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

    103 Downloads (Pure)


    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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