Petrea Cornwell

Patient centered goal-setting in a subacute rehabilitation setting

Purpose. The purpose of this research is to describe current practices in goal-setting within a subacute rehabilitation setting from the perspective of therapists representing the disciplines of occupational therapy, speech pathology and physiotherapy. Method. Qualitative semi-structured email interviews were conducted with therapists from the Geriatric Assessment and Rehabilitation Unit of an Australian hospital. Therapists were required to respond to questioning with reference to identified rehabilitation patients with stroke. Results. Three approaches to goal-setting were identified: therapist controlled, therapist led and patient centred. Goals aimed at the ICF levels of impairment and activity limitations were predominant. Barriers to a patient centered goal-setting approach largely outweighed facilitators. Potential successful resolutions were offered to overcome these barriers. Conclusions. The inability of patients to participate fully in the goal-setting process largely determines the approach taken by therapists. This influences the level of patient centeredness incorporated into the goal-setting process. Goals expressed at the level of impairment, by therapists, may be stepping stones to perceived patient goals at the levels of activity and participation. Barriers to a patient centered approach can be overcome through education of the patient and family regarding the nature of the injury and modification of communication between therapist and patient.

A qualitative study of the transition from hospital to home for individuals with acquired brain injury and their family caregivers

Primary Objective: To explore the transition experiences from hospital to home of a purposive sample of individuals with acquired brain injury (ABI). Research Design: Phenomenological, qualitative design. Methods and Procedures: Semi-structured interviews were conducted with 13 individuals with ABI (mean time since discharge = 15.2 months) and 11 family caregivers. Each interview was recorded, transcribed verbatim and then inductively analyzed. Results: Through the inductive analysis process, a summary coding framework was developed that included that following eight main categories: the hospital experience; the transition process; the role of family caregivers; post-discharge services; friendship networks and community involvement; meaningful activities and time management; physical and psychological wellbeing; and barriers and facilitators. Conclusions: The results of the study provide valuable insights into the lived experiences of participants and provide evidence to support the existence of a distinct transition phase within the ABI rehabilitation continuum; additional to and closely associated with the acute, post-acute and community integration phases.

The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations.

Purpose. To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. Method. Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. Results/discussion. A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. Conclusion. Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.

The short- and long-term effectiveness of the LSVT®for dysarthria following TBI and stroke

Objectives: To examine the effectiveness of Lee Silverman Voice Treatment (LSVT®) for the treatment of 10 individuals with dysarthria following TBI and stroke. Research design: ABAA experimental research design. Methods: Participants received 4 weeks of the standard LSVT® programme. To measure the effects of intervention, participants were assessed using perceptual and acoustic speech measures and everyday communication outcome measures prior to, immediately post and 6 months post-treatment. Results: Following treatment, participants demonstrated statistically and clinically significant improvements to several acoustic and perceptual parameters. This included increased vocal loudness in sustained phonation and connected speech, increased vocal frequency range and improved word and sentence intelligibility. Improved ratings of communication initiation and participation and well-being were also found on the AusTOMs and items on participant questionnaires post-LSVT®. The majority of treatment effects were maintained 6 months following treatment. Conclusions: LSVT® has the potential to be a viable treatment option for individuals with dysarthria featuring respiratory-phonatory impairments following TBI and stroke.

Identifying factors associated with perceived success in the transition from hospital to home after brain injury.

Objective:To identify the factors associated with perceived success of the transition from hospital to home after traumatic brain injury (TBI). Design:Prospective longitudinal cohort design with data collection at discharge and 1, 3, and 6 months postdischarge. Participants:A total of 127 individuals with TBI discharged to the community and 83 significant others. Main Measures:An analog scale (0–100) of perceived success of the transition from hospital to home rated by individuals and significant others; Sentinel Events Questionnaire; EuroQol Group Quality-of-Life measure visual analog scale; Sydney Psychosocial Reintegration Scale; Mayo-Portland Adaptability Inventory-4; short form of the Depression, Anxiety, Stress Scales; Craig Hospital Inventory of Environmental Factors; and Caregiver Strain Index. Results:Greater perceived success of transition for individuals with a TBI was associated with higher levels of health-related quality of life, level of community integration, and more severe injury. Among survivors, sentinel events such as returning to work and independent community access and changing living situation were associated with greater perceived success; financial strain and difficulty accessing therapy services were associated with less success. Among significant others, lower ratings of transition success were associated with higher significant other stress levels as well as lower levels of community integration and changes in the living situation of the individual with TBI. Conclusion:A combination of sentinel events and personal and environmental factors influences the perceptions of individuals and their families regarding the success of the transition from hospital to home.

Perceived service and support needs during transition from hospital to home following acquired brain injury

Objective. To explore the service and support needs of individuals with acquired brain injury (ABI) and their family caregivers during the transition phase from hospital to home. Methods. The study utilised a qualitative research design. Participants included 20 individuals with ABI and 18 family caregivers recruited from a specialist inpatient brain injury rehabilitation unit. Data collection entailed in-depth semi-structured interviews, which were conducted at three time points: pre-discharge, and 1- and 3- months post-discharge. Thematic analysis of the interview transcripts involved open, axial and selective coding techniques. Results. The following primary themes, each with associated secondary themes, emerged from the analysis: (1) balancing the service and support equation; (2) negotiating the rehabilitation maze; (3) working with or against ‘the system’. The first theme describes the varying types and level of support received by participants during the transition phase, while the second theme highlights the difficulties participants experienced in negotiating the rehabilitation process between hospital and home. The final theme depicts the challenges experienced by participants in accessing and utilising service support. Conclusions. The findings suggest that the scope of existing service models need to be extended to bridge the existing gap between inpatient and community services, thereby easing the impact of transition.

Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis

Study design:Systematic review and meta-analysis.Objectives:To review the evidence for the use of an abdominal binder on breathing, speech and cardiovascular function in people who have suffered a spinal cord injury (SCI).Setting:Brisbane, Australia.Methods:A search of multiple databases (Medline, Cinahl, Cochrane, Embase, PEDro) was undertaken accompanied by the reference list evaluation of each relevant publication identified. Methodological quality of studies identified was assessed using the PEDro scale. The size of effect of an abdominal binder on outcomes was also calculated where sufficient data were reported. Further descriptive analysis was performed.Results:Eleven studies met the review inclusion criteria and employed either crossover or within subject designs. Comparison of studies involving elastic and non-elastic binders was performed. A PEDro mean score of 4.3 out of 8 (range: 3–6) was found. Meta-analysis indicated that the use of abdominal binders improved vital capacity (VC) by (weighted mean difference (95% confidence interval (CI)) 0.32 (0.09, 0.55) litres, decreased functional residual capacity (FRC) by 0.41 (0.14, 0.67) litres, but did not significantly influence total lung capacity (TLC).Conclusions:This review found some evidence that the use of an abdominal binder improves VC, but decreases FRC when assuming the sitting or tilted position in people who have suffered SCI. Overall, the quality of the studies was poor. Available evidence is not yet sufficient to either support or discourage the use of an abdominal binder in this patient population. Further studies utilizing more methodologically rigorous designs are required.

Perceptions of recovery during the early transition phase from hospital to home following acquired brain injury: A journey of discovery

The increasing volume of literature concerning community-based rehabilitation for individuals with acquired brain injury (ABI) has recently brought into focus the importance of the early hospital-to-home transition phase. The present study aimed to explore the perspectives of individuals with ABI and their family caregivers concerning recovery and adjustment during the early transition phase from hospital to home. The study utilised a qualitative phenomenological design and included 20 participants with ABI and 18 family caregivers. Participants completed in-depth semi-structured interviews at the following time points: pre-discharge, and 1 and 3 months post-discharge. Data analysis entailed thematic analysis of the interview transcripts and incorporated open, axial and selective coding techniques. The following four primary themes emerged from the analysis process: (1) adapting to life in the real world; (2) variations in recovery; (3) the emotional adjustment rollercoaster; and (4) discovering the new me. Collectively, the findings highlight that while returning home was typically perceived to facilitate ongoing recovery, the process of adjusting emotionally to life at home posed a significant challenge for many participants during the transition phase. The clinical/service implications of the findings relate to the need for: (1) contextually appropriate rehabilitation options during the transition phase; and (2) the expansion of transition-based models of service delivery to include targeted psychological intervention approaches.

Dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour

The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. Dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.

Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme

Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains. Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL). Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination. Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL. Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted.