Brain Impairment最新文献

Background The transition from inpatient rehabilitation to community living is a challenging time for adults with acquired brain injury (ABI). This study aimed to investigate barriers to evidence-based discharge practices in inpatient ABI rehabilitation and to collaboratively design implementation solutions with rehabilitation healthcare professionals. Method We used a theoretical problem-analysis approach guided by the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) - Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) model. Participants were healthcare professionals working in inpatient ABI rehabilitation and external stakeholders working with patients with ABI post-discharge. Triangulation of data and methods (audits, surveys, focus groups) were employed to provide a comprehensive analysis of barriers and their causes. Results A total of 47 healthcare professionals (70% female) and 14 external stakeholders (71% female) participated. Factors negatively impacting on discharge were classified as pre-disposing (inconsistent planning, limited staff knowledge of discharge goals), enabling (accommodation and funding) and reinforcing (communication, family, nursing involvement). Suggested facilitators for coordinated discharge included clear and consistent communication, support for patient-family emotional adjustment to disability and discharge plans, and improved early access to funding schemes. Conclusion Theory-informed and collaborative methods led to recommendations including a discharge pathway and checklist, meetings with clear objectives for discharge discussions, and an increase in family and nursing staff involvement to improve discharge processes.

Background Maladaptive illness perceptions are known to contribute to the development of persistent post-concussive symptoms 3-6months after mild traumatic brain injury (mTBI), but it is unclear which role these perceptions play in the chronic phase. This study examined which illness perceptions impact post-concussive and psychological symptoms in the chronic phase post-mTBI. Methods This observational study used data from 112 adults who experienced persistent symptoms following mTBI and were referred for multidisciplinary treatment. Measures included a short version of the Illness Perception Questionnaire, the Rivermead Post-Concussion Symptoms Questionnaire and the Brief Symptom Inventory 18. Results Specific illness perceptions were unique predictors of post-concussive symptoms (understanding, identity, duration and emotional response) as well as anxiety and depression symptoms (understanding and emotional response). Conclusion Although the aetiology of persistent post-concussive symptoms is multifactorial, the finding that specific illness perceptions contribute to experienced symptoms in the chronic phase post-mTBI underline the importance of psychoeducation and psychotherapeutic interventions in this population.

Background Despite experiencing complex health needs, there are limited targeted resources to assist older adults with traumatic brain injury (TBI) to age well. This report aims to describe the co-design and co-production of a tailored resource designed with, and for, older people with TBI, their families/carers, and health professionals working with them. Methods A five-stage design-thinking process was followed, incorporating 'empathising' with older adults with TBI and their families/carers (stage 1); 'defining' health priorities/information needs (stage 2); 'ideating' the resource's content, structure, and design (stage 3); 'prototyping' (stage 4); and 'testing' (stage 5). Results 'Tools for ageing well with traumatic brain injury' was launched in September 2024, in the format of a printed manual and online web version with downloadable text resources and videos. The resource includes information to help older adults with TBI and their families/carers engage with health services, self-manage health conditions, navigate health care and funding systems, and advocate proactively for health care and support needs. Conclusions This study reinforced the value of co-design and co-production within a five-stage design-thinking process in developing a resource that had meaning and relevance for people with brain injury and their families/carers, helping them to proactively plan for ageing well with TBI.

Objective To identify and examine whether evidence-based psychological interventions reduce externalising behaviours in persons who sustained a traumatic brain injury (TBI) in childhood and adolescence. Methods This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases (i.e. MEDLINE, PsycINFO, PubMed, EMBASE and ERIC) were systematically searched, with publication dates ranging from 1946 to February 2025. Terms, such as 'TBI', 'externalising', 'aggression', and 'paediatric', were employed in the search. Results The overall searches returned 3551 articles. Of the total, 535 duplicates were excluded, and 2973 records were excluded through screening titles and abstracts. Seventy studies met preliminary established criteria. Of these, 10 studies met inclusion criteria; one (10%) was a nonrandomised study (quasi-experimental design), six (60%) were randomised controlled trials (RCTs) with one-group comparison and three (30%) were RCTs with two-group comparison. Conclusions Despite a limited number of studies, five preliminary clinical practice recommendations were developed. Specifically, this review has identified Family Problem-Solving Therapy and Teen Online Problem Solving as having potential efficacy for adolescence to emerging adulthood (moderate to severe TBI) and late childhood to adolescence (mild to severe TBI) age groups. Additional clinical and methodological implications, along with limitations and future directions, are considered.

Background: Stroke now represents the condition with the highest need for physical rehabilitation worldwide, with only low or moderate-level evidence testing telerehabilitation compared to in-person care. We compared functional ambulation in subacute patients with stroke following telerehabilitation and matched in-person controls with no biopsychosocial differences at baseline.

Methods: We conducted a matched case-control study to compare functional ambulation between individuals with stroke following telerehabilitation and in-person rehabilitation, assessed using the Functional Ambulation Categories (FAC) and the Functional Independence Measure™ (FIM).

Results: The telerehabilitation group (n = 38) achieved significantly higher FAC gains (1.5 (1.3) vs 1.0 (1.0)) than the in-person rehabilitation group, with no differences in ambulation efficiency, in individuals: admitted to rehabilitation within 60 days after stroke onset; aged 49.8 (±11.4) years at admission; 55.3% female sex; moderate stroke severity; 42.1% with 'good' motor FIM at baseline; mostly living with sentimental partner (73.7%); with 21.1% holding an university education degree.

Conclusions: The groups showed no significant differences in ambulation efficiency, though the telerehabilitation group achieved higher FAC gains. Our results suggest that home telerehabilitation can be considered a good alternative to in-person rehabilitation when addressing ambulation in patients with moderate stroke severity and whose home situation mostly includes a cohabiting partner.

Introduction Locked-in syndrome (LIS) is a complex neurological condition characterised by paralysis of all four limbs and anarthria. Persons with LIS may communicate via eye blinks/low technology Augmentative and Alternative Communication devices (low tech AAC devices) or may use high technology Augmentative and Alternative Communication devices (high tech AAC devices). Our three objectives were: (1) to describe the distribution of communication modalities used by persons with LIS, (2) to describe the satisfaction of persons with LIS with their communication modality and social participation, and (3) to compare the characteristics and social participation among high tech AAC devices users versus low tech AAC devices or eye blinking users. Methods The questionnaires were sent by e-mail to persons with LIS. Data collected were communication modality, examination of communication ability, satisfaction with the communication modality and contribution of the communication modality to social participation. Results Of the 53 participants, their mean age was 52years, 43% used low tech AAC devices, 43% used high tech AAC devices and 13% communicated via eye blinking. Communication ability was examined in only half the participants. Participants' satisfaction with their communication modality in terms of ergonomics, rapidity, adaptability and functionality were 80, 67, 36 and 47% respectively. Participants who used high tech AAC devices had significantly better e-mail and social network access, could more often initiate conversations and had longer communication durations. Conclusion The communication abilities of persons with LIS should be examined as quickly as possible and repeated regularly. High tech AAC devices should be rapidly and systematically proposed.

Background There are currently 5.7million informal caregivers in the UK, with many experiencing psychological distress, compromised social functioning and poor quality of life. Improving the negative impact of caregiving has been a key focus of research in this population. However, there is limited research on the positive experiences of informal caregivers, particularly those caring for traumatic brain injury (TBI) survivors. This study aimed to explore whether informal TBI caregivers have positive experiences resulting from their role and investigate the possibility of post-traumatic growth (PTG). Methods Mixed-methods study. Quantitative data analysed using descriptive statistics. Qualitative data were analysed thematically. Data sets were synthesised and compared for agreement. Online semi-structured interviews were conducted with informal TBI caregivers, alongside a demographic questionnaire and validated PTG measure (Post-Traumatic Growth Inventory - Short Form, PTGI-SF). Results Ten TBI caregivers were recruited (n =10 male). The highest-scoring PTGI-SF domain across participants was 'personal strength' (mean=8.3; standard deviation, s.d.=1.5). The lowest-scoring domain was 'greater appreciation for life' (mean=7.1, s.d.=2.6). Six qualitative themes included: (1) deepened personal connections, (2) strengthened spiritual beliefs, (3) personal growth and resilience, (4) transformed life priorities and purpose, (5) improved coping mechanisms and (6) emergence of new opportunities and pathways. Findings revealed how caregivers adapted positively through caregiving experiences. Conclusions TBI caregivers appeared to experience PTG through caring. Future studies should employ mixed-methods to explore PTG in female TBI caregivers, adaptive coping strategies and the prevalence of occupational burden, facilitating the development of targeted interventions.

Background The Behavioural Assessment Screening Tool (BAST), which measures self-reported neurobehavioural symptoms experienced by adults with traumatic brain injury (TBI), was specifically developed as a self-reported measure for remote symptom reporting. Our aim was to assess the convergent, discriminant, and known-groups validity of the BAST among community-dwelling adults with TBI. Methods We assessed correlations and group differences with previously validated measures in two existing datasets (n =111, n =134). Other measures were the Patient Health Questionnaire-9 (depression), Generalized Anxiety Disorder-7 (anxiety), Positive and Negative Affect Schedule, Frontal Systems Behavior Scale (Executive Dysfunction, Apathy, Disinhibition), Modified Fatigue Impact Scale, Patient-Reported Outcomes Measurement Information System (Fatigue), Aggression Questionnaire (anger, hostility, physical and verbal aggression), and Alcohol Use Disorders Identification Test (alcohol misuse). Results BAST subscales had stronger correlations with measures of similar (|r |=0.602-0.828, P r |=0.364-0.589, P r |d =1.2-1.9) for known groups with moderate-severe depression, moderate-severe anxiety, fatigue, problematic disinhibited and frontal executive behaviours, and alcohol misuse. Results support the construct validity of the BAST subscales. Conclusion(s) The BAST demonstrated good convergent, discriminant, and known-groups validity, supporting its use for remote self-reported symptom reporting to improve chronic symptom monitoring in community-dwelling adults with TBI.

Background Cognitive-communication disorders are highly prevalent after traumatic brain injury and have significant impacts on rehabilitation outcomes. TBIBank Grand Rounds was developed as an online multimedia resource to support clinical education about cognitive-communication disorders. The objective of this study was to survey speech pathology educators to establish their views towards TBIBank Grand Rounds. Method An online survey with 37 items was distributed internationally to obtain a cross-section of international educators. The survey consisted of five sections covering (1) participant details; (2) awareness, interest, and use; (3) interface design and delivery; (4) content; and (5) overall impressions. The question formats included yes/no questions, multiple choice options, rating scales, and free text questions. Survey responses were analysed descriptively, with free text supporting interpretation. Results Twenty-five participants completed the online survey. Overall, most users agreed that the design and content of TBIBank Grand Rounds met their needs for supporting education about cognitive-communication disorders. The survey identified high interest but limited prior awareness of the resource. Survey respondents identified useful directions for updates, future enhancements, and dissemination of TBIBank Grand Rounds. Conclusions Incorporating feedback from educators has identified priorities for future enhancements, such as improving cultural diversity. High interest and positive feedback indicate that the TBIBank Grand Rounds is a valuable resource for education about cognitive-communication disorders. However, limited awareness internationally suggests the need for improved dissemination. Enhancing speech pathologists' knowledge about cognitive-communication disorders after TBI may lead to improved clinical care and outcomes.