Social isolation is a prevalent consequence of acquired brain injury (ABI) that has notable impacts on wellbeing. Although social connection is recognized as central to recovery, little is known about how service providers understand and promote it. This study explored how services foster social connection post-ABI, the barriers and enablers encountered, how success is understood and what could strengthen future provision. Six online focus groups were conducted with 19 individuals working or volunteering across ABI services in the UK, USA, Australia and New Zealand. Data were analysed using reflective thematic analysis from a critical realist perspective, allowing attention to both participants' experiences and the organizational and structural conditions influencing service delivery. Two themes were developed: (1) Groups as psychosocial lifelines: safety, identity and providing the conditions for recovery, capturing the role of group spaces in rebuilding connection, identity, confidence and belonging and (2) Visible impact, invisible labour: plugging gaps in a precarious system, highlighting the undervalued relational work of the workforce in resource-constrained systems and how unstable funding and inequalities shape access to support. These findings demonstrate the psychosocial value of group-based initiatives and reveal the structural mechanisms that shape their development, sustainability and accessibility.
Aphasia impairs communication and is associated with reduced employment, limited social participation, and lower quality of life. However, the relationship between aphasia severity and these outcomes remains underexplored, especially regarding employment. This cross-sectional study examined employment status, social participation, and quality of life in 136 individuals with chronic aphasia following cerebrovascular disease. Multiple logistic and linear regression models were used to evaluate the influence of aphasia severity, non-linguistic cognitive function, apathy, mobility, and social environmental barriers specifically focusing on the working-age population under 65 for employment analysis. Aphasia severity was a significant negative predictor of both employment status and quality of life. Social environmental barriers also negatively impacted quality of life. Reduced mobility, male gender, and older age were associated with lower social participation, while employment status was not significantly related to either social participation or quality of life. These findings highlight the central role of aphasia severity in shaping long-term socio-occupational outcomes and well-being. The results suggest that early interventions targeting language rehabilitation and environmental accessibility, along with tailored occupational support, may enhance quality of life and promote occupational engagement in individuals with aphasia.
Telehealth could potentially improve memory rehabilitation access post-stroke, but its suitability is underexplored. We aimed to characterize changes in stroke survivors' memory function and memory strategy use after completing a compensatory memory skills group intervention via telehealth, compared to in-person. Our retrospective study drew upon two previous parent studies, and examined change in memory goal attainment, everyday memory failures, and memory strategy use at program completion (T1) and follow-up (T2), relative to baseline. Non-inferiority analyses then compared change among in-person (n = 24) and telehealth (n = 30) participants. Among telehealth participants, repeated-measures ANCOVAs indicated goal attainment at T1 (p < .001, d = 1.08) and T2 (p < .001, d = 1.33), and reduced memory failures by T2 (p = .011, d = -0.58). Internal strategy use increased by T1 (p < .001, d = 0.89) and T2 (p = .003, d = 0.68), but external strategy use did not (pT1 = .079, dT1 = 0.43; pT2 = .319, dT2 = 0.25). While these findings were promising, non-inferiority analyses comparing telehealth and in-person delivery were inconclusive. Further research directly comparing delivery modalities is therefore needed. Offering participants their preferred intervention format in future trials may help further our understanding of how stroke survivors might maximally benefit from memory rehabilitation.
The Mayo-Portland Adaptability Inventory-4 (MPAI-4) is widely used to assess comprehensive outcomes following acquired brain injury (ABI). Although a Japanese version is available, its psychometric properties have not been evaluated. This study examined the measurement properties of the Japanese MPAI-4. A cross-sectional study was conducted with 163 participants receiving post-discharge rehabilitation between June 2024 and June 2025 at rehabilitation facilities in Japan. Rasch analyses examined reliability, unidimensionality, item fit, category functioning, targeting and differential item functioning. Classical Test Theory analyses assessed internal consistency and factor structure. The Japanese MPAI-4 demonstrated a Person Separation Index of 0.89 and high internal consistency (Cronbach's α = 0.91). Rasch analysis identified departures from model assumptions, including multidimensionality and disordered category thresholds. Exploratory factor analysis suggested a multifactorial structure, although it did not clearly align with the original three-domain model. These findings indicate that the Japanese MPAI-4 captures multiple aspects of post-ABI functioning, reflecting the complexity of outcomes in community rehabilitation. Although measurement issues should be considered when interpreting scores, the study provides initial psychometric evidence for the Japanese MPAI-4. These findings may support its clinical use for comprehensive assessment of post-ABI functioning in Japan, while contributing to the cross-cultural evidence base for the MPAI-4.
