[Life satisfaction and psychosocial outcome in severe traumatic brain injuries in Aquitaine]

Exploring the efficacy of housing alternatives for adults with an acquired brain or spinal injury: A systematic review

Objective:

Housing for people with acquired brain injury (ABI) or spinal cord injury (SCI) remains a significant issue in Australia and internationally. This review examined the current research evidence regarding the efficacy of housing alternatives for adults with ABI or SCI in relation to four principal outcomes of interest: the person’s (1) community integration/participation, (2) independence, (3) psychosocial well-being and (4) quality of life. The review also sought to identify how the reported efficacy of the housing alternatives might be impacted by individual factors.

Method:

For this systematic review, quantitative empirical, peer-reviewed research published after 1 January 2003 was sought. Ten journal articles met the eligibility criteria. None of the included studies comprised an adult SCI sample.

Results:

The research identified lower levels of community integration/participation, independence, psychosocial well-being and quality of life for adults (particularly younger adults) with ABI living in ‘structured settings’ (i.e., residential care) compared to those living in ‘home-like’ environments (i.e., private homes) and ‘disability-specific’ settings (i.e., shared supported accommodation, group homes, foster care homes, cluster units).

Conclusion:

More research is needed to compare ‘home-like’ and ‘disability-specific’ settings, and individual housing models more generally (i.e., living at home with friends vs with family vs living in shared supported accommodation vs living in residential care). This review identified a number of limitations in the current evidence base and several important directions for future research. Policymakers, architects, designers, builders, developers, funding agencies, international researchers as well as people with ABI or SCI and their families may benefit from the findings of this review.

A qualitative study of LoveYourBrain Yoga: a group-based yoga with psychoeducation intervention to facilitate community integration for people with traumatic brain injury and their caregivers

Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers.Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis.Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community.Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation.Implications for rehabilitationTraumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitationYoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community levelParticipants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefitsGroup-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors.

Effectiveness of a multidisciplinary rehabilitation program for persons with acquired brain injury and executive dysfunction

PURPOSE

The purpose of this study is to explore the effects of a multidisciplinary acquired brain injury rehabilitation out-patient program (5 d/week for 7 weeks) on improvements to participants' activity and participation outcomes related to meal preparation and to determine whether gains are maintained at 3 and 6 months post program.

METHODS

A single case experimental design with repeated measures pre- and post-intervention with 7 adult participants with ABI and executive dysfunction (4 females, mean age 38 ± 10.1 years) was used.

RESULTS

A strong improvement effect between pre and post phases was found for number of errors on the Cooking Task for 6/7 participants; four participants showed significant improvement immediately after the program and at 3 and 6 months post. Six out of seven participants improved significantly on the Instrumental Activities of Daily Living Profile and four participants improved between the post and 6 month follow-up. Four out of seven participants showed significantly improved Life Habits scores pre- versus post-program.

CONCLUSIONS

Significant improvements were observed in activity and participation outcomes related to preparing a meal in adults with ABI and executive dysfunction who participated in a 7-week multidisciplinary rehabilitation out-patient program. Treatment gains were maintained for the majority of participants at 3 and 6 months following the program. Implication of Rehabilitation A 7-week multidisciplinary rehabilitation out-patient program appears to improve activities and participation; the effects are sustainable after 6 months. A detailed description of the therapeutic interventions provided during the cooking activity should help clinicians better understand what specific functions are solicited or required during a particular activity. Knowledge from this study may help guide clinicians in their work within this complex area of rehabilitation.

Participation restrictions in patients with psychiatric and/or cognitive disabilities: preliminary results for an ICF-derived assessment tool

Participation in community life is a major challenge for most people with psychiatric and/or cognitive disabilities. Current assessments of participation lack a theoretical basis. However, the new International Classification of Functioning, Disability and Health (ICF) provides a relevant framework.

AIMS

The present study used an ICF-derived assessment tool to activity limitations and participation restrictions in two groups of participants with disabilities linked to schizophrenia or traumatic brain injury respectively.

METHODS

Twenty-six items (related to six ICF sections) were selected by reviewing the literature and gathering the clinician's opinions and representatives of patient associations. These items, yielded an ordinal rating of activity limitations, participation restrictions and contextual factors (social support, attitudes and, systems & politics). Special attention was paid to contextual and environmental factors. The final checklist (called the Grid for Measurements of Activity and Participation, G-MAP) was administered to 16 participants with traumatic brain injury (the TBI group) and 15 participants with schizophrenic disorders (the SD group). Psychometric assessments of cognition and, neurobehavioural, psychological and psychosocial functioning were also performed.

RESULTS

The internal consistencies for activity limitations (Cronbach's alpha coefficient=0.89) and participation restriction (Cronbach's alpha coefficient=0.89) were satisfactory. We did not observe any significant differences between the two groups in terms of the psychometric test results. The G-MAP scores demonstrated that the two groups were confronted with the same limitations in self care, domestic life, leisure and community life (i.e., the intergroup differences were not statistically significant in Mann-Whitney tests). However, interpersonal relationships and economic and social productivity appeared to be more severely limited in the SD group than in the TBI group. Similarly, participation restrictions in domestic life, interpersonal relationships and economic and social productivity were more severe in the SD group than in the TBI group.

CONCLUSION

G-MAP is a useful, feasible, relevant tool for performing a detailed, individualized assessment of participation restrictions in people with psychiatric and/or cognitive disabilities.

Life habits performance of individuals with brain injury in different living environments

BACKGROUND

Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments.

OBJECTIVE

To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements.

METHODS

One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined.

RESULTS

The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not.

CONCLUSION

Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.

Post-acute assessment programme for patients with traumatic brain injury: measuring the gap between patients' expectations on entering and end of programme recommendations

OBJECTIVE

To compare the expectations of patients with brain injury (TBI) entering a post-acute programme to the recommendations made at the end.

DESIGN

Retrospective study (1997 and 2009).

INTERVENTION

This 12-week post-acute programme included ecological multidisciplinary assessment of physical and cognitive disabilities, independence in activities of daily living and work abilities. Recommendations made at the conclusion of the programme included advice regarding the ability to work in an unsheltered or a sheltered environment and possible social activities.

RESULTS

Two hundred and forty patients participated. The main objective of 95.8% was return-to-work: 93.7% expected a normal work environment, 2.1% considered a sheltered environment and 4% entered the programme with the aim of improving social abilities and integration in the community. The recommendations included return-to-work in 68.3% of cases, in an unsheltered environment in 44.2% and in a sheltered environment in 24.1% and advice for contact with social services in order to achieve better social integration in 31.7%. There was a discrepancy between expectations and recommendations in half of the cases.

CONCLUSION

The discrepancy between patients' expectations and recommendations is in part due to the cognitive disorders; long-term rehabilitation programmes should focus on this issue.

Functional outcome after road-crash injury: description of the ESPARR victims cohort and 6-month follow-up results

OBJECTIVE

It is essential to know about the long-term consequences of road crashes involving corporal injury in order to adopt relevant public health measures.

METHODS

The ESPARR cohort comprises 1168 road-crash victims, aged 16 or over, managed in hospitals in the Rhône administrative départment (France). It is based on the Registry of Road Traffic Casualties, which has been collecting exhaustive data since 1995. Two groups are monitored: mild to moderate (M-AIS 1 or 2) and severe (M-AIS > or =3). Patients were interviewed at the point of primary care, between 1 October 2004 and 31 July 2006. 6 months later, their state of health and presence of pain were compared. Multivariate analysis (logistic regression) was performed to identify factors related to residual pain.

RESULTS

Adults of the cohort were compared to the road crash population as a whole recorded over the same period in the same area. At 6 months post-accident, only 31.9% of victims deemed their health status to have entirely returned to normal; 63.8% of mild to moderate and 89.2% of severe cases reported residual pain, but neither pain frequency nor intensity correlated with M-AIS. Residual pain was related to lower limb injuries (OR=1.6; 95% CI=1.1-2.4). After adjustment, pain was essentially related to age, seriousness of the lesions and a stay in a rehabilitation unit.

CONCLUSION

The ESPARR cohort provides a unique opportunity in France to describe the trajectory of a road crash victim, in terms both of care and rehabilitation and of resumption of work and personal activity.

Factors affecting leisure participation after a traumatic brain injury: an exploratory study

OBJECTIVE

To explore leisure participation by people with traumatic brain injury (TBI) and reasons underlying changes after the trauma.

PARTICIPANTS

Twenty-six individuals with mild to severe TBI.

MAIN MEASURE

Leisure Profile, a semi-structured questionnaire measuring involvement in leisure activities before and after TBI (frequency of activities, degree of interest, and desire to modify one's leisure activities), attitudes toward leisure, and difficulties that might influence leisure activities (impairments and environmental obstacles).

RESULTS

Leisure participation was greatly disrupted after TBI, with 92% of the participants reporting a reduction posttrauma. Less severe injuries, more time since the injury, and the presence of social obstacles in the environment were positively correlated with leisure participation. Motor impairments had a negative impact on leisure participation.

CONCLUSION

TBI has a significant negative effect on leisure participation. Leisure activities should be evaluated and included in a therapy program designed to promote reintegration into society and work.

The potential unlimited programme: an outdoor experiential education and group work approach that facilitates adjustment to brain injury

Two pilot Potential Unlimited Programmes (PUPs) were examined to determine participant outcomes related to adjustment to acquired brain injury (ABI) and to investigate the contribution of the group work component of the programme. A mixed qualitative and quantitative longitudinal design was employed with 14 participants and a demographically matched comparison group of eight respondents. Results showed significant and sustained improvement in participants' subjective quality of life. Analysis of interview data provided insights into how the programmes provided opportunities for participants to engage in key tasks of adjustment to injury. Participants who regularly attended the follow-up group stages of the programmes made significantly greater gains than non-attendees. In conclusion, the combination of outdoor experiential education with extensive group work found in the PUPs is likely to represent a unique and powerful approach for addressing many of the issues associated with the process of psychosocial adjustment to injury and restoring quality of life, following ABI.

Ecological assessment of the dysexecutive syndrome using execution of a cooking task

Patients with a dysexecutive syndrome often have severe disabilities in daily life activities. The aims of this study were to use a naturalistic experimental task to assess patients' disabilities, and to study the nature of the cognitive disorders underlying them. Execution of a cooking task involving multi-tasking (Chevignard et al., 2000) was studied in 45 patients with a dysexecutive syndrome following acquired brain injury. Patients made significantly more errors and were slower than controls; more than half of the patients did not achieve the goal and demonstrated dangerous behaviours. Those results were significantly correlated to the results of the Six Elements Task and to a behavioural questionnaire. They were also correlated to brain injury severity and to patients' cooking habits. This naturalistic assessment is clinically relevant to better assess patients' dysexecutive impairments in complex activities of daily living. Correlations of the results in the cooking task with the neuropsychological assessment highlighted the role of the dysexecutive syndrome in patients' disabilities, indicating control alterations rather than planning disorders, difficulty in dealing with the environment, and inhibiting inappropriate actions. The role of attention and prospective memory was also underlined, whereas other cognitive functions did not influence task performance.

Neuropsychological rehabilitation

Neuropsychological rehabilitation (NR) is concerned with the amelioration of cognitive, emotional, psychosocial, and behavioral deficits caused by an insult to the brain. Major changes in NR have occurred over the past decade or so. NR is now mostly centered on a goal-planning approach in a partnership of survivors of brain injury, their families, and professional staff who negotiate and select goals to be achieved. There is widespread recognition that cognition, emotion, and psychosocial functioning are interlinked, and all should be targeted in rehabilitation. This is the basis of the holistic approach. Technology is increasingly used to compensate for cognitive deficits, and some technological aids are discussed. Evidence for effective treatment of cognitive, emotional, and psychosocial difficulties is presented, models that have been most influential in NR are described, and the review concludes with guidelines for good practice.

[Ecological assessment of executive functions in a patient with acquired brain injury]

Dysexecutive syndrome is one of the most frequent sequel of severe traumatic brain injury. It causes severe disabilities and it is incompletely assessed by the classical "paper and pencil" neuropsychological tests. We developed an ecological assessment conducted in a naturalistic situation, consisting of a cooking task, and we described a classification of errors. This assessment is very sensitive, even to a mild dysexecutive syndrome.

OBJECTIVE

To describe the disabilities in activities of daily living of a traumatic brain-injured patient and to demonstrate the sensitivity of an ill-structured ecological assessment.

METHOD

We report a single case study illustrating how the ecological assessment by the cooking task helped better understand and characterize the patient's disabilities.

RESULTS

The patient presented severe disabilities in daily life activities, which were well described by his family. His cognitive disorders were mild in the cognitive tests, even those supposed to be more ecological, such as the Six Elements Task or script generation. He exhibited very severe disorders in the cooking task, with a very high number of errors. Moreover, duration of the cooking task was very long; he did not achieve the goal and exhibited dangerous behaviour.

DISCUSSION AND CONCLUSION

The cooking task involves abilities to deal with multitasking, which particularly involve executive functions. The most severe disorders were observed during the patient's interaction with the environment while conducting a complex goal-directed action plan, indicating control disorders. This type of naturalistic assessment provides very useful information to help patients organise their familial, social or professional reintegration.

Le Profil du Loisir, un instrument prometteur en ergothérapie

Description : Les bienfaits du loisir sont bien connus, mais peu d'instruments ont été conçus dans l'optique de mesurer l'engagement d'une personne dans ses loisirs et d'évaluer les facteurs personnels ou environnementaux qui diminuent sa capacité de s'y engager. But : Cet article à pour but de présenter les étapes du développement du Profil du Loisir entre 1990 et 2002. Méthodologie : La planification, la construction et la validation de l'outil ont été faites selon les étapes de Benson et Clark (1982). Les premières versions ont été expérimentées par des ergothérapeutes auprès de personnes ayant eu un traumatisme cranio-cérébral. Résultats : La validation a permis l'élaboration de la version finale (3.0). L'outil présente une fidélité inter-juges allant de acceptable (kappa 0,21–0,4) à très bien (0,61–0,80) et test-retest de acceptable à modérée (0,41–0,60). Conséquences pour la pratique : Le Profil du Loisir s'avère prometteur pour amener les ergothérapeutes à considérer le loisir dans leur pratique et à l'évaluer de façon systématique.

[Non-verbal communication and executive function impairment after traumatic brain injury: a case report]

Following post-traumatic impairment in executive function, failure to adjust to communication situations often creates major obstacles to social and professional reintegration. The analysis of pathological verbal communication has been based on clinical scales since the 1980s, but that of nonverbal elements has been neglected, although their importance should be acknowledged.

OBJECTIVE

The aim of this research was to study non-verbal aspects of communication in a case of executive-function impairment after traumatic brain injury.

METHODS

During the patient's conversation with an interlocutor, all nonverbal parameters - coverbal gestures, gaze, posture, proxemics and facial expressions - were studied in as much an ecological way as possible, to closely approximate natural conversation conditions. Such an approach highlights the difficulties such patients experience in communicating, difficulties of a pragmatic kind, that have so far been overlooked by traditional investigations, which mainly take into account the formal linguistic aspects of language.

RESULTS

The analysis of the patient's conversation revealed non-verbal dysfunctions, not only on a pragmatic and interactional level but also in terms of enunciation. Moreover, interactional adjustment phenomena were noted in the interlocutor's behaviour.

CONCLUSION

The two inseparable aspects of communication - verbal and nonverbal - should be equally assessed in patients with communication difficulties; highlighting distortions in each area might bring about an improvement in the rehabilitation of such people.

[Outcome of the Aquitaine Unit for Evaluation, Training and Social and Vocational Counselling (UEROS) at 5-year follow-up in young adults with brain damage]

INTRODUCTION

Difficulties in social and vocational adjustment are common in adults with brain damage. A French government-funded program, UEROS (Unit for Evaluation, Training and Social and Vocational Counselling), was developed to improve cognitive adjustment, social autonomy and return to work for these people.

OBJECTIVES

To describe the outcome and satisfaction with life after 5 years for patients who participated in the UEROS-Aquitaine network program.

MAIN OUTCOME MEASURES

EBIS Document to evaluate people with traumatic brain injury.

RESULTS

Seventy-five of the 102 patients participating in UEROS from 1997 to 1999 were assessed during a phone-structured interview based on the EBIS Document. The sample consisted of young adults (mean age 28.5 years), most (65, 85%) with brain injury and moderate disability (Glasgow Outcome Scale 2: 57%) or severe disability (Glasgow Outcome Scale 3: 42%). On entering the program, 33% of the subjects needed no help physically or cognitively. None were employed. At the end of the program, 9% were students or were learning a job, 8% worked full-time, 16% were in sheltered conditions, and 13% had volunteer activities. At 5-year follow-up, 50% of the subjects were independent, 4% were in school, 10.6% worked full-time, and 26.7% were in sheltered conditions. Playing sports was associated with good social adjustment. The professional status at 5 years was significantly correlated with following the UEROS program (r=0.30, P<0.01) and status at the end of the program (r=0.29, P<0.05). However, 41.3% of the subjects were still unsatisfied with their conditions of life.

DISCUSSION-CONCLUSION

In patients with brain damage, the UEROS-Aquitaine network program improves independence in daily living and allows for nearly one inactive adult in two (42%) to be engaged in an activity or a job.

[Non-pharmacological treatment of neurobehavioural disorders following severe traumatic brain injury. A commented literature review]

OBJECTIVES

Neurobehavioural disorders are a major public health problem and a daily challenge for neurological rehabilitation. This review presents the state of art in the field of traumatic brain injury regarding non-pharmacological treatments of neurobehavioral disorders.

METHODOLOGY

Medline data base and main reference books going back for 15 years were searched.

RESULTS

Prevention is based on information and counselling for a better coherence in the care and a better understanding of behaviour problems. Prevention of complications is based on adaptation of units and management (one-on-one care for example). Non-pharmacological treatment can be classified according to 3 approaches: (1) Behavioural approaches: with well-established procedures for each patient; (2) Holistic approaches: addressing both lesional and psychopathological as well as environmental features; (3) Psychotherapeutic approaches: either integrated to holistic programs, or adapted from classical psychotherapy, or systemic therapy.

CONCLUSION

Practices trend to a convergence through a comprehensive approach: behaviour analysis and management of its neuropsychological, psychopathological and environmental components. Everybody will be able to pick out elements adaptable for his own practice.