The benefits of assistive technology (AT) have been well established to positively support participation within disability. Clinicians have an important role in guiding clients to choose goal-centred AT. This study aims to explore (i) the frequency and types of AT prescribed by clinicians and (ii) real-world implementation of AT by clinicians, employing the ISO 9999 framework, and the challenges involved with AT prescription. An online survey was circulated to brain injury clinicians within New South Wales (NSW). Data were exported into IBM SPSS Statistics v.27 for analysis. Free text responses were analysed using a mixed-methods content analysis. A total of 31 AT products were reported 131 times by clinicians. The most frequently reported AT category was mainstream technology ( = 81), used amongst all professions. Using the ISO 9999 framework, the most reported class use of AT was "communication and information management" ( = 77/131). Challenges around AT implementation were funding acquisition, customizability of AT and time constraints with training. NSW clinicians have demonstrated varied use of AT to support cognitive, physical and communication functions. However, with the rapidly advancing nature of AT, there needs to be quicker approaches to generate high-quality evidence to support its use.

There is a need for accessible rehabilitation that promotes meaningful participation, wellbeing, and adjustment to life with acquired brain injury (ABI). VaLiANT (Valued Living After Neurological Trauma) is an 8-week holistic group intervention that integrates Acceptance and Commitment Therapy (ACT) and cognitive rehabilitation techniques to support adjustment and meaningful reengagement in life. This Phase II pilot randomized controlled trial explored feasibility and preliminary efficacy signals to determine the viability of a larger trial. Adults (>3 months post-ABI) were randomly allocated to VaLiANT plus treatment-as-usual (TAU), or TAU waitlist-control, with assessments at baseline, post-intervention (8 weeks), and follow-up (16 weeks). Feasibility criteria included recruitment, dropout, outcome assessment completion, adherence, and delivery fidelity. Preliminary treatment effects were assessed on a range of adjustment-related outcomes using mixed linear models, proportions of reliable change, and minimal clinically important differences. 54 participants were recruited (= 50.6,  = 5.4) predominately with stroke (52%) and traumatic brain injury (22%). All feasibility criteria were met. Treatment effects were identified on measures of psychological distress, experiential avoidance, valued living, and self-identity, but not meaningful participation, quality-of-life, or wellbeing. A larger trial is viable but VaLiANT will benefit from refinement first to improve its impact on all intended outcomes. ACTRN12619001243101.

Posttraumatic stress disorder (PTSD) is prevalent in individuals with acquired brain injury (ABI). This study investigated the effectiveness and applicability of Eye Movement Desensitization and Reprocessing (EMDR) for PTSD in individuals with ABI. Data were collected using a non-concurrent multiple baseline single case experimental design (SCED), with a baseline, treatment, maintenance, and 3-month follow-up phase, across four cases. EMDR treatment was provided using a manualized standard EMDR protocol. The primary outcome was PTSD symptoms. Secondary outcomes were general mental health and cognitive functions. Visual analyses, TAU- analyses, and analyses using the Reliable Change Index were performed. All four participants (two with TBI, two with stroke) showed a significant decrease in PTSD symptoms, which continued in maintenance and was retained at follow-up. The participants no longer fulfilled criteria for PTSD classification and showed reliable improvement in PTSD severity score post-treatment and at follow-up. No adverse events occurred and no adjustments in EMDR protocol were necessary. There was no consistent improvement in general mental health nor a consistent improvement in cognitive functioning. This study provided empirical support for the effectiveness and applicability of EMDR for PTSD in four participants with stroke or TBI.

Mental health difficulties are common post-stroke and developing support for psychological adjustment is a research priority. Wellbeing After Stroke (WAterS) is a nine-week, online, group-based Acceptance and Commitment Therapy (ACT)-informed intervention, delivered by trained third-sector practitioners, supervised by a clinical neuropsychologist. This study aimed to explore the acceptability of WAterS from the stroke survivors' perspective.Semi-structured interviews were conducted with twelve stroke survivors who received WAterS. The interview schedule was informed by theorised components of acceptability, including understanding, burden and perception of effectiveness. The data were analysed inductively and deductively using Template Analysis.Six qualitative themes were generated. Results indicate the intervention was mostly understandable and participants were able to engage with ACT and apply it to life. Online delivery reduced burden in accessing the intervention, and was acceptable when supported by live facilitation and a physical handbook. Group cohesion and understanding was facilitated by practitioners. The social aspect of the group was beneficial. Attending WAterS supported some participants to seek further support; others were left feeling unsupported when the intervention ended.Stroke survivors valued attending an online, group ACT-informed intervention, delivered by practitioners. This is a promising avenue in increasing the reach of interventions to support wellbeing.

Auditory motion stimulation is a promising new therapeutical approach for visual neglect, whereby patients listen to music which repeatedly moves from the ipsi - to the contralateral hemispace. In this study, we investigated the feasibility, enjoyability, and efficacy of auditory motion simulation in an inpatient neurorehabilitation setting. 30 patients with left-sided visual neglect due to a right-hemispheric subacute stroke participated in the study. 15 patients were included prospectively and received 45 minutes of auditory motion stimulation per day for three weeks in addition to best possible standard neglect therapy. 15 further patients - who were matched based on neglect severity at admission, time since stroke, rehabilitation duration, and age - received best possible standard neglect therapy alone and served as a control group. Feasibility was assessed using remote time tracking, whereas enjoyability was measured with the Flow State Scale for Rehabilitation Tasks (FSSRT). Efficacy was evaluated using video-oculography during free visual exploration (FVE) at admission, discharge, and after three months. Our findings indicate that auditory motion stimulation is feasible and enjoyed by patients. Auditory motion stimulation significantly improved visual neglect at discharge. Randomized controlled studies are needed to confirm that auditory motion stimulation represents a valuable add-on therapy for visual neglect.

Individuals living with neurological conditions often face chronic issues including motor and sensory impairments and cognitive deficits. These challenges can lead to significant psychological difficulties, including anxiety, depression, and post-traumatic stress. Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach which aims to enhance psychological flexibility and acceptance while promoting behavioural change. Although ACT groups have shown promise in supporting individuals with neurological conditions, the evidence on patients' experiences of attending them is sparse. This project explored the experiences of individuals with a range of neurological conditions who had attended ACT group sessions as part of routine clinical practice, with the aim to refine future iterations of the intervention and enhancing patient care. Ten individual qualitative semi-structured interviews were carried out and the data were analysed thematically. Three overarching themes emerged from the analysis: (1) Initial Barriers to Group Attendance and Engagement; (2) Building an Environment of Acceptance; (3) Developing an ACT toolkit. Overall, the results showed that the ACT group intervention led participants to develop stronger emotional connectedness, better knowledge of their difficulties, more effective psychological skills, and different mindsets regarding their condition. Implications for the refinement of future ACT groups, neuropsychological service development, and clinical practice are discussed.

The Strategy Use Measure (SUM) was developed as a systematic tool to assess cognitive, behavioural and emotional strategy use by clients and carers after acquired brain injury. Comprehensive content development was undertaken across four clinical service sites via expert clinician consultation and consensus, file review of strategies used in clinical practice, and consumer consultation. Statistical analysis was undertaken to evaluate items and assess reliability, validity and factor structure. Two final versions of the SUM were developed, for use with clients (SUM-ABI; 14 items) and carers (SUM-C; 24 items). Internal consistency for the total scales was sound (SUM-ABI = ; SUM-C = ) as was test-retest reliability (SUM-ABI ; SUM-C ). Meaningful factors were identified for both scales (SUM-ABI: Memory and Planning, Emotion and Mood, Cognitive Load; SUM-C: Executive Support, Emotion/Behaviour Support, Enhancing Task Performance, Motivation Support) with all subscales demonstrating strong internal consistency (≥.80). Construct validity for both scales was explored using validated measures. The SUM versions were evaluated against COSMIN instrument design standards and found overall to be reliable and valid, with promising utility in rehabilitation for clinicians and researchers.

Self-discrepancy, i.e., negative changes in self-concept, is a common post-stroke phenomenon which is closely associated with depression and quality of life. In earlier research, self-discrepancy has been measured with the 18-item seven-stepped (HISDS-III), by comparing pre- and post-morbid self-concepts. As completing this scale may be demanding especially for cognitively impaired stroke survivors, a straightforward instrument is desirable. Therefore, the validity of the (IOSS), which measures self-discrepancy with a single visualized item, was cross-sectionally examined in 123 individuals three years after stroke. Results revealed a substantial correlation between the IOSS and the established HISDS-III ( = .47,  < .001) and a Gini Index corresponding to an AUC of 0.74, both indicating convergent validity. Both measures showed similar correlations with relevant covariates. Prediction of depressive symptoms using established predictors was significantly improved by the inclusion of the IOSS (Δ = .07,  < .001). The findings indicate the high validity of the IOSS as an economic measure of global self-discrepancy after stroke. In addition, the results confirm self-discrepancy as a relevant determinant of post-stroke depression and thus as a potential target for psychological interventions in stroke patients.

The purpose of this study was to examine correlations between injury- and child-factors and participation and quality of life (QoL) after childhood traumatic brain injury (TBI).

Stigma represents a major obstacle in rehabilitation and community reintegration after brain injury. However, appropriate tools to measure stigma in Spanish-speaking countries are lacking. This study examined the psychometric properties of the Spanish version of the Anticipated Stigma and Concealment Questionnaire (ASCQ). An observational cross-sectional study was conducted with 103 participants who completed the ASCQ and other measures. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to assess the scale's structure. Associations between the ASCQ and other mental health measures were explored to establish its nomological validity. All ASCQ items loaded significantly onto a single factor, with factor loadings ranging from .7 to .84. While (35) = 56.282,  < .05, some fit indices indicated excellent model fit (CFI = .997 and TLI = .996), while others suggested a good fit (RMSEA = .077, 90% CI [.036, .113], and SRMR = .060). Significant associations were found between the ASCQ and measures of loneliness, depressive symptoms, quality of life, and self-esteem. The ASCQ is a valid and reliable tool for assessing anticipated stigma and the motivation to conceal information after acquired brain injury. It can aid rehabilitation professionals in identifying individuals with interpersonal difficulties during community reintegration.

In the clinical context of stroke, health-related quality of life (HRQOL) is a crucial patient-reported outcome measure that is frequently used to assess the effectiveness of neurorehabilitation programs. Despite its significance, the absence of a stroke-specific quality-of-life instrument translated into Romanian and validated for use in Romanian stroke patients, including those with aphasia, presents a notable gap in current research. This study briefly describes the translation and cross-cultural adaptation of the Stroke and Aphasia Quality of Life Scale-39 g (SAQOL-39 g) into Romanian (RO-SAQOL-39 g). Subsequently, the results of a prospective cohort study on psychometric validation of the RO-SAQOL-39 g are presented. In enrolled stroke patients, measures such as the Barthel Index, HRQOL, and indices of stroke severity including NIHSS, MRC scale for Muscle Strength, and mRS were used. The RO-SAQOL-39 g exhibited excellent reliability (Cronbach's alpha = 0.95 for total score) and repeatability (ICC = 0.96). Moreover, the RO-SAQOL-39 g demonstrated utility as a metric of stroke burden in differentiating between mild and moderate-to-severe stroke, as assessed by NIHSS scores ( = 0.004). In summary, the RO-SAQOL-39 g exhibits promising attributes as a tool for assessing HRQOL in post-stroke individuals.

Experiences of loss and change following acquired brain injury (ABI) are frequent and multi-contextual, yet the long-term experiences of people with ABI are not well understood. This study explored the experiences of intrapersonal loss, grief and change in people with ABI, a decade after their injury. Twelve adults with ABI were interviewed 10-13 years post-injury. Using interpretative phenomenological analysis, we identified four overarching themes: a dawning realization of the impact of injury; loss of personhood; loss and liminality; and learning to live with loss and grief. Our findings indicate that in the decade following ABI, people continue to develop awareness of the impact of their injury and experience oscillating acceptance towards enforced changes. Participants reported a diminished sense of agency and autonomy in how they were perceived by and interacted with following injury. Additionally, identity may be lost, suspended, and renegotiated. Findings suggest dynamic, active, and flexible coping strategies that continue to be present over the long term. Considering the persistent nature of the injury and the evolving needs of the individual, a longer term view of rehabilitation outcomes may be required, contextualised by relational and intrapersonal challenges that may present over the longer term.

Prosopagnosia is a neurological disorder; characterized by an impairment in facial recognition. It can occur from acquired prosopagnosia (occurring in approximately 5.6% of the population), or from developmental prosopagnosia (occurring in approximately 2% of the population). Despite the relatively high prevalence of prosopagnosia, there has been limited research into intervention for this condition. The current systematic review aimed to review the evidence base to aid the development of practice guidelines for clinicians working with impacted individuals. A systemic search identified 14 studies, 10 of which involved participants with developmental prosopagnosia, while the remaining studies involved participants with acquired prosopagnosia. Overall, the findings identified two strategies which produced significant improvement in face recognition in prosopagnosics. The first strategy involved a perceptual learning strategy (a restorative approach). While this strategy improved face processing abilities, the intervention was time-consuming and relied on specific software. The second strategy involved learned association of distinguishable facial features (a compensatory approach). This intervention produced improvements in face recognition and was quick to administer, however, the gains made were not generalisable to untrained faces. The current review identified a number of limitations in the existing literature, such as the lack of single-case experimental designs and randomized controlled trials, limited control for practice effects, and no consensus with regard to the assessment and diagnosis of prosopagnosia. This review highlighted the need for further research to inform practice guidelines.

For some, post-concussion symptoms following a mild traumatic brain injury (mTBI) are prolonged in nature, lasting for a minimum of 12 months and up to many years. There remains limited insight into the effectiveness of psychological interventions for the treatment of prolonged post-concussion symptoms (PrPCS). This systematic review aimed to evaluate the effectiveness of psychological interventions for PrPCS (>12 months post mTBI). A search was performed across five databases (PsychINFO, Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), & PubMed). Two independent researchers assessed the studies against pre-defined eligibility criteria and completed quality appraisals. Ten studies were included in the review and underwent narrative synthesis. Four psychological interventions for PrPCS were found (i.e., Cognitive Behavioural Therapy (CBT), Neurofeedback Therapy, Psychoeducation, & Mindfulness-based therapy). Emerging empirical data tends to support the assertion that psychological interventions can improve PrPCS and quality of life. CBT appears to have the strongest evidence base to date and to be the most effective in improving anxiety, anger, and overall mental well-being. However, the evidence base is still very much in its infancy and requires research with more robust methodological designs to be conducted before any conclusions can be reliably asserted.

Traumatic Brain Injury (TBI) significantly affects social interactions and emotional well-being. Following COVID-19, there has been growing interest in how individuals with TBI use online social media groups for support. This study examined engagement patterns in four Facebook support groups: two for TBI and two control groups. A deductive approach was used to categorize 4,133 posts and comments into a framework of support discourse, including seeking and giving support, and non-social support. Each category was further subdivided to analyze post content in more detail. Comments on posts were coded for helpfulness/appropriateness. Results revealed that posts in all groups fell into the identified discourse categories, with comments generally being appropriate. Minor differences were noted between TBI and control groups, suggesting that individuals with TBI engage in online support similarly to others. These findings highlight the role of online support groups for individuals with TBI, offering insights that can guide the development of more tailored interventions and improve support services for this population.

Considering the implications of executive function (EF) in the core symptoms of attention deficit hyperactivity disorder (ADHD), further research is required on strategies such as therapies, treatments, and rehabilitation programs focused on improving EF. This study aimed to assess the potential of an EF training program called "Braingame Brian" in improving working memory, inhibition, and cognitive flexibility in children with ADHD. The programme was developed in the Netherlands and has been shown to be effective in pilot studies of ADHD populations conducted in this country. However, it has not been used before in the Spanish-speaking population. A total of 41 children (aged 8-12 years) were assigned to the EF training or waitlist control groups. The intervention consisted of a 25-session training programme of approximately 45 min per day for nine consecutive weeks. Treatment outcomes were assessed using cognitive tasks of the trained EF, as well as evaluations of EF behaviors by parents and teachers. The initial findings suggest that the implementation of the Braingame Brian programme may be associated with improvements in working memory, inhibition, and cognitive flexibility. These preliminary results also indicate the potential for enhancements in parents' and teachers' perceptions of EF difficulties in children with ADHD.

Concussions are commonly occurring injuries in sport. The short-term impacts of concussions, including symptoms and recovery trajectories, often are the focus of concussion research. However, limited studies have explored the long-term consequences of concussions, especially in adolescents. The purpose of this study was to explore adults' experiences with concussions sustained during their adolescence (5-15 years prior). This qualitative study was guided by an interpretivist philosophy. Twenty young adults (11 men, 9 women, median age 26) who had sustained at least one sport-related concussion during their adolescence participated in a one-on-one semi-structured interview. We aimed to explore their experiences with their concussion at the time of injury and any consequences they experienced as a result of their concussion. We organized participants' concussion experiences into six main themes: (1) Concussion diagnosis and experiences with health care providers; (2) Emotional symptoms following concussion; (3) Concussion recovery; (4) Change in sport participation and engagement; (5) Concern about the potential long-term consequences; and (6) Impact on social relationships. We used the Biopsychosocial Model of Sport Injury Rehabilitation to organize the themes. Future research should explore how acute multi-disciplinary support could reduce the negative long-term consequences of concussion in adolescents.

Family members frequently provide both physical and emotional support to patients. Previous studies have focused primarily on the experiences of patients with traumatic brain injury (TBI) and their caregivers during home care and the transition from hospital care to the community, with less emphasis on their experiences during acute hospital care immediately after TBI. This study aimed to explore the experiences of caregivers of patients with TBI during acute hospitalizations. A qualitative descriptive study using individual semistructured interviews was conducted at the trauma center of a tertiary hospital in western China. A purposive sample of 21 caregivers of patients with TBI were recruited. The interviews were conducted face to face in the inpatient ward from July to September 2023. Conventional content analysis was used to conduct the framework analysis. The experiences of caregivers were identified within three key themes: TBI consequences in patients (physical impairments, psychological distress, and cognitive dysfunctions), challenges of caregivers (physiological/emotional/economic burdens, conflicts, and concerns regarding recovery), and needs of caregivers (health information, medical services, and recovery expectations). This study highlights the experiences of caregivers of patients with TBI during hospital stays in western China. The challenges faced by caregivers and the needs of caregivers are multidimensional. Appropriate support should be provided to alleviate the burden of caregiving.

Prior research provides little guidance on how to support return to school post-concussion. Peer support may be one strategy to enable adolescents to return to school post-concussion. The purpose of this study was to explore what high school students preferred in a school-based peer support program post-concussion. We conducted a qualitative instrumental case study in one high school in Calgary, Canada. Seven semi-structured focus groups were conducted with 53 high school students (16 boys, 36 girls, 1 preferring not to disclose gender; median age = 16 years, range = 15-18 years). All adolescents were enrolled in a sport medicine course and had either a history of concussion ( = 20) or were interested in supporting peers who had sustained a concussion ( = 33). Focus group questions aimed to solicit which factors the adolescents believed should be considered in the development of a post-concussion peer support program. We analyzed the focus group transcriptions using content analysis. Adolescents preferred a one-on-one Buddy Program. A one-on-one environment would provide a trusting and confidential relationship between the student with a concussion and their buddy. Peer support could include social support, advocacy support for academic accommodations, tutoring support, and concussion education. In future, the Buddy Program should be piloted in high schools.

Recent studies have demonstrated a possible association between cognitive impairments and traumatic upper limb injuries. This study aims to track the cognitive changes in individuals with such injuries. In this longitudinal study, 36 participants with traumatic upper limb injuries and 36 uninjured participants were enrolled. Cognitive functions were assessed using the Rey Auditory Verbal Learning Test (RAVLT) and the Stroop Color and Word Test (SCWT) over a period of 6 months, with evaluations conducted on three occasions: 1 month (T1), 3 months (T2), and 6 months (T3). The results revealed that participants with nerve injuries exhibited significantly lower RAVLT scores overall and at each time point (Overall: Wald χ = 7.99,  < .05; T1: Wald χ = 7.61,  < .05; T2: Wald χ = 5.95,  < .05; T3: Wald χ = 5.76,  < .05). In contrast, no significant impairment in RAVLT performance was observed in participants without nerve injuries. Additionally, the SCWT showed no significant differences between injured and uninjured participants over the six-month period ( > .05). In conclusion, traumatic nerve injuries to the upper limbs negatively affect memory, and this impairment does not spontaneously recover within six months.

Prospective memory (PM) impairment is a common consequence of moderate-severe traumatic brain injury (TBI). Compensatory strategy training and rehabilitation (COMP) is the usual treatment of PM deficits through environmental modification and the use of assistive methods such as diaries and routines. The study intends to examine the changes in white matter integrity, as measured by advanced diffusion magnetic resonance imaging (dMRI) following COMP intervention in moderate-severe TBI patients. Nine COMP intervention and twelve routine care comparison cohort moderate-severe TBI patients were recruited from level 1 trauma centres in the Brisbane metropolitan area. Both groups were imaged at least one-month post-TBI for a baseline scan. COMP group was imaged again after a 6-week COMP intervention program and the comparison group was imaged again at least 6 weeks after the baseline scan. MRI scan included structural imaging and dMRI, which the latter fitted for the Neurite Orientation Dispersion and Density Imaging (NODDI) model. Only the comparison group had decreased Neurite Density Index in the major white matter tracts and increased isotropic diffusion in the fluid space between the cortical folds. Our results indicated that COMP intervention slowed down the neural degeneration in moderate-severe TBI patients as compared to routine medical care/rehabilitation.

Integrating technology-based therapies into existing treatment approaches has proven useful in the endeavour to improve impaired social cognition in patients with neurological diseases. To this end, we present a novel online-based therapy programme for the treatment of impairments of social cognition (""), particularly tailored for patients with acquired brain injuries (ABIs). This study was designed to investigate the online therapy's feasibility including processing time and acceptability in a healthy older sample as, according to previous studies, older individuals show subtle impairments of social cognition. Between 50 and 52 participants (depending on outcome measures) underwent pre-post assessments, completed one out of three therapy modules (emotion recognition, perspective taking, social problem-solving) over a period of four weeks (four sessions per week) and evaluated the therapy concerning feasibility, acceptability and content aspects with a newly developed questionnaire. All modules showed comparable ratings on a low to moderate level in terms of feasibility, acceptability and content aspects, which seems plausible due to the sample under investigation. Processing time of the three modules was comparable for psychoeducation (mean 17.45 min) and training sessions (mean 21.91 min). The results provided important indications for necessary adjustments regarding a subsequently completed randomized controlled trial involving patients with ABIs.

To synthesise the qualitative research related to the processes of loss and grief experienced by adults who have sustained a moderate to severe ABI.

Following stroke, fatigue is highly prevalent and managing fatigue is consistently rated a key unmet need by stroke survivors and professionals. Domain-specific cognitive impairments have been associated with greater fatigue severity in earlier stages of stroke recovery, but it is unclear whether these associations hold in chronic (>2 years) stroke. The present cross-sectional observational study evaluates the relationship between domain-specific cognitive functioning and the severity of self-reported fatigue among chronic stroke survivors. Participants (= 105; mean age = 72.92, 41.90% female; mean years post-stroke = 4.57) were assessed in domains of attention (Hearts Cancellation test), language (Boston Naming Test), episodic memory (Logical Memory Test), working memory (Digit Span Backwards task), and executive functioning (set-shifting: Trail Making Test, Part B), as part of the OX-CHRONIC study, a longitudinal stroke cohort. Fatigue was assessed using the Fatigue Severity Scale. In a multiple linear regression analysis inclusive of above cognitive domains, only poorer executive functioning was associated with increased fatigue severity. This provides insight into the cognitive impairment profile of post-stroke fatigue long-term after stroke, with executive functioning deficits as the key hallmark.

Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.

Acquired Brain Injury (ABI), an important cause of long-term disability, is associated with increased rates of depression in addition to common cognitive and physical consequences. Past research has linked post-ABI depression to injury severity (e.g., extent of physical or cognitive impairment) and premorbid mood problems. In the general (non-ABI) population, depression is associated with cognitive vulnerabilities that have informed the development of psychological interventions. In this observational study in a heterogeneous sample of individuals with chronic stage ABI, we examine two cognitive vulnerabilities - dysfunctional attitudes (DAs) and autobiographical memory specificity - and explore whether these are linked to depression symptoms and ongoing cognitive difficulties as in the general population. Compared to control participants, individuals with an ABI demonstrated increased endorsement of DAs and reduced specificity of autobiographical memory recall. Within the ABI group, cognitive vulnerability-depression symptom correlations were detected for an explicit measure of DAs, but not for a more implicit DA measure or for autobiographical memory specificity. While individual differences in injury severity and other factors likely obscured subtle relationships between mood and cognitive vulnerabilities, evidence of these vulnerabilities may be relevant to changes in identity and psychological interventions that target low mood in ABI.

ClinicalTrials.gov identifier: NCT04798859.

This study examined the feasibility of "Concussion Essentials" (CE), an individualized, multimodal intervention for persisting post-concussion symptoms (pPCS). Thirteen 6-18 year-olds with pPCS at 1-month post-concussion, as determined by the Post Concussion Symptom Inventory - Parent Report (PCSI-P), completed education, physiotherapy, and psychology modules, for up to 8-weeks or until pPCS resolved. Intervention participants were matched to a longitudinal observational cohort who received usual care (n = 13). The study enrolled 70% of participants symptomatic on screening and the dropout rate was <30% between baseline and post-programme assessments (4-weeks to 3-months post-injury). Symptoms improved for 100% of CE participants, with the number of symptomatic items on the PCSI-P reducing from 4-weeks, Median (IQR) = 14.0 (8.0-19.0) to 3-months, Median (IQR) = 1.0 (0.0-5.0). Comparatively, symptoms improved for approximately half of matched usual care participants. CE participants (n = 8) and their parents (n = 11) completed acceptability questionnaires. Most parents (91%) agreed CE was acceptable for children with concussion. All participants agreed CE was appropriate for concussion, while approximately 88% agreed they enjoyed the intervention and would recommend CE to others. Findings suggest CE is a feasible and acceptable treatment for paediatric pPCS. Further investigation within a larger scale randomized clinical trial is warranted.

The assessment of unilateral spatial neglect (USN) primarily relies on paper-and-pencil tests, which do not fully represent daily life difficulties. To address this limitation, ecological tests, like the Baking Tray Test (BTT), have been developed. However, the original BTT identifies the presence of USN without providing information on its severity. In this aim, a new severity measure, the Centre of Mass (CoM), has been proposed, but its calculation in real environments poses challenges. Immersive virtual reality (VR) offers a promising solution for implementing a BTT in which measures are automatically calculated. This study aimed to assess the feasibility and relevance of an immersive VR BTT. Nineteen right brain-damaged patients with and without USN and 25 healthy participants were included. Group analyses showed an equivalence between the two BTT versions. Individual analyses revealed that all USN patients, except one, had pathological results in both versions. They also underlined pathological scores in patients without USN signs on paper-and-pencil tests. Finally, the CoM strongly correlated with paper-and-pencil tests and appeared to be a good indicator of USN severity. These findings support the relevance of implementing the BTT in an immersive VR version, suggesting its potential to enhance USN assessment.

Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was -14.3 in the GET + UC group and -5.3 in the UC group. The estimated average change on the WHODAS was -5.3 in the GET + UC group and -3.2 in the UC group. Between-group differences post-treatment were -5.3 on the RPQ and -1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.