The Competing Demands of Adolescent TBI Rehabilitation: An Investigation of Adolescents' Perceived Confidence and Competence in Executive Functioning Skills Following Childhood Traumatic Brain Injury

Lucie Shanahan

Research output: ThesisDoctoral Thesis

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Traumatic brain injury (TBI) is the leading cause of long-term disability
in children and young adults. An injury acquired in childhood results in
functional impairments across a range of domains, with some impairments
not becoming apparent and others worsening as a child progresses through
childhood to adolescence. The chronic nature of impairments associated
with paediatric TBI and the realisation that pre- and post-injury child
development influences recovery and progression post-injury, has
necessitated the development of rehabilitation models of care that are
specific to the paediatric population. Disruption to executive function
development in particular, can result in unrealised academic, vocational
and psychosocial potential and children, adolescents, their families,
educators and employers require ongoing, well-timed and well-informed
rehabilitation support to maximise community integration. Paediatric TBI
rehabilitation is now recognised as a specialist field within its own right,
but research that documents consumers’ experiences of rehabilitation or
research that informs the ongoing development of rehabilitation models
designed to meet the specific and particular needs of adolescents remains

The aim of the research reported in this exegesis and accompanying
portfolio, was to ascertain how adolescents who had sustained a TBI during
childhood, and who had subsequently been engaged with a specialist
paediatric TBI rehabilitation programme on a long-term basis, perceived their executive functioning (EF) skills. The perceptions of a parent of each
adolescent were also sought.

This research was undertaken in three phases using a pragmatic
research approach. A mixed methods design saw the collection of a broad
range of data from participants. The first phase of the study collected
standardised assessment data with each adolescent participant, and the
second phase focussed on ecological assessment and the commencement
of qualitative data collection via participant self-reflection. The third stage
of data collection used unstructured, in-depth interviews with each
adolescent and their mother.

The results indicated that both adolescents, despite long term
engagement with a specialised paediatric TBI rehabilitation programme,
continued to experience pervasive EF impairments. The levels of
confidence and competence perceived by adolescents and their parents
with regard to EF skills varied. Qualitative data recorded for this study
indicated that adolescents’ perceptions of their EF skills were responsive to
the contextual supports available to them. Data also revealed that
adolescents and parents viewed confidence and competence in EF skills
differently, with adolescents focussed on developing confidence in their
skills and parents more focussed on observing competent skill use.

The findings highlight the need for adolescent TBI rehabilitation
models to be considerate of normal developmental tasks of adolescence
such as identity and role development. Through synthesising the findings of
this study with a number of existing rehabilitation frameworks and models
of adolescent development, the Ripe for Rehab framework, a framework
for engaging adolescents in cognitive rehabilitation, is proposed. This
research contributes to the ongoing development of TBI rehabilitation
frameworks and models of care that specifically address the needs of
adolescents and their families, and support their ongoing development and community integration post-injury
Original languageEnglish
QualificationDoctor of Health Science
Awarding Institution
  • Charles Sturt University
  • Curtin, Michael, Co-Supervisor
  • McAllister, Lindy, Co-Supervisor
Award date01 Sep 2013
Place of PublicationAustralia
Publication statusPublished - 2014

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