Characteristics of residential community integration programs for adults with brain injury

Modelling verbal aggression, physical aggression and inappropriate sexual behaviour after acquired brain injury

Understanding the underpinnings of behavioural disturbances following brain injury is of considerable importance, but little at present is known about the relationships between different types of behavioural disturbances. Here, we take a novel approach to this issue by using confirmatory factor analysis to elucidate the architecture of verbal aggression, physical aggression and inappropriate sexual behaviour using systematic records made across an eight-week observation period for a large sample (n = 301) of individuals with a range of brain injuries. This approach offers a powerful test of the architecture of these behavioural disturbances by testing the fit between observed behaviours and different theoretical models. We chose models that reflected alternative theoretical perspectives based on generalized disinhibition (Model 1), a difference between aggression and inappropriate sexual behaviour (Model 2), or on the idea that verbal aggression, physical aggression and inappropriate sexual behaviour reflect broadly distinct but correlated clinical phenomena (Model 3). Model 3 provided the best fit to the data indicating that these behaviours can be viewed as distinct, but with substantial overlap. These data are important both for developing models concerning the architecture of behaviour as well as for clinical management in individuals with brain injury.

Treatment taxonomy for rehabilitation: past, present, and prospects

The idea of constructing a taxonomy of rehabilitation interventions has been around for quite some time, but other than small and mostly ad hoc efforts, not much progress has been made, in spite of articulate pleas by some well-respected clinician scholars. In this article, treatment taxonomies used in health care, and in rehabilitation specifically, are selectively reviewed, with a focus on the need to base a rehabilitation treatment taxonomy (RTT) on the "active ingredients" of treatments and their link to patient/client deficits/problems that are targeted in therapy. This is followed by a description of what we see as a fruitful approach to the development of an RTT that crosses disciplines, settings, and patient diagnoses, and a discussion of the potential uses in and benefits of a well-developed RTT for clinical service, research, education, and service administration.

Effectiveness of Rehabilitation in Enhancing Community Integration After Acute Traumatic Brain Injury: A Systematic Review

OBJECTIVE. We assessed evidence for post–acute traumatic brain injury (TBI) rehabilitation interventions used to enhance community integration (CI) relevant to occupational therapy.

METHOD. We conducted a systematic review of intervention studies on TBI rehabilitation from 1990 to 2007.

RESULTS. We analyzed and summarized 10 studies that met the inclusion criteria. Of 10 studies, 7 found that post–acute TBI rehabilitation benefits CI; all effective studies involved occupational therapy or involved interventions occupational therapists can do.

CONCLUSION. Many CI programs show positive results and should be studied more rigorously. Such promising programs should also be considered when decisions about post–acute TBI rehabilitation services for clients are being made. To further establish that post–acute TBI rehabilitation interventions improve CI, future studies should include intervention strategies based on injury severity, a control group, and longer term follow-up. The role of occupational therapy in these effective programs should be further explored.

Characteristics of home-based community integration programmes for adults with brain injury

OBJECTIVES

To conduct a nationwide telephone survey in order to gather data on some of the quantifiable characteristics of home-based community integration programmes available in the US to adults with brain injury.

DESIGN

Survey.

METHODS

The Community Integration Programme Questionnaire (CIPQ) was used to interview 13 home-based community integration programmes. This study then used descriptive statistics to analyse the characteristics of the programmes.

OUTCOME

There was a good deal of variability in client and programmatic characteristics.

CONCLUSIONS

There is considerable variability in characteristics among home-based community integration programmes.

Validity and reliability of the Community Integration Program Questionnaire

The Community Integration Program Questionnaire was developed to measure various quantifiable characteristics of community integration programs for people with brain injury. There are three versions: one for outpatient facility-based, one for residential and one for home programs. In this study questionnaires were administered to directors and associate directors of seven programs. A research assistant then went on-site to collect corresponding data using patient records, planning books and schedules, annual and quarterly reports, employee lists, staff curricula vitae, census data, insurance payment data, team meeting notes, incident reports, and staff logs. Matching criteria between questionnaire and on-site data were established before either was collected. The survey data matched data acquired on-site in 42.2, 56.4, and 56.8% of questions in the three versions, respectively. Interviewers and a second listener recorded the same information 91.5% of the time across seven program interviews. For two programs, comparisons between a Program Director and Program Coordinator yielded matches on 42.8 and 40.6% of questions, respectively. In conclusion, the Community Integration Program Questionnaire does not have acceptable construct validity and inter-rater reliability. Researchers requiring information about quantifiable characteristics of community integration programs should go on-site to collect the data.