Participant perspectives on an individualised self-awareness intervention following stroke: a qualitative case study.

Most research investigating the efficacy of neurorehabilitation has focused upon pre- versus post-intervention functioning, which is important for evidence-based practice but overlooks the therapeutic process. Therefore, this qualitative study aimed to investigate a participant's perspective of experiences in therapy throughout an awareness rehabilitation intervention. The participant(CP), a young male with awareness deficits following a right thalamic stroke,had repeatedly attempted to return to work and experienced recurrent periods of depression associated with his employment difficulties. Throughout a12-session rehabilitation intervention, which targeted self-awareness and self-regulation skills, CP provided interview feedback concerning his experiences of different therapy exercises. The key themes emerging from the data regarding CP's perspectives included: understanding benchmarks and the value of feedback, learning through practical exercises, and individualising therapy. In collaboration with a disability employment support service, CP achieved paid durable employment. This study highlights the importance of considering participants' perspectives of the therapeutic process to assist in the design and evaluation of awareness rehabilitation interventions.

Self-identified goals and the ability to set realistic goals following acquired brain injury: a classification framework.

OBJECTIVE: To develop a framework for classifying the nature of goals identified by people with acquired brain injury (ABI) and explore the extent to which goals and the ability to set realistic goals vary over time and according to stage of recovery. METHODS: Participants included 60 people with ABI comprising two subgroups: a post-acute subgroup (n = 28, mean time since injury = 1.1 years, SD = 0.5) and a long-term subgroup (n = 32, mean time since injury = 4.9 years, SD = 3.0). Participants completed the Self-Awareness of Deficits Interview, which includes a goal-setting component, at an initial assessment and at 12-month follow-up assessment. Data generated from the interviewing process were analysed using a combination of qualitative and quantitative methods. RESULTS: Through an inductive analysis, a classification framework was developed consisting of the following goal categories: 'relationships', 'work and education', 'injury/rehabilitation', 'health and leisure', 'daily life management' and 'general life/personal goals'. Each of these categories comprised several subcategories of goals. Overall, the post-acute subgroup identified more goals in the improve function/rehabilitation subcategory than the long-term subgroup (P = 0.002), whereas the nature of other life goals remained consistent over time. The ability to set realistic goals improved over time for the entire sample (P = 0.013). CONCLUSION: The findings provide therapists with greater insight into the goals most commonly identified by individuals with ABI. The classification framework may assist therapists to elicit client goals and tailor rehabilitation accordingly.

The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations.

PURPOSE: To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. METHOD: Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. RESULTS/DISCUSSION: A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. CONCLUSION: Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.

The investigation of factors underlying deficits in self-awareness and self-regulation.

PRIMARY OBJECTIVE: To examine a theoretical model which suggests that a contribution of both psychological and neuropsychological factors underlie deficits in self-awareness and self-regulation. RESEARCH DESIGN: Multivariate design including correlations and analysis of variance (ANOVA). METHODS: Sixty-one subjects with acquired brain injury (ABI) were administered standardized measures of self-awareness and self-regulation. Psychological factors included measures of coping-related denial, personality-related denial and personality change. Neuropsychological factors included an estimate of IQ and two measures of executive functioning that assess capacity for volition and purposive behaviour. MAIN OUTCOMES AND RESULTS: The findings indicated that the relative contribution of neuropsychological factors to an outcome of deficits in self-awareness and self-regulation had a more direct effect than psychological factors. In general, measures of executive functioning had a direct relationship, while measures of coping-related and personality-related denial had an indirect relationship with measures of self-awareness and self-regulation. CONCLUSION: The findings highlighted the importance of measuring both neuropsychological and psychological factors and demonstrated that the relative contribution of these variables varies according to different levels of self-awareness and self-regulation.