Primary objective: Recent research studies attest to the presence of deficits in emotion perception following severe traumatic brain injury (TBI). Additionally, a growing number of studies report significant levels of alexithymia (disorder of emotional cognition) following TBI. This research aimed to examine the relation between the two, while assessing the influence of posttraumatic stress disorder (PTSD). Design: Cross-sectional study examining levels of alexithymia, emotion perception disorders and PTSD and their association, in 20 people with severe, chronic TBI and 20 adults without brain injuries. Methods: Participants were assessed on the Toronto Alexithymia — 20 Scale, the Posttraumatic Diagnostic Scale and on two emotion perception tasks: matching and labelling of photos depicting the 6 basic emotions. Results: The group with TBI were impaired relative to controls when matching facial expressions. Their performance on ‘fear’ was especially poor. Performance on labelling was similar in pattern, although failed to reach significance. There was no association between poor performance on fear, or other negative expressions, and either PTSD or alexithymia symptoms in the TBI group. Conclusions: Alexithymia, as assessed by the TAS-20, taps a constellation of difficulties that do not appear to include difficulties with emotion perception in people with traumatic brain injuries.

In this special article we describe a number of reporting guidelines endorsed by the CONSORT (Consolidated Standards of Reporting Trials) group for a range of research designs that commonly appear in scientific journals: systematic reviews, clinical trials with and without randomisation, observational studies, n-of-1 (or single-case experimental design) trials, and diagnostic studies. We also consider reporting guidelines for studies using qualitative methodology. In addition to reporting guidelines, we present method quality rating scales, which aim to measure risk of bias that threatens the internal validity of a study. Advantages of reporting guidelines and method quality rating scales for authors include the provision of a structure by which to improve the clarity and transparency of report writing; for reviewers and readers advantages include a method by which to critically appraise an article. Brain Impairment endorses these reporting guidelines and applies them within the review process for submissions to the journal.

Dysphagia and aspiration pneumonia are prevalent but infrequently studied complications following severe traumatic brain injury (TBI). Aspiration pneumonia is responsible for a significant number of long-term deaths in this population, however, the reported number of deaths attributed to aspiration pneumonia may be inaccurate. This multicentre inception cohort (n = 2545) study analysed consecutive discharges from 3 metropolitan inpatient brain injury rehabilitation units from January 1990 to October 2007 following inpatient rehabilitation following primary TBI. Subject data was linked to national death registries to determine cause of death where relevant. This study aimed to (a) evaluate the prevalence of aspiration pneumonia, percutaneous endoscopic gastrostomy (PEG) insertion and dysphagia following TBI, (b) identify the number of deaths ascribed to aspiration pneumonia, and (c) characterise associated risk factors for long-term aspiration pneumonia related deaths compared to all other causes of death. In-hospital PEG insertion occurred in 18.4% of the sample, two thirds of whom remained dysphagic at discharge. In-hospital aspiration pneumonia was recorded in 3.6% of the sample. Postdischarge, people with TBI were 79 times more likely to die from aspiration pneumonia than the general population. Risks were higher for subjects discharged to a nursing home, with severe ongoing functional disability, dysphagia at discharge, in those who had experienced in-hospital aspiration pneumonia or required PEG insertion. Early identification and risk management of dysphagia and aspiration pneumonia in TBI nursing home populations may maximise these individuals' quality and length of life.

rimary Objectives: To examine the HADS structure in TBI, using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), and investigate the effects of TBI severity, Gender, and Age on factor scores. Methods and Procedures: HADS data from 186 TBI patients in a population study in Tasmania were subjected to EFA. HADS data from a second sample of 185 TBI participants in the same study underwent CFA. One-month follow-up data were used, allowing inclusion of severe TBI patients while still being early post-injury. Factor loadings were used to investigate the effects of demographic and clinical variables at 2 weeks post-injury. Results: While EFA suggested 2-factor (anxiety, depression) and 3-factor (anxiety, psychomotor, depression) structures provided adequate descriptions, CFA strongly supported the 3-factor model. Using this model, significant effects of TBI severity were noted on Psychomotor and Depression scores at 2 weeks post-injury. Males reported significantly fewer symptoms on all 3 factors, as did younger participants. Conclusions: CFA indicates that a 3-factor model provides the best fit for HADS data in TBI. One factor, Psychomotor, has been relatively neglected in the literature, and the current findings suggest its assessment and rehabilitation should receive more attention.

This article introduces the concept of posttraumatic growth and briefly reviews the limited number of empirical studies on posttraumatic growth in survivors of brain injury. The relationship between posttraumatic growth and psychological understandings of human spirituality is then explored and it is argued that posttraumatic growth is a type of spirituality that is of particular theoretical and practical interest to healthcare professionals. Specific aspects of the situation of people with acquired brain injury are then considered in this light and some suggestions are made for the integration of spiritual care aimed at supporting personal resilience and promoting posttraumatic growth into rehabilitation practice.

Preliminary research supports that acquired brain injury (ABI) can act as a catalyst for positive psychological changes, and that such posttraumatic growth (PTG) increases with time since injury. In this study, posttraumatic growth refers to positive psychological changes in domains including interpersonal relationships, new possibilities, personal strength, spirituality and appreciation for life. This study aimed to identify associations between levels of subjective impairment and depressive symptoms at discharge, and PTG at 6-months postdischarge following ABI. Sixty participants (73% male) with ABI (Mean days of hospitalisation = 32.92, SD = 40.74) were consecutively recruited from an inpatient rehabilitation unit at discharge and were administered measures of subjective impairment (Mayo-Portland Adaptability Index–4; MPAI-4) and depression (Depression, Anxiety Stress Scales; DASS). Participants were followed up at 6-months postdischarge and administered the Post-Traumatic Growth Inventory, DASS and MPAI-4. The results indicated that levels of PTG reported at six months postdischarge were relatively modest and ranged between no to very small degree of change (‘spirituality’) and a small to moderate degree of change (‘a greater appreciation of life’). Level of subjective impairment at discharge significantly predicted overall level of PTG at 6-months follow-up (β =.40, p < .05, sr2 = .28). Further, at 6-months postdischarge, individuals with a greater appreciation for life reported significantly higher levels of subjective impairment (r = .35; p < .01) and depressive symptoms (r = .34, p < .01) at that time point. These findings indicate that individuals who perceive greater functional consequences of their ABI are more likely to experience PTG. Further, the process of reevaluating priorities and values in life after ABI may be associated with emotional distress during the early stages of community reintegration.

The results of a pilot randomised controlled trial of computerised cognitive training in older adults with mild cognitive impairment (MCI) are reported. Participants (N = 25) were randomised into either the treatment or waitlist training groups. Sixteen participants completed the 30-session computerised cognitive training program using exercises that target a range of cognitive functions including attention, processing speed, visual memory and executive functions. It was hypothesised that participants would improve with practice on the trained tasks, that the benefits of training would generalise to nontrained neuropsychological measures, and that training would result in improved perceptions of memory and memory functioning when compared with waitlist controls. Results indicated that participants were able to improve their performance across a range of tasks with training. There was some evidence of generalisation of training to a measure of visual sustained attention. There were no significant effects of training on self-reported everyday memory functioning or mood. The results are discussed along with suggestions for future research.

This article considers 10 of the most important developments in neuropsychological rehabilitation over the past 5 years. While several leaders in the field were contacted to discover what they considered to be the most important developments, the selection discussed here is the author's alone and is, therefore, a personal view. Included are: computational models; support for people with dementia; new assessment procedures; new treatment strategies for cognitive, emotional and psychosocial problems; new theoretical models to improve our understanding of the consequences of brain injury; and recognition of the need to find new ways to evaluate the efficacy of rehabilitation. The final section of the article considers possible future developments in rehabilitation, including stronger links with basic neuro-science; better use of imaging procedures; collaboration with pharmaceutical companies; better evaluation of our programs; and the need to educate researchers and practitioners as to the meaning of rehabilitation.

Apathy is a decrease in behavioural, cognitive and emotional components of goal-directed behaviour. Clinically, it is characterised by diminished initiation, reduced concern, and decreased activity. Apathy is a common occurrence following traumatic brain injury (TBI), occurring in around 60% of people. Consequences are widespread, negatively impacting independence, social integration, rehabilitation outcome, vocational outcome, coping and caregiver burden. The current knowledge base on apathy following TBI is presented, with implications for clinical practice. This includes a review of clinical presentations, neuroanatomical and neurochemical substrates associated with apathy, and differential diagnoses. Instruments to measure apathy are presented, highlighting those with demonstrated reliability and validity for the TBI population. Current evidence for pharmacological and non-pharmacological methods of treatment is described, with a model for non-pharmacological interventions provided and discussion of challenges faced by clinicians when treating the patient with apathy. In the TBI arena, greater understanding of apathy and methods of treatment is pivotal given the frequency of occurrence and widespread negative consequences.

Irritability is not uncommon after traumatic brain injury (TBI). Unfortunately, no instruments are available to directly measure this clinical feature. This study thus aimed to develop a specific scale to evaluate the irritability for patients with TBI. A total of 144 participants, which include 80 healthy participants and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS). Our results showed the NTUIS has good reliability. The factor analysis further revealed 2 different components: annoyance, and verbal aggression. Moreover, both self-reported and family-reported irritability postinjury were significantly higher than the irritability reported by the healthy participants. Indeed patients with TBI have significant problems with irritability after injuries, and thus a more specific assessment tool to carefully evaluate patients' irritability should be used.

Introduction: Research has indicated that individuals may report benefit finding (BF) as a result of experiencing potentially life-threatening traumatic events, such as being diagnosed with cancer or sustaining an acquired brain injury (ABI). No study to date has examined the incidence and correlates of BF in adult brain tumour samples. The present study aimed to investigate the association between BF and demographic and psychosocial variables in adults treated for a benign meningioma. Method: Seventy participants aged 36 to 87 years completed questionnaires that assessed perceived BF resulting from one's meningioma experience, intrusion and avoidance symptoms, emotional wellbeing and perceived quality of social support. Results: 39% of the sample had been diagnosed with their tumour within a 2-year period prior to assessment (‘early’ meningioma subgroup), while the remaining 61% of participants had been diagnosed with their tumour for more than 2 years (‘late’ meningioma subgroup). Almost two thirds (63%) of the sample reported deriving a moderate amount of BF due to their meningioma experience; although different psychological variables were found to be associated with BF according to group status. Whereas greater BF was found to be significantly associated with elevated depressive symptoms in the ‘early’ subsample, elevated BF was significantly positively correlated with intrusions and avoidance symptoms in the ‘late’ subsample. Conclusions: The findings indicate that BF may co-occur in context of both adaptive and positive illusory processes, which is consistent with the Janus-Face model of growth following adversity. The findings also support the use of psychosocial interventions to facilitate psychosocial adjustment following health crises.

There is evidence that individuals with an acquired brain injury (ABI) are at increased risk of developing psychological problems and that they commonly experience difficulties in social communication, associated with poorer long-term outcomes. Although several relevant group interventions have been evaluated, there has been limited exploration of the feasibility of an ABI inpatient intervention. This nonrandomised pilot study tested the feasibility of an inpatient multidisciplinary social communication and coping skills group intervention within 1-year post traumatic/nontraumatic ABI. Seven participants completed a 4-week group program (3 × 1 hour sessions per week) facilitated by a speech pathologist and clinical psychologist and were assessed pre/post intervention and at 3 months with the La Trobe Communication Questionnaire, Correct Information Unit analysis, Hospital Anxiety and Depression Scale, Mini International Neuropsychiatric Interview, Coping Self-Efficacy scale and World Health Organization Quality of Life assessment. Most participants improved between baseline and 3 months post intervention in terms of greater informativeness and efficiency of connected speech and reduced anxiety and they provided positive feedback about the group program. Despite the challenges and limitations of this pilot study, the findings are encouraging and support both the value and feasibility of developing such a program into routine inpatient rehabilitation services.

Positive psychology (PP) is the scientific study of positive emotion and wellbeing. In recent years, there has been a shift in the focus of PP from understanding the factors that contribute to wellbeing to developing and evaluating interventions to improve wellbeing. This article addresses the question of whether the principles and practice of PP are relevant to brain injury rehabilitation. It is concluded that PP is indeed relevant to brain injury rehabilitation; that much of our current (best) practice is consistent with the principles of PP, but there remain areas where brain injury rehabilitation practice could draw further on the specific methods of PP.

Acceptance and commitment therapy (ACT) is increasingly used in clinical practice to manage anxiety conditions. This psychotherapeutic approach focuses on the following: (1) acceptance of an individual's experience of the spectrum of psychological and emotional states, (2) choosing valued direction for the individual's life, and (3) commitment to action that leads the individual in the direction of those values. This article presents an empirical review of ACT for treatment of anxiety in two parts. In the first part we systematically review the literature for studies examining ACT for anxiety management in the general population with anxiety problems. In the second part, we discuss applicability of acceptance-based approaches for a health population in which these techniques may have applicability, that is, for people with acquired brain injury (ABI). Electronic searches for the review were conducted on PsycINFO and Medline. Inclusion criteria were as follows: (1) used an ACT intervention study, (2) the target of the intervention was an anxiety disorder or anxiety symptomatology, (3) the intervention used a randomised controlled trial (RCT) or single case experimental design (SCED) methodology, and (4) the paper was available in English. Studies were rated for methodological quality using standardised assessment procedures. Four RCTs provided support for ACT for obsessive compulsive disorder (OCD), maths anxiety, trichotillomania (TTM), and mixed anxiety and depression. Three SCED trials scoring in the high range on the scale of methodological quality revealed some support for ACT for managing TTM, skin picking, and OCD. Although no studies were identified that investigated ACT for managing anxiety in people with ABI, the review highlights issues for consideration when applying ACT in this population.