Objective: To summarise the effect of upper limb rehabilitation interventions on motor function in adults with traumatic brain injury. Data sources: Databases were last searched on August 2, 2008. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL); Cochrane Database of Systematic Reviews, the Database of Effectiveness Reviews; MEDLINE, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence database (OTseeker); Google Scholar; and reference lists of included studies. Review methods: Two reviewers determined whether retrieved abstracts met the inclusion criteria: systematic reviews and randomised controlled trials (RCTs); English language; adult participants; ≥ 50% of study participants with a brain injury; interventions designed to improve upper limb motor function. Included papers were appraised for: study design, participants, therapy approach, therapy protocol (indications, contra-indications, intensity and duration), safety and adverse events, and outcomes. The methodological quality of RCTs was rated using the PEDro scale (1–10 highest). Methodology of systematic reviews was rated using the QUOROM criteria. Results: Of the 333 references identified, six were appraised: three systematic reviews and three RCTs. Methodological quality was high for two RCTs, and moderate for one, based on the PEDro scale score. Interventions included upper limb casting, electrical stimulation, and coordination training using meal preparation tasks (making a sandwich and hot drink). In the latter trial, practice of functional kitchen tasks improved fine motor coordination speed on one of four Jebsen-Taylor hand function subtests by 9.38 seconds (95% CI, 1.1 to 17.7). Remaining trials reported non-significant effects for hand function. Small sample sizes and limited reporting of results reduce the interpretability of two RCTs. Conclusion: No conclusive evidence was found on which to base upper limb motor rehabilitation after brain injury, however, lack of evidence does not equate to evidence of no effect.

Objective: To describe the development of a functional communication assessment. A secondary aim is to illustrate a process for identifying functional communication outcomes in clients with traumatic brain injury (TBI). The TBI Index for Social and Vocational Communication Outcomes (SAVCO) is designed to identify limitations to everyday communication activities that may present following TBI. It was constructed by anchoring communication activities derived from studies within New Zealand into an internationally recognised theoretical construct, the International Classification of Functioning, Disability and Health (ICF). Four key principles: authenticity of the items, attention to context, collaboration and transparency, underpin the assessment. Main outcomes: The article describes the process of developing a TBI measure that is authentic to an intended population. It provides a preliminary description of the SAVCO, its different constructs and the rationale for their inclusion. The SAVCO is an assessment that highlights everyday activities that are relevant targets for intervention for the individual. The client's performance on the identified activities is explored according to the efficiency and manner of executing the activity. The scope and level of the activity are also determined. Conclusions: The development of the SAVCO illustrates a process for identifying relevant and important functional communication activity items and promotes the use of the ICF framework and rating scales. The preliminary findings suggest that the SAVCO has clinical relevance providing speech–language therapists with a functional communication assessment that leads to the identification and measurement of client-centred therapy outcomes.

The long-term outcome of persons with impaired consciousness after brain injury remains relatively unclear. The first 12 months post ictus are widely reported as the period of greatest change, with an estimated 20% of persons with traumatic brain injury recovering consciousness. However, beyond 12 months post traumatic and 6 months post-nontraumatic injury the chances of further recovery are thought to diminish significantly. The aim of this study was to investigate the behavioural and psychosocial outcome of 12 patients with impaired consciousness 2 years post ictus. At the time of recruitment five of these patients met the diagnostic criteria defining the vegetative state and seven of these patients met the diagnostic criteria defining the minimally conscious state. Patients were assessed using the Wessex Head Injury Matrix at recruitment and again at least 2 years after initial contact. Functional and psychosocial outcome were also explored. Most patients showed some improvements to their behavioural portfolio, but all were still very dependent physically and all required a high level of support in their activities of daily living. None of the patients had emerged from their original condition, despite exhibiting larger behavioural portfolios. The implications of these findings for the management of patients in low awareness states are discussed.

The current study was designed to determine whether the Social Performance Survey Schedule (SPSS; Lowe & Cautela, 1978) is a useful measure of social skills in people with traumatic brain injuries (TBI). Forty-nine adults with TBI were compared on the SPSS to 190 adults without injuries. The validity of the SPSS was also investigated in relation to another measure of social performance, the first scale of the Katz Adjustment Scale (KAS-R1; Katz & Lyerly, 1963) and a broad measure of social function (the SPRS; Tate, Hodgkinson, Veerabangsa, & Maggiotto, 1999). Individuals with TBI had significantly lower scores on the positive scale of the SPSS than nonbrain-injured individuals. They did not have lower scores on the SPSS negative scale relative to the normative sample. Significant correlations with the KAS-R1 and SPRS provided evidence for the construct and criterion validity of SPSS within this population. In conclusion, this study suggests that where an appropriate normative sample is used, the positive subscale of the SPSS is a sound measure for detecting the extent and nature of deficits in prosocial behaviour seen in TBI, but raises the question as to how we define negative behaviours in the 21st century on scales such as the SPSS.

The International Classification of Functioning, Disability and Health (ICF) is a taxonomy that classifies health states and health conditions. It is a complex and detailed taxonomy, with 1,424 categories, covering body structures and functions, activities and participation, and environmental factors. The complexity and detail, however, can serve as a barrier in its everyday application. A number of strategies have been developed to facilitate use of the ICF in clinical and research practice, including the development of ‘core sets’. In this article, we present another method which will assist both the newcomer and those more familiar with the ICF. Along with a description of the ICF structure and contents, the article presents a graphical representation of ‘ICF trees’ as a vehicle to more readily grasp the detail of the ICF structure and contents and facilitate its use in the area of acquired brain impairment.

This article provides a review of the development and clinical practice of the ABI Behaviour Consultancy (the ‘Consultancy’), a specialist clinical service that provides outreach behaviour management support across the state of Victoria, Australia, to people with acquired brain injury (ABI) and their social network (i.e., family members, friends, support workers, and therapists). The Consultancy is a small, unique service that has developed ways of providing behaviour management strategies in community settings, despite the difficulties presented by changing and uncontrolled environments. The aim of this article is to provide a detailed account of this service. Information from the first 7 years of full operation, 1998 to 2004, is presented, during which a small number of psychologists saw more than 800 clients. A detailed description is given of behaviours referred and associated risks, assessment procedures, intervention approaches, and research activity. A variety of key service aspects are detailed, including the qualifications required of specialised staff, the service funding levels, and funding and service issues. These detailed accounts of service delivery are placed in the context of several major themes: specialist versus generalist services, the deployment of targeted interventions throughout the lifespan of a brain-injured individual, the role of specialist behaviour management services in the continuum of brain-injury support services, and broader equity issues.