Melbourne School of Psychological Sciences - Theses
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ItemAn investigation of family-centred service in the rehabilitation of paediatric acquired brain injury( 2022)Paediatric acquired brain injury (ABI) can have significant impacts on children, adolescents, and their families. Family-centred service is considered best practice in paediatric rehabilitation and emphasises the importance of supporting families and involving them in care planning, implementation, and evaluation. However, there are varied definitions and approaches to delivering family-centred service, family needs are often unrecognised and unmet in rehabilitation, and there is a lack of research evidence informed by the lived experience of families. The aim of this program of research was to develop a better understanding of family-centred service within paediatric ABI rehabilitation. The first part of this project was a scoping review of programs involving the families of children/adolescents with ABI. Information about the programs was synthesised to develop an understanding of how families are involved in ABI rehabilitation programs. The second part of this project explored subjective experiences of family-centred rehabilitation from the perspectives of children and adolescents with ABI, their families, and rehabilitation clinicians. Two qualitative studies were conducted in the context of a state-wide paediatric rehabilitation service. Across the two studies, thirteen rehabilitation clinicians, ten parents/caregivers, five siblings, and four children/adolescents with ABI participated in semi- structured interviews, and data were analysed using constructivist grounded theory methods. The findings yielded three manuscripts, one of which has been published in a peer-reviewed journal, with the remaining two submitted to journals and currently under review. Collaboration between clinicians and families during rehabilitation was identified as central to family-centred service, with participants reflecting on how this collaboration changes over time. The importance of clinicians developing an understanding of families and their unique lives following paediatric ABI was highlighted, as was the value of hearing children’s and adolescents’ voices during rehabilitation. The key role of clinicians was also emphasised, and participants recognised that the implementation of family-centred service requires active input and facilitation from clinicians. The findings contribute novel insights into family-centred service within paediatric ABI rehabilitation, with practice recommendations to support the implementation of this approach in practice. Keywords:
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ItemReconceptualising paediatric traumatic brain injury as a disorder of the ‘social brain’: a longitudinal prospective study of brain-behaviour relationships( 2017)Background: Childhood and adolescence coincide with rapid maturation of distributed neural systems implicated in complex socio-emotional behaviours; however, little is known about the impact of early traumatic brain injury on the acquisition and establishment of these skills. This longitudinal prospective study evaluates the influence of paediatric traumatic brain injury (TBI) on social cognitive and sociobehavioural functioning, and examines factors associated with long-term outcome and recovery of these skills. Method: High resolution T1, susceptibility-weighted and diffusion-weighted MRI sequences were acquired sub-acutely in 112 children and adolescents with mild-severe TBI. For comparison, 43 typically developing children of similar age and sex were scanned. Formal child outcome assessments and parent ratings of social behaviour were completed at both 6- and 24-months post-injury. Results: Findings reveal that social cognitive and sociobehavioural skills are vulnerable to long-term disruption from TBI, with evidence for a time-dependent emergence of social cognitive impairment in younger children for whom skills were emerging or not yet established at the time of injury. Poorer long-term social outcomes were documented in association with diffuse cerebral microbleeds, lower family affective responsiveness, poorer parent mental health, and grey and white matter neuroanatomical differences in large-scale neural systems implicated in social behaviour. Poorer post-acute social cognition mediated the prospective impact of sub-acute neuroanatomical abnormalities on chronic sociobehavioural problems. Conclusions: Evidence for robust brain-behaviour relationships accord with a network paradigm of sociocognitive disturbance, and should prompt clinicians to consider structural connectivity when interpreting impairments in children with TBI, especially in the domain of social cognition. Results suggest that, although high resolution MRI has potential to unlock prognostic markers associated with poorer social outcomes, neuroanatomical differences in large scale neural systems represent one of several factors that contribute to the emergence and persistence of social difficulties after child TBI. Clinicians should monitor the presence of broad range of injury, child-related, and modifiable family environmental risk factors, and incorporate these indicators into clinical management and rehabilitation planning.