Background and Objective: Victoria's trauma management system provides acute care and rehabilitation following traumatic brain injury (TBI), with care of more complex injuries generally provided in specialist centres in metropolitan Melbourne. Little is known about how the outcomes of TBI survivors living in metropolitan Melbourne compare to those who reside in regional Victoria once they return to their community, where support services may be less available. The aim of the present study was to compare, in TBI individuals who have been treated at an inner-city rehabilitation centre in Melbourne, the long-term outcomes of those who live in metropolitan Melbourne (termed ‘Metro’) with those who reside in regional Victoria, termed ‘Regional.’ Design and participants: Comparative study with quantitative outcome measures. A total of 959 patients, of whom 645 were designated ‘metro’ and 314 ‘regional’, were followed-up routinely at 2 years post-injury. Outcome measures: Structured Outcome Questionnaire, Glasgow Outcome Scale — Extended, Sickness Impact Profile, Craig Handicap Assessment and Reporting Technique, Hospital Anxiety and Depression Scale, Alcohol Use Disorders Identification Test and Drug Abuse Screening Test. Results: Few differences in outcomes were found between groups. However, after controlling for group differences in age and injury severity, some non-significant trends were suggestive of better outcomes in terms of less social isolation and anxiety and fewer dysexecutive behaviours in regional dwellers. Conclusions: These findings suggest that outcomes in patients from regional areas are at least as good as those from metropolitan Melbourne.

Objective: To investigate the relationship between physical fitness and work integration following stroke. Design: Single-group study, measurement of physical fitness pre and post physical training, measurement of employment status in a follow-up assessment 2 to 36 months after rehabilitation. Setting: Interdisciplinary outpatient rehabilitation program. Participants: 58 stroke survivors (62% male, mean age at program start 46.7 years, mean time since stroke 1.1 years) who were consecutively referred to the program. Intervention: 1½ hours of intensive training of cardiorespiratory fitness and muscle strength 1–3 times weekly as part of the 3-month program. Measures: Physical fitness was measured with a modified Harvard Step Test, the Åstrand Cycling Test, and walking/running speed. The type of participants' employment as well as the amount of working hours was registered. Results: Good physical fitness as measured by the Harvard Step test, but not the Åstrand Cycling Test and walking/running speed, was related to return to competitive, full-time employment. Test results from training tended to predict work reintegration better than test results from training start. Improvement of physical fitness as measured by the Harvard Step Test was also related to follow-up employment. Conclusions: The results imply a relationship between physical fitness and work integration following stroke and should be confirmed with a randomised controlled study design.

Objective: This exploratory study applied a biopsychosocial perspective to investigate cognitive and psychosocial factors related to emotional adjustment and QoL after brain tumour. Methods: Participants included 30 adults with a brain tumour (60% benign and 40% malignant) who were aged 28 to 71 years (M = 51.5, SD = 12.3) and on average 5.4 years post-diagnosis (SD = 5.6 years). Participants completed a brief battery of cognitive tests and self-report measures of emotional status (Depression, Anxiety Stress Scale), subjective impairment (Patient Competency Rating Scale), coping (COPE), social support (Brief Social Support Questionnaire), and QoL (Functional Assessment of Cancer Therapy — Brain Tumour [FACT-Br]). Results: QoL was significantly associated with global cognitive ability (r = .49, p < .01), subjective impairment (r = .66, p < .01), and satisfaction with support (r = .50, p < .05). Level of depressive symptoms was significantly correlated with premorbid IQ (r = -.49, p < .01), use of planning to cope (r = -.48, p < .01), and satisfaction with support (r = -.47, p < .01). Conclusions: Overall, these exploratory findings indicate that emotional adjustment and QoL after brain tumour is related to a slightly different pattern of neuropsychological, psychological (self-perceptions and coping) and social factors. The clinical implications for interventions with individuals with brain tumour are discussed.

Primary Objective: To explore levels of depression, anxiety, stress and strain symptomatology experienced by caregivers of adults with traumatic brain injury (TBI) during the phase of transition from hospital to home. Research Design: Prospective study with data collected at three time-points: pre-discharge, 1-month post-discharge, and 3-months post-discharge. Methods and Procedures: Twenty-nine caregivers of adults with TBI (mean age 48 years), recruited on patient discharge from rehabilitation, completed the Caregiver Strain Index and the Depression, Anxiety and Stress Scale at the three time points. Results: Paired t tests showed significantly lower levels of caregiver strain at one month compared to pre-discharge, and significantly less strain and depression symptoms at 3-month follow-up compared to pre-discharge. Non-significant reductions were observed in level of stress and anxiety across the follow-up time points. Independent group t tests found that female caregivers experienced greater strain than male caregivers at 3 months post-discharge, and caregivers who were immediate family members of the patient experienced greater anxiety than those who were spouses/partners of the patient at 1-month follow-up. Conclusions: The rate of depressive symptoms in caregivers of people with TBI was greater than the general population, and strain was prevalent during the transition period. The results suggest more specific caregiver support and preparation is needed before patient discharge from hospital, and that adequate time spent in rehabilitation is beneficial for caregiver wellbeing.

There is some evidence that in patients with temporal lobe lesions, the presence and temporal pattern of deficits in autobiographical event memory depends on aetiology and the methodology used. In this study, 19 patients with mesial temporal lesions that involved the hippocampus (14 temporal lobectomy [TL] and 5 cerebral vascular accident [CVA]) were compared to 20 normal control [NC] subjects on the Autobiographical Memory Interview, Autobiographical Fluency Test for Events (AFT-Events) and a modified Crovitz Cue Technique. All three measures revealed impairments in autobiographical event recall for the TL patients, but only the Crovitz Cue Technique detected a deficit for the CVA group. No temporal gradients in retrograde recall were found. The findings indicate that test methodology and aetiology of lesion influence the likelihood of finding deficits in recall of autobiographical events but not the temporal pattern of deficits.

Objectives: The aim of this article is to describe the characteristics, needs and preferences of people under 50 with an acquired brain injury (ABI) living in residential aged care in Victoria and examine implications for service development. Participants: Sixty-one people under 50 with an ABI living in residential aged care in the state of Victoria. Measures: Care and Needs Scale, Community Integration Questionnaire, Overt Behaviour Scale, Health of the Nation Outcome Scale — ABI Version, Role Checklist, Resident Choice Scale. Results: The younger people with ABI in this study were a diverse group with a complex range of health and support needs that were not being adequately met within residential aged care. Many people (44%) required the highest level of support, indicating they could not be left alone while 26% could be left for part of the day and overnight. Most people (81%) and their support networks indicated they would like to explore moving out from residential aged care into community accommodation settings. Conclusions: This article provides clear direction for the development of services to meet the care needs of this group, to enable them to participate in the life of the community and to pursue a lifestyle of choice.

Background: People with severe acquired brain injury (ABI) often require high and ongoing levels of paid support, which is sometimes provided within a shared supported accommodation service (SSA). In Victoria there are more than 140 people with severe ABI living in shared supported accommodation services who have a similar level of disability as young people with ABI in residential aged care (RAC). Objectives: The aims of this article are twofold: (1) to describe the characteristics, support needs and level of community inclusion of people with an ABI living in shared SSA in Victoria and (2) to compare the characteristics, support needs, social contact, community integration and leisure participation of this group with a group of people with ABI under 50 years old living in RAC reported in a previous study. Participants: Information was obtained from SSA managers on 128 residents with an ABI, aged under 60 years, who were living in shared supported accommodation. Measures: Questionnaires were used to obtain information about the characteristics, support needs and occupational participation of participants. Support needs were measured utilising the Care and Needs Scale (CANS). Method: Questionnaires were sent to and completed by SSA managers. Results: Of the 39 SSA managers contacted, 32 provided information about the characteristics of 128 residents with ABI living in their facilities. While 72% of SSA residents accessed the community almost everyday or more often, 40% of this sample received a visit from a friend less often than once per year. Results of the CANS indicated that the SSA group required a similar level of support to the comparison group of people with ABI living in RAC, but went outside, participated in community based leisure activities, and visited friends significantly more often. There was no significant difference between the two groups in the frequency of visits to the facility from relatives or friends. Conclusion: Although the relationship between client outcomes and accommodation is a complex one, this study suggests that the type of accommodation and support has a significant impact on the frequency of community participation experienced people with ABI and high care needs.