A parent's cancer affects the whole family (Faulkner & Davey, 2002). Parents diagnosed with cancer and their spouses have limited capacity due to the demands of the illness (Gazendam-Donofrio et al., 2008; Helseth & Ulfsaet, 2005), with many reporting feelings of guilt about failing to be a "good parent" and struggles in communicating with their children about the cancer (Semple & McCance, 2010; Zahlis & Lewis, 2010). The treatment course may take months or even years, throughout which children must contend with the parent's absence or decreased availability, changes in family roles and routines and questions surrounding mortality due to their parent's disease

No abstract

Objectives To describe the prevalence, patterns, and predictors of multimorbidity in adults with an acquired brain injury (ABI) on presentation to a community-based neurorehabilitation service. Design Retrospective cohort study using routinely collected admissions and clinical data. Setting Community-based neurorehabilitation. Participants Individuals (N=263) with non-traumatic brain injury (NTBI; n=187 [71.1%]) versus traumatic brain injury (TBI; n=76 [28.9%]). Interventions Not applicable. Main Outcome Measures Comorbidity was defined as the co-occurrence of at least one chronic condition in conjunction with a primary diagnosis of ABI. Multimorbidity was defined as the co-occurrence of 2 or more chronic conditions across 2 or more body systems, in conjunction with a primary diagnosis of ABI. Results Comorbidity was present in 72.2% of participants overall, whereas multimorbidity was present in 35.4% of the cohort. The prevalence of comorbidity (76% vs 63%; P =.036) and multimorbidity (40% vs 24%; P =.012) was higher in NTBI compared with participants with TBI. Participants with NTBI had a higher prevalence of physical health multimorbidities, including cardiovascular (44% vs 6%; P <.001) and endocrine (34% vs 10%; P =.002) disease, whereas participants with TBI had a higher prevalence of mental health conditions (79% vs 48%; P <.001). Depression (36.3%) and hypertension (25.8%) were the most common diagnoses. Increasing age was the only significant predictor of multimorbidity. Conclusions Most participants experienced multimorbidity. Effective management of multimorbidity should be included as part of individual rehabilitation for ABI and planning of resource allocation and service delivery. The results of this study can help guide the provision of treatment and services for individuals with ABI in community-based rehabilitation. Our study highlights access to mental health, cardiovascular, endocrine, and neurology services as essential components of rehabilitation for ABI.

No abstract

Objective To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic). Design A 12-month follow-up observational retrospective cohort study. Setting Staged community-based brain injury rehabilitation. Participants Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months. Intervention Not applicable. Main Outcome Measures The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team. Results After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total ( P <.001) and across Ability ( P <.001) and Participation ( P <.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech ( P <.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication ( P <.01) than the hemorrhagic right hemisphere group at admission. Conclusions There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.