NeuroRehabilitation - Volume 38, issue 3

Authors: Yeates, Giles

Article Type: Editorial

DOI: 10.3233/NRE-161313

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 221-222, 2016

Authors: Helps, Sarah

Article Type: Research Article

Abstract: BACKGROUND: Families play an important role in facilitating the development and well-being of children with autism spectrum conditions. OBJECTIVES: After setting the scene with a clinical example, and providing a brief discussion of the current thinking about the aetiology of Autism spectrum conditions, this paper provides a review of the literature regarding the practice of systemic psychotherapy with families in which a child has an autism spectrum condition (ASC). METHODS: A search of databases and journals revealed a large number of opinion papers regarding how family therapists might work with families of children with ASCs …and a smaller number of papers that describe or explore actual clinical practice. RESULTS: Pilot studies using qualitative methods and practice-based evidence in the form of descriptions of clinical work offer a solid footing on which to develop systemic practice to help families where a person has an ASC. CONCLUSION: Given the multifactorial nature of the aetiology of ASCs it is suggested that systemic interventions have the potential to influence changes at multiple levels of functioning for the child and the family. Show more

Keywords: Autism spectrum condition, family therapy, systemic psychotherapy

DOI: 10.3233/NRE-161314

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 223-230, 2016

Authors: Gan, Caron | Ballantyne, Marilyn

Article Type: Research Article

Abstract: BACKGROUND: Strengths-based approaches are increasingly utilized in health care, but little is known about their practical application in rehabilitation with families after pediatric acquired brain injury (ABI). OBJECTIVE: To describe a strengths-based model, Solution-Focused Brief Therapy (SFBT) and its clinical application to family intervention for adolescents with ABI. METHODS: A literature review highlights a growing movement towards resilience and strengths-based approaches to family intervention after pediatric ABI. The authors introduce the assumptions, tenets, and clinical application of SFBT, which is a competency-based and resource-based model that focuses on family strengths and successes. A direct comparison …is made between the traditional medical model and the solution-focused paradigm. RESULTS: Key elements of SFBT are described, including specific strategies, techniques, and its clinical application in the Brain Injury Family Intervention for Adolescents (BIFI-A). The BIFI-A, designed for adolescents with ABI and their families, is a 12-session manualized intervention that encompasses education about ABI, skill building, and emotional support. CONCLUSIONS: Given the increased interest for research regarding strengths-based approaches in pediatric rehabilitation, the utilization of SFBT with families of adolescents with ABI warrants further attention and investigation. The BIFI-A, with its underpinnings of SFBT, is a promising new family system intervention that also merits further research. Show more

Keywords: Family, brain injuries, adolescent, family therapy, strengths-based family interventions, solution-focused therapy, rehabilitation

DOI: 10.3233/NRE-1601315

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 231-241, 2016

Authors: Togher, Leanne | McDonald, Skye | Tate, Robyn | Rietdijk, Rachael | Power, Emma

Article Type: Research Article

Abstract: BACKGROUND: Training for communication partners of people with traumatic brain injury (TBI) is efficacious when using blinded independent ratings of casual conversations measured in the clinic. However, the question remains as to whether participants with TBI and their significant other perceive changes to everyday social communication as a result of training. OBJECTIVE: To determine whether treatment focused on improving the conversational skills of everyday communication partners of people with severe TBI using a program called TBI Express resulted in improvements in perceived communicative ability as measured by the La Trobe Communication Questionnaire (LCQ). METHODS: …Non randomized controlled trial comparing treatment of people with TBI together with communication partners (JOINT) with treatment of people with TBI without partner involvement (TBI SOLO) and a waitlist control group (CTRL) with follow-up at 6 months post-treatment. Forty-four outpatients from brain injury units in Sydney with severe chronic acquired brain injuries were recruited. A further 27 eligible outpatients refused to participate or could not be contacted. A total of 41 people completed treatment and 38 completed 6 month follow up assessment. The measure of perceived communication ability is the report of the participant with TBI and their partner on the LCQ. RESULTS: Communication partner training (JOINT) improved conversational performance relative to training the person with TBI alone and a waitlist control group on the LCQ. The TBI SOLO group improved in terms of report on the LCQ relative to the CONTROL group. Results were maintained at six months post-training. CONCLUSION: Training communication partners of people with chronic severe TBI using TBI Express led to perceived improvements in everyday communication ability by both the person with TBI and their family member. Show more

Keywords: Communication, communication partner, traumatic brain injury, clinical, rehabilitation

DOI: 10.3233/NRE-151316

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 243-255, 2016

Authors: Tams, Rachel | Prangnell, Simon J. | Daisley, Audrey

Article Type: Review Article

Abstract: BACKGROUND: Management of the uncertainty inherent in a diagnosis of a progressive neurological illness is one of the major adjustment tasks facing those affected and their families. A causal relationship has been demonstrated between perceived illness uncertainty and negative psychological outcomes for individuals with progressive neurological illness. Whilst there is a small and promising intervention literature on the use of a range of individually focused strengths based psychological interventions there appears to be little guidance available how clinicians might help those family members of those affected. OBJECTIVE: To undertake a systematic review of the evidence on the …use of strengths based, family focused interventions that target illness uncertainty. METHODS: A systematic literature search was undertaken using the National Library for Health abstract database. RESULTS: Five papers were included in the review, only two of which were published in peer reviewed journals. All five reported on strengths based approaches that could be used with families but only two explicitly identified illness uncertainty as a target. Outcome measures were heterogeneous so data could not be aggregated for meta-analysis. The results suggested that these interventions showed promised but the review highlighted a number of methodological issues which mean that the results must be interpreted with caution. CONCLUSIONS: There is very little evidence of the use of strengths based approaches to helping families manage the uncertainty associated with progressive neurological illness despite it having been identified as a key target for intervention. The review highlights the need for the development of an intervention framework to address this key clinical issue and suggests one model that might show promise. Show more

Keywords: Progressive neurological illness, Multiple Sclerosis, Motor Neurone Disease, Parkinson’s disease, Huntington’s disease, family, children, resilience, psychological therapy, strengths based approaches, illness uncertainty

DOI: 10.3233/NRE-161317

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 257-270, 2016

Authors: Kreutzer, Jeffrey S. | Sima, Adam P. | Marwitz, Jennifer H. | Lukow II, Herman R.

Article Type: Research Article

Abstract: BACKGROUND: Spousal caregivers have an important role in recovery after brain injury, and there is evidence that injury has an adverse impact on uninjured partners as well as survivors. Unfortunately, the impact of brain injury on coupled relationships has received limited attention from clinical researchers. OBJECTIVE: To characterize marital stability after traumatic brain injury considering the perspectives of the patient and the uninjured partner. To identify predictors of marital stability. METHODS: Forty-two couples with mild to severe injury completed the Marital Status Inventory, a measure of relationship stability, and the Revised Dyadic Adjustment Scale (RDAS), …a measure of relationship quality. RESULTS: Twenty-four percent (24%) of patients viewed their marriage as unstable as did 29% of partners. Most individuals (72%) agreed with their partner regarding the stability of their relationship. About half of patients (52%) and partners (50%) reported clinically significant levels of marital dissatisfaction. Multivariate logistic regression indicated that the RDAS was a salient predictor of marital stability. Findings indicate relatively high levels of marital stability despite high levels of marital distress. CONCLUSIONS: Marital stability can be classified beyond labeling couples as married, separated, or divorced. Researchers have suggested that postinjury marital relationships are prone to instability and divorce in comparison to the general population. The present findings suggest otherwise. Show more

Keywords: Traumatic brain injury, marital stability, marital quality

DOI: 10.3233/NRE-161318

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 271-279, 2016

Authors: Simpson, Grahame K. | McCann, Brett | Lowy, Michael

Article Type: Research Article

Abstract: BACKGROUND: Sexual dysfunction is common after traumatic brain injury (TBI) but evaluation of treatment interventions have been sparse. OBJECTIVE: To report on the treatment of sexual dysfunction for two males with severe TBI. METHODS AND RESULTS: Case one was treated for erectile dysfunction (ED). After a medical examination which found no underlying physiological problems, Sildenafil was prescribed. Scores on the Golombok Rust Inventory of Sexual Satisfaction Impotence subscale found that scores had improved from the dysfunction range at baseline to the functional range at 6 weeks follow-up. There was some reduction in this improvement at …3 months follow-up, maybe associated with a co-morbid deterioration of emotional state. Case two was treated for idiopathic delayed ejaculation (DE). A standard sex therapy intervention was employed that resulted in the resolution of the problem, documented on the Sex Behavior sub-scale of the Derogatis Inventory for Sexual Functioning-Self Report (comparing baseline to post intervention and follow-up scores). CONCLUSIONS: The case reports show promise for the treatment of sexual dysfunction after severe TBI using standard medical and sex therapy treatments. In the future, controlled evaluations are required to demonstrate the efficacy of such interventions. Show more

Keywords: Erectile disorder, delayed ejaculation, traumatic brain injury, sildenafil, viagra, sex therapy

DOI: 10.3233/NRE-161319

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 281-289, 2016

Authors: Palmer, Siobhan | Herbert, Camilla

Article Type: Research Article

Abstract: BACKGROUND: Social re-integration after acquired brain injury is an important part of successful rehabilitation outcome, both in terms of return to work and emotional wellbeing. Residential rehabilitation often places individuals at a distance from their pre injury social context. Supporting the maintenance or development of intimate relationships is therefore a crucial aspect of neurobehavioural rehabilitation. However, the development of new relationships is not without risk. OBJECTIVE: To provide a framework for considering interventions around personal and intimate relationships post brain injury, taking into account the complexities of risk assessment and risk management. METHOD: The authors …have used clinical case examples to develop a framework to support risk assessment and intervention planning. The framework has been used in a residential rehabilitation service to support the development and maintenance of intimate relationships post injury. No formal data collection was used. RESULTS: Case examples are used to illustrate how the framework can assist clinical practice. CONCLUSIONS: The authors provide a framework to assist clinicians working with complex clinical cases to think through options for intervention to maintain or develop friendships and intimacy whilst taking account of factors affecting risk management. Show more

Keywords: Intimacy, friendship, capacity, risk, brain injury

DOI: 10.3233/NRE-161320

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 291-298, 2016

Authors: Yeates, Giles | Rowberry, Michelle | Dunne, Stephen | Goshawk, Michelle | Mahadevan, Mythreyi | Tyerman, Ruth | Salter, Mandy | Hillier, Martin | Berry, Alister | Tyerman, Andy

Article Type: Research Article

Abstract: BACKGROUND: Social cognition and executive functioning difficulties following acquired brain injury have been linked to negative employment outcomes, such as demotion and loss of vocational roles. These are very counter-intuitive and challenging difficulties for other employees and work supervisors who have little or no brain injury knowledge, whose perceptions of play a key role in their responses to these difficulties and the final outcome of such problems for vocational status. OBJECTIVES: This study aimed to study the relationship between social cognition and executive functioning difficulties and the perceptions of work supervisors’ appraisal of survivor interpersonal behaviour and …social skills in the workplace. METHOD: The performance of 73 survivors of acquired brain injury (47% TBI, 38% CVA, 15% other ABI type; 73% male; mean age 45.44 years, range 19-64 years; mean time since injury 6.36 years, range 10.5-31.33 years), currently in a vocational rehabilitation placement) on neuropsychological tests of executive functioning and social cognition was measured. Informant ratings on the Social Skills Factor subscale from the Work Personality Profile (WPP, Bolton & Roessler, 1986) were used as the primary outcome measure, a vocational functioning questionnaire assessing social and presentational aspects of workplace behaviour. The raters were non-clinical workplace informants acting in a supervisory role (supervisory placement providers and job coaches). RESULTS: Correlational analysis identified significant associations between the WPP and survivor goal-orientated planning and implementation, mentalising ability, recognition of positive and negative emotions, and recognition of simple sarcasm (all significant at p  <  0.05). These correlates were entered into a stepwise multiple regression. The combination final of survivor mentalising ability and executive functioning explained 32 % of the variance in the WPP ratings (F (2, 52) =  12.15, p  <  0.001). CONCLUSION: Certain limitations of the study withstanding, the current findings add to previous literature in highlighting the relevance of survivor executive functioning and social cognition difficulties for the perceptions and appraisal of work colleagues, consistent with other studies that have identified negative vocational outcomes associated with such neuropsychological difficulties. The implications for vocational rehabilitation are discussed. Show more

Keywords: Brain injury, stroke, social cognition, mentalising, executive functioning, vocational, work, interpersonal, social skills

DOI: 10.3233/NRE-161321

Citation: NeuroRehabilitation, vol. 38, no. 3, pp. 299-310, 2016