'Lonely in my head': The experiences of loneliness in individuals with brain injury

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

OBJECTIVE

To examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry.

DESIGN

Secondary analysis of a longitudinal prospective cohort study.

SETTING

TBI Model Systems centers.

PARTICIPANTS

Community-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Homebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry.

RESULTS

In our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y).

CONCLUSIONS

The negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

"I felt like I was missing 'me'": Long-term experiences of intrapersonal loss, grief, and change in adults with an acquired brain injury

Experiences of loss and change following acquired brain injury (ABI) are frequent and multi-contextual, yet the long-term experiences of people with ABI are not well understood. This study explored the experiences of intrapersonal loss, grief and change in people with ABI, a decade after their injury. Twelve adults with ABI were interviewed 10-13 years post-injury. Using interpretative phenomenological analysis, we identified four overarching themes: a dawning realization of the impact of injury; loss of personhood; loss and liminality; and learning to live with loss and grief. Our findings indicate that in the decade following ABI, people continue to develop awareness of the impact of their injury and experience oscillating acceptance towards enforced changes. Participants reported a diminished sense of agency and autonomy in how they were perceived by and interacted with following injury. Additionally, identity may be lost, suspended, and renegotiated. Findings suggest dynamic, active, and flexible coping strategies that continue to be present over the long term. Considering the persistent nature of the injury and the evolving needs of the individual, a longer term view of rehabilitation outcomes may be required, contextualised by relational and intrapersonal challenges that may present over the longer term.

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.

Experiences of Acquired Brain Injury as Expressed Through Mask-Making: A Qualitative Analysis

PURPOSE

Acquired brain injury (ABI) extends beyond the immediate aftermath, and understanding individual experience of ABI is paramount to providing effective support mechanisms. This study examined how people with ABI used mask-making to engage in self-expression.

METHOD

Publicly available data from the Unmasking Brain Injury Project website, an advocacy group for people with ABI, were analyzed. A qualitative approach with hybrid inductive/deductive analysis was used to explore how people with ABI use art to express their emotional experiences of ABI.

RESULTS

In total, 1,049 masks had narratives describing the visual components and meaning in the associated masks. Three major themes emerged: the multiplicity of experiences after ABI, including positive, negative, and mixed outcomes; the expression of emotional pain and living with loss through art; and the importance of positivity, purpose, and faith in the experience with ABI. Multiplicity was the central expression represented in the masks. The most commonly represented emotional experiences were: emotional pain and living with loss and positivity, purpose, and faith. The masks incorporated literal depictions of the ABI, visual metaphors, and intentional use of colors and shapes for self-expression.

CONCLUSIONS

These results support previous findings that emotional experiences after ABI are complex and often interlaced with several emotions. The most prominent feelings include emotional pain and living with loss, and positivity, purpose, and faith. Mask-making may be a particularly appropriate method for people with ABI to process or express emotional experiences, as well as to provide clinicians with visual records of sense of self, coping, or progress.

'It gives you encouragement because you're not alone': A pilot study of a multi-component social media skills intervention for people with acquired brain injury

BACKGROUND

People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI.

AIMS

To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation.

METHODS & PROCEDURES

The study used a mixed-methods, pre-post-intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self-guided course about social media skills (social-ABI-lity course), and then participated in a private, moderated Facebook group over a 12-week period (social-ABI-lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre-intervention, post-intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post-intervention interview.

OUTCOMES & RESULTS

At post-intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention.

CONCLUSIONS & IMPLICATIONS

This pilot study provided preliminary evidence that an intervention comprising a short, self-guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention.

WHAT THIS PAPER ADDS

What is already known on the subject Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge This pilot study reports the outcomes of people with ABI completing a short, self-guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work? With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive-communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection.

Factors Influencing Stroke Internal Stigma Among Stroke Survivors

Introduction

Poststroke internal stigmatization in patients is often overlooked, yet it makes significant contribution to their recovery and quality of life. After stroke, the survivors often have negative perception toward themselves triggered by the internal stigma. Consequently, it affects the rehabilitation outcomes and increases the risk of long-term complications. Therefore, deeper analysis related to the factors influencing the internal stigma was crucial in order to develop an appropriate and innovative strategy to overcome this issue and optimize the recovery in stroke survivors.

Objective

This study aimed to identify predominant factors influencing the internal stigma in stroke survivors in Indonesia.

Methods

This study used descriptive analytical design and applied stratified nonprobability consecutive sampling involving 439 poststroke respondents from nine hospitals in Bali throughout 2023. This study used various instruments, namely stroke stigma scale (SSS), perceived family support, stroke self-efficacy scale (SSEQ), stroke awareness questionnaire, self-acceptance scale, knowledge of stroke and the respondents' demographic data. The analysis was conducted using Pearson product-moment correlation and multiple regression.

Results

The results from multiple regression analysis showed that self-acceptance (β = .374, p = .000), self-awareness (β = .132, p = .000), self-efficacy (β = .154, p = .000), family support (β = .090, p = .015), age (β = .083, p = .000), and stroke symptoms (β = -.347, p = .000) could explain the internal stigma for 62.8% (F = 124.266, p = .000).

Conclusion

Self-acceptance became the most predominant factor towards internal stigma in the stroke survivors because it showed the ability in accepting changes after stroke, which eventually helped them to overcome the challenge and free themselves from internal stigma that interrupted the process of recovery and adaptation to poststroke physical and psychosocial changes.

Uncovering the social determinants of brain injury rehabilitation

Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness.

Loneliness and disability: A systematic review of loneliness conceptualization and intervention strategies

Introduction

People with disabilities experience loneliness to a greater extent than people without disabilities. To better understand this problem, we have conducted a systematic review of studies that involved disability and loneliness. The aims are to research what loneliness is and to conceptualize and define it in the context of disability, and the intervention strategies that have been developed.

Methods

The research protocol is based on the PRISMA guidelines. Two hundred and eighty-one papers were screened and 75 reports were assessed for eligibility.

Results

We have not found whether loneliness in disability is a single construct or a collection of various subtypes. We have found that there are protective factors against loneliness in disabled people, such as having a job or living in an environment without physical barriers.

Discussion

In terms of the interventions for people with disabilities, the same strategies have been adopted as for the non-disabled: social skills training, enhanced social support, opportunities for interactions, and cognitive training.

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

Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.