The prevalence and determinates of depression in 67 older adults were assessed at 1 year post-stroke. The sample had an average age of 74 years (SD = 7, range = 60–87 years) at the time of their stroke and 52% were female. The relative contribution of demographic (gender, age), medical (history of previous stroke, hemispheric location of stroke), two measures of functional independence (Barthel Activities of Daily Living (ADL) Index and Nottingham Extended ADL Index) and aspects of cognitive functioning (IQ, attention, verbal memory and verbal fluency) to depression (Geriatric Depression Scale) was investigated. Results indicated that 51% of patients had impairment in activities of daily living, and 33% reported clinically significant levels of depression. Prevalence of cognitive impairment ranged from 28% on a measure of basic cognitive functioning through to 87% on a measure of complex attention. The results from a hierarchical multiple regression analysis showed that the combination of variables explained 40% of the variance in depression scores. In addition, the two individual variables of history of previous stroke and functional independence made significant unique contributions to the variance in depression scores. These results demonstrate the wide variety of factors involved and provide support for a biopsychosocial model of post-stroke depression.

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.

Background: International research identifies indigeneity as a risk factor for traumatic brain injury (TBI). Aotearoa New Zealand studies show that mokopuna (grandchildren; used here to encompass the ages and stages of infant, child and adolescent development and those in young adulthood) are significantly overrepresented in TBI populations. The important role of whānau (family) is also well established in child and adolescent TBI scholarship. Despite awareness of these factors, no studies have been identified that explore whānau knowledge about mokopuna TBI. The aim of this study was to explore two questions: (1) What do Māori people say about mokopuna TBI in the context of the Māori cultural belief that the head is the most sacred part of the body? and (2) How could this information be used to build theory that could inform addressing the rehabilitation needs of this group?

Method: Eighteen marae wānanga (culture-specific fora in traditional meeting houses) were held. The wānanga typically lasted approximately 2 hours. Footage and written transcripts were analysed using Rangahau Kaupapa Māori (Māori indigenous research methods).

Results: The wairua theory of mokopuna TBI proposes that TBI not only injures brain anatomy and physiology but also injures wairua (defined here as a unique connection between Māori and all aspects of the universe). Injury to wairua means that culturally determined interventions are both indicated and expected. The wairua theory of mokopuna TBI thereby provides a guide to intervention.

Conclusion: A Māori theory of mokopuna TBI has been identified which describes a culture-specific aspect of TBI. This theory proposes that pre-existing whānau knowledge salient to TBI is critical to optimising recovery. Further research is needed to test this theory not only in TBI but also in other areas such as in mental illness, neurodegenerative disease and addiction.

Background: Application of salient cultural knowledge held by families following child and adolescent traumatic brain injury (TBI) has yet to be documented in the literature. While the importance of the family is a well-established determinant of enhanced outcomes in child and adolescent TBI, the emphasis to date has been on the leading role of professional knowledge. The role of whānau (extended family) is recognised as an essential aspect of hauora (wellbeing) for Māori, who are overrepresented in TBI populations. However, whānau knowledge systems as a potent resource for enhancing recovery outcomes have not previously been explored. This paper describes the development of an indigenous intervention, Te Waka Oranga.

Method: Rangahau Kaupapa Māori (Māori determined research methods) theory building was used to develop a TBI intervention for working with Māori. The intervention emerged from the findings and analysis of data from 18 wānanga (culturally determined fora) held on rural, remote and urban marae (traditional meeting houses).

Results: The intervention framework, called Te Waka Oranga, describes a process akin to teams of paddlers working together to move a waka (canoe, vessel) in a desired direction of recovery. This activity occurs within a Māori defined space, enabling both world views, that of the whānau and the clinical world, to work together. Whānau knowledge therefore has a vital role alongside clinical knowledge in maximising outcomes in mokopuna (infants, children, adolescents and young adults) with TBI.

Conclusion: Te Waka Oranga provides for the equal participation of two knowledge systems, that of whānau and of clinical staff in their work in the context of mokopuna TBI. This framework challenges the existing paradigm of the role of families in child and adolescent TBI rehabilitation by highlighting the essential role of cultural knowledge and practices held within culturally determined groups. Further research is needed to test the intervention.

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.

Clinical care guidelines exist internationally recommending the appropriate standards of care for adults following brain injury. These guidelines recommend a care pathway including acute, inpatient and outpatient rehabilitation and community-based care. However, if and how these guidelines are implemented is largely unknown. The aim of this study was to explore the recollected continuum of care experienced by 202 adults with moderate to severe traumatic brain injury (TBI) in Victoria, Australia. The experiences of participants in this study were investigated using a mixed methods research approach (surveys and in-depth interviews). The results indicated that only 20% of participants in this study recollected receiving care in line with recommendations made in clinical care guidelines. Reasons they identified for their problematic access to services included: a lack of information about the services available, the absence of an advocate and services being restricted by limited funding. The findings of this study indicate that while guidelines provide recommendations regarding standards of care and can serve as a benchmark to improve the quality of services, they do not ensure the equitable delivery of services. Clinicians using these guidelines need to be aware of the factors that restrict clients’ access to services and take these into account when planning the delivery of services.

Background: Previous research addressing cognitive recovery after traumatic brain injury (TBI) in adults has predominately used cross-sectional methods. This systematic review examines longitudinal research into cognitive recovery in the first 2 years following moderate-to-severe TBI in adults and aims to identify apparent methodological issues with the existing literature.

Design: Systematic review of the first 2 years post-trauma.

Setting: Data were extracted from three electronic databases and manual searches of published articles until October 2012.

Participants: Two hundred and forty-two participants with severe TBI and 281 comparison participants were used to calculate effect sizes.

Results: Twenty papers met the selection criteria, with effect sizes computed from four studies. Moderate-to-large effect sizes were initially observed between the TBI and comparison groups on most measures (range: d = 0.2–2.8). Recovery continued in all five cognitive domains over the 2 years post-injury.

Conclusions: Results demonstrated that cognitive recovery was continuous throughout the first 2 years following moderate-to-severe TBI. Findings also indicated different rates of recovery for the specific cognitive domains, highlighting the heterogeneous nature of cognitive recovery after TBI. The review highlighted several methodological issues within the limited existing literature; recommendations were developed to improve the evidence base.

In 2005 Elliott et al. published a paper entitled ‘Effect of posture on levels of arousal and awareness in vegetative and minimally conscious patients: a preliminary investigation’. Twelve patients, of whom 5 were in the vegetative state (VS) and 7 in the minimally conscious state (MCS), were assessed with the Wessex Head Injury Matrix (WHIM) when supine and when upright on a tilt table. The present study replicated and extended these findings by including a third position, sitting, in addition to supine and standing. We assessed 16 patients (8 in the VS and 8 in the MCS) with mixed aetiologies and compared the observed behaviours in three different positions (supine, sitting and standing) using the WHIM. Most patients (75%) showed more behaviours when in the upright position, compared to lying down (p < .003). Our findings are similar to those seen in the study reported by Elliott et al. With regard to sitting, 62.5% of patients were more responsive when assessed sitting in a wheelchair (p < .05) than in a supine position, and almost 69% were more responsive if assessed in an upright position compared to sitting. This was particularly true for patients in the MCS, where 87.5% did better if assessed on a tilt table or standing frame compared to sitting, suggesting that positional changes can have an effect on the level of arousal and awareness among patients in the VS and MCS.