Participants’ perspectives of feasibility of a novel group treatment for people with cognitive communication difficulties following acquired brain injury

Purpose: To determine whether treatment was acceptable to participants and perceived as beneficial by exploring the experiences of people with cognitive communication difficulties following acquired brain injury who participated in a novel, group, communication, project-based treatment. The purpose of the treatment was to improve participants’ communication skills and quality of life, by focusing group activity towards the production of a project and by incorporating individualised communication goals into group sessions. Methods: Twenty-one people with acquired brain injury recruited from community settings participated in project-based treatment, which comprised one individual and nine group sessions (of 2-3 people) over six weeks. Structured interviews were conducted post-treatment as part of a broader assessment battery. Interviews were transcribed verbatim and analysed using content analysis to identify codes, categories and themes. Results: Themes identified from the analysis centred around the treatment experience (general experience; group experience; project experience; working on goals) and benefit of treatment (communicative benefit; other benefits; emotional effects; meeting others; something to do). These themes were consistent with the treatment being perceived as acceptable and having initial efficacy for the participant group. Conclusion: The qualitative data presented here provide positive feasibility findings (acceptability and initial efficacy) of project-based treatment for people with acquired brain injury. The results highlight the value of incorporating participants’ views in assessing feasibility in developing novel interventions

Convolution of multifractals and the local magnetization in a random field Ising chain

The local magnetization in the one-dimensional random-field Ising model is essentially the sum of two effective fields with multifractal probability measure. The probability measure of the local magnetization is thus the convolution of two multifractals. In this paper we prove relations between the multifractal properties of two measures and the multifractal properties of their convolution. The pointwise dimension at the boundary of the support of the convolution is the sum of the pointwise dimensions at the boundary of the support of the convoluted measures and the generalized box dimensions of the convolution are bounded from above by the sum of the generalized box dimensions of the convoluted measures. The generalized box dimensions of the convolution of Cantor sets with weights can be calculated analytically for certain parameter ranges and illustrate effects we also encounter in the case of the measure of the local magnetization. Returning to the study of this measure we apply the general inequalities and present numerical approximations of the D_q-spectrum. For the first time we are able to obtain results on multifractal properties of a physical quantity in the one-dimensional random-field Ising model which in principle could be measured experimentally. The numerically generated probability densities for the local magnetization show impressively the gradual transition from a monomodal to a bimodal distribution for growing random field strength h.Comment: An error in figure 1 was corrected, small additions were made to the introduction and the conclusions, some typos were corrected, 24 pages, LaTeX2e, 9 figure

The randomly driven Ising ferromagnet, Part I: General formalism and mean field theory

We consider the behavior of an Ising ferromagnet obeying the Glauber dynamics under the influence of a fast switching, random external field. After introducing a general formalism for describing such systems, we consider here the mean-field theory. A novel type of first order phase transition related to spontaneous symmetry breaking and dynamic freezing is found. The non-equilibrium stationary state has a complex structure, which changes as a function of parameters from a singular-continuous distribution with Euclidean or fractal support to an absolutely continuous one.Comment: 12 pages REVTeX/LaTeX format, 12 eps/ps figures. Submitted to Journal of Physics

Communication and quality of life outcomes in people with acquired brain injury following project-based treatment

Communication impairments are common following acquired brain injury (ABI) and have a significant impact on a person’s quality of life (QOL) post-injury. While some treatments have improved communication skills, few have measured QOL, and even fewer have shown improved QOL for people with ABI following communication-based treatments. Project-based treatment is an alternative treatment approach that could have an impact on communication skills and QOL for people with ABI who are long-term post-injury. The treatment is embedded in a context of meaningful activities chosen by people with brain injury, whereby, as a group, they work collaboratively to plan and achieve a concrete goal or outcome that contributes others and/or the wider community. Project-based treatment has not been empirically evaluated for people with ABI. More specifically, no research has evaluated whether projects can improve both communication skills and QOL in people with ABI. Therefore, this research aims to evaluate the effectiveness of project-based treatment on the communication skills and QOL for people with ABI. An exploratory study was designed as a prospective quasi-randomised controlled trial with pre, post and follow-up assessments, using mixed methods, and feasibility testing to investigate the effect of project-based treatment. Twenty-one people with ABI were recruited from community settings, allocated to either a TREATMENT (n=11) or WAITLIST group (n=10). Treatment was completed over 6 weeks and comprised an individual session (to set specific communication goals with the person with ABI and their communication partner), followed by nine sessions conducted in groups of 2-3 people. These sessions involved a range of meaningful activities chosen by people with ABI that contributed to a tangible end product designed to help others (e.g. video, pamphlet, radio podcast, piece of art). Mixed methods were used to determine the effect of the treatment on people with ABI. The primary communication outcomes were: (1) Blind ratings of the person with ABI’s conversations on the Interaction and Transaction scales of the Adapted Measure of Participation in Conversation (MPC). The secondary communication outcomes were: (1) Blind ratings of the communication partner’s involvement in conversations on the Acknowledging and Revealing Competence scales of the Adapted Measure of Support in Conversation (MSC); (2) Blind ratings for the Impression scales that described how appropriate, rewarding, effortful, and interesting a conversation was; (3) La Trobe Communication Questionnaire (LCQ) as rated by the person with ABI, and their communication partner; and (4) Goal Attainment Scaling (GAS). The primary QOL outcome was the Satisfaction With Life Scale (SWLS), and the secondary QOL outcome was the Quality of Life in Brain Injury (QOLIBRI) measure. The qualitative data was drawn from semi-structured interviews conducted post-treatment. The first set of analyses for the primary and secondary outcome measures, compared the TREATMENT group with the WAITLIST group over two time points, between which only the TREATMENT group had received the treatment. This showed that people with ABI in the TREATMENT group had improved Interaction scores on the MPC, their communication partners had improved Revealing Competence scores on the MSC, and the conversation was perceived as less effortful, compared to the WAITLIST group. No changes were found for the remaining communication outcomes, or the QOL outcomes. The second analyses compared pre-treatment, post-treatment, and follow-up scores across all people with ABI (i.e. scores for both the TREATMENT and WAITLIST group were combined). This showed significant changes for communication partners on the MSC and LCQ, and significant achievement of communication goals on GAS, as rated by both the person with ABI, and their communication partners. Significant improvement on the QOLIBRI was found, with a trend towards significance on the SWLS. No other significant changes were found. Qualitative data was analysed using content analysis where the content and context of the interview transcripts were analysed and themes identified. People with ABI described overwhelmingly positive experiences of the treatment, the group, the project, and working on goals. They also described a range of positive benefits including improved awareness and skill, and positive feelings. Project-based treatment made modest improvements to both communication skills, and QOL. Moreover, people with ABI perceived positive experiences, and benefited from inclusion in the treatment. While this study was an exploratory trial, with feasibility testing, the results highlight that this treatment could be a potential alternative to other treatments available to people with ABI

Orbits and phase transitions in the multifractal spectrum

We consider the one dimensional classical Ising model in a symmetric dichotomous random field. The problem is reduced to a random iterated function system for an effective field. The D_q-spectrum of the invariant measure of this effective field exhibits a sharp drop of all D_q with q < 0 at some critical strength of the random field. We introduce the concept of orbits which naturally group the points of the support of the invariant measure. We then show that the pointwise dimension at all points of an orbit has the same value and calculate it for a class of periodic orbits and their so-called offshoots as well as for generic orbits in the non-overlapping case. The sharp drop in the D_q-spectrum is analytically explained by a drastic change of the scaling properties of the measure near the points of a certain periodic orbit at a critical strength of the random field which is explicitly given. A similar drastic change near the points of a special family of periodic orbits explains a second, hitherto unnoticed transition in the D_q-spectrum. As it turns out, a decisive role in this mechanism is played by a specific offshoot. We furthermore give rigorous upper and/or lower bounds on all D_q in a wide parameter range. In most cases the numerically obtained D_q coincide with either the upper or the lower bound. The results in this paper are relevant for the understanding of random iterated function systems in the case of moderate overlap in which periodic orbits with weak singularity can play a decisive role.Comment: The article has been completely rewritten; the title has changed; a section about the typical pointwise dimension as well as several references and remarks about more general systems have been added; to appear in J. Phys. A; 25 pages, 11 figures, LaTeX2

Setting and achieving individualised social communication goals for people with acquired brain injury (ABI) within a group treatment

Background and Aims: Cognitive-communication disorders are common following an acquired brain injury (ABI). Remediation should involve individualised goal setting, yet few reports describe the effectiveness of setting communication goals in a group setting. This paper aims to describe a process for setting and achieving goals for people with ABI. Methods and Procedures: Twenty-one participants with ABI participated in a group treatment (triads and dyads) over 6 weeks (20 hours in total). Specific social communication goals were set using Goal Attainment Scaling (GAS) with the participant and their communication partner. Goals targeted strategy use that accounted for existing cognitive abilities. The participant and their communication partner evaluated the goals post-treatment and 6-8 weeks later. Data was analysed using Friedman’s Test to identify achievement of GAS goals. Outcomes and Results: Twenty participants recalled goals independently post-treatment. Significant improvement post-treatment on GAS goals was rated by both the participant (p<0.001) and their communication partner (p<0.001). This improvement was maintained at follow-up. No significant differences in ratings were found between participants and their communication partners at either time point. Conclusions and implications: Individualised social communication goals can be set and achieved for people with ABI in group treatment, even when participants are several years post-injury. GAS offers a method for structuring and quantifying goal progress. Involving communication partners and cognitive strategies were effective in improving communication

Adjustment with aphasia after stroke: study protocol for a pilot feasibility randomised controlled trial for SUpporting wellbeing through PEeR Befriending (SUPERB)

Background: Despite the high prevalence of mood problems after stroke, evidence on effective interventions particularly for those with aphasia is limited. There is a pressing need to systematically evaluate interventions aiming to improve wellbeing for people with stroke and aphasia. This study aims to evaluate the feasibility of a peer-befriending intervention. Methods/design: SUPERB is a single blind, parallel group feasibility trial of peer befriending for people with aphasia post-stroke and low levels of psychological distress. The trial includes a nested qualitative study and pilot economic evaluation and it compares usual care (n = 30) with usual care + peer befriending (n = 30). Feasibility outcomes include proportion screened who meet criteria, proportion who consent, rate of consent, number of missing/incomplete data on outcome measures, attrition rate at follow-up, potential value of conducting main trial using value of information analysis (economic evaluation), description of usual care, and treatment fidelity of peer befriending. Assessments and outcome measures (mood, wellbeing, communication, and social participation) for participants and significant others will be administered at baseline, with outcome measures re-administered at 4 and 10 months post-randomisation. Peer befrienders will complete outcome measures before training and after they have completed two cycles of befriending. The qualitative study will use semi-structured interviews of purposively sampled participants (n = 20) and significant others (n = 10) from both arms of the trial, and all peer befrienders to explore the acceptability of procedures and experiences of care. The pilot economic evaluation will utilise the European Quality of life measure (EQ-5D-5 L) and a stroke-adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This study will provide information on feasibility outcomes and an initial indication of whether peer befriending is a suitable intervention to explore further in a definitive phase III randomised controlled trial. Trial registration: ClinicalTrials.gov identifier NCT02947776, registered 28th October 2016

Randomly Evolving Idiotypic Networks: Structural Properties and Architecture

We consider a minimalistic dynamic model of the idiotypic network of B-lymphocytes. A network node represents a population of B-lymphocytes of the same specificity (idiotype), which is encoded by a bitstring. The links of the network connect nodes with complementary and nearly complementary bitstrings, allowing for a few mismatches. A node is occupied if a lymphocyte clone of the corresponding idiotype exists, otherwise it is empty. There is a continuous influx of new B-lymphocytes of random idiotype from the bone marrow. B-lymphocytes are stimulated by cross-linking their receptors with complementary structures. If there are too many complementary structures, steric hindrance prevents cross-linking. Stimulated cells proliferate and secrete antibodies of the same idiotype as their receptors, unstimulated lymphocytes die. Depending on few parameters, the autonomous system evolves randomly towards patterns of highly organized architecture, where the nodes can be classified into groups according to their statistical properties. We observe and describe analytically the building principles of these patterns, which allow to calculate number and size of the node groups and the number of links between them. The architecture of all patterns observed so far in simulations can be explained this way. A tool for real-time pattern identification is proposed.Comment: 19 pages, 15 figures, 4 table

Current practices and beliefs regarding supporting dating skills in rehabilitation for Traumatic Brain Injury: A survey study

Background: Relationships are important to quality of life after traumatic brain injury (TBI). However, there has been limited research into how to support dating skills or how professionals view this area. Method: An online 52-item survey was developed and sent to professionals in the UK involved in rehabilitation after TBI. Recruitment was through professional networks, special interest groups and social media. Results: 125 participants from a range of professions completed the survey. Many agreed that dating skills are important in rehabilitation (81.6%), but fewer (51.2%) reported engaging in this work. Psychologists, SLTs and OTs were identified as well placed to address dating skills. Case managers also appeared aware of this work. Participants reported using a range of activities to address dating skills, including managing disinhibited behavior and teaching interaction skills. Perceived barriers were both personal and professional, including lack of resources and feeling embarrassed. Conclusion: This study has highlighted an awareness of the importance of dating in brain injury, but professionals face multiple barriers to supporting dating skills. It is possible to draw on recommendations from related areas, including rehabilitation for cognitive communication difficulties and sexual dysfunction with further research to specifically link these areas to dating skills