BACKGROUND:Motor imagery-based brain-computer Interface (MI-BCI) utilises electroencephalographic signals from imagined limb movements for control commands, enabling real-time interaction with external devices. Clinical trials suggest its potential for upper limb recovery post-stroke. This study aims to systematically evaluate the effectiveness of MI-BCI on upper limb motor function in patients with post-stroke hemiplegia. METHODS:A comprehensive search was conducted across PubMed, Cochrane Library, Web of Science and Embase through March 2026 for randomised controlled trials assessing MI-BCI effects on upper limb motor impairments post-stroke. A systematic review and meta-analysis were performed. RESULTS:The analysis included 27 studies for systematic review, with meta-analyses encompassing 24 studies involving 846 participants. MI-BCI training showed statistically significant improvements in measures of isolated limb movement and fine motor control, specifically the Fugl-Meyer Assessment for Upper Extremity (s.m.d. 0.31, 95% CI: 0.18-0.45; I² = 17%) and the Wolf Motor Function Test (s.m.d. 0.45, 95% CI: 0.24-0.66; I² = 39%). CONCLUSIONS:MI-BCI training can improve upper limb motor function, particularly for isolated movements and fine motor control, in stroke patients. Its effects on complex functional activities, activities of daily living and spasticity were not significant in the current evidence. Due to heterogeneity in control conditions (including sham interventions) across studies, the current evidence does not support definitive conclusions regarding its superiority over standardised traditional rehabilitation.
BACKGROUND:Mild traumatic brain injury (mTBI) is a common public health issue, and a substantial minority of individuals experience persistent symptoms that disrupt everyday functioning. Although vestibular symptoms, noise sensitivity and anxiety are each recognised following mTBI, little is known about how people make sense of these symptom experiences or perceive their interaction during recovery. METHODS:This qualitative study explored the lived experiences of 14 adults recovering from mTBI, purposively sampled from a larger longitudinal cohort. Equal numbers had short (<6 months) or prolonged recovery. Semi-structured interviews were conducted 8-12 months post-injury and analysed using inductive thematic analysis informed by a critical realist framework. RESULTS:Three themes were identified. 'Noise really hurts' described distressing sensitivity to layered or unexpected noise and strategies to seek quiet. 'Broken spirit level' captured vestibular disturbance, including balance, spatial orientation and visual difficulty. 'Amplified apprehension' reflected heightened anxiety, and avoidance of symptom-provoking activities. Although most participants reported one or more symptoms, a minority explicitly described perceived relationships between them. Noise sensitivity was particularly prominent among those with prolonged recovery. CONCLUSION:Symptom experiences following mTBI are context dependent and can meaningfully constrain participation. Greater clinical attention to vestibular symptoms, noise sensitivity, and anxiety/fear-avoidance may support more responsive assessment and rehabilitation following mTBI.
BACKGROUND:The Sport Concussion Assessment Tool (SCAT) is widely used to evaluate suspected concussion, yet its cultural suitability for Aboriginal and Torres Strait Islander peoples remains underexplored. METHODS:Guided by a social constructionist framework, this study examined perspectives on the SCAT5 through semi-structured yarns with community members in Perth, Western Australia. RESULTS:Reflexive thematic analysis of data identified concerns related to medical jargon, inconsistent terminology, reliance on written instructions and overall readability of the SCAT5. Participants underscored the importance of trust, clear explanations and culturally appropriate communication formats, such as pictorial or verbal information. CONCLUSIONS:Although the SCAT6 introduces some improvements, our findings highlight the need for community-endorsed, culturally valid adaptations in future iterations. Culturally responsive concussion assessment tools are essential to support accurate diagnosis, foster patient-clinician trust, and promote safer recovery pathways for Aboriginal and Torres Strait Islander peoples.
AIM:This qualitative study explored barriers and facilitators experienced by primary school teachers returning to work after mild traumatic brain injury (mTBI) in Aotearoa, New Zealand. METHODS:Seven participants were recruited from a target population of primary school teachers who had sustained an mTBI that affected their ability to work. Semi-structured interviews were employed to collect data, and reflexive thematic analysis methods were used to understand participants' perspectives within their context. RESULTS:Three themes were identified: (1) 'My classroom never stops', (2) 'Invisible injury: understanding affects expectations', and (3) 'Trying to link everyone together'. Findings indicated participants felt pressure to return to work (RTW) quickly after their injury to minimise disruption to others. Pressure to RTW was explicit from employers, whom some participants perceived as lacking an understanding of mTBI. Furthermore, teachers face challenges in implementing accommodations due to a lack of flexibility in work hours and tasks. Participants felt isolated while trying to coordinate competing stakeholder priorities. CONCLUSION:Overall, the barriers and facilitators experienced by teachers as they RTW after mTBI are not merely at the level of the individual and their work tasks but are embedded within the complex interactions between the individual, personal, workplace, healthcare, and insurance/legislative systems.
BACKGROUND:Telehealth could expand access to specialised concussion care; however, physiotherapists report low confidence in assessing physical symptoms remotely. This study adapted measures of vestibular, oculomotor, cervical and autonomic function for telehealth delivery, and evaluated their feasibility and comparability with in-person assessment. METHODS:Using a repeated-measures design, 16 participants with concussion and 20 controls completed assessment modalities in random order (3 × 4 block randomisation). Feasibility was evaluated through completion rates, technical issues, adverse events and clinician feedback. Concurrent validity was examined using percentage agreement, Cohen's kappa, and sensitivity and specificity analyses. RESULTS:Telehealth assessment was feasible; most concussion participants and all controls completed the protocols, there were minimal technical issues, no adverse events and shorter administration times. Clinicians reported high usability and efficiency. High agreement and sensitivity were observed across vestibular, ocular convergence, autonomic and cervical range of motion measures. Nuanced assessment of ocular smooth pursuits showed lower agreement, and a potential ceiling effect on autonomic assessment was identified. CONCLUSION:This study preliminarily supports the feasibility and comparability of telehealth compared with in-person physical concussion assessments. Assessment of smooth pursuits and autonomic function require protocol refinement to enhance accuracy. Replication in larger samples is required to establish comparability.
Background Recent studies report a global shift in the demographics of individuals sustaining a traumatic brain injury (TBI). An increasingly higher proportion of older adults now experience TBIs, falls have overtaken transport-related accidents as the leading cause of injury, and there is high prevalence of TBIs classified as mild. However, it remains unclear whether these demographic and clinical shifts are also occurring in Australia. This study aimed to examine the clinical characteristics of patients hospitalised following TBI and assess whether similar trends were evident. Methods A retrospective cohort study was conducted in a metropolitan hospital in Sydney. Data from 260 patients were extracted and analysed. Results A total of 50% of patients hospitalised following a TBI were aged >60 years. Falls were the leading mechanism of injury (64%) for younger and older adults, and severe TBI cases (43%) were most frequently encountered. Males dominated the sample, except among adults aged >75 years, where distribution of cases was comparable for males and females. Conclusions Results indicated that demographic trends in this Australian sample broadly reflect those reported globally, with older adults and falls predominating. Future research should focus on examining whether these findings are observed across diverse settings while improving recruitment of underrepresented populations.
Background. Australian inpatient rehabilitation facilities are increasingly integrating rehabilitation technologies to support patient recovery. However, little is known about patient perceptions of rehabilitation technologies and the intensity of therapy able to be facilitated. This study aimed to quantify the amount of practice being achieved by patients in an Australian inpatient rehabilitation setting and explore their perceptions of upper limb rehabilitation technologies. Methods. A multimethod study design was used to investigate the perceptions and use of rehabilitation technologies (i.e. InMotion, Fourier ArmMotus, SaeboReJoyce and Touch Accessible Platform for Interactive Technology) by adult inpatients. Semi-structured interviews and the System Usability Scale were completed. Observations of routine therapy sessions were undertaken to quantify the amount and intensity of technology-based practice. Results. Ten participants were recruited (50% male, mean age 62 years). A total of 15 sessions were observed across all participants using robot-assisted therapy and Touch Accessible Platform for Interactive Technology at an average duration of 35 min/session; of which 29 min was active therapy. Most participants described their experiences with rehabilitation technologies positively, highlighting benefits for recovery, enjoyability and easy usability. Participants rated the technologies highly on the System Usability Scale, with total scores ranging between 65 and 100 for usability, and a minimum rating of 'good' for user-friendliness. Conclusion. Rehabilitation technologies were well received by adults undergoing inpatient rehabilitation and with application for a range of impairments. The technologies facilitated enjoyment of daily therapy, and participants were comfortable with limited therapist input when using the devices. Additionally, participants were able to engage in highly intensive practice using the technologies.
BACKGROUND:In the middle-aged and older population, the association between different levels of physical activity and the risk of stroke remains unclear. METHODS:Data were sourced from the China Health and Retirement Longitudinal Study. A cross-sectional analysis of risk factors for stroke incidence in the middle-aged and older population was conducted. Mendelian randomisation analyses, conducted using European population data, were utilised to assess causality between physical activity and the reduction of stroke risk. RESULTS:A total of 1368 (7.05%) participants developed stroke among the 19,395 participants. The incidence of stroke was higher among participants aged ≥65 years (OR 1.049, 95% CI 1.043-1.055, P < 0.001), those married but separated (OR 2.004, 95% CI 1.091-3.683, P = 0.025) and widowed individuals (OR 1.669, 95% CI 1.452-1.919, P < 0.001). After adjusting for marital status and education level, being aged ≥ 65 years (OR 2.398, 95% CI 2.139-2.668, P < 0.001) was associated with an increased risk of stroke incidence. Being female (OR 0.834, 95% CI 0.746-0.933, P ＝ 0.001) was associated with a decreased risk of stroke incidence. Additionally, moderate-intensity physical activity (OR 0.755, 95% CI 0.652-0.874, P < 0.001) and high-intensity physical activity (OR 0.498, 95% CI 0.433-0.572, P < 0.001) were also associated with a reduced risk of stroke incidence. The Mendelian randomisation analyses, leveraging the inverse variance weighted method, unveiled substantial causal links between physical activity and stroke risk. CONCLUSION:Engaging in moderate physical activity could lower the risk of stroke. Additionally, being female, having higher levels of education and enjoying a satisfying family life may also contribute to reducing the risk of stroke incidence.
BACKGROUND:Parents play a role in the prevention, identification and management of concussion in their children. This study aimed to examine perceived concussion knowledge, self-efficacy regarding concussion identification and management, and concern about concussion among Australian parents. METHODS:The Royal Children's Hospital National Child Health Poll is a periodic cross-sectional survey completed by a nationally representative sample of parents and caregivers selected from a consumer panel. Data were weighted to reflect the distribution of the Australian parent population. RESULTS:The survey was completed by 1953 parents of 3260 children. One-third of parents reported having very little knowledge about concussion. One in five parents reported low self-efficacy in recognising signs of concussion or managing their child's recovery. Parents were most worried about their child sustaining a concussion in contact sports (85% of children). Due to their concern about the risk of concussion, some parents stopped their children participating in contact sport, non-contact sport and other physical activities. CONCLUSIONS:Parents reported having little knowledge about concussion and low self-efficacy in identification and management. Parents are concerned about the risk of concussion, with implications for child sport and physical activity participation. These findings identify knowledge, self-efficacy and concern about concussion risk as intervention targets within the Australian parent population.
BACKGROUND:Vocational rehabilitation (VR) supports people to return to work after traumatic injury (traumatic brain injury, multi-trauma orthopaedic injury including traumatic amputation, and spinal cord injury). In Australia, funding circumstances and clinician knowledge can impact VR delivery. This study aimed to ascertain current VR practice by allied health clinicians working in traumatic injury rehabilitation, and to explore their knowledge, confidence and training needs. METHODS:An online questionnaire was disseminated throughout Australia, targeting allied health clinicians working in traumatic injury rehabilitation. Respondents were asked to describe any prior VR training, describe current VR provision, to rate knowledge and confidence across specified VR interventions, and to identify any training needs. RESULTS:There were 107 respondents with an average 15.87 years of experience and 7.58 years providing VR. Most worked predominantly in community or outpatient settings with variable scope of VR provision. A total of 74% reported currently providing VR interventions, but only 10% strongly agreed that they had the resources to effectively deliver VR. Over half reported little or no knowledge or confidence with employer engagement and vocational assessment, with 43.6 and 36.6% reporting that they were 'somewhat knowledgeable' and 'somewhat confident', respectively, in providing education on return to work processes. The majority (93.1%) confirmed an interest in receiving VR training. CONCLUSIONS:Among the experienced cohort of respondents, VR is practised largely outside the hospital setting, with variable scope of interventions provided, and clinicians reporting variable levels of confidence and knowledge in delivering this intervention. Respondents endorsed an interest in VR training.
BACKGROUND:People living with a neurological condition often report having smaller social networks and less frequent social contact, leading to greater loneliness and worse quality of life. This study explored the relationships between personality traits, social network size (SNS) and perceived loneliness in this population. METHODS:Sixty-eight individuals diagnosed with a neurological condition participated in this study. Perceived loneliness was assessed using the UCLA Loneliness Scale - Version 3, SNS was evaluated by the Social Network Index and personality traits were examined using the NEO Factor Five Inventory. Path analysis was conducted to determine if loneliness was negatively associated with SNS and if personality traits mediated the relationship. RESULTS:Loneliness was positively correlated with neuroticism (r = 0.65), and negatively correlated with extraversion (r = -0.26), conscientiousness (r = -0.37) and SNS (r = -0.36). Neuroticism decreased with increased conscientiousness (r = -0.39), extraversion (r = -0.24) and SNS (r = -0.25). SNS was significantly positively associated with extraversion (b = 0.31 ± 0.11, P = 0.004). CONCLUSION:A larger SNS was associated with decreased neuroticism and loneliness, and may be mediated by extraversion. Knowledge of this can help with the creation of targeted social interventions for individuals with neurological conditions.
Background Psychosocial difficulties or reduced functioning in social-cognitive, emotional/mental health, or behavioural domains are common following moderate-to-severe traumatic brain injury. However, there is currently no Australian-based guideline for management of these difficulties. To inform development of such a guideline, we aimed to integrate evidence available with stakeholder input to establish the guideline scope. Methods Overarching governance for the project was provided through an established Guideline Development Group who oversaw the four key steps of the scoping process: (1) initial areas of relevance were generated; (2a) scoping reviews were conducted to establish the availability of evidence; (2b) priority surveys with health professionals (n = 86) and individuals with lived experience of traumatic brain injury or close others (n = 55) were completed; (3) a panel comprising 26 experts convened at a 1-day workshop to conceptualise the initial guideline scope; and (4) the scope was then iteratively refined, leading to a scoping document specifying the key clinical questions, difficulties/disorders and treatment outcomes the guideline would address. Results The scoping reviews identified intervention studies across mental health (n = 74), behaviour (n = 55) and social cognition (n = 19). Survey results prioritised most psychosocial difficulties and identified key treatment outcomes. The final guideline scope included one key clinical question relating to treatment effectiveness, four sub-questions related to treatment decisions for specific groups and circumstances, and two areas of additional commentary to supplement recommendations. Conclusions The methodology used to establish the guideline scope will facilitate the development of a clinical practice guideline for the management of psychosocial difficulties in adults with moderate-to-severe traumatic brain injury.
We used contemporary factor analytic procedures to assess whether the Depression Anxiety Stress Scales (DASS) can reliably differentiate depression, anxiety, and stress in individuals with TBI. One-hundred and thirty-six adults (Mage = 38.51 years; 77.94% male) with moderate-severe TBI completed the DASS42. Various confirmatory factor models were estimated for both the DASS21 and DASS42, with a focus on novel statistical indices derived from bifactor modeling. Bifactor modeling revealed a dominant general distress factor, accounting for 89% of the systematic variance in DASS21 total scores. Specific depression, anxiety, and stress factors added little specific information when holding the general factor constant, accounting for only 11–27% of residual systematic variance in the subscale scores. Omitting the specific factors and instead treating the DASS21 as a unidimensional measure introduced minimal bias in parameter estimates. However, some multidimensionality was apparent when considering individual items, particularly from the depression scale. Additionally, first- and second-order factor models indicated that the specific factors were not well-differentiated from one another or from the general factor. These findings extended to the DASS42. In conclusion, scores on the DASS after TBI predominately reflect a single underlying latent variable of general distress, providing support for using the total score over the three conventional scales.
‘Co’ approaches, including collaboration, co-production, and co-design, are hot commodities in research right now. However, evidence-based research is only starting to be published that demonstrates best practice for these ‘co’ approaches. This special collection aims to showcase both the successes and challenges and build on the evidence base for planning and implementing rigorous and influential ‘co’ approaches’ in research across our field. This article belongs to the collection: Collaboration, Co-production, & Co-design: Moving Ahead in Brain Impairment.
Background To understand the experience of family members of people with severe acquired brain injury (ABI) as they support their loved one to commence community and social participation during inpatient rehabilitation and transition to the community.Methods Constructivist grounded theory methodology guided the process of data collection and analysis. Data were collected via in-depth interviews using a semi-structured interview guide.Results Eight family members were interviewed, inclusive of five parents and three spouses of people living with severe ABI. The participants' family member with ABI were on average 4 years post-discharge from hospital at the time of the interview. Data analysis produced a core category: 'An arduous journey' and four categories: adjusting to change, overwhelming responsibility, learning on the job and needing people to understand.Conclusion Although family members clearly play an important role in the achievement of community and social participation, the participants of this study identified many factors that impact their experience of supporting positive outcomes. There are important implications for rehabilitation services, such as ensuring families feel welcomed and engaged within rehabilitation, positioning the person with ABI within their family context in rehabilitation, and providing opportunities for supported, meaningful and contextual experiences within rehabilitation.
BACKGROUND:It is common for individuals with cognitive communication disorders (CCD) and aphasia to experience changes to cognition, communication and psychological status, which can alter their identity and sense of self. METHODS:Five individuals with CCD and two with aphasia co-designed and co-produced an interest-holder-engaged investigation of their own poems about living with CCD and/or aphasia. They wished to demonstrate the value they associate with poetry as a vehicle for self-expression and processing their recovery. A project-based intervention served as a framework for implementing this co-analysis process. Co-investigators with CCD and aphasia participated at the highest level of engagement, serving as partners and decision-makers for the entire process. Individuals with CCD and aphasia were trained by three speech-language pathology graduate students on how to complete reflexive thematic analysis. RESULTS:Co-investigators with CCD and/or aphasia performed these analyses with a high level of rigour and integrity. Qualitative analyses identified two main themes: loss and overcoming. Loss included the subthemes of frustrations, impairments and loss of self. Overcoming included subthemes of community, redemption and successes, poetry as a means of expression, and emotional adjustment. CONCLUSIONS:Co-investigators were able to complete the analyses with training and support from the graduate student clinicians. Poetry served as a vehicle for self-expression and identity renegotiation. Take aways: Poets were able to process recovery, trauma, and adjustment through writing and sharing their work in a safe space. By sharing illness narratives and making sense of their CCD/aphasia, poetry provides a modality for exploring post-CCD/aphasia self and renegotiating identity.
BACKGROUND:Despite the established success of co-design in healthcare and disability settings, there is limited practical guidance for researchers regarding how to empower people with acquired brain injury (ABI) to lead programs. This study aimed to provide practical insights into maximally authentic co-design processes, emphasising the leadership roles of individuals with ABI in program initiation, planning, delivery and reporting. A second aim was to describe and qualitatively evaluate a process of employing and training people with ABI to facilitate co-designed workshops, reflecting the co-delivery stage. METHODS:Using a relationship-building project conducted in partnership with an ABI self-advocacy organisation (Brain Injury Matters) as an illustrative case example, this paper outlined the steps of co-design from the formation of a collaborative team of 11 individuals to the delivery of three peer-led workshops. A qualitative thematic analysis was conducted of interviews with 18 workshop participants and facilitators. RESULTS:Thematic analysis revealed three key themes: pre-existing ABI-related identity and relationship challenges, the transformative impact ('magic') of lived experience and the benefits of co-delivered workshops. CONCLUSIONS:This work demonstrates the potential of people with ABI to lead complex projects when provided with appropriate support and resources, offering valuable guidance for the growing field of ABI-led co-design in neurorehabilitation. The findings contribute to the development of accessible, authentic, and sustainable models of co-designed services and support.
BACKGROUND:Co-design methodologies, which actively involve interest-holders in intervention development, are increasingly used in health care. In brain injury rehabilitation, they offer potential for tailored support for individuals with communication disabilities. However, the diversity of approaches and lack of communication-specific adaptations can limit their effectiveness and authenticity in equitably engaging interest-holders with communication disability. METHODS:This meta-synthesis reviewed 30 studies involving adolescents (aged ≥12 years) and adults with acquired brain injury affecting communication. Systematic searches of six databases identified studies using co-design in rehabilitation contexts. The review aimed to define minimum requirements for co-design and explore evidence-based adaptations that support inclusive participation. RESULTS:Studies used varied theoretical frameworks and qualitative methods, including interviews, focus groups and workshops. Adaptations to support communication included easy-read materials, bespoke design tools, and member-checking. Innovative techniques, such as the Someone Who Isn't Me technique for perspective-taking and modified consensus-building, were noted. Despite the value of lived experience, contributions were often underutilised due to inaccessible practices and inconsistent reporting. CONCLUSION:Authentic co-design was demonstrated in studies that embedded inclusive principles and tangible adaptations. This review offers practical guidelines for optimising research inclusion by integrating accessible communication strategies, ensuring interventions are genuinely co-designed.
OBJECTIVE:To characterise social-legal knowledge in adults with and without traumatic brain injury (TBI). METHOD:Participants, 19 adults with TBI and 21 uninjured comparison peers, completed a social-legal knowledge interview to discuss their understanding of laws and legal systems. We used grounded theory to define thematic content within participants' self-reported knowledge. RESULTS:Social-legal knowledge in both groups comprised five thematic categories. Three categories (normative rules, legal procedures, and structural characteristics) described the legal system itself, whereas two categories (personal anecdotes and uncertainty) described the participants' relationship to the law. Participants' social-legal knowledge was often technical and complex, defining a clear 'arrest-trial-jail' schema and well-defined roles for legal actors; however, participants often struggled to expand knowledge or to answer follow-up questions, and participants tended to frame the structural characteristics and their personal anecdotes negatively. Post-hoc analysis of total coded items showed no between-group differences in any of the five thematic categories. CONCLUSION:Adults with moderate-to-severe TBI articulated complex, albeit superficial, social-legal knowledge, with no thematic differences to the knowledge of adults without TBI. The results identify key thematic content areas that comprise social-legal knowledge in adults with and without TBI and highlight areas of relative strength and relative weakness within lay persons' internal understanding of laws and legal systems.
OBJECTIVE:This study described the rehabilitation services accessed by children with stroke following acute admission to two Australian paediatric tertiary hospitals prior to the implementation of clinical practice guidelines. It also evaluated quality-of-care indicators for inpatient rehabilitation within these two settings. METHODS:Data were obtained from electronic medical records between 2014 and 2020. Quality-of-care was evaluated by comparing documented clinical care during that period with quality-of-care indicators for childhood stroke rehabilitation. RESULTS:A total of 129 children (56% acute arterial ischaemic) with newly diagnosed stroke were identified (83 from Victoria, 46 from Western Australia). Of those, 45 in Victoria and 27 in Western Australia required inpatient rehabilitation. Children received high-quality inpatient rehabilitation care across both hospital settings, with the application of validated outcome measures and provision of rehabilitation care plans. Areas for improvement included greater involvement of families in the rehabilitation process, particularly with respect to the provision of regular family meetings to facilitate engagement. CONCLUSION:Although most children with stroke received high-quality care when compared against clinical practice guidelines, the findings highlight the importance of ongoing evaluation and continuous improvement in service provision, and the benefits of benchmarking the quality of current service provision against best practice treatment approaches recommended by consensus-based guidelines.
