For the families of children with traumatic brain injury (TBI) the transition from hospital to home, school and community can be a very stressful time for everyone involved. The present phenomenological study explored the experiences and perceptions of parents of children with TBI during this important transition time with the aim to better inform health-workers involved in discharge management and rehabilitation. Six family representatives were interviewed, with the format of interviews being semistructured. An interview guide was used that outlined key issues to be explored with each participant. The primary analytical approach was inductive and thematic content analysis was used. The themes which emerged related to the emotional journey experienced by the family, the impact of significant relationships in the process of adjustment, along with service provision and coping strategies. These themes are highlighted with respect to how they can influence intervention strategies. Implications for service referral and the communication style of health professionals are also addressed.

Stroke has a marked impact on the ability to return to work. However, the stroke and its residual cognitive, physical and language deficits do not fully explain return-to-work success. While those with very severe deficits are less likely to return to work, and presence of disability is important, other extrinsic and intrinsic factors, such as having a job to go back to, beliefs and attitudes about work, job markets and the benefits system all play an important part. Vocational rehabilitation services developed with the stroke service user in mind are scarce in the United Kingdom. However, recent government interest in vocational rehabilitation and a recognition that evidence to support poststroke vocational rehabilitation is lacking have prompted efforts to develop new vocational rehabilitation services. People with stroke need specialist vocational rehabilitation services delivered by those who have an in-depth understanding of stroke and its effects. Service developers need to acknowledge and address factors that enable or impede return to work after stroke in service design. Research is needed to evaluate vocational rehabilitation interventions aimed specifically at the needs of stroke patients.

Psychosocial adjustment problems following traumatic brain injury (TBI) frequently present a major barrier for rehabilitation. The ability to cope has been linked with psychological well-being following stressful and traumatic events, but has been poorly examined in the area of TBI. In terms of conceptualisation, most coping research has adopted the Lazarus and Folkman (1984) dichotomy of coping, namely problem-focused and emotion-focused. Despite the popularity of this theory, recent conceptualisations of coping have suggested that other dimensions are equally important and require investigation in the TBI area. However, measurement of coping continues to provide a major barrier for research in this area, particularly given the potential difficulties associated with self-report data in people with TBI. The current study used a contextually sensitive assessment technique to test current conceptualisations of coping in the TBI population. Specifically, the study examined coping strategies and styles in response to four stressful video-based scenarios. Rather than using a self-report questionnaire to assess predetermined coping strategies, participants spontaneously provided their own coping strategies, which were then coded into distinct coping strategies. The strategies were categorised into four groups according to their focus (emotion or problem) and approach (active or passive). Both the number and type of coping strategies differed across situations, providing support for the use of a contextually sensitive measurement technique. Further, the theoretically expected pattern of relationships was found between coping types and outcomes. However, these relationships differed across situations and over time, confirming suggestions that coping efficacy may differ depending on the demands of the situation and that chronic situations such as TBI may have an impact on coping style over time.

The purpose of this study was to describe differences in activity participation between younger and older individuals with stroke to inform transition after stroke. This was a cross-sectional study with individuals six-months poststroke (n = 177). All individuals completed an outcomes assessment battery that included the Stroke Impact Scale, the Reintegration to Normal Living Index and the Activity Card Sort. The sample was divided into two groups: (1) Young — those under the age of 65 (n = 89); and (2) Old — those 65 or older (n = 88). Analysis was completed to examine differences between the groups on the primary outcome measures of the study and to look at differences between the groups on individual questions/items on the specific measures. The results of this study demonstrate: (1) significant differences in both the quantity and nature of activity participation prior to and after stroke between younger and older stroke survivors and (2) total scores and measures of central tendency do not necessarily provide therapists with the information they need to guide treatment. Rehabilitation professionals should focus on providing clients with the tools they will need to be successful in transitioning back to home and community environments once rehabilitation has ended.

Single-case experimental designs meeting evidence standards are useful for identifying empirically-supported practices. Part of the research process entails data analysis, which can be performed both visually and numerically. In the current text, we discuss several statistical techniques focusing on the descriptive quantifications that they provide on aspects such as overlap, difference in level and in slope. In both cases, the numerical results are interpreted in light of the characteristics of the data as identified via visual inspection. Two previously published data sets from patients with traumatic brain injury are re-analysed, illustrating several analytical options and the data patterns for which each of these analytical techniques is especially useful, considering their assumptions and limitations. In order to make the current review maximally informative for applied researchers, we point to free user-friendly web applications of the analytical techniques. Moreover, we offer up-to-date references to the potentially useful analytical techniques not illustrated in the article. Finally, we point to some analytical challenges and offer tentative recommendations about how to deal with them.

The Interpersonal Reactivity Index (IRI) is a multidimensional individual-difference measure of empathy. The original IRI has been used in many studies to assess both normal and clinical samples. Because of its wide availability and convenience of use, the IRI has been translated into several languages. In Taiwan, the IRI was translated into traditional Chinese as a Chinese Version of the Interpersonal Reactivity Index (C-IRI) in 1987. Because the C-IRI was developed over 26 years ago and recent studies have shown some unsatisfactory psychometric properties on the C-IRI, there was a need to develop an alternative to the C-IRI and verify its psychometric properties again. In this study, we assessed the psychometric properties of an alternative C-IRI by administering it to 516 college students, 35 community residents and 70 schizophrenic patients, all of whom are adults. Exploratory factor analyses revealed a four-factor structure: Fantasy, Perspective Taking, Empathy and Personal Distress. Acceptable convergent and divergent validity supported the construct validity of the alternative C-IRI. Evidence was also found for its discriminant validity between patients with schizophrenia and normal controls on the Empathy subscale and Affective Empathy, while the full scale and its factors demonstrated good internal consistency and test–retest reliability. In the future, the alternative C-IRI should be validated with adolescent or elderly samples, and different clinical samples.

This study investigated cognitive flexibility as indexed by the Written and Oral Trail Making Test (TMT) in sixteen persons with dementia and 60 normal elderly. Written and Oral TMT performances were significantly correlated with each other and with other tests of cognitive flexibility providing an index of the convergent construct validity of these tests. Part B of the Written TMT was influenced by psychomotor ability although this was diminished by the use of a ratio score B/A rather than simply Part B performance. The Oral test was not related to visual or motor skills, providing evidence for its divergent validity. Both parts of the Written and Oral TMT were found to be sensitive to cognitive decline in dementia. Performance on both Oral and Written TMT was also influenced by age, gender, education and intellectual ability. Previous norms (e.g., MOANS) for the Written TMT which are based on relatively educated elderly, tended to provide deflated scores for the community group tested here. Some additional, preliminary normative data for both tests were compiled which take into account the influences of each of these variables.

Computers are encountered increasingly in the clinical setting, including during aphasia rehabilitation. However, currently we do not know what people with aphasia think about using computers in therapy and daily life, or to what extent people with aphasia use computers in their everyday life. The present study explored: (1) the use of computers by people with aphasia; and (2) the perceptions of people with aphasia towards computers and computer-based therapy. Thirty-four people with aphasia completed an aphasia-friendly paper-based survey about their use of computers before and after the onset of their aphasia, and their attitudes towards computer-based aphasia therapy. There was a high level of computer usage by people with aphasia both before and after the onset of their aphasia. However, the nature of the computer use changed following aphasia onset, with a move away from work-based usage. The majority of the cohort used computers for aphasia therapy and liked using computer-based aphasia therapy, provided that the programs were perceived as appropriate for their individual needs. The results highlight the importance of exposing people with aphasia to computer-based aphasia therapy in a supported clinical environment, and the need to ensure that computer-based therapy is individualised for each client. It should be noted, however, that while the majority of participants reported positive experiences with using computers, this does not mean that the computer-based therapy software used was necessarily an effective treatment for aphasia.

Hypoxic brain injury is an under-recognised consequence of heroin overdose. This article documents the disability experienced by 10 people with hypoxic brain injuries following heroin overdose who presented in the 2-year period July 1997 to June 1999 at the Royal Talbot Rehabilitation Centre, a brain injury rehabilitation facility in Melbourne, Australia. Medical histories of these clients were reviewed and follow-up interviews were conducted between 2 and 4 years postinjury. Measures included the Functional Independence Measure (FIM) and the Community Integration Questionnaire (CIQ). The results showed that there were significant and enduring consequences for most of the 10 participants. At follow-up two participants had died from subsequent overdose, three required support to live in the community and one lived in an aged care facility. Only one participant was able to return to work. Cognitive problems were present in most of the group and problem solving and social interaction difficulties were the most commonly recorded problems. Three cases are described in detail to highlight some of the significant issues identified in this sample. Implications for the rehabilitation of people with brain injury following heroin overdose are discussed.

Brain cancer is a complex and distressing illness with a typically poor prospect for survival. Worldwide, approximately 256,000 people (1800 in Australia) are diagnosed each year (Ferlay, Soerjomataram & Ervik, 2013). Cancer of the brain poses a double threat – to one's survival and sense of self. Most people with primary brain tumour develop serious neuro-cognitive symptoms (e.g., seizures, memory loss) and experience poor mental health and quality of life, which places enormous burden on family care givers. Not surprisingly, high rates of psychological distress have been reported by people with brain tumour and their family care givers. Psychological distress can persist beyond primary treatment, and often increases in the long-term phase of illness due to the perceived threat and experience of recurrence and functional decline. Over the last decade, there have been many advances in the psychosocial management of people with brain tumour. This paper provides an overview of the functional, psychological and social consequences of brain tumour, summarises some leading developments in psychological assessment and management, and outlines future directions in intervention research.

The term ‘cognitive-linguistic’ has been widely adopted in descriptions of a variety of communication disorders of neurogenic origin. Despite this, clear agreement on the meaning of the term has yet to be reached, with the result that it is used both inconsistently and misleadingly. This lack of terminological clarity also undermines the assessment of complex communicative function. In this article the terminology associated with complex communication disorders is discussed and a simple framework for conceptualising cognitive-linguistic function is outlined. On the basis of this it is proposed that some currently available assessments that purport to measure cognitive-linguistic skills in fact have less explanatory power than other assessments that are often not specifically targeted at communication. Further, it is suggested that the framework offers an ecologically valid basis for the systematic assessment of cognitive-linguistic function.

Up to 90% of people with severe traumatic brain injury (TBI) report dissatisfaction with the status of their leisure participation and/or social integration. Yet, there are virtually no studies that have investigated the benefits of interventions that target leisure specifically for this population. The purpose of this study was to determine whether the Leisure Education Program (Carbonneau, Fontaine, & Lussier, 2006) designed to assist people with stroke to engage in meaningful leisure activities, build leisure self-efficacy and promote general wellbeing would have similar benefits for survivors of TBI. We recruited three community-dwelling survivors of TBI to participate in a 10-week leisure program. All three participants reported some benefit in leisure satisfaction and self-efficacy. This extended to improvements in general wellbeing and health-related quality of life for two of the three. These findings suggest that further investigations into the benefits of leisure education for adults with TBI should be conducted.

Objective: Obtaining baseline neuropsychological (NP) data to assist management of sports-related concussion has been considered the standard of care. The validity of this approach has been questioned, with suggestions that post-concussion testing alone will suffice. The present study compared the sensitivity of baseline and normative paradigms in the setting of sports-related concussion.

Method: Baseline NP data were collected for 194 Australian rugby league athletes on a brief battery of paper-and-pencil NP tests. During competition, 27 athletes sustaining concussion referred from a sports physician were retested within two days of injury. Twenty-six uninjured controls were assessed at similar intervals. The baseline paradigm was assessed using a reliable change index for pre- and post-concussion scores. The normative paradigm was assessed comparing the post-concussion score to a normative mean.

Results: The baseline paradigm was consistently more sensitive to negative change following concussion than the normative paradigm when using continuous data, despite reasonable agreement. However, when data were categorised as ‘impaired’ or ‘not-impaired’, using either 68% or 90% confidence intervals, the difference between paradigms failed to reach significance. Comparison of ROC curves for both paradigms found superior overall classification for one test and the composite score using baseline comparison data.

Conclusions: Despite being a time and resource intensive process, the baseline paradigm as a repeated-measures design may be more sensitive than the between-subjects design of the normative paradigm for detecting changes following concussion. Further work is required to determine the validity of normative assessment in sports-related concussion.

This article reviews current literature on social support and friendship, loneliness and social isolation, and discusses these in the context of disability and specifically acquired brain injury. The examination provides a backdrop for considering interventions which aim to promote or regenerate friendships in the lives of people with this injury. The social consequences for individuals who have sustained an acquired brain injury have been well documented and are briefly reviewed. An understanding of the social support and friendship literature, reviewed in this article, is helpful for practitioners in designing interventions in the lives of this group of people, whose limited friendship and social support systems compromise quality of life and inclusion in the community. The article describes interventions that have been attempted to facilitate network building and friendship development for vulnerable or disadvantaged people in a wide range of contexts. The role of informal support systems is also discussed. A critique of these interventions is also presented and the conclusion reached is that while such models are not perfect and are often not rigorously evaluated, it is critical to provide assistance in order to achieve genuine social inclusion of people with acquired brain injury. It is their human right.

Objective: This exploratory study applied a biopsychosocial perspective to investigate cognitive and psychosocial factors related to emotional adjustment and QoL after brain tumour. Methods: Participants included 30 adults with a brain tumour (60% benign and 40% malignant) who were aged 28 to 71 years (M = 51.5, SD = 12.3) and on average 5.4 years post-diagnosis (SD = 5.6 years). Participants completed a brief battery of cognitive tests and self-report measures of emotional status (Depression, Anxiety Stress Scale), subjective impairment (Patient Competency Rating Scale), coping (COPE), social support (Brief Social Support Questionnaire), and QoL (Functional Assessment of Cancer Therapy — Brain Tumour [FACT-Br]). Results: QoL was significantly associated with global cognitive ability (r = .49, p < .01), subjective impairment (r = .66, p < .01), and satisfaction with support (r = .50, p < .05). Level of depressive symptoms was significantly correlated with premorbid IQ (r = -.49, p < .01), use of planning to cope (r = -.48, p < .01), and satisfaction with support (r = -.47, p < .01). Conclusions: Overall, these exploratory findings indicate that emotional adjustment and QoL after brain tumour is related to a slightly different pattern of neuropsychological, psychological (self-perceptions and coping) and social factors. The clinical implications for interventions with individuals with brain tumour are discussed.

This article discusses the significance of conversation in current clinical practice with individuals with aphasia and their conversation partners. It explores the nature of everyday talk, and provides an overview of how studies to date have examined the conversations of individuals with aphasia and have provided some promising treatment avenues. It also proposes another framework, Speech Function Analysis, that may assist further in incorporating conversational principles into the therapy context. The framework provides a system network for examining speech functions in dialogue, while considering the effects of both lexical and syntactic limitations, and context. Examples of conversations between three individuals with aphasia and their partners are used to illustrate the analysis. The authors suggest that further knowledge of both aphasic speakers' and their partners' interactions as well as clinician–client interactions may increase our insights into this area, and make authentic and meaningful conversation more accessible in the clinical situation and beyond.

Childhood and adolescence coincide with rapid structural and functional maturation of brain networks implicated in Theory of Mind (ToM); however, the impact of paediatric traumatic brain injury (TBI) on the development of these higher order skills is not well understood. ToM can be partitioned into conative ToM, defined as the ability to understand how indirect speech acts involving irony and empathy are used to influence the mental or affective state of the listener; and affective ToM, concerned with understanding that facial expressions are often used for social purposes to convey emotions that we want people to think we feel. In a sample of 84 children with mild-severe TBI and 40 typically developing controls, this study examined the effect of paediatric TBI on affective and conative ToM; and evaluated the respective contributions of injury-related factors (injury severity/lesion location) and non-injury-related environmental variables (socio-economic status (SES)/family functioning) to long-term ToM outcomes. Results showed that the poorest ToM outcomes were documented in association with mild-complicated and moderate TBI, rather than severe TBI. Lesion location and SES did not significantly contribute to conative or affective ToM. Post-injury family affective responsiveness was the strongest and most significant predictor of conative ToM. Results suggest that clinicians should exercise caution when prognosticating based on early clinical indicators, and that group and individual-level outcome prediction should incorporate assessment of a range of injury- and non-injury-related factors. Moreover, the affective quality of post-injury family interactions represents a potentially modifiable risk factor, and might be a useful target for family-centred interventions designed to optimise social cognitive outcomes after paediatric TBI.

Objective: Very few studies have examined permanent post-concussion symptoms (PCSs) after mild traumatic brain injury (MTBI). None have reported the nature of such symptoms. Our recent study was the first to report on a wide range of factors affecting PCSs in a representative sample of such patients. This paper presents the frequencies of the different PCSs experienced by this group and compares them with PCSs at earlier stages post injury.

Method: One hundred consecutively referred patients to a Community Head Injury Service in Buckinghamshire, UK, for the treatment of long-term PCSs after MTBI were invited to participate in the original study. Those consenting to do so (n = 24, mean time post injury = 6.9 years) completed a Rivermead Post Concussion Symptoms Questionnaire. The frequency of the types of symptoms reported is presented. These are then contrasted with comparable PCS presentations at 7–10 days and 6 months post injury from two other studies.

Results: Fatigue was reported by all long-term patients. Poor concentration, sleep disturbance, taking longer to think and irritability were the other most frequently endorsed permanent symptoms. The least reported were blurred/double vision, photophobia, nausea, headache and dizziness. A similar pattern was present in those at earlier stages post injury.

Conclusions: The most common permanent PCSs may be those best conceptualised as the more cognitively and emotionally based symptoms, and the least common the more somatically based ones. There may be some consistency in the nature of PCSs reported over time.