Acquired Brain Injury Research Articles (Page 1)

ABSTRACT Aim Definitions and cutoff values for impaired near point of convergence, and for dominant/non-dominant hand completion of line bisection and cancellation tasks, in older adults are lacking. In this study, we investigate the measurements, response times, and accuracy in a non-clinical population with healthy eyes and cognition. Methods This was a prospective cross-sectional study recruiting adults older than 50 years. Demographic data included hand dominance, sex, age, and ethnicity. The average of three near point of convergence measurements was recorded. Accuracy and speed of task completion were recorded for two-line bisection tasks (3 lines and 10 lines) and for the clock cancellation task, using dominant and non-dominant hands. Results A total of 240 participants (161 female), with mean age of 61.23 years (SD8.71, range 50–97) were recruited. All participants had best corrected visual acuity of better than 0.1logMAR in each eye with no ocular pathology, and with no neurological disease. Overall mean near point of convergence was 9.22 cm (SD4.13), with slight decrease in convergence with increasing age (mean 11.71 cm in the 80th decade). Error cutoff for line bisection was determined as 6 mm with greater accuracy for the 10-line vs 3-line task. Error cutoff for the clock cancellation task was 42 with mean completion time of 1.5 minutes. Conclusions We report normative ranges of older adults ( >50 years) to which future clinical comparisons can be made when evaluating near point of convergence and visual inattention. Further research is required in acquired brain injury populations to take into consideration any additional impact on task completion due to co-morbidities/associated sequelae of the brain injury.

Introduction Previous studies have demonstrated that impulsivity is positively correlated with excessive smartphone use, indicating the involvement of frontal lobe circuits. This study examined excessive smartphone use, impulsivity, and mental wellbeing in patients with acquired brain injury (ABI) before and after occupational rehabilitation treatment, and control participants. Procedure Participants consisted of 44 patients with ABI [10 patients with orbitofrontal syndrome (OFS) and 34 without OFS] and 69 control participants with no history of brain injury. The procedure included a smartphone application that tracked daily smartphone use and frequency of device unlocks, computerized tasks that evaluated impulsive choice (Delay Discounting Task), impulsive action or response inhibition (the ability to stop an already-initiated action—the Go/No-Go task), and questionnaires measuring excessive smartphone use, obsessive–compulsive symptoms [Yale–Brown Obsessive–Compulsive Scale (YBOCS)], impulsivity [Barratt Impulsiveness Scale (BIS-11), which measures non-planning, motor and attention impulsivity], and mental wellbeing [Depression, Anxiety, and Stress Scale (DASS-21), which measures depression, anxiety, and stress]. Data were collected at two time points: baseline (T1) and 5 months later (T2). Results At baseline (T1), patients with ABI and OFS exhibited higher impulsive action, indicated by more commission errors on the Go/No-Go task, excessive smartphone use, and higher ratings of depression compared with control participants. Secondly, patients with ABI without OFS showed higher trait attention-impulsivity ratings compared with control participants. After treatment (T2), patients with ABI showed improved impulsive choice, indicated by improved delay discounting, but no improvement in smartphone use. Discussion Brain injury, particularly in frontal regions, is associated with impulsiveness and excessive smartphone use. Patients with ABI showed an improvement in delay discounting after treatment, which is likely due to occupational therapy and training in control of impulsivity. It is recommended that specific treatment program for excessive smartphone use will be developed for patients with ABI.

Acquired brain injury (ABI) is a leading global cause of morbidity, affecting millions, many of whom face a diverse range of cognitive, physical, and psychological challenges, often made worse due to limited access to timely assessment and appropriate care. In recent years, digital technologies have emerged as potential tools to support more accessible, efficient, and scalable methods for assessment; however, the breadth of research in this area remains unclear. This scoping review aimed to identify and synthesize contemporary research on how digital technologies may help screen, assess, and monitor the complications of ABI in order to uncover trends, themes, and priorities for future research. Following the Arksey and O'Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a systematic search was conducted across Embase, MEDLINE, and Scopus, as well as four clinical trial registries to help capture gray literature. A search string incorporating terms related to "ABI," "clinical assessment," and "digital tools" was developed a priori. Studies from 2013 to 2024 leveraging digital health tools, for example, smartphones, tablets, websites, telemedicine, and virtual reality, to aid ABI complication assessment were included. Exclusion criteria comprised studies involving bespoke clinical hardware (eg, radiographs and EEG monitors), nonhuman subjects, or review articles. Following this, data synthesis and domain mapping were performed. Of 5293 screened records, 88 met the inclusion criteria: 2 retrospective studies, 4 qualitative studies, 35 cohort studies, 42 cross-sectional studies, and 5 randomized controlled trials. The median sample included 26 participants with ABI; 51 studies also involved non-ABI participants (median of 10 participants included). Digital platforms varied, with 45 studies using smartphone or tablet technologies, 23 PC or web-based platforms, 11 telemedicine solutions, and 9 virtual reality platforms. The predominant research themes included the use of digital technology to aid screening for traumatic brain injury, identifying or monitoring symptoms or functional outcomes; physical examination, the assessment of cognition and communication, and providing a comprehensive consultation. Most tools were reported to be well-tolerated, with accuracy often described as comparable to standard assessments. However, the studies were heterogeneous, with limited validation of tools across broad representative populations or multiple sites or studies. There was also little discussion on potential ethical concerns such as accessibility, access, and data privacy. This investigation provides an extensive overview of current research trends and highlights the need for larger, more rigorous studies to optimize the use of digital technologies in ABI assessment, as well as gaps in the assessment of common complications. Expanding research into underexplored ABI complications, broadening the scope of assessments to include a broader range of complications, and including larger, more diverse populations will be critical for advancing the field and improving outcomes for individuals with ABI.

Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP ApproachTM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP ApproachTM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge.

Objective Evaluate the internal consistency, inter-rater and test–retest reliability, convergent and divergent validity and clinical usability of the Cognition in Daily Life scale for patients with acquired brain injury. Design Validation study. Participants A total of 75 patients with acquired brain injury (mostly male [n = 47, 68%]; mean age 67 years) were recruited from inpatient care facilities. Sixty participants (81%) had sustained a stroke. Main measures Outcome measure: Cognition in Daily Life scale. Reference measures: Utrecht Scale for Rehabilitation-Cognition subscale, Montreal Cognitive Assessment, Barthel Index, Hospital Anxiety and Depression Scale and Fatigue Severity Scale. Results After removing redundant items, all subscales of the Cognition in Daily Life scale demonstrated satisfactory internal consistency. Test–retest reliability was good (intraclass correlation coefficient [ICC] = 0.847), and inter-rater reliability was moderate (ICC = 0.615). Convergent validity was confirmed through moderately strong correlations between most subscales of the Cognition in Daily Life Scale and other measures of cognition. Cognition in Daily Life subscales generally did not correlate with the Hospital Anxiety and Depression Scale and Fatigue Severity Scale, indicating divergent validity. Moderate correlations with the Barthel Index suggested related, but distinct constructs. Clinicians found the Cognition in Daily Life scale easy to administer and relevant for practice, though time-consuming. They suggested layout improvements for greater usability. Conclusion The Cognition in Daily Life scale is adequately valid, reliable and clinically usable for assessing cognition in daily life in patients with acquired brain injury in a clinical setting. Future research needs to evaluate the scale's sensitivity to change and its performance in other settings and populations.

Self-awareness (SA) is a crucial component of the neurorehabilitation processes for persons with acquired brain injury. Specific intervention programs to improve SA have been developed and implemented with heterogeneous results. The current study was undertaken to summarize this evidence by conducting a systematic review of relevant literature and to perform a meta-analysis of the most reliable and important results. A systematic literature search made in May 2023 across three databases (Web of Science, PubMed, and PsycINFO) resulted in a final selection of 16 primary studies based on 17 different groups. In an initial meta-analysis, the effect sizes were calculated as the standardized d, that is, pre-post change scores corrected for bias. Using a random-effects model, we obtained a significant mean effect size for the interventions, k = 17, g = 0.6404 [0.411, 0.870] with significant heterogeneity among the studies, Q(16) = 43.06, p < .001, and a significant, but modest publication bias. Moderator analysis showed that the SA intervention efficacy could be improved by "metacognition" as an intervention technique. A second meta-analysis was carried out considering the seven studies with between-subjects designs, and again a significant mean effect size was obtained, k = 7, g = 0.6713 [0.403, 0.94]. Overall, the present study provided positive evidence to support the efficacy of specific SA interventions in adults with acquired brain injury. Further studies are warranted to explore the mechanisms by which SA interventions exert their effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Towards precision rehabilitation medicine after acquired brain injury: Exploring the prediction of patient independence using structured clinical data.

Background: Acquired brain injury (ABI) often produces heterogeneous cognitive and emotional outcomes that are not fully explained by conventional neuropsychological testing. Diffusion tensor imaging (DTI) tractography may capture patient-specific patterns of white matter connectivity and thereby complement clinical assessment. Methods: We conducted an exploratory case series of nine patients in the subacute phase of ABI (traumatic brain injury or subarachnoid hemorrhage). Each underwent a brief cognitive-emotional battery and 1.5 T DTI with deterministic tractography of major association tracts and the corpus callosum. Tract lateralization was quantified using the Structural Asymmetry Index (SAI), and individual profiles were compared with neuropsychological and emotional data. Results: Six patients met criteria for clinically significant anxiety, and four for depression, often dissociated from global cognitive screening. Tractography revealed heterogeneous asymmetry patterns, most often in the superior longitudinal fasciculus, uncinate fasciculus, and cingulum. In several cases, structural asymmetries diverged from neuropsychological findings, suggesting dissociations between behavioral testing and connectivity-based measures. Conclusions: Within-subject tract asymmetry analysis provided preliminary, potentially clinically relevant information not captured by tests alone. These findings indicate that individualized tractography could enrich the interpretation of cognitive and emotional profiles and help guide hypothesis generation for connectivity-informed neurorehabilitation.

BackgroundPeople who sustain a concussion and live in remote areas can experience challenges in accessing specialized assessments. In these cases, virtual approaches to assessment are of value. There is limited information on important psychometric properties of physical assessment measures used to evaluate people postconcussion virtually.ObjectiveThe aims of this method-comparison psychometric study were to determine (1) inter- and intrarater reliability of a battery of concussion physical tests administered virtually in people with brain injury and (2) sensitivity and specificity of the virtual battery when compared to the in-person assessment.MethodsA total of 60 people living with acquired brain injuries attended an in-person and virtual assessment at the Ottawa Hospital Rehabilitation Centre. The order of the assessments, in-person and virtual, was randomized. The following physical measures were administered in-person and virtually: finger-to-nose test, vestibular ocular motor screening (VOMS), static balance testing (double leg, single leg, and tandem), saccades, cervical spine range of motion, and evaluation of effort. The virtual assessment was recorded, and a second clinician viewed and independently documented findings from the recordings twice at 1-month intervals.ResultsThe mean age of the participants was 45.65 (SD 16.50) years. The sensitivity metrics ranged from moderate (60%, 95% CI 30-86) to excellent (100%, 95% CI 71-100) for saccades and cervical spine right lateral flexion, respectively. Specificity ranged from 75%, 95% CI 35-95 to 100%, 95% CI 91-100 for left single leg stance eyes closed and left finger-to-nose testing, respectively. The interrater reliability ranged from poor for cervical spine extension (Cohen κ=0.20, 95% CI −0.07 to 0.47) to excellent for VOMS change in symptoms (Cohen κ=0.93, 95% CI 0.83-1). The intrarater reliability ranged from poor for cervical spine extension (Cohen κ=0.31, 95% CI 0.04-0.58) to excellent for the finger-to-nose testing on the right (Cohen κ=0.90, 95% CI 0.71-1). The wide CIs highlight variability in precision and suggest that further research with larger samples is needed before clinical use can be fully standardized.ConclusionsThis study provides information on the psychometric properties associated with virtual administration of concussion measures. The VOMS change in symptoms measure appears to have the most promising properties when administered virtually when in-person visits are not possible. This is particularly relevant for patients in rural areas, for those facing access barriers, and in contexts where timely follow-up is challenging. However, caution should be maintained when administering certain concussion measures virtually. The wide CIs for some measures caution against over-reliance on single test findings, and clinicians should consider both the strengths and limitations of virtual delivery. Clinicians are encouraged to make informed decisions about which measures can be effectively used remotely, and which may still require in-person administration to maintain accuracy.

ABSTRACT Objective To investigate the role of social cognition in relationship satisfaction and continuity among couples following an acquired brain injury (ABI) in one partner. Method A total of 64 participants, each in a relationship with an individual who had experienced an ABI, completed assessments evaluating their partner’s social cognition, their own relationship satisfaction both before and after the injury, and a measure of relational continuity post-injury. Results Participants reported a significant decline in relationship satisfaction following their partner’s ABI. Those indicating a substantial decrease in satisfaction had partners with notably lower social cognition scores compared to those reporting minimal changes. Regression analysis demonstrated that overall social cognition scores significantly predicted relational continuity; however, no individual domain within the social cognition measures independently predicted continuity outcomes. Conclusion Social cognition deficits in individuals with ABI are associated with decreased relationship satisfaction and continuity. These findings highlight the importance of assessing and addressing social cognition in rehabilitation programs to support couples in maintaining relationship satisfaction and continuity following ABI.

Introduction: Acquired brain injury (ABI) produces significant cognitive, motor, and psychosocial impairments that affect people’s daily functioning. Rehabilitation programs increasingly combine physical activity with neuropsychological strategies for greater effectiveness. Purpose: The aim of this study was to analyze the effects of neurophysiotherapy based on physical activity and neuropsychological rehabilitation on cognitive and psychosocial functioning in individuals with an acquired brain injury (ABI). Method: A total of 19 individuals between the ages of 24 and 89 years (M ± SD: age = 59.26 ± 19.01) belonging to the Acquired Brain Injury Association of Málaga (ADACEMA) participated in this study. A quasi-experimental design with pre- and post-test measures and multiple experimental groups was used. The instruments used were the digit subtest of the Barcelona Test, the Five Digit Test (FDT), the Tower of Hanoi, the modified six-element subtest of the Behavioural Assessment of the Dysexecutive Syndrome, the Trail Making Test (TMT), the WHOQOL-BREF, and the Profile of Mood States (POMS) questionnaire. The Kruskal–Wallis H, Mann–Whitney U, and Wilcoxon tests were used to analyze the data. Results: The results obtained showed a positive effect of physical activity (PA) combined with neuropsychological rehabilitation on working memory, planning, emotional well-being, personal relationships, depressive symptoms, and overall quality of life. Conclusions: The findings suggest that combining neurophysiotherapeutic physical-activity-based rehabilitation with other neuropsychological interventions may be a promising approach to improving executive functioning, emotional well-being, and quality of life in people with an ABI. These preliminary results highlight the potential value of multidisciplinary programs in post-injury recovery, although further studies with larger and more homogeneous samples are needed to confirm these effects.

Background: This study validated the Italian version of the Confusion Assessment Protocol (CAP), a tool designed to assess Post-Traumatic Confusional State (PTCS) in patients with severe acquired brain injury (sABI) who are not evaluable with standard neuropsychological evaluations. Objectives: The primary aim of this study was to promote the CAP as a tool for assessing patients who are not still eligible for standard neuropsychological evaluation and to adapt it to Italian-speaking sABI patients by translating it into Italian and conducting a cross-cultural adaptation and evaluating its psychometric properties. The secondary objective was to correlate the CAP scores with broader functional scales, such as the Levels of Cognitive Functioning Assessment Scale (LCF) and Disability Rating Scale (DRS). Methods: A total of 42 sABI patients were enrolled at IRCCS Fondazione Santa Lucia. The CAP was translated and culturally adapted using international back-translation guidelines. Cross-cultural validity was assessed in 20 patients. The final version was administered by three trained raters over two days to evaluate inter- and intra-rater reliability. Results: The Italian version of the CAP demonstrated high internal consistency and substantial inter-rater reliability for key symptoms, including night-time sleep disturbances, decreased daytime arousal, and psychotic-type symptoms. Cognitive impairment showed moderate inter-rater agreement, likely due to symptom fluctuations typical of this recovery phase. The convergent validity of the CAP was confirmed through its correlations with the Levels of Cognitive Functioning (LCF) and the Disability Rating Scale (DRS), demonstrating its clinical utility in integrating cognitive and behavioral symptom assessments. Conclusions: The Italian version of the CAP is a reliable and valid tool for assessing PTCS in sABI. Future developments should address limitations related to symptom intensity, behavioral domains, and differential symptom weighting.

Assistive technology can change the way executive function support is provided to people with acquired brain injury (ABI). However, tools to guide consideration and selection of technology for cognitive support are lacking. The aim of this study was to co-design and co-produce a tool that can be used by assistive technology advisors collaborating with people with ABI to evaluate assistive products used for cognitive support. McKercher's six-phase co-design process was used. A small circle co-design group was purposively constructed including people with ABI lived experience, practicing health professional and researchers, and injury and disability insurers. The small circle co-design work was coupled with large circle stakeholder engagement across three online health professional workshops and one in-person workshop. A Framework for the Evaluation of Assistive Technology was drafted, tested and refined using detailed co-design and co-production processes across six phases. Workshop feedback was iteratively incorporated to finalise the framework. The Framework for the Evaluation of Assistive Technology is now available for use via a free website, called My Technology Space. Co-design of the Framework for the Evaluation of Assistive Technology across multiple phases of work enhanced its utility and drew on perspectives of people with ABI who use assistive technology, as well as health professionals and funders of assistive products and services.

Decannulation outcomes in pediatric patients with acquired brain injury: a retrospective study

BackgroundAfter a severe acquired brain injury (sABI), individuals might experience mild-to-severe cognitive impairments. In these patients, cognitive rehabilitation is provided as early as possible, to take advantage of and guide brain plasticity. According to a restorative approach, traditional cognitive training (TCT) usually involves repeated paper-and-pencil exercises of increasing difficulty and targeting specific cognitive domains. Recently, some evidence supported the use of virtual reality (VR) for ABI rehabilitation, particularly focusing on stroke cases. Nonetheless, there is limited evidence in sABI and in different etiologies. The present multicenter randomized controlled trial aims at exploring the effectiveness, in terms of clinical-functional, neurophysiological, and biomarker changes, of a cognitive rehabilitation focused on executive functions performed by a non-immersive VR device, compared to TCT, in a cohort of patients with sABI.MethodsAccording to an a priori power analysis, 28 adult patients with sABI will be enrolled by 5 Italian neurorehabilitation units within the Fit for Medical Robotics (https://www.fit4medrob.it/) Consortium. Patients will be randomly assigned to receive either 30 min of VR or TCT sessions each day throughout the trial. At study entry (T0), patients will undergo clinical-functional evaluation, neurophysiological assessments, and serum blood sampling. Thereafter, VR or TCT will be provided daily, five times per week, for 5 weeks (25 total treatment sessions). Clinical-functional and neurophysiological assessments will be repeated at the end of the treatment (T1). A follow-up evaluation will be performed after 1 month from T1 (T2). Statistical analyses will be conducted blindly, according to the intention-to-treat principle.DiscussionVR has recently been gaining popularity as a cognitive rehabilitation tool. Notwithstanding substantial evidence supporting the use of VR for ABI rehabilitation, there is limited evidence in sABI from traumatic or anoxic etiology. This multicenter pragmatic trial will provide new insights into the effectiveness of VR in sABI cognitive rehabilitation.Trial registrationClinicalTrials.gov NCT06474871. Registered on December 2, 2024.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09128-7.

Purpose Acquired brain injury (ABI) encompasses any injury to the brain that occurs after birth and impacts an estimated two million people in the UK. The invisible deficits associated with ABI can leave individuals at risk from a range of safeguarding issues including abuse, neglect and self-neglect. The purpose of this study is to investigate brain injury case managers (BICMs) experiences of raising safeguarding concerns about clients with ABI with local authority statutory services within the UK. Design/methodology/approach Sixty-one BICMs responded to a mixed-methods online survey about safeguarding concerns and practice, with a further seven BICMs being interviewed using a semi-structured approach. Qualitative data were combined across the two stages of study and analysed using thematic analysis. Quantitative data were analysed descriptively. Findings On average BICMs reported 17.72 safeguarding concerns raised about their clients with ABI within the 12-month period prior to data collection. All respondents stated that safeguarding concerns were directly linked to their clients’ cognitive and behavioural impairments. Safeguarding concerns related to psychological, emotional and financial factors. The qualitative data identified a “lack of understanding of ABI”, “absence of information sharing and communication”, “failure to assess mental capacity” and poor “safeguarding training” within statutory services led to inadequate response to safeguarding concerns. Addressing these factors could lead to “improved client outcomes”, such as improved wellbeing and reduced levels of abuse and/ or neglect. Originality/value This study adds to the increasing volume of literature highlighting the safeguarding issues associated with ABI but is the first to analyse service data pertaining to safeguarding concerns in this area.

This study aimed to examine the clinical relevance and usability of the digital self-report version of the Mayo-Portland Adaptability Inventory - fourth edition, MPAI-4 (MPAI-4-S-dig). In its paper version, MPAI-4 is well validated for patients with acquired brain injuries (ABIs) and neurological disorders (NDs), but time consuming. An additional aim was to investigate whether MPAI-4-S-dig is reliable for repeated measurements. Community neurorehabilitation in Stockholm, Sweden. MPAI-4-S-dig was administered to 40 patients with ABI or ND 2 weeks apart. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC); clinical relevance of data was assessed through Pearson's Correlation Coefficient with Montreal Cognitive Assessment (MoCA), the Community Integration Questionnaire - Revised (CIQ-R), and Hospital Anxiety and Depression Scale (HADS). ICC values ranged from 0.86 to 0.93 for total and subscales. Significant correlations were found between MPAI-4-S-dig participation and CIQ-R Total, social integration and home integration and MoCA naming, MPAI-4-S-dig adjustment and CIQ-R Social integration, MPAI-4-S-dig Total and all subscale scores and HADS Anxiety score, MPAI-4-S-dig Total, abilities and participation and HADS Depression. The demonstrated reliability and clinical relevance of MPAI-4-S-dig for patients undergoing neurorehabilitation permits the implementation of digital data capture in patients with mild acquired cognitive impairment.

Background: The Coma Recovery Scale–Revised (CRS-R) is the gold standard for diagnosing chronic disorders of consciousness (DoC); however, its clinical utility is limited by lengthy administration and the need for specialized training. The Simplified Evaluation of Disorders of Consciousness (SECONDs) provides a faster and more user-friendly alternative. Objective: This study aims to evaluate the validity and reliability of the Argentine adaptation of the SECONDs scale in adults with chronic DoC due to acquired brain injury. Methods: Twenty-nine patients were evaluated over two consecutive days by three blinded raters. On day one, rater A administered the SECONDs (A1) and rater B administered the CRS-R (B) to assess concurrent validity. On day two, rater A repeated the SECONDs (A2), and rater C performed an additional SECONDs assessment (C), permitting evaluation of intra-rater (A1 vs. A2) and inter-rater (A vs. C) reliability. Results: The SECONDs demonstrated excellent intra-rater (ICC = 0.98) and inter-rater (ICC = 0.86) reliability. Concurrent validity with the CRS-R was strong (r = 0.73, p < 0.001). Diagnostic agreement was high between A1 and B (κ = 0.75) and between both A1-A2 and A1-C (κ = 0.82). The median administration time was significantly shorter for the SECONDs (10 vs. 15 min; p < 0.001). Conclusion: The Argentine SECONDs is a valid, reliable, and efficient tool for the clinical assessment of DoC patients in rehabilitation settings.

Objective: This study aims to evaluate the effectiveness of a combined rehabilitative program integrating Graded Motor Imagery (GMI) and Occupational Therapy in improving upper limb function and autonomy in individuals with acquired brain injuries (ABIs), including stroke and traumatic brain injury. Methods: Twelve patients (mean age of 56.4 years) underwent a six-week intervention combining GMI and Occupational Therapy. Outcome measures included the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), Jebsen Taylor Hand Function Test (JTHFT), Canadian Occupational Performance Measure (COPM), 12-Item Short Form Health Survey (SF-12), Numeric Rating Scale for pain (NRS), and Montreal Cognitive Assessment (MoCA). Assessments were conducted at baseline, post-treatment, and at 3- and 6-month follow-ups. Data were analyzed using the Wilcoxon signed-rank test. Results: Statistically significant improvements (p < 0.05) were found in upper limb function (DASH), occupational performance and satisfaction (COPM), and physical health status (SF-12 physical component). Specific gains in hand function—particularly in writing and eating—were detected using the JTHFT. No significant changes were observed in pain perception or mental health outcomes. Conclusions: The integration of GMI with Occupational Therapy appears to be a promising and well-tolerated intervention for enhancing motor function and daily life participation in individuals with ABI. Although the small sample limits generalizability, these preliminary findings support further investigation through larger, controlled studies.

Abstract Background Acquired brain injury (ABI) poses a significant burden on healthcare systems and society, with high acute and long-term costs. Integrated care-encompassing medical, rehabilitative, and vocational services-can support recovery and sustainable reintegration. In Switzerland, however, services remain fragmented and poorly coordinated, with efforts focused mainly on healthcare, often neglecting the vocational and social aspects funded by social security. People with ABI and their families frequently feel overwhelmed navigating this complex system. Poor coordination among institutions delays interventions, increases chronicity, and hinders integration. Objectives To develop user-centered recommendations to support individuals with ABI and their families in navigating the Swiss health and social security systems. Methods An Integrated Knowledge Translation (IKT) approach was used, involving a project team that included a person with ABI, professionals, and representatives from disability insurance and an employers’ association. Focus groups with persons with ABI, professionals, and employers, and surveys with rehabilitation centers and social security offices, identified key challenges and solutions. An expert panel refined the recommendations, which were finalized through a Delphi survey with persons with ABI and family members. Results Between July 2023 and May 2025, ten recommendation areas were identified, including diagnosis, prognosis, care transitions, insurance, rehabilitation, and vocational reintegration. Each area includes background information, practical guidance, and relevant contact points. Conclusions The IKT approach enabled the co-creation of targeted recommendations that reflect the needs of individuals with ABI. The final resource offers structured, accessible guidance to individuals with ABI to navigate complex service systems, reduce delays, and support sustainable integration. Key messages • Using an IKT approach, stakeholder-informed recommendations were co-developed to improve service navigation. • The final set of recommendations supports timely access to coordinated services, promoting sustainable recovery and societal reintegration for people with ABI.