Enter the word ‘transition’ into an internet search engine and you will be overwhelmed by the number of web pages that talk about transitions from an economical, scientific, literary or organisational perspective (just to name a few). Common to the description of transition from the differing perspectives is the inclusion of the terms movement and/or change from one state to the next. It is important that healthcare professionals who work with people with both traumatic and nontraumatic brain injury appreciate and understand that from the point of brain insult, the patient and their family will experience multiple transitions involving movement or change in ‘state’, such as changes to roles and altering levels of participation and activity.

Although advances in stroke care have been shown to improve functional outcomes and survival, evidence suggests that stroke survivors continue to report restricted participation and dissatisfaction with life after returning home. There remains a need to identify ways to improve participation after stroke, considering the person within their context. The International Classification of Functioning, Disability and Health (ICF) provides a valuable framework that can be useful for categorising key components associated with participation. The two parts of the ICF — (a) Functioning and Disability and (b) Contextual Factors — encourage consideration of the functions/body structures, activity and participation, and personal and environmental factors, respectively. Previous research has identified links between body functions, structures and activity, with increasing attention being given to the ways in which these link with participation. Although some of the components influencing participation poststroke are well defined, there is a need to further develop our understanding of how personal and environmental factors may affect participation. In this article, stroke literature is categorised using the ICF and a range of personal and environmental factors are investigated as potential contributors to levels of participation poststroke. This article concludes that research investigating contextual factors and their interactions with participation is warranted.

The purpose of this study was to describe differences in activity participation between younger and older individuals with stroke to inform transition after stroke. This was a cross-sectional study with individuals six-months poststroke (n = 177). All individuals completed an outcomes assessment battery that included the Stroke Impact Scale, the Reintegration to Normal Living Index and the Activity Card Sort. The sample was divided into two groups: (1) Young — those under the age of 65 (n = 89); and (2) Old — those 65 or older (n = 88). Analysis was completed to examine differences between the groups on the primary outcome measures of the study and to look at differences between the groups on individual questions/items on the specific measures. The results of this study demonstrate: (1) significant differences in both the quantity and nature of activity participation prior to and after stroke between younger and older stroke survivors and (2) total scores and measures of central tendency do not necessarily provide therapists with the information they need to guide treatment. Rehabilitation professionals should focus on providing clients with the tools they will need to be successful in transitioning back to home and community environments once rehabilitation has ended.

Objectives: To explore living situation, support and participation outcomes of people with severe acquired brain injury (ABI) residing in either home-like or disability-specific accommodation settings, who were provided with 3 years of occupational therapy intervention based on the Community Approach to Participation (CAP).

To examine transitions for a subgroup whose accommodation and support model changed during this 3-year period and identify factors critical to this change.

Method: Forty-three participants who had sustained severe to extremely severe ABI, and were an average of 6.73 years post-injury, were provided with CAP intervention over a 3-year period. Living situation and support model, participation levels and accommodation transition data were collected at four time points.

Results: Participants were living in a range of home-like and disability-specific accommodation settings at baseline. The disability-specific accommodation group had mainly noncompensable injuries and required a significantly higher level of daily support at all four time points. They also received higher total hours of support, which averaged 170.83 hours per week at baseline and did not change significantly over the 3 years. In contrast, 86% of the participants residing in home-like settings had compensable injuries and received an average of 91.46 hours of support per week at baseline. This reduced to 70.97 hours per week over the 3-year intervention period, a change that was statistically significant.

Conclusion: It is possible to achieve accommodation transitions to more independent, home-like situations many years post-injury and regardless of injury severity. Home-like settings provide scope to adjust support along a continuum to reflect gains in independence, community integration and role participation that the fixed models and hours of support in disability-specific accommodation do not. Over time, these gains can flow into a significant reduction in hours of support.

Background and aims: Community-based rehabilitation programs for people with a brain injury are diverse. Comparative program evaluation is required to identify optimal type, intensity and duration of programs. The aim of this study was to compare the effectiveness of two community-based rehabilitation programs using a set of standardised outcome measures.

Methods: The study used a quantitative, multicentre, longitudinal design. Persons with severe traumatic brain injury (TBI, n = 39) and acquired brain impairment (n = 2) were recruited from two residential, transitional living programs (TLU; n = 21) and two home-based community rehabilitation programs (CR; n = 20). Participants were assessed via interview at program entry, 2 months and 6 months later using a broad range of standardised measures. The quantity and types of intervention provided to study participants were recorded. Results: No significant differences were identified between the TLU and CR groups at baseline or 6-month follow-up. Two significant group-by-time interactions were identified on the Community Integration Questionnaire (CIQ). First, the CR group had significantly greater changes in productivity (p = .003; d = 1.0) compared to the TLU group over time; by contrast, the TLU group showed significantly greater improvements in social integration (p = .007; d = .86). The TLU participants received up to five times more intervention than the CR participants. This finding is significant considering the similar levels of improvement in function made by both TLU and CR participants.

Conclusions: Both TLU and CR groups improved on a range of measures. The TLU group however, received significantly more face-to-face interventions. Further examination of the relationship between participant contextual factors, such as coping style and self-esteem, and impairments such as challenging behaviour and decreased self-awareness, of people attending TLU and CR programs is required.

This article presents early findings from the implementation and ongoing evaluation of a new model of care that employs a comprehensive approach to rehabilitation case management for clients with traumatic brain injury, with the aim of improving transition from inpatient rehabilitation to community settings. The evaluation explores the design, implementation, utility and acceptability of the new model using clinicians’ perceptions and experiences. Method: The evaluation framework employs a participatory evaluation approach, drawing on semistructured interview data. Interviews were conducted with brain injury unit clinicians, rehabilitation case managers and external stakeholders at the model's implementation and four months later, as part of a 12-month evaluation period. The data were descriptively organised, then coded and subjected to interpretative analysis to identify key issues. Results: Early findings suggest that the new model provides increased consistency for staff, clients and carers; promotes efficiency in discharge planning and facilitates a more streamlined and seamless transition between inpatient rehabilitation and community services. Data gathered across the remainder of the implementation trial will extend understanding of this comprehensive rehabilitation case management model and its potential utility in other services and settings.

This qualitative study aimed to explore transitions from hospital to the home over a period of one year.

Methods and procedures: A longitudinal, phenomenological approach was employed and 18 individuals with severe traumatic brain injury, their family members and rehabilitation professionals were interviewed using semistructured interviews, when the person with brain injury was discharged from the ward, after 6 months and again after one year.

Results: Themes identified within the data included returning home, getting back to normal, moving forward and the role of rehabilitation in the transitional period. Further subthemes were also identified including issues of life-course disruption, self-identity, status and reconstruction.

Conclusions: Data suggested that access to rehabilitation programs employing individualised, contextual interventions following discharge to the home were integral in enabling the transition through to autonomy and independence. Consideration of issues of identity and status can enable a different and potentially important perspective on the experience of transitions for those with brain injury. Reclaiming personal autonomy and control appeared to be central to the reconstruction of a coherent sense of self, enabling a meaningful life after brain injury.

Background and aims: The ‘transition’ phase from hospital to home following brain injury is well established as a critical period of adjustment for individuals and their families. There is, however, a lack of knowledge about the experience of transition following nontraumatic brain injury (e.g., stroke, aneurysm) for individuals of working age. The purpose of this study was to explore the transition experiences of individuals with nontraumatic brain injury using mixed methods approach.

Methods: Six individuals with nontraumatic brain injury were recruited from a larger study using maximum variation sampling criteria. Individuals participated in semistructured interviews at 6-months postdischarge and completed quantitative measures of psychosocial outcomes predischarge and at 6-months postdischarge. Results: Qualitative content analysis of interviews identified three themes: (1) changes in role performance, (2) support and services and (3) coping with life after brain injury. The transition experience was characterised by loss of valued roles including driving and work, identified as major barriers to regaining independence postdischarge. Informal support provided by family and friends were relied on, while formal supports were accessed infrequently. Life post-injury presented a number of challenges including adjusting to changes in physical and cognitive abilities and a fear of reinjury. Qualitative data were supported by an overall trend of improved functioning on the quantitative measures over the 6 months.

Conclusions: Key life circumstances of working age adults with nontraumatic brain injury influence the transition experience. Clinically, the findings support the need for individualised, structured transition services pre- and postdischarge for this group.

Background and Aims: Return to work presents a unique transition for the person with mild stroke who is often unsupported and does not anticipate difficulties from hidden impairments. The aim of this study was to explore the return to work experience from the perspective of one person with mild stroke.

Methods: An inductive thematic analysis was undertaken with a narrative of e-mail correspondence from a person with mild stroke. The analysis follows the participant from three to six years after stroke during a process of upskilling and training for return to work.

Results: The female participant was 32 years old at the time of stroke and returned to tertiary studies after experiencing difficulties with initial return to work. Four themes emerged from the analysis of the narrative: I don't know which identity to choose, My anxieties and reactions, I need support and structure, and I am exhausted.

Discussion: The results demonstrate the impact of hidden impairments on the struggle to reconcile a past with present identity. The process of reconciliation was ongoing and dependent on work-based experiences that enhanced understanding of strengths and limitations, and required adaptations. The impact of fatigue on performance in work and non-work time was highlighted.

The transition from hospital to home following traumatic brain injury (TBI) has been identified as the point where responsibility for care shifts from rehabilitation services to informal family caregivers. There has, however, been little research examining the experiences of family members during this important transition that involves adopting or, in some cases, resuming a caring role (e.g., a parent caring for an adult child). The aim of this qualitative investigation was to understand the experiences of family caregivers during the transition from hospital to home, defined as the first six months postdischarge. The sample included 10 family caregivers, of which all were female and either a mother, spouse or ex-partner of an individual with TBI. Semistructured interviews were conducted on average nine months following community reentry and data were analysed thematically using a framework approach. The overarching theme was that caregivers wished to move past the injury. This desire to move forward stemmed from a realisation of how their life had changed and the weight of the care responsibility. Caregivers were also aware of how the life of the individual with a TBI had changed and hoped for a return to normality (by regaining independence, engaging in meaningful occupation and having meaningful relationships). Implications of the findings for research and clinical practice are discussed. There is a need for services to support family caregivers during the transition from hospital to home.