This Master's thesis focuses on Occupational therapy for patients after application of botulinum toxin to upper limb. The aim of the thesis was to evaluate and compare a progress of functional independence in patients after acquired brain injury. There were twenty patients involved in the research, who were further divided into two groups and separated by ten people in each group. Both groups underwent the application of botulinum toxin whereas the experimental group A went through the occupational therapy. The control group had ordinary rehabilitation at home and without any occupational intervention for the duration of twelve week under guided self-rehabilitation contract of spastic paresis, so-called GSC. A programme of the group A included over the counter rehabilitation outpatient occupational therapy. The patients attended the course twice a week for the duration of four weeks. Afterwards, they received a home programme for the duration of eight weeks, during which they had two examinations at occupational therapy. All the participants were evaluated by Global Subjective Self-Assessment which is focused on spasticity. There were further evaluated according to Functional Independece Measure and modified Frenchay Arm Test. The experimental group with outpatient occupational therapy was...

The evidence base for Mindfulness-Based Cognitive Therapy (MBCT) is growing, but there is a lack of experimental validation among populations with acquired brain injuries (ABI). The purpose of this study was to investigate the acceptability and effectiveness of MBCT in fostering psychological recovery among adults with ABI. More specifically, this study was conducted to:(a) extend Finucane and Mercer’s (2006) study by applying MBCT to another population (i.e., adults with ABI); (b) corroborate the Bedard et al. (2008) finding of MBCT’s effectiveness in reducing depression in adults with TBI; (c) establish if empirical findings of the effectiveness of MBCT on depression and anxiety in the general population and in primary care patients with active symptoms of depression and anxiety extended to adults with ABI; and (d) explore the effect of MBCT treatment on measures of locus of control, satisfaction with life, self-awareness, and coping in adults with ABI. A mixed methods design was used and participants were recruited from two community-based brain injury programs. The final sample comprised 12 adults with mild, moderate, and severe injuries. Interview and self-report measures were administered pre- and post-treatment. Qualitative data were collected through semi-structured focus groups following MBCT treatment. Depression, denial, and self-awareness among participants showed statistically significant improvements and participants’ demonstrated statistically significant increases in positive reframing and active coping. Focus group data confirmed MBCT as an acceptable and effective approach for adults with ABI, and also speak to implications for the use of MBCT in ABI populations specifically. The need for a larger replication study with a control group is discussed. / Graduate

Introduction : Les troubles cognitifs et comportementaux après une lésion cérébrale peuvent entraîner des limitations d’activités et des restrictions de participation. Un programme de réadaptation, pluridisciplinaire et holistique a été développé à la Pitié Salpêtrière. D’une durée de 7 semaines, il vise l’amélioration de la participation en associant des rééducations individuelles et des mises en situation écologiques (ex : préparation de repas, reprise des transports en commun...). Les effets du programme n’ont jamais été investigués. Objectif : 1) définir et valider le programme de réadaptation par l’équipe multidisciplinaire à l’aide d’un modèle logique et 2) documenter l’effet du programme sur l’activité «préparer les repas». Méthode : Mesures répétées pré (T1 et T2) et post programme (T3, T4, T5 jusqu’ à 6 mois) avec 7 sujets uniques. Outil de mesure : Cooking Task (CT) (Chevignard, 2000), Profil des Activités Instrumentales (PAI) (Bottari, 2009) et Mesure des Habitudes de Vie (MHAVIE) (Noreau, 2002). Résultats : Objectif 1 : la documentation de chaque activité du programme est validée par des groupes d’experts. Objectif 2 : Les méthodes « two standard deviation band» et “non-overlap of all pairs” (NAP) pour cas unique démontrent des différences significatives entre les périodes pré et post programme au nombre total d’erreurs au CT (6/7 sujets), en besoin en aide (PAI). L’item préparation de repas de la MHAVIE suggère une amélioration pour 4/7 sujets. Discussion : L’ensemble des résultats du CT (diminution des erreurs), du PAI et de la MHAVIE suggère une amélioration globale de l’activité « préparer un repas » à la suite du programme de réadaptation. / Background: Cognitive and behavioural difficulties following acquired brain injury (ABI) may lead to severe limitations in activities and restrictions in participation. A specific ABI, holistic and multidisciplinary rehabilitation program was developed at the Salpêtrière hospital (Paris, France). Over a 7-week period, the program aims to improve participants’ participation by combining individual rehabilitation and environmental scenarios such as meal preparation, transportation etc. Program effects have never been investigated. Objectives: 1) to define and validate the rehabilitation program by a multidisciplinary team using a logic model and 2) to document the program's effect on the activity "prepare meals." Method: Repeated measurements pre-program (T1 and T2) and post-program (T3, T4, T5 up to 6 months) with 7 subjects using the Cooking Task (CT) (Chevignard, 2000), Instrumental Activities of Daily Living (IADL) (Bottari, 2009), and Measure of Life Habits (LIFE-H) (Noreau, 2002). Results: Using the two standard deviation band method and “non-overlap of all pairs” (NAP) methods for small n design, significant differences in pre and post program measures were found for the total number of errors in CT (6/7 subjects), the need of assistance (IADL). The results of the LIFE-H suggest an effect of improving the preparation of meals for 4/7 subjects. Discussion: The combined results from the CT (fewer errors), IADL and LIFE-H suggest an overall improvement in the activity "preparing a meal" after the rehabilitation program.

This paper examines the expression of emotion in narrative speech among individuals with acquired brain injury (ABI). We are particularly interested in the effects of ABI on the use of metaphor (c.f. Stroinska et al., 2014). Conceptualizing traumatic events and sharing them with others is crucial for prognostic purposes and reflected in the speech patterns of those who experience some level of post-traumatic growth (PTG). Emotion and metaphor constitute a relatively unexplored domain within the ABI community and merit further research given the prevalence of emotional disturbances following a brain injury. This study explores emotional valence (i.e. the ‘pleasantness’ of the emotions invoked) and concreteness (i.e. how perceptible the referent of the word is) in metaphorical constructions. Emotional norm data was analysed using a corpus of approximately 14,000 commonly used English words ranking valence and arousal (Warriner et al., 2013; Kuperman et al., 2014). Thirteen semi-structured interviews with ABI survivors were conducted at a rehabilitation facility eliciting narrative recall of traumatic events and their experience across three temporal representations, namely past, present, and future. Results highlight importance of demographic information in recovery outcomes, which in our study accounts for 32% of the variance in emotion. Measures of valence revealed significantly increased use of positive metaphor over time, while the analysis of concreteness indicated events further in time represented more abstractly. Together, the findings shed some new light on emotional outcomes following ABI and indicate possible uses that figurative language may provide in understanding PTG. / Thesis / Master of Science (MSc) / Metaphors represent one important method to interpret the world around us. Humans rely on metaphorical language to capture the essence of our experiences in meaningful and relatable ways. This is particularly true of those who have experienced a traumatic event, such as an acquired brain injury (ABI). Conveying feelings associated with trauma can often be challenging for individuals since the way they interact and perceive the world changes as a result. The shifting perspective is often described using metaphor to organize thoughts and give meaning to trauma. The current study examines the role of metaphor as a tool to uncover emotion following ABI and explore the implications it has in understanding psychological growth following the event. By exploring how abstract and emotional metaphors were, our results revealed that participants in the study had more positive elements in their metaphor use when describing their life over time and imagining the future.

The changes in emotivity and behavior are common after acquired brain injury, which complicates the readaptation of an individual to his environment. Compared to cognitive problems, these changes are not so greatly regarded because their complexity requires care in the context of its special neuropsychological treatment. The objective of the theoretical part of this thesis was to elucidate the issue of acquired brain injury and summarize current knowledge and experience in the field of therapeutic work with this specific group of people. The aim of the empirical part of this thesis was to design an appropriate educationally based preventive program that would focus on the experience of personality change after ABI. The goal of this program was to provide patients with information about the usual consequences of ABI and to provide a place to share the problems they experience. The effectiveness of this program was measured via the European Brain Injury Questionnaire (EBIQ) and the Zung Self-rating Depression Scale (ZSDS). The results were compared in the experimental group (N=30) before and after the completion of the program and in the control group (N=30). In the group that undertook the intervention, the EBIQ-P showed significant improvement in the subscale Physical. The ZSDS results showed...

Prospective memory is very important for everyday life of all people. Patients with brain injury often have problems with their prospective memory, the ability to remember what they would like to do in the future and to remember that intention at the right time. Rehabilitation and prospective memory training differ in the literature as well as its efficacy results. The thesis deals with the issues of prospective memory and its rehabilitation with people with acquired brain injury. The aim of this work is to create a summary of existing knowledge about prospective memory, design and implementation of prospective memory training program with patiens with acquired brain injury. The theoretical part of the thesis summarizes basic information about prospective memory, its division and overview of theories. An important part of the thesis is an overview of methods for prospective memory diagnostics. The end of the theoretical part of thesis is about different ways of rehabilitation prospective memory. The empirical part presents the theoretical basis for the cognitive rehabilitation. On this basis a prospective memory training was developed and subsequently tested with patiens with acquired brain injury. The thesis also includes a detailed manual for prospective memory training. The effectivness of the...

This diploma thesis deals with monitoring the movement of the upper limbs in patients after acquired brain injury using an accelerometer. The diploma thesis is processed from the perspective of occupational therapy. The thesis is divided into the theoretical and practical part. The main objective of the theoretical part is to collect specialist literature about monitoring the movement of the upper limbs by accelerometer in rehabilitation, especially in the occupational therapy. The practical part of the thesis has three objectives. The first objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to an objective improvement of the activity of daily living (ADL) in the areas of eating, washing and dressing. The second objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to subjective improvement in the same ADLs, and the third objective is to compare whether objective and subjective improvement is related. The practical part was prepared in the form of pilot studies. Quantitative research was used, specifically the type of pre-experiment - One Group Pretest Posttest Design. The study included 14 patients after acquired brain injury. The...

This diploma thesis deals with monitoring the movement of the upper limbs in patients after acquired brain injury using an accelerometer. The diploma thesis is processed from the perspective of occupational therapy. The thesis is divided into the theoretical and practical part. The main objective of the theoretical part is to collect specialist literature about monitoring the movement of the upper limbs by accelerometer in rehabilitation, especially in the occupational therapy. The practical part of the thesis has three objectives. The first objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to an objective improvement of the activity of daily living (ADL) in the areas of eating, washing and dressing. The second objective is to find out whether monitoring of the upper limbs using the accelerometer in patients after acquired brain injury will lead to subjective improvement in the same ADLs, and the third objective is to compare whether objective and subjective improvement is related. The practical part was prepared in the form of pilot studies. Quantitative research was used, specifically the type of pre-experiment - One Group Pretest Posttest Design. The study included 14 patients after acquired brain injury. The...

The number of informal carers in the UK is rising, yet the dynamics of care within informal care relationships remain poorly understood. The present research examined adaptation of informal care relationships affected by Acquired Brain Injury. The research addresses four pairs of questions: (1a) Are there any disagreements and/or misunderstandings between carers and people with Acquired Brain Injury (PwABI) regarding carer identity? (1b) How can the pattern of divergences be explained? (2a) Are there any disagreements and/or misunderstandings between carers and PwABI regarding PwABI identity? (2b) How can the pattern of divergences be explained? (3a) What strategies do carers and PwABI use in collaboration on a joint task? (3b) Is the type of input provided by carers on the joint task comparable to scaffolding as described in the child development literature? (4a) What happens when carers and PwABI collaborate to fill in the Disability Living Allowance (DLA) claim form? (4b) Why do carers see more disability than PwABI when filling in the DLA form? Four mixed-method data sets were used to answer these questions: (1) numerical ratings given by PwABI and carers to map out convergences and divergences (2) videos of discussions between participants and researcher during rating tasks (3) videos of carers and PwABI engaging in a joint task - planning inviting a friend or relative round for a meal and (4) videos of carers and PwABI filling in part of the DLA claim form. All data was collected from the same 28 PwABI/carer dyads who were two or more years post injury. Chapter 4 addresses questions 1a and 1b. Carers’ and PwABIs’ perspective ratings revealed a number of disagreements regarding carer identity. Carers perceived themselves negatively compared to their partners’ view of them. Regarding question 1b, carers feel negatively about themselves due to difficulties in the transition to the role of ‘carer’. They experience a lack of recognition for this caring role as a result of concealing the burden of care. Carers require more long term support from health services to help them achieve recognition for their role, such as facilitating attendance at support groups. Chapter 5 addresses questions 2a and 2b. Carers’ and PwABIs’ perspective ratings revealed only one disagreement and corresponding misunderstanding regarding PwABI identity. Regarding question 2b, alignment was found between the perspectives of carers and PwABI regarding PwABI due to the relational rating method used. It is carer identity which is the source of most divergences of perspective, not PwABI identity as commonly assumed. Using a relational rating method shows promise as a tool to explore perspectives as it treats all viewpoints as equal and avoids pathologising the perspective of PwABI. Chapter 6 addresses questions 3a and 3b. Analysis of strategies shows that completing a joint task is a collaborative process. Carers direct the background of the task but PwABI are in charge of the foreground, making task decisions. However, carers dominate the process and control where and how PwABI contribute. Regarding question 3b, the interaction meets the criteria for scaffolding in the strategies chosen and the flexibility of collaboration. However, removal of supports is often an unrealistic goal, leading to frustration in carers. Examination of processes of collaboration has elucidated the strategies used by carers and PwABI and can enhance theoretical discussion of the applicability of the scaffolding metaphor for a cognitively impaired adult sample. Chapter 7 address questions 4a and 4b. Disagreements were frequent when completing the DLA form. Contestations were almost exclusively in the direction of carers seeing greater disability than PwABI. Regarding question 4b, carers see greater disability due to the communication required to complete the form. Dyads are forced to confront disability, a pattern of interaction they avoid in everyday life. Carers marginalise PwABI point of view and position themselves as ‘expert’ on the PwABI. Differences in frames of reference regarding audience, aim and scope lead carers to maximise the disability and PwABI to minimise this. The impact of completing complex forms on relationships and identity needs to be considered during development of disability benefit assessment methods. A relational approach which studies both halves of informal care partnerships simultaneously allows us to go beyond outcomes of ABI and affords a greater understanding of processes of adaptation.

Previous research has shown that cognitive deficits arising from neurological impairment can impact on driving performance. The diverse nature of cognitive, perceptual and behavioural impairments experienced by drivers with neurological impairment and the resulting impact on driving ability has been the subject of extensive research involving the use of psychometric off-road measures, road safety statistics, actual on-road driving assessments and self-report. This research has shown that some drivers can compensate for limitations in their driving skills but this is dependent upon realistic self-appraisal of driving abilities. Few studies have investigated the role of self-awareness of driving abilities on on-road driving performance in persons with neurological impairment. Aims: To investigate the relationship between self-awareness of driving related abilities in neurologically impaired drivers and on-road driving performance. Participants: Retrospective data were collated on 79 participants who were referred for Occupational Therapy driving assessment, comprising 24 with Closed Head Injury (CHI) (mean age 24.67 + 5.57 yrs), 30 with Cerebrovascular Accident (CVA) (mean age 61.00 + 9.08 yrs) and 25 with 'Other' diagnosis (mean age 50.64 + 21.14 yrs). All participants held a current driver's licence or learner's permit Results: Five predictor variables were significantly associated with the on-road driving assessment outcome including three demographic variables:- diagnosis (2(2)= 7.69, p = 0.021), time since injury/illness onset (2(2)= 6.40, p = 0.041), and mileage (2(2)= 5.84, p = 0.05); and two self-awareness variables:- reaction time (2(2)= 8.04, p = 0.018), and impulse control (2(2)= 13.47, p = 0.001). Logistic regression yielded a final best model containing two predictor variables (2(4) = 20.81, p = 0.000), including diagnosis (p = 0.02) and self-awareness of impulse control (p = 0.01). Discussion and Conclusion: Participants who over-estimated their driving abilities were more likely to fail a driving assessment or require driving rehabilitation than participants who under-estimated or accurately predicted their performance and participants with a diagnosis of CVA were more likely to fail or require driving rehabilitation than those with a CHI or 'Other' diagnosis.