This issue brings 2015 to a close, and it has been a year of major change for Brain Impairment. We have seen a change of guard with our appointments as Co-editors, and the appointment of a new Associate Editor, Petrea Cornwell. A well-attended meeting of the Editorial Board was convened at the INS/ASSBI conference in Sydney in July. And the journal has been delivered in an on-line format for the full year.

The first editorial for Brain Impairment was entitled ‘Landmark development’. Published in May 2000, the editorial both told a story and painted a context. In two paragraphs it recounted the pioneering work of Professor John Walsh and the history of the first two decades of the Australian Society for the Study of Brain Impairment (ASSBI), culminating in the foundation of the journal. In telling this story, the context for the journal was also outlined. Reflecting the nature of ASSBI, the journal would aim to be multidisciplinary and to address the full range of conditions that affect brain function across the lifespan.

This year is a year of significant steps in the evolution of Brain Impairment. As outlined in the Editorial for Issue 16.1, a new team has been handed the baton from foundation editors Dr Jacinta Douglas and Dr Robyn Tate. The second major development occurring in 2015 is the move from hard copy to an exclusively on-line journal. From the beginning of this year, Brain Impairment will only be available on-line. This development reflects broader moves in academic publishing to an ever increasing footprint within the on-line universe. Many new journals have been launched as purely on-line publications. Established rehabilitation journals that pre-existed the on-line revolution are also joining the trend, adopting hybrid models, with a mix of hard copy and e-articles, all documented in the Issue Contents. Furthermore, most journals have now created e-archives of all past issues, increasing the ease of access for practitioners and scholars alike, and reducing even further, the need for hard copy.

Primary objective: Social cognition underlies social skills and can be disrupted in numerous developmental and acquired brain disorders during childhood and adolescence. Despite this, there are few tools to assess social cognition clinically in this age group. This study examined adolescent performance on The Awareness of Social Inference Test (TASIT), a valid measure of social cognition in adults.

Design: Cross-sectional design examining performance on Parts 1, 2 and 3 of TASIT (and alternate forms) in Australian girls and boys with varying levels of English familiarity.

Methods: 665 schoolchildren from private and government schools were administered TASIT subtests. Of these, 464 students aged 13–15 were selected to provide normative data. Scores from a further 97 provided information about the effects of lack of English familiarity.

Results: The two Forms of TASIT were statistically equivalent for two of the three parts. Adolescents performed lower than adults, although the differences were not large. Some incremental effects were seen for chronological age. Gender effects were apparent on all subtests. Lack of English familiarity (i.e., English not spoken at home) reduced scores a further 6–13% relative to high English proficiency.

Conclusions: TASIT appears to be suitable for adolescents. Norms are best aggregated across ages in adolescence and stratified according to gender.

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.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system leading to physical and cognitive disability. The impact of the disease on social cognition has only come to light quite recently. The aim of this study was to evaluate the social cognition abilities of MS patients and their links with characteristics of the disease, such as physical disability, cognitive impairment and disease duration.

The performances of a group of 64 MS patients were compared with that of 30 matched healthy individuals in facial emotion recognition and Faux Pas tasks as well as on a battery of standardized neuropsychological tests.

The MS patients performed worse than the control group in the recognition of the expressions of fear and anger and in the interpretation of faux pas. The impairment in social cognition increased with overall disease course. Executive impairment did not correlate with the performance in the social cognition tests.

Our results show that emotional impairment is observed at early stages of the disease in the absence of cognitive dysfunction, even if social cognition abilities worsen with the progression of MS. These data highlight the need to attempt to identify these impairments in clinical practice.

Little is known about clinicians’ experiences in rehabilitation for people with traumatic brain injury (TBI). This survey study aimed to investigate clinicians’ scope of practice, perceived barriers to practice, factors influencing confidence levels and professional development preferences. Participants included 305 clinicians (88% female, 97% aged 20–60 years) from psychology (28%), occupational therapy (27%), speech pathology (15%), physiotherapy (11%), social work (6%), rehabilitation medicine (3%) and nursing (3%) disciplines. Survey results indicated that goal setting, client or family education, and assessment for rehabilitation, were the most common activities across all disciplines (>90%). Client-related barriers, family-related barriers and client–therapist relationship barriers were more frequently selected than workplace context and professional skill barriers (p < .05). Clinicians working with clients with mild TBI reported significantly fewer barriers (p < .05); yet, they were less confident in overcoming barriers than clinicians working with clients with more severe TBI (p < .001). Clinicians with fewer years of experience (<2 years) reported significantly lower confidence in overcoming barriers than clinicians with 2–10 years and >10 years of experience (p < .01). The most commonly selected professional development areas included new interventions and therapies, translating rehabilitation research into everyday practice and client specific topics. These findings provide a unique multidisciplinary perspective on clinicians working in TBI rehabilitation in Australia. Understanding of the perceived barriers to practice and professional development needs may guide training and support initiatives for clinicians which, in turn, may enhance the quality of brain injury rehabilitation.

There is no research on the assessment or treatment of help-seeking behaviours for individuals with traumatic brain injury (TBI). This paper describes the development of a protocol, NICE (Noticing you have a problem, Identifying the information you need for help, Compensatory strategies, Evaluating progress) to train help-seeking for adults with TBI when lost. Theoretical and treatment components from three empirically validated interventions that target social problem-solving and communication skills were adapted to develop NICE: the Group Interactive Structured Treatment for Social Competence (GIST), the Problem Solving Group Protocol (PSG) and Interpersonal Recall (IPR). Preliminary pilot data evaluating the efficacy are presented for three adult persons with TBI. All three participants improved on the Executive Function Route Finding Task (EFRT) and help-seeking behaviours when wayfinding. Help-seeking is a constitutive factor in the wayfinding process capable of improvement. Preliminary evidence supports further investigation of this group intervention.

An important aspect of cognitive functioning that is often impaired following traumatic brain injury (TBI) is visuospatial learning and memory. The Austin Maze task is a measure of visuospatial learning that has a long history in both clinical neuropsychological practice and research, particularly in individuals with TBI. The aim of this study was to evaluate visuospatial learning deficits following TBI using a new computerised version of the Austin Maze task. Twenty-eight individuals with moderate-to-severe TBI were compared to 28 healthy controls on this task, together with alternative neuropsychological measures, including the WAIS-III Digit Symbol and Digit Span subtests, the Trail Making Test, WMS-III Logical Memory, and Rey Osterrieth Complex Figure Test. The results demonstrated that TBI individuals performed significantly more poorly on the Austin Maze task than control participants. The Austin Maze task also demonstrated good convergent and divergent validity with the alternative neuropsychological measures. Thus, the computerised version of the Austin Maze appears to be a sensitive measure that can detect visuospatial learning impairments in individuals with moderate-to-severe TBI. The new computerised version of the task offers much promise in that it is more accessible and easier to administer than the conventional form of the test.

Assessment of executive functions, such as planning, often relies on tasks such as the Tower of Hanoi, which assess plan execution but not planning knowledge. Survivors of brain injury may perform within normal ranges on plan execution tasks yet have profound deficits in planning knowledge required for daily life. We examined survivors of brain injury and non-injured participants on an errand-planning task, to assess planning knowledge, and on a reading comprehension task, to distinguish inference-based knowledge of planning versus physical cause and effect. Errand-planning performance discriminated survivors of brain injury from non-injured participants. Additionally, survivors with higher scores performed similarly to non-injured participants on both inference tasks, whereas survivors with lower scores did not discriminate these two types of inferences. Findings suggest that the errand-planning task may be a useful measure of planning comprehension for survivors of brain injury and suggest a cognitive retraining strategy.

Background and aims: International research has shown the public hold various misconceptions about traumatic brain injury (TBI). Yet, relatively little has been done towards developing appropriate measures of public knowledge of TBI. The Head Injury Knowledge Scale (HIKS, Ono, Ownsworth, & Walters, 2011) is a newly developed measure of misconceptions and expectations about the effects of TBI. Additional investigation of its psychometric properties appeared warranted. The aims of this further preliminary study were to examine the factor structure of the HIKS and the relationship between psychosocial variables and factor scores.

Method: A convenience sample comprising 167 adults, of whom 65% were females, responded to an online survey including the HIKS. The two-factor HIKS structure was tested using confirmatory factor analyses and the relationships between psychosocial variables and the HIKS factors were investigated.

Results: A good fit was found for the structure of the HIKS. All items loaded adequately onto the HIKS Over-generalisation and Minimisation factors and their internal consistencies were good. Significant differences between gender groups and for level of education were observed on the HIKS Over-generalisation scale, suggesting various groups in the community may have differing levels of knowledge of TBI.

Conclusion: This study confirmed the robustness of the HIKS factor structure. The HIKS is likely to be an important measure of community understanding of TBI in future research.

Background and aims: As many as 50–60% of patients with traumatic brain injury (TBI) admitted to rehabilitation facilities may have olfactory impairment (OI). These incidence estimates are derived from studies conducted internationally and there is no comparable data available in the Australian context. The primary aim of this study was to identify the incidence of OI following TBI in a consecutive sample of adults admitted to the Epworth Hospital Brain Injury Rehabilitation Program in Victoria, Australia. A secondary aim was to investigate whether age, duration of posttraumatic amnesia (PTA) and presence of facial fractures made a significant contribution to the prediction of severity of OI.

Method: The sample comprised 134 adults (mean age 39.09 years, SD 18.36), the majority of whom had sustained moderate to severe injury (PTA mean 21.57 days, SD 18.78). OI was measured using the Pocket Smell Test (PST) and the University of Pennsylvania Smell Identification Test (UPSIT).

Results: Seventy-three participants (54.48%) demonstrated OI on the PST whereas 89 (66.42%) demonstrated OI on the UPSIT. Age, PTA duration, and presence of facial fractures predicted 10.3% of the variance in severity of OI.

Conclusion: A substantial proportion of adults admitted for rehabilitation following TBI has OI. Accurate assessment and appropriate management of post-traumatic OI must be incorporated into rehabilitation programs.

Objective: The aim of this qualitative study was to explore how spouses/partners experience social, emotional and behavioural changes in persons following traumatic brain injury (TBI), with a particular focus on their emotional impact and the effect on the couple relationship.

Method: Interpretative phenomenological analysis (IPA) of interview data explored five women's experiences of these changes in their partners following TBI.

Results: Themes describe the direct emotional impact of living with the changes as well as the emotional impact of attempts to manage and make sense of the changes (identity change, managing the changes and making sense of the changes). The impact on the couple relationship is described under the themes of feeling love and receiving love. Changes led three of the participants to experience their partner as having been replaced by a new person; they actively disliked this new person; they felt unable to love the new person in the same way as the old person; and their love was defined in terms of a caring relationship, rather than a spousal relationship.

Conclusions: The study provides insight into why social, emotional and behavioural changes might be so consistently associated with reduced emotional wellbeing and lower levels of relationship quality and satisfaction.

Background: Partners of people with Parkinson's disease (PD) have first-hand knowledge relevant to the management of the person with Parkinson's (PwP). If captured, this knowledge may improve effective care for the PwP. However, there is a lack of research focusing primarily on partners’ experiences of engagement with health professionals working in PD (HPPs).

Methods: Interpretative Phenomenological Analysis (IPA) was used to investigate the meaning of partners’ experiences of engagement with HPPs. Semi-structured interviews with 15 partners of PwP provided primary data. Each interview was digitally recorded, transcribed verbatim and analysed for emerging themes.

Results: Three themes emerged: (i) partners’ lack of entitlement for their own needs to be met; (ii) submersion of self in the partnership and (iii) health professionals as agents of support. Additionally, sub-themes were identified, such as barriers to feeling entitled, setting up a premise for entitlement, and lost identity. Together, these themes highlight the current lack of focus on the partners of PwP. A process model was developed to describe partners’ cyclic progression through the various stages of their experience, and in the process, identifying initiatives for intervention.

Conclusion: Given a lack of focus on the needs of partners of PwP, these preliminary insights could inform the delivery of improved services that support partners. This will ultimately benefit the PwP.

Distinguishing the comprehension of goal-directed actions from the enactment of those actions is the mental stage of planning, which we identify as planning knowledge. This distinction allows rehabilitation efforts to utilise reading comprehension of a fictional character's plans as a possible cognitive retraining tool. Hypothesising that comprehension of physical cause and effect is relatively intact in brain injury survivors, we compared survivors with high vs. low scores on the errand-planning task for comprehension of inferences based on physical cause and effect versus planning knowledge domains. Results indicate that those survivors with high errand-planning scores formed inferences from both knowledge domains, while survivors with low errand-planning scores were unable to form knowledge-based inferences. These findings suggest that a rehabilitation focus on comprehension of actions towards a goal state may retrain survivors’ skill at the mental stage of planning.

Aims: To identify and compare, family support needs following an acquired brain injury (ABI) in metropolitan and regional/remote areas in order to inform the development of a state-wide family peer support network.

Design: Mixed methods design including postal survey and focus groups.

Results: The survey was completed by 194 family members who provide support to an adult with ABI. Focus groups included 43 participants (29 family members, 14 people with ABI). Thematic analysis of open-ended survey responses and focus group transcripts revealed 15 areas of needed support. Although all themes were identified by both geographic groups, regional/remote participants commented more frequently on the need for coordinated, accessible and tailored services. A strong focus was placed on the need for counselling and emotional support, as well as family support groups from both major city and regional/remote participants. Each support was reviewed to identify those which could be augmented through peer-supports, including: emotional support; family support groups; ABI information; family social activities; help to navigate the system; early supports (within the first year of ABI); and self-advocacy training.

Conclusions: Results highlight a need for ongoing supports for the entire family following ABI in both metropolitan and regional/remote regions of SA (South Australia). Support themes can inform the development of family-centred services, including the role of peer-support networks.

Various studies have shown the efficacy of errorless learning (EL) in teaching patients with dementia a wide variety of skills and everyday tasks, with some studies showing beneficial effects and others reporting limited or no advantage. However, EL procedures vary greatly and, to date, no clinical guidelines or manuals are available. Here, we present a nationwide survey exploring the interest in, and feasibility of, EL in dementia care in The Netherlands. Based on the survey results and available evidence in the literature, we subsequently drafted an EL manual and had this concept manual evaluated in a Delphi round using the AGREE instrument. Forty-five health professionals associated with 22 dementia care facilities in The Netherlands, including those survey respondents who had piloted an EL intervention in accordance with the concept manual and an eight-strong expert panel representing various disciplines, deemed EL to be meaningful and feasible for use in dementia care and their residential facilities. Although our manual was favourably received, future studies are required to examine how EL can best be implemented in clinical practice and to determine the optimal outcome measures and quality indicators to reliably evaluate intervention outcomes and to consider the cost-effectiveness of the approach.

Objectives: (1) Examine the opportunities young people with acquired brain injury (ABI) have to make everyday choices after moving out of residential aged care (RAC) into community-based shared supported accommodation (SSA); (2) Compare everyday choice making of this group with a group of people with ABI living in RAC.

Research design: Mixed methods comparing two independent groups.

Method and procedures: Responses on eleven relevant items of the Resident Choice Scale (RCS) were compared between two groups; 45 people with ABI living in RAC and 20 people with ABI who had moved from RAC to live in SSA. In addition, the choice making experiences of the SSA group were investigated through semi-structured interviews with the individual and/or their family member. Interviews were recorded, transcribed and thematically analysed.

Results: Greater opportunities for everyday choice making were demonstrated on 10 out of the 11 RCS items for people living in SSA, compared to RAC. These included improved choice regarding meals, bedtime and leisure activities. Qualitative data also illustrated new choice opportunities afforded to the SSA group. Five key themes relating to choice were identified: rules and routines, communication, things to do, food and home-like environment.

Conclusions: Community-based, age-appropriate and small-scale supported accommodation provides people with ABI more opportunities for everyday choice making than RAC.

Background: Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.

Method/Design: The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.

Discussion: This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.

Traumatic brain injury (TBI) can reduce people's ability to monitor their own actions and identify and correct errors on everyday tasks. This usually occurs because of damage to neural pathways that support ‘metacognition’ or the higher-order capacity to reflect upon and regulate one's own behaviour. This paper initially reviews the neuro-cognitive mechanisms underlying error self-regulation. An overview of assessment approaches is provided which emphasises how approaches to measuring error self-regulation following TBI have been extended from the laboratory to people's real life environments. Over the last few decades, the evidence base supporting the efficacy of error-based learning or metacognitive approaches in rehabilitation has advanced considerably. An overview of the theory underpinning rehabilitation approaches and evidence supporting the efficacy of error-based learning is provided. Finally, the paper briefly describes the protocol for a randomised controlled trial that aims to determine whether people with severe TBI benefit from making errors when they learn new complex tasks.