make the task easier. This presidential address covers three interrelated themes that inform assessment in neurorehabilitation: First, it reviews current concepts and the status of behavioural assessment in neurorehabilitation. It then examines evidence-based clinical practice as applied to assessment of function, along with methods to benchmark the scientific quality of assessment instruments. Finally, the article considers the need to move beyond outcome measurement in the neurorehabilitation setting.
{"title":"Measuring outcomes and monitoring progress in the era of evidence-based clinical practice","authors":"R. Tate","doi":"10.1017/BrImp.2019.28","DOIUrl":"https://doi.org/10.1017/BrImp.2019.28","url":null,"abstract":"Abstract Health outcome measurement is a growth industry. Thousands of behavioural assessment instruments, developed for neurological populations alone, are available for diagnosis, prediction and evaluation of interventions. The task of selecting the best instrument for the purpose at hand is thus a daunting one for the clinician and researcher. Fortunately, there are guides that make the task easier. This presidential address covers three interrelated themes that inform assessment in neurorehabilitation: First, it reviews current concepts and the status of behavioural assessment in neurorehabilitation. It then examines evidence-based clinical practice as applied to assessment of function, along with methods to benchmark the scientific quality of assessment instruments. Finally, the article considers the need to move beyond outcome measurement in the neurorehabilitation setting.","PeriodicalId":56329,"journal":{"name":"Brain Impairment","volume":"17 1","pages":"276 - 288"},"PeriodicalIF":0.8,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75385922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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