ARTICLE (epub 2018; doi:10.1080/09602011.2018.1488746) – Neuropsychological Rehabilitation
Tate RL, Wakim D, Sigmundsdottir L, Longley W.
Evaluating an intervention to increase meaningful activity after severe traumatic brain injury: a single-case experimental design with direct inter-subject and systematic replication. What the study is about
Many people with severe degrees of traumatic brain injury (sTBI) have limited participation: less than 50% return to work and around 80% show reduction in their leisure activity. Our systematic review (Tate, Wakim & Genders, 2014) also showed that very few programmes are available to address non-vocational activity and occupation for people with sTBI who cannot return to work. This study aimed to develop such a programme (which we called the Programme for Engagement, Occupation, and Activity, PEPA), and evaluate its efficacy. The PEPA is a goal-directed intervention which comprises three stages: (i) in the initial set-up stage people with sTBI and clinicians work collaboratively to develop three goals in each of the domains of leisure, lifestyle and social; (ii) the next stage comprises 15 weekly, face-to-face, 1-hour sessions and between session homework; (iii) the final forward-planning stage commences in sessions 14 and 15, together with two booster sessions following programme completion.
What we did
We conducted a series of single-case experiments, using a multiple-baseline design across behaviours in seven participants. In this design, data on the primary outcome variables (in this case, the three target behaviours in the areas of leisure, lifestyle and social) were collected frequently, both during the 5-week pre-programme baseline and throughout the 15-week programme. In this way, the participant serves as his or her own control. The participants all had sTBI, and a range of cognitive and behavioural impairments, including clinically significant levels of apathy (lack of interest, enthusiasm for everyday activities). None of the participants was working, but all lived in the community. Four participants were functionally independent, but the remaining three had substantial support needs which were provided by family.
What we found
Data were evaluated using structured visual analysis, supplemented with statistical analysis. The PEPA was successful for six of the seven participants. It was particularly effective for participants meeting their goals in the lifestyle and leisure areas. Results from this study show that the PEPA is an effective intervention for increasing goal-directed activity levels in people with apathy after sTBI.
The study was funded by the Lifetime Care and Support Authority of New South Wales, Australia, and the NHMRC Centre for Research Excellence in Psychosocial Recovery after TBI. We acknowledge the advice provided by Dr Michael Perdices on data analysis, and the contributions of Ulrike Rosenkoetter, Janet Doubleday, Dr Amanda Lane-Brown, and Michelle Genders in the conduct of the study.