Post-acute Brain Injury Rehabilitation Programme Research Articles

The Behavioural Assessment of Self-Structuring (BASS): A Factor Analysis in a Post-Acute Brain Injury Rehabilitation Programme

Research has indicated structure and a client’s ability to self-structure is integral to post-acute brain injury rehabilitation. Self-structuring has previously been theorised to include components referred to as Anchors, Scaffolding, and Strategies. A reliable and validated measure of self-structuring – The Behavioural Assessment of SelfStructuring (BASS) – was used in the current study aimed to identify possible sub-groups of the scale and further explore construct validity. 197 consecutive admissions to the Transitional Rehabilitation Units (TRU) were assessed using the BASS and the results were subjected to a varimax rotation factor analysis. Four factors were revealed, all of which could be related to the theoretical model of self-structuring including Systems (Scaffolding), Routines (Anchors), Awareness and Self-Regulation (both emerging as two sub-divisions of Strategies). Despite orthogonality, all four factors were highly correlated. Only age at brain injury and cause of brain injury showed a significant relationship with Awareness (Strategies), Routines (Anchors), and Systems (Scaffolding). No significant relationship was found for gender, age at admission or length of admission. In conclusion, the findings are consistent with previous research and confirm theoretical models of self-structuring. Further insight has been gained into the complexities of self-structuring as the results propose compelling evidence that the 26-items of the BASS can now be sub-divided into four distinct sub-categories: Awareness, Systems, Routines, and Self-Regulation. Sub-categories can now be utilised to identify individual strengths and areas of weakness within self-structuring. This can inform the adaptation of neurorehabilitation programmes or approaches dependent on client need, and change in scores could be evaluated over time.

Reduction in Post-concussive Symptom Severity Following Sub-Acute Interdisciplinary Cognitive Rehabilitation

To determine the utility of a structured, interdisciplinary, post-acute brain injury rehabilitation program in addressing persisting symptoms of brain injury.

Balint's syndrome and post-acute brain injury rehabilitation: A case report

Background: Balint's syndrome includes the clinical symptom triad of simultagnosia, ocular apraxia and optic ataxia. These symptoms, in combination, are rare and can be quite debilitating as they impact visuospatial skills, visual scanning and attentional mechanisms.Case Study: The literature addressing rehabilitation of individuals with Balint's syndrome is sparse. The current case report describes the outcome of a 58-year old male who presented with Balint's syndrome secondary to severe traumatic brain injury and following completion of a comprehensive post-acute brain injury rehabilitation programme. The patient was 4-months post-injury onset upon admission and received 6 months of rehabilitation services as an inpatient. The patient's comprehensive rehabilitation programme involved a 3-pronged approach including the implementation of (a) compensatory strategies, (b) remediation exercises and (c) transfer of learned skills in multiple environments and situations with implementation of psychoeducation and psychotherapy. Comprehensive neuropsychological and occupational therapy evaluations were performed at admission and at discharge in order to monitor cognitive, affective, neurological and functional change over time.Conclusions: Neuropsychological test improvements were noted on tasks that assess visuospatial functioning, although most gains were noted for functional and physical abilities.

Changes in supervision needs following participation in a residential post-acute brain injury rehabilitation programme

Objective: Supervision needs typically increase following moderate-to-severe traumatic brain injury (TBI). Research assessing the impact of TBI residential rehabilitation programmes on supervision needs is limited.Research design: Prospective cross-sectional study.Methods and procedures: Ninety-four participants with moderate-to-severe TBI admitted to a post-acute brain injury rehabilitation programme (PABIR) were administered the supervision rating scale (SRS) at admission and at 1 month post-discharge. To account for spontaneous neurological recovery, patients were separated into those who were less than 1 year (L1Y, n = 55) or greater than 1 year (G1Y, n = 39) post-injury.Experimental intervention: None.Main outcomes and results: A mixed factorial design yielded a significant interaction (F(1, 92) = 18.2; p < 0.0001) with post-hoc results revealing that the L1Y group improved more dramatically in terms of supervision needs than the G1Y group. Using reliable change methodologies, 52.7% of the L1Y demonstrated decreasing scores on the SRS vs 20.5% of the G1Y group.Conclusions: Decreases in supervision needs following PABIR can be found, even after accounting for the impact of spontaneous neurological recovery both at the group and individual level.

Postinjury Personality and Outcome in Acquired Brain Injury: The Millon Behavioral Medicine Diagnostic

To examine the relationship between postinjury personality and outcome in individuals with acquired brain injury. It was hypothesized that patients with differing levels of Introversive, Dejected, and Oppositional coping styles as described by Millon's Theory of Personality would show different outcomes after completion of a rehabilitation program. A retrospective chart review and completion of an outcome assessment was undertaken to examine study hypotheses. A postacute brain injury rehabilitation program. Fifty patients who completed the rehabilitation program between 2005 and 2008, who were 18 years of age or older, who possessed at least a sixth-grade reading level, and who completed a valid Millon Behavioral Medicine Diagnostic (MBMD) were selected. Rehabilitation therapists who worked with these patients were also recruited to assess patient outcomes. Charts of patients that met inclusion criteria were reviewed. Rehabilitation therapists completed the outcome measure retrospectively. The MBMD was used to predict outcome. The MBMD is a self-report questionnaire designed to assess psychosocial factors that relate to the course of medical treatment in chronic illness. The Mayo-Portland Adaptability Inventory (MPAI-4) was used to assess patient outcome. It is a 29-item assessment designed to evaluate the common physical, cognitive, emotional, behavioral, and social issues after acquired brain injury. Findings supported our hypotheses that patients with differing levels of Introversive and Oppositional Coping Styles would have significantly different outcomes after rehabilitation. Thus, individuals with mild/moderate to moderate/severe limitations had significantly greater scores on the Introversive and Oppositional coping compared with individuals with more successful outcomes. The results of this study support the idea that postinjury personality is an important factor in understanding outcome after completion of a brain-injury rehabilitation program. Personality variables accounted for significant variance above and beyond variance accounted for by the severity of the injury alone. These findings have important implications for the development and implementation of rehabilitation treatment planning.

Goal Attainment Scaling in Rehabilitation

Applications, controversies, and statistical issues related to goal attainment scaling (GAS) in rehabilitation are examined on the basis of available literature and outcome data from a postacute brain injury rehabilitation programme. Prior studies suggest that GAS is a promising method for measuring progress towards the type of highly individualised goals that characterise rehabilitation. GAS appears useful for (1) monitoring progress in a time-limited epoch of care, (2) structuring team conferences, (3) planning and making decisions about ongoing rehabilitation, (4) ensuring concise, relevant communication to the client, significant others, referral source, and funding sources, (5) guiding the delivery of social reinforcement, and (6) evaluating the programme. In brain injury rehabilitation specifically, the highly structured, systematic, and concrete goal-setting process provided by GAS may be helpful in (7) encouraging more accurate self-awareness, and for (8) redeveloping the capacity for goal setting. In rehabilitation settings, GAS has shown superior sensitivity to change compared to other functional outcome measures, excellent inter-rater reliability, and satisfactory concurrent validity with other outcome measures. Concerns about the idiosyncratic nature of GAS measures may not be as pertinent in rehabilitation as in mental health. For instance, the concurrent validity of GAS in rehabilitation generally appears stronger than in mental health settings. Nonetheless, GAS is probably best employed as one facet of a comprehensive outcome measurement system that also includes standardised measures of functional outcomes. The inclusion of GAS in a comprehensive outcome measurement system is recommended by its potential benefits, particularly its responsiveness to change, and its sensitivity to the values of clients.

Development of Critical Paths for Postacute Brain Injury Rehabilitation: Lessons Learned

One important tool for case management is critical path analysis. This article explains four critical pathways developed by an interdisciplinary team for a post-acute brain injury rehabilitation program. The heterogeneity of the brain injury population mandates the need for systematic coordination of direct care services. Yet, variations in the neurobehavioral consequences of brain injury necessitate differing goals and treatment tracks for individual clients. The critical pathways in this setting define and describe the procedures and services to be rendered from admission to discharge to achieve optimal goals for four treatment program tracks: Return to Work, Return to School, Functional Independence, and Neurorehabilitation. The tracks reflect a hierarchy of expectations for information processing and functional performance. Critical pathways provide a tool for enhancing communication among service providers and external case managers and for determining the extent to which a client's course of treatment compares with a clinical standard considered to be ideal. This article compares the four critical pathways, provides representative case samples, and discusses lessons learned in the development and implementation process.

The relationship between neuropsychological functioning and instrumental activities of daily living following acquired brain injury

The present study examined the ecological validity of neuropsychological tests relative to instrumental activities of daily living (IADLs) among 55 participants in a post-acute brain injury rehabilitation program. Stronger intellectual abilities, visual memory, delayed memory, verbal learning, and cognitive flexibility were significantly associated with success on the IADL tasks. However, each IADL task placed unique demands on cognitive abilities. Behavioral ratings of attention span and frustration tolerance also were positively related to task completion. Multiple aspects of patient functioning (neuropsychological abilities, self-regulatory behaviors), as well as task characteristics, must be considered to predict outcomes in everyday functioning.

Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation.

Relationships among two-month and final goal attainment scaling (GAS) scores, preadmission and final Portland Adaptability Inventory (PAI) scores, and work outcome for 16 graduates of a comprehensive, postacute brain injury rehabilitation program were examined. Final GAS scores were higher for program graduates who obtained the most desirable work outcomes, and preadmission and final PAI scores were lower for the successful program graduates. Final GAS scores were significantly correlated with other outcome measures. Preadmission PAI scores predicted work outcome, and two-month GAS scores predicted final GAS scores. Initial PAI scores distinguished between program successes and failures, but not between program successes and dropouts. A brief look at one case illustrates the modified application of GAS in postacute brain injury rehabilitation. Results of this study and case analyses support GAS as a quantifiable, individualized measure that is useful for (1) monitoring patient progress, (2) structuring team conferences, (3) ongoing rehabilitation planning and decision-making, (4) concise, relevant communication to family, referral sources, and funding sources, and (5) overall program evaluation when used in the context of other objective outcome measures. Although our results support the clinical utility of GAS, further study is recommended to assess the psychometric characteristics of GAS in this application.