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BackgroundAlthough research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. ObjectiveThis study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. MethodsWe used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. ResultsTwo main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). ConclusionsOur web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities.

BackgroundLong-term physical, cognitive, and psychosocial problems resulting from moderate to severe traumatic brain injury (TBI) can prevent individuals from returning to preinjury lifestyles because of significant challenges with employment, leisure, and relationships. While physical activity (PA) is proposed as a cost-effective method to alleviate problems after moderate to severe TBI, there is no review to date that synthesizes the evidence for PA in the community-based context. Further, although sex- and gender-based considerations in research are considered requisite to good science, there is no review on PA and TBI that has included this explicit focus. ObjectiveThe purpose of this review is to map and synthesize the current evidence identified through a systematic search of community-based PA interventions for individuals of all ages with moderate to severe TBI and provide an overview of that evidence by asking the following research questions: (1) what are the characteristics of community-based PA programs for individuals with moderate to severe TBI, (2) what are the reported health-related outcomes and measurement tools used to evaluate them, and (3) what considerations have been given to sex and/or gender? MethodsSearches will be conducted of six academic databases for peer-reviewed articles. Two reviewers will independently screen the articles for inclusion and extract data for the analysis. The extracted data will be coded according to the Consensus on Exercise Reporting Template checklist and the Template for Intervention Description and Replication checklist to provide sufficient detail for replication. ResultsThe abstract screening was completed by two reviewers and the extracted data were analyzed. A qualitative synthesis and description of community-based PA interventions for individuals with moderate to severe TBI will be provided. ConclusionsThis scoping review will generate new knowledge from published and publicly available literature. Dissemination of the results will include activities related to knowledge transfer for community-based PA after moderate to severe TBI for future research and practice. Evidence-based recommendations, future directions, potential limitations, use of online/digital components, and the possible need for a systematic review will be discussed as well. International Registered Report Identifier (IRRID)DERR1-10.2196/24689

BACKGROUND: Over two decades of research about traumatic brain injury (TBI) rehabilitation emphasized the persistence of racial health disparities in functional outcomes that disproportionately impact Black populations without naming or addressing racism as the root problem. Further, the experiences of Black people with TBI have yet to be documented and accounted for in scientific scholarship from the perspectives of Black persons in Canada. PURPOSE: This study intended to examine the rehabilitation narratives of Black TBI survivors, family caregivers, and rehabilitation providers and use critical race theory as a conceptual framework to understand how anti-Black racism manifests in those experiences. METHODS: Through critical narrative inquiry informed by a critical constructivist paradigm and a critical race theory lens, in-depth narrative interviewing were conducted with seven survivors, three family caregivers, and four rehabilitation providers. Data were analyzed using reflexive thematic analysis within and across groups of participants to conceptualize themes and sub-themes. FINDINGS: Themes captured how racism becomes institutionalized in TBI rehabilitation: (1) the institutional construction of deficient Black bodies, (2) the institutional construction of rehabilitation access, (3) the institutional investment in resisting and approximating whiteness in rehabilitation practice, and (4) the institutional construction of deficient Black futures. CONCLUSION: Study findings point to the dire need to ensure rehabilitation programs, services, and the delivery of care are not determined based on inequitable practices, racial biases and assumptions about Black people, which determine who deserves to get into rehabilitation and have opportunities to be supported in working towards living a full and meaningful life.

Background: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). Methods: An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. Results: One hundred and thirty-five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return-to-learn protocol in place and 90% reported having a return-to-play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty-seven percent of respondents believed that PPM158 improves student well-being. Conclusions: Identified implementation barriers and facilitators can inform concussion policy practices to improve student well-being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools.

Author(s): Zoe Colclough 1, Maria Jennifer Estrella 2, Julie Michele Joyce 2, Sara Hanafy 3,4, Jessica Babineau 5,6, Angela Colantonio 2,3,4,7,8, Vincy Chan 3,4,7,* Introduction Traumatic brain injury (TBI) affects [...], Background Traumatic brain injury (TBI) is disproportionately prevalent among individuals who intersect or are involved with the criminal justice system (CJS). In the absence of appropriate care, TBI-related impairments, intersecting social determinants of health, and the lack of TBI awareness in CJS settings can lead to lengthened sentences, serious disciplinary charges, and recidivism. However, evidence suggests that most clinical practice guidelines (CPGs) overlook equity and consequently, the needs of disadvantaged groups. As such, this review addressed the research question "To what extent are (1) intersections with the CJS considered in CPGs for TBI, (2) TBI considered in CPGs for CJS, and (3) equity considered in CPGs for CJS?". Methods and findings CPGs were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of identified CPGs on November 2021 and March 2023 (CPGs for TBI) and May 2022 and March 2023 (CPGs for CJS). Only CPGs for TBI or CPGs for CJS were included. We calculated the proportion of CPGs that included TBI- or CJS-specific content, conducted a qualitative content analysis to understand how evidence regarding TBI and the CJS was integrated in the CPGs, and utilised equity assessment tools to understand if and how equity was considered. Fifty-seven CPGs for TBI and 6 CPGs for CJS were included in this review. Fourteen CPGs for TBI included information relevant to the CJS, but only 1 made a concrete recommendation to consider legal implications during vocational evaluation in the forensic context. Two CPGs for CJS acknowledged the prevalence of TBI among individuals in prison and one specifically recommended considering TBI during health assessments. Both CPGs for TBI and CPGs for CJS provided evidence specific to a single facet of the CJS, predominantly in policing and corrections. The use of equity best practices and the involvement of disadvantaged groups in the development process were lacking among CPGs for CJS. We acknowledge limitations of the review, including that our searches were conducted in English language and thus, we may have missed other non-English language CPGs in this review. We further recognise that we are unable to comment on evidence that is not integrated in the CPGs, as we did not systematically search for research on individuals with TBI who intersect with the CJS, outside of CPGs. Conclusions Findings from this review provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. Conducting research, including investigating the process of screening for TBI with individuals who intersect with all facets of the CJS, and utilizing equity assessment tools in guideline development are critical steps to enhance equity in healthcare for this disadvantaged group.

Purpose: The need for specialized rehabilitation considerations to address racial health disparities and optimize functional outcomes such as participation in daily life for Black people with traumatic brain injury (TBI) has been acknowledged. This study uses anti-racism as an entry point for addressing institutional racism by examining what the experiences of Black survivors of TBI, rehabilitation providers, and family caregivers tell us about imagined possibilities for rehabilitation to promote Black futures. Material and methods: A constructivist-informed narrative inquiry using critical race theory and in-depth narrative interviewing was applied across ten women and four men. Reflexive thematic analysis within and across groups of participants led to conceptualizing two main themes and five sub-themes. Results: Conceptualized themes captured requirements for TBI rehabilitations' investments in Black futures: (1) the need for critical information and specialized educational supports and particular requirements for supporting participation in meaningful life situations, and (2) responsibilities of delivering rehabilitation care for Black service users. Conclusion: TBI rehabilitation must be tailored to the realities of living while being Black, integrate personal values, beliefs, interests, and equitable supports to maximize optimal functioning and participation if the goal of rehabilitation is community integration for all persons living with the impacts of TBI. IMPLICATIONS FOR REHABILITATION: Rehabilitation care that challenges institutional racism is fundamental to meeting the unmet functional and participation goals of Black people living with traumatic brain injury. At the individual-level, investments in anti-racist rehabilitation for Black traumatic brain injury service users require attention to clinical encounters between providers and patients and specifically the importance of the therapeutic relationship. Organizational level changes include critical information and education about intersections of race and traumatic brain injury, supporting participation in meaningful life situations, and particular responsibilities for Black and non-Black rehabilitation providers to inspire recovery. Knowledge of the rehabilitation professions requires racial consciousness of the practices, protocols, and guidelines underpinning care and how these bodies of documents reinforce racial health disparities which have implications for training and practice. [ABSTRACT FROM AUTHOR]

Purpose: To develop a series of infographics providing persons with traumatic brain injury (TBI) and their circle of care with evidence-based information on sex and gender topics in TBI. Materials and Methods: We employed an iterative participatory design engaging knowledge users, scientists, and experts in brain injury and patient education. To inform infographic content, we conducted an information needs assessment with knowledge users through semi-structured interviews and referred to our previously published evidence syntheses on TBI topics. We followed principles of graphic design and science communication to create materials reflecting lived experiences of knowledge users. Results: We created a series of infographics with actionable messages and visual representations of evidence-based information. We achieved a Flesch Reading-Ease score of 60.1, corresponding to a Grade 7/8 reading level. The infographics met the color contrast criteria of the Web Content Accessibility Guidelines. Knowledge users found the material useful, visually appealing, and helpful in understanding complex topics. Conclusions: There is value in merging art and science to develop educational materials that meet the unique information needs of knowledge users. Iterative participatory design engaging diverse stakeholders is essential for co-creating knowledge translation tools to improve access to health information and quality of care after TBI. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic brain injury (TBI) is a chronic disease process and a public health concern that disproportionately impacts Black populations. While there is an abundance of literature on race and TBI outcomes, there is a lack of scholarship that addresses racism within rehabilitation care, and it remains untheorized. This article aims to illuminate how racism becomes institutionalized in the scientific scholarship that can potentially inform rehabilitation care for persons with TBI and what the implications are, particularly for Black populations. Material and methods: Applying Bacchi's What's the Problem Represented to be approach, the writings of critical race theory (CRT) are used to examine the research about race and TBI rehabilitation comparable to CRT in other disciplines, including education and legal scholarship. Results: A CRT examination illustrates that racism is institutionalized in the research about race and TBI rehabilitation through colourblind ideologies, meritocracy, reinforcement of a deficit perspective, and intersections of race and the property functions of whiteness. A conceptual framework for understanding institutional racism in TBI rehabilitation scholarship is presented. Conclusions: The findings from this article speak to the future of TBI rehabilitation research for Black populations, the potential for an anti-racist agenda, and implications for research and practice. IMPLICATIONS FOR REHABILITATION: Critical race theory contributes to a comprehensive understanding of racism in the literature about race and traumatic brain injury (TBI) rehabilitation by asking how racism operates in the scholarship, including methods, analyses, interpretations, and conclusions. Applying a critical race theory lens in TBI rehabilitation has the potential to inform antiracist scholarship that holds important implications for critical rehabilitation research, practice, professional training, and policy. Implications for rehabilitation practice include opening up opportunities to address how race and racism shape rehabilitation outcomes to imagine different possibilities, programs, and futures for Black people with TBI with various communities of practice. [ABSTRACT FROM AUTHOR]

Background: Work-related traumatic brain injury (wrTBI) is considered a critical injury that can be prevented. Few studies have integrated clinical data and workers' injury narratives to inform sex-specific wrTBI prevention. Objective: To examine sex differences in pre-injury factors and provide recommendations for primary prevention of wrTBI. Methods: Concurrent mixed methods study. The Person-Environment-Occupation (PEO) model served as a theoretical framework for qualitative and quantitative data analyses. Results: The sample consisted of 93 workers (51% female, 67% aged over 40) with wrTBI sustained as a result of being struck by/against an object (SBA, 46%), falls (30%), motor vehicle accident (13%), and assault (11%). Qualitative analysis of injury events revealed distinct patterns between male and female workers in the nature and physical/social load of occupational activities performed at the time of injury. Quantitative analysis enriched interpretation of observed sex differences across PEO factors. New insights emerged by stratifying SBA injury cases, revealing sex differences in Environment- and Occupation-related factors unique to workers struck by an object. Implications: Sex- and cause-specific analysis of injury events is essential for surveillance and prevention of wrTBI. Addressing fitness for duty, supervisor–worker relationships, and industry-specific hazards in prevention strategies is essential to ensure workplace safety. [ABSTRACT FROM AUTHOR]

Objectives: There is a dearth of reviews exploring rehabilitation for violence-related traumatic brain injury (TBI) despite its increasing rates and distinct risk factors and outcomes. The aim of this scoping review is to determine the extent to which rehabilitation is available to and accessed by people who sustain TBI from interpersonal violence. Method: Electronic databases (i.e., MEDLINE, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Criminal Justice Abstracts, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health) and grey literature (i.e., relevant organizations' websites) were systematically searched for peer-reviewed articles and reports that met eligibility criteria. To be included, articles had to report primary findings on rehabilitation interventions that included individuals who sustained a TBI through interpersonal violence. Articles based on the military population were excluded. Data were synthesized through a descriptive numerical summary and qualitative content analysis. Results: Fifty-two primary research articles and five grey literature reports were included. Most (77.2%) of these articles described rehabilitation interventions that addressed TBI sequalae without consideration for violence as a mechanism of injury, beyond reporting sample characteristics. Only thirteen articles (22.4%) considered violence-related TBI by investigating the rehabilitation profile (13.8%) or designing programs specifically for survivors of violence-related TBI (8.6%). There was limited attention to social determinants of health across all studies. Conclusion: This is the first scoping review to our knowledge that explored the extent and nature of rehabilitation among persons who experience TBI through violence in civilian populations. Priorities for education, research, and practice are identified. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is a global public health crisis. Often repetitive and occurring over prolonged periods of time, IPV puts survivors at high risk of brain injury (BI). Mental health concerns are highly prevalent both among individuals who have experienced IPV and those who have experienced BI, yet the interrelatedness and complexity of these three challenges when experienced together is poorly understood. This qualitative study explored care provision for IPV survivors with BI (IPV-BI) and mental health concerns from the perspectives of both survivors and providers. Methods: This qualitative interpretive description study was part of a broader research project exploring employment, mental health, and COVID-19 implications for survivors of IPV-BI. Participants (N = 24), including survivors and service providers, participated in semi-structured group and individual interviews between October 2020 and February 2021. Interviews were recorded, transcribed, and thematically analyzed. Findings: Four themes were developed from interview findings: 1) identifying BI and mental health as contributing components to survivors' experiences is critical to getting appropriate care; 2) supporting survivors involves a "toolbox full of strategies" and a flexible approach; 3) connecting and collaborating across sectors is key; and 4) underfunding and systemic barriers hinder access to care. Finally, we share recommendations from participants to better support IPV survivors. Conclusions: Identifying both BI and mental health concerns among IPV survivors is critical to providing appropriate supports. Survivors of IPV experiencing BI and mental health concerns benefit from a flexible and collaborative approach to care; health and social care systems should be set up to support these collaborative approaches. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mild traumatic brain injury (mTBI) can profoundly impact overall health, employment, and family life. Incidence of mTBI in the workplace represents an important subgroup with poorer outcomes. Mental health (MH) and substance use (SU) challenges are a primary correlate of TBI, but are rarely assessed among individuals with a work-related (wr)-mTBI, particularly at a population-level. OBJECTIVE: This study aimed to assess the association between lifetime wr-mTBI and non-wr-mTBI and the experience of MH and SU challenges. METHODS: The 2019 Centre for Addiction and Mental Health (CAMH) Monitor is a cross-sectional telephone survey of adults aged≥18 years in Ontario, Canada, employing a stratified (six regions) two-stage (telephone number, respondent) list-assisted random digit dialing probability selection procedure (N = 1792). Adjusting for sociodemographic variables, binary logistic regression was conducted to assess the association between lifetime wr-mTBI and non-wr-mTBI (relative to no TBI) and four outcomes: hazardous use of alcohol and of cannabis, psychological distress, and fair/poor mental health. RESULTS: Adjusting for sociodemographic variables, non-wr-mTBI demonstrated increased odds of hazardous alcohol (AOR = 2.12, 95% CI = 1.41, 3.19) and cannabis use (AOR = 1.61, 95% CI = 1.05, 2.45), psychological distress (AOR = 1.68, 95% CI = 1.14, 2.49), and fair/poor mental health (AOR = 1.70, 95% CI = 1.11, 2.59). Lifetime wr-mTBI demonstrated increased odds of reporting psychological distress (AOR = 3.40, 95% CI = 1.93, 5.97) and fair/poor mental health (AOR = 2.16, 95% CI = 1.12, 4.19) only. CONCLUSIONS: Non-wr-mTBI was associated with both MH and SU, whereas wr-mTBI was associated with MH only. MH outcomes were more strongly associated with wr-mTBI than non-wr-mTBI. Physicians, employers, and insurers need to consider the potential association between wr-mTBI and MH, and provide care accordingly. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is a global public health crisis, with physical violence leaving IPV survivors at high risk of brain injury (BI). Both BI and IPV have significant physical, psychological, cognitive, and social impacts, including a high risk of mental health concerns, yet there is limited exploration of IPV survivors' experiences with BI and mental health. This study aimed to explore the BI- and mental health-related needs and experiences of IPV survivors from the perspectives of survivors and service providers with the objective of developing knowledge translation materials to raise awareness and support survivors and service providers in addressing these concerns. Methods: This qualitative interpretive description study involved 19 semi-structured interviews and two focus group discussions (2–3 participants each) with 24 participants including IPV survivors experiencing BI and mental health concerns as well as IPV, mental health, and BI service providers between October 2020 and February 2021. Three screening questions were used to identify probable BI among survivors. Participants across groups were an average of 48.5±12.7 years old and were predominantly cisgender women (96%), of European origin (75%), with a university degree (71%). Interviews were recorded, transcribed, and thematically analyzed. Findings: Across interviews, participants spoke about IPV, BI, and mental health as being complex and interrelated experiences that have impacts across the survivor's life and extend well beyond the abusive relationship. Because of the underrecognized nature of BI in IPV, finding and accessing care requires persistence that survivors spoke of as being like "a full-time job." The benefit of making meaningful connections, particularly with other survivors, was highlighted. Conclusions: Recognition of BI as a contributing factor shaping the lived experience of IPV survivors; acknowledgement that the impacts of IPV, BI, and mental health are far reaching and long lasting; and reducing barriers to finding and accessing appropriate care are critical to better supporting IPV survivors with BI and mental health concerns. Clinicians should consider BI and its lingering impacts among the IPV survivors with whom they work. Health and social policy that supports integration of care and the reduction of unnecessary barriers should be a priority. [ABSTRACT FROM AUTHOR]

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Evidence syntheses for advancing equitable traumatic brain injury (TBI) research, policy, and practice presents formidable challenges. Research and clinical frameworks are currently not specific to equity, diversity, and inclusion considerations, despite evidence that persons with TBI live in societies in which power imbalances and systems of social dominance may privilege some people and marginalize others. The present protocol outlines a strategy for a research program, supported by the Canadian Institutes of Health Research, that explores the integration of PROGRESS-Plus parameters in research with the goal of advancing open-science databases and tools to improve our understanding of equity in cognitive and brain health outcomes in TBI. PROGRESS-Plus is a framework outlining social, economic, and cultural parameters that may influence health opportunities and outcomes (e.g., place of residence, race, occupation, gender, etc.). A multistep research program is proposed to support three objectives: (1) organizing existing data on TBI-induced changes in cognition and brain health into a template to facilitate future research, including research using machine learning techniques; (2) updating published evidence with a more rigorous approach to the consideration of PROGRESS-Plus parameters; and (3) mobilizing knowledge on the current state of evidence that is relevant, equitable, and accessible. This program facilitates partnerships with knowledge users across clinical, research, academic, and community sectors to address the three research objectives through a unifying workflow of exchange, synthesis, and knowledge mobilization. We anticipate that this global collaboration between topic experts and community leaders in equity in brain health will add significant value to the field of TBI by promoting equity-transformative advancements in knowledge synthesis, policy, and practice. [ABSTRACT FROM AUTHOR]