For individuals with an acquired brain injury (ABI) who have dependent children their ABI has the potential to impact upon their parenting abilities, skills and relationships. Parenting capacity is an important clinical issue supported by a wide body of existing literature and arises in many specialties, such as adult mental health, learning disabilities and forensics. In the field of ABI the issue of parenting capacity is less developed, yet it remains an important clinical issue. This systematic review examined the current state of knowledge about this within the ABI field and discovered the literature is, as yet, under developed, with little theory and no clear practice guidelines specific to brain-injured parents. Recommendations are made for the development of a parenting capacity assessment protocol for brain-injured parents. Additionally little research has been conducted to explore the effect ABI has on parenting. This empirical study aimed to qualitatively explore the experiences and needs of parents who have suffered an ABI in the last two years from their own perspectives. Interpretive phenomenological analysis was used to analyse the data, leading to the identification of 4 main themes: (1) Multiple Losses, (2) A mix of resigned acceptance and uncertain future (3) Giving and receiving support is part of the healing process, (4) Hopes and aspirations. The results supported the idea of a circular, bi-directional, 'pendulum like' process of movement between experiencing the multiple losses of their parental role and attempting to adapt and adjust to these changes. The clinical and research implications of the systematic review and empirical paper are discussed.

Background: Until recently, qualitative researchers have avoided interviewing participants with brain injuries because of the ethical and practical dilemmas which may arise and because it has been argued that they may not be able to reflect and accurately report upon their experiences. Therefore, little research has been produced which explores the personal experience of living with a brain injury. Recently, however, some researchers have challenged the view that people with brain injuries are unsuitable as interviewees in qualitative research and have, through their own research, highlighted the importance of understanding their views and perspectives in order to provide them with the best care and rehabilitation. Aims: With this in mind, and in line with current calls for more research gaining the brain injured person’s perspective, this study attempted to gain an in depth understanding of what it is like from the brain injured person’s perspective, to live with an acquired brain injury. The study focussed upon the experience of gaining consciousness following a brain injury, the experience of living with permanent memory loss, the experience of gaining awareness of deficits, the experience of losing an identity and adjusting to a new identity, the impact on relationships with friends and family and experiences as an inpatient in a Brain Injury Unit. Sources of strength and coping mechanisms were also explored. Method: Semi-structured interviews were conducted with six individuals who had severe acquired brain injuries and were inpatients in a post-acute neuro-rehabilitation unit. The verbatim transcripts of the semi-structured interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes. These were: ‘Piecing together the past and becoming aware of the present’, ‘The transition from old self to new self’, ‘Sources of strength and survival’ and ‘Experiences in rehabilitation’. A description of these themes is presented with the corresponding subordinate themes. Conclusions: The clinical implications of the research and guidance for future research are discussed. The study produced a valuable insight into the personal experience of living with a severe acquired brain injury that could be used to inform rehabilitation interventions. The results also indicated that people with acquired brain injuries may experience Post Traumatic Growth.

Despite extensive research into the impact of brain injury on individuals and their adult relatives, much less is know about the impact of parental brain injury on child relatives. The aim of the study was to identify if there was a relationship between changes in how children construed themselves and their parents following the brain injury and adjustment, and to identify if there was a relationship between structure of the child’s construct system and level of adjustment. There were four hypotheses to be tested. Hypothesis one predicted that larger changes in how young people construe themselves and significant others following parental brain injury compared to how they were construed prior to parental brain injury would be associated with poorer adjustment. Hypothesis two predicted that more structured ‘before acquired brain injury’ constructs in comparison to the structure of ‘after acquired brain injury’ constructs would be associated with poorer adjustment. Hypothesis three predicted that more superordinate ‘before acquired brain injury’ constructs in comparison to ‘after acquired brain injury’ constructs would be associated with poorer adjustment. Hypothesis four predicted that tighter construing would be associated with better adjustment following parental brain injury. There were 10 participants in the study aged 10-17 who had a parent with a brain injury. Each participant completed a repertory grid and the Personality Inventory for Youth, a measure of adjustment. It was found that larger distances between how children construed themselves or their parents currently compared to how they were construed pre-injury were related to poorer adjustment. There was also found to be a relationship between relative intensity of the post-brain injury construct system and some aspects of adjustment. There was no significant relationship between adjustment and relative superordinancy of post-injury constructs or adjustment and tightness of construing. Future research is indicated to verify the findings of this study, and to explore possible interventions for young people experiencing poor adjustment following parental brain injury.