Few studies have explored emotion processing abilities in children following Acquired Brain Injury (ABI). This study develops previous research in this area by exploring emotion processing skills in children with focal ABI, using eye tracking technology. It was hypothesised that children with focal ABI would demonstrate impaired emotion recognition abilities relative to a control group and that, similar to adult eye tracking studies, they would show an atypical pattern of eye moments when viewing faces. Sixteen participants with focal ABI (10-16 years) and 27 healthy controls (10-16 years) completed one novel and one adapted visual emotion processing task, presented using a T120 Tobii eye-tracker. The eye-tracker measured eye-movement fixations in three areas of interest (AOIs; eyes, nose, mouth), as participants viewed the stimuli. Emotion perception accuracy was recorded. All participants from the ABI group also completed neuropsychological assessment of their immediate visual memory, visual attention, visuospatial abilities, and everyday executive function. The results of the study showed no significant difference in accuracy between the ABI and control groups. However, on average children with ABI appeared slightly less accurate than the control group in both emotion recognition tasks. Within-subjects analysis revealed no effect of lesion location and laterality or age at lesion onset upon emotion recognition accuracy. Eye tracking analysis showed that children within the ABI group presented with an atypical pattern of eye movements relative to the control group, demonstrating significantly greater fixation times within the eye region, when viewing disgusted, fearful angry and happy faces. The ABI group also showed reduced mean percentage fixation duration within the nose and mouth regions, relative to controls. Furthermore, it was observed that the ABI group took longer on average to give an accurate response to sad, disgusted, happy and surprised faces and this difference reached statistical significance for the accurate recognition of happy and surprised faces. It is suggested that the atypical fixation patterns noted within the ABI group, may represent a difficulty with dividing visual attention rapidly across the whole of the face. This slowing may have an impact upon functioning in everyday social situations, where rapid processing and appraisal of emotion is thought to be particularly important. It is therefore suggested that eye tracking technology may be a valuable method for the identification of subtle difficulties in facial emotion processing, following focal ABI in childhood, and may also have an application in the rehabilitation of these difficulties in future.

It is estimated that there are 12.5 million people in England living with neurological disorders (Neurological Alliance, 2014). People with neurological disorders as a result of acquired brain injury (ABI) are living with short and long-term disabilities. These include cognitive impairment, and physical and emotional distress. One of the most common complaints by individuals who have ABI is attention impairment. Attention difficulties can have serious ramifications for daily functioning. Although studies have explored the effects of evidence-based interventions such as mindfulness-based therapy on attention abilities, and have found that it improves individuals' attention skills (Moore et al, 2012), thus far research has been conducted mainly with non-clinical populations. This study set out to investigate whether a mindfulness-based intervention could prove beneficial for people with neurological disorders, particularly whether it could positively impact on attention impairment. The study employed a one group pre-test post-test design. The intervention was adapted from the MBSR programme developed by Kabat-Zinn. Twenty-two participants with ABI were recruited. The Conners Continuous Performance Test 3rd Edition (CPT-3), Mindful Attention Awareness Scale (MAAS), Attention Process Training-II Attention Questionnaire (APT-II AQ) and Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM) were utilised to measure outcomes. The results revealed that there was a clinical improvement in self reported measures of mindfulness (MAAS) (Cohen d=0.28), attention (APT-II AQ) (Cohen d=0.33), and psychological distress (CORE-OM) (Cohen d=0.72). This was not observed using the neuropsychological test of attention (CPT-3) for overall group scores, but further evaluation showed some individuals' scores improved. The study is promising as it indicates that mindfulness based treatment can be effective with attentional problems as well as in reducing psychological distress for individuals with ABI. This could be valuable in terms of providing treatment for this client group and adds to the expanding research base on mindfulness-based intervention with this population.

Syfte:Syftet med litteraturstudien var att undersöka hur en smartphone kan användas inom rehabilitering efter FHS, i vilken utsträckning smartphonen används. Vilka effekter smartphonen kan ge på i det dagliga livet samt betydelsen en smartphone kan utgöra. Metod:För att besvara syftet så utfördes en litteraturstudie som innefattar kvalitativ och kvantitativ forskning baserad på åtta studier.  Resultat:Smartphonen har många fördelar som ett kompensatoriskt hjälpmedel samt är betydelsefull för personerna i det dagliga livet på många sätt. Signifikanta effekter kunde uppmätas som ledde till att fler aktiviteter både påbörjas och avslutades i rätt tid, därmed så hanteras många av grundproblemen med förvärvad hjärnskada (FHS), såsom svårigheter med minne, planering, initiering och organisering. Smartphonen föredrogs också av användarna framför andra hjälpmedel.  Slutsats:Studien visar att de finns stora fördelar med att implementera smartphonen som en del av rehabiliteringen av förvärvad hjärnskada. Vidare visar studien att smartphonen är den del av människors liv oavsett med eller utan FHS.  Det finns behov av vidare forskning inom ämnet då det finns få studier som belyser smartphonens som kompensatoriskt hjälpmedel i dagsläget. / Aim: The aim of this literature study was to describe how the smartphone is used as a compensatory aid in rehabilitation and the importance it can have for people with acquired brain injury. Method: To answer the purpose, a literature study was carried out which included qualitative and quantitative research based on eight studies. Result: The smartphone has many advantages as a compensatory aid and it shows important for people with acquired brain injury in their daily life in many ways. Significant effects could be measured which led to more activities being initiated and completed at the right time, thus many of the basic problems with acquired brain injury are addressed, such as problems with memory, planning, initiation and organization. The smartphone was also preferred by the users in front of other devices. Conclusion: The study shows great advantages in implementing the smartphone as part of the rehabilitation of acquired brain injury. Furthermore, the study shows that the smartphone is the part of people's lives regardless of if they suffer from acquired brain damage or not. There is a need for further research within the subject since there are few studies that shed light on smartphone's as compensatory aid at present.

Introduction: High intensity holistic neuropsychological rehabilitation is the most evidenced-based intervention for post-acute ABI rehabilitation. However, the majority of the current evidence has examined inpatient or residential treatment contexts. Little is known about the efficacy of community neuropsychological rehabilitation interventions or the clinical validity of both high and low intensity forms of rehabilitation in a community rehabilitation setting. The systematic review synthesises the existing evidence for community-based holistic neuropsychological rehabilitation and its psycho-social outcomes. Changes in self and group identity have been suggested to underpin evidence-based neuropsychological rehabilitation. However, little is known about how these processes of identity change following ABI and throughout the rehabilitation process. The empirical study explores key turning points in the self-narratives of individuals with ABI in order to better understand the clinical and contextual factors which influence their rehabilitation. Methods: A search was conducted of Embase, Embase classic, Medline and PsycInfo. Studies were assessed for risk of bias and outcomes were synthesised following the PRISMA guidelines for systematic reviews. A ‘holistic-content’ narrative methodology was then employed to explore the post-acute adjustment and rehabilitation narratives of 11 individuals following ABI. Three-dimensional analysis of interaction, continuity and situation was used to examine individuals’ personal reflections of identity changes across their illness experience; and cross-case comparisons identified common transformational themes. Results: 15 studies were included in the review. Two distinct levels of intervention intensity were identified: high intensity interventions delivered multiple days per week, and low intensity interventions delivered only once a week. A synthesis of nine studies examining high intensity neuropsychological rehabilitation found evidence that these interventions can improve psychological wellbeing and enhance community integration following ABI when delivered on an outpatient basis. A synthesis of six low intensity interventions found limited evidence that they can lead to improved psycho-social outcomes when structure to target specific difficulties, and evidence that they can effectively support the achievement of individual patient goals. Following the analysis of ABI survivor narratives, themes of ‘Rehabilitation focus and psychological distress’, ‘Reclaiming efficacy in valued life domains’, and ‘Social comparisons: inclusion and exclusion’ were identified; each representing a continuum of personal and social understanding along which people moved during their rehabilitation. Conclusions: The systematic review suggested that high intensity forms of outpatient neuropsychological rehabilitation are effective at improving psycho-social outcomes. Low intensity forms of outpatient neuropsychological rehabilitation appear to offer a less favourable alternative to supporting psycho-social adjustment in the community at present. Findings from the empirical paper suggest that illness identity may be co-constructed in the context of early treatment experiences, and appears to influence post-acute rehabilitation focus; and that pre-injury values and self-identity guided participant approaches to re-establishing self-efficacy. These processes were supported by clinical, social and group interactions.

Background: It is often considered that, following paediatric acquired brain injury (pABI) and epilepsy, higher-level cognitive deficits, such as prospective memory (PM), are impaired and may only become apparent over time when these abilities are expected to develop and mature in a typically developing child. Interventions supporting PM have the potential to increase independence and enhance social participation. Despite research indicating PM difficulties in children and adolescents with pABI and epilepsy, and also in children with PM difficulties with unknown aetiology, currently, there is a limited evidence-base for interventions, although previous research has attempted to address this following pABI (Rous, 2011). Objective: The objective of this empirical paper was to build upon the work of Rous (2011) and optimise the effectiveness of brief metacognitive 'Remembering Goals' Training (RGT) and external content-free cueing (in the form of 'STOP' text messages) on PM task performance and the achievement of real-life goals. Method: The research employed a single-case series design with a randomised, alternating treatment (Barlow & Hayes, 1979). Eight participants (aged 10-15 years) completed the study. Three participants had an ABI, two participants had epilepsy, and three participants experienced PM difficulties with unknown aetiology. The PM task required participants to send three text messages at set times and to complete three real-life goals each working day for a four-week period. After a baseline period, participants completed brief RGT via Skype twice during the study (once following baseline, and again half way through the study). The brief RGT facilitated metacognitive skills and participants learnt to associate texts reading 'STOP' with mentally reviewing their goals and tasks for that day. Six 'STOP' text messages (cues) were sent at random times on half of the days of the intervention. The number and accuracy of texts messages, and the achievement of real-life goals, were compared across cued and un-cued days to evaluate the efficacy of the intervention for each participant. Results: Five participants demonstrated improved PM text message performance and seven participants demonstrated improved performance in real-life goals. Most of the participants reported positive gains in self-reported PM abilities, and most parents of children with acquired neurological conditions reported reduced levels of family stress and burden following the intervention. Conclusions: This research offers some evidence in support of the efficacy of content-free cueing and RGT for facilitating PM abilities. The majority of participants engaged in more frequent and accurate PM tasks and, most importantly, achieved more of their real-life goals as a result of the intervention.

Historically, there has been limited empirical study of children whose parents have suffered an acquired brain injury. This is despite the fact that both clinical opinion and qualitative study suggest that these children may represent a population at risk for a variety of emotional and behavioral problems. The current study set out to evaluate the overall psychosocial functioning of a small subset of children whose parents had suffered an acquired brain injury (TBI, stroke) and who were in the more chronic phase of recovery (average time post-injury = 3.3 years). Factors that have been proposed to impact child psychosocial functioning in this population were assessed including the neurobehavioral profile of the parent with an injury, parental depression, and the child’s report of the parental relationship. In all, ten children (average age = 13 years) from seven families with parental ABI were evaluated both on a comprehensive measure of child psychosocial functioning (BASC-2) and a series of qualitative measures. As compared to a normative sample, results of quantitative analyses suggest a group of children not experiencing general clinical distress. In fact, statistical analyses suggest resiliency in the current sample as compared to normative data. At the individual level, two of the children in the sample evidenced behavior that warrants further clinical evaluation, though this finding may be on par with the base rates of clinical distress seen in the general population. Qualitative analyses provide a richer understanding of the experiences of these children and their families and suggest avenues for further empirical evaluation. Results are presented in the context of other studies to date. Recommendations for clinicians and researchers based on current findings are provided. / Graduate / 0622 / rlillie@uvic.ca

Acquired Brain Injury (ABI) has been associated with significant family disruption, yet few studies explore the experiences of child-relatives. This cross-sectional study sought to explore the experiences of young people and their families (n = 3) following parental ABI. The major aims were (1) to develop an understanding of the processes by which family members make sense of events, and (2) to explore the implications for adjustment in young people and their families. A Personal Construct Psychology (PCP) methodology was implemented and construal processes were identified through individual interviews facilitated by Perceiver Element Grids (PEG; Procter, 2002). The Family Assessment Device (FAD; Epstein et al., 1983) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) were used to explore aspects of adjustment. Data analysis comprised of two parts; intra-family and inter-family exploration of similarities and differences in construal. The themes identified suggest that following ABI, family members may be faced with a process of reconstrual, in which they are required to assimilate new information into their construct systems, renegotiate their roles, and come to terms with loss. The research offers an insight into some of the processes that may contribute to patterns of interpersonal relating that may negatively impact on adjustment. Psychological support following parental ABI may therefore be a crucial component of supporting young people and their families through these changes whilst reducing the impact on their own psychosocial wellbeing. This research offers an insight into the experiences of three families at one moment in time. Further exploration is recommended to better inform clinical practice, and ensure that the needs of this population are not overlooked.

This thesis concerns with the functioning of coordinated team co-operation in organizations which provide social services to persons after acquired brain injury. Due to the frequency of occurrence and its deadful impact, these injuries become one of the most serious diseases not only in the Czech Republic but in the world. A person who has suffered brain injury is struggling with a number of socio-economic changes. A precondition for achieving full social integration of this individual is to ensure timely care and cooperation of individual experts on the given case. Such cooperation among experts is often missing in interconnected organizations. This can cause slowdown of the process of integration of an individual back to their everyday life. Equally important is the cooperation with family members who have an irreplaceable influence on the rehabilitation. The thesis is divided into two parts - theoretical and research. The theoretical part focuses on the consequences of acquired brain injury as well as on the the possibilities of social security provided by the state. Also, much of the text concerns with the coordinated rehabilitation and multidisciplinary collaboration which has a significant impact on improving the quality of life of people after brain injury. The data collection was carried out with the help of the method of qualitative research strategy, the technique of semi-structured interview with social workers in organizations of the city of Ceske Budejovice who provide social services according to Act 108/2006 Coll., on social services, as amended. The research is aimed at finding out how the coordinated rehabilitation is implemented in social services working with persons after acquired brain injury and then to create a proposal to streamline the implementation of coordinated rehabilitation in these organizations. Following the objectives, two research questions were examined: Which experts are involved in coordinated rehabilitation in social services providing services to people after brain injury? How is the cooperation of the team working with people after brain injury implemented? The data was processed in Atlas.ti 7. The research was carried out within the successfully accepted project at the Faculty of Health and Social Sciences, called Coordinated rehabilitation of patients with brain injury (reg. No. GAJU 138/2016/S), funded by the Grant Agency of the University of South Bohemia. The research results show insufficient cooperation of experts in social services providing care to persons with acquired brain injury. In spite of an acute need of coordinated and multidisciplinary support to such persons, the organizations miss specific professionals or employ workers who carry out works of other professions without the necessary qualification. The time, organizational and financial demands of teamwork make it impossible to provide high-quality multidisciplinary care, which is an important precondition for reintegration of people with brain injury back into work and social life. Team multidisciplinary cooperation brings a lot of positives, on the other hand, it also encounters barriers, which need to be further discussed in order to come to suitable solutions that are not only in the interest of the client and his family, but also great for the whole multidisciplinary team.

Introduction: Socio-emotional behaviour difficulties following acquired brain injury (ABI) have been shown to have a persisting negative effect on quality of life. A systematic review was carried out to look at the efficacy and clinical effectiveness of available psychological treatments for socio-emotional behaviour difficulties following ABI. Research was carried out to further understand socio-emotional behaviour by exploring the possible underlying cognitive aspects (specifically social cognition) in a traumatic brain injury (TBI) population. The study investigated the relationship between social cognition and socio-emotional behaviour post-TBI. Method: A systematic search of articles published between January 2008 and November 2013 was carried out following the Cochrane (2008) guidelines. Papers were quality assessed to identify strengths and weaknesses. In the research study, forty TBI participants were asked to complete tasks of emotion recognition, theory of mind, cognitive flexibility, processing speed, attention and working memory. Selfrated and proxy-rated behaviour questionnaires were also administered. Results: The systematic review revealed seven studies for inclusion; three papers looked at a Comprehensive Holistic Approach, two papers on Cognitive Behavioural Therapy, and two on Cognitive Rehabilitation Therapy. The findings suggested that CHA showed the best efficacy and generalization. However, there were also positive results within the CBT studies. The research paper found that the TBI group performed significantly poorer than the control group on measures of emotion recognition and three out of the four ToM tasks. The TBI group also performed significantly poorer on measures of processing speed and working memory (executive function). There was no association found between performance on any of the cognitive tests and socio-emotional behaviour. Conclusions: This is an area of limited research, likely due to the challenges of carrying out research in an ABI population. The systematic review highlighted the limited research available which has implications in clinical practice due to a lack of evidence base for potentially effective interventions. The research study results suggest that there is still a lack of understanding of socio-emotional behaviour and its underlying cognitive functioning. Further research would improve understanding and could also focus appropriate post-ABI interventions for socio-emotional behaviour problems.

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