Understanding and Supporting Peer Relationships during Acute Neurorehabilitation Following Acquired Brain Injury: The Peer Event Initiative



Naomi De Souza


Naomi De Souza
Miranda Loveday
Tamsin Jones



- How do peer events impact on patient’s narratives about their friendships?
- How do peer events impact on the development of resources for social relationships within patients and their friends?

It is well documented that the peer relationships of children and adolescents are important for the development of social competence and confidence, and for mental health. Following Acquired Brain Injury (ABI), problems with disinhibition, impulsiveness, poor social judgement, lack of emotional response and slowed processing can all contribute to difficulties maintaining relationships with peers and in acquiring new ones. In addition, a ‘patient’ is set apart from their peers through their experience of a ‘serious illness’ and often an acquired physical disability. Research and local experience shows clearly that when children and young people attempt to reconnect with their pre-injury peers the result is often a gradual loss of friendships and increasing isolation. Loneliness has been reported as a dominant concern for individuals living with a brain injury.

In response to these concerns we developed a peer event initiative within our acute neurorehabilitation service. Our aim was to promote better social competence and confidence, to reduce the likelihood of peer rejection for our patients, and to enhance understanding and involvement of their close friends in their peer’s brain injury and recovery from it. In addition, these events were designed to provide a context for an ecologically valid assessment of strengths and barriers to patients’ social function as well as an opportunity for remediation.

Feedback collected from nine events over the past eighteen months has demonstrated a positive impact of the sessions on participants' understanding of brain injury and their feelings about what has happened to their friend. Furthermore, following the events peers identified concrete steps to take to support their friend. Patients themselves also gave positive feedback about the events, noting changes in the quality of their friendships. However, in later follow-up appointments concerns about peer relationships remain a key theme.

An in-depth study of the narrative that adolescent patients tell us about their peer relationships at different stages of recovery from an ABI has been carried out. At an early stage of rehabilitation information is gathered about valued social relationships and this is reviewed across the inpatient stay. Changes are explored therapeutically, visual representations of these relationships are created, and questionnaire data is gathered. At follow-up these themes are revisited and barriers to social integration are explored in order to map changes. As outlined in the narrative therapy approach, the story that patients tell about their friendships across their recovery is thereby 'thickened', allowing for new possibilities to be considered.

In this symposium, Dr Naomi de Souza (Psychologist), Miranda Loveday (Speech and Language Therapist) and Tamsin Jones (Occupational Therapist) will outline the contributions made to these events from their own professional perspectives, drawing on themes of narrative and identity, social communication, and social integration.



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