Driving cessation can result in a range of negative consequences, including impacts on identity, mood, and life satisfaction. The aims of this study were to explore the needs and experiences of people who cease driving following a stroke, with the aim of informing clinical practice. Method: Using a qualitative phenomenological approach, semi-structured, audiotaped interviews were conducted to gain an understanding of the needs and experiences of 24 participants (17 male, 7 female, mean of 5.5 years post driving cessation) who had ceased driving following a stroke. Results: After constant comparative analysis, four themes emerged from the data. These were labelled ‘life without driving’, ‘key times of need’, ‘alternatives and other ways’, and ‘carer support and assistance’. Most participants found stopping driving after their stroke to be a sudden, unexpected and intense experience and raised issues, including the loss of numerous life-roles, challenges associated with arranging alternative transport, and reliance on carers and the need for more information throughout the process. Conclusion: Individuals who cease driving following a stroke have unmet needs and difficult experiences throughout the process. Key times of particular need have been identified in this study. These findings have important implications for health professionals that include providing more information and support with driving cessation and alternatives to driving.

Objective: To investigate the participation outcomes of individuals with severe acquired brain injury (ABI) who were provided with up to 12 months of intervention based on the Community Approach to Participation (CAP). Method: A case series study design was undertaken with a total of 85 participants from two private practices specialising in community-based, CAP rehabilitation for people with severe ABI. Inclusion criteria were the person had sustained an acquired brain injury, was aged over 18 years and had received up to 12 consecutive months of CAP input from one of the two practices within a three-year period between January 2004 and January 2007. Twenty-six of the 85 participants were an average of 343 days post injury (Early group) and 59 of the participants were an average of 10.2 years post injury (Late group). They were living in a range of community environments and residential facilities. Initial participants were identified for the study in January 2005. Data were gathered using the Functional Independence Measure (FIM™), Community Integration Questionnaire (CIQ), and Role Checklist (RC Part 1) at two time points: prior to intervention (baseline), and after a 12-month period or at discharge (TI). Within the intervention period, all participants received a customised community occupational therapy (OT) rehabilitation program based on the key principles of the CAP. Intervention focused on participation goals of the individual, and development of the associated skills that underpinned valued role performance. Results: Participants each received an average of 51.01 hours of CAP OT during the 12-month period of intervention. Considerable improvement was seen in functional independence, community integration, and role participation after intervention in both the Early and Late groups. A statistically significant increase in FIM™ and CIQ total scores was found for all participants from Baseline to T1. The number of roles in which participants engaged increased on average by almost one role per participant following intervention, from a mean of 3.06 to 3.99. Increased participation in volunteer, home maintainer, participant in organisations and hobbyist roles were most common. Conclusion: Increased functional independence, community integration, and participation in both the Early and Late groups over a 12 month period demonstrates the potential for improved participation outcomes for people with complex needs following ABI, even many years post injury.

Objective: To examine the care and support and participation outcomes for individuals with severe Acquired Brain Injury (ABI) provided with three consecutive years of Community Approach to Participation (CAP) intervention. Method: A case series study design was undertaken with a total of 43 participants from two private occupational therapy practices specialising in community-based, CAP rehabilitation for people with severe ABI. Data were collected at four time points: January 2004 (Baseline), January 2005 (T1), January 2006 (T2), and January 2007 (T3) and included rating on the Care and Needs Scale (CANS); number of hours of paid and gratuitous weekly support; FIM™ and Community Integration Questionnaire scores; and number of current life roles (as recorded on Part 1 of the Role Checklist). Participants were an average of 6.73 years post injury and were living in a range of community environments and residential facilities. Results: There was considerable change in participants' CANS rating across the intervention period, with statistically significant decreases occurring from Baseline to T1 and T1 to T2. Ninety-five per cent of participants received some level of weekly paid support throughout the intervention period, with the amount varying considerably. Paid care decreased by an average of 10.78 hours per week from 85.85 hours per week at Baseline to 75.06 at T3. Although not statistically significant, this equated to an average cost saving of AU$324.84 per participant per week by the end of CAP intervention. There was an overall mean reduction of 4.96 hours of gratuitous care per week per participant over the intervention period, which was statistically significant. Increases in functional independence, community integration, and role participation were also found. On the FIM™, statistically significant improvement occurred between Baseline and T1 and on the CIQ between Baseline and T1 and T1 and T2. Significant increase on the Role Checklist occurred between Baseline and T1 and between T2 and T3. The number of life roles in which participants engaged increased by an average of 1.65 roles by the end of the intervention period. A reduction in care and support needs (measured by the CANS) was significantly associated with: (1) a reduction in total care hours, (2) and an increase in functional independence on the FIM™, and (3) an increase in community integration on the CIQ. Conclusion: With a long term approach and contextualised intervention targeted at skill development in the areas that underpin personally valued participation, increased role performance and community integration can be achieved by people with severe ABI, even many years post injury. This increased capacity has been found to be associated with a reduction in care and support needs, including paid and gratuitous care hours, over time.

Three single participant studies examined effects of in-home parent-implemented Positive Behaviour Support (PBS) interventions on behaviour of individuals with brain injuries. Parental and independent observations of morning routine behaviour or problem behaviour (viz., noncompliance during meals or morning routines, yelling, kicking, swearing, and so on) were taken during baselines and PBS interventions, which consisted of person-centred functional assessments of behaviour, emphasis on changing behavioural antecedents, parent participation in assessing, treating, and evaluating behaviour change, and in-home parent coaching and support. Results show decreased problem behaviour or improved morning routine behaviour, which corroborate and add to the few studies that applied similar parent-implemented interventions. Future comparative studies between PBS and out-patient interventions are indicated.

This study aimed to assess planning ability in adults with traumatic brain injury (TBI) using a 4-disk version of the Tower of London (TOL). Thirty three individuals with TBI were compared with equivalent numbers of matched controls. Overall, the TOL4 was shown to be sensitive to the effects of brain injury, with the TBI group performing significantly more poorly on this version of the planning test than the matched controls. More specifically, group differences were found to be related to the complexity of the planning problems, particularly among a TBI subgroup with localised prefrontal damage. Results of the study provide support for the adverse effects of TBI on planning ability, and the important role of the prefrontal cortex in planning.

Objective: To explore the availability and perceived adequacy of service support for younger people with ABI and their families in Queensland during the transition phase from the perspective of service providers. Research Design: A qualitative research design utilising survey-based open-ended questioning. Methods and Procedures: Participants were service provider organisations in Queensland for younger people with aquired brain injury (ABI). A two-part survey was developed for the purpose of the study. The first part of the survey obtained general information regarding client base and service characteristics for each organisation, while the second part was designed to identify gaps in, and barriers and facilitators to service provision. Snowballing recruitment was used with the initial seed point an existing Brain Injury Network. Results: A response rate of 20% was obtained with a total of 12 surveys returned representing seven service providers. Services currently available included rehabilitation, consultancy, education and training, and practical and emotional supports. Existing gaps in, and barriers to service provision were clustered under three key themes: service infrastructure, transition support, and transition context. Some of the facilitators to service provision identified included interagency linkages and financial compensation for injury. Conclusions: Gaps in, and barriers to service provision during the transition phase were identified that could be utilised to develop models of service delivery to improve short- and long-term outcomes for younger people with ABI.