Background: One in three women experience intimate partner violence (IPV) in their lifetime. The majority of injuries to women experiencing IPV are to the head, face, and neck, leaving survivors at high risk for brain injury (BI). It is estimated from violence history and symptom reports that 75- 92% of female IPV survivors are living with probable BI and possibly bearing the accompanying physical, cognitive, and mental health consequences of both IPV and BI. However, the intersection of IPV and BI (IPV-BI) remains largely unrecognized. Engaging in a community-based conversation to generate interdisciplinary solutions, the research team convened a national multi-stakeholder summit. This summit brought together BI and IPV experts and led to the development of a national agenda to address the enormous gap on the IPV-BI intersection and to advance IPV-BI care. Here we report on the care-level findings from this summit and consider barriers, needs, and priorities related to healthcare and support services for women survivors of IPV-BI.

Methods: Using a community-based participatory research approach, we engaged 30 key partners - drawn from a national IPV-TBI Knowledge-to-Practice (K2P) Network including diverse women survivors, service providers, researchers, and decision makers - in two half-day virtual meetings. The objectives for the summit were to (1) identify needs, facilitators, and barriers to care for women survivors of IPV presenting with TBI; and (2) co-create ideas for resources and principles for identification, clinical care, and support for healthcare practitioners who treat women exposed to IPV-BI. Data were gathered through small group breakout sessions using semi-structured discussion guides. Sessions were recorded, transcribed verbatim, and analysed using thematic analysis techniques. Key partners contributed to analysis and knowledge translation through member checking activities. Research ethics board approval was obtained through the University of Toronto.

Findings: Three main themes around service access and delivery emerged from the discussions: (1) challenges and benefits of screening for brain injury among women survivors of IPV; (2) missing elements of support; and (3) ongoing need for widespread education, awareness, and advocacy. We explore these findings here and provide research and practice recommendations and suggestions.

Conclusion: The findings here add much needed information to our current understanding of support needs among women survivors. The recommendations can contribute to a global agenda for IPV-BI research and practice.

Introduction: The World Health Organization aims to strengthen community-based rehabilitation for people with disabilities. Peer-based community interventions can promote this objective. Active Rehabilitation is one such intervention that provides structured peer support from peer mentors through residential training camps. Currently, there is limited evidence about the impact of Active Rehabilitation camps or similar community peer-based interventions on children with acquired brain injury. This qualitative study explores the experiences of children with acquired brain injury and their caregivers in Active Rehabilitation camps.

Methods: We observed and interviewed nine children with acquired brain injury and ten caregivers participating in Brain Camp Yng 2022, a week-long Active Rehabilitation camp in Norway. We interviewed participants twice: immediately after the camp and after six months. We utilised an abductive thematic analysis and interpreted the results using the Self-determination theory.

Results: We constructed three subthemes and one overarching theme. The first subtheme, “Interacting with peers made me smarter”, reflects how study participants gained new knowledge about brain injury and how to manage subsequent impairments. The second subtheme, “Nudging from peer mentors made me feel better”, explores how the children's motivation, confidence, and mastery improved through involvement in sports and leisure activities and peer mentors' encouragement. It also highlights how the caregivers were inspired to support their children’s independence in daily activities. The third subtheme, “A sense of companionship through meeting peers”, describes how children, caregivers, and mentors connected and how these meetings made study participants feel less isolated and provided hope for the future. Peer mentors were perceived as essential in facilitating knowledge gain, personal growth, and network building for children with acquired brain injury and caregivers. This is reflected in the study’s overarching theme, “Active Rehabilitation peer mentorship camps enrich the lives of children with acquired brain injury and their caregivers”. This theme also incorporates sports and leisure activities and a safe and supportive camp environment, which was essential for the children’s and caregivers' experiences. In line with the Self-determination theory, many of the study participants' experiences may be facilitated by nourishing basic psychological needs and elements of high-quality relationships.

Conclusion: Despite the short duration, Brain Camp Yng provided children with acquired brain injury and caregivers with valuable knowledge and experiences. Study participants expressed that the camp offered a supportive environment, encouraging the children's enjoyment, mastery, motivation, self-worth, and injury management. Moreover, the children developed meaningful relationships with peers and mentors. Caregivers found great value in the support network they formed. Camp participation gave them newfound insight into brain injury, which led to positive changes in their parenting approaches (i.e., increased patience and reduced assistance with daily activities). Furthermore, meeting mentors gave them a more positive outlook on their children’s future.

Background: Patients and families living with TBI frequently report that their medical and educational providers lack empathy and understanding. Experiential learning is a model of empathy training that can include disability simulation, giving a glimpse of “walking in another’s shoes”. While simulations can be impactful, challenges creating ethical disability point-of-view simulations exist, particularly for stigmatized conditions like TBI.

Purpose: To co-create a TBI point-of-view simulation using best practices to facilitate changes in empathy.

Method: A literature review assessing published brain-injured simulations and best practice recommendations for ethical disability simulation was overlaid with suggestions for effective healthcare empathy training. Participatory team members with lived experience had mixed severities of TBI including 2 authors who participated for the duration, 7 undergraduate and graduate students, and 3 partners/family members. All provided feedback after engaging in simulation beta-testing that was incorporated into the intervention.

Intervention: The half-day TBI empathy training was created with the following recommended principles: 1) including individuals with TBI lived experience in simulation construction and delivery; 2) amplifying the patient’s voice; 3) having explicit objectives; 4) considering disability at individual and systems levels; 5) implementing a debrief; and 6) supporting a positive attitude toward living with disability. In addition, participation was voluntary and learning was facilitated through reflective writings. The empathy training included four station activities (e.g., tinnitus, double vision, injured college student) and listening to an individual living with TBI. The initial training was completed with 20 speech-language pathology graduate students, with 19 participating in research (95%). Post-intervention, students had statistically significant increases in TBI knowledge (large effects), the importance of advocacy and interprofessional collaboration (large effects) and empathy (moderate effects).

Qualitative Results: Beta-test participants with TBI lived experiences described their surprise at the simulation authenticity, such as visceral feelings of dizziness and nausea, or cognitive feelings of cloudiness and overwhelm. They appreciated that those engaging in training would have increased TBI insights and recommended expansions for family members. Some were concerned that participants might not appreciate how symptoms have intertwined cumulative effects. This feedback was then built into training materials. Published outcomes included a communication-friendly summary for those living with TBI and the TBI Empathy Bridge conceptual model. This model, drawing from data and lived experiences, created a bridge for providers to connect more effectively with their patients and families. The primary challenge to co-creation was the significant increase in time required for meetings to ensure full understanding of study design, data analysis, and publication. The study team deemed co-creation exceptionally valuable and felt different study outcomes would have occurred without inclusion.

Conclusion: Point-of-view disability simulation can be successfully and meaningfully co-created as an approach to empathy training. Continued expansion for TBI co-design and participatory research is recommended.

Objective: Mindfulness, yoga, and psychoeducation have been shown to improve cognitive, emotional, behavioral, and motor functioning after TBI, however, no online programming exists with these components.

Methods: This pre-post, retrospective study evaluated LoveYourBrain Mindset, a six-week online mindfulness, yoga, and psychoeducation program with weekly interactive Zoom classes and pre-recorded mindfulness tools. Two interactive class types (45-minute group discussion, 75-minute group discussion and gentle yoga) were offered to enhance accessibility. The curriculum focuses on a specific theme each week – resilience, mindfulness, intentions, realistic optimism, positive thinking, and gratitude. People were eligible for the study if they experienced TBI, were a caregiver, or clinician; ≥15 years old; capable of gentle exercise and group discussion; and signed up within a 1.5 year period. Self-reported data was collected on electronic eligibility and feedback forms. We analyzed attendance, program ratings, mindfulness tools utilization, and pre/post-intervention differences in the Quality of Life after Brain Injury overall scale and four TBI-QOL scales (Resilience, Emotional/behavioral dysregulation, Cognition, and Positive affect/well-being) using multiple linear regression.

Results: 1,539 individuals signed up for LoveYourBrain Mindset, including 1,093 (71.02%) who participated in one/more classes. 607 feedback forms were submitted (response rate=55.5%), including 411 from unique participants with TBI. These participants were a majority female (82.1%), white (87.5%), and ranged in severity (44.2% mild, 34.2% moderate, 21.6% severe), and a commonly reported experiencing anxiety (73.2%), sleep disturbance (57.4%), and PTS/PTSD (39.2%). Mean program rating was 9.09 (SD=1.28). A majority (62.99%) used the mindfulness tools each week. Multiple linear regression models controlling for age, severity, and gender indicated significant improvements in QOL, resilience, emotional/behavioral dysregulation, cognition, and positive affect/well-being (p<0.001).

Conclusions: LoveYourBrain Mindset is feasible, acceptable, usable, and may be effective at improving quality of life outcomes among people with TBI. Future research is necessary to determine the potential benefits of this program and how best to maximize the online delivery for greater access to high-quality rehabilitation services throughout the TBI healing journey.

Introduction: In response to the significant impact of cognitive impairments on the ability of individuals with acquired brain injury (ABI) to safely and independently prepare meals, for more than 15 years our team has been working on developing the Cognitive Orthosis for coOKing (COOK). This technology is a web-based, context-aware system comprised of three key components: a) A sensor-based safety system to enhance safety during meal preparation; b) A cognitive assistance application to promote independence by providing step-by-step instructions via a touchscreen tablet. This application supports executive function sub-skills such as goal setting, planning, recipe selection, following instructions, task completion, and evaluating goal attainment; c) A configuration system allows COOK's features to be customized to the individual's specific needs. It also provides clinicians with access to COOK's logs (e.g., types of safety rule violations), enabling experts’ oversight and personalized interventions. This innovative assistive technology aims to address the unique needs of individuals with ABI by offering real-time and task-specific support.

Objective: In this study, we employed the concept mapping method to elaborate the processes and procedures behind our user-centered design approach.

Methods: To ensure that the development of COOK was rooted in the real-world needs of its users, a mixed-methods approach was utilized. This involved both qualitative and quantitative studies to conduct an in-depth needs analysis, ideation, prototype design and evaluation, lab and field testing, and modifications. Additionally, usability and feasibility testing using everyday meal preparation scenarios for individuals with ABI within home and community residences were carried out. This process applied to the development of all three main components of COOK. For each step, we collaborated with various stakeholders including persons living with a moderate or severe ABI, informal caregivers, care providers, computer and rehabilitation scientists.

Results: Our needs analysis findings elucidated the influence of motivation, cognitive impairments, motor skills, and environmental factors on meal preparation for individuals with ABI. We crafted personas and scenarios to steer the iterative design of an interactive prototype, shaped by user insights. Laboratory assessments indicated COOK's efficacy in bolstering independence and safety, despite barriers such as financial limitations and software deficiencies. Using real-world validation studies after various prototype improvements, COOK showed substantial advancements in safe and independent meal preparation, while underscoring the necessity of training for successful implementation. Additionally, the support from formal/informal caregivers was seen as a valuable asset for implementing COOK in real-life contexts.

Conclusion: COOK is a promising technology for meal preparation for clients with ABI. Ongoing and future research will continue to be geared towards further enhancing COOK's capabilities, including operationalizing a recommendation system designed to facilitate the personalization of treatment options and facilitating the overall use of COOK by therapists.

Objectives: 1) To document the situa4ons of discriminanation that can be experienced by individuals living with TBI 2) To co-construct a toolkit aimed at reducing these situationsof discrimination.

Methods: This project was carried out by a specialized community organization providing services to individuals living with TBI and their loved ones. To address the first objective, semi-structured interviews were conducted with healthcare professionals, individuals living with TBI, and caregivers. These interviews were analyzed thematically using the Dedoose software. The findings informed the co-construction phase of the
project. A steering committee comprised of four community workers, one individual living with TBI, and a knowledge broker, participated in nine meetings to develop the toolkit. Co-construction activities included brainstorming sessions, crea4ng a persona and presenting prototypes.

Results: A total of 11 interviews were conducted (n=5 individuals with TBI, n=3 healthcare professionals, n=3 caregivers). Individuals with TBI reported experiencing discrimination, in the form of insistent stares in public places and derogatory comments about their employability. Healthcare professionals highlighted discrimination related to access to certain services, while caregivers identified a lack of knowledge about TBI as the primary cause of discrimination. The co-construction process resulted in the development of a toolkit that includes: nine video vignettes, ten informational cards to challenge preconceived ideas about TBI (n=6) and caregiving (n=4), a comic strip, a glossary defining terms related to TBI, and a poster with actionable strategies for addressing bullying or
discrimination. The videos and informational cards cover various themes identified during the interviews, such as permanent sequelae, relationships, employability, and substance use in the context of TBI.

Conclusions: This project successfully developed concrete tools to raise public awareness about the realities and challenges faced by individuals living with TBI. These resources help demystify TBI, thereby helping to reduce the risk of discrimination.

Background: People with a traumatic brain injury (TBI) can experience social isolation and loneliness due to changes in their cognitive-communication. Due to these cognitive-communication changes, people with a TBI can also find it challenging to use social media. However, social media platforms can offer vital opportunities for social participation after TBI. Research exploring TBI representation on Twitter (now known as X) identified that people with TBI used the platform for making and maintaining relationships, with many sharing their experiences and strategies following brain injury, as well as for activism and altruism. However, the use of Twitter/X and other social media platforms differs greatly. Research was warranted to understand content posted on different platforms to provide health professionals with a greater understanding of the benefits and risks of social media use for people after TBI and inform interventions that incorporate these platforms.

Methods: Two studies using mixed methods were conducted to explore content shared on YouTube and Instagram. A sample of 100 posts that included the term ‘brain injury’ were collected from YouTube and from Instagram. Content analysis was applied to all 200 posts to categorise the content. From each category, representative posts were selected to be analysed in more depth, using visual data analysis to develop narratives which were then analysed thematically.


Results: The sample of 100 YouTube videos contained educational, lived experience, and promotional videos. The sample of 100 Instagram posts yielded these same three categories with an additional category of motivational posts. An overarching theme of ‘Video tells a story’ was generated from detailed analysis of eighteen YouTube videos, with three major sub-themes: we choose how the story is told, recovery is a process, and it changed my life. Detailed analysis of nine Instagram posts generated four themes: sharing their stories, navigating challenge, anticipating more, and building community. Our presentation will provide an overview of findings, clinical implications, and our recommendations for healthcare professionals who may wish to use these two platforms for public awareness and advocacy.

Conclusion: Community groups and people with TBI used YouTube and Instagram to facilitate social connections and exchange stories. These platforms provided a space for supportive and positive communities, suggesting integration of their use in TBI rehabilitation may be beneficial for reducing social isolation. This research provides critical evidence-based guidance for rehabilitation to build social media skills for communication and social participation after TBI, as well as for the use of these two platforms for health communication and advocacy. Future research is warranted to explore other social media platforms, and to trial the use of the recommendations identified in supporting people with TBI to share their stories and for generating online communication materials to build engagement and address misinformation about TBI.

Support groups have long offered critical fora to build community for those in need. In the wake of COVID-19, online support groups on social media sites such as Facebook have become popular platforms to connect, share milestones, seek information, and learn from others. For individuals living with traumatic brain injury (TBI), these online groups offer individuals access to a global community of shared experiences, insight, and expanded networks of support. While the general format and themes of discourse of traditionally moderated in-person support groups have been well-studied, discourse featured on online, public TBI support groups has not been examined. Limited research investigating online behaviors in TBI groups has focused on posts in private, specially moderated groups with no control group. Therefore, little is known about how these groups are utilized when they are accessible to a global audience with little moderation. Therefore, the purpose of this comparison study was to investigate the discourse themes identified in two open access, public TBI support groups on Facebook compared to two control group pages, one arthritis support group and a caregiver support group. A qualitative content analysis was performed on 400 posts wherein each was deductively organized into three overarching categories: Seeking Support, Giving Support, or Other. Each category was expanded into a total of 64 subcategories ranging from socializing, information, emotional, network, esteem, or tangible support, among others, to identify the purpose or goal of the post. Mixed methods were used to assess differences in posting trends between the groups and to compare the number of comments, replies, and exchanges on posts. Minor significant differences were identified between the groups in these areas which was partially consistent with our hypothesis that the TBI groups would show differences in their posting trends compared to the control groups. Results indicated that the TBI groups produced significantly more posts giving support compared to the control groups, specifically in offering access to a network of supporters. Within group analysis revealed that the TBI groups were most focused on asking for advice (52%) and validation for struggles (49%) and offered teaching-related information (52%) and encouragement (56%). These findings suggest that individuals with TBI successfully utilize online support groups to a similar degree as individuals without brain injury. Further expansion of this work is of particular clinical relevance in that isolation and loneliness are significant contributors to depression and suicidal behaviors in this population. Understanding the wealth of online support systems and avenues for information gathering that exist is an important tool for expanding the support services and community for those affected by TBI.