Dalarna University's logo and link to the university's website

INTRODUCTION: Traumatic brain injury (TBI) is a global health issue and a leading cause of long-term disabilities and mortality worldwide. There is growing evidence that TBI rehabilitation should be differentiated and individualised according to gender to provide more effective healthcare and rehabilitation. However, there is a lack of reviews focusing on the rehabilitation for women with TBI and there is a need to summarise existing knowledge to guide and individualise their rehabilitation. This scoping review aims to identify and map evidence on content and outcome of non-pharmacological rehabilitation for women with TBI aged below 65 years.

METHODS AND ANALYSIS: This scoping review will follow the methodological guidelines of the Joanna Briggs Institute (JBI) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). The databases searched will be PubMed, CINAHL and PsycINFO. The following inclusion criteria will be applied: peer-reviewed studies published in English over the years 2000-2024 including description of content and outcomes of non-pharmacological TBI rehabilitation for women aged between 16 and 65 years in both inpatient and outpatient contexts. All severities of TBI ranging from concussion through to extremely severe will be included. Text and opinion papers, conference abstracts and grey literature will be excluded. Studies fulfilling the inclusion criteria will be independently reviewed by three researchers. A data extraction form will be used including specific details about the participants, concept, context, study methods and key findings. The results will be presented in tabular format accompanied by a narrative summary.

ETHICS AND DISSEMINATION: Due to the nature of data, no approval from an ethics committee is required. Dissemination of results are planned in an open-access peer-reviewed journal and in professional networks.

REVIEW REGISTRATION NUMBER: OSF, https://doi.org/10.17605/OSF.IO/QUY3T.

BACKGROUND: Research shows that variety of factors are related to risks of not returning to work among people with acquired brain injury (ABI). In Sweden, 40% of those with ABI in working age return to work within two years after the injury, which in line with international findings. However, since countries may differ in work rehabilitation, social security systems, culture and laws, different factors may influence the possibilities of returning to work across countries.

AIMS: The aim of this study was to investigate person, injury, activity and rehabilitation related risk markers for not return to work among persons with ABI in Sweden.

METHODS: Retrospective data of an ABI cohort of 2008 people from the WebRehab Sweden quality register were used.

RESULTS: Analyses showed that the risk ratio for not returning to work was larger for people that, among the Personal factors, were woman, born outside of Sweden, had low education level, and not having children in the household; among the injury related factors, had long (> 2 months) hospital stay, aphasia, low motor function, low cognitive function, high pain/discomfort, and high anxiety/depression; among the activity related factors, had low function in self-care, inability to perform usual activities, and had their driver´s license suspended; and finally among the rehabilitation related factors, were satisfied with treatment and having influence over their rehabilitation plan.

DISCUSSION / CONCLUSION: Several factors in different areas were risk markers for not returning to work among people with ABI. This suggest that work rehabilitation and interventions, in addition to direct injury related issues, need to address personal related, activity related and rehabilitation related factors in order to increase the patient´s possibility to return to work. Influences of general and country specific factors on returning to work among people with ABI will be discussed.

The International Network for Social Workers in Acquired Brain Injury (INSWABI) com-missioned a systematic scoping review to ascertain the social work-generated evidence base on people with traumatic brain injury (TBI) of working age. The review aimed to identify the output, impact and quality of publications authored by social workers on this topic. Study quality was evaluated through assessment frameworks drawn from the United Kingdom National Service Framework for Long- Term Conditions. In the 40- year period from 1975 to 2014, 115 items were published that met the search criteria (inter-vention studies, n = 10; observational studies, n = 52; literature reviews, n = 6; expert opinion or policy analysis, n = 39; and others, n = 8). The publications could be grouped into five major fields of practice: families, social inclusion, military, inequalities and psy-chological adjustment. There was a significant increase in the number of publications over each decade. Impact was demonstrated in that the great majority of publications had been cited at least once (80.6%, 103/115). Articles published in rehabilitation jour-nals were cited significantly more often than articles published in social work journals. A significant improvement in publication quality was observed across the four decades, with the majority of studies in the last decade rated as high quality.

Background: Many people who suffer an acquired brain injury (ABI) are of working age. There are benefits, for the patient, the workplace, and society, to finding factors that facilitate successful return to work (RTW).

Objective: The aim was to increase knowledge of opportunities and barriers for a successful RTW in patients with ABI.

Method: Five men and five women with ABI participated. All had successfully returned to work at least 20 hours a week. Their experiences were gathered by semi-structured interviews, which were subsequently subjected to qualitative content analysis.

Results: Three themes that influenced RTW were identified: individually adapted rehabilitation; motivation for RTW; and cognitive and social abilities. An individually adapted rehabilitation was judged important because the patients were involved in their own rehabilitation and required individually adapted support from rehabilitation specialists, employers, and colleagues. A moderate level of motivation for RTW was needed. Awareness of the person's cognitive and social abilities is essential, in finding compensatory strategies and adaptations.

Conclusions: It seems that the vocational rehabilitation process is a balancing act in individualized planning and support, as a partnership with the employer needs to be developed, motivation needs to be generated, and awareness built of abilities that facilitate or hinder RTW.

Background: Acquired brain injury (ABI) is often a lifelong disability that entails a marked change in a person’s life. It involves biopsychosocial levels and return to work (RTW) is one of the main goals for the person. Several of those suffering an ABI are of working age. The society and the individuals are both winners if the person could get back to work and sustain working.

Objective: The aim of this study was to increase knowledge about the opportunities and barriers for successful RTW among individuals with ABI.

Methods: Adults who have ABI and had participated in work rehabilitation were interviewed in regard to their experiences of the process. The informants (five females, five males) had participated in work rehabilitation, had successfully RTW and had worked at least 50% in at least a year after the injury. The interviews were transcribed, structured and analysed by latent content analysis with a hermeneutic approach.

Results: Three main themes that influenced RTW after ABI were identified: (i) individually adapted rehabilitation process, (ii) motivation for RTW and (iii) cognitive abilities and inabilities. The results indicate that an individually adapted vocational rehabilitation (VR) process was an important issue. The individuals with ABI actively involved in their own rehabilitation process also required continuous support from the society, the specialists, their employers and colleagues; this support has to be designed for each individual. A moderate level of motivation for RTW was necessary for the best result to RTW, in other words it was important to achieve a balance between too high and too low motivation. Finally, a comprehensive knowledge about the cognitive abilities and inabilities of the individual after ABI helped the individuals and their employers to find compensatory strategies to handle their work tasks. One implication of the findings was the necessity of a good support system and a good VR that functions well and lasts for a longer period. When there are obstacles in the VR process, it is important to have strategies and awareness of how to proceed further.

Conclusions: Consequently, the support built for a person individually, with a balanced motivation, knowledge about the cognitive abilities and awareness of how to proceed further in the process will help to build a successful and sustainable RTW.

Introduction and aim:

Return to work (RTW) after acquired brain injury (ABI) is a demanding process for the client and need support. This study’s aim was to understand the support person’s perception of supporting clients with ABI to a successful RTW.

Method:

Nine persons who acted as support persons in the vocational rehabilitation (VR) process were chosen by clients with ABI participating in a previous study. Three of the support persons had a formal mandate to support the client by the employer and six of them were characterized as providing informal support. All the support persons had different kind of work. Semi structured interviews were conducted and analyzed by latent content analysis.

Findings:

The analysis elicited three themes describing the support person’s perception in the assistance for the client to successfully RTW: (i) Commitment, (ii) Adaptation and (iii) Cooperation. Within each of the theme multiple mechanisms were identified, reflecting the complexity that the VR process had for the client. The mechanisms were about strategic issues, reflection and decision making. The support persons experienced that their role was extra valuable for the client in contexts where adaptation and cooperation was required. Commitment built on social relations is linked to sustainability of the support.

Conclusion:

Support persons play a multi-dimensional role which is important for client with ABI to successfully RTW.

The aim is to explore the perception of being a support person for clients with acquired brain injury undergoing vocational rehabilitation. Nine support persons, identified by clients with brain injury, were interviewed. Interviews were analyzed using qualitative content analysis, resulting in three themes for assisting the client: (i) commitment; (ii) adaptation; and (iii) cooperation. Within each theme, multiple dimensions were identified, reflecting the complexity of vocational rehabilitation following acquired brain injury. Commitment built on social relations is linked to sustainability of support. The included support persons' role was especially valuable in contexts where adaptation and cooperation were required.

PURPOSE: This study investigated changes in quality of life (QoL) in relation to return to work among patients with acquired brain injury (ABI).

METHOD: The sample consisted of 1487 patients with ABI (63% men) aged 18-66 years (mean age 52) from the WebRehab Sweden national quality register database. Only patients who worked at least 50% at admission to hospital and were on full sick leave at discharge from hospital were included. QoL was measured by the EuroQol EQ-5D questionnaire.

RESULTS: Patients who returned to work perceived a larger improvement in QoL from discharge to follow-up one year after injury compared to patients who had not returned to work. This difference remained after adjustment for other factors associated with improved QoL, such as having a university education, increased Extended Glasgow Outcome Scale scores and getting one's driving licence reinstated.

CONCLUSION: Return to work is an important factor for change in QoL among patients with ABI, even after adjusting for other factors related to QoL. This is consistent with the hypothesis that having employment is meaningful, increases self-esteem and fosters participation in society. Thus, helping patients with ABI return to work has a positive influence on QoL.

Research aim

The aim of this study was to increase our knowledge about the opportunities and barriers for successfully return to work (RTW) among individuals with acquired brain injury (ABI).

Methodology

Adults who have ABI were interviewed in regard to their experiences of the work rehabilitation process. The informants (5 females, 5 males) had participated in a work rehabilitation, had successfully RTW and had worked at least 50 % in at least a year after the injury. The interviews were transcribed, structured and analyzed by latent content analysis with a hermeneutic approach.

Findings and conclusions

Three main themes that influenced RTW after ABI were identified: (i) individually adapted rehabilitation process, (ii) motivation for RTW and (iii) cognitive abilities and inabilities.

The findings indicated that an individually adapted vocational rehabilitation (VR) process was important because the individuals with ABI involved actively in their own rehabilitation process and they required continuous support from the society, the specialists, their employers and colleagues. A moderate level of motivation for RTW was necessary to achieve the best result for RTW and it was important to achieve a balance between too high and too low motivation. Finally, a comprehensive knowledge about the cognitive abilities and inabilities of the individual after ABI helped the individuals and their employers to find compensatory strategies to handle their work tasks.

One implication of the findings was the necessity of a good support system and a good VR that functions well and lasts for a longer period. When there are obstacles in the VR process, it is important to have strategies and awareness of how to proceed further.

Consequently the support built for a person individually, with a balanced motivation, a high knowledge about the cognitive abilities and awareness of how to proceed further in the process will help to build a successful and sustainable RTW.

Purpose: The aim of this study is to investigate person-related, injury-related, activity-related and rehabilitation-related risk markers for not return to work among patients with acquired brain injury (ABI).

Methods: Retrospective data from the Quality register, WebRehab Sweden, on an ABI cohort of 2008 patients, was divided into two groups: those who had returned to work (n = 690) and those who had not returned to work (n = 1318) within a year of the injury.

Results: Risk ratio analyses showed that several factors were risk markers for not returning to work: personal factors, including being a woman, being born outside of Sweden, having a low education level, and not having children in the household; injury-related factors, including long hospital stay (over 2 months), aphasia, low motor function, low cognitive function, high pain/discomfort, and high anxiety/depression; activity-related factors, including low function in self-care, inability to perform usual activities, and not having a driver's license; and rehabilitation-related factors, including being dissatisfied with the rehabilitation process and the attentiveness of the staff having limited influence over the rehabilitation plan, or not having a rehabilitation plan at all. Conclusion Several factors in different aspects of life were risk markers for not returning to work among patients with ABI. This suggests that rehabilitation and interventions need to address not only direct injury-related issues, but also person-related, activity-related, and rehabilitation-related factors in order to increase the patient's opportunities to return to work.

Att stödja patienter i rehabilitering efter stroke är en viktig funktion för hälsoochsjukvårdskuratorn. I denna artikel analyseras hälso- och sjukvårdskuratornsfunktion utifrån ett systemteoretiskt perspektiv med stöd av patienternaserfarenheter av resiliens och livskvalitet. Intervjuer med 19 personermed stroke sekundäranalyserades tematiskt och resulterade i fem områdenav betydelse för hälso- och sjukvårdskuratorns funktion. De teman somframkom på mikronivå var: trygghet och förutsägbarhet; mening och hopp.På mesonivå: socialt och formellt stöd; samordna och informera. På makronivå:kunskapsspridning och kompetens. Den legitimerade hälso- och sjukvårdskuratornfunktioner återfinns således systemteoretiskt på alla nivåervilket innebär att de professionellt antar en helhetssyn med fokus på individeni relation till dennes situation och kontext.

Citizen perceptions of justice, regarding both processes and outcomes, are closely related to the perceived legitimacy of the authorities involved and are thus significant for trust. This study investigates how a withdrawn driving license due to visual field loss might affect trust in the authorities involved in withdrawal processes and outcomes: the health-care system, the Swedish Transport Agency, and the judicial system. The factors influencing trust were investigated as was whether the withdrawal experience had changed the trust in other authorities not involved in the withdrawal process. Also, the aetiology of the visual field loss and gender were investigated. A survey study was conducted in which 402 Swedish respondents with visual field loss and a withdrawal experience participated. Variance, regression, and content analyses were conducted. The following conceptual factors were used in understanding trust: Benevolence, Openness, Integrity, Ability, and Value Congruence. The results revealed that processes and outcomes affected the overall trust in all three authorities, although the highest trust was in the health-care system (but still low). Diagnosis, but not gender, was important for the experienced trust. Differences in levels of trust in each authority were related to the aetiology of the diagnosis. Benevolence and Ability were the trust factors most important for overall trust in the health-care system and the Swedish Transport Agency. For some respondents (46%), the negative experiences of the withdrawal had worsened their trust in other, not involved authorities, as well. © 2023 The Author(s)

Citizens’ trust of authorities is of general importance, as it can affect trust in society as a whole. The Swedish Transport Agency is a state administrative authority responsible for driving license withdrawal. If withdrawals are experienced as unfair by those affected, this might lead to decreased trust in the agency and in other actors involved. This study accordingly examines how the experiences of people who have had their driving license for a private car withdrawn due to visual field loss might affect their distrust of the authorities, as related to outcomes and processes. Follow-up interviews were conducted with nine people from a previous study. Content analysis revealed one overarching theme, struggling for justice within a system perceived as unfair, which comprised four identified categories: preparedness for and understanding of the withdrawn driving license (WDL); perceptions of assessment methods, reactions and actions regarding the decision, and perceptions of the authorities’ performance. In sum, the vision tests on which withdrawals are based were perceived as unfair, as they did not measure individual driving ability. Furthermore, rejections of appeals led to feelings of hopelessness. Distrust regarding outcomes and processes related to the withdrawals was also fueled by experiences of deficiencies regarding, for example, performance and information.

The purpose of this study is to illuminate the changeover process experienced by people with traumatic brain injury (TBI) and increases the understanding of social recognition occurring after injury. Fifteen persons, ageds 28-56, with TBI have been in-depth interviewed. Data were first analysed by latent-content analysis using a hermeneutic approach, and later re-contextualised within a matrix constructed from theories of social recognition. Results were initially structured into six themes and then re-described in terms of recognition, i.e. the individual dimension, the legal dimension and the value dimension. The conclusions suggest that people with TBI experience both recognition and non-recognition during the recovery process and later in life, living in society with the sequel of TBI. Such experiences are described on all dimensions.

The purpose of this study is to illuminate the changeover process experienced by people with traumatic brain injury (TBI) and to increase the understanding of the process of social recognition aroused after injury.

Persons who have acquired TBI have been interviewed (in-depth) using an interview-guide. Informants were in total 15, aged 28-56. Data were first structured and analysed by latent-content analysis with a hermeneutic approach, and later re-contextualised within a matrix construct from theories of social recognition.

The results were in the first step structured into six themes: meaning of care, meaning of action, autonomy, social interaction, theme of changes, emotions, and in the next step re-described in terms of social recognition, i.e. the individual dimension, the legal dimension and the value dimension.

Conclusions: Significant others have had an important function as a driving force for life-situation after injury. Informants were initially satisfied with support from society. The recovery was a prolonged process, probably never ending. The individual dimension is principally connected to the individuals’ experiences of their primary-relations, e.g. next of kin. The legal dimension is closely associated to rules and regulations in society, e.g. disability rights. The value dimension is related to standards and value-system in society, e.g. solidarity.

Objectives: The overall purpose of this study is to illuminate the changeover process experienced by people with traumatic brain injury (TBI) in every day life and to increase our understanding of this process. Three main questions are in focus: (i) the process in time, (ii) social support and (iii) long-term consequences.

Methods: Persons who as adults acquire a TBI have been interviewed using an interview guide comprising six themes: (i) consequences of TBI, (ii) family and social network, (iii) working life and occupation, (iv) life-changes, (v) support from society and (vi) every day life. The interviews are qualitative deep interviews, lasting 1-2 hours. The informants were in total 15, aged 19-53 when injured and 28-56 when interviewed.

Results: Reported consequences were positive as well as negative, some were of physical, cognitive or psychosocial sort, e.g. 11 had problems with movements and coordination, 11 had memory disorder and 10 reported depression. The positive consequences were, e.g. better self-knowledge, deeper family ties and new life values. A majority of the informants had difficulties in returning to the work force. Almost all had in hospital rehabilitation in connection to the initial hospital care.

Conclusion: A preliminarily conclusion shows that significant others, e.g. next of kin, have had an important function as a driving force for training and for the life-situation after injury. Moreover, a majority of those interviewed were satisfied with support from society, e.g. hospital-care, rehabilitation and community support. Such support, initially, flew without problems but demanded more of the TBI-personals’ initiatives to work out in the extension. A long-term support which deals with physical, cognitive as well as psychosocial consequences is important for the outcomes in everyday life.

Objectives: The overall purpose of this study is to illuminate the changeover process experienced by people with traumatic brain injury (TBI) in every day life and to increase our understanding of this process. Three main questions are in focus: the process, social support and long-term consequences.

Methods: Persons who as adults acquire a TBI have been interviewed using an interview guide comprising six areas: consequences of TBI, family and social network, working life and occupation, life-changes, support from society and every day life. The interviews are qualitative in-depth interviews. Informants were in total 15, aged 19-53 when injured. Data were structured and analysed by latent content analysis with a hermeneutic approach, and later within a theory of social recognition.

Results: The findings were presented in six themes: the meaning of care, a question of formal versus informal support, the theme of changes, a question of process versus stagnation, the meaning of action, a question of activity versus inactivity, social interaction, a question of encounter and treatment, empowerment, a question of dependence versus independence, emotions, a oscillation between hope and hopelessness.

Conclusions: A preliminarily conclusion shows that significant others, e.g. next of kin, have had an important function as a driving force for training and for life-situation after injury. A majority of the interviewed were satisfied with support from society, e.g. hospital-care, rehabilitation and community support. Such support, initially, flew without problems but demanded more of the TBI-personals’ initiatives to work out in the extension. A long-term support which deals with physical, cognitive as well as psychosocial consequences is important for outcomes in everyday life. Reported consequences were negative as well as positive.

The purpose of this study is to illuminate the changeover process, support and consequences experienced by adults who acquired traumatic brain injury (TBI). Fifteen persons were in-depth interviewed using a semi-structured interview guide. Data were analysed by latent-content analysis and structured into six themes.

Consequences were negative as well as positive. Significant others were important as a driving force for training and life-situation. The informants were initially satisfied with social supports but in the longer term became more critical regarding accessibility to such supports. The majority had difficulties in returning to working-life after injury. The outcomes seemed to be a prolonged process, probably never-ending, which gradually became integrated as a part of life.

Att förvärva en hjärnskada i vuxen ålder innebär en livsomställning som för de allra flesta medför behov av stöd i form av rehabiliteringsinsatser för att kunna återgå till ett fungerande vardagsliv. Rehabiliteringen kan utformas på många olika sätt och det finns ingen naturlig samordning av rehabiliteringsinsatser. På senare år har vi dock kunnat se att samhället rest krav på att rehabiliteringsaktörer måste samordna sina insatser. Det har bland annat uttryckts i Samordnad individuell plan (SIP) och i Individuell plan (IP) och är lagstadgat, samt i författningen om Samordning av insatser för habilitering och rehabilitering (SOSFS 2007:10). Inom rehabiliteringen för personer med förvärvad hjärnskada har även behovet av en samordnad vårdkedja artikulerats inom det akuta, det subakuta såväl som det sena skedet. Enligt Socialstyrelsen (2012) finns särskilda samordningsresurser endast i ett fåtal landsting/regioner. Detta kapitel kommer att fokusera på en stöd- och samordningsfunktion, case management, för personer som i vuxen ålder förvärvat en hjärnskada.

Inom hjärnskaderehabiliteringen har det under den senaste tiden införts case managers, eller i Sverige så kallade hjärnskadekoordinatorer, i syfte att vara en oberoende stöd- och resursperson för den som förvärvat en hjärnskada och dennes anhöriga. En övergripande målsättning med denna stödform är att tillsammans med den skadade och dennes anhöriga samordna och koordinera samhällets olika vård- och omsorgsinsatser. Syftet med kapitlet är att beskriva denna stödform med särskilt fokus på relationsarbetet mellan case managern och klienten med förvärvad hjärnskada eller dennes anhöriga.

Approximately 70 000 acquire a brain injury yearly in Sweden which often result in disabilities. Acquired brain injury (ABI) can be caused by trauma, stroke or disease. The rehabilitation process is divided into acute and subacute phase and the late stage. Studies shows that clients with moderate and severe injuries have difficulties in coordinating rehabilitation and societal support. Rehabilitation can be a long-term process and clients with ABI are often referred to next of kin for coordinating societal support, e.g. rehabilitation and social services. Case-management have since 1980’s been a rehabilitation support in an international perspective, but in a Swedish context it is a relatively new form of support.

The aim is to describe, based on a book chapter (Strandberg 2018), how this form of support has been developed in Sweden, as well as putting the form of support in relation to the client’s empowerment.

The results show that there are different theoretical models for how Case-management can be organized, the support is designed differently in different countries and context. Furthermore, it is demonstrated that the support may be helpful to the client as well as the next of kin in terms of participation.

Although, Case-management has been known since 1980s, the scientific studies are limited and there is no evidence for the clinical significance using this support. Research is therefore necessary to demonstrate its clinical significance.

Approximately 70 000 acquire a brain injury yearly in Sweden which often result in disabilities. Acquired brain injury (ABI) can be caused by trauma, stroke or disease. The rehabilitation process is divided into acute and subacute phase and the late stage. Studies shows that clients with moderate and severe injuries have difficulties in coordinating rehabilitation and societal support. Rehabilitation can be a long-term process and clients with ABI are often referred to next of kin for coordinating societal support, e.g. rehabilitation and social services. Case-management have since 1980’s been a rehabilitation support in an international perspective, but in a Swedish context it is a relatively new form of support.

The aim is to describe, based on a book chapter (Strandberg 2018), how this form of support has been developed in Sweden, as well as putting the form of support in relation to the client’s empowerment.

The results show that there are different theoretical models for how Case-management can be organized, the support is designed differently in different countries and context. Furthermore, it is demonstrated that the support may be helpful to the client as well as the next of kin in terms of participation.

Although, Case-management has been known since 1980s, the scientific studies are limited and there is no evidence for the clinical significance using this support. Research is therefore necessary to demonstrate its clinical significance.

The purpose of this study is to illuminate the changeover process experienced by people with traumatic brain injury (TBI) and to increase the understanding of the process of social recognition aroused after injury. 

Persons who have acquired TBI have been interviewed (in-depth) using an interview-guide. Informants were in total 15, aged 28-56. Data were first structured and analysed by latent-content analysis with a hermeneutic approach, and later re-contextualised within a matrix construct from theories of social recognition.

The results were in the first step structured into six themes: meaning of care, meaning of action, autonomy, social interaction, theme of changes, emotions, and in the next step re-described in terms of social recognition, i.e. the individual dimension, the legal dimension and the value dimension.

Conclusions: Significant others have had an important function as a driving force for life-situation after injury. Informants were initially satisfied with support from society. The recovery was a prolonged process, probably never ending. According to the theories of social recognition:

(I) The individual dimension is principally connected to the individuals’ experiences of their primary-relations, e.g. next of kin.

(II) The legal dimension is closely associated to rules and regulations in society, e.g. disability rights.

(III) The value dimension is related to standards and value-system in society, e.g. solidarity.

The overall purpose of this study is to investigate the rehabilitation process facilitating return to working life after acquired brain injury (ABI) according to: (I) experiences of the rehabilitation process – possibilities and challenges, and (II) long-term perspective – factors that facilitate a sustainable working life. The study was undertaken within a disability research paradigm. Specifically, this study was derived from a social perspective in studying outcomes in vocational rehabilitation.

Persons who acquired a brain injury as adults were interviewed using an interview guide focusing the experiences of the rehabilitation process. The informants (5 females, 5 males) had participated in a work rehabilitation program and successfully returned to work, at least 50 % for a minimum period of one year. The interviews were qualitative. Data were structured and analysed by latent content analysis with a hermeneutic approach, and analysed within a social science theory.

The findings are preliminary. Many of those who as adults acquired a brain injury are already established at the labour market. Accordingly return to work could be seen as easier for the ABI group than for other unemployed groups of disabled. Despite this, many of those with ABI have difficulties in return to work after injury due to different circumstances. Therefore it is important to identify such circumstances. An important aim for the rehabilitation process is a long-term perspective in maintaining a job. Some factors of importance for the rehabilitation outcomes can be summarised as: assistive devices, support at the working place, social insurance and individual motivation. Such knowledge is important for the rehabilitation practitioner when meeting clients’ in the stage of work rehabilitation. The implications of this study can be useful in both rehabilitation medicines as well as for social workers in supporting people with ABI.

Background

The overall purpose of this study is to investigate the rehabilitation process facilitating return to working life after ABI. Two main themes are in focus: (I) experiences of the rehabilitation process – possibilities and challenges, and (II) long-term perspective – factors that facilitate a sustainable working life. The study was undertaken within a disability research paradigm, which is an interdisciplinary approach that includes medical, technical, behavioural and socio-cultural perspectives. Specifically, this study was derived from a social perspective in studying outcomes in working life after ABI.

 Methodology

Persons who acquired a brain injury as adults were interviewed using an interview guide focusing the experiences of the rehabilitation process. The informants (6 females and 6 males) had participated in a work rehabilitation program and successfully returned to work. Importantly, at least 50 % maintained employment for a minimum period of one year. In some cases, a person (e.g. family member, service provider, and employer) who had been of great importance for the rehabilitation process was also interviewed. The interviews were qualitative, in-depth, and are being conducted longitudinally at the autumn 2010. Data will be structured and analysed by latent content analysis with a hermeneutic approach, and analysed within a social science theory.

Results

The findings are preliminary and can only be presented as hypotheses. Many of those who as adults acquired a brain injury are already established in the labour market. Accordingly return to work could be seen as easier for the ABI group than for other unemployed groups of disabled. Despite this, many of the cases with ABI have difficulties in returning to work after injury concerning different circumstances. Relating to that it is important to identify such circumstances, especially possibilities. An important aim for the rehabilitation process is a long-term perspective in maintaining a job after injury. Some factors of importance for the rehabilitation outcomes can be summarised as: assistive devices, support at the working place, social insurance and individual motivation.

Conclusions

Such knowledge is of great importance for the rehabilitation practitioner when meeting clients’ in the stage of work rehabilitation. The implications of this study can be useful in both rehabilitation medicine as well as for social workers in supporting people with ABI who have vocational goals. The common aim is to develop a program for work rehabilitation for people with ABI.

The article is built upon tree topics: feminism, sexuality and disability. The purpose is to illuminate traumatic brain injury (TBI) among women in perspectives of gender, role and sexuality. On the basis of literature studies the article summarize (i) gender specific onsequences for women (ii) sexual consequences for women (iii) women role changes.

The article brings up sexual consequences with TBI as increased and decreased sexual lust and problem with orgasms. Role changes are illuminated as working role, hobbyist and role as a family member. Even gender specific differences between cognition and emotion are mentioned.

The article set focus on TBI as a hidden less recognised consequence for battered women. Gender perspectives are problemized and discussed in connection to TBI. Thinking in processes is described in purpose to give a more holistic perspective on mankind and its sexuality. Violence against women having TBI and frequents of injuries seen in a gender perspective is mentioned.

Background: Disability research as an academic field was established in 1960s and 1970s in the Nordic countries as in the Anglo-Saxon world. Disability research was studied within the medical model, e.g. in medical and rehabilitation studies, while disability studies became a part of the social model, e.g. in social and psychological studies. According to a Nordic context disability was mainly studied within medicine, social science and special education (Roulstone, 2013).

It has been a lack of theoretical perspective in disability research and according to that a discussion of theoretical approaches in disability studies has been raised during the recent years (see e.g. Gustavsson, 2004; Bhaskar & Danermark, 2006; Söder, 2013).

Aim: The aim of this paper is conceptually to describe and illustrate how vertical and horizontal knowledge integration appears in disability research, with an example from a study within brain injury.

Results: Vertical integration is an understanding between different levels on a biological, psychological and social level. Horizontal integration is an understanding across varying disabilities. The study indicates that vertical and horizontal integration in disability research are useful for a broader and deeper understanding of the phenomena. It also indicates that different theoretical perspectives has been more common in disability research during last years and fill an important need in the development of disability research as an academic field.

Disability research as an academic field was established in1960s and 1970s in the Nordic countries as in the Anglo-Saxon world. Disability research was studied within the medical model, e.g. in medical and rehabilitation studies, while disability studies became a part of the social model, e.g. in social and psychological studies. According to a Nordic context disability was mainly studied within medicine, social science and special education (Roulstone, 2013).

It has been a lack of theoretical perspective in disability research and according to that a discussion of theoretical approaches in disability studies has been raised during the recent years (see e.g. Gustavsson, 2004; Bhaskar & Danermark, 2006; Söder, 2013).

The aim of this paper is conceptually to describe and illustrate how vertical and horizontal knowledge integration appears in disability research, with an example from a study within brain injury.

Vertical integration is an understanding between different levels on a biological, psychological and social level. Horizontal integration is an understanding across varying disabilities. Beside those concepts a bio-psycho-social perspective is mentioned and two theoretical approaches within disability research are described: human functioning sciences and interdisciplinary research. 

The study indicates that vertical and horizontal knowledge-integration in disability research are useful for a broader and deeper understanding of the phenomena. It also indicates that different theoretical perspectives has been more common in disability research during last years and fill an important need in the development of disability research as an academic field.

The aim of this paper is conceptually to describe and illustrate how vertical and horizontal integration appear in disability research. Beside those concepts a bio-psycho-social perspective is mentioned and two theoretical approaches within disability research are described: human functioning sciences and interdisciplinary research. Vertical integration is an understanding between different levels on a biological, psychological and social level. Horizontal integration is an understanding across varying disabilities. The study indicates that vertical and horizontal integration in disability research are useful for a broader and deeper understanding. Different theoretical perspective has been more common in disability research during last years.

The overall purpose of this study is to illuminate the changeover process experienced by individuals who as adults acquired a traumatic brain injury (TBI), to increase the knowledge and the understanding of this process, and describe the meaning of support in every day life.

Persons who acquired a TBI as adults were administered a semi-structured interview covering six areas: consequences of TBI, family and social networks, working life and occupation, life-changes, support from society and everyday life. The interviews were qualitative and in-depth. A total of 15 informants participated, aged between 19-53 years when injured. Data were structured and underwent two phases of analysis. In the first phase, data underwent latent content analysis, underpinned by a hermeneutic approach, and in the subsequent phase, reanalysed within a framework derived from the theory of social recognition.

Findings from the first phase of inductive analysis elicited key themes: (i) the meaning of care, a question of formal and/or informal support; (ii) the meaning of action, a question of activity versus inactivity; (iii) autonomy, a question of dependence versus independence; (iv) social interaction, a question of encounter and/or treatment; (v) the theme of changes, a question of process versus stagnation; and (vi) emotions, an oscillation between hope versus hopelessness. After the construction of the six themes each of them were, through a discursive analysis, connected with theories, earlier studies in the field of brain injuries and important interview quotations from the empirical material. During this phase, an interest developed to study the material from a new theoretical point of view. The second phase of analysis therefore involved the development of a framework derived from Honneth’s (1995) theory of social recognition. The central construct of ‘recognition’ was analysed from three different dimensions proposed by Honneth: the individual dimension, the legal dimension, the value dimension. Using this framework, the data were reanalysed. The scientific term for this process of re-contextualisation and re-description of data is abduction inference.

Reported consequences were negative as well as positive. Significant others (e.g. next of kin) had an important function as a driving force for training and preparation for life-situation after injury. A majority of the informants were satisfied with support from society, such as hospital-care, rehabilitation and community support. Such support, initially, proceeded without problems but as time passed, the responsibility shifted to the person with TBI to take the initiative in arranging longer-term services. Long-term support which addresses physical, cognitive as well as psychosocial consequences of the TBI is important for outcomes. The majority of the informants had difficulties in returning to working life after the injury. The outcomes and recovery seemed to be a prolonged process, probably never ending, but which gradually over time becomes integrated as a part of life. The informants gave varying accounts of the extent to which they experienced social recognition.

BAKGRUND

Flertalet av dem som förvärvar en traumatisk hjärnskada får vanligtvis funktionsnedsättningar av varierande slag som kan påverka vardagslivet med ibland livslånga konsekvenser som följd. Sådana förändringar kan grovt indelat vara av fysisk, perceptuell, minnesmässig och/eller kognitiv art, samt av beteende, personlighet och/eller social och relationsmässig karaktär. Tidigare studier som fokuserar de hjärnskadades egna erfarenheter av att leva med sådana funktionsnedsättningar är begränsade särskilt inom det socialvetenskapliga området. Att belysa och öka förståelsen för de hjärnskadades livssituation, omställningsprocess och återanpassning till vardagslivet är därför av betydelse och legitimerar behovet av dylika studier. Samhällsnyttan av sådana studier kan i förlängningen innebära att vård och rehabilitering, samt stöd och omsorgsformer utvecklas så att personer med förvärvad hjärnskada kan ta del av ett ännu bättre och för dem anpassat samhällsstöd.

SYFTE

Syftet med studien är att öka kunskapen för, samt att belysa omställningsprocesser och konsekvenser som vuxna personer med traumatisk hjärnskada erfar och upplever i vardagslivet och i samhällsstödet efter en förvärvad traumatisk hjärnskada.

METOD

Studien antar en intensiv (kvalitativ) ansats. Genom semistrukturerade djupintervjuer har 15 personer berättat om sina erfarenheter av att leva med traumatisk hjärnskada. Intervjuguiden består av sex frågeområden: konsekvenser till följd av skadan, familjeliv och socialt nätverk, arbetsliv och sysselsättning, livsförändring, samhällsstöd samt vardagsliv. Informanterna var vid intervjutillfället i åldrarna 28-56 år. Datamaterialet har strukturerats och analyserats induktivt, utifrån en tolkande innehållsanalys och kommer senare att analyseras abduktivt, utifrån Axel Honneths teori om socialt erkännande.

RESULTAT

Det preliminära resultatet från innehållsanalysen redovisas i sex övergripande teman som konstituerar de intervjuades erfarenheter av att leva ett vardagsliv med traumatisk hjärnskada. Dessa teman redovisas i form av dikotomier och kopplas till tidigare studier och teoretiska antaganden: Omsorgens betydelse, en fråga om informellt vs formellt stöd. Handlingens betydelse, en fråga om aktivitet vs inaktivitet. Empowerment, en fråga om självständighet vs osjälvständighet. Social interaktion, en fråga om möte och bemötande. Förändringens tema, en fråga om process vs stagnation. Emotioner, en pendling mellan hopp och hopplöshet.

SLUTSATS

Studien är i process och konklusionen är därför preliminär. Den påvisar bl.a. att betydelsefulla andra, t.ex. anhöriga har en viktig funktion att fylla som motivation och drivkraft för träning, återkomst och för livssituationen efter skadan. De intervjuade var initialt nöjda med samhällets stöd, t.ex. med avseende på rehabilitering, ett stöd som till en början fungerat väl men som senare under processen krävt allt mer av egen aktivitet för att fungera. Rapporterade konsekvenser är såväl negativa som positiva.