Living in a reshaped reality: Exploring social participation and self-identity after TBI

Exploring the goals and outcomes of adults with severe acquired brain injury participating in an extended inpatient brain injury rehabilitation unit in Australia

PURPOSE

To explore the rehabilitation goals and evaluate goal attainment outcomes of people with severe acquired brain injury (ABI), and investigate the relationship between goal engagement and goal attainment.

MATERIALS AND METHODS

Mixed-methods cohort study with twenty-nine adults with severe ABI in Australia. Demographic data, goal statements and pre-post program Goal Attainment Scale scores as well as Goal Engagement Scale scores were collected. Goals were coded using inductive content analysis and categorised by ICF component and domain. Goal attainment within ICF categories was described and compared using descriptive statistics. Pre-post program change in goal attainment was evaluated using Wilcoxon signed rank tests and correlations between goal engagement and attainment was explored using Spearman's (rho).

RESULTS

94% of 320 goals were categorised as ICF Activity and Participation. There was significant improvement in goal attainment between admission and discharge (z=-0.47, p < 0.01). There was no significant relationship between goal engagement and goal attainment however there was a positive association between engagement in goal setting at admission and discharge.Conclusions: This interdisciplinary, inpatient rehabilitation program underpinned by key-worker facilitated person-centred, role-based goal setting resulted in goal attainment in chosen goals, which were primarily activity and participation-focused.

Community Integration of Disability: A Bibliometric and Knowledge-Map Analysis

Background

Community integration (CI) is the ultimate goal of rehabilitation for individuals with disabilities. It plays a significant role in restoring their social functioning and facilitating their reintegration into community and family life. However, no studies have utilized bibliometric methods to explore community integration.

Objective

To conduct a review about community integration of disabilities and to clarify the knowledge, hotspots, and trends through the bibliometric method.

Methods

Studies on community integration from 1990 to 2023 were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace 6.2.R4 and Microsoft Office Excel 2019 were applied. The CiteSpace node types involved in this study include keyword, reference, cited author, cited Journal, and the dual-map overlay of journals. CiteSpace presented the keyword cluster map, keywords timeline view map, keywords bursts map, and overlay map of journals. Microsoft Office Excel 2019 was used to present the trend of annual publications and draw up related tables and figures.

Results

A total of 2239 hits were included. The number of publications related to community integration is increasing gradually. The three most frequent keywords is Brain Injury (571, 13%), Individuals (488, 11%), Quality of Life (434, 10%). Keyword cluster map and timeline map with eight clusters were obtained, and the current strongest citation burst keywords are social participation, substance use, experiences, interventions, and Afghanistan. Willer is the author with the most citations. McColl has the largest centrality in the first ten cited authors. The most cited reference is published by the World Health Organization (WHO). Archives of Physical Medicine and Rehabilitation is the journal with the highest co-citation frequency. The overlay map of journals presented four distinct paths: the journals in "psychology education, health" and "neurology, sports, ophthalmology" often cite journals in "health, nursing, medicine" and "psychology, education, social".

Conclusion

Community integration for individuals with disabilities is gradually becoming a hot topic. Research on community integration related to traumatic brain injury (TBI), stroke, children, and spinal cord injuries is current focus of community integration. Future research should explore the experiences and feelings of different groups of disabilities regarding community integration and develop more effective interventions for their community integration. Community integration is complex, and future research on community integration for individuals with disabilities needs to be explored more specifically.

'Would you take a drug for this?': attitudes by individuals with traumatic brain injury towards medication to improve social functioning

Background Many people with traumatic brain injury (TBI) report problems with social functioning that can have immediate and enduring impacts. We aimed to explore perceptions of social functioning after TBI and understand attitudes towards medication that could improve long-term social outcomes. Method A qualitative descriptive approach using interview methods was conducted in Victoria, Australia. Using purposive sampling we conducted 15 semi-structured interviews with people with moderate to severe TBI between July and September 2021. Results Using a framework approach, we thematically identified three themes: (1) impacts of TBI on social roles and activities, including changes in recreational activities and role changes in family units; (2) change in social networks, resulting from shifts in attitudes to social activities and mental health issues; and (3) openness to novel treatments to improve social functioning - willingness to take potential medication to improve social functioning and the factors that have an impact on decision making. Conclusion Our results highlight that people with TBI experience a range of changes in social participation post-TBI, and that they have a strong interest in improving their social functioning. Such insights provide opportunities to tailor patient-centric treatments and circumnavigate barriers in the early stages of medication development for successful translation into practice in this population.

Social support after TBI: an investigation of Facebook posts in open access support groups

Traumatic Brain Injury (TBI) significantly affects social interactions and emotional well-being. Following COVID-19, there has been growing interest in how individuals with TBI use online social media groups for support. This study examined engagement patterns in four Facebook support groups: two for TBI and two control groups. A deductive approach was used to categorize 4,133 posts and comments into a framework of support discourse, including seeking and giving support, and non-social support. Each category was further subdivided to analyze post content in more detail. Comments on posts were coded for helpfulness/appropriateness. Results revealed that posts in all groups fell into the identified discourse categories, with comments generally being appropriate. Minor differences were noted between TBI and control groups, suggesting that individuals with TBI engage in online support similarly to others. These findings highlight the role of online support groups for individuals with TBI, offering insights that can guide the development of more tailored interventions and improve support services for this population.

Experiences of loss and grief in adults with acquired brain injury (ABI): A systematic review and meta synthesis of qualitative studies

OBJECTIVE

To synthesise the qualitative research related to the processes of loss and grief experienced by adults who have sustained a moderate to severe ABI.

METHOD

We conducted a systematic review and thematic synthesis of the experiences of loss and grief in adults with moderate to severe ABI. Five electronic database searches (PubMed, CINAHL, EMBASE, PsycINFO and Scopus) were conducted, identifying 2434 studies, of which 25 met inclusion criteria.

FINDINGS

Thematic synthesis generated four overarching analytical themes: the loss within me; devaluation of social roles and social identity; acceptance of grief and loss as an active process; and an ambivalent experience of loss. Our findings indicate that the experiences of grief and loss following brain injury are dynamic processes, requiring significant adjustment to and reappraisal of the sense of self, an often uncomfortable reconstruction and sometimes reluctant acceptance of new personal and social identities, and development of tolerance for the ambiguity of one's experience.

CONCLUSION

Findings suggest that people with moderate to severe ABI go through a significant process of change and adaptation in relation to grief and loss and their sequelae. Given the enduring nature of the injury and changing needs of the individual, rehabilitation may need to be increasingly personalised and responsive.

Characterizing post-traumatic growth in individuals with traumatic brain injury according to social participation, self-awareness, and self-identity

PURPOSE

After traumatic brain injury (TBI), individuals may face challenges in their social participation, self-awareness, and self-identity. However, positive life changes can also be experienced (i.e., post-traumatic growth). This study aimed to characterize the social participation, self-awareness, and self-identity of individuals with TBI displaying post-traumatic growth.

MATERIALS AND METHODS

Fifteen participants (male = 10, mean age = 49.7 years) with moderate to severe TBI (average years post-injury = 15.2) were included in this mixed-methods study. Self-report questionnaires were used to assess social participation, self-awareness, and self-identity. Qualitative data, collected using semi-structured interviews, were used to categorize participants into two groups: higher (n = 8) and lower (n = 7) post-traumatic growth. Descriptive statistics were used to characterize participants in each group in terms of their social participation, self-awareness, and self-identity.

RESULTS

Participants with higher post-traumatic growth had increased social participation, higher self-awareness, and fewer negative discrepancies between their pre- and post-injury self-identities, compared to participants with lower post-traumatic growth.

CONCLUSION

This study contributes to a more comprehensive understanding of post-traumatic growth through the use of both qualitative and quantitative data. These findings can inform future research and development of programs to promote post-traumatic growth post-TBI.

Priorities for quality of life after traumatic brain injury

BACKGROUND

After traumatic brain injury (TBI), individuals can experience changes to quality of life (QOL). Despite understanding the factors that impact QOL after TBI, there is limited patient-oriented research to understand the subjective priorities for QOL after TBI. This study aims to understand the priorities for QOL after TBI using a group consensus building method.

METHODS

The Technique for Research of Information by Animation of a Group of Experts (TRIAGE) method was used to determine priorities for QOL after TBI. In phase one, expert participants were consulted to understand the context of QOL after TBI. In phase two, participants with TBI completed a questionnaire to broadly determine the factors that contributed to their QOL. In phase three, a portion of participants from phase two engaged in focus groups to identify the most relevant priorities. Data was analyzed thematically. In phase four, expert participants were consulted to finalize the priorities.

RESULTS

Phase one included three expert participants who outlined the complexity and importance of QOL after TBI. Phase two included 34 participants with TBI who described broad priorities for QOL including social support, employment, and accessible environments. Phase three included 13 participants with TBI who identified seven priorities for QOL: ensuring basic needs are met, participating in everyday life, trusting a circle of care, being seen and accepted, finding meaning in relationships, giving back and advocating, and finding purpose and value. In phase four, four expert participants confirmed the QOL priorities.

INTERPRETATIONS

Findings emphasize the critical need to address priorities for QOL after TBI to ensure improved health outcomes.

A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation

RESEARCH OBJECTIVES

1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury.

DESIGN

Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants.

SETTING

Four focus group sessions were conducted online through a video calling platform.

PARTICIPANTS

22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database.

RESULTS

Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development.

CONCLUSIONS

This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.

Formation mechanism of contributors' self-identity based on social identity in online knowledge communities

Introduction

Contributors' self-identity is a critical element in the sustainable development of online knowledge communities (OKCs). However, research concerning the formation mechanism of contributors' self-identity remains scarce. This research posits information support, novel posting and sense of self-worth as mediating variables between social identity and self-identity to construct a path model, aiming to explore the way in which self-identity is formed on the basis of social identity in OKCs.

Methods

To examine this mode, an online survey was administered to many different OKCs, and 515 usable questionnaire responses were collected. Structural equation modeling was then employed to examine the model.

Results

The R2 value of self-identity was 0.627, thus indicating that the model was able to explain 62.7% of the variance in self-identity. We find that self-identity emerges through the mediating effects of information support, novel posting and sense of self-worth. In addition, social identity can elicit novel posting and information support, which are all beneficial for enhancing the dynamics of OKCs and further generate sense of self-worth. We also observe that although social identity and individualized behavior (novel posting) are generally incompatible, they can be compatible in the context of OKCs.

Discussion

Self-identity as a contributor can be formed on the basis of social identity via the social path and the psychological path in OKCs, while the two paths for fostering self-identity are not independent of each other, and there is also a very strong link between behavioral and psychological mechanisms.