Moving Ahead is a research centre specifically focused on learning more about psychosocial outcomes after brain injury. The CRE actively promotes evidence-based practice, meaning that clinicians need to be skilled consumers and assessors of research. We have a number of resources to assist clinicians’ access and understanding of research that forms the evidence-base for treatment. At Moving Ahead, we have targeted a number of areas which we know can interfere with rehabilitation and community reintegration that are commonly affected by moderate to severe traumatic brain injury (TBI).
Ultimately, if psychosocial difficulties persist for a long time after a person’s injury, they can cause significant problems with that person’s relationships and their re-engagement in society, like employment or education. Eventually, they can lead the person to become increasingly socially isolated and lower their quality of life. Some of these difficulties, such as fatigue, problems with speech and emotion regulation are major targets for remediation early in the recovery process. Others such as self-awareness might be better addressed in a person’s transition back to the community. This is when the person with TBI needs to start re-engaging with previous roles and relationships and learn to adjust to life post-injury, understanding their own strengths and weaknesses.
Yet other skills that are often affected are specifically social, such as communication, perception of other peoples’ emotions, social cognition and social skills. These kinds of abilities are best addressed at a time when the person with TBI has the opportunity to interact with friends, family, colleagues and others from their own communities. Further, anxiety and depression are crucial to acknowledge and treat, especially in the post-acute phase as they are unfortunately common and debilitating after severe TBI.
Moving Ahead is conducting research into each of these facets, ranging from direct remediation of basic impairments through to orchestrating opportunities to maximize activity and participation. Our view of how these abilities interact with co-existing factors (such as pre-injury skills) and the rehabilitation process can be found here.
Below you will find resources for each of these domains including short videos from our experts working in the field, assessments, treatment manuals, research articles, and links to other useful websites.
You could also explore PsycBITE and speechBITE which are freely available databases that index papers that provide evidence for non-pharmacological treatments of psychological and cognitive disorders arising from traumatic brain injury and other disorders. Specific papers can be searched using key terms and each paper is rated based on its methodological rigour, i.e. how reliable the evidence is for the treatment. These websites also provide on-line training on how to use these resources appropriately.
Fatigue – Feeling exhausted, being tired or having a lack of energy are typical descriptions associated with fatigue. For most people diagnosed with a TBI, fatigue is a commonly reported problem – whether it is categorized as physical fatigue, psychological fatigue or mental fatigue. The specific cause of fatigue after TBI is not known, but it does have a direct affect in a person’s success towards rehabilitation after a brain injury.
Communication & Speech – Communication is fundamental to human relationships, to work, family and friendships. There are a number of ways in which communication can be disrupted following TBI. There may be difficulties with speaking clearly, problems with language production and comprehension (aphasia) and also with cognitive-communication. The latter refers to difficulty with the normal to and fro of conversation and discourse despite intact language skills.
Arousal & Emotion Regulation – The ability to control one’s emotional, physiological (arousal) and behavioral response to changing situational demands is routinely disrupted following TBI. Problems with emotional control can lead to moon swings, aggression and emotional lability, with irritability the most common behavioral complaint made by people with TBI and their families. Issues with arousal may manifest as apathy, loss of drive and initiative and difficulties with cognitive flexibility. Many of these symptoms persist over time following TBI due to damage to the frontal lobes, and alterations in arousal and emotional regulation strongly predict cognitive functioning.
Self-Awareness – Difficulties with self-awareness affect roughly 50-60% of individuals with severe TBI and predict poor long-term social outcomes. Individuals with reduced self-awareness are unable to self-monitor behaviour and have difficulty adjusting to life with a disability, which ultimately affects their personal, occupational and social relationships. Heightened self-awareness following TBI can also be problematic, as people struggle to adjust to their new capabilities and identity compared to their pre-injury self. This can decrease self-esteem and increase the risk of developing adjustment disorders, such as depression and anxiety.
Emotion Perception – Picking up cues from another person’s facial expression, body language, and tone of voice are all important ways we detect someone else’s emotion. After a TBI, this can become more difficult and more mishaps can happen (e.g. mistaking that a person with a neutral facial expression is feeling angry). This can understandably have a big effect on how a person with TBI interacts with other people and influence their rehabilitation outcome.
Social Cognition – When we interact with other people, we all make quick decisions about what is going through their mind, how they are feeling, and what they might do next. The collection of these processes is known as social cognition. Misunderstandings can happen to anyone but they can happen more often after a TBI – it can become more difficult for people to pick up the subtle cues that indicate what someone else is thinking or what they are planning to do. This can lead to problems for people in their social lives and so it is important we think about this more in rehabilitation.
Social Skills – Social skills are all the things we say and do to interact with others. They involve knowing social etiquettes and boundaries and, importantly, knowing how to appropriately behave in different situations. A person with a brain injury may experience difficulties in being aware of, and applying, these social norms. They may lack an awareness of another’s personal space or they may be less sensitive to another’s feelings, which can sometimes lead to awkward conversations or misunderstandings in social interactions.
Anxiety & Depression – A TBI will suddenly and often drastically change someone’s life. Feeling sad about losses experienced as a result of the injury and going through a time of adjustment to a new way of living, are completely normal experiences for people to go through. Sometimes, however, these feelings can become overwhelming and impact a person’s life more than they’d like. It can lead some to experience anxiety and/or depression, which are characterised in turn by low mood (often including thoughts of death and suicide) and worry that is out of proportion to the situation someone is in.
Increased Participation – The aftermath of TBI leads to physical, cognitive, emotional and psychosocial deficits, which can detrimentally affect a person’s ability to participate in activities that are meaningful and purposeful to his or her everyday life. Changes to psychosocial function after TBI can be the biggest challenge for a person with TBI, their family, and friends, to overcome. An emerging field in rehabilitation research after TBI focuses on fostering ways to increase participation in a range of activities that are personally meaningful for the individual affected. Increasing meaningful participation, even if avocational, has the potential to improve individuals’ mood, wellbeing, and self-efficacy.