Objectives: To summarise available evidence for responsiveness of six key assessments used with patients with disorders of consciousness: Coma Recovery Scale – Revised (CRS-R), Disorders Of Consciousness Scale (DOCS), Sensory Modality Assessment and Rehabilitation Technique (SMART), Sensory Stimulation Assessment Measure (SSAM), Wessex Head Injury Matrix (WHIM), and the Western Neuro Sensory Stimulation Profile (WNSSP).

Method: A literature search of five electronic databases was conducted using a systematic search strategy. Relevant literature was evaluated and pertinent information extracted.

Results: Database searches using key terms initially yielded 132 articles. Following review for inclusion identified 24 articles. No studies were specifically designed to investigate responsiveness of any of the measures and therefore responsiveness data were either based on statistical significance of change post-treatment or descriptive analysis of change scores. The majority of studies identified used the CRS-R (n = 11), WHIM (n = 5) and WNSSP (n = 6) and have established responsiveness to change. There is some preliminary evidence for the responsiveness of the other measures, based on very few available studies: DOCS (n = 2), SMART (n = 1) or SSAM (n = 1).

Conclusion: Future studies should seek to include responsiveness analysis, particularly in relation to the DOCS, SMART and SSAM.

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.

Aims: To determine whether double concussions can result in longer-lasting cognitive dysfunctioning than a single concussion and/or whether cognitive dysfunction is a greater risk factor for double concussions than for a single concussion.

Method: Through a national hospitalisation database, 2753 men were found who, at ages between infancy and early adulthood, had, on two separate occasions, been briefly hospitalised after a concussion. This cohort was compared with a previously obtained and comparable sample of men who had suffered a single concussion. From Draft Board records a dichotomised index was obtained indicating whether or not they had performed at or above a cut-off total score on a cognitive screening test involving four timed subtests, below cut-off being considered as dysfunctional.

Findings: For all age groups, double concussions were associated with higher rates of cognitive dysfunction than single concussions. This was especially true where the concussion(s) had occurred after cognitive testing [odds ratio = 2.53, 95% confidence interval (CI) = 1.92–3.36]. Where double concussions had occurred before cognitive testing but after age 12, cognitive dysfunction was more prevalent when the interval between concussions was less than 1 month than at longer intervals (odds ratio = 3.91, 95%CI = 1.14–13.34). It is concluded that cognitive dysfunction in young men is a risk factor for repeat concussions; at the same time cognitive dysfunction can also be a long-term consequence of two concussions occurring in close temporal proximity.

Developing an awareness of the preferences of healthcare consumers is essential in determining the ‘reality’ of service provision, in planning the provision of brain-injury services and in service evaluation. Consumers should be given the opportunity to express satisfaction or dissatisfaction with the services they receive, offering their perceptions of barriers to service access, which could be removed once known. This article presents narratives of the healthcare journeys of three adults with a moderate to severe brain injury. The experiences of these participants were elicited through in-depth interviews. The aim of this article is to convey how the needs and experiences of adults with brain injury change throughout time, affecting their ability to access care over time. Previous research by the authors of this paper identified five factors that affect consumers’ experiences of care: acceptance and readiness, support, advocacy, the right service at the right time and mismatched expectations. The fluidity and interaction of these factors through time is demonstrated in this article as facilitating and impeding access to services. The implications for clinicians in considering these factors when planning services for adults with moderate to severe brain injuries are explored.

In Australia, 20% of stroke survivors are aged less than 55 years. These younger survivors value age-appropriate, identity-affirming goals, such as resuming employment. This article reports on a small qualitative research project that explored the experiences of young, higher functioning stroke survivors in re-establishing identity and returning to work. The participants understood identity as both an inner sense of self and as socially and discursively constructed. The research found that the participants actively pursued identity continuity while managing biographical disruption. Resumption of life roles and responsibilities were important for identity re-establishment, but fraught, particularly the return to work. The findings suggest that psychosocial rehabilitation could play a greater role in supporting survivors’ resumption of valued life roles, including return to work.

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.

This study responded to a need for an updated set of film clips for the elicitation of emotion. Previous such stimuli are not only dated, but are limited in that they have been validated using participants from a narrow age range, which is problematic given conflicting reports regarding age differences in self-reported emotion elicited in a laboratory setting. The present study aimed to develop a new film stimulus set standardised on a wide age range of participants, while investigating age differences in self-reported emotion in response to film clips. An ancillary aim was to standardise film clips that were with and without dialogue. Two researchers composed a shortlist of 60 clips that were chosen to elicit six target emotions of amusement, anger, disgust, fear, happiness and sadness, as well as a neutral state. Each of the 109 participants (55 males, 54 females), aged between 18 and 88 years (M = 44.94) viewed all 60 clips. Self-reported emotional experience was measured using a computerised Visual Analogue Scale. Age differences were observed whereby participants aged 46–88 reported more intense positive and negative emotions in response to film clips than participants aged 18–45. Consistent with previous research, difficulties were found in eliciting the target emotion of anger. A success index was calculated for each film that took into consideration the mean rating on the target emotion and the degree to which the film elicited only the target emotion. We present a list of film clips recommended for future research.

Objectives and Background: In patients with medically refractory seizures 20–30% do not have epilepsy, and the majority are diagnosed with psychogenic non-epileptic seizures (PNES). Almost one-third of this group has a prolonged episode that is termed as PNES status epilepticus (PNES-SE). The aim of this study was to describe the characteristics of patients with (1) PNES-SE only and (2) PNES-SE with concurrent epileptic seizures.

Methods: We screened retrospectively all patients who underwent video-electroencephalogram (video-EEG) long-term monitoring at our institution between 1996 and 2009. Patients with PNES were identified by typical clinical features with no ictal EEG changes. Patients with continuous episodes for at least 30 min that led to intubation were identified as PNES-SE. They were divided into two groups: group 1, pure PNES-SE and group 2, PNES-SE with concurrent epilepsy. Group characteristics were defined with respect to demographic, clinical, electroencephalographic, neuroimaging and psychiatric variables.

Results: PNES were recorded in 88/916 patients (10%) of whom 6 (7%) were treated intensively due to misdiagnosis of status epilepticus (SE), with two having coexistent epileptic seizures. All patients had concurrent psychiatric disorder(s), diagnosed by a psychiatrist. Duration of time until correct diagnosis was lengthy in all cases, and particularly for patients with PNES-SE with coexisting epileptic seizures (more than 10 years).

Conclusion: To avoid iatrogenic complications and to treat the underlying psychiatric conditions, early diagnosis of PNES is necessary. Understanding the clinical characteristics of PNES-SE leads to early diagnoses, which may avoid iatrogenesis and economic burden.

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.

Aim: To investigate the characteristics of Australian organisations providing case management to individuals who have acquired brain injury, and to determine the methods of case management service delivery including professional development and evaluation of outcomes.

Method: An anonymous 23-item web-based survey was used. Respondents were case managers who deliver services to adults and/or children with brain injuries. A snowball sampling method was used to recruit respondents from around Australia.

Findings: Fifty-one case managers completed the survey. Respondents were from a wide range of professions, the largest group being occupational therapy. The majority of respondents were based in metropolitan areas, were employed within the public health system and were based in the community. Respondents reported that the main determinant for clients receiving case management was the severity of the brain injury followed by complex family needs. Variations in practice and a lack of consistency in outcome measurement, goal setting and professional development were noted.

Discussion: This study provides an overview of characteristics of case management practices for people with acquired brain injury (ABI). Identifying roles and responsibilities of case managers is the first step to developing future research designs, which determine the effectiveness of case management.

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.

The Austin Maze has declined in use in both clinical and research contexts due to difficulties in accessing the conventional button-box form of the test. Computer-based versions of the Austin Maze offer a potential means of making the test more accessible, but as yet there is limited evidence regarding the equivalence of computer and conventional versions of the Austin Maze. The present study compared performance on a computer version of the Austin Maze by Bray and McDonald with performance on the traditional button maze in 63 participants aged 18–27 years. The results showed no differences between the computer and conventional versions in terms of mean scores and distributions, and performances on the two versions were significantly correlated. Examination of correlates found no relationship between Austin Maze performance and years of education or age for either version of the Austin Maze performance. Intellectual function was modestly associated with performance on the conventional version but not the computer version. Overall, these findings suggest that scores on the Bray and McDonald computer version of the Austin Maze produces comparable scores to the conventional form of the test and can be interpreted using existing normative data.

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.

There are many challenges in incorporating an evidence-based approach into clinical practice and a large literature exists on various barriers and facilitators. Within this context, we have developed a framework to advocate an empirical approach to therapeutic interventions, using our Model to Assess Treatment Effect (MATE). The MATE is designed to characterise how an intervention is delivered to an individual patient/client. It is organised hierarchically into seven levels, from low levels of capacity to demonstrate treatment effect (e.g., Level 1: treatment commenced without pre-intervention assessment) to high levels where cause–effect relationships can be established between the intervention and the behaviour being treated (e.g., Level 6: implementation of a well-designed single-case experimental design). Consequently, the MATE captures all levels of clinical intervention and can be applied readily to an individual patient, as well as an entire clinical setting. In this paper, we present a decision tree in the form of a detailed flow-chart which assists the clinician to classify treatment delivery on the MATE. We believe that the MATE has the capacity not only to document current clinical practice, but also to provide a model whereby future treatments can be planned and implemented with greater scientific rigour and hence accountability in relation to treatment outcomes.

This article reports on the design of a two-arm, randomised controlled trial of neuropsychological assessment with feedback as a direct therapeutic intervention to improve psychological wellbeing in multiple sclerosis (MS). MS patients and their caregivers are randomly allocated to one of two groups: neuropsychological assessment with feedback (the intervention), or ‘sham wait-list’ control. The trial investigates: (1) whether the intervention directly benefits patients by leading to improved knowledge of their own specific cognitive strengths and weaknesses, and improved use of adaptive psychological strategies for coping with MS; and (2) whether the intervention directly benefits caregivers by leading to improved knowledge of the patients’ specific cognitive strengths and weaknesses, and to a more positive caregiving outcome. A range of primary and secondary measures is used to evaluate these outcomes. The protocol utilises a wait-list control method which is structured to effectively blind patients and caregivers to their group allocation. Publishing the protocol prior to the results of the trial being available has a number of important methodological benefits, and informs the research community of the work that is under way to allow for collaboration and to reduce duplication of research effort. (This trial has been registered on the ANZCTR; ACTRN12612000161820.)

Severe traumatic brain injury (TBI) is the most common cause of brain injury in the Western world and leads to physical, cognitive and emotional deficits that reduce independence. Changes to psychosocial function are the most disruptive, resulting in vocational difficulties, family stress and deteriorating relationships, and are a major target for remediation. But rehabilitation is expensive and its evidence base is limited. Thus, new collaborative initiatives are needed. This article details the development of ‘Moving Ahead’, a model for a Centre of Research Excellence (CRE) for Traumatic Brain Injury Rehabilitation. This CRE offers several major innovations. First, it provides an integrated, multi-faceted approach to addressing psychosocial difficulties embracing different clinical standpoints (e.g., psychological, speech pathology, occupational therapy) and levels of investigation (e.g., basic science to community function) across the lifespan. It is based upon a close relationship with clinicians to ensure transfer of research to practice and, conversely, to ensure that research is clinically meaningful. It provides an integrated platform with which to support and train new researchers in the field via scholarships, postdoctoral fellowships, websites, meetings, mentoring and across-site training, and thus build workforce capacity for individuals with TBI and their families. It has input from the international community to contextualise research more broadly and ensure scientific rigour. Finally, it provides collaboration across sites to facilitate research and data collection.

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.

Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.

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.

This paper describes the added value that arises from capitalising on academic and social networks for researchers and people with acquired brain injury. First, it is proposed that brain injury researchers are connected within six degrees of separation. As a model, ‘The Oracle of Bacon’ demonstrates how any actor can be linked through his or her film roles to the actor Kevin Bacon within six steps. This concept is extrapolated to the existing networks of brain injury researchers. Capitalising on these networks can lead to potent and ground-breaking discoveries. The Clinical Centre of Research Excellence (CCRE) in Aphasia Rehabilitation provides an example of the benefits of networking and collaboration in the quest to improve the lives of people with aphasia. The CCRE uses multiple theoretical perspectives in studies evaluating the assessment and treatment of aphasia. It is utilising capacity building, knowledge translation and a community of practice to inform and expand research capacity. Networks can also be used to improve the communication of people with brain injury within their everyday environment. A recent study is described where communication partners were trained to improve the interactions of people with traumatic brain injury, which led to improvements in social networks and improved engagement in life activities. Finally, it is suggested that with the advances in e-communication, there is a great deal of scope for the use of social networking technologies in the assessment and treatment of people with acquired brain injury.