Transitions to independent living after ABI.

One of the most challenging questions facing service providers and policy makers alike is the appropriate level of supervision for adults living in the community following a brain injury. In a 3-year province-wide study of people entering the community following brain injury rehabilitation, four individuals (out of 22 studied) made a transition from fully supervised living to lower levels of formal supervision during their first year in the community. The present study seeks to provide more information about these four individuals, the factors that allowed them to move to lower levels of supervision, and the perceived success of that transition. For each participant, the interviews conducted over the 1 year period in the initial study were reviewed in detail for information about independent living. In addition, each participant was interviewed again for this study, along with his significant other and three of the community programme staff who were most closely involved with his transition. To summarize, factors most salient in the success of transition included: (1) Roles and relationships of family and programme personnel; (2) staying away from drugs and alcohol; (3) availability of structured daily activities, including productive activity or community programme; (4) financial management; and (5) emotion and behaviour self-control. Secondary themes related to successful community living also included the availability of transportation and prior experience with community living since the onset of brain injury. These results offer the experience of four individuals in moving towards independent living. As such, they provide a starting point for further discussions of the process of supporting individuals to pursue the ultimate goal of independent living.

The definition of community integration: perspectives of people with brain injuries.

Despite considerable attention to community integration and related topics in the past decades, a clear definition of community integration continues to elude researchers and service providers. Common to most discussions of the topic, however, are three ideas: that integration involves relationships with others, independence in one's living situation and activities to fill one's time. The present study sought to expand this conceptualization of community integration by asking people with brain injuries for their own perspectives on community integration. This qualitative study resulted in a definition of community integration consisting of nine indicators: orientation, acceptance, conformity, close and diffuse relationships, living situation, independence, productivity and leisure. These indicators were empirically derived from the text of 116 interviews with people with moderate-severe brain injuries living in the community. Eighteen adults living in supported living programmes were followed for 1 year, to track their evolving definition of integration and the factors they felt were related to integration. The study also showed a general trend toward more positive evaluation over the year, and revealed that positive evaluation was frequently related to meeting new people and freedom from staff supervision. These findings are interpreted in the light of recommendations for community programmes.

Neurocognitive assessment in the treatment of incontinence following severe traumatic brain injury.

Although a variety of techniques have been developed for treatment of incontinence, strategies for applying these techniques to adults having significant cognitive impairments or mobility restrictions have not been well described in the literature. This case study describes the rehabilitation of urinary incontinence in a 20-year-old woman through behavioral interventions targeting the cognitive impairments that prevented her from independently managing her own continence needs. The outcome demonstrates the importance of blending cognitive assessment with behavioral intervention techniques in individuals having severe cognitive and mobility impairments following brain injury.

Repatriation Community Programs, Part I: A collaborative model of service delivery.

The Repatriation Community Programs pilot project was funded by the Ontario Ministry of Health in 1990. Its mandate is to facilitate the return of brain-injured individuals from US rehabilitation facilities to their home communities in Ontario. Most Ontario residents receiving rehabilitation in the US fall into one of two 'hard to serve' groups: (1) those with severe behavioural difficulties; and (2) those at various levels of post-comatose unawareness whose families are unwilling to accept chronic care 'maintenance'. The pilot programme has been charged with demonstrating the feasibility of community-based care for severely brain-injured individuals and their families, as well as developing a model of service delivery and interagency collaboration which will expedite province-wide implementation of similar programmes. This paper describes the collaborative model developed over the first 2 years of the project. Issues leading to this model are identified and elements of the model are discussed.

Attention deficit hyperactivity disorder and the frontal lobe syndrome.

The usefulness of frontal lobe (FL) dysfunction as a conceptual model for Attention Deficit Hyperactivity Disorder (ADHD) was investigated. Twenty-four ADHD and 24 normal control (NC) children were tested using two batteries of tasks. The first was sensitive to FL deficits in motor control and problem solving skills. The second consisted of memory tasks sensitive to temporal lobe dysfunction. ADHD children differed significantly from NCs on measures of FL function, but not on tests of temporal lobe functions. Where norms were available for normal children on the same FL tests, ADHDs performed like 6- to 7-year-olds, despite their mean age of 10 years and minimum age of 8 years. The differential performance of ADHDs on tasks sensitive to FL and temporal lobe dysfunction supports the hypothesis that ADHD deficits are analogous to FL dysfunction and demonstrates that the children's deficits do not reflect generalized cognitive impairment.

A validation study of a short-form hypnotic-experience questionnaire and its relationship to hypnotizability.

This study investigated the validity of a 16-item scale inquiring about hypnotic experience, drawn from the Hypnotic Experience Questionnaire developed by Kelly (1985) to measure components of hypnotic experience. We administered the HEQ-S and the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) to 198 students. Factor analysis of the scale produced three stable principal components accounting for 70% of the data variance: Dissociation/Altered State (DAS), Rapport (RAP), and Relaxation (REL). Subscales representing these three factors and a composite measure, "General Depth," were constructed. Subscale correlations with HGSHS:A scores were highest for the DAS subscale (.69) and lowest for REL (.41). Applications of the HEQ-S in clinical and research use are considered.