Accommodation Outcomes and Transitions Following Community-Based Intervention for Individuals with Acquired Brain Injury

2012 ◽  
Vol 13 (1) ◽  
pp. 24-43 ◽  
Author(s):  
Sue Sloan ◽  
Libby Callaway ◽  
Dianne Winkler ◽  
Kirsten McKinley ◽  
Carlo Ziino
Keyword(s):  
Brain Injury ◽  
Injury Severity ◽  
Community Integration ◽  
Acquired Brain Injury ◽  
Post Injury ◽  
Living Situation ◽  
Time Points ◽  
Severe Acquired Brain Injury ◽  
Occupational Therapy Intervention ◽  
Support Model

Objectives: To explore living situation, support and participation outcomes of people with severe acquired brain injury (ABI) residing in either home-like or disability-specific accommodation settings, who were provided with 3 years of occupational therapy intervention based on the Community Approach to Participation (CAP).To examine transitions for a subgroup whose accommodation and support model changed during this 3-year period and identify factors critical to this change.Method: Forty-three participants who had sustained severe to extremely severe ABI, and were an average of 6.73 years post-injury, were provided with CAP intervention over a 3-year period. Living situation and support model, participation levels and accommodation transition data were collected at four time points.Results: Participants were living in a range of home-like and disability-specific accommodation settings at baseline. The disability-specific accommodation group had mainly noncompensable injuries and required a significantly higher level of daily support at all four time points. They also received higher total hours of support, which averaged 170.83 hours per week at baseline and did not change significantly over the 3 years. In contrast, 86% of the participants residing in home-like settings had compensable injuries and received an average of 91.46 hours of support per week at baseline. This reduced to 70.97 hours per week over the 3-year intervention period, a change that was statistically significant.Conclusion: It is possible to achieve accommodation transitions to more independent, home-like situations many years post-injury and regardless of injury severity. Home-like settings provide scope to adjust support along a continuum to reflect gains in independence, community integration and role participation that the fixed models and hours of support in disability-specific accommodation do not. Over time, these gains can flow into a significant reduction in hours of support.

The Community Approach to Participation: Outcomes Following Acquired Brain Injury Intervention

2009 ◽  
Vol 10 (3) ◽  
pp. 282-294 ◽  
Author(s):  
Sue Sloan ◽  
Libby Callaway ◽  
Dianne Winkler ◽  
Kirsten McKinley ◽  
Carlo Ziino ◽  
...  
Keyword(s):  
Brain Injury ◽  
Community Integration ◽  
Case Series ◽  
Acquired Brain Injury ◽  
Functional Independence ◽  
Post Injury ◽  
Community Approach ◽  
Case Series Study ◽  
Severe Acquired Brain Injury ◽  
Community Environments

AbstractObjective: To investigate the participation outcomes of individuals with severe acquired brain injury (ABI) who were provided with up to 12 months of intervention based on the Community Approach to Participation (CAP). Method: A case series study design was undertaken with a total of 85 participants from two private practices specialising in community-based, CAP rehabilitation for people with severe ABI. Inclusion criteria were the person had sustained an acquired brain injury, was aged over 18 years and had received up to 12 consecutive months of CAP input from one of the two practices within a three-year period between January 2004 and January 2007. Twenty-six of the 85 participants were an average of 343 days post injury (Early group) and 59 of the participants were an average of 10.2 years post injury (Late group). They were living in a range of community environments and residential facilities. Initial participants were identified for the study in January 2005. Data were gathered using the Functional Independence Measure (FIM™), Community Integration Questionnaire (CIQ), and Role Checklist (RC Part 1) at two time points: prior to intervention (baseline), and after a 12-month period or at discharge (TI). Within the intervention period, all participants received a customised community occupational therapy (OT) rehabilitation program based on the key principles of the CAP. Intervention focused on participation goals of the individual, and development of the associated skills that underpinned valued role performance. Results: Participants each received an average of 51.01 hours of CAP OT during the 12-month period of intervention. Considerable improvement was seen in functional independence, community integration, and role participation after intervention in both the Early and Late groups. A statistically significant increase in FIM™ and CIQ total scores was found for all participants from Baseline to T1. The number of roles in which participants engaged increased on average by almost one role per participant following intervention, from a mean of 3.06 to 3.99. Increased participation in volunteer, home maintainer, participant in organisations and hobbyist roles were most common. Conclusion: Increased functional independence, community integration, and participation in both the Early and Late groups over a 12 month period demonstrates the potential for improved participation outcomes for people with complex needs following ABI, even many years post injury.

scholarly journals A-125 An Analysis of the Traumatic Brain Injury Outcomes and Needs of People in Urban, Rural and Remote Areas

2020 ◽  
Vol 35 (6) ◽  
pp. 918-918
Author(s):  
Sullivan K ◽  
Hennessy M
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rural Communities ◽  
Injury Severity ◽  
Community Integration ◽  
Rural And Remote ◽  
Post Injury ◽  
Patient Reported ◽  
Rural And Remote Areas ◽  
Urban Rural

Abstract Objective Little is known about the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities. These communities typically differ in terms of the availability of formal and informal supports. We compared patient-reported TBI outcomes for three communities (urban, rural, and remote) and modelled their predictors. Method Six hundred and sixty-two cases with mild-to-severe TBI were identified from hospital records. These individuals received a mail-out survey comprised of standardized outcome measures. The measures assessed: symptoms, quality-of-life, service obstacles, unmet needs, mental health, and community integration. Ninety-one people who were less than two years post-injury returned a usable survey (18% response rate). The location of communities was coded using the Accessibility Remoteness Index of Australia (urban n = 22, rural n = 43, remote n = 26). Results There were no differences in the outcomes due to location (p’s > .05). The significant individual predictors of five of the six outcomes were the participant’s sex, age, and the injury severity; but location did not play a role. TBI outcomes were typically worse if the injury was severe, or if the injured person was older or female. For one outcome (community integration) males fared worse than females. Conclusion Contrary to expectations, location did not affect patient-reported TBI outcomes. This could indicate that the same supports are available to patients, despite their location or; that the different supports were relied on to achieve the same outcomes. The overall findings urge continued investment in TBI rehabilitation, particularly for the subgroups that experienced the worst outcomes.

scholarly journals Social Behavior and Impairments in Social Cognition Following Traumatic Brain Injury

2017 ◽  
Vol 23 (5) ◽  
pp. 400-411 ◽  
Author(s):  
Michelle May ◽  
Maarten Milders ◽  
Bruce Downey ◽  
Maggie Whyte ◽  
Vanessa Higgins ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Social Behavior ◽  
Emotion Recognition ◽  
Social Functioning ◽  
Injury Severity ◽  
Comparison Group ◽  
Response Selection ◽  
Community Integration ◽  
Post Injury

AbstractObjectives:The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning.Methods:Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- and proxy reports of pre- and post-injury behavior, mood, and community integration were collected.Results:The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education.Conclusions:The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning. (JINS, 2017,23, 400–411)

Post-injury personality in the prediction of outcome following severe acquired brain injury

Brain Injury ◽  
2011 ◽  
Vol 25 (11) ◽  
pp. 1035-1046 ◽  
Author(s):  
Charlotte Jane Cattran ◽  
Michael Oddy ◽  
Rodger Llewellyn Wood ◽  
Jane Frances Moir
Keyword(s):  
Brain Injury ◽  
Acquired Brain Injury ◽  
Prediction Of Outcome ◽  
Post Injury ◽  
Severe Acquired Brain Injury

Changes in Care and Support Needs Following Community-Based Intervention for Individuals With Acquired Brain Injury

2009 ◽  
Vol 10 (3) ◽  
pp. 295-306 ◽  
Author(s):  
Sue Sloan ◽  
Libby Callaway ◽  
Dianne Winkler ◽  
Kirsten McKinley ◽  
Carlo Ziino ◽  
...  
Keyword(s):  
Brain Injury ◽  
Community Integration ◽  
Acquired Brain Injury ◽  
Functional Independence ◽  
Support Needs ◽  
Intervention Period ◽  
Post Injury ◽  
Community Based ◽  
Care And Support ◽  
Life Roles

AbstractObjective:To examine the care and support and participation outcomes for individuals with severe Acquired Brain Injury (ABI) provided with three consecutive years of Community Approach to Participation (CAP) intervention.Method:A case series study design was undertaken with a total of 43 participants from two private occupational therapy practices specialising in community-based, CAP rehabilitation for people with severe ABI. Data were collected at four time points: January 2004 (Baseline), January 2005 (T1), January 2006 (T2), and January 2007 (T3) and included rating on the Care and Needs Scale (CANS); number of hours of paid and gratuitous weekly support; FIM™ and Community Integration Questionnaire scores; and number of current life roles (as recorded on Part 1 of the Role Checklist). Participants were an average of 6.73 years post injury and were living in a range of community environments and residential facilities.Results:There was considerable change in participants' CANS rating across the intervention period, with statistically significant decreases occurring from Baseline to T1 and T1 to T2. Ninety-five per cent of participants received some level of weekly paid support throughout the intervention period, with the amount varying considerably. Paid care decreased by an average of 10.78 hours per week from 85.85 hours per week at Baseline to 75.06 at T3. Although not statistically significant, this equated to an average cost saving of AU$324.84 per participant per week by the end of CAP intervention. There was an overall mean reduction of 4.96 hours of gratuitous care per week per participant over the intervention period, which was statistically significant. Increases in functional independence, community integration, and role participation were also found. On the FIM™, statistically significant improvement occurred between Baseline and T1 and on the CIQ between Baseline and T1 and T1 and T2. Significant increase on the Role Checklist occurred between Baseline and T1 and between T2 and T3. The number of life roles in which participants engaged increased by an average of 1.65 roles by the end of the intervention period. A reduction in care and support needs (measured by the CANS) was significantly associated with: (1) a reduction in total care hours, (2) and an increase in functional independence on the FIM™, and (3) an increase in community integration on the CIQ.Conclusion:With a long term approach and contextualised intervention targeted at skill development in the areas that underpin personally valued participation, increased role performance and community integration can be achieved by people with severe ABI, even many years post injury. This increased capacity has been found to be associated with a reduction in care and support needs, including paid and gratuitous care hours, over time.

Clinical course of SARS-CoV-2 infection in patients with severe acquired brain injury and a disorder of consciousness: an observational study

Brain Injury ◽  
2021 ◽  
Vol 35 (5) ◽  
pp. 520-529
Author(s):  
Antonio Caronni ◽  
Emanuele Liaci ◽  
Anna Bianchi ◽  
Alessandro Viganò ◽  
Francesco Marenco ◽  
...  
Keyword(s):  
Brain Injury ◽  
Observational Study ◽  
Clinical Course ◽  
Acquired Brain Injury ◽  
Disorder Of Consciousness ◽  
Severe Acquired Brain Injury

Consumer perspectives of vocational rehabilitation and return to work following acquired brain injury

2021 ◽  
pp. 1-21
Author(s):  
Kerrin Watter ◽  
Areti Kennedy ◽  
Vanette McLennan ◽  
Jessica Vogler ◽  
Sarah Jeffery ◽  
...  
Keyword(s):  
Brain Injury ◽  
Return To Work ◽  
Vocational Rehabilitation ◽  
Acquired Brain Injury ◽  
System Level ◽  
Structured Interviews ◽  
Post Injury ◽  
Vocational Rehabilitation Services ◽  
Workplace Supports ◽  
Vocational Goals

Abstract Introduction: Following acquired brain injury, the goal of return to work is common. While return to work is supported through different rehabilitation models and services, access to vocational rehabilitation varies within and between countries, and global rates of employment post-injury remain low. The literature identifies outcomes from vocational programs and experiences with return to work, yet little is known about individuals’ perceptions and experiences regarding rehabilitation to support their vocational goals and experiences in attempting to return to work. Method: This qualitative study investigated the experiences of community-living adults with acquired brain injury (n = 8; mean age 45 years; mean time post-injury of 5.5 years) regarding their vocational rehabilitation and return to work. Focus groups and semi-structured interviews were conducted, with data analyzed via thematic analysis. Results: Participants identified negative and positive experiences with vocational rehabilitation and return to work. Five overarching themes were identified: addressing vocational rehabilitation in rehabilitation; facilitators of recovery and return to work; the importance and experience of working again; acquired brain injury and identity; and services, systems and policies. Participants also identified five key areas for early vocational rehabilitation services: education; service provision; employer liaison; workplace supports; and peer mentors. Study findings inform current and future practice and service delivery, at a clinical, service and system level.

scholarly journals Chronic complement dysregulation drives neuroinflammation after traumatic brain injury: a transcriptomic study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Amer Toutonji ◽  
Mamatha Mandava ◽  
Silvia Guglietta ◽  
Stephen Tomlinson
Keyword(s):  
Gene Expression ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Complement System ◽  
Classical Pathway ◽  
Post Injury ◽  
Complement Inhibition ◽  
Time Points ◽  
Complement Gene ◽  
The Complement System

AbstractActivation of the complement system propagates neuroinflammation and brain damage early and chronically after traumatic brain injury (TBI). The complement system is complex and comprises more than 50 components, many of which remain to be characterized in the normal and injured brain. Moreover, complement therapeutic studies have focused on a limited number of histopathological outcomes, which while informative, do not assess the effect of complement inhibition on neuroprotection and inflammation in a comprehensive manner. Using high throughput gene expression technology (NanoString), we simultaneously analyzed complement gene expression profiles with other neuroinflammatory pathway genes at different time points after TBI. We additionally assessed the effects of complement inhibition on neuropathological processes. Analyses of neuroinflammatory genes were performed at days 3, 7, and 28 post injury in male C57BL/6 mice following a controlled cortical impact injury. We also characterized the expression of 59 complement genes at similar time points, and also at 1- and 2-years post injury. Overall, TBI upregulated the expression of markers of astrogliosis, immune cell activation, and cellular stress, and downregulated the expression of neuronal and synaptic markers from day 3 through 28 post injury. Moreover, TBI upregulated gene expression across most complement activation and effector pathways, with an early emphasis on classical pathway genes and with continued upregulation of C2, C3 and C4 expression 2 years post injury. Treatment using the targeted complement inhibitor, CR2-Crry, significantly ameliorated TBI-induced transcriptomic changes at all time points. Nevertheless, some immune and synaptic genes remained dysregulated with CR2-Crry treatment, suggesting adjuvant anti-inflammatory and neurotropic therapy may confer additional neuroprotection. In addition to characterizing complement gene expression in the normal and aging brain, our results demonstrate broad and chronic dysregulation of the complement system after TBI, and strengthen the view that the complement system is an attractive target for TBI therapy.

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