Impact of rehabilitation on self-concept following traumatic brain injury: An exploratory systematic review of intervention methodology and efficacy

Abstract

To date, reviews of rehabilitation efficacy after traumatic brain injury (TBI) have overlooked the impact on sense of self, focusing instead on functional impairment and psychological distress. The present review sought to address this gap by critically appraising the methodology and efficacy of intervention studies that assess changes in self-concept. A systematic search of PsycINFO, Medline, CINAHL and PubMed was conducted from inception to September 2013 to identify studies reporting pre- and post-intervention changes on validated measures of self-esteem or self-concept in adults with TBI. Methodological quality of randomised controlled trials (RCTs) was examined using the Physiotherapy Evidence Database (PEDro) scale. A total of 17 studies (10 RCTs, 4 non-RCT group studies, 3 case studies) was identified, which examined the impact of psychotherapy, family-based support, cognitive rehabilitation or activity-based interventions on self-concept. The findings on the efficacy of these interventions were mixed, with only 10 studies showing some evidence of improvement in self-concept based on within-group or pre-post comparisons. Such findings highlight the need for greater focus on the impact of rehabilitation on self-understanding with improved assessment and intervention methodology. We draw upon theories of identity reconstruction and highlight implications for the design and evaluation of identity-oriented interventions that can supplement existing rehabilitation programmes for people with TBI.

“I’ve never been a yes person”: Decision-making participation and self-conceptualization after severe traumatic brain injury

“…[37,42,82,84,94] The findings of this study highlight the importance of intervention and interaction with the clinical team being based upon knowledge of an individual's self-concept. As it has been argued that individuals are likely to consider intervention that is not aligned with their self-concept irrelevant, [52] links between specific intervention goals and higher order life goals (and future selves) should be made explicit.…”

“…[55,80,81] There is a growing body of research illustrating the impact of TBI on self-conceptualization. [1,37,38,42,53,54,82,83] Based on the findings of previous research, several possible links between decision-making participation and self-conceptualization were identified. The findings of this study provide evidence that the process of decision making affords a medium through which a person fashions the self.…”

“…There is evidence that chronic illness can alter both situational and dispositional selfconcept. [37,45] Changes to self-concept occur in a dynamic and cyclical fashion after TBI, as the person develops awareness of the consequences of the injury and adapts to new experiences and challenges. [1,38,46] A person's social environment and their interactions with others plays a crucial role within this context.…”

“…[35] Self-conceptualization after TBI There is a growing body of literature investigating the self after TBI. [1,6,[36][37][38][39][40][41] Researchers have noted a lack of agreement relating to how the self is defined and conceptualized, including imprecise distinctions between a number of related terms and concepts (such as sense of self, self-identity, self-knowledge, and self-concept). [42] Despite this, literature within psychological and sociological fields generally describes two separate characterizations of self.…”

Custom Fabrication of a 3‐Dimensionally Printed Helmet for Improved Socialization and Subjective Self‐Assessment in a Case of Acquired Cranial Defect: A Case Presentation

“…A recent systematic review of patients with traumatic brain injury (TBI) demonstrated consistent depreciation in subjective assessments of self‐esteem by a majority of study participants [1]. This perhaps intuitive conclusion is contrasted heavily when compared to the body of literature suggesting that rehabilitation efforts after TBI tend to overlook the impact on the sense of self, focusing instead on functional impairment and psychological distress [2]. In a study by Ponsford et al, patients who sustained TBI had significantly lower mean scores of global self‐esteem and self‐concept compared to controls.…”