Background and Objective: Victoria's trauma management system provides acute care and rehabilitation following traumatic brain injury (TBI), with care of more complex injuries generally provided in specialist centres in metropolitan Melbourne. Little is known about how the outcomes of TBI survivors living in metropolitan Melbourne compare to those who reside in regional Victoria once they return to their community, where support services may be less available. The aim of the present study was to compare, in TBI individuals who have been treated at an inner-city rehabilitation centre in Melbourne, the long-term outcomes of those who live in metropolitan Melbourne (termed ‘Metro’) with those who reside in regional Victoria, termed ‘Regional.’ Design and participants: Comparative study with quantitative outcome measures. A total of 959 patients, of whom 645 were designated ‘metro’ and 314 ‘regional’, were followed-up routinely at 2 years post-injury. Outcome measures: Structured Outcome Questionnaire, Glasgow Outcome Scale — Extended, Sickness Impact Profile, Craig Handicap Assessment and Reporting Technique, Hospital Anxiety and Depression Scale, Alcohol Use Disorders Identification Test and Drug Abuse Screening Test. Results: Few differences in outcomes were found between groups. However, after controlling for group differences in age and injury severity, some non-significant trends were suggestive of better outcomes in terms of less social isolation and anxiety and fewer dysexecutive behaviours in regional dwellers. Conclusions: These findings suggest that outcomes in patients from regional areas are at least as good as those from metropolitan Melbourne.

Sustaining a traumatic brain injury (TBI) as an adolescent has a significant impact on life roles and most notably on that of school participation. In the literature there is a wide range of studies that provide clinicians with information regarding recommendations for assisting students in their return to school. However this information has predominantly been provided from the perspectives of educators and rehabilitation staff. The aim of this preliminary project was to hear the stories of three male adolescent students as they reflected on their own experiences of what it was like to go back to school after sustaining a severe TBI. Using a qualitative research design and in-depth interviews, the students' stories were transcribed and coded using grounded theory principles. Despite persisting communication difficulties, the students were able to provide rich stories indicative of their personal experiences. Three key themes emerged from the interviews: the adolescent student's sense of self, changes the students noted; and supports the students identified. A tentative model illustrating the relationship between these areas was developed. It is anticipated that this model will assist clinicians and educators to develop a holistic picture of a student's school participation from transition to ongoing school life.

This systematic review examined the psychometric properties and application of assessments used to evaluate participation outcomes and environmental factors for children with acquired brain injury (ABI). An electronic search of eight databases for articles published up to June 2009 revealed reference to 98 outcome measures. According to inclusion criteria based on the International Classification of Functioning, Disability and Health (ICF: Child and Youth version), five were identified as measures of participation (Children's Assessment of Participation and Enjoyment [CAPE], Child and Adolescent Scale of Participation [CASP], Assessment of Life Habits for Children [LIFE-H], Participation Index of the Mayo-Portland Adaptability Index [M2PI], and the Participation Subscale of the School Function Assessment [SFA-PS]). Six were identified as measures of environment (Child and Adolescent Scale of Environment [CASE], Craig Hospital Inventory of Environmental Factors [CHIEF], European Child Environment Questionnaire [ECEQ], Family Inventory of Life Events and Changes [FILE], HOME Inventory, and the Multidimensional Scale of Perceived Social Support Scale [MSPSS]). The measures were critiqued in relation to content, validity, reliability, clinical utility, responsiveness, and overall strengths/weaknesses. These measures need to be evaluated more extensively with children who have ABI to further determine their psychometric properties and clinical usefulness with this population.

Objective: To investigate the relationship between physical fitness and work integration following stroke. Design: Single-group study, measurement of physical fitness pre and post physical training, measurement of employment status in a follow-up assessment 2 to 36 months after rehabilitation. Setting: Interdisciplinary outpatient rehabilitation program. Participants: 58 stroke survivors (62% male, mean age at program start 46.7 years, mean time since stroke 1.1 years) who were consecutively referred to the program. Intervention: 1½ hours of intensive training of cardiorespiratory fitness and muscle strength 1–3 times weekly as part of the 3-month program. Measures: Physical fitness was measured with a modified Harvard Step Test, the Åstrand Cycling Test, and walking/running speed. The type of participants' employment as well as the amount of working hours was registered. Results: Good physical fitness as measured by the Harvard Step test, but not the Åstrand Cycling Test and walking/running speed, was related to return to competitive, full-time employment. Test results from training tended to predict work reintegration better than test results from training start. Improvement of physical fitness as measured by the Harvard Step Test was also related to follow-up employment. Conclusions: The results imply a relationship between physical fitness and work integration following stroke and should be confirmed with a randomised controlled study design.

This article presents an introduction to some potential applications of a critical discourse perspective to the field of traumatic brain injury. Critical Discourse Analysis (CDA) examines spoken and written texts as a means to understand the two-way relationship between discourse and cultural context. CDA is particularly interested in how language use reflects and creates power relationships between those involved in the communication. In order to illustrate this perspective, this paper discusses a purposively selected set of written texts about brain injury from a range of institutional contexts: a scholarly journal article, a submission to government from an advocacy group, the home web page of a support group, a newspaper article from the general media, and personal letters written by people with traumatic brain injury. The analysis involved investigation of key linguistic features reflecting the experiential, interpersonal and textual aspects of these texts. Three main lines of tension between competing discourses emerged from an examination. Tension emerged within each text between medical vs. lay terminology, and this was seen as reflecting the widespread power of the scientific paradigm. Tension was apparent between problem talk vs. positive talk. Talk about the problems associated with brain injury forms an essential component when seeking support, and yet talk about positive outcomes forms an essential component when describing the rehabilitation journey. There were also competing discourses in terms of the focus of the talk, between person centredness vs. other centredness. The methodology of CDA is proposed as a tool for reflective clinical practice at both an individual and professional level, as it provides a systematic means to examine health professionals' interactions and promotes the development of a critical understanding of the cultural ideologies and institutions in which practice is located.

The aim of this research was to identify the number and characteristics of adults under the age of 65 with a diagnosis of traumatic brain injury (TBI) living in long-term care homes (nursing homes, homes for the aged and charitable homes) in Ontario, Canada. Methods: The study used a cross-sectional design. Secondary data analysis of a comprehensive provincial database of long-term care homes was conducted. Results: Of the 399 residents coded as having a TBI, 154 were < 65 years of age. Virtually all residents were limited in personal care and required assistance for eating (94.2%), toileting (92.2%) and dressing (99.4%). A large percentage also required care for challenging behaviours, while care needs due to substance abuse was common among 12.3% of TBI residents. Conclusion: As similar research in Australia has found, young persons in long-term care homes in Ontario, Canada, have high level personal health needs, however the appropriateness of this environment is questionable.

Objective: This exploratory study applied a biopsychosocial perspective to investigate cognitive and psychosocial factors related to emotional adjustment and QoL after brain tumour. Methods: Participants included 30 adults with a brain tumour (60% benign and 40% malignant) who were aged 28 to 71 years (M = 51.5, SD = 12.3) and on average 5.4 years post-diagnosis (SD = 5.6 years). Participants completed a brief battery of cognitive tests and self-report measures of emotional status (Depression, Anxiety Stress Scale), subjective impairment (Patient Competency Rating Scale), coping (COPE), social support (Brief Social Support Questionnaire), and QoL (Functional Assessment of Cancer Therapy — Brain Tumour [FACT-Br]). Results: QoL was significantly associated with global cognitive ability (r = .49, p < .01), subjective impairment (r = .66, p < .01), and satisfaction with support (r = .50, p < .05). Level of depressive symptoms was significantly correlated with premorbid IQ (r = -.49, p < .01), use of planning to cope (r = -.48, p < .01), and satisfaction with support (r = -.47, p < .01). Conclusions: Overall, these exploratory findings indicate that emotional adjustment and QoL after brain tumour is related to a slightly different pattern of neuropsychological, psychological (self-perceptions and coping) and social factors. The clinical implications for interventions with individuals with brain tumour are discussed.

Introduction: The ability to use both hands to interact with objects is required in daily activities and is therefore important to measure in clinical practice. The Assisting Hand Assessment (AHA) is unique in evaluating the function of a child or youth's assisting hand, through observing the spontaneous manipulation of objects during bimanual activity. The AHA was developed for children with unilateral motor impairment, and shows strong psychometric properties when used with children who have cerebral palsy (CP) or obstetric brachial plexus palsy (OBPP). The AHA is currently used in clinical practice with children who have an acquired brain injury (ABI), however there is limited research on the measurement properties of its use with this population. Objectives: The study aimed to determine the interrater and intrarater reliability of the AHA for children and youth with unilateral motor impairment following ABI. Methods: For interrater reliability, two occupational therapists (OT1 and OT2) independently rated the same 26 children and youth. For intrarater reliability, OT2 conducted a second assessment on the 26 participants 1 week later. Association between item scores on the AHA were analysed using weighted kappa (Kw), while intraclass correlation coefficients (ICCs) were used for domain and total scores. Results: The AHA items demonstrated good to excellent intrarater reliability (Kw = 0.67–1.00). Interrater reliability was good to excellent (Kw=0.60–0.84) for 20 of the 22 items of the AHA. Interrater and intrarater reliability coefficients for all domain and total scores were in the excellent range (ICC = 0.85–0.99). Conclusion: The current study indicates that the AHA shows good interrater and intrarater reliability when used with the paediatric ABI population. Findings provide preliminary support for the continued use of the AHA for children and youth with acquired hemiplegia.

Traumatic brain injury in older adults is an increasing problem in our aging community. Traditional functional outcome measures, such as return to work or academic achievement, as used with younger samples following traumatic brain injury are of limited use for older people. Although challenging to assess reliably, evaluation of prospective memory is gradually being included in outcome assessments following traumatic brain injury in younger samples and may be a useful index of cognitive competence in everyday life when assessing older adults following traumatic brain injury.

Primary Objective: To explore levels of depression, anxiety, stress and strain symptomatology experienced by caregivers of adults with traumatic brain injury (TBI) during the phase of transition from hospital to home. Research Design: Prospective study with data collected at three time-points: pre-discharge, 1-month post-discharge, and 3-months post-discharge. Methods and Procedures: Twenty-nine caregivers of adults with TBI (mean age 48 years), recruited on patient discharge from rehabilitation, completed the Caregiver Strain Index and the Depression, Anxiety and Stress Scale at the three time points. Results: Paired t tests showed significantly lower levels of caregiver strain at one month compared to pre-discharge, and significantly less strain and depression symptoms at 3-month follow-up compared to pre-discharge. Non-significant reductions were observed in level of stress and anxiety across the follow-up time points. Independent group t tests found that female caregivers experienced greater strain than male caregivers at 3 months post-discharge, and caregivers who were immediate family members of the patient experienced greater anxiety than those who were spouses/partners of the patient at 1-month follow-up. Conclusions: The rate of depressive symptoms in caregivers of people with TBI was greater than the general population, and strain was prevalent during the transition period. The results suggest more specific caregiver support and preparation is needed before patient discharge from hospital, and that adequate time spent in rehabilitation is beneficial for caregiver wellbeing.

Purpose: Traumatic brain injury (TBI) often leads to executive functions deficits, which may be responsible for severe and longstanding disabilities in everyday activities. Sensitivity and ecological validity of neuropsychological tests of executive functions have been questioned. The aims of this study were to pilot an ecological open-ended assessment of executive functions in children, the ‘Children's Cooking Task’ (CCT), specifically to report its reliability, discriminant validity and concurrent validity. Methods: Twenty-five children with mild (n = 10) or moderate-to-severe TBI (n = 15), and 21 matched controls (aged 8 to 20 years) participated in the study. An open-ended cooking task was designed to test multi-tasking abilities. It required the preparation of two simple recipes using specific instructions. Outcome measures included the number of errors and an overall qualitative analysis of the task. Validating measures of executive functions included the Delis Kaplan Executive Function System, the Six-Part Test and two questionnaires completed by the child's primary care-giver: the Behavior Rating Inventory of Executive Function and the Dysexecutive Questionnaire for Children. Results: Internal consistency of the Children's Cooking Task was high (Cronbach's alpha = .86), as was test–retest reliability (ICC = .89). Children with moderate-to-severe TBI, as well as children with mild TBI made significantly more errors in the Children's Cooking Task in comparison to controls (p < .001). The CCT was correlated with several tests and one questionnaire of executive functioning (Trails, verbal fluency, sorting, 20 questions, Dysexecutive Questionnaire). Discussion and Conclusion: The Children's Cooking Task has good interrater and test–retest reliability, as well as good discriminant and concurrent validity.

There is some evidence that in patients with temporal lobe lesions, the presence and temporal pattern of deficits in autobiographical event memory depends on aetiology and the methodology used. In this study, 19 patients with mesial temporal lesions that involved the hippocampus (14 temporal lobectomy [TL] and 5 cerebral vascular accident [CVA]) were compared to 20 normal control [NC] subjects on the Autobiographical Memory Interview, Autobiographical Fluency Test for Events (AFT-Events) and a modified Crovitz Cue Technique. All three measures revealed impairments in autobiographical event recall for the TL patients, but only the Crovitz Cue Technique detected a deficit for the CVA group. No temporal gradients in retrograde recall were found. The findings indicate that test methodology and aetiology of lesion influence the likelihood of finding deficits in recall of autobiographical events but not the temporal pattern of deficits.

Research on observer rating of memory in children is examined in relation to the potential to develop screening instruments to improve efficiency in memory assessment, to shed light on the area of everyday memory in children, and to develop observer rating to the point where it may substitute for objective assessment. Several scales including the Parent Memory Questionnaire, the Children's Memory Questionnaire, the Observer Memory Questionnaire — Parent Form and the Working Memory Rating Scale are reviewed. Only the Working Memory Rating Scale has been published. Some of the other scales have good internal consistency and test–retest reliability but none have proven to be effective screening instruments and none can yet be recommended for clinical application. Relationships with objective test results have been at best modest, an issue that requires more detailed analysis if such instruments are to become effective screeners or even substitutes for objective assessment. Further observer rating research will shed light on everyday memory in children including its relationship to objective assessment and its place in models of memory. It remains to be established whether observer ratings add unique information to memory assessment or whether they can become a reliable, cost-effective substitute for objective assessment.

Objectives: The aim of this article is to describe the characteristics, needs and preferences of people under 50 with an acquired brain injury (ABI) living in residential aged care in Victoria and examine implications for service development. Participants: Sixty-one people under 50 with an ABI living in residential aged care in the state of Victoria. Measures: Care and Needs Scale, Community Integration Questionnaire, Overt Behaviour Scale, Health of the Nation Outcome Scale — ABI Version, Role Checklist, Resident Choice Scale. Results: The younger people with ABI in this study were a diverse group with a complex range of health and support needs that were not being adequately met within residential aged care. Many people (44%) required the highest level of support, indicating they could not be left alone while 26% could be left for part of the day and overnight. Most people (81%) and their support networks indicated they would like to explore moving out from residential aged care into community accommodation settings. Conclusions: This article provides clear direction for the development of services to meet the care needs of this group, to enable them to participate in the life of the community and to pursue a lifestyle of choice.

Moral reasoning skills are crucial for appropriate and adaptive social functioning. Impairments in moral reasoning have been associated with aggressive and violent behaviours. Traditional measures of moral reasoning may provide limited insight into daily behavioural functioning as these measures are dependent on several higher order cognitive skills and, as such, may be limited in their utility with certain clinical populations. In Study 1, new measures of sociomoral reasoning and maturity, the So-Moral and So-Mature, were described. Further, the psychometric properties of the So-Moral and So-Mature were investigated in a sample of 50 adolescents aged 11 to 19 (mean age = 14.5, SD = 2.6 years, 25 male). Preliminary support was found for the validity and reliability of both tasks. In Study 2, the clinical applicability of the So-Moral and So-Mature were examined in a sample 25 adolescents with traumatic brain injury (TBI; mean age = 13.8, SD = 2.3 years, 15 male). Response trends suggested that adolescents with TBI generated less developmentally mature responses to sociomoral dilemmas and those with more severe injuries performed most poorly. The sociomoral reasoning tasks described promote participant's emotional involvement and investment as well as being appropriate for use with clinical populations.

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.