'Online therapy' to reduce caregiver's distress and to stimulate post-severe acquired brain injury motor and cognitive recovery: A Sicilian hospital experience in the COVID era.

INTRODUCTION: Severe acquired brain injury(SABI) often results in the deterioration of physical, cognitive and emotional functions in the patient and a significant caregiver's distress syndrome, which is now amplified by the social isolation, depression and financial difficulties related to the COVID-19 pandemic. The use of web-based online-therapy has been shown to be useful to overcome caregiver's distress syndrome and further stimulate cognitive-motor recovery of SABI-patients. Our study aimed to investigate whether a systematic online Skype-therapy(OLST) may be of support in favoring global cognitive and sensory-motor recovery in SABI-patients and reducing caregiver distress. METHODS: Twenty-five SABI-subjects in inpatient regimen were provided with intensive OLST with the caregiver for 12 weeks in addition to standard neurorehabilitation. Each subject and caregiver was evaluated before and after the treatment by administering an ad hoc battery. Furthermore, 18 of 27 patients were provided with EEG recording in resting state. RESULTS: We found a significant reduction in caregiver's anxiety (p<0.0001) and burden(p<0.0001). Patients showed significant improvement in trunk control (p<0.0001), functional independence (p = 0.005), functional (p = 0.01) and global communication (p = 0.004), cognitive functioning (p = 0.001), and behavioral responsiveness (p = 0.0004). The training yielded a significant connectivity change within the fronto-centro-parietal areas in the delta frequency band (p<0.0001) and the centro-parieto-occipital areas in the alpha range (p = 0.004). DISCUSSION: OLST may be a useful and complementary treatment to optimize global cognitive and functional recovery in SABI-subjects and reduce caregivers' concerns in the Covid-era. OLST can foster cognitive-motor recovery potentially by favoring the plasticity-dependent functional recovery. Therefore, OLST could be proposed as a tool allowing social conversations also in the hospital setting.

Using DTI tractography to guide tDCS interventions in a complex acquired brain Injury neurorehabilitation protocol - a case report

51-year-old man (C.P.) had a diffuse-axonal-injury after falling from a 5-meter height, followed by a 22-minute anoxia due to a cardiac arrest. In the ICU, he tested positive to COVID-19, and needed intubation. After coronavirus infection, C.P. presented Guillain-Barre syndrome. 2months after discharge, he was admitted to rehabilitation. DTI tractography for evaluation of the structural integrity of white matter tracts revealed: i) Lesions in the basal ganglia;ii) Sequelary lesions in the right frontal, cortical, subcortical, temporal, parieto-occipital and cerebellar hemispheres;iii) Asymmetry of the corticospinal tracts - less fibers on the left;iv) Poor definition of the fibers of the right arcuate fasciculus;v)Asymmetrical thinning of the cortico-ponto-cerebellar tracts, worse on the left, and more discreetly in the spinocerebellar tracts. Based on this, C.P. underwent 4 different 30-session tDCS protocols consisting of twice-daily 20min 2mA sessions (10min interval), 5days/week (120sessions total), combined with physiotherapy, cognitive, swallowing and speech therapy. Montages: Pr1 (anode: Cz - 5x10cm;cathode: 10th Thoracic Vertebra - 5x7cm);Pr2 (1 - anode:C3;cathode:Fp2 / 2 - anode: Cerebellum;cathode:Fp2);Pr3 (anode:F3;cathode:Fp2) and Pr4 (anode:Cp5;cathode:Fp2). Except for Pr1, electrode size for all protocols were 5x7cm. We used the Coma Recovery Scale (CRS-R) and Rancho Los Amigos Scale (RLAS) for clinical assessments at the baseline and after every 10 sessions until the end of the intervention. At the baseline, C.P. presented a minimal responsive state of consciousness (CRS-R: 3;RLAS: Level 1) and tolerated well the tDCS interventions. CRS-R scores gradually improved in various domains during the treatment. At the end, RLAS score was level 5 and CRS-R, 19. Our preliminary results suggest DTI tractography may be a potential biomarker to guide more personalized tDCS interventions for complex cases of patients with acquired brain injuries. A second DTI tractography will be made in the future for comparison purposes. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: Acquired Brain Injury, Traumatic Brain Injury, COVID-19, Guillain Barre SyndromeCopyright © 2023

Lockdown life - experiences of partners of individuals with an acquired brain injury during the covid-19 pandemic: A qualitative study

Objectives: The present study sought to investigate the experience of individuals living with their partner with an acquired brain injury (ABI) during the first lock down period of the COVID-19 pandemic. Method: Semi-structured interviews were conducted with seven partners of individuals who had sustained a range of ABIs. Interviews were transcribed verbatim and thematic analysis was carried out by two of the researchers exploring the unique narratives. Results: ABI occurs within a relational framework, which means that it has repercussions not only for the individual but also the entire family system. COVID-19 prevented family systems (living separately) from coming together which negatively impacted them;however, it also slowed life down, with many people working from home with flexible arrangements in place which participants found to be beneficial. Three main themes emerged from the interview data: partner focus, slowing down and support networks. The narratives identified the struggles of having to continue their partner's rehabilitation when face to face services could not visit the home, the importance of establishing routine, the positives of a slower paced life (due to COVID-19) that enabled them to build stronger relationships with their partners, and the difficulties of being separated from family and loved ones. Conclusion: This research suggests that it is imperative to consider individual experiences and choices. Some families benefited from reduced treatment and a slowed pace of life, whilst others may find this overwhelming and burdensome. The study makes recommendations for supporting couples after an ABI during the ongoing pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Experiences of acquired brain injury one-month post-discharge from acute hospitalisation.

Background: Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI. Objective: To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation. Method: Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed. Results: Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI. Conclusion: Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period. Contribution: This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI.

Community in the pandemic: experiences and strategies by people with acquired brain injury and their families during COVID-19.

PURPOSE: This study explored the experiences of people with acquired brain injury and their families during the COVID-19 pandemic, focusing on how they maintained their communities and sense of belonging, the strategies they found helpful, and advice they have for improving service provision and community connectedness. METHODS: Semi structured interviews with pictorial mapping were conducted with ten adults with ABI and six of their family members. Participants responded to recruitment information circulated by a state-wide ABI peer support network in South Australia. RESULTS: Four primary themes were identified from the findings: (1) disruptions to routine; (2) social isolation; (3) using technology; and (4) strategies for staying safe and keeping well. Results are discussed using a social and urban geography lens and a conceptual framework of belonging to explore the experiences of people with ABI and their communities. CONCLUSIONS: The study reinforces the role of robust peer/support networks to stay connected, stay well and support others. Government, health services and community groups must provide clear and accessible information and supports, and regularly reach out to ensure the safety and wellbeing of people with ABI and their families during the pandemic.IMPLICATIONS FOR REHABILITATIONPeople with acquired brain injury and their families experienced increased challenges to maintaining contact with their communities during the COVID-19 pandemic.The main challenges were disruptions to routine, social isolation, and use of technology for health, therapy and social contact.Strategies to support people with ABI to maintain connections, stay engaged, and access technology and information to stay safe and well during lock-down are presented.

Pilot of a dog-walking program to foster and support community inclusion for people with cognitive disabilities.

PURPOSE: To evaluate a dog-walking program (called "Dog Buddies") designed to address the need for evidence-based programs that create opportunities for people with cognitive disabilities to be more socially included in mainstream society. The research question was: Does community dog walking foster social interaction for people with cognitive disabilities? MATERIALS AND METHODS: Single-case experimental design was used with four individuals (three with intellectual disability; one with Acquired Brain Injury (ABI)) recruited via two disability service providers in Victoria. Target behaviours included frequency and nature of encounters between the person with disability and community members. Change was measured from baseline (five community meetings with a handler but no dog) to intervention period (five meetings minimum, with a handler and a dog). Semi-structured interviews, audio-recorded and transcribed verbatim, provided three participants' subjective experiences of the program. RESULTS: Dog Buddies increased the frequency of encounters for all participants. The presence of the dog helped to foster convivial encounters, community members were found to be more welcoming, and some participants were recognised or acknowledged by name over time in the intervention phase. CONCLUSIONS: The dog-walking program offered a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities.IMPLICATIONS FOR REHABILITATIONThe co-presence of people with disabilities in the community with the general population does not ensure social interaction occurs.Both disability policy, and the programs or support that is provided to people with disabilities, needs to have a strong commitment to the inclusion of people with disabilities in mainstream communities.Dog Buddies is a promising example of a program where the presence of a pet dog has been demonstrated to support convivial, bi-directional encounters of people with cognitive disabilities and other community members.Dog-walking offers a simple means of influencing the frequency and depth of community-based social interactions for people with cognitive disabilities.

Is the "Family Glass Cabin" Useful to Safely Allow Inpatient-Caregiver Interaction in the COVID-19 Era? A Pilot Study on Severe Acquired Brain Injury.

Acquired Brain Injury (ABI) is a life-changing event that can have a devastating impact on all aspects of a person's functioning. Patients with ABI present several behavioral problems that have worsened during the COVID-19 pandemic. This study aimed at investigating the role of a "Family Glass Cabin" (FGC) both in improving cognitive function and communicative abilities of people with ABI and in potentiating the mental health of their caregivers. Fifteen subjects affected by ABI and their caregivers were enrolled in this experimental study. Training was performed through the FGC and was based on either psychoeducational sessions for the caregivers or cognitive stimulations for the patients. The participants attended biweekly meetings for 12 consecutive weeks. Each participant was assessed by means of a complete psychometric and clinical battery, before (T0) and after (T1) the training. We found significant changes in all patients' outcomes, including global cognitive function and communication abilities (p < 0.01), as well as an improvement in caregivers' well-being. Our data suggest that the physical presence of the caregiver in the rehabilitation setting, using a safe setting such as the FGC, can be a valuable means to increase ABI patients' functional recovery and reduce caregivers' anxiety and emotional burden.

Healing Right Way RCT: Novel interventions to enhance the cultural security of rehabilitation services for Aboriginal Australians with brain injury

Background: Access to rehabilitation services for Aboriginal people following acquired brain injury (ABI) is frequently hindered by challenges navigating: i) complex medical systems, ii) geographical distances from services and iii) culturally insecure service delivery. Healing Right Way is the first randomised control trial (RCT) to address these issues in partnership with multiple health service providers across Western Australia (WA). Aims: To outline the multicomponent Healing Right Way intervention by providing case studies, and describing challenges, facilitators and implications for rehabilitation services. Method: This stepped-wedge cluster RCT involved four metropolitan and four regional sites across WA. Aboriginal adults hospitalised for ABI were recruited from 2018-2021. Intervention components comprised ABI-related cultural security training (CST) for hospital staff, and employment of Aboriginal Brain Injury Coordinators (ABICs) to support ABI survivors for six months post-injury. The primary outcome was quality of life (measured with Euro QOL-5D-3L VAS) at 26 weeks. Secondary outcomes included participants' overall function and disability, anxiety and depression, carer strain, and changes to service delivery across the 26-week follow-up period. Detailed process and cost evaluations were also undertaken. Results: 108 participants were recruited from the participating sites. The CST was delivered across all eight participating hospitals with 250 hospital staff trained. ABICs supported 61 participants, 70% residing in regional, rural or remote areas. Challenges to implementation of the intervention included impacts from COVID-19 responses, hospital staff turnover and availability, recruitment of people with traumatic brain injury and methods for maintaining contact with participants and next-of-kin across locations. Collaboration with Aboriginal health providers and community networks were invaluable to maintaining contact with participants during follow-up, as was telehealth and research partnerships. Discussion/Conclusions: This landmark trial provides a novel multicomponent intervention in an underserviced population to inform muchneeded service improvements for Aboriginal people with ABI across metropolitan and rural settings.

Foreign accent syndrome and other neuropsychological sequelae of a parieto-occipital lesion following COVID-19 associated posterior reversible encephalopathy syndrome.

OBJECTIVE: We describe a previously fit and well 54-year-old female who acquired a range of severe and persisting neuropsychological impairments following a posterior reversible encephalopathy syndrome (PRES) complication of COVID-19. The initial presentation included aphasia, a neurogenic foreign accent syndrome (FAS) and a persisting complete cortical blindness from the underpinning parieto-occipital brain injury. METHOD: Neuropsychological single clinical case report. RESULTS: The patient retained insight and made good early progress with their adjustment to the numerous losses caused by the COVID-19 associated acquired brain injury. Comprehensive neuropsychological investigation characterised an acalculia, along with deficits in focused, sustained and divided attention impacting on verbal memory, working memory and executive functioning, amongst numerous relative strengths. CONCLUSION: Similar to PRES from other aetiologies, COVID-19 associated PRES can in some cases cause irreversible acquired brain injury. The diverse neuropsychological effects need to be comprehensively investigated and managed. This case adds to the neuropsychological literature on PRES, FAS and acquired brain injury as a rare complication of SARS-CoV-2.

Enabling participation in children and young people (CYP) with acquired brain injuries (ABI) and their families-mixed methods study-preliminary survey results

Introduction: Annually an estimated 40,000 CYP in the UK sustain an ABI with many experiencing significant, life-long impairments that impact on physical and psychological development, health-related quality of life (HRQoL), educational achievement and social inclusion. Patients and methods: A quantitative cross-sectional survey was completed as part of a mixed methods study which aims to explore the longer term needs of CYP-ABI aged 5-18 and their families in one region of the UK. Participants were recruited using eligibility criteria through a regional specialist clinical service. Ethical approval was gained (REC-20/ EM/0258). The survey consisted of demographic questions and standardised outcome measures completed by the parent or CYP-Pediatric Quality of Life Inventory 4.0 (PedsQL), PedsQL-Family Impact Module (PedsQL-FIM), Child and Adolescent Scale of Participation (CASP), Parental Health Questionnaire-4 (PHQ-4). Additional free text questions were included to capture parent and CYP goals, impact of Covid-19 lockdowns and any other information they wished to share. Results: 44 families have completed the survey so far, a response rate of 26%. CYP PedsQL scores indicated 31% were at risk of impaired HRQoL and the CASP indicated 68% had severely impaired social participation. 48% of families had impaired family HRQoL (PedsQL-FIM) and 48% of parents screened positive for anxiety, depression or both (PHQ-4). Conclusion: These preliminary results indicate the long-term impact of an ABI on CYP and family HRQoL and CYP social participation. The context behind these scores will be explored more deeply in qualitative interviews during the next phase of the study.

Exploring challenges and opportunities posed by COVID-19 on team working and the delivery of residential neurorehabilitation to children and young people with acquired brain injury

Introduction: COVID-19 has placed major demands on healthcare services and practitioners (HCP's). Research has highlighted resilience, new skills and new ways of working. However, little attention has been paid as to whether challenges faced may have demonstrated or influenced effective change in working practices of individuals and teams delivering neurorehabilitation services to children and young people following an acquired brain injury. Patients and Methods: Exploratory qualitative study. Fourteen HCP's (10 female, 4 male) across 6 occupational disciplines participated in semi-structured interviews (February-May 2021). Transcriptions analysed using thematic content analysis managed in NVivo. Five broad topic areas explored (1) professional roles, role identity and professional autonomy, (2) role boundaries, (3) team working, (4) collective identity in relation to organisational challenges, (5) working practices. Results: A wealth of data was retrieved, analysis of findings from three of the key theme categories presented: Individual Professionalism, Working as Team and, Delivery of Rehabilitation services. Although there was much uncertainty, rapidly changing information and constraints imposed by the pandemic, the professionalism of the team was evident as HCP's regrouped and reviewed how service provision could continue. Personal and professional growth saw teams collectively flourish. Creative solutions led to teams working differently and more cohesively. A greater appreciation of team roles and goals within the specialist environment of paediatric rehabilitation emerged. Conclusions: Changes in structure, processes and provision of services necessitated greater interdisciplinary team integration and sharing of skills and expertise. As confidence and competencies of HCP's grew the potential for a more 24/7 approach to rehabilitation gained wide staff acceptance.

Multiprofessional Neurorehabilitation After COVID-19 Infection Should Include Assessment of Visual Function.

Objective: To report vision-related symptoms and neuro-visual clinical signs in patients approximately 4 months after discharge from hospitalization after COVID-19 infection. To report on coexisting functional and activity limitations. Design: The study is part of an ambidirectional population-based cohort study. Setting: An outpatient setting in a hospital environment. Participants: Patients from a population-based cohort study including all patients with laboratory-confirmed COVID-19 admitted to hospital during a 3-month period in a health care region in Sweden. Among patients who, based on a standardized telephone interview, were identified as having persisting rehabilitation needs 4 months after discharge (n=185), several (n=57) reported vision-related symptoms. All 57 patients were invited to a neuro-visual examination. Six patients declined, 6 were unavailable, and 3 did not fulfil the inclusion criteria. Thus, 42 patients were included in the analysis (N=42). Interventions: Not applicable. Main Outcome Measures: Vision-related symptoms, neuro-visual function, and coexisting impairments affecting activities of daily life and participation. Results: A total of 31% of patients with rehabilitation needs after COVID-19 reported vision-related symptoms. Reading-related issues (73.8%), blurry vision (69.0%), and light sensitivity (66.7%) were the most common symptoms. Patients with reading-related issues showed a higher level of eye strain (P<.001). Neuro-visual deficits were found in 83.3% of the patients, mainly concerning eye teaming (23.1%-66.7%) and eye movement (28.6%-30.8%) functions. Patients with vision-related symptoms reported fatigue and 18 other coexisting symptoms to a greater extent (P≤.0001 to .049). Conclusions: Neuro-visual symptoms and signs should be considered when assessing rehabilitation needs after COVID-19. The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation underlines the need for multiprofessional rehabilitation assessment and intervention.

An Adapted Delivery of the Brick-by-Brick™ Programme to Develop Communicative Competence in Children with Acquired Brain Injury (ABI) who use Augmentative and Alternative Communication (AAC) Systems

Background: Communicative rehabilitation can be complex and challenging for children with an acquired brain injury (ABI) who use augmentative and alternative communication (AAC) systems. The development of communicative competence (CC) in children with use AAC systems is in itself complex and multifaceted (Light, 1989, Light and McNaughton, 2014) and it can be challenging for clinicians to target multiple competencies effectively through direct intervention. The Brick-by-Brick™ programme (previously known as LEGObased therapyR) has an evidence base routed in research with verbal young people with Autism Spectrum Condition. The programme is a collaborative play therapy originally designed as a social intervention to target the development of social communication and interaction skills (LeGoff, 2004). Introduction: The presentation aims to explore a use of the Brick-by-Brick™ programme with children with ABI who use AAC to support or replace their verbal communication, as well as the areas of potential clinical need for adaptations to its delivery to increase access for this client group. It will also discuss the theory behind adaptations and the need for evidence to support decision making clinically around this topic. The aims and methods of the presenter's current research will be discussed using Janice Light's framework of communicative competence (Light, 1989;Light and McNaughton, 2012) to discuss areas of competence during the presentation. Methods: The research agenda of an embedded quasiexperimental mixed methods design will be shared, along with considerations for the commencement of data collection in a country still significantly affected by the health, social, and educational repercussions of the Covid-19 pandemic. Clinical adaptations to the programme made by the presenter in her role as highly specialist speech and language therapist will be discussed and linked to her current research. Discussion, Conclusions and Recommendations: Adapting the delivery of the Brick-by-Brick™ programme for use with AAC users with ABI is not without difficulties, but these are not insurmountable. Practical and theoretical recommendations for the adaptation of the programme in both educational and healthcare rehabilitation settings will be shared. Future thoughts on the development of the current research base will also be discussed.

Post-Covid growth in Neuro-rehabilitation Services in Ireland-Covid-19 as a Potential Catalyst for Change in the Field of Neuro-rehabilitation for those with an Acquired Brain Injury?

Acquired Brain Injury (ABI) consists of any trauma to the brain. While the world has been dealing with the Covid-19 pandemic, the prevalence of ABI is a pandemic of a silent nature which is nonetheless an emerging health burden. Global estimates suggest that traumatic brain injury (injury caused by an external force) affects 10 million people annually (Hyder et al., 2007). In light of Covid-19, those working in the field of Neuro-rehabilitation had to adapt in order to provide vital support and continued rehabilitation for those with ABI. Many services switched to a Tele-Rehabilitation (TR) strategy to allow rehab to continue remotely while maintaining physical distancing. TR has been widely utilized in countries such as the United States, and Australia, and has a strong evidence base for its efficacy. This presentation will use case studies to explore the adaptation of TR by an ABI Neuro-rehabilitation service, and discuss how we can use this time as an opportunity to reconceptualize the way we structure neuro-rehabilitation in Ireland to combat service shortages, and in doing so improve outcomes for our clients.

A Cross-Sectional Study of Caregivers and Service Providers Adapting to COVID-19 in a Canadian Brain Injury Service Organization

Objectives: The COVID-19 pandemic has caused a disproportionate disruption to the delivery of in-person services in a multitude of essential and non-essential health service organizations. Management teams have had to seek alternative methods for effective service delivery while meeting appropriate safety precautions. COVID-19 mediated work changes have sparked an increasing concern about allied health worker's well-being and health in the work environment. Vista Centre Brain Injury Services (VCBIS), a Canadian organization committed to providing services to individuals with acquired brain injury, has modified in-person services and transitioned to remote work in response to the pandemic. This study aims to investigate and compare the impact of the pandemic among VCBIS workers. We surveyed individual staff members to assess their physical, psychological and social well-being in their work environment. Additionally, we investigated the staff's perspective on current management strategies and pandemic prospects. Methods: Between March 16th, 2021 and April 2nd, 2021, staff members were surveyed on changes in service due to COVID- 19 and its effect on workflow and well-being. In total, there were ninety-two questions containing a mixture of binary and linear numeric response formats. Fifty-seven questions asked staff members to reflect on their experience since the onset of the pandemic (?Retrospective component?) and thirty-five questions asked about thoughts and feelings about the future of the pandemic as it relates to their employment (?Prospective component?). For descriptive statistics, numeric variables are presented as means with standard deviations and categorical variables are presented with frequencies and percentages. We tested for the differences in responses between genders, age groups, employment status, and program involvement using a student's t-test, or single factor Anova and Tukey-kramer test post hoc. Results: Twenty-five staff members responded to the survey during the response period (32% female, 68% male). Most reported their age in the 30-39 range (28%), followed by the 60 or older, (24%), 18-29 (16%), 40-49 (16%) and 50-59 (16%) age ranges. Statistical analysis is in progress to elucidate significant differences across gender, age groups, employment status and program involvement. Conclusions: The results of this study have important implications for VCBIS service delivery, team management and funding distribution. Due to the long-lasting impact of the pandemic, it is important to consider these findings as VCBIS operates through the pandemic and transitions back to normal services. Preliminary results demonstrate that the COVID-19 pandemic service changes have impacted staff, suggesting the need for additional support and resources to improve staff work productivity, satisfaction and overall well-being. Given that many health organizations have had to readjust as a result of the pandemic, it is expected that staff outside VCBIS may share similar experiences.

Evaluating a Compassion Focused Therapy Group for Adults with Acquired Brain Injury

Objective: Evaluate the effectiveness of a Compassion Focused Therapy (CFT) group for adults with Acquired Brain Injury in the context of coping with stressors. Design: The original quantitative (pre/post questionnaires) design was altered due to COVID-19 restrictions ending the group prematurely at session 7 of 10. Contact with the group continued by e-mail for the next 3 months. Qualitative interviews were then carried out 6 months later and questions on the altered ending were included. Method: Out of the eight participants who started the group, six consented to take part in the qualitative interview which due to COVID-19 restrictions were completed remotely. An interview protocol focusing on eight key areas (including session content, group experience and impact of COVID-19 restrictions on session completion) was utilized. The content of the interviews were analyzed using interpretative phenomenological analysis. Results: Three core themes emerged from the interviews, namely the usefulness of the compassion focused model to address stress, the importance of group cohesion and the timing of the intervention. A preference was expressed for face-toface group work rather than through technology options. Conclusions: Participants successfully transferred strategies discussed during the group to daily life and reported increased coping with stress as a result. The feedback provides encouragement for continued provision of this type of therapeutic group to clients when COVID-19 restrictions ease. The positive impact of attending a CFT group adds to the growing body of research in this area.

IBIA 2021: A Global Conference and Meeting of Minds for Adult and Pediatric Brain Injury Professionals

The proceedings contain 258 papers. The topics discussed include: spontaneous migration of a falling bullet in the cerebellum reveals the importance of intraoperative skull X-Ray;concussion in women?s flat-track roller Derby;using PPI (public and patient involvement) in neurorehabilitation service research prioritization;emergency preparedness and ensuring the safety of persons with brain injuries;brain injury: voices of a silent epidemic;evaluating a compassion focused therapy group for adults with acquired brain injury;post-covid growth in neuro-rehabilitation services in Ireland - Covid-19 as a potential catalyst for change in the field of neuro-rehabilitation for those with an acquired brain injury?;and prevalence, predictors, and outcomes of traumatic brain injury in young offenders.

A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study.

BACKGROUND: Acquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person's life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness. OBJECTIVE: The aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model. METHODS: This is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample. RESULTS: Data collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023. CONCLUSIONS: End-user evaluation of the Social Brain Toolkit's implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31995.

COVID-19-induced surge in the severity of gender-based violence might increase the risk for acquired brain injuries.

While initial reports have emphasized a global rise in the frequency of intimate partner violence following COVID-19, emerging data are now showing a concerning surge in the severity of COVID-19-induced physical intimate partner violence. One of the most dangerous, frequent, yet hidden consequences of severe physical intimate partner violence is acquired brain injury, including repetitive mild traumatic brain injury and hypoxic brain injury. Although the increase in high-risk physical abuse during COVID-19 is gaining recognition, what still remains absent is the urgent discussion on intimate partner violence-related acquired brain injury during these times. The potential analogous surge in intimate partner violence-related acquired brain injury may have implications for both healthcare providers and healthcare actions/policies as repeated brain injuries have been associated with residual functional deficits and chronic disability. In addition, even in the pre-pandemic times, intimate partner violence-related acquired brain injury is likely unrecognized and/or misclassified due to overlap in symptoms with other comorbid disorders. This review aimed to raise awareness about intimate partner violence-related acquired brain injury within the context of COVID-19. Health actions and policies that should be considered as part of the pandemic response to minimize adverse outcomes associated with intimate partner violence-related acquired brain injury have also been discussed.

The Impact of Psycho-Social Interventions on the Wellbeing of Individuals With Acquired Brain Injury During the COVID-19 Pandemic.

Individuals with Acquired Brain Injury (ABI) suffer chronic impairment across cognitive, physical and psycho-social domains, and the experience of anxiety, isolation and apathy has been amplified by the COVID-19 pandemic. A qualitative evaluation was conducted of 14 individuals with ABI who had participated in series of COVID adapted group-based intervention(s) that had been designed to improve wellbeing. Eight themes were identified: Facilitating Safety, Fostering Positive Emotion, Managing and Accepting Difficult Emotions, Promoting Meaning, Finding Purpose and Accomplishment, Facilitating Social Ties, (Re)Connecting to Nature, and Barriers to Efficacy. Findings are discussed with respects to recent theoretical developments in positive psychology and wellbeing science and support the use of online and outdoor interventions to enhance wellbeing in individuals living with ABI during the COVID-19 pandemic. This paper makes a unique contribution to second wave positive psychology (PP2.0) through the application of recent advances in wellbeing science to an ABI population during the COVID-19 pandemic. In doing so, this paper lays the foundation for new interventions that not only reduce impairment and distress, but also create opportunities for meaning and enhanced wellbeing in people living with chronic conditions and those individuals living with ABI in particular.