Experiences of Using Pathways and Resources for Engagement and Participation (PREP) Intervention for Children with Acquired Brain Injury: A Knowledge Translation Study

Background: Children with acquired brain injury experience participation restrictions. Pathways and Resources for Engagement and Participation (PREP) is an innovative, participation focused intervention. Studies have examined PREP in Canadian research contexts, however little is known about implementation in real-life clinical settings. This study aimed to understand experiences of clinicians implementing PREP in a UK clinical context, with a focus on implementation processes and key factors for successful implementation. Methods: A qualitative single-site 8-week knowledge translation intervention study, guided by an action research framework, explored clinicians’ experiences of implementation. Six occupational therapists (OTs) working in a neurorehabilitation setting participated. The therapists provided two intervention sessions per week, over four weeks for one child on their caseload. Planning, implementation and evaluation were explored through two focus groups. Thematic analysis was used to analyse data. Results: Two themes, “key ingredients before you start” and “PREP guides the journey”, were identified before introducing PREP to practice. Four additional themes were related to PREP implementation: “shifting to a participation perspective”, “participation moves beyond the OT”, “environmental challengers and remedies” and “whole family readiness”. A participation ripple effect was observed by building capacity across the multi-disciplinary team and families. The involvement of peers, social opportunities and acknowledging family readiness were key factors for successful implementation. Conclusions: The findings illustrate practical guidance to facilitate the uptake of participation-based evidence in clinical practice. Further research is required to understand aspects of knowledge translation when implementing participation interventions in other UK clinical settings.

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Significance of Virtual Reality-Based Rehabilitation in Acquired Brain Injury

Virtual and Augmented Reality ◽

10.4018/978-1-5225-5469-1.ch074 ◽

2018 ◽

pp. 1586-1601

Author(s):

Artemisa R. Dores ◽

Liliana Mendes ◽

Irene P. Carvalho ◽

Sandra Guerreiro ◽

Isabel Almeida ◽

...

Keyword(s):

Virtual Reality ◽

Brain Injury ◽

Neural Plasticity ◽

Ecological Validity ◽

Real Life ◽

Acquired Brain Injury ◽

Immediate Feedback ◽

Daily Life Activities ◽

Neurocognitive Rehabilitation ◽

Independent Functioning

Recent research has shown the potential of Virtual Reality (VR) in the field of rehabilitation, namely neurocognitive rehabilitation. This technology will certainly revolutionize the rehabilitation of the future. Its advantages include greater ecological validity than conventional rehabilitation methods, provision of safe contexts for learning/training, the possibility of programs to be contingent on patient performance, with increasing levels of task difficulty and provision of immediate feedback, and the use of a “game factor” that promotes motivation for participation. These are important aspects in the rehabilitation of patients with acquired brain injury. Patients with this and other types of neurological injuries endure cognitive deficits that cause difficulties in independent functioning and daily-life activities. Their rehabilitation calls for systematic intervention programs that are theoretically grounded and use innovative approaches to their advantage. In this paper we present a review about the advantages of VR in the generalization of acquired skills to real-life contexts, to promote patients' functionality and quality of life, and propose an innovative program of neurocognitive rehabilitation. Research in the field shows positive effects of VR programs, but urges progress in terms of the development of techniques (e.g., facial synthesis and of more research on the impact of these interventions. Future studies should also explore the existence of neuro-anatomical correlates of behavioral changes, contributing to the investigation of the relationship between neural plasticity and behavior and providing evidence for clinical practice.

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Fluctuating capacity and impulsiveness in acquired brain injury: the dilemma of “unwise” decisions under the Mental Capacity Act

The Journal of Adult Protection ◽

10.1108/jap-11-2015-0035 ◽

2016 ◽

Vol 18 (4) ◽

pp. 229-239 ◽

Cited By ~ 4

Author(s):

Chris Lennard

Keyword(s):

Decision Making ◽

Brain Injury ◽

Real Life ◽

Acquired Brain Injury ◽

Mental Capacity ◽

Individual Autonomy ◽

Main Concern ◽

Content Type ◽

Code Of Practice ◽

Mental Capacity Act

Purpose – The purpose of this paper is to examine the dilemma at the heart of nursing care – the striving for empowerment of people in nurses’ care with the responsibility to protect vulnerable adults from harm. In doing so, it argues that in difficult and borderline cases, capacity assessment is complex and ultimately based on a judgment involving interpretation, and welcomes the views of clinicians who have challenged the procedural test of capacity in the Mental Capacity Act (MCA). Design/methodology/approach – It presents an illustrative study of a person with acquired brain injury (ABI) resident in a nursing home, who had been assessed under the MCA and judged to have capacity regarding health and welfare decisions, who subsequently displayed a persistent and impulsive desire to leave the unit without thought of risk and vulnerability to herself, prompting safeguarding concerns, and a reassessment of her capacity. Findings – The paper asserts that supporting people with ABI during capacity assessments, as the MCA decrees, in a very structured way can create a false sense of “capacity”. It maintains that executive impairments in ABI, being difficult to assess in formal settings, are best undertaken over time, in real-life settings, with evidence from third parties. It welcomes the MCA’s desire to protect individual autonomy and avoid undue paternalism, through ensuring people are not deemed to lack capacity simply because they make an unwise decision. Originality/value – But it goes on to argue that in ABI it is often the fact of unwise decision making that is the prominent factor and main concern, particularly in regard to impulsive decision making. If nurses have to make a judgment as to how unwise decisions made with decision-making capacity are to be distinguished from unwise decisions made without it in people with ABI, then, the author concludes, a major area of difficulty for nurses is ascertaining when the presumption of capacity should be challenged, an area that an updated code of practice needs to clarify.

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Effects of a multifaceted treatment program for executive dysfunction after acquired brain injury on indications of executive functioning in daily life

Journal of the International Neuropsychological Society ◽

10.1017/s1355617709991020 ◽

2009 ◽

Vol 16 (1) ◽

pp. 118-129 ◽

Cited By ~ 105

Author(s):

JACOBA M. SPIKMAN ◽

DANIELLE H.E. BOELEN ◽

KIRSTEN F. LAMBERTS ◽

WIEBO H. BROUWER ◽

LUCIANO FASOTTI

Keyword(s):

Brain Injury ◽

Executive Functioning ◽

Daily Life ◽

Real Life ◽

Acquired Brain Injury ◽

Executive Dysfunction ◽

Well Being ◽

Post Treatment ◽

Strategy Training ◽

Experimental Group

AbstractA multicenter randomized control trial (RCT) was conducted to evaluate the effects of a treatment for dysexecutive problems after acquired brain injury (ABI) on daily life functioning. Seventy-five ABI patients were randomly allocated to either the experimental treatment, multifaceted strategy training for executive dysfunction, or a control treatment, computerized cognitive function training. Assessment took place before, directly after, and 6 months post-treatment. The primary outcome measure, the Role Resumption List (RRL), and two other follow-up measures, the Treatment Goal Attainment (TGA) and the Executive Secretarial Task (EST), were indications of daily life executive functioning. The experimental group improved significantly more over time than the controls on the RRL and attained significantly higher scores on the TGA and EST. We conclude that our treatment has resulted in significant improvements of executive functioning in daily life, lasting at least 6 months post-treatment. Although control patients’ satisfaction and subjective well-being were at the same level, the experimental group had better abilities to set and accomplish realistic goals, to plan, initiate, and regulate a series of real-life tasks, and to resume previous roles with respect to work, social relations, leisure activities, and mobility. (JINS, 2010, 16, 118–129.)

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Significance of Virtual Reality-Based Rehabilitation in Acquired Brain Injury

Advances in Medical Technologies and Clinical Practice - Virtual Reality Enhanced Robotic Systems for Disability Rehabilitation ◽

10.4018/978-1-4666-9740-9.ch009 ◽

2016 ◽

pp. 164-179 ◽

Cited By ~ 1

Author(s):

Artemisa R. Dores ◽

Liliana Mendes ◽

Irene P. Carvalho ◽

Sandra Guerreiro ◽

Isabel Almeida ◽

...

Keyword(s):

Virtual Reality ◽

Brain Injury ◽

Neural Plasticity ◽

Ecological Validity ◽

Real Life ◽

Acquired Brain Injury ◽

Immediate Feedback ◽

Daily Life Activities ◽

Neurocognitive Rehabilitation ◽

Independent Functioning

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Training-the-Trainer on Assistive Technology for Cognition (ATC): Current Practices

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld23.2.90 ◽

2013 ◽

Vol 23 (2) ◽

pp. 90-94 ◽

Cited By ~ 2

Author(s):

Laurie Ehlhardt Powell ◽

Tracey Wallace ◽

Michelle ranae Wild

Keyword(s):

Brain Injury ◽

Assistive Technology ◽

Acquired Brain Injury ◽

Online Training ◽

Evidence Based ◽

Train The Trainer ◽

Rehabilitation Professionals ◽

Remote Locations ◽

Training Package ◽

And Training

Research shows that if clinicians are to deliver effective, evidence-based assistive technology for cognition (ATC) services to clients with acquired brain injury (ABI), they first need opportunities to gain knowledge and experience with ATC assessment and training practices (O'Neil-Pirozzi, Kendrick, Goldstein, & Glenn, 2004). This article describes three examples of train the trainer materials and programs to address this need: (a) a toolkit for trainers to learn more about assessing and training ATC; (b) a comprehensive, trans-disciplinary program for training staff to provide ATC services in a metropolitan area; and (c) an overview of an on-site/online training package for rehabilitation professionals working with individuals with ABI in remote locations.

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