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Brain Impairment Brain Impairment Society
Journal of the Australasian Society for the Study of Brain Impairment
Table of Contents

Volume 25 Number 1 2024

Going home after a stroke is a significant milestone in the stroke recovery journey; however, stroke survivors have unmet needs in relation to discharge planning processes. Our survey found that healthcare professionals working in stroke care experience challenges in coordinating care between services, resulting in inconsistent practice. Our study suggests that clearer guidance and support is needed to improve communication between hospital-based clinicians and primary and community care providers, which will benefit outcomes for stroke survivors.

This article belongs to the Collection Clinical Implementation to Optimise Outcomes.

This descriptive qualitative study explores the perceived changes within a community-based organisation following the implementation of a strength-based approach for people living with the sequela of a traumatic brain injury. Positive changes resulting from the implementation process were revealed through semi-structured interviews with community support workers of the organisation.

IB23091Developing consensus-based clinical competencies to guide stroke clinicians in the implementation of psychological care in aphasia rehabilitation

Caroline Baker 0000-0001-8605-5181, Brooke Ryan, Miranda L. Rose, Ian Kneebone, Shirley Thomas, Dana Wong and Sarah J. Wallace

People with aphasia after stroke can have difficulty with conversations, healthcare decisions, relationships and returning to work. Aphasia can have negative impacts on psychological and mental health, such as depression and anxiety. Stroke clinicians report a lack of knowledge and skills in how to best support communication and psychological care needs. Consumers with lived experience of aphasia and expert clinicians contributed to the identification of a preliminary list of clinical competencies to guide clinician skill development.

This article belongs to the Collection Clinical Implementation to Optimise Outcomes.

Stroke survivors often disagree with others (e.g. clinicians) regarding the nature and extent of their post-stroke impairments – a phenomenon termed ‘impaired self-awareness’ (ISA). Using 45 stroke survivors, this study examined biological, psychological and social factors associated with ISA at two time points during rehabilitation. ISA was associated with a number of biopsychosocial markers of poorer outcomes across the rehabilitation journey. Results highlighted the clinical importance of ISA and suggested there may be value in biopsychosocial-informed assessment and management approaches.

IB23062Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey

Jennifer Fleming 0000-0002-5603-2410, Sarah Prescott, Larissa Claridge, Emmah Doig 0000-0002-7020-053X, Anna Copley 0000-0003-1784-9070, Emma Finch 0000-0002-9690-8165, Christina Kerr and Julie Henry 0000-0002-2081-3717

A needs analysis of 103 providers of cognitive rehabilitation services to people with brain injury in Queensland indicated a need for further training in this complex area of practice. Respondents perceived a need for further training on the management of complex impairments such as in executive function, self-awareness and functional cognition. There was a preference for flexible delivery of training with support from the workplace to overcome barriers associated with time constraints and affordability.

Children and young people with acquired brain injury (CYP-ABI) and their families experience long-term impact on their well-being and participation in activities at home, school and in their community. They have substantial unmet needs and face multiple barriers, with a lack of awareness and understanding, support for parents and cross-sector collaboration being key. The findings are informing intervention development and recommendations for improving service provision to ensure the needs of CYP-ABI and their families are met and they experience improved health and well-being.

This article belongs to the Collection Clinical Implementation to Optimise Outcomes.

Although people with acquired brain injury (ABI) may be vulnerable to online scams, there are no existing ways of assessing cyberscam risks or the effectiveness of interventions for people with ABI. A screening tool (‘The CyberABIlity Scale’) was developed and revised based on feedback from clinicians and people with ABI. The CyberABIlity Scale was found to be accessible and relevant, and has the potential to be an effective tool for identifying online vulnerability for people with ABI.

Helping patients navigate changes in sexual functioning and wellbeing after traumatic brain injury is an important aspect of recovery often overlooked in health care. This study tackles the hesitancy around discussing sexuality by identifying barriers and enablers and co-designing solutions with a healthcare team. This exploration revealed the importance of addressing institutional and environmental barriers to tackle the discomfort in addressing sexuality and to achieve sustainable behavioural change within healthcare teams.

This article belongs to the Collection Clinical Implementation to Optimise Outcomes.

IB23072Quality of life and broader experiences of those with acoustic neuroma: a mixed methods approach

Lior Ben-Harosh, Suzanne Barker-Collo, Alicja Nowacka, Joanne Garrett and Anna Miles 0000-0003-3260-5824

This study explored the experiences of people with an acoustic neuroma in New Zealand. We asked about changes to quality of life and the provision of information, support and services. We concluded that there are negative impacts of acoustic neuroma for New Zealanders and gaps in person‐centred care, such as provision of information, education, and access to formal and informal support. There is a need for practical information, education and support during diagnosis, treatment and post‐treatment.

IB23066What does cognitive screening reveal about early cognitive performance following endovascular clot retrieval and intravenous thrombolysis in acute ischaemic stroke?

Sam Humphrey 0000-0002-0404-7047, Kerryn E. Pike 0000-0002-0474-1215, Brian Long, Henry Ma, Robert Bourke, Danielle Byrne, Bradley Wright and Dana Wong 0000-0001-9619-1929

Cognitive impairment is common after stroke and can have an ongoing negative impact on the everyday lives of stroke survivors. However, little is known about cognitive outcomes following different treatments for ischaemic stroke. We found that treatment with clot retrieval was associated with better performance on a measure of cognitive screening in the days following a stroke, indicating that clot retrieval may improve cognitive outcomes in addition to its established benefit in reducing the degree of disability in treated patients.

Traumatic brain injury (TBI) is associated with lifelong consequences. The potential for long-term negative consequences from multiple TBIs has inspired discussion about how to measure Lifetime TBI Exposure (LTE). This pilot study applied an online version of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) for LTE screening in the general adult population in Australia. Results indicated that the online OSU TBI-ID is a feasible and valid measure for assessing LTE. This method could assist in identifying TBIs that have previously gone unrecognised, unreported, or untreated.

There are more than 400 000 Australians living with dementia and an estimated 200 000 family or friends providing care to them. While the carer’s experience can be a positive one, it can also be very stressful. This study shows that an online carer support program was received well and can be helpful in improving mood. Support should be offered to all carers of people living with dementia.

Symptoms associated with concussion (e.g. headaches, tiredness) are experienced in the absence of concussion such that it’s important to understand how symptoms are experienced among people without concussion. We asked adults without a brain injury how they experience concussion-like symptoms and found that people with higher levels of worry about illness and negative feelings tended to experience greater symptom severity. These findings highlight the importance of interpreting symptom experience in concussion populations in the context of a broader clinical picture.

Stigma surrounding Acquired Brain Injury (ABI) significantly impacts the recovery process of survivors, and it represents an area of immense importance that is gaining overdue attention. This review conceptualizes and offers evidence about the four main types of stigma after ABI: self-stigma, public stigma, stigma-by-association and implicit/explicit stigma. Understanding these nuances not only sheds light on the challenges faced by ABI survivors, but also provides a roadmap for developing interventions that support overall recovery and societal inclusion.

IB23087An exploration of families’ lived experiences of attention-related communication difficulties following traumatic brain injury

Maegan VanSolkema 0000-0002-6705-3022, Clare M. McCann 0000-0003-1221-608X, Laura Dixon, Jemma Horne, Suzanne Barker-Collo 0000-0002-8659-0202 and Allison Foster 0000-0001-8779-6088

Communication difficulties following traumatic brain injury (TBI) can affect both the individual and the family following the injury.  This paper reviews the specific nature of attention-related difficulties following TBI on the family through qualitative analysis of interviews.  Families were found to adapt their social lives and implement specific strategies to improve the ability of their loved ones to interact and participate in conversations.

Scientific conferences are a common way for researchers to share their findings, but the impact of conference participation on clinical and research practice is not well understood. In our survey of clinicians, researchers and students who attended a stroke conference, participants reported that conferences are more influential in changing clinical practice than journal articles. This suggests that conference presentations can be a useful method for enhancing evidence‐based practice.

People with acquired brain injuries often require long-term tracheostomy tubes, yet there is a lack of standardised guidelines for decannulation that consider the complex motor, sensory, and cognitive presentations. This systematic review found evidence that a formalised process for decannulation reduced the duration of tracheostomy for individuals with acquired brain injuries. This finding holds significance for clinical practice and underscores the need for further, more rigorous research.

IB23071A scoping review of remote group-based psychological interventions for people after transient ischemic attack and stroke

Jade Kettlewell 0000-0002-6713-4551, Eirini Kontou 0000-0001-5837-9891, Abigail R. Lee 0000-0003-2931-8111, Shirley Thomas 0000-0003-0704-9387, Naomi Thorpe 0000-0002-4539-8564 and Dana Wong 0000-0001-9619-1929

Evidence suggests remotely delivered interventions can support psychological issues following stroke or transient ischemic attack (TIA). However, it is unclear whether this approach is effective and acceptable. This review aimed to identify current evidence for remote group-based psychological interventions post-TIA/stroke. Six studies involving stroke patients were reviewed. No studies included TIA patients. Improved mood and/or quality of life was reported in the four studies. More research is needed to explore the potential benefits of, and barriers to, remote group-based interventions in this population.

IB23074Addressing unmet needs following minor stroke (SUN study): a randomised controlled trial

Emma Finch 0000-0002-9690-8165, Tegan Cruwys, Jennifer Fleming, Ian Williams, Ashley Cameron, Adele Coleman, Philip Aitken, Katherine Jaques and Darshan Shah

Despite the name, people with minor stroke can experience debilitating long‐term consequences post‐stroke that impact on multiple areas of everyday life. Our study found that a new multicomponent treatment can improve wellbeing in people with a minor stroke but did not fully meet all their unmet needs. Further research is required; however, the new treatment has the potential to provide a service pathway for people with minor stroke that could be used by other health services.

Understanding how Australian speech-language pathologists (SLPs) assess cognitive-communication disorders in children and adolescents with traumatic brain injuries (TBIs) is crucial for improving paediatric care. In a survey of 111 SLPs, although professional optimism was high, results found diverse measurement practices and feelings of nervousness and difficulty among clinicians. These insights highlight the need for standardized practices and enhanced training to ensure accurate and consistent assessments to ultimately improve outcomes for children and adolescents recovering from TBIs.

IB23085Anxiety and depressive symptoms during hospitalisation are strong predictors of post-stroke anxiety: a prospective study

Stefany Elias, Maria Luiza Benevides, André Martins, Gladys Martins, Ana Marcos and Jean Nunes

Ischemic stroke is a leading cause of mortality worldwide and anxiety symptoms after stroke are frequent. Symptoms of anxiety and depression during stroke hospitalisation are strongly associated with anxiety 90 days after stroke. Early identification of patients at greater risk of developing anxiety 90 days after stroke is relevant as it allows a timely diagnosis and appropriate treatment.

Fatigue is one of the biggest problems for everyday life following a brain injury. There are some treatment approaches that have positive effects but these do not adopt the team approach that is promoted for brain injury rehabilitation. The findings highlight  that further research is needed to develop, evaluate, and implement a team approach to fatigue that can reduce the impacts on everyday life. 

Motor imagery is a promising treatment tool for Parkinson’s Disease. One benefit of motor imagery is that it can be safely carried out in an individual’s home. However, little guidance exists for researchers and clinicians who are interested in implementing a motor imagery intervention for people with Parkinson’s Disease. This study examined patient and therapist perspectives on home-based motor imagery training programs. These perspectives are then integrated with the established literature to provide recommendations for the implementation of such programs.

In this letter to the editor, additional commentary is provided to the article by Beal et al., titled ‘Lockdown life ‐ Experiences of partners of individuals with an acquired brain injury during the COVID‐19 pandemic: A qualitative study’. One limitation of this study that could have further refined the findings was the lack of detail on the severity of the patients’ ABIs. Regardless, the study excellently highlights the importance of providing support to patients’ partners.

Young adults (aged 18–65) with acquired disability and complex needs are at risk of being stuck in hospital or discharged to nursing homes. This study focused on improving hospital discharge for young adults with acquired disability and complex needs. It found that effective discharge involves coordinated care, involving people and their families in planning, and collaboratively arranging community support and housing. Better communication and early arrangements for support are key to successful transitions from hospital to community.

IB23079Being a pioneer: a qualitative study of moving into individualised housing from the perspective of adults with neurological disability

J. Douglas 0000-0003-0940-6624, D. Winkler 0000-0003-3899-6248, K. D’Cruz 0000-0002-5155-1350, S. Oliver 0000-0003-0841-0795, S. Liddicoat 0000-0001-6485-8223, J. Naismith and D. Wakim

Individualised housing has the potential to enable people with disability to realise their right to choose where and with whom they live. Understanding the experience of moving into individualised housing is critical to informing effective policy and the disability housing market. This study contributes new knowledge about the transition experience from the perspective of people with neurological disability and highlights the need for investment in transtion-specific policy and support models to better prepare and support people through the transition process.

Ageing involves changes in complex cognitive functions that result in a decline in autonomy and quality of life. Everyday cognition describes the capability to resolve complicated cognitive problems in one’s daily life. Our research has identified the advantages of an intervention based on everyday cognition, as it predicts improvements in daily performance. These expected enhancements relate to everyday performance and not only to specified cognitive functions, thus suggesting their potential application in the routine activities of older individuals.

The COVID‐19 pandemic has reshaped the way we support those with mental health challenges, highlighting the silent struggles of caregivers. This Letter to the Editor expands upon a recent study, revealing the heightened emotional toll on partners of brain injury patients due to pandemic‐related restrictions. It underscores the urgent need for tailored support mechanisms, spotlighting the resilience of families amid healthcare crises.

IB23069Processes for identifying and managing traumatic brain injury in the justice sector

Lara Wilson 0009-0004-8706-9699, Jason Chua 0000-0002-0224-2818, Christine Howard-Brown, Michelle Wilkinson, Kay Sloan, Kirsty Fraser and Alice Theadom 0000-0003-0351-6216

There is a high occurrence of brain injuries in offenders within the justice sector. This study interviewed staff working in the justice sector about how brain injuries are currently identified and managed. It was found that a national standard for screening for brain injuries, addressing factors affecting reporting of new injuries, provision of clear healthcare pathways and improved communication would help to improve how people are supported following brain injury in the justice sector.

IB23089Parent–child interaction after mild traumatic injury in preschoolers

Joy Noelle Yumul 0000-0002-8439-0020, Vicki Anderson 0000-0001-5233-3147, Cathy Catroppa 0000-0002-9750-0436 and Audrey McKinlay 0000-0001-9846-8514

Preschool children are heavily reliant on their parents to report on their symptoms after a mild traumatic brain injury. Little is currently known regarding what may impact parental reports, and this study found that the quality of parent‐child interaction is linked with parents’ ratings of child behaviour and post‐concussive symptoms. The quality of parent‐child interaction may provide important information when assessing recovery and possible avenues for intervention post‐injury.

Cognitive fatigue occurs frequently after brain injury and impacts functioning, but little is known about cognitive fatigue for children with brain injury. This paper found that children with brain injury had greater cognitive fatigue after school and weekend days than their peers without brain injury but that children with TBI had similar levels of fatigue after school compared to after a weekend. This study shows that children with brain injury might need supports to reduce fatigue in both school and leisure (weekend) settings.

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