Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.
March of Dimes Canada , Toronto , Ontario , Canada.
Disabil Rehabil. 2019 Nov;41(22):2708-2717. doi: 10.1080/09638288.2018.1474495. Epub 2018 Jun 12.
There is a growing trend in traumatic brain injury (TBI) rehabilitation, and research, to focus on the processes of adaptation following the injury. Resiliency is an umbrella term describing the range of personal protective factors, environmental supports and resources, as well as self-regulatory processes, engaged in response to adversity. An affective, cognitive, and behavioural self-regulatory process model of resiliency in the workplace was adapted to suit the TBI context. Through a narrative review of the literature pertaining to brain injury rehabilitation, participation, and resilience, we substantiated the model, and explained how resiliency can frame research on life experiences following the injury. TBI represents a cascading adversity as the injury and subsequent life experiences (e.g., job loss) shape adaptation. Resiliency is shaped by: personal characteristics (e.g., hope, social functioning, self-awareness, memory, spirituality, coping, and self-efficacy), environmental resources/supports (e.g., services and social support), and self-regulatory processes that lead to the resiliency-related outcomes, which we suggest involve re-engaging in activities, adapting participation, and reconstructing identity. This conceptual model outlines and defines the factors and processes operating and contributing to resiliency following TBI. Recommendations for future research are outlined. Implications for rehabilitation Investigating resiliency processes can move the traumatic brain injury field beyond examining individual traits and protective factors, to transactional processes that influence participation experiences and opportunities over time. The Traumatic Brain Injury Resiliency Model can be used to frame the targets and desired outcomes of rehabilitation interventions, such as self-regulatory processes or environmental supports known to enhance resiliency. Studying resiliency will help to shift the paradigms of traumatic brain injury research, and rehabilitation practice, to a focus on life experiences and adaptation, helping individuals, clinicians, and families consider processes of positive change, rather than focusing solely on adversity.
创伤性脑损伤 (TBI) 康复和研究中出现了一种趋势，即更加关注损伤后的适应过程。韧性是一个涵盖性术语，用于描述个人保护因素、环境支持和资源以及自我调节过程的范围，这些因素和过程用于应对逆境。我们对与脑损伤康复、参与和韧性相关的文献进行了叙述性综述，从而使韧性的工作场所情感、认知和行为自我调节过程模型适应了 TBI 环境。通过对与脑损伤康复、参与和韧性相关的文献进行叙述性综述，我们证实了该模型，并解释了韧性如何为损伤后生活经历的研究提供框架。TBI 代表了一连串的逆境，因为损伤和随后的生活经历（例如失业）塑造了适应。韧性由以下因素塑造：个人特征（例如希望、社交功能、自我意识、记忆、灵性、应对方式和自我效能感）、环境资源/支持（例如服务和社会支持）以及自我调节过程，这些过程导致了与韧性相关的结果，我们认为这些结果涉及重新参与活动、适应参与和重塑身份。这个概念模型概述并定义了影响和促进 TBI 后韧性的因素和过程。我们还提出了未来研究的建议。对康复的影响研究韧性过程可以使创伤性脑损伤领域超越检查个体特征和保护因素，转向影响参与体验和机会的交互过程。创伤性脑损伤韧性模型可用于构建康复干预的目标和预期结果，例如自我调节过程或已知可增强韧性的环境支持。研究韧性将有助于改变创伤性脑损伤研究和康复实践的范式，将重点转移到生活经历和适应上，帮助个人、临床医生和家庭考虑积极变化的过程，而不仅仅关注逆境。
