Background and Aim: Rehabilitation after TBI and multiple injuries improves patients’ functional outcomes, however, requires comprehensive multi-professional rehabilitation services. A discrepancy between rehabilitation provision and needs for services has been documented, many TBI survivors have unmet rehabilitation needs following hospital discharge. There is a need for knowledge on the impact of regional variations and clinical characteristics on rehabilitation needs to optimize rehabilitation services after TBI and multiple injuries. The aim was to describe needs for community-based rehabilitation in patients with TBI and moderate-to-severe traumatic injuries at 12-months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet rehabilitation needs at 12 months.

Methods: A 12-months follow-up study of patients ≥ 18 years with TBI among moderate-to-severe traumatic injuries as assessed by New Injury Severity Scale (NISS) admitted in 2020 to two regional trauma centers in Norway within 72 hours after injury, and with a hospital stay of at least 2 days. Sociodemographic, injury-related characteristics, and functioning were registered. Rehabilitation needs in the municipalities were estimated by the rehabilitation subscale Needs and Provision Complexity Scale (NPCS) assessing the number of therapy disciplines, therapy intensity and vocational/educational support. Unmet rehabilitation needs at 12 months were defined as discrepancies between estimated needs at 6 months using the clinician rated NPCS-rehabilitation subscale and provided NPCS rehabilitation services at 12 months. Logistic regression analysis was used to explore associations between demographic and injury-related characteristics at baseline, functioning on the Glasgow Outcome Scale Extended (GOSE) at 6 months, and unmet community-based rehabilitation needs at 12 months. Ethics: Regional Committee for Medical and Health Research Ethics #31676.

Results: 235 patients, mean age 51.9 years (SD 17.6), 77% male were included. Mean NISS was 31.3 (SD 14.3). Mean number of injuries was 7.1 (SD 3.9). 84% had an AIS Head ≥ 3. At 12-months follow up 42% had unmet rehabilitation needs. Predictors of unmet community-based rehabilitation needs at 12 months included centrality of residence areas OR=2.18 (CI1.06-4.50) p=0.035, AIS Head ≥ 3 OR 3.35 (CI 1.13-9.88) p=0.029, and GOSE at 6 months OR 0.64 (CI 0.47-0.86) p=0.004.

Conclusions: There was a high rate of unmet rehabilitation needs in the communities at 12 months post injury. Living in less central areas, having a more severe injury, and lower functioning at 6 months post-injury increased the odds of having unmet rehabilitation needs in the community at 12 months post-injury.

Background: The ways that youth concussion ‘recovery’ is conceptualized play a central role in shaping the health and rehabilitation supports and services that are offered to youth following concussion. In earlier research, our team conducted a critical conceptual review of clinical guidelines and empirical studies in the field of youth concussion. Notably, our review found that the perspectives of youth concerning concussion recovery were largely absent. Furthermore, our results illustrated how dominant ideas about youth concussion recovery have been constructed in narrow terms (e.g., as a return to ‘normal’ function) and in ways that place responsibilities on youth and their families to ‘recover’ along a predictable path and timeline. To begin to address these concerns, we aimed to expand understandings of youth concussion recovery (e.g., what recovery ‘is’, what it looks like, what constitutes a ‘successful’ recovery) through research that centered the perspectives of youth themselves.

Methods: Using a multimedia storytelling method, we engaged six youth who had sustained concussion (18-24 years of age) as expert ‘storytellers’. Working alongside multimedia professionals in a series of online group workshops, participants were supported to create their own stories of ‘recovery’. Specifically, each youth storyteller co-produced a short film detailing their experiences and understandings of concussion recovery and participated in a follow-up interview. Our team-based approach to data analysis was oriented by a series of critical interrogative questions of the data (films, observations, reflexive fieldnotes, and interviews) such as: what (if any) taken-for-granted assumptions underlie the conceptualization of concussion ‘recovery’ represented in the data?, whose perspectives are privileged in this representation and whose are silenced, discounted, or left out?, what alternative conceptualizations of concussion ‘recovery’ are suggested ? This analytic framing was informed by a Foucauldian theoretical framework developed in the context of our team’s earlier research.

Results: Drawing on representative data, including the films themselves, we demonstrate the ways in which youth stories contributed nuanced and complex understandings of concussion ‘recovery’ that both align and diverge from dominant constructions of recovery as a return to normal (e.g. concussion recovery as living well with symptoms, concussion recovery as returning to a ‘new normal’).

Implications: This research suggests new lines of inquiry including exploring the hidden work that youth engage in to adapt to life after concussion. Moreover, this research suggests there is a need to work in direct collaboration with youth toward developing actionable recommendations for advancing concussion treatment and supports in ways that are attuned to the real-world needs and priorities of youth.

Deficits in discourse, or cohesive verbal macrostructures characterized by thematic progression, are common following traumatic brain injury (TBI), and prior studies have shown that individuals with TBI produce discourse that is of poorer microlinguistic and macrolinguistic quality. Post-TBI deficits in discourse may be particularly relevant in legal contexts, which depend heavily on discourse-based communication; however, the relationship between TBI and social-legal discourse, or discourse about social-legal themes, has not been well characterized quantitatively or qualitatively.

Objective: To characterize social-legal discourse in adults with and without TBI.

Method: Participants, 19 adults with moderate-to-severe TBI and 21 uninjured comparison peers, completed a legal-knowledge interview in which they were prompted to discuss laws and legal systems. Dependent quantitative variables were microlinguistic and macrolinguistic features of participants’ discourse. We then used grounded theory to define qualitative thematic categories within participants’ discourse.

Results: The TBI group produced more overall microlinguistic errors, t(38) = -3.07, adjusted p < .05, η2p = .20, and more overall macrolinguistic errors, t(38) = -2.86, adjusted p < .05, η2p = .18, than the comparison group. This corresponded to a higher rate of both microlinguistic errors t(38) = -3.08, adjusted p < .05, η2p = .20, and macrolinguistic errors, t(38) = -3.94, adjusted p < .05, η2p = .29, than participants in the comparison group. Number and rate of microlinguistic and macrolinguistic errors were positively correlated with working memory, verbal memory, and processing speed. Thematically, participants in both groups defined legal systems through three major categories (normative rules, legal procedures, and structural characteristics). There were no between-group differences in any of the thematic categories. Participants’ discourse was often technical and complex, defining a clear “arrest-trial-jail” schema and well-defined roles for legal actors, but participants struggled to expand on their knowledge or to answer questions based on their knowledge.

Conclusion: Adults with moderate-to-severe TBI produced social-legal discourse of poorer micro- and macrolinguistic quality than their uninjured peers, although discourses were thematically equivalent across groups. Results suggest that linguistic quality, not informational or thematic content, is a feature of social-legal discourse following TBI. Findings point to areas of communication limitations for individuals with TBI in social-legal contexts, identify possible avenues for accommodation, and underscore structural communication risks within social-legal systems.

Purpose: This study sought to develop a grounded theory related to the experience of individuals with mild-severe traumatic brain injuries (TBI) across the rehabilitation continuum (i.e., acute, subacute, and chronic phases of recovery). Specifically, this was focused on perceptions towards providers and perceived quality of care across phases of recovery.

Methods: Sixty-four individuals completed the mCARE-TBI, a patient reported experience measure (PREM) distributed via Qualtrics to individuals with TBI in the US and Canada. The present study only examined the open-ended responses, which were optional on this survey. Grounded theory was used to generate a theoretical model addressing perceptions of lived experiences within the healthcare and rehabilitation contexts specific to TBI.

Results: Three main categories were derived from qualitative analyses, including positive characteristics, neutral, and negative characteristics of providers. Positive characteristics included themes of collaboration, empathy and attitudes, strong communication skills, and being knowledgeable. Neutral characteristics included themes of having knowledge and providing adequate care. Negative characteristics included themes of poor communication and limited knowledge, being unprofessional and lacking empathy, and being dismissive and neglectful. Several sub themes were associated with each of these themes. These sub themes, which form the basis of suggestions for providers, will be discussed in our presentation. Grounded theory contributed to a model, which included characteristics of effective or “present” providers versus ineffective or “absent” providers.

Conclusions: While past research about the perceptions of individuals affected by TBI towards providers, across the recovery continuum, has identified the frustrations faced with providers, particularly in the chronic phase of recovery, there has been limited productive movement regarding development of adaptive strategies. The model developed in this study identifies specific suggestions for providers, primarily derived from subthemes, which could be used to develop provider training. The specific suggestions include things that providers should incorporate and avoid, as they interact with people with TBI.

Introduction: Bill C-277 is a current campaign for the Canadian government to enact a national strategy on brain injury. In turn, this will require Canadian provinces to implement provincially sensitive plans to meet the needs of people affected by brain injury. Manitoba, a prairie province with a diverse population of 1.48 million people spread across a vast geography, presently lacks a provincial strategy, resulting in many brain injury supports and services being under-resourced or unavailable.

Objective: Our aim was to develop a unified understanding, focus, and recommendations for provincially sensitive action, advocacy, and improvement in brain injury supports and services.

Methods: Our research team, including people with lived, work, or research-related experience, used community-engaged methods to complete phase 1 of the Brain Injury in Manitoba (BIMb) project in 2023-2024. Phase 1 included facilitating a World Café as a qualitative data collection and networking method with a focus on the Winnipeg region, which is the largest urban centre and 60% of the provincial population. The World Café included 10 people who live with brain injury, 2 caregivers, and 23 people with work-related brain injury experience. Using a content analysis approach, including counting of ideas, we generated idea categories and sub-categories using qualitative summary notes and written responses collected at the World Café. We then used the categories to develop a framework and recommendations. Last, we held four anonymous online town-hall feedback sessions for people with lived or work-related brain injury experience, where summary notes further developed our framework and recommendations.

Results: We developed the “Hour-glass Framework for a Manitoba Brain Injury Strategy,” which represents a dynamic relationship between four inter-connected categories: (1) shared philosophy of brain injury care; (2) macro-level decision-making and administration; (3) micro and meso-level practice for supports and services; and (4) brain injury awareness through advocacy and activism. At the World Café, the most discussed idea subcategories within the hour-glass framework included focusing on thriving and living in one’s community (philosophy; n= 31 discussion idea counts); treating brain injury as a chronic condition (philosophy; n= 14), increased funding for supports and services (macro decision-making; n= 39), improving system integration (macro decision-making; n= 39), creating enough and timely supports and services (micro-/meso-level practice; n= 40), enhanced case management supports (micro-/meso-level practice; n= 35), varied supportive housing options (micro-/meso-level practice; n= 20), increased general awareness and education (advocacy/activism; n= 33), and including the voice of lived experience (advocacy/activism; n= 20).

Conclusions: Our framework and recommendations implore the collaborative involvement of the government, health authorities and systems, and people with lived, work, and research-related experience. The results from phase 1 of the BIMb project are already being used within Manitoba to advocate for change and could be meaningful to other areas.

Introduction: Advancements in medical, social and rehabilitation practices have significantly improved the life expectancy of individuals living with traumatic brain injury (TBI). The importance of social participation, viewed as involvement in life situations providing interactions and shared experiences with others at the societal level, has been increasingly recognized in maintaining the health of individuals aging with TBI. However, older adults with TBI often face challenges in social participation due to agism and disability-related stigma. Interventions specifically designed to support social participation for this population are limited and rarely studied. Community organizations providing services to individuals with TBI have identified a need to create activities that maintain and improve social participation for their aging members. Intergenerational activities can positively affect the physical, cognitive, and psychological health of older adults and enhance their social participation. Thus, developing and implementing intergenerational initiatives is a promising avenue to support social participation of individuals aging with TBI.

Objectives: To co-design an intergenerational initiative centered on the creation of life stories for individuals aging with TBI, presented through photographs.

Methods: A participatory study was conducted using Design Thinking to guide the co-design process of the intergenerational initiative. Six co-design workshops, each lasting an average of two hours, were conducted. These workshops involved four individuals from two different generations – both young (18 – 35 years old) and older (55 years old and more) – living with TBI in Quebec (Canada), as well as four community workers and a manager from a non-profit community organization which supports social participation in this population, and experts in photography and medical narrative. The co-design activities included brainstorming sessions, group discussions, individual interviews, art creation (e.g., photography and illustrations), and prototyping.

Results: The resulting intergenerational prototype for people with TBI comprised seven sessions, which culminated in a public photo exhibition. A participant workbook, a tool for pairing intergenerational TBI-affected individuals, and strategies for promoting the initiative were also co-developed. Recommendations were made regarding the development process of intergenerational initiative for individuals with TBI, such as considerations for language sensibility and complexity and adaptation to their short-term memory impairments.

Conclusions: The co-design process allowed the involvement of key knowledge users in co-developing an innovative intergenerational initiative, which will be implemented and evaluated in the fall of 2024. This program will offer valuable opportunities for social participation, supporting the health of individuals aging with TBI, while fostering intergenerational solidarity and bridging the gap between generations. The public photo exhibition will also help reduce the stigma associated with TBI.

Background: People with traumatic brain injury (TBI) consider relationships and finding someone to love as important to them in their lives post-injury. However, helping a person find love is not often a goal set by rehabilitation professionals. The dating process and meeting someone is complex. Dating requires a deep understanding of the verbal and non-verbal nuances of social interaction, which are skills often impaired after TBI. Moreover, modern dating requires an understanding and ability to navigate a range of dating sites, apps, and social media to meet someone. Little is known about how people date after TBI. The objective of this study was to explore the experiences of dating for people with TBI including their attitudes towards dating, how to find a date and skills considered important for dating.

Method: A qualitative study (2020-2023) using purposive sampling was used to recruit 10 people with TBI in the UK. Participants included 7 males, and 3 females; aged between 24-38 years; sustained either a moderate (n=1) or severe (n=9) injury; and 3-22 years post-injury. Six participants were single at the time of the interview and four were in a relationship. Participants were met via Microsoft Teams in two sessions. The first session involved the collection of demographic information, and the second session involved a semi-structured interview. The interview used a topic guide and lasted between 37-60 minutes. Interviews were transcribed verbatim and analyzed using Framework Analysis.

Results: Seven core themes were identified from the data: (1) purpose of dating; (2) sense of self; (3) disclosure; (4) stigmatizing beliefs; (5) vulnerability and other challenges; (6) disinhibition; and (7) facilitative support and strategies. Both positive and negative experiences were described across all themes with the dating process made challenging by impaired communication and behavior for people with TBI.

Conclusions: Dating is considered important to people with TBI but is complex and challenging. People described a range of experiences, skills and behaviors that led to positive and successful dates. This research helps to raise awareness and reduce the stigma for clinicians to address this important area as a meaningful activity for people with TBI. Unique insights are also added that may help inform the design and development of future rehabilitation interventions in this area.

The current study explores to what extent three commonly discerned aspects of social cognition (emotion recognition, theory of mind, and empathy) are associated with relationship satisfaction and relationship continuity following acquired brain injury (ABI), thereby considering the viewpoints of both individuals with ABI and their partners. We currently report on an analysis of the first 56 couples included in our cross-sectional study. Results indicate that the relationship satisfaction of partners of individuals with ABI correlates with their assessment of their injured partner's empathetic abilities. In addition, the relationship continuity experienced by partners of individuals with ABI was found to be associated with their assessment of their injured partner's empathic abilities, and the injured individual’s capacity to recognize sadness in facial expressions. No significant correlations were found between the relationship satisfaction of individuals with ABI and any of the aspects of social cognition. For now, there are sufficient indications that social cognition problems have the potential to affect partner relationships following ABI, underscoring the importance of addressing social cognition post-ABI. Final analyses on 92 couples, available by the end of 2024, will provide more conclusive results. Furthermore, the role of social cognition and coping in relation to the partner relationship and mental wellbeing following ABI will be considered in the upcoming analyses.