Frances L. Vaughan

Traumatic brain injury and substance misuse: A systematic review of prevalence and outcomes research (1994–2004)

A systematic review of the evidence on substance misuse prevalence in patients with traumatic brain injury (TBI) and outcomes associated with this population is presented. Building upon an earlier review of the area by Corigan (1995), this review is limited to research published between 1994 and 2004. Psycinfo and Medline abstract databases were searched for English-language publications citing research from Western countries on the epidemiology and outcomes of adult TBI patients (aged 15 years or older). The majority of reviewed studies were undertaken in the USA and the investigation foci and methods used were multifarious, constraining the generalisation of the review findings. Prevalence for alcohol intoxication at time of injury in the review was found to be almost identical to that in Corrigans review: 37–51% and 36–51%, respectively. Pre-TBI history of alcohol misuse was found to be less prevalent in the present as opposed to Corrigans review: 37–51% and 55–66%, respectively. Outcome findings were mixed (also found by Corrigan), but mainly in the expected direction of poorer outcomes (neurological, medical, neuropsychological, and functional) in patients with pre-TBI substance misuse. Further research and implications for services are outlined.

Brain injury spousal caregivers’ experiences of an acceptance and commitment therapy (ACT) group

Purpose – The purpose of this paper is to understand the experiences of acquired brain injury (ABI) family caregivers who attended an acceptance based group intervention. Design/methodology/approach – A qualitative design and interpretative phenomenological analysis methodology were used. Findings – Five key themes were identified: increasing personal awareness; the dialectic of emotional acceptance vs emotional avoidance; integration of acceptance and commitment therapy (ACT) principles; peer support; and moving forward after the group. It seemed that some individuals found the ACT exercises distressing, whereas others reported benefits. All participants described experiences of acceptance vs avoidant means of coping, and attempts to integrate new approaches into existing belief systems. Originality/value – This study is the first to explore the experiences of ABI caregivers undertaking an ACT group intervention.

Parental Bereavement and the Loss of a Child with Intellectual Disabilities: A Review of the Literature.

Inequalities in health care and other risk factors mean that children with intellectual disabilities are more likely to predecease their parents. Research on the effects on family members when a child with intellectual disability dies is sparse. In the present review, the authors describe 5 studies of bereavement in intellectual disability and then turn to general parental bereavement research to inform the field of intellectual disability. Questions for future research and some implications for services and professionals are discussed. In particular, professionals should be aware of dissatisfaction with care pre-loss, disenfranchised grief, and post-loss support needs of family members.

Grief after Brain Injury: A Validation of the Brain Injury Grief Inventory (BIGI):

The objective of this article is to determine whether a new questionnaire (the BIGI) is a valid and reliable measure of grief in a brain injured population. Design: Within group, questionnaire based prospective study of individuals with traumatic brain injury (TBI). The BIGI was compared with other questionnaires to determine the construct validity and repeated to assess test re-test reliability. Results: The loss scale of the BIGI had a higher internal consistency than the adjustment scale. Test re-test reliability for both variables was good. Younger individuals appeared to be more likely to show a positive adjustment to a TBI than older individuals. Women reported higher scores for loss than men. On the adjustment scale, married individuals achieved lower scores than single persons. Conclusions: The BIGI scales of loss and adjustment were associated with a number of the other measures. The loss scale had a higher internal consistency than the adjustment scale. The clinical utility of the scale is discussed and further research suggested.

The validity of the Brain Injury Cognitive Screen (BICS) as a neuropsychological screening assessment for traumatic and non-traumatic brain injury.

Abstract Objective: The Brain Injury Cognitive Screen (BICS) was developed as an in-service cognitive assessment battery for acquired brain injury patients entering community rehabilitation. The BICS focuses on domains that are particularly compromised following TBI, and provides a broader and more detailed assessment of executive function, attention and information processing than comparable screening assessments. The BICS also includes brief assessments of perception, naming, and construction, which were predicted to be more sensitive to impairments following non-traumatic brain injury. The studies reported here examine preliminary evidence for its validity in post-acute rehabilitation. Method: In Study 1, TBI patients completed the BICS and were compared with matched controls. Patients with focal lesions and matched controls were compared in Study 2. Study 3 examined demographic effects in a sample of normative data. Results: TBI and focal lesion patients obtained significantly lower composite memory, executive function and attention and information processing BICS scores than healthy controls. Injury severity effects were also obtained. Logistic regression analyses indicated that each group of BICS memory, executive function and attention measures reliably differentiated TBI and focal lesion participants from controls. Design Recall, Prospective Memory, Verbal Fluency, and Visual Search test scores showed significant independent regression effects. Other subtest measures showed evidence of sensitivity to brain injury. Conclusions: The study provides preliminary evidence of the BICS’ sensitivity to cognitive impairment caused by acquired brain injury, and its potential clinical utility as a cognitive screen. Further validation based on a revised version of the BICS and more normative data are required.

Neuropsychoanalytically informed psychotherapy approaches to rehabilitation: The North Wales Brain Injury Service – Bangor University experience 1998–2018

ABSTRACT The North Wales Brain Injury Service was developed 20 years ago, to provide multi-disciplinary community-based neuropsychological rehabilitation to the residents of North Wales. The theoretical underpinning of clinical service delivery is an adapted, slow-stream Holistic Neuropsychological Rehabilitation model. Some of its key aspects include the provision of long-term psychotherapeutic follow-up, to facilitate psychological adjustment, self-awareness, and encourage self-management over time. While financial realities undeniably influenced the way this model was developed (the North Wales Brain Injury Service is a publically funded NHS service), an equally influential factor was a recognition of the central role that neuropsychoanalytically informed psychotherapy can play in post-acute neuro-rehabilitation. In post-acute rehabilitation settings, where working psychotherapeutically with problems of self-awareness towards psychological adjustment is central to the clinical model, the relevance of time over intensity of intervention is very important. Over the past two decades the service has evolved in several areas. While the service is multi-professional, this paper mainly reports on the nature of program developments as regards psychotherapy, resulting from the close collaboration of the North Wales Brain Injury Service with its local academic partner, Bangor University. In this context, five distinctive but inter-related themes of neuropsychoanalytically-informed approaches used in the service are discussed.