PURPOSE: Best practice guidelines for neurorehabilitation recommend coordinated rehabilitation programmes to ensure seamless service transitions and comprehensive rehabilitation practices. However, this recommendation for practice and the evidence informing its advancement is based on unexamined assumptions. Therefore, this study investigates bio-psycho-social outcomes and perceptions of a coordinated rehabilitation programme. METHOD: In a prospective, naturalistic mixed methods study, rehabilitation outcomes for 82 adults (18–66 years) with moderate to severe acquired brain injury were investigated. Clients who received the coordinated rehabilitation programme KORE ( n = 27) were compared to clients from the same area who received standard rehabilitation prior to the implementation of the KORE programme ( n = 37) and clients who received other coordinated efforts elsewhere ( n = 18). The study employed quantitative data from standardized tests (Functional Independence Measure, Major Depression Inventory, Quality of life, and Impact on Participation and Autonomy Questionnaire, as well as information on return to work and qualitative interviews with clients ( n = 82) and their relatives ( n = 40). RESULTS: Outcomes did not improve from hospital discharge to two years later. Notably, physiological recovery had probably been achieved to the extent possible, but depression and reduced psychological well-being remained prevalent across groups. Qualitative interviews suggested several barriers to improvement, such as identity dilemmas and unmet needs for psychological support, while rehabilitation services focused on physical and practical training. CONCLUSION: Coordinated interventions do not guarantee comprehensive rehabilitation and better outcomes for clients with acquired brain injury. Psychological support seems to be important and largely unaddressed.

The transition from being well and fully functioning to being suddenly disabled by an acquired brain injury (ABI) and having to start a recovery process has a huge impact on a person’s life and, presumably, identity. However, research is still sparse on the psychosocial consequences of ABI, and there is a lack of identity research based on interviews with clients, i.e. exploring how clients themselves construct their situations, and recovery processes following ABI. The present study aims to fill this gap by investigating identity (re‑)construction after ABI and possible changes throughout the recovery process. The data is part of a larger mixed-method longitudinal study and focuses on narrative identity constructions. This paper draws on interviews (semi-structured) with 42 Danish adults aged 18–66 years with moderate or severe ABI. The participants were interviewed twice. The first interview was conducted while they were hospitalized and the second one-year post injury in their own homes. This article describes the key patterns of identity construction in this cohort, and explores those patterns more explicitly through the use of a single case study. It investigates re-constructions of identity through self-narratives by appeal to methods of discourse analysis, drawing especially on the concept of positioning, and placing particular focus on changes and developmental processes in these self-narratives. The narrative re-constructions point to a developmental change of identity in the course of the different phases of the recovery process, including conflicting voices from society, service providers and other adults with ABI. Results will be discussed in the light of current identity research.

Purpose: Clients with an acquired brain injury (ABI) are at risk of mental health problems and it has been argued that transitions throughout the rehabilitation process are a challenge for rehabilitation practice; however, the link between transitions and psychosocial outcome has been under-researched. Therefore, this study aims to (1) investigate the status of clients with moderate or severe ABI two-year post-discharge on the following outcomes variables: Physical and cognitive function, depression, quality of life, civil and work status, (2) examine correlations between these outcomes and (3) explore through qualitative interviews the subjective experiences of individuals with ABI in order to increase our understanding of clients’ perspectives on this outcome and its relation to life transitions in a two-year period.Method: 37 individuals aged 18–66 with moderate or severe ABI were interviewed two years after discharge. At this time, they also completed standard measures of depression (MDI), quality of life (WHOQOL-bref) and functional independence (FIM™). Historical data of their FIM™ status at discharge were obtained for comparison.Results: We found psychological problems two years post-hospitalization, especially depression (35.1%) and decreased psychological QOL (61%). Analysis of interviews found six main factors perceived as important for psychosocial outcome: family relations, return to work, waiting lists, psychological support, fatigue and personal competences.Conclusions: Clients’ status two years post-hospitalization is often characterized by psychological problems. Based on clients’ accounts, we found a connection between psychosocial outcome and life transition experiences and developed a model of factors that are perceived as helping and hindering positive outcome.

Acquired brain injury (ABI) represents a great burden for not only the person with ABI but also their partner. Grief among partners of adults with ABI is a broadly recognized phenomenon. However, few studies have examined partners’ experience of grief, and little is known about grief as a reaction to ambiguous loss. This article presents a phenomenological study that aimed to explore the experience of grief among caregiving partners. Four semi-structured interviews were conducted and analyzed by a phenomenological descriptive analysis. Through the analysis, nine themes were identified: the process of becoming a caregiver, grief emotions, loss, emotionally closer relations to the partner relations, dyadic coping, unmet needs for support, future opportunities, changes over the life course, and understanding of grief. The themes are interrelated and highlight various aspects of the phenomenon of grief as experienced by caregivers. Results reveal that grief is often a reaction to ambiguous loss and is experienced as disenfranchised. Furthermore, the study indicates that caregivers’ perception of grief and the situation in general were essential to the experience of grief.

Several studies have investigated biopsychosocial consequences after acquired brain injury (ABI) in the early rehabilitation phases. However, longitudinal studies are rare and few go beyond three years post-injury. The aim of the present study was to assess biopsychosocial challenges in a long term perspective and investigate which challenges remain after five years. With reference to the biopsychosocial model our study holds a special emphasis on the psychosocial aspects of it. Methods: Adults (N = 45) with moderate or severe ABI were evaluated at three time points: at discharge from hospitalization, 1-year post-injury, and 5-year follow-up. Data were derived from self-reported questionnaires: Major Depression Inventory, Quality of life, Impact on Participation and Autonomy Questionnaire and self-reports on work and marital status. Repeated measures ANOVAs were used for analysis. Results: Physical QOL and aspects of autonomy increased over time whereas social QOL decreased. Family roles were challenged at discharge and remained so at 1-year and 5-year follow-up, and the frequency of being married or in a relationship dropped. Level of depression did not change significantly over time, and one in four were still above clinical cut-off at the 5-year follow-up. Employment increased over time but remained less than half of the pre-injury level. Conclusion: Improvements in perceived physical function and autonomy are possible long after the injury, whereas social relations remain a challenge and signs of depression persist.

A severe mental illness like Post Traumatic Stress Disorder (PTSD) is known to have psychosocial consequences that can lead to a decreased quality of life. Research in Animal-Assisted Therapy (AAT) has revealed that the presence of a dog can have a positive effect on health, e.g., increase quality of life and lessen depression and anxiety. However, canine companionship is not a catch-all solution. Previous research has revealed methodological limitations that prohibit any clear conclusions, as well as a sparsity of critical reflection in anecdotal reports and case studies, which means that more research is needed to contextualize the findings. There has been an increasing interest in animal-assisted intervention in Denmark in recent years. Previously, authorities could only grant service dogs to adults with physical disabilities, but now this has been extended to adults with mental illnesses. Therefore, it has become important to explore how these service dogs are incorporated into rehabilitation practices in mental health, and how rehabilitation professionals react to the use of service dogs. This paper is a case study of a person who suffers from PTSD. This study examines how the person describes the significance of having a dog during her rehabilitation process, and how this is integrated with existing rehabilitation. The case study has been developed based on a semi-structured interview. A Thematic Content analysis was used to reveal dominant patterns and categories. This study revealed a lack of communication and collaboration between public administration (social service), service dog providers, health rehabilitation services, and providers of psychological treatment. It also revealed limited access for the dog to public services, limited success in incorporating the dog into goal-directed treatment and rehabilitation procedures, a strongly felt emotional support from the dog, and a perceived stigma by having the dog wearing a vest with he words “mentally ill” printed on it.