Traumatic brain injury resiliency model: a conceptual model to guide rehabilitation research and practice

Abstract

There is a growing trend in traumatic brain injury (TBI) rehabilitation, and research, to focus on the processes of adaptation following the injury. Resiliency is an umbrella term describing the range of personal protective factors, environmental supports and resources, as well as self-regulatory processes, engaged in response to adversity. An affective, cognitive, and behavioural self-regulatory process model of resiliency in the workplace was adapted to suit the TBI context. Through a narrative review of the literature pertaining to brain injury rehabilitation, participation, and resilience, we substantiated the model, and explained how resiliency can frame research on life experiences following the injury. TBI represents a cascading adversity as the injury and subsequent life experiences (e.g., job loss) shape adaptation. Resiliency is shaped by: personal characteristics (e.g., hope, social functioning, self-awareness, memory, spirituality, coping, and self-efficacy), environmental resources/supports (e.g., services and social support), and self-regulatory processes that lead to the resiliency-related outcomes, which we suggest involve re-engaging in activities, adapting participation, and reconstructing identity. This conceptual model outlines and defines the factors and processes operating and contributing to resiliency following TBI. Recommendations for future research are outlined. Implications for rehabilitation Investigating resiliency processes can move the traumatic brain injury field beyond examining individual traits and protective factors, to transactional processes that influence participation experiences and opportunities over time. The Traumatic Brain Injury Resiliency Model can be used to frame the targets and desired outcomes of rehabilitation interventions, such as self-regulatory processes or environmental supports known to enhance resiliency. Studying resiliency will help to shift the paradigms of traumatic brain injury research, and rehabilitation practice, to a focus on life experiences and adaptation, helping individuals, clinicians, and families consider processes of positive change, rather than focusing solely on adversity.

Predicting Wellness After Pediatric Concussion

“…The definition of wellness used here was based on a straightforward conceptualization combining the absence of impairment with a single indicator of suitable functioning and was applied only to the outcome of concussion. Future work could broaden this definition to other spheres of functioning (e.g., occupational, physical, social, intellectual, spiritual, emotional) and could contribute to the empirical validation of resiliency models for TBI (see, e.g., Nalder et al, 2018).…”

Resilience-Oriented Interventions for Patients With Traumatic Brain Injury: Prototypes Analysis and New Program Development

“…In addition, most of the analyzed interventions focus on many phenomena and possible resilience factors at once and do not have a single theory or model at their core. At the same time, in recent years a number of models have been created that distinguish specific components or groups of components (for example, a model proposed by Nalder E et al (Nalder, E., et al, 2018) and model of Parsons et al (Parsons, S., et al, 2016) and are designed to facilitate the selection of therapy targets. In our opinion, in further studies and interventions it would be more appropriate to focus on key aspects or categories, among which researchers distinguish a number of cognitive and emotional components (Nalder, E., et al, 2018;Parsons, S., et al, 2016;Stainton, A., et al, 2018).…”

“…At the same time, in recent years a number of models have been created that distinguish specific components or groups of components (for example, a model proposed by Nalder E et al (Nalder, E., et al, 2018) and model of Parsons et al (Parsons, S., et al, 2016) and are designed to facilitate the selection of therapy targets. In our opinion, in further studies and interventions it would be more appropriate to focus on key aspects or categories, among which researchers distinguish a number of cognitive and emotional components (Nalder, E., et al, 2018;Parsons, S., et al, 2016;Stainton, A., et al, 2018). Cognitive components such as cognitive flexibility, concentration, effective memory, executive function (Kreutzer, J., et al, 2018;Nalder, E., et al, 2018;Stainton, A., 2018;Malhi, G., et al, 2019;Rice, V., & Liu, B., 2016) and emotional components such as flexible processing of affective stimuli, emotional control and effective emotional management, positive outlook and positive emotions (Kreutzer, J., et al, 2018;Nalder, E., et al, 2018;Stainton, A., 2018;Malhi, G., et al, 2019;Rice, V., & Liu, B., 2016;Horn, S., & Feder, A., 2018;Helmreich, I., et al, 2017;Lee, J., et al, 2013;van Kessel, G., 2013) can be critical for effective resilience.…”

“…In our opinion, in further studies and interventions it would be more appropriate to focus on key aspects or categories, among which researchers distinguish a number of cognitive and emotional components (Nalder, E., et al, 2018;Parsons, S., et al, 2016;Stainton, A., et al, 2018). Cognitive components such as cognitive flexibility, concentration, effective memory, executive function (Kreutzer, J., et al, 2018;Nalder, E., et al, 2018;Stainton, A., 2018;Malhi, G., et al, 2019;Rice, V., & Liu, B., 2016) and emotional components such as flexible processing of affective stimuli, emotional control and effective emotional management, positive outlook and positive emotions (Kreutzer, J., et al, 2018;Nalder, E., et al, 2018;Stainton, A., 2018;Malhi, G., et al, 2019;Rice, V., & Liu, B., 2016;Horn, S., & Feder, A., 2018;Helmreich, I., et al, 2017;Lee, J., et al, 2013;van Kessel, G., 2013) can be critical for effective resilience. There is currently no emphasis on both of these components in existing resilience-oriented interventions, therefore there is a need for further development of more structured interventions.…”

“…After analyzing various programs and empirical approaches, we have developed our own program of resilience-oriented intervention, which consists of six sessions lasting 60 minutes. The main models of resilience that became the basis of the program are models proposed by Nalder et al (Nalder, E., et al, 2018), Parsons et al (Parsons, S., et al, 2016) and processual model of resilience (Stainton, A., et al, 2018). The resilience and adjustment intervention (Kreutzer, J., et al, 2018) due to its structure and theoretical basis became the main prototype of our program -in particular, the topics about psychoeducation on traumatic brain injury, effective strategies for goal setting and problem solving, management of negative emotions, positive outlook.…”