This quasi-experimental study investigates neuropsychological functioning differences between 63 active duty soldiers who were placed into three groups (MTBI, PTSD, control) to provide better information for differentiating PTSD and MTBI. The ANAM and MicroCog were utilized to measure psychomotor speed, memory, and attention. Participants with PTSD performed worse on most measures of psychomotor speed and attention, and endorsed more symptoms of depression and anxiety when compared to MTBI and control participants. Further, attention appears to be the best cognitive domain for differentiating PTSD from MTBI, whereas memory variables did not differentiate these groups. Clinical and research implications of these findings are discussed.

Fragestellung: Ein neues Modell der kortikalen Kontusion (Controlled Cortical Impact Injury, CCII) soll in der vorliegenden Arbeit für den Einsatz von Therapiestudien evaluiert werden. Material und Methoden: Bei 89 Sprague Dawley Ratten wurden eine links parieto-temporale Kontusion appliziert. 23 Stunden nach Trauma erfolgte eine neurologische Untersuchung. Die Gehirne wurden 24 Stunden nach Trauma entnommen. Das posttraumatische Hirnödem wurde gravimetrisch anhand des Wassergehalts und der Hemisphärenschwellung bestimmt. Das Kontusionsvolumen wurde mittels TTC-Färbung planimetrisch gemessen. Die Extravasation von Evans blue wurde spektralfotometrisch quantifiziert. Die histologische Charakterisierung erfolgte anhand der Hämatoxylin/Eosin-Färbung, Bielschowsky-Färbung und Evans blue Fluoreszenzmikroskopie. In einer repräsentativen Therapiestudie mit einem 5-Hydroxytryptamin1A-Agonisten (Bay X 3702) wurden 24 Stunden nach Trauma vergleichend das Kontusionsvolumen, der Wassergehalt und die Hemisphärenschwellung bestimmt. Ergebnisse: Neurologisch zeigten sich Einschränkungen in der Spontanaktivität und der Balancierfähigkeit nach Trauma. Der posttraumatische Wassergehalt war in der traumatisierten Hemisphäre (82,5 ± 0,12%) gegenüber der Kontralateralen (79,98 ± 0,07%) signifikant erhöht. Die posttraumatische Hemisphärenschwellung lag bei 14,3 ± 1,2%. In der traumatisierten Hemisphäre zeigte sich eine signifikant höhere Evans blue Extravasation (47,28 ± 11,8 ng/mg TG). Das Kontusionsvolumen wurde mit 58,9 ± 9,1 cmm bestimmt. Histologisch zeigte sich eine kortikale hämorrhagische Nekrose. Der axonalen Schaden war auf das perikontusionelle Gewebe beschränkt. Evans blue zeigte sich perikontusionell im Intra- und Extrazellulärraum. In der Therapiestudie mit Bay X 3702 zeigten der Wassergehalt und die Hemisphärenschwellung keine signifikanten Unterschiede in den Versuchsgruppen. Im Gegensatz zu neuroprotektiven Eigenschaften in Modellen der zerebralen Ischämie war das Kontusionsvolumen nach Bay X 3702 Gabe mit 126 ± 21,8 cmm signifikant größer als in der Plazebo-Gruppe (58.6 ± 7.5 cmm). Es wurde eine signifikante Abnahme des arteriellen Blutdrucks bis 30 Minuten nach Injektion der Substanz gemessen. Die Abnahme des mittleren Blutdrucks und die Zunahme des Kontusionsvolumens korrelierte signifikant. Schlußfolgerung: Das CCII imitiert wichtige Aspekte des menschlichen Schädel-Hirn-Traumas. Der posttraumatische Schaden ist reproduzierbar und quantifizierbar. Trotz fehlendem Nachweis eines neuroprotektiven Effekts in der durchgeführten Therapiestudie konnte gezeigt werden, daß das CCII als Modell der fokalen Kontusion für Therapiestudien geeignet ist. / Objective: A new model of focal contusion (Controlled Cortical Impact Injury, CCII) should be evaluated to proof potential neuroprotective drug effects on posttraumatic alterations. Materials and Methods: In 86 Sprague Dawley rats a left temporo-parietal contusion was applied. 23 h following CCII rats were examined neurologically. In all animals brains were removed 24 hours after contusion. Posttraumatic hemispheric swelling and water content were determined gravimetrically. Using the triphenyltetrazoliumchloride (TTC) staining contusion volume was measured planimetrically. Extravasation of Evans blue was quantified sepctrophotometrically. For histological characterization hematoxylin/eosin staining, Bielschowsky staining and Evans blue fluorescence microscopy was used. In a representative study the potential neuroprotective effect of a 5-hydrxoytryptamine1A receptor agonist (Bay X 3702) on contusion volume and brain edema following CCII was determined. Results: Neurological examination showed deficits in motility and beam balance task, respectively. Posttraumatic hemispheric water content increased significantly after contusion (82.5 ± 0.12%) versus contralateral hemisphere (79.8 ± 0.08%). Posttraumatic swelling was 14.3 ± 1.2%. Spectrophotometrically, concentration of extravasated Evans Blue was 47.3 ± 11.8 ng/mg dry weight. Contusion volume was 58.9 ± 9.1 cmm. Histologically, a hemorrhagic necrosis was observed following CCII. Axonal injury was found in pericontusional area, only. Evans Blue was detected pericontsionally in the ipsilateral extra- and intracellular space. Bay X 3702 had no significant effect on posttraumatic hemispheric swelling and water content. In contrast to neuroprotective effect, shown following focal and global ischemia Bay X 3702 administration resulted in significant increase of contusion volume to 126 ± 21.8 cmm, versus placebo group (58.6 ± 7.5 cmm) following CCII. MABP showed significant decreased values after injection of Bay X 3702 up to 30 Minutes following trauma. A significant correlation could be shown between decrease of MABP and increase of contusion volume. Conclusion: The Controlled Cortical Impact Injury represents important aspects of human focal traumatic brain injury. The posttraumatic lesion is reproduceable and quantifiable. Although a neuroprotective effect of the 5-hydroxytryptamine1A agonist could not be verified, effects of potential neuroprotective agents can accurately be proved in this model.

Problématique. Le traitement de la douleur procédurale est essentiel pour le confort des personnes incapables de communiquer à l’unité de soins intensifs (USI) après avoir subi un traumatisme craniocérébral (TCC). Bien que les échelles d’observation des comportements comme le Critical Care Observation Tool-Neuro (CPOT-Neuro) soient utilisées dans ce contexte, les comportements sont souvent atténués chez la personne TCC à l’USI, dû aux fortes doses de sédation. But. Cette étude visait à examiner si les paramètres du réflexe photo-lumineux (RPL), mesurés avec un vidéo- pupillomètre, peuvent prédire les comportements relatifs à la douleur observés lors de procédures de soins courantes chez des personnes TCC incapables de communiquer à l’USI. Méthode. 12 participants (10 hommes, 41 ans ± 21) avec TCC sévère ont été observés avant, pendant et 15 minutes après une procédure de soin douloureuse et non douloureuse. À chaque observation, les paramètres du RPL (amplitude, vitesse, latence) et le score CPOT-Neuro ont été recueillis. L’auto- évaluation de la douleur a été collectée chez les participants pouvant communiquer. Résultats. Des fluctuations significatives dans la latence du RPL et du CPOT-Neuro ont été observées entre la mesure prise avant et celle pendant la procédure douloureuse. La latence du RPL a été le seul prédicteur significatif d’un score CPOT-Neuro ≥ 2. Aucune corrélation entre le RPL et l’auto- évaluation des participants a été observée. Conclusion. Bien que préliminaires, les résultats suggèrent que la latence du RPL peut prédire la présence de douleur lors de la mobilisation chez les personnes TCC incapables de communiquer à l’USI. / Background. The management of procedural pain is essential for the comfort of noncommunicative individuals in the intensive care unit (ICU) after a traumatic brain injury (TBI). Although behavioral observational scales like the Critical Pain Observation Tool-Neuro (CPOTNeuro can be used in this context, behaviors are often attenuated in TBI individuals in the ICU due to high doses of sedatives. Aim. This study aimed to examine if the parameters of the pupillary light reflex (PLR), measured with a video-pupillometer, can be used to predict pain-related behaviors observed during common care procedures in non-communicative TBI individuals in the ICU. Method. Twelve participants (10 males; 41 years ± 21) with severe TBI were observed before, during, and 15 minutes after a painful and a non-painful care procedure. At each observation, the PLR (amplitude, velocity, latency) and CPOT-Neuro scores were collected. Selfreported pain was collected from participants who could communicate. Results. Significant fluctuations in the latency of PLR and CPOT-Neuro scores were observed between measurements taken before. And during the painful procedure. Of all PLR parameters, the latency of PLR was the only significant predictor of a CPOT-Neuro score ≥ 2. No correlation was observed between PLR and participant’s self-reported pain. Conclusion. Although preliminary, findings suggest that PLR latency could predict pain for the mobilization procedure in non-communicative TBI individuals in the ICU.

In der vorliegenden Arbeit wird die Erstellung eines computergestützten Systems zum multimodalen zerebralen Monitoring von Patienten mit schwerem Schädel-Hirn-Trauma beschrieben. Das multimodale zerebrale Monitoring dient der Erfassung, graphischen Darstellung und elektronischen Speicherung von physiologischen Meßdaten. Zur kontinuierlichen Überwachung der zerebralen Sauerstoffversorgung wurden die jugularvenöse Oxymetrie, die Hirngewebe-Sauerstoffpartialdruckmessung und die Nah-Infrarot-Spektroskopie hinsichtlich ihrer Stabilität und Sensitivität vergleichend getestet. Weiterhin erfolgte die prospektive Untersuchung der Inzidenz zerebraler hypoxischer Episoden, ihrer möglichen Ursachen, sowie des Einfluß der zerebralen Hypoxie auf das neurologische Outcome er Patienten mit schwerem Schädel-Hirn-Trauma. Zur kontinuierlichen Überwachung der zerebralen Oxygenierung ist gegenwärtig die Messung des lokalen Hirngewebe-pO2 am besten geeignet. Als häufigste Ursachen der zerebralen Hypoxie wurden die systemische Hypokapnie, ein verminderter zerebrale Perfusionsdruck und ein erhöhter intrakranieller Druck identifiziert. Das akkumulierte Auftreten zerebraler hypoxischer Episoden für mehr als 30 Minuten war mit einem signifikant schlechteren neurologischen Outcome der Patienten verbunden. Durch die Einführung weiterer Methoden zur invasiven und nicht-invasiven Überwachung von Patienten mit schwerem Schädel-Hirn-Trauma, wie zum Beispiel der zerebralen Mikrodialyse, können zukünftig die metabolischen Veränderungen durch eine zerebrale Hypoxie untersucht werden. / Cerebral hypoxia is considered the main cause of secondary damage to the vulnerable brain following severe traumatic brain injury, and critical care management is primarily focused on the prevention of cerebral hypoxic events. Goals of this study were: First, the development of a computerized multimodal cerebral monitoring system to continuously acquire, display, and record data from multiple monitoring devices. Second, the comparative study of different methods for monitoring of cerebral oxygenation, as there are jugular venous oxygen saturation, near-infrared spectroscopy, and brain tissue oxygen tension. Third, the prospective determination of a critical hypoxic threshold, the incidence of cerebral hypoxia, the influence of standard therapeutic maneuvres to treat intracranial hypertension on cerebral oxygenation, the significance of possible causes of cerebral hypoxia, and the influence of cerebral hypoxia on neurological outcome. The multimodal monitoring system was successfully established on a neurosurgical intensice care unit. Monitoring of local brain tissue pO2 was most appropriate for monitoring of cerebral oxygenation. The critical hypoxic threshold in brain tissue pO2 was 10 mmHg. Standard therapeutic maneuvres to treat elevated intracranial pressure were, in part, unsuccessful in improving cerebral oxygen delivery. Cerebral hypoxic episodes were predominantly associated with arterial hypocarbia and low cerebral perfusion pressure. Patients with a total of more than 30 minutes of cerebral hypoxic events had a significantly worse neurological outcome. Future investigations using cerebral microdialysis will help to further improve insight into pathophysiology and metabolic changes following traumatic brain injury.

Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers.

Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers.

Text in Afrikaans / In this study an instrument is suggested for implementation by the Educational Psychologist to design a support programme, aimed at handling family members' stress where a child has sustained a brain injury. Attention was paid to the phenomenon "brain injured child" to ascertain demands and needs (physical, cognitive, psychological and emotional). Specific note was taken of the toll on each family member in their observance, experience, assistance and giving· meaning to the child. Reference was made to existing support programmes for such family members from the acute care phase to the final acceptance and readjustment of the family. With this study the need for a continuous support programme and the contents of such a programme was addressed. Using these guidelines the Educational Psychologist will be able to prepare the family for the stress possibilities in dealing with the brain injured child. / Met hierdie studie is 'n instrument daargestel vir die ontwerp van 'n hulpverleningsprogram vir gebruik deur die Opvoedkundige Sielkundige. Hierdie hulpprogram het as doel, die hantering van stres, deur die gesin van 'n kind, wat 'n breinbesering opgedoen het. In die studie is aandag gegee aan die tipiese gedrag wat oor die algemeen van 'n breinbeseerde kind verwag kan word. Daar is ook gepoog om te bepaal hoe elke lid van die gesin die breinbeseerde kind beleef, aan hom betekenis gee, en hom probeer help ten opsigte van die eise (fisiek en emosioneel) wat hy stel. Verder is daar gekyk na bestaande hulpverlening (gerig op die hantering van stres) aan die gesinslede van 'n breinbeseerde kind vanaf die akute versorgingsfase tot en met die aanpassing en herorganisering van die gesin. Met hierdie studie is 'n behoefte aan 'n kontinue hulpverleningsprogram en die inhoud van so 'n program by gesinslede aangespreek. Aan die hand van die riglyne sal die Opvoedkundige Sielkundige 'n gesin kan voorberei op die stres wat hulle ten opsigte van die hantering van 'n breinbeseerde kind te wagte kan wees. / Psychology of Education / M. Ed. (Voorligting)

Infants with hypoxic-ischaemic encephalopathy (birth asphyxia) have a high risk of death or disability. Those with poor prognosis are sometimes allowed to die after withdrawal of intensive care. In recent years, doctors have used new types of brain scan, magnetic resonance imaging (MRI), to predict the type and severity of impairment if the infant survives and to help with such decisions. In this thesis, I analyse the issues arising from the use of MRI for prognostication and decision-making in newborn infants. I argue that previous prognostic research has been hampered by a failure to identify and focus on the most important practical question and that this contributes to uncertainty in practice. I outline recommendations for improving research. I then look at existing guidelines about withdrawal of life-sustaining treatment. I identify several problems with these guidelines; they are vague and fail to provide practical guidance, they provide little or no genuine scope for parental involvement in decisions, and they give no weight to the interests of others. I argue that parental interests should be given some weight in decisions for newborn infants. I develop a new model of decision-making that, using the concept of a Restricted Life, attempts to set out clearly the boundaries of parental discretion in decision-making. I argue that where infants are predicted to have severe cognitive or very severe physical impairment parents should be permitted to request either withdrawal or continuation of treatment. I justify this model on the basis of overlapping interests, (prognostic, experiential and moral) uncertainty, asymmetrical harms, and the burden of care. In the conclusion, I set out a guideline for the use of MRI in newborn infants with hypoxic-ischaemic encephalopathy. I suggest that this guideline would provide a more robust, coherent and practical basis for decision-making in newborn intensive care.

Tissue engineers – in order to develop therapies for the treatment of complex neurological injuries and diseases – attempt to recreate elaborate developmental mechanisms in vitro. Neuronal precursor cells are excellent candidates for the study of developmental operations such as cell adhesion, differentiation, and axonal pathfinding. Hyaluronan (HA) is a common polysaccharide that is found extensively throughout the neuronal extracellular matrix (ECM), and can be functionalised and crosslinked to form stable hydrogels that support growing neuronal cells. Hyaluronan hydrogels can be modified chemically and mechanically to mimic the ECM of the developing brain, awarding control over mechanisms such as differentiation and axonal pathfinding. This thesis is concerned with the functionalisation and characterisation of HA hydrogels, ultimately in order to simulate vital properties of the developing brain. Here we show that HA hydrogels can be finely tuned mechanically (by modulating stiffness and viscosity), and chemically, by the conjugation of peptides that mimic the neural cell adhesion molecule (NCAM). NCAM mimics and novel mimics of sialylated NCAM significantly influence the differentiation of NSPCs in 2D and 3D. HA hydrogels successfully support long term culture of neural cells in 3D, and encourage the formation and extension of neurites of several cell types including human, mouse and rat neuronal precursor and stem cells. These results demonstrate for the first time that novel NCAM mimicking peptides can be conjugated to well defined hydrogel matrices that influence intricate developmental behaviours in 3D. Understanding how neural cells form functional networks is essential for the development of clinical approaches that attempt to address the injuries and diseases that affect these systems.

La vie de famille avec un adolescent comporte son lot de défis. Les émotions de l’adolescent qui se présentent parfois comme des montagnes russes peuvent rendre les relations tendues et difficiles au sein de la cellule familiale, voire même au-delà de celle-ci. Par son caractère inattendu, l’avènement d’un traumatisme craniocérébral (TCC) chez l’adolescent vient fragiliser encore davantage la dynamique familiale. En outre, la myriade d’impacts engendrés par le TCC contraint la famille à modifier son projet de vie en s’investissant ensemble pour le reconstruire. La résilience devant une situation de traumatisme ne se manifeste pas de la même façon pour toutes les familles qui y sont confrontées. Certaines d’entre elles réussissent à se transformer positivement, tandis que d’autres n’y parviennent pas ou manifestent plus de difficultés. Il convient alors d’actualiser des approches de soins interdisciplinaires centrées sur la famille qui favoriseraient la reconnaissance des éléments pouvant soutenir son processus de résilience à travers cette épreuve et, enfin, aider à transformer son projet de vie. Avec comme perspective disciplinaire le modèle humaniste des soins infirmiers (Cara, 2012; Cara & Girard, 2013; Girard & Cara, 2011), cette étude qualitative et inductive (LoBiondo-Wood, Haber, Cameron, & Singh, 2009), soutenue par une approche collaborative de recherche (Desgagné, 1997), a permis la coconstruction des composantes d’un programme d’intervention en soutien à la résilience familiale, avec des familles dont un adolescent est atteint d’un TCC modéré ou sévère et des professionnels de la réadaptation. Le modèle de développement et de validation d’interventions complexes (Van Meijel, Gamel, Van Swieten-Duijfjes, & Grypdonck, 2004) a structuré la collecte des données en trois volets. Le premier volet consistait à identifier les composantes du programme d’intervention selon les familles (n=6) et les professionnels de la réadaptation (n=5). La priorisation et la validation des composantes du programme d’intervention, soit respectivement le deuxième et troisième volets, se sont réalisées auprès de ces mêmes familles (n=6 au volet 2 et n=4 au volet 3) et professionnels de la réadaptation (n=5 aux volets 2 et 3). Le processus d’analyse des données (Miles & Huberman, 2003) a repéré cinq thèmes intégrateurs, considérés comme les composantes du programme d’intervention en soutien à la résilience familiale à la suite du TCC modéré ou sévère d’un adolescent. Ce sont : 1) les caractéristiques de la famille et ses influences; 2) les stratégies familiales positives; 3) le soutien familial et social; 4) la prise en charge de l’aspect occupationnel et; 5) l’apport de la communauté et des professionnels de la santé. Les résultats issus de ce processus de coconstruction ont produit une matrice solide, suffisamment flexible pour pouvoir s’adapter aux différents contextes dans lesquels évoluent les familles et les professionnels de la réadaptation. Cette étude offre en outre des avenues intéressantes tant pour les praticiens que pour les gestionnaires et les chercheurs en sciences infirmières et dans d’autres disciplines quant à la mise en place de stratégies concrètes visant à soutenir le processus de résilience des familles dans des situations particulièrement difficiles de leur vie. / Family life with an adolescent has its share of challenges. The adolescent’s emotional rollercoasters can make relationships tense and difficult within the family unit, and even outside of it. By virtue of its unexpected character, the occurrence of traumatic brain injury (TBI) in an adolescent can undermine the family dynamics even further. Additionally, the myriad of impacts caused by a TBI forces the family to alter its plans for the future by committing themselves together to rebuild them. Resilience to trauma does not manifest itself in the same way for all families. Some manage to effect positive changes, while others are unable to do so, or experience more difficulties. In light of this, it appears relevant to develop family-centred care approaches fostering the recognition of elements that can support the family’s resilience process through hardships and, ultimately, help reconstruct its plans for the future. Using the humanist model of nursing care (Cara, 2012; Cara & Girard, 2013; Girard & Cara, 2011) as a disciplinary perspective, this qualitative and inductive study (LoBiondo-Wood, Haber, Cameron, & Singh, 2009), supported by a collaborative research approach (Desgagné, 1997), led to the co-construction of the building blocks for an intervention program to support family resilience in conjunction with families with an adolescent suffering from moderate or severe TBI and rehabilitation professionals. The complex intervention design and validation model (Van Meijel, Gamel, Van Swieten-Duijfjes, & Grypdonck, 2004) inspired a three-stage data collection process. The first stage consisted in identifying the building blocks of the intervention program in the eyes of families (n=6) and rehabilitation professionals (n=5). The prioritization and validation of these building blocks, respectively the second and third stages, were conducted with the same families (n=6 for stage 2 and n=4 for stage 3) and rehabilitation professionals (n=5 for stages 2 and 3). The data analysis process (Miles & Huberman, 2003) identified five encompassing themes, considered to be the building blocks of an intervention program to support family resilience following moderate to severe TBI in adolescents. They are: 1) family characteristics and its influences; 2) positive family strategies; 3) family and social support; 4) management of occupational aspects; 5) contribution of the community and health professionals. The results of this co-construction process established a strong matrix that is flexible enough to adapt to the various contexts in which families and rehabilitation professionals live and work. This study also offers promising avenues for practitioners, administrators and researchers in nursing and other fields with respect to the implementation of concrete strategies to support the resilience process of families facing particularly difficult times in their lives.