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Reports on BI articles


The Authors report on their article in Brain Impairment


ARTICLE  2019 (First View, Published online: 04 June 2019. DOI: https://doi.org/10.1017/BrImp.2019.12) Brain Impairment

Brunner, A; Palmer, S; Togher, L; Dann, S; and Hemsley, B.

“If I knew what I was doing on Twitter then I would use it more”: Twitter experiences and networks of people with traumatic brain injury (TBI)

What the study is about

Addressing social communication and participation is a part of core business in rehabilitation after traumatic brain injury (TBI) given the devastating impacts a TBI can have on a person’s social communication and relationships. As yet, we have little information about how social media is used by people with TBI or how it can be addressed during rehabilitation to support social participation. Considering the high rate of TBI in young adults and the widespread use of Twitter by young adults generally, this study aimed to investigate the Twitter experiences and networks of six people with a TBI.

What we did

We recruited six people who self-identified as having a TBI who used Twitter. With their permission, we collected their tweets and analysed them. We then interviewed the participants about their experiences in using Twitter and their perspectives on using the platform. During the interviews, we showed them data visualisations of their tweet analysis to reflect on their use over time and who they connected with. The interview data was then analysed qualitatively.

What we found

Two males and four females took part in the study, ranging in age from 26 to 72 years. All the participants in this study used more than one social media platform (e.g., Twitter, Facebook, Instagram). With regards to Twitter, they reported diverse experiences, with two participants being experienced users and four being novice users. None had received any support to use it aside from setting up their account. All the participants used Twitter to feel connected and included; and reported both positive and negative experiences. Engaging in Twitter communities facilitated their higher frequency of tweeting and established feelings of enjoyment and connection. Novice and established users alike were keen to continue using Twitter and eager to learn more but had not received any rehabilitation support for their social media goals. However, they all learnt to use social media through ‘giving it a go’ and experimenting. They also reported difficulties with cognitive fatigue and understanding concepts around using Twitter, for example knowing how to use hashtags properly. People with TBI use Twitter for connection but approach the sometimes-confusing platform using trial-and-error to develop their skills. Considering their cognitive-communication disability and increased risk for social media safety incidents they are likely to require more active integration of social media if they wish to use it during rehabilitation and beyond for safe and enjoyable social connection. This will likely require individual tailored and explicit training and ongoing support in social media use during rehabilitation and in the community.

This research gives us great insights into the experiences of using Twitter by people with TBI – but what about health professionals? We followed this study up with focus groups with TBI rehabilitation professionals to find out what the experiences and perspectives were of health professionals working in TBI rehabilitation on the use of social media by people with TBI. You can read more about this focus group study in Disability and rehabilitation here: https://doi.org/10.1080/09638288.2019.1685604.


The authors would like to acknowledge and thank the participants for their time and for sharing their experiences, Dr Lucy Bryant for acting as an independent consensus coder in tweet data analysis, and the University of Newcastle and the University of Technology Sydney for administration of funding and support in the conduction of this study. This research was funded through an Australian Government Research Training Program scholarship (Melissa Brunner) and a Discovery Early Career Research Award from the Australian Research Council (Bronwyn Hemsley). Melissa was also supported through ASSBI through a student conference travel grant in 2019 to present these findings at the ASSBI-NZRA Inaugural Trans-Tasman Conference.

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ARTICLE  2019 First View – Brain Impairment

DOI: https://doi.org/10.1017/BrImp.2019.32

Carmichael, J; Gould, K; Hicks, A; Feeney, T and Ponsford, J

Understanding Community ABI Therapists’ Preferences for Training in and Implementing Behaviour Interventions: A Focus on Positive Behaviour Support

What the study is about

Following acquired brain injury (ABI), people may present with distressing and persistent challenging behaviours, such as aggression, inappropriate social behaviours and lack of initiation. These behaviours may place the person with brain injury and others at risk of harm and impede the person’s ability to reintegrate back into the community. Research suggests that not all individuals with ABI who present with challenging behaviours receive satisfactory behaviour support. Potentially, this results from barriers therapists face to being trained in and implementing behaviour interventions. Positive Behaviour Support (PBS) is one approach that aims to improve the person’s quality of life and proactively reduce challenging behaviours through environmental modification, skill-building and supporting engagement in meaningful relationships and activities. The intervention is designed and implemented in collaboration with the person and their natural supports (e.g., family, carers). Although there is a growing evidence base for PBS, it is not known how widely PBS or other intervention approaches are currently used by community ABI therapists to address challenging behaviours. This study aimed to investigate Australian community ABI therapists’ experiences of using, training in and implementing behaviour interventions, with a focus on PBS.

What we did

We designed and distributed an online survey asking 136 community ABI therapists about their experiences with behaviour interventions and PBS specifically. Participants included occupational therapists, clinical neuropsychologists, clinical psychologists, speech therapists, physiotherapists, case managers and coordinators. We used a modified version of the Organisational Readiness for Implementing Change Scale to measure participants’ readiness to learn and implement new behaviour interventions. Data were analysed by computing frequency and descriptive statistics and through content analysis, non-parametric group comparisons and multiple regression.

What we found

Participants identified a range of approaches as important in addressing challenging behaviours including teamwork and collaboration, person-centred practice, working with antecedents, environmental modification, improving quality of life and skill-building. These approaches were consistent with PBS. In general, participants expressed a high level of desire and readiness to learn and implement new behaviour interventions, preferring part-day face-to-face workshops, online courses/webinars and clinical supervision to train in this area. However, 80% reported facing one or more barriers to training and implementation. Major barriers were lack of time, organisational funding and confidence and disengagement of the individual’s support network. Participants with higher confidence in using behaviour interventions (b= 0.31, p = .002) and fewer barriers (b = –0.30, p = .002) were predicted to have greater readiness to learn and implement new behaviour interventions. Confidence, past training experiences and future training preferences did not appear to differ based on clinical role/discipline. The results suggest that community ABI therapists support PBS-consistent approaches to addressing challenging behaviours and would be receptive to training in PBS. Moreover, this study provides valuable information to tailor strategies for the clinical translation of behaviour interventions to specific barriers and preferences of community ABI therapists.


The authors would like to thank the participants for giving their time for this study and the Transport Accident Commission (through the Institute for Safety Compensation and Recovery Research) for their generous funding of the research.

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ARTICLE  2018 Volume 19, Special Issue 2 (Mild Traumatic Brain Injury) – Brain Impairment

Theadom, A; Barker-Collo, S; Greenwood, A; Parmar, P; Jones, K; Starkey, NMcPherson, K and Feigin VL on behalf of the BIONIC Research Group

Do Mild Traumatic Brain Injury Severity Sub-Classification Systems Help to Identify People Who Go on to Experience Long-Term Symptoms?

What the study is about

Up to 95% of traumatic brain injuries (TBI) are classified as being of mild severity. Whilst many individuals who have sustained a mild TBI recover naturally within a few days to weeks, up to half of those affected can experience persistent symptoms and difficulties participating in everyday activities. Consequently, there is a need to unravel the wide heterogeneity in mild TBI and identify people who are more likely to need clinical treatment to facilitate their recovery. The challenges are that classification systems need to be easy to implement within a busy clinical environment, capture the full breadth of possible presentations and have high predictive validity. This study aimed to identify sub-classification systems for mild TBI and to determine their utility in predicting outcome.

What we did

We conducted a systematic review to identify mild-TBI sub-classification systems published until March 2016. Systems were included in the review if they graded mild-TBI into two or more

categories, were an independent system (the most up to date version of a system was used) and did not require specialist physical assessment or MRI or CT scans (which would not be feasible to implement in a community setting. We classified a sample of 290 adults who had experienced a mild-TBI according to each of the identified sub-classification systems based on their medical records at the time of injury. Assessment data on reported post-concussion symptoms experienced at 1-year post injury collected as part of a previous research study was then extracted for these participants. A series of ANOVAs and regression models were used to determine whether each sub-classification system could distinguish between outcomes.

What we found

Nineteen different subclassification systems were identified as part of the review. The proportions of mild-TBI participants classified into the different sub-classification grades varied considerably between different systems. The systems were based on a range of factors including period of loss of consciousness, worst Glasgow Coma Score and acute symptoms such as headache, amnesia, vomiting and confusion.  Only one classification system by Saal et al (1991) was able to significantly differentiate the experience of post-concussion symptoms 1-year post injury. However, the findings did not remain significant following correction for multiple comparisons and inclusion of socio-demographic and contextual factors in the regression model. Results from this study reveal that current sub-classification systems based on initial level of consciousness and acute symptoms fail to identify those most at risk of experiencing longer-term post-concussion symptoms. Other factors such as psychological and pre-injury variables may have more influence on longer-term outcomes from mild TBI and need to be explored.


The authors would like to thank the Health Research Council of New Zealand who funded the initial recruitment and collection of data of the mild TBI sample.


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