BACKGROUND: Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a stepped-wedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staff and 2.Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service received, and improved hospital experience. Assessments were undertaken at baseline, 12- and 26-weeks post-injury. Only MPCs and hospital experience were found to improve among intervention patients. We report on the process evaluation aiming to support interpretation and translation of results.
METHODS: Using mixed methods, the evaluation design was informed by the Consolidated Framework for Implementation Research. Data sources included minutes, project logs, surveys, semi-structured interviews, and observations. Four evaluation questions provided a basis for systematic determination of the quality of the trial. Findings from separate sources were combined to synthesise the emerging themes that addressed the evaluation questions. Three components were considered separately: the trial process, CST and ABIC.
RESULTS: The complex HRW trial was implemented to a satisfactory level despite challenging setting factors, particularly rural-urban system dynamics. Patient recruitment constraints could not be overcome. The vulnerability of stepped-wedge designs to time effects influenced recruitment and trial results, due to COVID. Despite relatively high follow-up, including to rural/remote areas, data points were reduced. The lack of culturally appropriate assessment tools influenced the quality/completeness of assessment data. The ABIC role was deemed feasible and well-received. The CST involved complex logistics, but rated highly although online components were often incomplete. Project management was responsive to staff, patients and setting factors.
CONCLUSIONS: Despite mostly equivocal results, the ABIC role was feasible within mainstream hospitals and the CST was highly valued. Learnings will help build robust state-wide models of culturally secure rehabilitation for Aboriginal people after brain injury, including MPC, workforce, training and follow-up.

BACKGROUND: People with acquired brain injury (ABI) may experience concurrent conditions such as, mental health and substance use concerns, that require specialized care. There are services that aim to support people with ABI and these conditions separately; however, little is known about the facilitators and barriers of these services. Therefore, the purpose of this study was to engage stakeholders to investigate the facilitators and barriers of healthcare services for ABI and concurrent issues.
METHODS: Semi-structured focus groups were conducted in-person and virtually with people with ABI, caregivers, healthcare professionals, and policy makers during a one-day event in British Columbia, Canada. Manifest content analysis was used with a constructivist perspective to analyze data.
RESULTS: 90 participants (including 34 people with ABI) provided insights during 15 simultaneous focus groups. Three categories were identified: (1) complexity of ABI, (2) supports, (3) structure of care. Complexity of ABI outlined the ongoing basic needs after ABI and highlighted the need for public awareness of ABI. Supports outlined healthcare professional and community-based supports. Structure of care described people with ABI needing to meet criteria for support, experiences of navigating through the system and necessity of integrated services.
CONCLUSIONS: These findings highlight the facilitators and barriers of healthcare services for ABI and concurrent conditions and provide insights into the changes that may be needed. Doing so can improve the accessibility and quality of ABI healthcare services.

UNASSIGNED: People with acquired brain injury (ABI) often have Social Cognition (SC) deficits. Impairment of SC causes the individual to have difficulties in daily functioning and can lead to social isolation. Research aimed at rehabilitation of SC in individuals with ABI is scarce and almost always addresses only one component of this ability.
UNASSIGNED: This pilot study aimed to assess the effectiveness of the new \"SocialMind\" program in improving all core components of SC in people with ABI.
UNASSIGNED: The study included 31 participants with ABI, divided into experimental and control groups. The study spanned 44 weeks, involving an initial meeting, evaluation, training, and final assessment phases. The SocialMind program, structured into four modules, each with a duration of 30 h, targeted each SC component through tailored exercises. The program addressed emotion recognition, social awareness, ToM, and empathy.
UNASSIGNED: The SocialMind group demonstrated significant improvements in emotion recognition (p = 0.017), social knowledge (p < 0.001), and empathy (p = 0.001) compared to the control group. ToM also showed a notable improvement that approached significance (p = 0.057).
UNASSIGNED: This pilot study suggests that the SocialMind program effectively enhances three of the four core components of SC in individuals with ABI.

Background/Objectives: Acquired brain injury (ABI) is a major cause of global disability. Many ABI patients exhibit oculomotor dysfunctions that impact their daily life and rehabilitation outcomes. Current clinical tools for oculomotor function (OMF) assessment are limited in their usability. In this proof-of-principle study, we aimed to develop an efficient tool for OMF screening and to assess the feasibility, acceptability, and relevance in a small sample of ABI and control participants. Methods: We created the Rehabilitation Oculomotor Screening Evaluation (ROSE) by reviewing existing OMF assessments. ROSE was pilot-tested on ABI patients (n = 10) and age-matched controls (n = 10). Data regarding the characteristics of the assessment, such as the duration, level of participant comprehension, and participant experience were also collected. Results: ROSE takes <20 min (x¯ = 12.5), is easy to complete (agreement x¯ = 4.6/5), and is well-accepted (x¯ = 4.8/5). Patients scored higher in all subtests and total score (x¯ = 34.8 for ABI vs. 8.9 for controls). Most subtests did not provoke any symptoms, especially for controls. There were no significant between-group differences in symptom provocation. This proof-of-principle study shows that ROSE is feasible, acceptable, and relevant for adult ABI patients. Conclusions: ROSE needs further evaluation for reliability testing and validation in larger samples and diverse neurological conditions. Establishing norms for various ages, sexes, and populations should be considered for the deployment of ROSE as an OMF clinical tool.

Low vitamin D (VD) has been associated with poor clinical course in several neurological diseases. Supplementation has been suggested to improve outcomes. Severe acquired brain injury (sABI) subjects have low VD levels and disabling conditions requiring rehabilitation. The aim of the present study was to evaluate if VD supplementation produced a better clinical course and a better functional outcome in sABI during rehabilitation. A randomized single-blind study was performed. sABI subjects were randomized to the VD supplementation group (VDsG) (initial dose of 50.000 UI and 1.000 daily) and usual care control group (CG). Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability. A total of 73 subjects (42 M and 31 F; mean age 53.2 ± 15.7) were randomized: 36 (21 M and 15 F; mean age 57.52 ± 14.88) to VDsG and 37 (20 M and 17 F; mean age 48.28 ± 17.47) to CG. Both groups significantly improved after rehabilitation, and no between-group difference was observed. The mean score values for DRS, GOS, and LCF in VDsG were 18.83 ± 4.27 and 9.42 ± 5.83; 2.89 ± 0.32 and 3.78 ± 0.80; and 4.81 ± 1.70 and 7.53 ± 1.28, at admission and discharge, respectively. Likewise, mean values for DRS, GOS, and LCF in CG were 18.57 ± 4.80 and 9.84 ± 6.34; 2.84 ± 0.37 and 3.81 ± 0.94; and 4.97 ± 2.01 and 7.41 ± 1.32, respectively. VD supplementation did not improve functional outcomes in sABI during rehabilitation treatment.

UNASSIGNED: Challenging behaviours and emotional dysregulation are common sequelae of acquired brain injury (ABI), but treatment remain underdeveloped. Dialectical behaviour therapy is an evidence-based therapy for emotional dysregulation.
UNASSIGNED: To explore the feasibility and preliminary efficacy of dialectical behaviour therapy for ABI.
UNASSIGNED: An exploratory longitudinal study that compared thirty adults with brain injury presenting persistent emotion dysregulation or challenging behaviours. Control group received a personalized multidisciplinary program only (n = 13). The dialectical behaviour therapy group received five months of emotion regulation skills learning as an add-on (n = 17). Preliminary efficacy was measured on Difficulties in Emotion Regulation Scale-16 and Quality of Life after Brain Injury total score and emotion subscore.
UNASSIGNED: Fourteen participants completed the dialectical behaviour therapy. This study provided preliminary evidence for the feasibility and acceptability of dialectical behaviour therapy. Repeated measures revealed improvement on the Difficulties in Emotion Regulation Scale-16 (-7.6 [-17.3; 1.7]; Pr = 0.95) and on the Quality Of Life emotion subscore (13.5 [-3.8; 30.9]; Pr = 0.94).
UNASSIGNED: This study raises important questions regarding the type of patients who can benefit from this intervention, necessary adaptations of dialectical behaviour therapy and the way it can help post-traumatic growth and identity reconstruction after ABI.

OBJECTIVE: The purpose of this study was to engage key stakeholders in a health research priority-setting process to identify, prioritize and produce a community-driven list of research questions addressing intersectional issues on mental health and addictions (MHA) in acquired brain injury (ABI).
METHODS: A multiphasic health research priority-setting process was co-designed and executed with community-based stakeholders, including researchers, health professionals, clinicians, service providers, representatives from brain injury associations, policy makers and people with lived experience of ABI and MHA, including patients and their family members. Stakeholders\' ideas led to the generation of research questions, which were prioritized at a 1-day workshop.
RESULTS: Fifty-nine stakeholders participated in the priority-setting activity during the workshop, which resulted in a rank-ordered list of the top 10 questions for research addressing the intersections of ABI and MHA. Questions identified touched on several pressing issues (e.g., opioid crisis, homelessness), encompassed multiple subtypes of ABI (e.g., hypoxic-ischaemic, mild traumatic), and involved different domains (e.g., identification, intervention) of health research.
CONCLUSIONS: This community-driven health research priority-setting study identified and prioritized research questions addressing the intersections of ABI and MHA. Researchers and funding agencies should use this list to inform their agendas and address stakeholders\' most urgent needs, fostering meaningful improvements to clinical services.
UNASSIGNED: An 11-person working group comprised of people with lived experience, service providers, researchers, healthcare professionals and other key stakeholders collaboratively developed and informed the scope, design, methodology and interpretation of this study. Over 50 community-based stakeholders contributed to the research priority-setting activity. One co-author is a person with lived experience.

BACKGROUND: Physical activity is emerging as an outcome measure. Accelerometers have become an important tool in monitoring physical behavior, and newer analytical approaches of recognition methods increase the degree of details. Many studies have achieved high performance in the classification of physical behaviors through the use of multiple wearable sensors; however, multiple wearables can be impractical and lower compliance.
OBJECTIVE: The aim of this study was to develop and validate an algorithm for classifying several daily physical behaviors using a single thigh-mounted accelerometer and a supervised machine-learning scheme.
METHODS: We collected training data by adding the behavior classes-running, cycling, stair climbing, wheelchair ambulation, and vehicle driving-to an existing algorithm with the classes of sitting, lying, standing, walking, and transitioning. After combining the training data, we used a random forest learning scheme for model development. We validated the algorithm through a simulated free-living procedure using chest-mounted cameras for establishing the ground truth. Furthermore, we adjusted our algorithm and compared the performance with an existing algorithm based on vector thresholds.
RESULTS: We developed an algorithm to classify 11 physical behaviors relevant for rehabilitation. In the simulated free-living validation, the performance of the algorithm decreased to 57% as an average for the 11 classes (F-measure). After merging classes into sedentary behavior, standing, walking, running, and cycling, the result revealed high performance in comparison to both the ground truth and the existing algorithm.
CONCLUSIONS: Using a single thigh-mounted accelerometer, we obtained high classification levels within specific behaviors. The behaviors classified with high levels of performance mostly occur in populations with higher levels of functioning. Further development should aim at describing behaviors within populations with lower levels of functioning.

UNASSIGNED: Educators often lack the knowledge and resources to assist students with acquired brain injury (ABI). TeachABI, an education module, was created to help elementary school teachers support students with ABI in classrooms. This study examined the adaptability of TeachABI for high school educators.
UNASSIGNED: A qualitative descriptive study explored high school educators\' (n = 9) experiences reviewing TeachABI and its adaptability for high school through semi-structured interviews. The interview guide was informed by implementation and adaptation frameworks. Transcripts were examined using directed content analysis.
UNASSIGNED: Teachers felt TeachABI was a good foundation for creating a high school-based education module. Adaptations were highlighted, such as streamlining content (e.g., mental health) and strategies (e.g., supporting test taking), to better meet educator needs.
UNASSIGNED: Using implementation science and adaptation frameworks provided a structured approach to explore the adaptive elements of TeachABI. The module was perceived as a suitable platform for teaching high school educators about ABI.
UNASSIGNED: TeachABI is an innovative, user informed education module, providing a multi-modal (e.g., case study, videos) and replicable approach to learning about ABI. Applying frameworks from different fields provides concepts to consider when tailoring resources to align with educator needs (e.g., grade, class environment) and facilitate innovation uptake.

In several medical fields, generative AI tools such as ChatGPT have achieved optimal performance in identifying correct diagnoses only by evaluating narrative clinical descriptions of cases. The most active fields of application include oncology and COVID-19-related symptoms, with preliminary relevant results also in psychiatric and neurological domains. This scoping review aims to introduce the arrival of ChatGPT applications in neurorehabilitation practice, where such AI-driven solutions have the potential to revolutionize patient care and assistance. First, a comprehensive overview of ChatGPT, including its design, and potential applications in medicine is provided. Second, the remarkable natural language processing skills and limitations of these models are examined with a focus on their use in neurorehabilitation. In this context, we present two case scenarios to evaluate ChatGPT ability to resolve higher-order clinical reasoning. Overall, we provide support to the first evidence that generative AI can meaningfully integrate as a facilitator into neurorehabilitation practice, aiding physicians in defining increasingly efficacious diagnostic and personalized prognostic plans.