Cognitive-Communication Disorders and Mindfulness-Based Interventions in Children and Adolescents with Acquired Brain Injuries

Abstract

Objectives: Cognitive-communication disorders (communication difficulties due to underlying cognitive impairments) are a common consequence of acquired brain injuries (ABI) in children and adolescents, with devastating effects on daily functioning. Mindfulness-based interventions (MBIs) have shown promise in improving cognitive, emotional, and behavioural outcomes, yet their application in pediatric populations remains poorly understood. Addressing these gaps is critical to advancing evidence-based rehabilitation practices for children and adolescents with ABI. This thesis aimed to (1) synthesize existing evidence on MBIs for children and adolescents, (2) examine current cognitive-communication rehabilitation practices for pediatric ABI, and (3) assess the feasibility and acceptability of a smartphone MBI for adolescents with ABI. Methods: Three studies were conducted to achieve these objectives. Study 1 was a scoping review examining MBIs in pediatric populations. Study 2 involved a retrospective chart review of cognitive-communication rehabilitation practices in a pediatric inpatient ABI setting. Study 3 was a pilot study evaluating the feasibility and acceptability of an application (app)-based MBI for adolescents with ABI. Results: The scoping review identified heterogeneity in MBI types, adaptations and populations, and underspecified intervention ingredients and targets. The chart review revealed infrequent interprofessional collaboration and limited speech-language pathologist (SLP) involvement in cognitive rehabilitation. The feasibility study demonstrated that an app-based MBI was feasible and acceptable, with participants reporting improved mindfulness skills, well-being, and fatigue, but recruitment and adherence challenges prevailed. Conclusions: The findings of this thesis reveal the complexities of providing comprehensive and collaborative rehabilitation services for children and adolescents with ABIs, as well as the fragmented state of mindfulness research and use in pediatric populations. This work advocates for greater involvement of SLPs in cognitive rehabilitation and emphasizes the potential of integrating mindfulness into ABI care. The scoping review and chart review establish a foundational understanding of these challenges, while the feasibility study offers preliminary evidence for the use of digital MBIs to support the needs of this population. Overall, this thesis lays the groundwork for advancing evidence-based, innovative approaches to improve outcomes for children and adolescents with ABI