There has been a dramatic increase in recent years in the literature available on community integration among people with acquired brain injuries. At the same time, however, clinicians are calling for information that has utility in the complex environment of community practice. The study was a scoping review to address the question: What is known from the existing literature regarding the best ways to promote community integration in the postacute phase of brain injury recovery? From a preliminary pool of 925 studies identified by electronic searching of 5 databases in a 15-year time window, a final set of 30 was selected for further review, referring to 25 distinct programs. This scoping review has shown that there are 5 types of programs typically offered to survivors of brain injuries to assist with community integration: supported employment, traditional rehabilitation, environmental adaptation, support development and transitional living. These 5 approaches were primarily used to address 2 aspects of community integration: traditional rehabilitation was most commonly used to promote independent living, and supported employment was the most common approach used to promote productive occupation. Themes that emerged from the review were the need for highly individualised programming, in vivo approaches, tailored supports, early intervention and a focus on participation. Methodologically, the study represents an important acknowledgment of the valuable information that is available in the literature in descriptive and small sample research.

Background: Persistent post-concussion symptoms (PCS) are associated with adverse psychosocial outcomes, including psychological distress and poorer health-related quality of life (HRQOL). Research has found that the occurrence of persistent PCS can be lowered via paper-based psychoeducation. Unfortunately, these resources have mostly been evaluated in adult populations. Studies in children have failed to address the role of parents in the development and maintenance of PCS, and unfortunately fail to reach a large proportion of the mild traumatic brain injury (mTBI) population who do not attend hospital. This study aimed to describe and evaluate a parent information booklet and child information website, for the prevention of paediatric PCS.

Methods: Children with uncomplicated mTBI were randomly assigned to either the Intervention (n = 29) or Usual Care condition (n = 20). Families completed pre-treatment, post-treatment (3 month) and follow-up (6 month) assessments of children's PCS, cognitive and psychosocial functioning, and parent's psychosocial functioning. Families also provided feedback on the psychoeducation resources.

Results: The Intervention programme, compared to Usual Care, was not associated with significant reductions in children's PCS or HRQOL, parent or child psychological distress, or parent or child knowledge of mTBI.

Conclusions: Psychoeducation resources do not appear to be superior to usual care in promotion of both child and parent psychosocial outcomes following mTBI.

Many individuals require long-term community-based support following acquired brain injury (ABI). However, very few studies have examined individuals' perceptions of these support needs. The present exploratory study examined individuals' perceptions of community-based support following severe ABI. Participants included eight individuals (aged 20–48 years) with severe ABI, seven relatives and three case managers. The individuals were receiving long-term specialised lifestyle support ranging from 3–70 hours per week. A structured interview with open and closed questions was developed to explore perceptions of individuals' support needs across the areas of personal and home-based activities, community-based activities, self-organisation and vocational activities and social and psychological well-being. The questions investigated whether support was needed, the importance of support, the sources of support, the effectiveness of support and the need for change. A comparison of the three respondent groups' perceptions of support indicated a general consensus that community-based activities were the most important and most effective area of support. When the issues raised by the three respondent groups were compared and contrasted two main themes emerged from the data, which were labelled “relationships” and “individual choice versus support needs”. These themes are discussed in relation to the provision of long-term community-based support services following ABI.

With visible disabilities, observers tend to overgeneralise from the disability. In contrast, with invisible disabilities such as traumatic brain injury and stroke, observers often fail to allow for challenges resulting from the disability. Persons who have suffered a stroke claim that people misunderstand their symptoms and stigmatise them as a result of these symptoms. This misunderstanding, which happens particularly with young survivors of stroke, may reflect people's causal attributions for symptoms that follow a stroke. Using a scenario design, this cross-sectional study examined whether people attribute ambiguous symptoms that may result from stroke to other causes (the stroke survivor's personality and age) and whether these attributions reflect the age of the stroke survivor. Participants (N = 120) read scenarios describing a male who was aged either 22, 72, or whose age was unstated and who showed four symptom changes: fatigue, depression, irritability and reduced friendships. For each symptom change, participants rated three causal attributions: the person's age, his personality and stroke. The age of the person in the scenario affected attributions; when the person in the scenario was 22, participants attributed his symptoms significantly more to his personality than to his age or stroke, whereas when he was 72, participants attributed his symptoms more to his age than to his personality or stroke and when his age was unstated, they attributed his symptoms equally to age, stroke and personality. Because misattributions for stroke symptoms hinder rehabilitation, therapy can target people's misattributions to enhance rehabilitation for survivors of stroke.

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.

Recently, there has been a surge of interest and research in social functioning throughout childhood and adolescence, and how social development is affected by acquired brain injury (ABI). Despite ongoing research and theoretical advances, there remains a lack of specific, relevant and robust measurement tools that draw upon current clinical and social neuroscience knowledge, and which are developmental in nature, to assess social competence within the nonclinical and the ABI population. The aim of the current project was to develop a questionnaire to measure social competence and the quality of relationships of children and adolescents between the ages of 5 and 18 years. This questionnaire, the Developmental Assessment of Social Competence (DASC), also aimed to be sensitive to the specific social problems often associated with children who have suffered ABI. The current article outlines the process and challenges faced in developing such a measure up to the initial pilot stage. Participants included a pilot group of 40 parents who completed the pilot questionnaire, as well as an established questionnaire that assesses social functioning. Parents rated their own children who were aged between 6 and 14 years, and who were within the nonclinical population. Preliminary analyses found that the children generally scored highly on the DASC, and that a higher score on most scales of the DASC tended to be associated with a higher score on an established questionnaire measuring social skills. These data are promising, and provide important information for the following stages of development and evaluation of this new questionnaire.

Self-awareness is often impaired after acquired brain injury (ABI) and this hampers rehabilitation, in general: unrealistic reports by patients about their functioning and poor motivation and compliance with treatment. We evaluated a self-awareness treatment that was part of a treatment protocol on executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). A total of 63 patients were included, aged 17–70, suffering non-progressive ABI, and minimum time post-onset of 3 months. Self-awareness was measured by comparing the patient's Dysexecutive Questionnaire (Wilson, Alderman, Burgess, Emslie, & Evans, 1996) score with that of an independent other. As emotion recognition is associated with self-awareness and influences the effect of rehabilitation treatment, we assessed this function using the Facial Expressions of Emotion-Stimuli and Tests (Young, Perrett, Calder, Sprengelmeyer, & Ekman, 2002). Results showed that patients in the experimental treatment group (n = 29) had better self-awareness after training than control patients (n = 34). Moreover, our results confirmed that the level of self-awareness before treatment was related to emotion recognition. Hence, self-awareness can improve after neuropsychological treatment fostering self-monitoring. Since neuropsychological treatment involves social learning, impairments in social cognition should be taken into account before starting and during treatment.

Assessment of posttraumatic amnesia (PTA) in young children remains problematic. This article details a version of the Westmead PTA Scale, which was adapted for use with children aged 4 and 5 years, and an evaluation of this scale with typically developing children. The Westmead PTA Scale for Children (WPTAS-C) comprises 2 orientation and 4 memory questions, including 2 items involving remembering pictures of familiar objects. Participants included 55 preschool and kindergarten children aged 4 and 5 years. The scale was administered for 4 consecutive days. Ninety-three per cent of the children achieved a score of 6 out 6 for the final 3 days of the 4-day test period. It is concluded that the WPTAS-C is an appropriate measure of orientation and continuous memory in 4- and 5-year-old typically developing children. Validation of the scale in clinical populations is recommended.

The present study aimed to determine whether including a sensitive test of immediate and delayed recall would improve the diagnostic validity of the Rapid Screen of Concussion (RSC) in mild Traumatic Brain Injury (mTBI) versus orthopaedic clinical samples. Two studies were undertaken. In Study 1, the performance of 156 mTBI and 145 orthopaedic participants was analysed to identify the number of individuals who performed at ceiling on the verbal memory subtest of the RSC, as this test required immediate and delayed recall of only five words. A second aim was to determine the sensitivity and specificity levels of the RSC. Study 2 aimed to examine whether replacement of the verbal memory subtest with the 12-word Hopkins Verbal Learning Test (HVLT) could improve the sensitivity of the RSC in a new sample of 26 mTBI and 30 orthopaedic participants. Both studies showed that orthopaedic participants outperformed mTBI participants on each of the selected measures. Study 1 showed that 14% of mTBI participants performed at ceiling on the immediate and 21.2% on delayed recall test. Performance on the original battery yielded a sensitivity of 82%, specificity of 80% and overall correct classification of 81.5% participants. In Study 2, inclusion of the HVLT improved sensitivity to a level of 88.5%, decreased specificity to a level of 70% and resulted in an overall classification rate of 80%. It was concluded that although inclusion of the five-word subtest in the RSC can successfully distinguish concussed from non-concussed individuals, use of the HVLT in this protocol yields a more sensitive measure of subtle cognitive deficits following mTBI.

There is mixed evidence linking adverse outcomes after traumatic brain injury to the presence of the ε4 allele of the apolipoprotein gene (APOE). Further, there has been limited investigation of the role of APOE in populations who have sustained severe brain injuries. In this study, 100 individuals aged 16 to 65 years with a severe to extremely severe traumatic brain injury were recruited prospectively from an inpatient rehabilitation unit. APOE genotypes were determined, and demographic and clinical data were collected by blind assessors at 6 months postinjury. Sixty-nine participants who were divided into an acute (less than 12 months postinjury) and chronic (greater than 12 months) groups also completed neuropsychological assessments testing various domains of memory, attention and problem-solving at follow-up. No significant differences in injury severity, cognitive or functional outcome were found between individuals with the ε4 allele and those without at either time postinjury. This finding is consistent with other recent data that has questioned the role of APOE status as a factor in recovery from TBI.

Individuals seeking compensation following traumatic brain injury (TBI) are often found to report a disproportionately high level of symptoms relative to objective indicators of impairment. Previous studies highlight that level of symptom reporting is also related to self-awareness, causal attribution, and emotional wellbeing. Therefore, the reasons for high symptom reporting in the context of compensation are generally unclear. This study aimed to identify whether self-awareness, causal attribution, and emotional wellbeing are significantly associated with level of symptom reporting after controlling for compensation status. A sample of 54 participants with TBI comprised two groups, namely, claimants (n = 27) and non-claimants (n = 27), who were similar in terms of demographic and neuro-cognitive variables. Participants completed the Symptom Expectancy Checklist, Hospital Anxiety Depression Scale, Awareness Questionnaire and a causal attribution scale. A series of independent t tests and Pearson's correlations identified that a higher level of symptom reporting was associated with the following: seeking compensation, less severe TBI, increased age, greater self-awareness, increased post-injury changes reported by relatives, a higher level of mood symptoms, and a tendency to blame other people. Multivariate analysis identified that after controlling for demographic, injury, and compensation status variables, level of mood symptoms and self-awareness were significantly associated with level of symptom reporting. The findings suggest that mood symptoms and heightened self-awareness are significantly related to high symptom reporting independent of compensation status, thus supporting the need for clinicians to interpret symptom reporting within a biopsychosocial context.

MS-related dementia is an under-recognised and misunderstood aspect of MS. It is relatively rare, occurring in approximately 10% of people with MS, while cognitive impairment in general occurs in 43% or more of people with MS. MS-related dementia is hard to detect on the basis of short social interactions or clinical interviews alone. There are very few clinically relevant scientific articles on this topic to help guide the management and support of people with MS-related dementia. This article was written in a preliminary attempt to address this problem: to describe the clinical presentation and characteristics of MS-related dementia, to alert health professionals to the sensitivities surrounding the use of dementia terminology within the MS community, and to outline the limited nature of the information, advice and support resources currently available in Australia for these middle-aged people with dementia.