Introduction: The La Trobe Communication Questionnaire (LCQ) was developed to measure perceived social communication ability from various sources including the self-perceptions of individuals as well as those of others with whom they converse regularly (e.g., family members, friends and clinicians). It has been psychometrically evaluated with healthy young adults and adults with traumatic brain injury (TBI) and found to have acceptable reliability and validity. The present study was conducted to gauge the ability of the LCQ to distinguish between a group of adolescents who had sustained TBI and a control group of neurologically normal adolescents matched on the variables of socio-economic status (SES), age, gender and level of education completed. Method: Participants were 19 TBI dyads (TBI adolescents and close relatives) and 19 control dyads. All TBI adolescents had sustained severe injury (mean posttraumatic amnesia duration 33.76 days, SD 18.13) due to moving vehicle-related trauma. Mean age at the time of injury was 16.33 years (SD 1.67) and at the time of assessment 17.11years (SD 1.90). The LCQ was administered to all participants at home. Results: Perceptions of TBI adolescents and their relatives were significantly different from those of control dyads and consistent with a higher frequency of social communication difficulties in the TBI group. Difficulties reflected reduced conversational fluency and problems with managing the multiple demands of social discourse. Conclusions: The LCQ is a clinical tool that has sound potential to contribute to the multifaceted assessment of social communication in adolescents with TBI.

This article aimed to review the assessment and treatment of prospective memory impairment in individuals with traumatic brain injury. The three assessment techniques reviewed included questionnaires, psychological tests, and experimental procedures. Because interest in this area is relatively new, not many assessment techniques have been specifically developed to assess the various constructs of prospective memory. Of these, most lack a firm theoretical basis, adequate norms, and strong psychometric properties. Rehabilitative techniques, based on remedial and compensatory approaches, were then evaluated. Intervention methods that show promise include a prospective memory training approach, diary or memory notebook use, and electronic aids. Nevertheless, there is a need for further controlled trials with larger sample sizes to more thoroughly evaluate these methods. Self-awareness of memory impairment and generalisation of gains from treatment are another two issues identified as important for assessing and treating prospective memory impairment.

This study was undertaken to establish empirically whether couples in which the husband has sustained a severe traumatic brain injury (TBI) differed significantly, with respect to perceptions of husbands' interpersonal communication skills, from control couples in which the husband had sustained a traumatic orthopaedic injury (ORTHO) without injury to the brain. Fifty married couples (25 TBI dyads and 25 ORTHO dyads) were interviewed and completed a questionnaire for the study. Analysis of variance and planned comparisons were used to examine between- and within-group differences. TBI dyads were significantly different to control dyads with respect to perceptions of husbands' communication abilities. Both husbands and wives in long-term TBI dyads reported husbands to experience continuing interpersonal communication difficulties. As a group, TBI husbands self-reported significantly more communication difficulties than did ORTHO husbands. TBI wives and ORTHO wives also produced significantly different perceptions of their husbands' communication abilities. TBI wives perceived their husbands to have a number of interpersonal communication difficulties, while control group wives reported their husbands to be competent communicators.

The transition from hospital to home following traumatic brain injury (TBI) has been identified as the point where responsibility for care shifts from rehabilitation services to informal family caregivers. There has, however, been little research examining the experiences of family members during this important transition that involves adopting or, in some cases, resuming a caring role (e.g., a parent caring for an adult child). The aim of this qualitative investigation was to understand the experiences of family caregivers during the transition from hospital to home, defined as the first six months postdischarge. The sample included 10 family caregivers, of which all were female and either a mother, spouse or ex-partner of an individual with TBI. Semistructured interviews were conducted on average nine months following community reentry and data were analysed thematically using a framework approach. The overarching theme was that caregivers wished to move past the injury. This desire to move forward stemmed from a realisation of how their life had changed and the weight of the care responsibility. Caregivers were also aware of how the life of the individual with a TBI had changed and hoped for a return to normality (by regaining independence, engaging in meaningful occupation and having meaningful relationships). Implications of the findings for research and clinical practice are discussed. There is a need for services to support family caregivers during the transition from hospital to home.

Acquired brain injury (ABI) can lead to a constellation of higher-order executive problems, which can impact significantly on everyday behaviour. While some neuropsychological assessments are able to measure these impairments objectively, increasingly, clinicians are finding that a subset of their patients passes these tests while still exhibiting difficulties in day-to-day living. Calls have therefore been made to develop assessments that are more sensitive and that are more ecologically valid. In this study, in Experiment 1, a multiple errands task (MET) based around a business office was created to assess concurrently nine aspects of executive functioning (planning, prioritisation, selective-thinking, creative-thinking, adaptive-thinking, multi-tasking, action-based prospective memory (PM), event-based PM and time-based PM). This new paradigm, the Jansari assessment of Executive Functions (JEF©) showed a significant difference between six individuals with ABI and matched healthy controls; further, it showed that across the nine constructs there was a range of performance. In Experiment 2, JEF© was recreated in a virtual environment resembling a computer game, and it was found that this version significantly differentiated between 17 individuals with ABI and 30 healthy controls. These results suggest that the virtual version of JEF© could be used as a new assessment of executive function. The profile of performance across the nine constructs for each individual provides a wealth of objective information that could potentially inform targeted rehabilitation.

Community integration is often cited as the ultimate aim of rehabilitation. However, outcome studies show that following severe traumatic brain injury (TBI), many people do not return to valued life roles or reach previous levels of integration within their community. More recent research, in association with extensive clinical experience, reveals significant variability in outcomes within this group. Although some people return to productive activity and maintain a network of family and friends, others lead lives characterised by boredom and loneliness. This paper has two aims. The first is to examine TBI community integration outcome literature and selected theoretical models. The second is to describe a Community Approach to Participation (CAP), an individualised and collaborative model of community-based practice, which endeavours to address the poor outcomes identified following TBI. The CAP will be illustrated in the detailed case study of Sarah.

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.

This article presents a systematic review identifying variables and their prognostic value for return to work (RTW) after traumatic brain injury (TBI). RTW has been identified as being a key goal following TBI, with estimates ranging from 10% to 70%. Prediction of postinjury employment is important for planning rehabilitation and structuring individualised vocational services. Studies examining prognostic factors were identified by searching four electronic databases, until June 2006. Searches yielded 1948 studies of which 55 met inclusion criteria and were subsequently rated for methodological quality. Mean methodological score for included studies was 3.9/6 (SD 0.9, range 1–6). Analysis focused on a subset of 27 studies which provided sampling from all three domains of preinjury, injury and early postinjury variables. Few studies considered preinjury variables, apart from simple demographics. Only five studies considered preinjury employment, which was a significant predictor in each case. Severity of injury variables were invariably examined, but were significant predictors in only 8/27 studies (30%). For early postinjury variables, 14/27 studies entered cognitive variables with 12/14 (86%) identifying them as significant predictors; 3/27 studies examined neurophysical variables, with 2/3 (67%) studies finding them significant; and 12/27 studies examined multidimensional/participation variables which were statistically significant individual predictors in 8/12 (67%) cases. The results are discussed in the context of methodological issues encountered during the course of the review that require addressing in future studies.

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.

Moral reasoning skills are crucial for appropriate and adaptive social functioning. Impairments in moral reasoning have been associated with aggressive and violent behaviours. Traditional measures of moral reasoning may provide limited insight into daily behavioural functioning as these measures are dependent on several higher order cognitive skills and, as such, may be limited in their utility with certain clinical populations. In Study 1, new measures of sociomoral reasoning and maturity, the So-Moral and So-Mature, were described. Further, the psychometric properties of the So-Moral and So-Mature were investigated in a sample of 50 adolescents aged 11 to 19 (mean age = 14.5, SD = 2.6 years, 25 male). Preliminary support was found for the validity and reliability of both tasks. In Study 2, the clinical applicability of the So-Moral and So-Mature were examined in a sample 25 adolescents with traumatic brain injury (TBI; mean age = 13.8, SD = 2.3 years, 15 male). Response trends suggested that adolescents with TBI generated less developmentally mature responses to sociomoral dilemmas and those with more severe injuries performed most poorly. The sociomoral reasoning tasks described promote participant's emotional involvement and investment as well as being appropriate for use with clinical populations.

This paper presents a unilevel and multilevel approach for the analysis and meta-analysis of single-case experiments (SCEs). We propose a definition of SCEs and derive the specific features of SCEs’ data that have to be taken into account when analysing and meta-analysing SCEs. We discuss multilevel models of increasing complexity and propose alternative and complementary techniques based on probability combining and randomisation test wrapping. The proposed techniques are demonstrated with real-life data and corresponding R code.

This study aimed to evaluate the influence of cognitive demand on prospective-memory in individuals with traumatic brain injury (TBI) using a dual-task paradigm. Fourteen individuals with severe TBI and 14 matched controls were required to undertake two tasks. A lexical-decision task was used as an ongoing task and had two levels of cognitive demand (viz., low and high). The event-based prospective-memory task involved performing a specific action whenever a target stimulus appeared during the ongoing task. The Letter-Number Sequencing Test, the Tower of London and the Controlled Oral Word Association Test were also administered to assess the relationship between prefrontal lobe functions and prospective memory. As hypothesised, participants in the TBI group performed more poorly than participants in the control group on the prospective-memory task in the high but not in the low demand condition. There were significant correlations between prospective-memory task performance and scores on the Letter-Number Sequencing Test and the Controlled Oral Word Association Test. These findings help to clarify the nature of prospective-memory impairment in individuals with TBI and support the involvement of prefrontal processes in prospective remembering.

Purpose: To determine validity, reliability and feasibility of accelerometers (ActivPAL™, Sensewear Pro2 Armband) and portable global positioning systems (GPS) (Garmin Forerunner 405CX) for community ambulation measurement after stroke.

Methods: Fifteen community-dwelling stroke survivors attended two sessions; completing a 6-minute walk, treadmill walking, and 200-m outdoor circuit. Feasibility was determined by wearing devices over four days. Measures collected included step count, time spent walking, distance, energy expenditure and location. Intra-class correlation coefficients (ICC), Bland–Altman plots and absolute percentage of error (APE) were used to determine validity and reliability.

Results: ActivPAL™ had excellent validity and reliability for most measures (ICC: 0.821–0.999, APE: 0%–11.1%), except for good-excellent findings at speeds < 0.42 m/s (ICC: 0.659–0.894, APE: 1.6%–11.1%). Sensewear had missing values for 23% of recordings and high error for all measures. GPS demonstrated excellent validity and reliability for time spent walking and step count (ICC: 0.805–0.999, APE: 0.9%–10%), and 100% accuracy for location. However, it was not valid or reliable for distance (ICC = −0.139, APE = 23.8%). All devices appeared feasible for community ambulation measurement with assistance for setup and data analysis.

Conclusions: ActivPAL™ and Garmin GPS appear valid, reliable and feasible tools for community ambulation measurement after stroke, except for distance. Sensewear demonstrated poor validity and reliability when worn on the paretic arm.

Sustaining a traumatic brain injury (TBI) as an adolescent has a significant impact on life roles and most notably on that of school participation. In the literature there is a wide range of studies that provide clinicians with information regarding recommendations for assisting students in their return to school. However this information has predominantly been provided from the perspectives of educators and rehabilitation staff. The aim of this preliminary project was to hear the stories of three male adolescent students as they reflected on their own experiences of what it was like to go back to school after sustaining a severe TBI. Using a qualitative research design and in-depth interviews, the students' stories were transcribed and coded using grounded theory principles. Despite persisting communication difficulties, the students were able to provide rich stories indicative of their personal experiences. Three key themes emerged from the interviews: the adolescent student's sense of self, changes the students noted; and supports the students identified. A tentative model illustrating the relationship between these areas was developed. It is anticipated that this model will assist clinicians and educators to develop a holistic picture of a student's school participation from transition to ongoing school life.

The purpose of the current paper was to conduct a systematic review of the literature on predictors of emotional distress in caregivers of persons with traumatic brain injury (TBI), and to provide evidence-based classification for prognostic variables to guide future research and clinical practice. A search was conducted using PubMed, CINAHL and PsycINFO databases. The citations of resulting articles were also reviewed. Twenty-eight articles met inclusion criteria and were retained for review. Reviews were conducted in accordance with the 2011 edition of the American Academy of Neurology (AAN) Guidelines for classifying evidence for prognostic studies. Data abstraction revealed one Class I study, four Class II studies, eight Class III studies, and 15 Class IV studies. Results of the review indicated that caregivers’ report of neurobehavioural problems in the person with injury is a probable predictor of emotional distress for caregivers of persons with complicated mild, moderate or severe TBI (Class B evidence). The level of participation in the person with injury, level of support needed by the person with injury, and family systems functioning are probably predictors of emotional distress for caregivers of persons with severe TBI (Class B evidence). Executive functioning impairment in the person with injury, pre-injury emotional distress in caregivers, caregiver age, caregivers’ use of emotion-focused coping, and social support may possibly be risk factors for caregivers’ emotional distress (Class C evidence). Recommendations for future research and implications for assessment and treatment of family caregivers are discussed.

Traumatic brain injury (TBI) impacts upon people's sexuality with 50% to 60% of persons reporting some level of disruption post-injury. However, only small proportions of patients/family members report that rehabilitation health professionals made inquiries about whether they had any sexual concerns. Rehabilitation programs have a responsibility to meet the challenge of addressing this important area of human functioning. An agency framework is described that provides a non-threatening, structured way for services to conceptualise, introduce or upgrade sexuality services in a manner that can be maintained over the long term. The framework contains an underlying philosophy of sexuality, five proposed modalities of service provision and detail of the underlying organisational structures that are required to provide sexuality services with consistency and effectiveness over the long term. Finally, organisational strategies that can be employed to implement the framework are discussed as well as suggestions about the sequencing of such strategies. By using the framework, rehabilitation services can put sexuality back onto their treatment agenda, as they seek to restore patients/clients with TBI to the “highest level of adaptation attainable” (World Health Organisation, 1996, p. 1) in all areas of their lives.

The ABI Behaviour Consultancy (the Consultancy) is a community-based service specialising in the management of challenging behaviour following acquired brain injury (ABI). Although there are many accounts in the literature of behaviour management techniques, very few describe how to tailor and implement programs to work in nonspecialised community settings where a client's environment has little structure and few resources. The Consultancy is often called upon to manage situations where existing behaviour interventions have not been successful, often because of incorrect assumptions about the client with ABI or because of unrealistic expectations of the setting. The Consultancy has developed a six-stage framework for the management of challenging behaviours that includes site visit, crisis management, engagement, intervention, education, and ongoing review. Case examples are used to illustrate each of these stages.

This qualitative study aimed to explore transitions from hospital to the home over a period of one year.

Methods and procedures: A longitudinal, phenomenological approach was employed and 18 individuals with severe traumatic brain injury, their family members and rehabilitation professionals were interviewed using semistructured interviews, when the person with brain injury was discharged from the ward, after 6 months and again after one year.

Results: Themes identified within the data included returning home, getting back to normal, moving forward and the role of rehabilitation in the transitional period. Further subthemes were also identified including issues of life-course disruption, self-identity, status and reconstruction.

Conclusions: Data suggested that access to rehabilitation programs employing individualised, contextual interventions following discharge to the home were integral in enabling the transition through to autonomy and independence. Consideration of issues of identity and status can enable a different and potentially important perspective on the experience of transitions for those with brain injury. Reclaiming personal autonomy and control appeared to be central to the reconstruction of a coherent sense of self, enabling a meaningful life after brain injury.

The past 20 years have seen the development of instruments designed to specify standards and evaluate the adequacy of published studies with respect to the quality of study design, the quality of findings, as well as the quality of their reporting. In the field of psychometrics, the first minimum set of standards for the review of psychometric instruments was published in 1996 by the Scientific Advisory Committee of the Medical Outcomes Trust. Since then, a number of tools have been developed with similar aims. The present paper reviews basic psychometric properties (reliability, validity and responsiveness), compares six tools developed for the critical appraisal of psychometric studies and provides a worked example of using the COSMIN checklist, Terwee-m statistical quality criteria, and the levels of evidence synthesis using the method of Schellingerhout and colleagues (2012). This paper will aid users and reviewers of questionnaires in the quality appraisal and selection of appropriate instruments by presenting available assessment tools, their characteristics and utility.

There has been controversy over Null Hypothesis Significance Testing (NHST) since the first quarter of the 20th century and misconceptions about it still abound. The first section of this paper briefly discusses some of the problems and limitations of NHST. Overwhelmingly, the ‘holy grail’ of researchers has been to obtain significant p-values. In 1999 the American Psychological Association (APA) recommended that if NHST was used in data analysis, then researchers should report effect sizes (ESs) and their confident intervals (CIs) as well as p-values. The APA recommendations are summarised in the next section of the paper. But as neuropsychological rehabilitation clinicians, the primary interest is (or should be) to determine whether or not the effect of an intervention is clinically important, not just statistically significant. In this context, ESs and their CIs provide information relevant to clinicians. The next section of the paper reviews common ESs and worked out examples are provided for the calculation of three commonly used ES (Cohen's d, Hedge's g and Glass’ delta). Web-based resources for calculating other ESs and their CIs are also reviewed.