ABSTRACT
PURPOSE: Physical activity (PA) is proposed for long-term problems after traumatic brain injury (TBI) with mood, quality of life, and participation. However, COVID-19 mitigation strategies resulted in widespread closures of community-based fitness centres, including one housing a peer-assisted PA program (TBI-Health). The purpose of this study was to provide an in-depth exploration of COVID-19's impact on the TBI-Health program for adults with moderate-to-severe TBI and determine how their PA behaviours could be supported in the pandemic. METHODS: Interpretative phenomenological analysis was employed to collect and analyze data from semi-structured Zoom-facilitated interviews with seven female and nine male adults with moderate-to-severe TBI (including program participants and mentors). RESULTS: Three major themes were identified. Need for PA after TBI included specific benefits of PA after TBI and desire for an adapted PA program. Lasting Impacts of the TBI-Health Program identified belonging to the TBI-Health community, benefits, and knowledge transfer from the program. Resilience and Loss through the Pandemic comprised the repercussions of COVID-19, loss of the PA program, adapting PA to the pandemic, and resilience after TBI. CONCLUSION: This study provides insights about impacts of participating in community-based peer-assisted PA programs after moderate-to-severe TBI and ways to support PA in unforeseen circumstances.IMPLICATIONS FOR REHABILITATIONOur community-based peer-assisted physical activity program for adults with moderate-to-severe traumatic brain injury (TBI) promoted a range of daily and social activities.Outdoor group-based physical activity programs provide physical activity and social opportunities for adults with moderate-to-severe TBI when indoor physical activity is restricted.Community-based peer-assisted physical activity programs can assist with posttraumatic growth after moderate-to-severe TBI.
ABSTRACT
Background: One in three women experience intimate partner violence (IPV) in their lifetime and both the rates and severity of IPV have increased during the COVID-19 pandemic. The majority of injuries to women experiencing IPV are to the head, face, and neck, leaving survivors at high risk for traumatic brain injury (TBI);however, the intersection of IPV and TBI (IPV/TBI) remains largely unrecognized. Here we report on the COVID-19 related impacts, barriers, needs, and priorities to healthcare and support services for women survivors of IPV/TBI. Methods: A pan-Canadian group of 30 stakeholders was engaged in a two-day virtual summit using a participatory research model. Stakeholders were drawn from an IPV/TBI knowledge-to-practice (K2P) Network comprising women survivors, service providers, researchers, and decision makers. Semi-structured discussion guides were used by the research team to facilitate small group break-out sessions which were recorded and transcribed verbatim. Thematic analysis techniques were used to analyze transcripts and develop themes. Stakeholders were given the opportunity to contribute to the analysis and KT through member checking activities. Ethics approval was obtained through the University of Toronto. Results: COVID-19 has increased rates and severity of IPV and resulted in barriers to help-seeking and accessing services. The impacts of the pandemic have been exacerbated by pre-existing infrastructure and resource limitations in rural and remote areas, including limited access to services. Stakeholders called for increased awareness across a number of groups. Survivors and the public need greater awareness of the resources available for survivors of IPV/TBI, particularly how access to or availability of resources and services have changed during the pandemic. Healthcare providers ranging from emergency departments to rehabilitation professionals need greater awareness of the intersection of IPV/TBI and how to appropriately manage these survivors' unique needs, particularly considering the impact of COVID on the accessibility of that care. Requests from survivors for peer support have increased significantly during the pandemic, highlighting the need for more formalized and better supported peer roles for IPV/TBI survivors. Stakeholders also noted the implications of virtual care, for example, safety, privacy, and usability, require careful consideration. Conclusions: The COVID-19 pandemic has intensified IPV/ TBI, increased challenges for women survivors, and accentuated the continued lack of IPV/TBI awareness. Key recommendations for healthcare and rehabilitation and a national strategy to address this priority are discussed.
ABSTRACT
Introduction: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Sex and gender influence employment in TBI. A large facilitator to employment in TBI is having workplace accommodation, however in many cases accommodations are unavailable or may not fit the needs of the individual. Further, it is unknown how the Coronavirus Disease 2019 (COVID-19) pandemic is impacting employment and accommodations for persons with TBI. This study aims to investigate sex and gender-specific workplace accommodations in persons with TBI, while considering the impact of COVID-19 on transitioning to work and on mental health in adults with TBI. Methods: The proposed research is a pilot study with an observational cross-sectional design. Sixty adults with TBI, including men, women and gender diverse people within the age range of 18-65 years inclusive, will be recruited. An online survey will be self-administered through Research Electronic Data Capture. The survey includes questions on demographics (e.g., sex, gender, age, ethnicity, injury severity, mechanism of injury);questions from the Canadian Survey on Disability 2017 on employment status, requirements and unmet needs for workplace accommodations;and questions from Statistics Canada on the impact of COVID-19 on work status. Results: Data collection is in progress. Planned analyses include multinomial logistic and multivariable linear regression analyses to evaluate the relationships between the predictor (i.e., sex, gender) and main outcome variables (i.e., the number and type of accommodations needed, change in employment status and mental health due to COVID-19). Descriptive statistics, between-group comparisons for sex and gender, and sexspecific and gender-specific stratification will be completed to understand emerging trends. Conclusion: Sex and gender influences in TBI can serve to inform rehabilitation professionals, employers and persons with TBI, to enable sex- and gender-sensitive interventions for community participation practices. Findings from this study will contribute to the body of evidence on sex- and gender-specific workplace accommodations, while bridging the knowledge gap of how to improve transition to work in persons with TBI. Results will also further the understanding of the specific needs of men, women and gender-diverse persons with a disability during community participation postdischarge, including during unprecedented times.