Background Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family. Methods Children aged 6–16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children’s and families’ self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted. Discussion The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021. Trial registration ClinicalTrials.govNCT04798859. Registered on March 15, 2021

Traumatic brain injury (TBI) is caused by trauma to the head and is one of the most frequent causes of acquired disability in children and adolescents. This article explores meaning structures and action reasons among four adolescents after TBI and potentials for transcending marginal positions and expanding agency. The theoretical framework for the analyses understands TBI as a condition or as "cause -effect" relations from an external standpoint, i.e. relations obtained by neuropsychological examinations at the individual level. These "causeeffect" relations are understood in dialectical relation to the adolescents' meaning structures, and this dialectical relation constitutes agency in interplay with social practice in and between contexts. Agency is thus understood as moveable in and through the particular contexts relying on this dialectic relation. The findings show that the adolescents had individual struggles and subjective reasons for action. Not to dare emerged as central to the adolescents' action reasons. However, when the adolescents felt confident and part of a we, this represented potentials for transcending marginal positions and expanding agency. The adolescents had a contextual and intersubjective dimension to their understanding of themselves and others. Their personal relations to the joint contextual practices, arrangements and relationships influenced how they participated and from which positions. The acknowledgement of what counts as agency after TBI seems to rely on qualifications, as assessed by neuropsychological examinations, and on particular kinds of contexts in relation to which it is possible for the adolescents to make up sufficient personal preconditions for participation.

Denne artikkelen undersøker foreldreperspektiver hos foreldretil barn som har blitt rammet av en traumatisk hjerneskade(TBI) og drøfter hva som kan bidra til å utvide mulighetsrommetfor foreldres deltagelse og innflytelse i skolen. Sosial praksisteori,herunder kritisk psykologi, utgjør den teoretiskeanalyserammen. Analysen av foreldreperspektivene og de utfordringerforeldrene opplever, har gjort det mulig å kommenærmere en forståelse av den betydningen TBI har hatt forforeldre og barn. Med denne bakgrunn argumenterer artikkelenfor behovet og muligheten for et utvidet mulighetsrom for foreldredeltagelseog innflytelse i barnets læring. Her framkommerbetydningen av at foreldre og profesjonelle i fellesskap kommertil forståelse av barnets behov, for å understøtte barnets utviklingi ulike kontekster. Artikkelen argumenterer følgelig forat “til tiden – på stedet” kunnskap, som forutsetter en dialogiskprosess mellom kunnskap om diagnosen TBI og praksisbegrunnetog erfaringsbasert viten hos foreldre, barnet, lærere ogøvrig involverte, vil kunne utvide foreldres mulighetsrom fordeltagelse og innflytelse. Artikkelen tilstreber med dette åanalysere utvidelse av mulighetsrom bredere enn spørsmåletom foreldreinnflytelse eller profesjonelles kunnskap alene.

Background This is a qualitative feasibility study of the Child in Context Intervention (CICI). The CICI is an individualized, goal-oriented and home-based tele-rehabilitation intervention which targets everyday functioning of children (6–16 years) with acquired brain injury in the chronic stage, and their families, one year or more after insult, who have ongoing challenges (physical, cognitive, behavioral, social and/or psychological). The aim of this study is to better understand how children, parents and teachers experienced participation and acceptability; to develop knowledge about the mechanisms of change, and to explore how the CICI was tailored to the context. Methods Six families and schools participated in the intervention, which comprised seven tele-rehabilitation sessions in which the child and parent participated, one in-person parent seminar and four digital school meetings. A multidisciplinary team delivered the intervention to 23 participants over a 4- to 5-month period. The intervention involved psychoeducation about targeted acquired brain injury-related problems, such as fatigue, pain, or social challenges. All but one consented to participate in the current digital interview study. The data were analyzed using content analysis. Results The experience of participation and acceptability varied among the children. Attendance was consistently high; the child participants felt mostly listened to and could influence goal setting and strategies. However, engaging and motivating the child participants proved somewhat challenging. The parents found the CICI rewarding, useful and relevant. However, they had different experiences regarding which intervention component they perceived as most helpful. Some argued in favor of the ‘whole intervention’, while others highlighted new knowledge, SMART goals or the school collaboration. The teachers found the intervention acceptable and useful but wanted a better meeting plan. They had difficulties in finding time for meetings, emphasized the involvement of school leaders, and appreciated the digital format. Conclusions Overall, the intervention was perceived as acceptable, and the participants felt that the various intervention components contributed to improvements. The CICI’s flexibility facilitated tailoring to different contexts based on the children’s functional level. The digital format saved time and provided flexibility regarding the amount of attendance but limited full participation from children with more severe cognitive impairments. Trial registration ClinicalTrials.gov Identifier: NCT04186182.