Thomas Strandberg

Adults with acquired traumatic brain injury : experiences of a changeover process and consequences in everyday life

The purpose of this study is to illuminate the changeover process, support, and consequences experienced by adults who acquired traumatic brain injury (TBI). Fifteen persons were in-depth interviewed using a semi-structured interview guide. Data were analyzed by latent-content analysis and structured into six themes. Consequences were negative as well as positive. Significant others were important as a driving force for training and life-situation. The informants were initially satisfied with social supports but in the longer term became more critical regarding accessibility to such supports. The majority had difficulties in returning to working life after injury. The outcomes seemed to be a prolonged process, probably never-ending, which gradually became integrated as a part of life.

Opportunities and barriers for successful return to work after acquired brain injury: A patient perspective

BACKGROUND: Many people who suffer an acquired brain injury (ABI) are of working age. There are benefits, for the patient, the workplace, and society, to finding factors that facilitate successful return to work (RTW). OBJECTIVE: The aim was to increase knowledge of opportunities and barriers for a successful RTW in patients with ABI. METHOD: Five men and five women with ABI participated. All had successfully returned to work at least 20 hours a week. Their experiences were gathered by semi-structured interviews, which were subsequently subjected to qualitative content analysis. RESULTS: Three themes that influenced RTW were identified: individually adapted rehabilitation; motivation for RTW; and cognitive and social abilities. An individually adapted rehabilitation was judged important because the patients were involved in their own rehabilitation and required individually adapted support from rehabilitation specialists, employers, and colleagues. A moderate level of motivation for RTW was needed. Awareness of the person’s cognitive and social abilities is essential, in finding compensatory strategies and adaptations. CONCLUSIONS: It seems that the vocational rehabilitation process is a balancing act in individualized planning and support, as a partnership with the employer needs to be developed, motivation needs to be generated, and awareness built of abilities that facilitate or hinder RTW.

Adults with Acquired Traumatic Brain Injury: A Theoretical Analysis from a Social Recognition Perspective

The purpose of this study is to illuminate the changeover process experienced by people with traumatic brain injury (TBI) and increase the understanding of social recognition occurring after injury. Fifteen persons, ages 28–56, with TBI have been in-depth interviewed. Data were first analyzed by latent-content analysis using a hermeneutic approach, and later re-contextualized within a matrix constructed from theories of social recognition. Results were initially structured into six themes and then re-described in terms of recognition, that is, the individual dimension, the legal dimension, and the value dimension. The conclusions suggest that people with TBI experience both recognition and non-recognition during the recovery process and later in life, living in society with the sequel of TBI. Such experiences are described on all dimensions.

Support Persons’ Perceptions of Giving Vocational Rehabilitation Support to Clients With Acquired Brain Injury in Sweden :

ABSTRACT The aim of this article is to explore the perception of being a support person for clients with acquired brain injury undergoing vocational rehabilitation. Nine support persons, identified by clients with brain injury, were interviewed. Interviews were analyzed using qualitative content analysis, resulting in 3 themes for assisting the client: commitment, adaptation, and cooperation. Within each theme, multiple dimensions were identified, reflecting the complexity of vocational rehabilitation following acquired brain injury. Commitment built on social relations is linked to sustainability of support. The included support persons’ role was especially valuable in contexts where adaptation and cooperation were required.

Promoting empathy in social care for older people

Purpose – The purpose of this paper is to identify connections between empathy and social care and to describe aspects of empathy in social care work, by bringing together research from different f ...

Change in quality of life in relation to returning to work after acquired brain injury: a population-based register study

ABSTRACT Purpose: This study investigated changes in quality of life (QoL) in relation to return to work among patients with acquired brain injury (ABI). Method: The sample consisted of 1487 patients with ABI (63% men) aged 18–66 years (mean age 52) from the WebRehab Sweden national quality register database. Only patients who worked at least 50% at admission to hospital and were on full sick leave at discharge from hospital were included. QoL was measured by the EuroQol EQ-5D questionnaire. Results: Patients who returned to work perceived a larger improvement in QoL from discharge to follow-up one year after injury compared to patients who had not returned to work. This difference remained after adjustment for other factors associated with improved QoL, such as having a university education, increased Extended Glasgow Outcome Scale scores and getting one’s driving licence reinstated. Conclusion: Return to work is an important factor for change in QoL among patients with ABI, even after adjusting for other factors related to QoL. This is consistent with the hypothesis that having employment is meaningful, increases self-esteem and fosters participation in society. Thus, helping patients with ABI return to work has a positive influence on QoL.

Vertical and horizontal knowledge integration in disability studies : A case illustrated from acquired brain injury

Background: Acquired brain injury (ABI) is often a lifelong disability that entails a marked change in a person’s life. It involves biopsychosocial levels and return to work (RTW) is one of the mai ...Accepted Abstracts from the International Brain Injury Association’s Eleventh World Congress on Brain InjuryObjective: To investigate whether: 1) traumatic brain injury (TBI) reduces striatal dopamine transporter (DAT) levels; 2) TBI causes structural changes to the substantia nigra and/or nigrostriatal tract; 3) DAT levels following TBI correlate with substantia nigra or nigrostriatal tract damage; 4) DAT levels relate to behavioural measures of apathy and/or speed of processing. Background: Persistent cognitive problems following TBI are common. The heterogeneous nature of TBI means that the basis of cognitive dysfunction is likely to be multi-factorial. Animal and human studies have shown dopaminergic disruption following TBI. However, the cause of this disruption is unclear and may relate to damage to the dopaminergic nuclei or their ascending projections. Design/Methods: 32 moderate/severe TBI patients with persistent cognitive problems and 15 healthy controls had an ioflupane ( 123 I) SPECT scan (DaTscan), MRI and full neuropsychological assessment. DAT levels in the striatum were measured. MRI was used to calculate substantia nigra volumes and nigrostriatal tract diffusion metrics. Results: Quantitative assessment showed reduced DAT levels in TBI patients. Patients had substantia nigra atrophy, as well as increased mean diffusivity in the nigrostriatal tract. There was a significant relationship between (1) DAT levels and substantia nigra volumes in patients and (2) mean diffusivity in the nigrostriatal tract and anterior striatal DAT levels. DAT levels showed a significant relationship with apathy measures but not speed of processing. Conclusions: A proportion of TBI patients with persistent cognitive problems have reduced striatal DAT levels implying a disruption to their dopaminergic system. DAT levels are correlated with structural changes in the substantia nigra and nigrostriatal tract. This supports a causal relationship between damage to these regions by TBI and functional dopaminergic dysfunction. Reduced DAT levels also relate to apathy. Dopaminergic therapies may therefore benefit those patients with evidence of disruption to their dopaminergic systems. Study Supported by: Guarantors of Brain NIHR Disclosure: Dr. Jenkins has nothing to disclose. Dr. De Simoni has nothing to disclose. Dr. Bourke has nothing to disclose. Dr. Cole has nothing to disclose. Dr. Sharp has nothing to disclose.Objectives: The majority of patients with traumatic brain injury (TBI) sustain a mild TBI, of which the prognosis isgenerally favourable. However, patients with moderate-to-severe TBI can experience long-lasting cognitive, emotional and behavioural deficits that interfere with functioning in daily life and the resumption of work. Current literature suggests that executive functioning and coping style are important factors affecting outcome. Moreover, it is suggested that intact executive functioning is a pre-requisite for the use of adaptive coping; as executive processes such as foresight, planning and initiation seem essential for the employment of active coping strategies. So far, the exact association between executive functioning and coping remains unclear, as literature has pro-vided us with mixed results. The aim of the present study is 2-fold. First, we aim to assess the association between executive functioning and coping among patients with TBI at different levels of severity. Second, we aim to investigate to what extent injury severity influences the association between executive ability and coping as a moderating factor.Methods: We included 109 TBI patients from two prospective follow-up studies, of which 53 patients were classified as mild TBI, 19 patients as moderate and 37 patients as severe. Additionally, 33 healthy controls were included. Executive functioning and coping style were assessed by neuropsycho-logical examination in the post-acute and chronic phase after TBI. Results: Greater self-reported executive dysfunction was related to greater use of passive coping styles in all separate levels of severity and in the mixed TBI group (β= 0.591,p<0.001). Additionally, a lower amount of self-reported executive dysfunction was related to higher levels of active coping in the mixed TBI group (β=–0.457,p< 0.001) and the mild and severe TBI groups. Additionally, better performance on an executive test for response inhibition was related to greater use of active coping in the total TBI group (β=–0.178,p=0.047). No evidence for a moderating effect of injury severity on the association between executive functioning and coping was found. Conclusions: Self-reported executive functioning was a significant predictor of coping style at all levels of injury severity inpatients with TBI. Individuals who reported greater executive problems were predisposed to rely on a maladaptive passive coping style. Furthermore, these results suggest that less self-reported executive dysfunction was related to a higher use of an active coping style.Libra Rehabilitation & Audiology Dept. of Neurorehabilitation PO Box 1355, 5602 BJ Eindhoven E info@libranet.nl I www.libranet.nl Correspondence to Ingrid Brands, MD, PhD i.brands@libranet.nl Introduction  Self-efficacy refers to the belief in one’s ability to achieve goals. In patients with acquired brain injury (ABI) higher levels of general self-efficacy and self-efficacy for managing brain injury-specific symptoms have shown to be associated with better quality of life (QoL).1  Being highly self-efficacious in managing one’s health issues is assumed to be a key factor in successful chronic disease selfmanagement.2  Neuropsychological rehabilitation programmes focus on teaching patients to compensate for and manage their cognitive deficits and the social and emotional consequences of ABI. Yet, do these programmes lead to higher levels of self-efficacy in managing brain injury-specific symptoms? Results  QoL and brain injury-specific self-efficacy increased significantly after neuropsychological rehabilitation. Table 2  Both general and brain injury-specific self-efficacy were positively associated with QoL after neuropsychological rehabilitation. Table 3  A lower initial level of cognitive functioning predicted worse QoL after neuropsychological rehabilitation (β = −.63, p = .05).  Cognitive functioning was not significantly associated with initial brain injury-specific self-efficacy (r = .13, p = .60). Objective We examined:  the influence of neuropsychological rehabilitation on general and brain injury-specific self-efficacy and on QoL,  whether initial levels of general and brain injury-specific selfefficacy and cognitive functioning would predict QoL after neuropsychological rehabilitation,  whether cognitive functioning was associated with initial selfefficacy for managing brain injury-related symptoms.Objectives: Disability research as an academic field was established in the 1960s and 1970s in the Nordic countries and in the Anglo-Saxon world. Disability research was studied within the medical model, e.g. in medical and rehabilitation studies, while disability studies became a part of the social model, e.g. in social and psychological studies. It has been a lack of theoretical perspective in disability research and according to that a discussion of theoretical approaches in disability studies that has been raised during recent years. The aim of the study is to describe and illustrate conceptually how vertical and horizontal knowledge integration appear in disability research, exemplified within a case from a person with acquired brain injury.Methods: The study adopted a qualitative approach to answer the research aim, undertaking a literature review to accompany an analysis of the concepts, vertical and horizontal. The concepts were thereafter analysed within theories from disability research and exemplified with a case from brain injury rehabilitation.Results: Tentatively the conceptions, vertical and horizontal, are described and, in addition, a bio-psycho-social perspective is mentioned andtwo theoretical approaches within disability research are described: human functioning sciences and interdisciplinary research. Vertical knowledge integration can be seen as a stratification between differentlevels on a biological, psychological and social level. Horizontal knowledge integration can be understood across varying disabilities. The study indicates that vertical and horizontal knowledge integration in disability research are useful for a broader and deeper understanding of disability and functional impairment where, over the last few years, different theoretical perspectives have become increasingly common. Furthermore, the study shows that acquired brain injury, in a scientific context, has been studied within different levels of society. For example:●On a biological level, e.g. within biochemical bloodanalysis;●On a psychological level, e.g. within neuropsychologicaldiagnostics; and●On a social level, e.g. as a changeover process duringrecovery.Conclusions: The study indicates that a variety of scientific contributions are needful in our understanding of the phenomenon of living withacquired brain injuryin the contemporary society.

Successful return to work after acquired brain injury : opportunities and barriers from a patient perspective

Background: Acquired brain injury (ABI) is often a lifelong disability that entails a marked change in a person’s life. It involves biopsychosocial levels and return to work (RTW) is one of the mai ...Accepted Abstracts from the International Brain Injury Association’s Eleventh World Congress on Brain InjuryObjective: To investigate whether: 1) traumatic brain injury (TBI) reduces striatal dopamine transporter (DAT) levels; 2) TBI causes structural changes to the substantia nigra and/or nigrostriatal tract; 3) DAT levels following TBI correlate with substantia nigra or nigrostriatal tract damage; 4) DAT levels relate to behavioural measures of apathy and/or speed of processing. Background: Persistent cognitive problems following TBI are common. The heterogeneous nature of TBI means that the basis of cognitive dysfunction is likely to be multi-factorial. Animal and human studies have shown dopaminergic disruption following TBI. However, the cause of this disruption is unclear and may relate to damage to the dopaminergic nuclei or their ascending projections. Design/Methods: 32 moderate/severe TBI patients with persistent cognitive problems and 15 healthy controls had an ioflupane ( 123 I) SPECT scan (DaTscan), MRI and full neuropsychological assessment. DAT levels in the striatum were measured. MRI was used to calculate substantia nigra volumes and nigrostriatal tract diffusion metrics. Results: Quantitative assessment showed reduced DAT levels in TBI patients. Patients had substantia nigra atrophy, as well as increased mean diffusivity in the nigrostriatal tract. There was a significant relationship between (1) DAT levels and substantia nigra volumes in patients and (2) mean diffusivity in the nigrostriatal tract and anterior striatal DAT levels. DAT levels showed a significant relationship with apathy measures but not speed of processing. Conclusions: A proportion of TBI patients with persistent cognitive problems have reduced striatal DAT levels implying a disruption to their dopaminergic system. DAT levels are correlated with structural changes in the substantia nigra and nigrostriatal tract. This supports a causal relationship between damage to these regions by TBI and functional dopaminergic dysfunction. Reduced DAT levels also relate to apathy. Dopaminergic therapies may therefore benefit those patients with evidence of disruption to their dopaminergic systems. Study Supported by: Guarantors of Brain NIHR Disclosure: Dr. Jenkins has nothing to disclose. Dr. De Simoni has nothing to disclose. Dr. Bourke has nothing to disclose. Dr. Cole has nothing to disclose. Dr. Sharp has nothing to disclose.Objectives: The majority of patients with traumatic brain injury (TBI) sustain a mild TBI, of which the prognosis isgenerally favourable. However, patients with moderate-to-severe TBI can experience long-lasting cognitive, emotional and behavioural deficits that interfere with functioning in daily life and the resumption of work. Current literature suggests that executive functioning and coping style are important factors affecting outcome. Moreover, it is suggested that intact executive functioning is a pre-requisite for the use of adaptive coping; as executive processes such as foresight, planning and initiation seem essential for the employment of active coping strategies. So far, the exact association between executive functioning and coping remains unclear, as literature has pro-vided us with mixed results. The aim of the present study is 2-fold. First, we aim to assess the association between executive functioning and coping among patients with TBI at different levels of severity. Second, we aim to investigate to what extent injury severity influences the association between executive ability and coping as a moderating factor.Methods: We included 109 TBI patients from two prospective follow-up studies, of which 53 patients were classified as mild TBI, 19 patients as moderate and 37 patients as severe. Additionally, 33 healthy controls were included. Executive functioning and coping style were assessed by neuropsycho-logical examination in the post-acute and chronic phase after TBI. Results: Greater self-reported executive dysfunction was related to greater use of passive coping styles in all separate levels of severity and in the mixed TBI group (β= 0.591,p<0.001). Additionally, a lower amount of self-reported executive dysfunction was related to higher levels of active coping in the mixed TBI group (β=–0.457,p< 0.001) and the mild and severe TBI groups. Additionally, better performance on an executive test for response inhibition was related to greater use of active coping in the total TBI group (β=–0.178,p=0.047). No evidence for a moderating effect of injury severity on the association between executive functioning and coping was found. Conclusions: Self-reported executive functioning was a significant predictor of coping style at all levels of injury severity inpatients with TBI. Individuals who reported greater executive problems were predisposed to rely on a maladaptive passive coping style. Furthermore, these results suggest that less self-reported executive dysfunction was related to a higher use of an active coping style.Libra Rehabilitation & Audiology Dept. of Neurorehabilitation PO Box 1355, 5602 BJ Eindhoven E info@libranet.nl I www.libranet.nl Correspondence to Ingrid Brands, MD, PhD i.brands@libranet.nl Introduction  Self-efficacy refers to the belief in one’s ability to achieve goals. In patients with acquired brain injury (ABI) higher levels of general self-efficacy and self-efficacy for managing brain injury-specific symptoms have shown to be associated with better quality of life (QoL).1  Being highly self-efficacious in managing one’s health issues is assumed to be a key factor in successful chronic disease selfmanagement.2  Neuropsychological rehabilitation programmes focus on teaching patients to compensate for and manage their cognitive deficits and the social and emotional consequences of ABI. Yet, do these programmes lead to higher levels of self-efficacy in managing brain injury-specific symptoms? Results  QoL and brain injury-specific self-efficacy increased significantly after neuropsychological rehabilitation. Table 2  Both general and brain injury-specific self-efficacy were positively associated with QoL after neuropsychological rehabilitation. Table 3  A lower initial level of cognitive functioning predicted worse QoL after neuropsychological rehabilitation (β = −.63, p = .05).  Cognitive functioning was not significantly associated with initial brain injury-specific self-efficacy (r = .13, p = .60). Objective We examined:  the influence of neuropsychological rehabilitation on general and brain injury-specific self-efficacy and on QoL,  whether initial levels of general and brain injury-specific selfefficacy and cognitive functioning would predict QoL after neuropsychological rehabilitation,  whether cognitive functioning was associated with initial selfefficacy for managing brain injury-related symptoms.Objectives: Disability research as an academic field was established in the 1960s and 1970s in the Nordic countries and in the Anglo-Saxon world. Disability research was studied within the medical model, e.g. in medical and rehabilitation studies, while disability studies became a part of the social model, e.g. in social and psychological studies. It has been a lack of theoretical perspective in disability research and according to that a discussion of theoretical approaches in disability studies that has been raised during recent years. The aim of the study is to describe and illustrate conceptually how vertical and horizontal knowledge integration appear in disability research, exemplified within a case from a person with acquired brain injury.Methods: The study adopted a qualitative approach to answer the research aim, undertaking a literature review to accompany an analysis of the concepts, vertical and horizontal. The concepts were thereafter analysed within theories from disability research and exemplified with a case from brain injury rehabilitation.Results: Tentatively the conceptions, vertical and horizontal, are described and, in addition, a bio-psycho-social perspective is mentioned andtwo theoretical approaches within disability research are described: human functioning sciences and interdisciplinary research. Vertical knowledge integration can be seen as a stratification between differentlevels on a biological, psychological and social level. Horizontal knowledge integration can be understood across varying disabilities. The study indicates that vertical and horizontal knowledge integration in disability research are useful for a broader and deeper understanding of disability and functional impairment where, over the last few years, different theoretical perspectives have become increasingly common. Furthermore, the study shows that acquired brain injury, in a scientific context, has been studied within different levels of society. For example:●On a biological level, e.g. within biochemical bloodanalysis;●On a psychological level, e.g. within neuropsychologicaldiagnostics; and●On a social level, e.g. as a changeover process duringrecovery.Conclusions: The study indicates that a variety of scientific contributions are needful in our understanding of the phenomenon of living withacquired brain injuryin the contemporary society.

Traumatisk hjärnskada hos kvinnor: perspektiv på kön, sexualitet och funktionshinder : en litteraturstudie med feministisk ansats

The article is built upon tree topics: feminism, sexuality and disability. The purpose is to illuminate traumatic brain injury (TBI) among women in perspectives of gender, role and sexuality. On the basis of literature studies the article summarize (i) gender specific consequences for women (ii) sexual consequences for women (iii) women role changes. The article brings up sexual consequences with TBI as increased and decreased sexual lust and problem with orgasms. Role changes are illuminated as working role, hobbyist and role as a family member. Even gender specific differences between cognition and emotion are mentioned. The article set focus on TBI as a hidden less recognised consequence for battered women. Gender perspectives are problemized and discussed in connection to TBI. Thinking in processes is described in purpose to give a more holistic perspective on mankind and its sexuality. Violence against women having TBI and frequents of injuries seen in a gender perspective is mentioned.