Lasting emotional and social communication deficits are common among children who have suffered brain injury. Concerns have been raised that current assessment and treatment methods are inadequate in addressing the needs of such children in rehabilitation. We advocate that a proportion of reported deficits occur as a result of compromise to emotion processing systems in the brain. In this article we review adult brain injury research, which indicates that dissociable subsystems are involved in distinguishing the nuances of emotional expression. Findings previously reported in the literature have been integrated into a dissociable heuristic framework, which offers a novel representation of subcomponents of the emotion processing system. In considering the development of the subcomponents of emotion processing, evidence indicates that intrinsic arousal systems are operational from birth, systems associated with sensory/spatial skills that are essential in reading emotional expression develop rapidly from birth, and systems utilised in executive system synthesis become increasingly sophisticated with development, stemming across childhood and into adulthood. In conclusion, it is proposed that the heuristic is a useful tool on which assessment measures may be based when considering the primary effects of brain injury in children.

People surviving severe acquired brain injury (ABI) may potentially benefit from the Council of Australian Governments' (COAG) 5-year initiative for young people with disability in residential aged-care facilities. Yet critical examination of this policy initiative for ABI population is warranted for 2 reasons. First, reliance on the disability sector to resolve the complexities of long-term care for people with ABI detracts attention from systemic failures at the health/disability sector interface, and notably, debate concerning the role of, and right to rehabilitation. Second, the COAG initiative is being pursued within an extraordinarily complex and variable contemporary care environment, involving multiple services and sectors, and historically, high unmet need. This raises questions as to the adequacy and sustainability of care provided under the responsibility of state-based disability services. In this article, it is argued that long-term care for young people with severe ABI is better served by incorporating a health and rehabilitation perspective alongside a disability support approach. Although the effectiveness of rehabilitation may be contested in some instances of very severe ABI, nevertheless the role of rehabilitation in seeking to reduce the number of young people at risk of entering residential aged care needs to be addressed in policy solutions. It is also suggested that provision of long time care in the contemporary care environment involves a number of challenges due to the complex and changing patterns of need, diverse funding arrangements and mix of government and nongovernment services, and the increasing demand for care.

This paper describes the value of collaboration from two perspectives. The first perspective highlights the benefit of teaching communication partners collaborative communication strategies to facilitate the interactions of people with traumatic brain injury (TBI). Collaborative strategies encompass the provision of collaborative intent, emotional and cognitive support, positive questioning styles and collaborative turn taking. Translating research outcomes into accessible resources is described with reference to the TBI Express website which has video demonstrations of conversation strategies for communication partners of people with TBI. The broader meaning of collaboration is also discussed, with particular focus on the advantages collaboration can provide in advancing rehabilitation outcomes for people with acquired brain injury, their families and social networks. Collaboration is described in terms of encompassing all relevant contributors to the development of research advances, including people with acquired brain injury, their families and social networks, stakeholders, clinicians, peak bodies, students and researchers. Two examples of large-scale research collaborations occurring within Australia are described, including the NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation and the NHMRC Moving Ahead Centre for Research Excellence in Brain Recovery, also known as Moving Ahead.

Dysphagia and aspiration pneumonia are prevalent but infrequently studied complications following severe traumatic brain injury (TBI). Aspiration pneumonia is responsible for a significant number of long-term deaths in this population, however, the reported number of deaths attributed to aspiration pneumonia may be inaccurate. This multicentre inception cohort (n = 2545) study analysed consecutive discharges from 3 metropolitan inpatient brain injury rehabilitation units from January 1990 to October 2007 following inpatient rehabilitation following primary TBI. Subject data was linked to national death registries to determine cause of death where relevant. This study aimed to (a) evaluate the prevalence of aspiration pneumonia, percutaneous endoscopic gastrostomy (PEG) insertion and dysphagia following TBI, (b) identify the number of deaths ascribed to aspiration pneumonia, and (c) characterise associated risk factors for long-term aspiration pneumonia related deaths compared to all other causes of death. In-hospital PEG insertion occurred in 18.4% of the sample, two thirds of whom remained dysphagic at discharge. In-hospital aspiration pneumonia was recorded in 3.6% of the sample. Postdischarge, people with TBI were 79 times more likely to die from aspiration pneumonia than the general population. Risks were higher for subjects discharged to a nursing home, with severe ongoing functional disability, dysphagia at discharge, in those who had experienced in-hospital aspiration pneumonia or required PEG insertion. Early identification and risk management of dysphagia and aspiration pneumonia in TBI nursing home populations may maximise these individuals' quality and length of life.

Social cognition refers to the ability to use social cues to infer the meaning and intentions behind the behaviour of others in order to respond in a socially adaptive manner. It is increasingly recognised that disorders of social cognition, including problems with emotion perception, theory of mind, conversational inference, morality judgements, decision making and social inhibition, characterise many developmental and psychiatric disorders and are highly relevant to many with acquired brain injuries or diseases, especially the frontotemporal dementias. This review provides an introduction and overview of the papers in this special edition on social cognition and places these in the context of other recent research. In doing so, several current issues in the clinical management of social cognition are delineated. Given that social cognition seems to be a sensitive predictor of psychosocial function, the assessment of social cognition is seen by many clinicians to be important although which profession is responsible is yet to be resolved. Issues in how social cognition are assessed are discussed, including the importance of context to social cognition, its interactive nature and the need to recognise influences such as family upbringing, gender and emotional state on social cognitive performance. There also needs to be development of tests that address all aspects of social cognition, including decision making and inhibition. Finally, this review discusses intervention research. Interventions are especially well developed in relation to schizophrenia, and less well developed in brain injury. These appear to be generally effective although treatments for emotional self-awareness are yet to be developed.

There is evidence that individuals with an acquired brain injury (ABI) are at increased risk of developing psychological problems and that they commonly experience difficulties in social communication, associated with poorer long-term outcomes. Although several relevant group interventions have been evaluated, there has been limited exploration of the feasibility of an ABI inpatient intervention. This nonrandomised pilot study tested the feasibility of an inpatient multidisciplinary social communication and coping skills group intervention within 1-year post traumatic/nontraumatic ABI. Seven participants completed a 4-week group program (3 × 1 hour sessions per week) facilitated by a speech pathologist and clinical psychologist and were assessed pre/post intervention and at 3 months with the La Trobe Communication Questionnaire, Correct Information Unit analysis, Hospital Anxiety and Depression Scale, Mini International Neuropsychiatric Interview, Coping Self-Efficacy scale and World Health Organization Quality of Life assessment. Most participants improved between baseline and 3 months post intervention in terms of greater informativeness and efficiency of connected speech and reduced anxiety and they provided positive feedback about the group program. Despite the challenges and limitations of this pilot study, the findings are encouraging and support both the value and feasibility of developing such a program into routine inpatient rehabilitation services.

Objective: Experiencing a traumatic brain injury (TBI) may increase the risk of post-traumatic stress disorder (PTSD); however, this has not been examined in a population-based context. This study examined prevalence and predictors (demographic and injury related) of PTSD 1 year after TBI in a population-based sample.

Method: A population-based TBI incidence and outcomes study was conducted in Hamilton and Waikato Districts of New Zealand over 12 months (February 2011–March 2012) with follow-up at 1 year. The relationship of baseline demographic and TBI characteristics to PTSD (Post-traumatic Diagnostic Scale; PDS) was examined in 431 adults (>15 years old) 1 year post-TBI.

Results: On average, participants reported three PTSD symptoms, with heightened arousal being the most commonly reported. Nearly 18% of participants met criteria for PTSD. These participants were significantly more likely to report pre-TBI history of depression/anxiety, and to have drugs implicated in the injury. Regression indicated that female gender, increased loss of consciousness (LOC) and intentional injury predicted PTSD severity (R2 = .109, F[6, 294] = 6.007, p < .001) and number of symptoms (R2 = .098, F[3, 297] = 4.562, p < .001).

Conclusion: PTSD occurred as a long-term sequela in 18% of participants after TBI, with increased PTSD severity and greater number of symptoms associated with female gender, longer LOC and intentional injury. These findings have implications for identification and targeting of assessment and intervention resources towards those at greatest risk of PTSD following TBI.

The aim of this paper was to review the limited, but growing, literature on prospective memory (PM) following stroke using a scoping study methodology. Multiple databases were systematically searched and yielded 11 studies that were classified as observational (n = 7) or intervention studies (n = 4) and reviewed for quality. PM impairment after stroke was more commonly identified using behavioural measures compared to self-report measures. There were mixed findings regarding the extent and nature of PM impairment poststroke; however, more studies reported impairment for time-based PM, compared to both event- and activity-based PM. Studies examining rehabilitative techniques for PM resulted in mixed findings and were limited as most were case studies of poor methodological quality. Overall previous research in this area was limited as most studies were often underpowered due to small sample sizes, or used single-item measures which may not be robust enough to reliably measure PM impairment. Additionally, the methods used to measure PM were varied and many studies did not control for retrospective memory impairment, which could impact the results, as PM has both a retrospective (remembering both the action and when it needs to be completed) and prospective component (remembering to perform the action when appropriate). In conclusion, PM impairment is apparent poststroke, specifically for time-based PM. However, more research is needed to determine why PM impairment occurs, and how it can be improved.

The study aimed to identify themes in songs written by clients with traumatic brain injury (TBI). Lyrics (1834) from 82 songs written by 11 female and 21 male clients aged between 5 and 60 years were categorised into 8 main themes and 24 subcategories. Incidence of subcategories and themes were calculated. Self-reflections and messages were the most frequent themes portrayed within songs. Memories and reflections about significant others were also frequently communicated. It was noticeable that clients felt safer to communicate thoughts and feelings about the past and present but were less inclined to confront the future.

This article presents preliminary findings on an investigation into the differences in communicative performance across varying speaking conditions, of an individual with a cognitive–linguistic impairment following traumatic brain injury (TBI). The article compares the communicative exchanges of an individual in a conversation with a therapist, a conversational dyad with a peer with TBI, and in a communication group task where they were interacting with other participants with TBI. The speaking conditions studied included an unstructured chat, the participant requesting information and the participant giving information. Results showed that the person with TBI responded to differences in communication partner and speaker role. He was best able to give information in the unstructured chat with the clinician and the information giving session in the group. Requesting was maximally facilitated in the information request condition with the clinician. Qualitatively, however, the most equal interactions occurred with the peer, with evidence of the person with TBI engaging in typical conversational strategies such as establishing common ground to facilitate topic development and co-constructing the discourse topics. These strategies did not occur in the clinician or group interactions, possibly due to power imbalance in the former and impaired cognitive–linguistic ability in the latter situation. Implications for clinical decision making regarding intervention strategies for patients with cognitive–communication deficits are discussed.

Purpose: Clients with an acquired brain injury (ABI) are at risk of mental health problems and it has been argued that transitions throughout the rehabilitation process are a challenge for rehabilitation practice; however, the link between transitions and psychosocial outcome has been under-researched. Therefore, this study aims to (1) investigate the status of clients with moderate or severe ABI two-year post-discharge on the following outcomes variables: Physical and cognitive function, depression, quality of life, civil and work status, (2) examine correlations between these outcomes and (3) explore through qualitative interviews the subjective experiences of individuals with ABI in order to increase our understanding of clients’ perspectives on this outcome and its relation to life transitions in a two-year period.

Method: 37 individuals aged 18–66 with moderate or severe ABI were interviewed two years after discharge. At this time, they also completed standard measures of depression (MDI), quality of life (WHOQOL-bref) and functional independence (FIM™). Historical data of their FIM™ status at discharge were obtained for comparison.

Results: We found psychological problems two years post-hospitalization, especially depression (35.1%) and decreased psychological QOL (61%). Analysis of interviews found six main factors perceived as important for psychosocial outcome: family relations, return to work, waiting lists, psychological support, fatigue and personal competences.

Conclusions: Clients’ status two years post-hospitalization is often characterized by psychological problems. Based on clients’ accounts, we found a connection between psychosocial outcome and life transition experiences and developed a model of factors that are perceived as helping and hindering positive outcome.

Background and aims: Previous research has highlighted that living in residential aged care (RAC) is associated with a range of negative outcomes for adults with acquired neurological disorders. This study sought to understand the lived experience of entering RAC for young people and their family members and characterise their needs during this process.

Method: Data included 64 written and verbal submissions to the 2015 Senate Inquiry into the Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia. In line with hermeneutic tradition, text was analysed using thematic analysis.

Results: Entry to RAC was experienced as a complex process that coalesced around three key events: an unexpected health crisis, a directive that time's up and the individual is required to leave the healthcare setting, with a subsequent decision to move into RAC. This decision was made in the absence of time, knowledge of options or adequate support.

Conclusions: Findings suggest that there are both immediate practice changes and longer term policy responses that can support the health and disability systems to uphold the rights of people with acquired disability to choose where and how they will live their lives.

Three single participant studies examined effects of in-home parent-implemented Positive Behaviour Support (PBS) interventions on behaviour of individuals with brain injuries. Parental and independent observations of morning routine behaviour or problem behaviour (viz., noncompliance during meals or morning routines, yelling, kicking, swearing, and so on) were taken during baselines and PBS interventions, which consisted of person-centred functional assessments of behaviour, emphasis on changing behavioural antecedents, parent participation in assessing, treating, and evaluating behaviour change, and in-home parent coaching and support. Results show decreased problem behaviour or improved morning routine behaviour, which corroborate and add to the few studies that applied similar parent-implemented interventions. Future comparative studies between PBS and out-patient interventions are indicated.

Depression is one of the most common psychiatric diagnoses among individuals with traumatic brain injury (TBI). Prevalence of post-TBI depression (PTBID) ranges from 12 to 60% and is generally higher than rates reported in the general population. The wide range in reported rates is attributed to methodological variability across studies, including measurement and sampling differences. Several systematic reviews have been published in the past 5 years, reporting on outcomes for depression across different classes of interventions, including pharmacological, biomedical and behavioural. The consensus across reviews is that more research is necessary to develop evidence-based practice guidelines. The present narrative review synthesises the findings of previous studies, focusing on the nature of the interventions, the eligibility criteria for inclusion and the assessment of outcome. Pharmacological studies are generally more rigorous methodologically, but provide mixed findings. Other biomedical interventions are only at the initial stages of research development, including case and pilot studies. The results of behavioural studies are positive regarding improvements in mood. However, the number of efficacy studies of behavioural interventions for depression is extremely limited. Recommendations for designing interventions are provided.

Individuals aged over 80 years represent the fastest growing segment of the population. It is becoming increasingly important to investigate the effect of age on cognitive functions such as language, in order to document “normal” and “abnormal” functioning. A task commonly used to test naming ability in clinical practice is the Boston Naming Test (BNT). Although norms exist for this age group, they may have limited applications because of small sample sizes on which they were derived. In addition, this test uses stimulus items that have been shown to be culturally specific. This study presents normative data for the BNT for two levels of education and two age bands based on a randomly selected Australian sample of older adults between the age of 81 and 94 years. Frequencies of the most common error types made in this group of nondemented individuals are also reported.

Social disinhibition difficulties are common following traumatic brain injury (TBI). However, clinically sensitive tools to objectively assess the difficulties are lacking. This study aimed to pilot a new clinical measure of social disinhibition, the social disinhibition task (SDT). Whether social disinhibition is dependent on the type of social information judgements required and whether disinhibited responses can be adjusted with additional guidance were also examined. Participants were 31 adults (25 Male) with moderate-to-severe TBI and 22 adult (17 Male) healthy control participants. Participants viewed scenes of complex social situations and were asked to describe a character in them (Part A), describe a character while inhibiting inappropriate or negative responses (Part B), and describe a character while not only inhibiting negative responses, but also providing positive responses (Part C). One-half of the items contained a faux pas requiring participants to make inferences about a character's mental state. TBI and control participants responded similarly to Part A, although control participants responded less positively than TBI participants in the faux pas items. TBI participants were significantly impaired on Part B indicating they experienced difficulties in inhibiting automatic responding. TBI participants were however able to adjust their responding in Part C so that they respond similarly to the control participants. Between group differences were not detected in reaction time. Overall, the SDT appears to be suitable to detect social inhibition difficulties in clinical settings and provides a new direction for remediation of the difficulties in individuals with TBI.

Objectives: (1) Evaluate the features of purpose-built apartment living on access, environmental control, and home and community mobility of people living with neurotrauma and (2) Examine tenant perceptions of those features.

Research design: Observational case series pilot study. Setting: Three apartments within a residential development in Melbourne, Australia. Participants: Three males (aged 30–55 years) with traumatic brain and/or spinal cord injury living in the three separate apartments.

Method and procedures: Measures: Two-published measures of user experience of built and technology environments, coupled with customised interdisciplinary post-occupancy evaluation (POE) methods and GPS-enabled mobility tracking. Analysis: Measures completed per manual guidelines and data reported descriptively. Customised measured drawings produced to represent tenants’ physical access and mobility. GPS community mobility data plotted on Google Earth.

Results: Built design features which enabled access and mobility included linear paths of travel, well-located furnishings, and joinery design that allowed approach from either side using a wheelchair. Personal home furnishing choices posed barriers to physical access. Home automation technologies positively influenced participants’ sense of control and independence, but posed learning challenges. Close proximity of housing to accessible public transport and services enabled community travel options.

Conclusion: Findings from this pilot study indicate the combination of housing location, design and technologies used, together with availability of local community services, provides an acceptable level of environmental control, access, mobility and tenant experience. Further research is required to determine validity of the novel measures used, and deliver rigorous research design to evaluate those features most important in achieving optimal outcomes.

Background: To retrain upper limb function after stroke, a high dose of activity-related therapy is recommended. However, observational studies indicate that the dose undertaken is minimal. While it is speculated that those with severe disability will perform less therapy, this remains to be explored.

Objective: Quantify the dose and content of upper limb therapy performed by stroke survivors with severe upper limb disability during routine inpatient rehabilitation.

Methods: Therapy provided by physiotherapists and occupational therapists to 32 stroke survivors receiving inpatient rehabilitation over 20 weekdays was recorded. Dose of individual and group therapy was analysed by discipline and severity of upper and lower limb disability. Dose and content of individual therapy was also analysed by functional domain.

Results: On average, 46 minutes of individual and 11 minutes of group upper limb therapy were provided per participant, per day. Occupational therapists provided a higher dose of both individual and group therapy compared to physiotherapists (p < 0.0005). Findings suggest that greater residual upper and lower limb movement can lead to provision of a higher dose of activity-related therapy. Within individual therapy, a higher dose (29 versus 17 minutes, p < 0.002) and greater number (1218 versus 549) of impairment- than activity-related interventions were administered.

Conclusions: The dose of activity-related upper limb therapy provided to stroke survivors with severe disability was limited. There is a need to identify interventions and models of service delivery that can increase the intensity and appropriateness of therapy that stroke survivors with severe disability undertake during inpatient rehabilitation.