Assessment and rehabilitation in acquired brain injury: The role of social and therapeutic engagement in recovery

Thesis AbstractRehabilitation outcomes following acquired brain injury are affected by a complex mix of variables, including demographics, injury characteristics, post-injury function and intensity and duration of rehabilitation. Assessing key factors and making prognostic judgements is therefore difficult. This thesis aimed to develop a greater understanding of assessment and predictive factors in rehabilitative outcomes following acquired brain injury, particularly focusing on the role of therapeutic and social engagement in rehabilitation.Literature ReviewThe Functional Independence Measure and Functional Assessment Measure is used extensively in UK rehabilitation services and worldwide; however, no recent review has been conducted into its psychometric properties. The current review examined 28 quantitative studies derived from six databases, identifying excellent internal consistency, interrater reliability and criterion validity, and good responsiveness. However, ceiling effects were identified in less functionally-impaired populations, evidence for manualised subscales was unconvincing, and qualitative patient goals are not well-reflected in scoring.Empirical StudyThe research study comprised two investigations. Firstly, the roles of group and individual social engagement and behaviours of concern in acquired brain injury rehabilitation outcomes were explored. Multiple regressions identified that greater group participation predicts better physical recovery, and greater individual therapy participation predicts poorer cognitive recovery; the latter may relate to the typical slower recovery of cognitive function post-injury or to ceiling effects. Individuals exhibiting behaviours of concern showed better mean physical recovery than controls, although their longer mean length of stay in hospital may have contributed. In the second investigation, the convergent validity of the FIM+FAM Social Interaction was evaluated, identifying significant correlations with ecologically-valid markers of engagement (individual therapy and group participation).AppendicesThe appendices provide detail about the empirical study, including the ethical review, key measures used, a methodological critique, and clinical and theoretical implications.