Self-efficacy outcomes of people with brain injury in cognitive skill training using different types of trainer-trainee interaction.

PRIMARY OBJECTIVE: To evaluate the effects of different trainer-trainee interaction patterns on the self-efficacy outcomes of trainees with brain injury. RESEARCH DESIGN: A pre-test and post-test randomized clinical trial design. METHODS AND PROCEDURES: One hundred and three subjects with brain injury were recruited and 83 subjects participated in analogical problem-solving training that was delivered in three respective interaction modes: (a) direct trainer-trainee interaction, (b) self-paced computer-assisted and (c) on-line training with real-time audio-visual interaction. Quizzes on daily behavioural problem- solving and a problem-solving self-efficacy rating scale were adopted as outcome measures. The trainees in the trainer-administered group that received instructions in person with a continuous 'human touch' showed more significant improvement in their problem-solving self-efficacy than the two other groups. CONCLUSIONS: Interactive modes of cognitive skill training can be flexible enough to match the needs of individual trainees. However, human interaction is considered important in promoting self-efficacy in trainees with brain injury.

Management of impaired self-awareness in persons with traumatic brain injury.

AIM: To develop and evaluate a systematic intervention programme for the management of impaired self-awareness (ISD) in people with traumatic brain injury. METHODS: This study adopted a pre-test-post-test control group design. Twenty-one patients with traumatic brain injury were randomly assigned to an experimental group and a control group according to their admission sequence. The groups joined a newly developed Awareness Intervention Programme (AIP) and a conventional rehabilitation programme respectively for 4 weeks. Pre- and post-intervention outcome measures taken from the two groups were compared. Wilcoxon Signed-Ranks Tests were conducted to compare the within-group changes of the outcome measures of the Self-Awareness of Deficits Interview (SADI), the Functional Independence Measure (FIM) and the Lawton Instrumental Activities of Daily Living Score (Lawton IADL) in the control and experimental groups. Mann Whitney U-tests were conducted to compare the across-group differences of improvements of outcome measures between the participants in the two groups. RESULTS: After AIP training, the participants in the experimental group demonstrated significant improvement in their level of awareness as compared to the control group. However, the functional outcomes of the participants in experimental group did not show significant differences. CONCLUSION: The AIP can promote improvement in the level of self-awareness of people with traumatic brain injury. This new programme can be further developed to extend a better carryover treatment effect to functional improvement in daily activities.

Computerized errorless learning-based memory rehabilitation for Chinese patients with brain injury: a preliminary quasi-experimental clinical design study.

AIM: To evaluate the effectiveness of a computerized, errorless learning-based memory rehabilitation program for Chinese patients with traumatic brain injury (TBI). METHODS: This study adopted a pre- and post-test quasi-experimental design. A total of 37 patients with TBI were randomly assigned to a Computer-Assisted Memory Training Group (CAMG), a Therapist-administered Memory Training Group (TAMG) and a Control Group (CG). Except for the CG, the patients in both the CAMG and TAMG groups received, respectively, 1-month memory training programmes that were similar in content but differed in delivery mode. All patients were followed up 1 month after treatment. The outcome measures that were taken were the Neurobehavioural Cognitive Status Examination (NCSE or Cognistat), the Rivermead Behavioural Memory Test (RBMT) and The Hong Kong List Learning Test (HKLLT). Repeated measure analyses were performed to investigate differences among the three groups. RESULTS: The patients in the Computer-assisted Memory Rehabilitation (CAMG) and Therapist-administered Memory Rehabilitation group (TAMG) were found to perform better than the CG in the NCSE and RBMT, but no significant differences were found between the CAMG and TAMG. The CAMG showed significant improvement in their HKLLT assessment as compared with the TAMG and CG. No statistically significant differences were found between the CAMG and TAMG when comparing the post-training outcome measures with the follow-up results. CONCLUSION: There is no difference between CAMG and TAMG, but the efficacy has been demonstrated when comparing with CG. It is suggested that the combined use of an errorless learning and a computerized approach may be an effective way of enhancing the memories of patients with TBI. This new method may smooth the progress of the whole human memory process and produce a better carryover treatment effect.

Health services needs and quality of life assessment of individuals with brain injuries: a pilot cross-sectional study.

BACKGROUND AND PURPOSE: Quality of Life (QoL) studies have received a substantial amount of attention in medical and rehabilitative practices. However, there is still a paucity of studies in the area, especially on persons with brain injuries (BI). This pilot study, on the QoL of individuals with brain injuries in Hong Kong, attempts to fill this void. It is hoped that the finding of this study will guide the development of programmes and services to people with brain injuries. METHODS: Through the Self-help Group for People with Brain Damage in Hong Kong, 35 subjects (22 men and 13 women) were successfully recruited to participate in this study by convenience sampling. Demographic data were collected through face-to-face interviews guided by a questionnaire and QoL data were gathered using the Comprehensive Quality of Life Scale--Intellectual/Cognitive Disability--5th edition (ComQol-I5). The general emotional condition of the participants over the past 2 months was measured by a validated Chinese version of the Positive and Negative Affect Scale (PANAS). The participants' ratings on the importance of and their satisfaction with 20 health services areas were also collected. RESULTS: Preliminary results show that the overall mean quality of life score, as measured by ComQol-I5, was slightly less than two-thirds of the maximum score. Among the seven QoL domains, health and safety received some of the highest scores, while the lowest scores were obtained in the area of material well-being, place in community and productivity. People whose injuries had occurred relatively recently (less than 5 years ago) were found to have higher intimacy QoL scores than their counterparts injured more than 5 years ago. In the domain of safety, persons with a brain injury who were employed scored significantly higher than those who were not. Positive affect scores and the total affect of PANAS scores correlated significantly with the overall QoL scores. Moreover, persons with a brain injury usually felt satisfied with the services they valued as important. The top five most important services were medical services, occupational therapy, physiotherapy, vocational counselling and social work. DISCUSSION AND CONCLUSION: The QoL profile of people with brain injuries in Hong Kong was initially obtained and low scores in the ComQoL were identified in the domains of material well-being, community activities and responsibility and productivity. These might be the consequences of their physical and cognitive limitations due to brain injury. This implies that appropriate interventions to improve their daily life conditions and their social integration would be necessary to improve their QoL. On the other hand, the BI sample also rated relatively high scores in other ComQoL areas such as safety and health, reflecting a good living environment and probably good health care services. Those whose brain injuries had occurred less than 5 years ago tended to have a higher ComQoL intimacy score than those whose injuries occurred more than 5 years ago. In other words, their social relationships may deteriorate with the longer period post-injury so that this group may need more supportive services. In the safety domain, it was found that subjects who were employed after their brain injury scored significantly higher than those who were not, which matched studies about the significant contribution of work towards life satisfaction. The satisfaction of their needs in the services they received, which may affect their QoL, was also investigated. It is clear that they valued the medical and rehabilitation services they received and felt satisfied with them.

Community-based cognitive rehabilitation services for persons with traumatic brain injuries in China.

The present study aims to explore the need for cognitive rehabilitation services (CRS) in the community for persons with brain injuries and to understand the level of knowledge and attitudes towards cognitive rehabilitation of health care professionals in the city of Guangzhou in southern China, including their use of innovative CRS. One hundred and fifty-five medical and allied health professionals responded to a self-administered questionnaire. Of this number, 128 completed questionnaires were returned; a response rate of 82.58%. Of the respondents, 95.4% agreed with the need to develop CRS in China. They identified four areas as those for which CRS is most urgently needed: language, memory, orientation and attention rehabilitation. The relative appropriateness of settings for such CRS delivery was ranked, from most to least, as the home, hospital and community, respectively. In prioritising the modes of CRS, it was suggested that the order of preference would be face-to-face, computer-assisted and online/web-based. Home-based intervention was also ranked top among the service treatment settings. The respondents also showed a preference for the innovative online mode, which they felt should be conducted in a home rather than a hospital setting.

Prediction of discharge status of persons with brain injury in rehabilitation.

The present study sought to identify the factors as well as what would predict discharge of persons with brain injury. Demographics (age, pre-injury educational level, pre-injury occupational status) and Disability Rating Scale (DRS) scores during admission and upon discharge were used for discharge status prediction. A multiple discriminant analysis (MDA) revealed that the DRS scores at admission and upon discharge were significant predictors that correctly classified 72% of grouped cases.

Exploring self-concepts of persons with brain injury.

BACKGROUND: This study explored the self-concepts of Hong Kong Chinese adults with brain injury. OBJECTIVES: The Adult Source of Self-concept Inventory (ASSEI) Chinese Version was adopted to identify the sources and basis of the self-conceptions of 120 persons with brain injury. METHOD: The Adult Source of Self-Esteem Inventory (ASSEI), a self evaluation tool using open-ended questions and interviewing, was used to identify the sources and basis of the self-concept of persons with and without brain injury. The subjects' important life aspects were identified through interpreting their responses to open-ended questions and interviews. Moreover, a structured questionnaire on their subjective perceptions of importance and satisfaction in different life areas was used to identify the relationships between discrete self-concept variables. The subjects' responses to the 20 items of the ASSEI were also subjected to an exploratory factor analysis. MAIN OUTCOME AND RESULTS: Five self-concept related factors, which accounted for 65.55% of the total variance, were successfully identified. They were family self, physical self, moral self, personal achievement and social self. The self-concept factors match the results of content analysis of the subjects' responses to the open-ended questions. The results showed that family, physical health, work and friends were the most important domains in lives of individuals with brain injury. Brain injury survivors felt good towards their family, work and friends in their daily life. However, the majority expressed the view that they felt bad due to deteriorating physical health, poor family relationships, emotional difficulties and poor working relationship with others. CONCLUSION: Findings from this study identified the self-concept basis of persons with brain injury that can indicate self-concept enhancement strategies to improve their rehabilitation outcomes. Hopefully, they can develop more positive self-images and, thus, achieve better community integration.

Development and application of the Family Empowerment Questionnaire in brain injury.

BACKGROUND: The present study was an ongoing development of a previous study of the Family Empowerment Questionnaire, which had already indicated a four-factor solution (Skill, Knowledge, Support and Aspiration) empowerment process among family caretakers for their family members with traumatic brain injury (TBI). OBJECTIVE: The Family Empowerment Questionnaire was used to further explore its applicability to rehabilitation professionals through investigating differences between rehabilitation professionals' and family members' perceptions of empowerment in the rehabilitation process of persons with TBI. METHOD AND PROCEDURES: The present study compared the 52-item Family Empowerment Questionnaire scores between 65 rehabilitation professionals with the results obtained from 211 family caretakers. MAIN OUTCOME: Statistical analyses using the factor-based scores of the four sub-scales revealed that professionals and family members differ significantly in their perceptions regarding family empowerment in TBI rehabilitation in any of the four empowerment factors and within individual items of each factor. CONCLUSIONS: Specific activities in which families and professionals' perceptions differed significantly should be explored further and clinical implications of the study are discussed.

Learning to live independently with expert systems in memory rehabilitation.

Expert systems (ES), which are a branch of artificial intelligence, has been widely used in different applications, including medical consultation and more recently in rehabilitation for assessment and intervention. The development and validation of an expert system for memory rehabilitation (ES-MR) is reported here. Through a web-based platform, ES-MR can provide experts with better decision making in providing intervention for persons with brain injuries, stroke, and dementia. The application and possible commercial production of a simultaneously developed version for "non-expert" users is proposed. This is especially useful for providing remote assistance to persons with permanent memory impairment when they reach a plateau of cognitive training and demand a prosthetic system to enhance memory for day-to-day independence. The potential use of ES-MR as a cognitive aid in conjunction with WAP mobile phones, Bluetooth technology, and Personal Digital Assistants (PDAs) is suggested as an avenue for future study.

Gender difference in self-esteem of Hong Kong Chinese with cardiac diseases.

Self-esteem is an indicator of a person's subjective quality of life due to its close relationship to a person's behavioural competence, positive self-experience, and sense of self-actualization. The present study aimed to investigate the basis of self-esteem in people with cardiac diseases, according to gender, after their cardiac surgery. The findings showed that there were prominent gender differences in the subjects' self-esteem. Women (aged<60) showed statistically significant higher ratings in the importance of 11 life events importance and the satisfaction of three life events than men. The study also found cultural uniqueness: Hong Kong Chinese (both men and women) with cardiac diseases generally indicated that social (interpersonal) self-concept dimensions were more important than achievement (personal) self-concept dimensions in their life perception. These findings are noteworthy for setting optimum goals of rehabilitation apart from return to work.

Family caregivers' reactions and coping for persons with brain injury.

BACKGROUND: This study was a follow-up of a previous study on the empowerment of families caring for Chinese persons with brain injury. OBJECTIVE: The present study examined, in a qualitative way, the impact of brain injury on the family and the complex array of factors that appears to be related to effective family coping and their independence. The reactions of families under stress and their coping strategies are summarized. Individual families' differences in terms of an empowerment framework are discussed for possible guidance in family intervention. METHOD: Individual families were interviewed using open-ended questions, their responses and the verbatim transcripts of long interviews performed with selected families were examined. RESULTS: A total of 50 family members were successfully recruited for interview. They were found to show typical coping strategies, including shock and uncertainty, which are suggested to be relating closely to the nature of brain injury and the difficulties in managing it. The physical and psychological burdens involved in caring for members with brain injury were also reflected. Content analysis of the long interviews of four selected families showed that it was not every family that coped well. Possible factors leading to better adjustment, such as clear personal expectations, a desire to master the situation, strong motivation, flexibility to adjust life goals and awareness of one's own powerless state are proposed. CONCLUSION: The results indicated that family coping varies with individual families and should be explored further for the development of intervention guidelines.