Visual impairments are common post-stroke and can lead to diminished functioning and difficulty accomplishing everyday tasks, such as reading and navigating unfamiliar environments independently. This pilot study investigates the usability, acceptability and preliminary efficacy of technological visuo-cognitive training (TVT) using the Senaptec Sensory Station for stroke survivors with visual field loss. Ten stroke survivors (8 males, 2 females; 43-79 years old; Mage = 65, SDage = 11.03) with a non-progressive visual field defect underwent TVT comprising baseline assessment, five 30-minute training sessions over 2-3 weeks, and post-intervention assessment. Measures of visual cognition, patient-reported outcomes, usability, and acceptability were assessed pre- and post-intervention, supplemented by qualitative interviews. Participants demonstrated meaningful gains in several aspects of visual search and functional vision. Reaction times on target capture tasks improved significantly, mirrored by more efficient performance on the Bell's Test. These behavioural changes aligned with reductions in reported visual difficulties and fatigue, both showing large effect sizes. Across sessions, participants also showed improvement in hand-eye coordination and visuomotor integration. Engagement with the system was high: perceived competence increased and usability ratings were excellent. Qualitative accounts contextualised these findings, describing enjoyment of the technology, occasional challenges related to adaptive difficulty or physical limitations, and perceived benefits such as greater awareness of visual scanning strategies in daily life. Notably, several sensory measures (e.g., visual clarity, contrast sensitivity, depth perception) remained unchanged, indicating that improvements were domain-specific rather than global. Overall, TVT demonstrated acceptability with selective improvements in visual search function and vision-related quality of life. Larger randomised controlled trials are needed to determine efficacy and comparative effectiveness against standard rehabilitation approaches.

Introduction: Peer support roles are well established in mental health services, yet their integration into neurorehabilitation remains limited. This study offers novel insight into how staff perceive the opportunities and challenges of introducing a peer support worker role into a community brain injury service. Methods: Using qualitative interviews and focus groups with clinical and support staff, we explored understandings of the role, its perceived value, and contextual barriers to implementation. Reflexive thematic analysis generated three themes: the perfect candidate, context for success, and connecting care. Rigour was ensured through pre-registration, triangulated coding discussions, and reflexive analytic practices. Results: Findings highlighted the unique value of lived experience in fostering trust, hope, and engagement, while also revealing neuro-specific challenges relating to cognition, behaviour, and role boundaries. Staff emphasised the need for tailored recruitment, training, and supervision frameworks distinct from existing mental health models. Conclusions: The study is significant in being the first to systematically examine the adaptation of peer support to neurorehabilitation, offering evidence to guide service development and policy. Collectively, the findings underscore both the transformative potential and the structural requirements of embedding peer support within neurorehabilitation contexts.

Objective: Farmers, their families, and employees face daily stressors that adversely affect their mental well-being. To improve understanding of stress and mental well-being in farming populations, this study examines this relationship in the United Kingdom (UK) and Canada. Method: Using an online cross-sectional survey, 569 adults from farming communities (37% male, 63% female; Mage = 47.57, SD = 12.55) completed measures of stress event load (EL), personal vulnerability to stress (PV), and subjective mental well-being. Data were analysed using analysis of variance and hierarchical multiple regression, with simple-slopes analysis. Results: Farming community members who reported higher PV reported significantly lower well-being, regardless of whether EL was low or high. In regression, when considered together, PV eliminated the predictive power of EL, highlighting the importance of PV. Although a significant interaction was observed, after Bonferroni correction, significance remained only for those with high PV, where well-being among farming community members was substantially lower than at low or average PV, across all levels of EL. While UK participants reported significantly lower mental well-being than Canadian participants, mental well-being was low in both countries at levels that necessitate support. Conclusion: While studies have traditionally focused on farming-specific causes of stress, personal vulnerability was a stronger determinant of mental well-being than stress event load across the two countries. Interventions targeting the psychological mechanisms that underpin stress appraisal will therefore help protect mental well-being in farming communities. Future research must utilise longitudinal measurements to explore the psychological resources of farming community members worldwide.

Abstract Background and aims Recurrent stroke substantially increases disability, healthcare costs and caregiver burden. Despite advances in acute stroke care, post-discharge support for lifestyle modification and self-management remains limited. My Stroke Companion (MSC) is a clinician-personalised digital platform delivering tailored information about their stroke, care and life after stroke to stroke survivors and their families. Methods This trial evaluates whether MSC, delivered at discharge, improves self-management of risk behaviours compared with standard care, and explores usability, acceptability, and potential impact on service offering. Results A dual-site mixed-methods trial is recruiting 120 stroke survivors from UCLH (MSC intervention) and St George’s Hospital (control, standard care). UCLH participants are pseudo-randomly allocated to MSC alone or MSC plus engagement support from the stroke buddy team at 30- and 60-day intervals. Primary outcomes are lifestyle behaviours and self-management. Secondary outcomes include medication adherence, quality of life, mood, fatigue, system usability, engagement with MSC and participant satisfaction. Quantitative analyses employ Bayesian methods with propensity weighting to adjust for baseline confounders. Semi-structured interviews with stroke survivors, caregivers and clinicians will explore acceptability, barriers and facilitators. Conclusions The study will generate comparative data across multiple domains, offering insight into the efficacy of a digital support intervention. Qualitative findings will contextualise usability, engagement and equitable access, while platform usage metrics will be mapped against demographics to explore health inequalities. Conflict of interest

OBJECTIVES:Peer support roles are well established in mental health services, yet their integration into neurorehabilitation remains limited. This study offers novel insight into how staff perceive the opportunities and challenges of introducing a peer support worker role into a community brain injury service. DESIGN:Using qualitative interviews and focus groups with clinical and support staff, we explored understandings of the role, its perceived value and contextual barriers to implementation. METHODS:Participants included eight staff members (100% female; Mage = 49.88). Data were analysed using reflexive thematic analysis. Rigour was ensured through pre-registration, triangulated coding discussions and reflexive analytic practices. RESULTS:Three themes were constructed: the perfect candidate, context for success and connecting care. Findings highlighted the unique value of lived experience in fostering trust, hope and engagement, while also revealing neuro-specific challenges relating to cognition, behaviour and role boundaries. Staff emphasized the need for tailored recruitment, training and supervision frameworks distinct from existing mental health models. CONCLUSIONS:The study is significant in being the first to systematically examine the adaptation of peer support to neurorehabilitation, offering evidence to guide service development and policy. Collectively, the findings underscore both the transformative potential and the structural requirements of embedding peer support within neurorehabilitation contexts.

Objectives: Farmers and their families are at risk of loneliness due to frequent solitary working, geographical isolation, and narrow social networks. These circumstances compromise the mental well-being of farming communities, highlighting the need for a better understanding of buffering protective factors. Resilience may buffer the negative effects of loneliness; however, evidence of its role in agricultural populations is scarce. This study considers whether resilience mediates the relationship between loneliness and mental well-being in the UK farming community.Methods: A cross-sectional online survey collected data from 320 members of the UK farming community (39.4% Males; Median Age = 43.1 years). Participants completed the Brief Resilience Scale, Loneliness RULS-6 scale, and Warwick-Edinburgh Mental Wellbeing Scale (Short). Results: Over half of participants (54.5%) exhibited mental well-being scores indicative of mild or clinical depression. Higher loneliness was associated with lower resilience and mental well-being, whilst higher resilience was related to higher mental well-being. Mediation analysis revealed that resilience reduced, but did not eliminate, the negative relationship between loneliness and mental well-being.Conclusion: This study provides vital evidence that enhancing resilience in UK farming communities plays a crucial role in mitigating the negative effects of loneliness on mental well-being. Our findings underscore the importance of resilience-building as a protective factor against the well-documented mental health challenges faced by people in farming communities.These novel insights support the development of targeted interventions that integrate both resilience-building and loneliness reduction as a comprehensive support package. Our study demonstrates that addressing these factors in tandem is essential for improving the mental well-being of UK farming communities, ensuring people receive the necessary tools and resources to foster strength and connection.

Mindfulness witnessed a substantial popularity surge in the past decade, especially as digitally self-administered interventions became available at relatively low costs. Yet, it is uncertain whether they effectively help reduce stress. In a preregistered (OSF https://doi.org/10.17605/OSF.IO/UF4JZ; retrospective registration at ClinicalTrials.gov NCT06308744) multi-site study (n sites = 37, n participants = 2,239, 70.4% women, M age = 22.4, s.d.age = 10.1, all fluent English speakers), we experimentally tested whether four single, standalone mindfulness exercises effectively reduced stress, using Bayesian mixed-effects models. All exercises proved to be more efficacious than the active control. We observed a mean difference of 0.27 (d = -0.56; 95% confidence interval, -0.43 to -0.69) between the control condition (M = 1.95, s.d. = 0.50) and the condition with the largest stress reduction (body scan: M = 1.68, s.d. = 0.46). Our findings suggest that mindfulness may be beneficial for reducing self-reported short-term stress for English speakers from higher-income countries. Does self-administered mindfulness effectively reduce stress? In a study across 37 sites involving 2,239 participants, four mindfulness exercises significantly reduced short-term, self-reported stress.

Background Stroke survivors are a population at increased risk of experiencing loneliness, thus exploring the effect of lockdown measures on stroke survivors is of paramount importance. We explored the personal experiences of loneliness among stroke survivors during lockdown in the COVID-19 pandemic and the lessons that can be learned from these experiences. Methods Seventeen stroke survivors from across the United Kingdom (10 females, 7 males; 45-83years old; M age =63.47) participated in semi-structured interviews. Reflexive thematic analysis was employed in the interpretation of the data. Results Three overarching themes were constructed: (1) hidden struggles, isolated lives; (2) divergent experiences and adaptations; and (3) rebuilding after lockdown. These themes explore survivors' experiences of loneliness generally after stroke and how this loneliness was assuaged with online video conferencing and other technological solutions. They also chronicle how these feelings changed during lockdown and survivors' feelings regarding society returning to 'normal' and the associated apprehension and anxiety this brings. Conclusions We recommend a focus on improving understanding of the challenges faced after stroke to reduce stigma, increase empathy and promote inclusive attitudes within society, alongside better pandemic preparedness through engagement with hybrid support solutions.

This paper examines the rhetorical strategies used by stroke survivors to attend to identity aloneness, a phenomenon in which individuals experience a sense of disconnect from others as a consequence of identity change, for which stroke is known as an antecedent. Three stroke survivors, and their spouses, were interviewed about their stroke, social support, and experiences with loneliness and identity change. The data was transcribed using a simplified version of the Jeffersonian method and analysed using a critical discursive psychological approach. This made it possible to examine the way in which the psychological business of identity aloneness was managed in participants' talk via discursive devices such as metaphors and category entitlement, while also leaving room to consider how broader societal discourses were drawn upon. The analysis revealed two critical ways in which participants attended to the issue of identity aloneness: (1) by crafting and occupying a position of resilience; (2) by managing the impact of the post-stroke social world on their identities. These findings offer insight into how the issue of identity aloneness is made sense of by stroke survivors in the context of a discussion with an interviewer. Finally, findings informed future directions for research, including developing a comprehensive theory of identity aloneness using a grounded theory approach and developing and validating a psychometric measure of identity aloneness to be applied in a rehabilitative setting.

Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness.

This study explored stroke survivors’ experiences of loneliness. Drawing on interviews with 29 community-dwelling stroke survivors living in the Northeast of England, we found several themes: loneliness as being alone, the season or time, lack of understanding from those without any experience of stroke, reduced autonomy, and deterioration of social relations. It is important that healthcare professionals pay attention to the aspects of life that may increase the chances of a stroke survivor becoming lonely after being discharged from hospital, and to measure loneliness in stroke survivors a more valid scale should include items that touch on the aspects reported here.

This chapter will provide a brief overview of the rich and fascinating history underpinning contemporary eye-movement research. Starting with the early work by Kepler and the largely observational investigations of eye-movements conducted by others, we will cover the development of eye-movement research in terms of the machinery used for early investigations, such as crude measurements using plaster of Paris, as well as set out some of the first instances of phenomena which are still keeping scientists occupied today. Hopefully, by the end of this chapter, you will appreciate the broad history behind some of the topics covered throughout the rest of this book.

BACKGROUND Visual field defects are a common consequence of stroke, and compensatory eye movement strategies have been identified as the most promising rehabilitation option. There has been a move toward compensatory telerehabilitation options, such as the Durham Reading and Exploration (DREX) training app, which significantly improves visual exploration, reading, and self-reported quality of life. OBJECTIVE This study details an iterative process of liaising with stroke survivors, carers, and health care professionals to identify barriers and facilitators to using rehabilitation tools, as well as elements of good practice in telerehabilitation, with a focus on how the DREX package can be maximized. METHODS Survey data from 75 stroke survivors informed 12 semistructured engagement activities (7 focus groups and 5 interviews) with 32 stroke survivors, 10 carers, and 24 occupational therapists. RESULTS Thematic analysis identified key themes within the data. Themes identified problems associated with poststroke health care from both patients’ and occupational therapists’ perspectives that need to be addressed to improve uptake of this rehabilitation tool and telerehabilitation options generally. This included identifying additional materials or assistance that were required to boost the impact of training packages. The acute rehabilitation setting was an identified barrier, and perceptions of technology were considered a barrier by some but a facilitator by others. In addition, 4 key features of telerehabilitation were identified: additional materials, the importance of goal setting, repetition, and feedback. CONCLUSIONS The data were used to try to overcome some barriers to the DREX training and are further discussed as considerations for telerehabilitation in general moving forward.

The loss of visual function is a common and debilitating effect of brain injury. Such effects include the inability to attend to the contralesional part of space (visual neglect) and loss of vision in part of the visual field in both eyes (homonymous visual field defects). The underlying mechanism of these functional deficits are varied which explains why no one intervention is effective in their treatment. In this chapter, we examine the cognitive neuroscience that underlies visual performance and attention with particular focus on what we know about visual exploration using search tasks in the laboratory. We then discuss how this knowledge has informed the development of interventions for poor visual function and how these can be maximized.

Saccadic eye movements are simple, visually guided actions. Operant conditioning of specific saccade directions can reduce the latency of eye movements in the conditioned direction. However, it is not clear to what extent this learning transfers from the conditioned task to novel tasks. The purpose of this study was to investigate whether the effects of operant conditioning of prosaccades to specific spatial locations would transfer to more complex oculomotor behaviours, specifically, prosaccades made in the presence of a distractor (Experiment 1) and antisaccades (Experiment 2). In part 1 of each experiment, participants were rewarded for making a saccade to one hemifield. In both experiments, the reward produced a significant facilitation of saccadic latency for prosaccades directed to the rewarded hemifield. In part 2, rewards were withdrawn, and the participant made a prosaccade to targets that were accompanied by a contralateral distractor (Experiment 1) or an antisaccade (Experiment 2). There were no hemifield-specific effects of the reward on saccade latency on the remote distractor effect or antisaccades, although the reward was associated with an overall slowing of saccade latency in Experiment 1. These data indicate that operant conditioning of saccadic eye movements does not transfer to similar but untrained tasks. We conclude that rewarding specific spatial locations is unlikely to induce long-term, systemic changes to the human oculomotor system.

BACKGROUND:Social cognition and executive functioning difficulties following acquired brain injury have been linked to negative employment outcomes, such as demotion and loss of vocational roles. These are very counter-intuitive and challenging difficulties for other employees and work supervisors who have little or no brain injury knowledge, whose perceptions of play a key role in their responses to these difficulties and the final outcome of such problems for vocational status.OBJECTIVES:This study aimed to study the relationship between social cognition and executive functioning difficulties and the perceptions of work supervisors' appraisal of survivor interpersonal behaviour and social skills in the workplace.METHOD:The performance of 73 survivors of acquired brain injury (47% TBI, 38% CVA, 15% other ABI type; 73% male; mean age 45.44 years, range 19-64 years; mean time since injury 6.36 years, range 10.5-31.33 years), currently in a vocational rehabilitation placement) on neuropsychological tests of executive functioning and social cognition was measured. Informant ratings on the Social Skills Factor subscale from the Work Personality Profile (WPP, Bolton & Roessler, 1986) were used as the primary outcome measure, a vocational functioning questionnaire assessing social and presentational aspects of workplace behaviour. The raters were non-clinical workplace informants acting in a supervisory role (supervisory placement providers and job coaches).RESULTS:Correlational analysis identified significant associations between the WPP and survivor goal-orientated planning and implementation, mentalising ability, recognition of positive and negative emotions, and recognition of simple sarcasm (all significant at p <  0.05). These correlates were entered into a stepwise multiple regression. The combination final of survivor mentalising ability and executive functioning explained 32 % of the variance in the WPP ratings (F (2, 52) =  12.15, p <  0.001).CONCLUSION:Certain limitations of the study withstanding, the current findings add to previous literature in highlighting the relevance of survivor executive functioning and social cognition difficulties for the perceptions and appraisal of work colleagues, consistent with other studies that have identified negative vocational outcomes associated with such neuropsychological difficulties. The implications for vocational rehabilitation are discussed.

The eye movement system is sensitive to reward. However, whilst the eye movement system is extremely flexible, the extent to which changes to oculomotor behavior induced by reward paradigms persist beyond the training period or transfer to other oculomotor tasks is unclear. To address these issues we examined the effects of presenting feedback that represented small monetary rewards to spatial locations on the latency of saccadic eye movements, the time-course of learning and extinction of the effects of rewarding saccades on exogenous spatial attention and oculomotor inhibition of return. Reward feedback produced a relative facilitation of saccadic latency in a stimulus driven saccade task which persisted for three blocks of extinction trials. However, this hemifield-specific effect failed to transfer to peripheral cueing tasks. We conclude that rewarding specific spatial locations is unlikely to induce long-term, systemic changes to the human oculomotor or attention systems.