Sage Journals: Discover world-class research

Abstract

Engagement in leisure activities is a significant contributor to health. Individuals with traumatic brain injury (TBI) report not returning to pre-injury levels of leisure participation. Self-regulation (SR) is a possible factor of limited re-engagement. This study aimed to examine leisure re-engagement patterns and the impact of SR on these patterns. Fifty-five adults with TBI were included in a cross-sectional study. Participants completed a leisure activity survey, rating engagement before and after injury. Participants and an informant completed the Frontal Systems Behavior Scale (FrSBe) to assess SR. Leisure was significantly lower after injury than before injury, t(54) = 3.83, p < .001. The FrSBe apathy score was significantly associated with lower re-engagement (eta = 0.42) and may predict engagement after injury (ΔR² = .09, p < .05). Apathy may contribute to difficulty re-engaging in leisure activities. Re-engagement in leisure activities should be a focus of occupational therapy intervention after TBI.

Plain Language Summary

How Traumatic Brain Injury Affects Leisure Activities and Self-Regulation

This study looks at how people who have had a traumatic brain injury (TBI) get back into leisure activities (such as hobbies, sports, and social engagements). Furthermore, this study looks at how a person’s ability to self-regulate impacts their ability to participate in leisure tasks. Self-regulation is how an individual is able to control their thoughts, actions, and emotions and includes three components addressed in this study: executive functioning, apathy, and disinhibition. Leisure activities are important for health and well-being. However, many people with TBI find it hard to return to these activities due to their impairments. We interviewed 55 adults with TBI about their leisure activities before and after their injury. They also completed a questionnaire with their family members to assess their self-regulation abilities, such as planning, monitoring, and changing their actions to meet their goals. The results showed that people engaged in leisure activities significantly less after their injury than before they were injured. We found that higher levels of apathy were linked to lower levels of re-engagement in leisure activities. In other words, those who demonstrated a lack of interest or enthusiasm were less likely to return to their hobbies and interests. These findings suggest that apathy plays a big role in whether someone with TBI will re-engage in leisure activities. Because of this, occupational therapists should include interventions and strategies to help manage apathy and encourage participation in leisure activities for better quality of life and outcomes.

Keywords

leisure functional outcomes cognition engagement

Get full access to this article

View all access options for this article.

References

Al-Adawi

Dorvlo

Burke

Huynh

Jacob

Knight

Shah

Al-Hussaini

(2004). Apathy and depression in cross-cultural survivors of traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 16(4), 435–442. https://doi.org/10.1176/jnp.16.4.435

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process—Fourth Edition. American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010p1–7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001

Baum

Edwards

(2008). ACS: Activity card sort. American Occupational Therapy Association.

Beck

Steer

Brown

(1996). Manual for the beck depression inventory-II (Vol. 1). Psychological Corporation.

Bier

Dutil

Couture

(2009). Factors affecting leisure participation after a traumatic brain injury: An exploratory study. Journal of Head Trauma Rehabilitation, 24(3), 187–194. https://doi.org/10.1097/HTR.0b013e3181a0b15a

Bureau of Labor Statistics. (2017). Time spent in leisure and sports activities increased by 32 minutes per day in 2020. U.S. Department of Labor. https://www.bls.gov/opub/ted/2021/time-spent-in-leisure-and-sports-activities-increased-by-32-minutes-per-day-in-2020.htm

Carbonneau

Martineau

É.

Andre

Dawson

(2011). Enhancing leisure experiences post traumatic brain injury: A pilot study. Brain Impairment, 12(2), 140–151. https://doi.org/10.1375/brim.12.2.140

Carvalho

Buelow

Ready

Grace

(2016). Associations between original and a reduced Frontal Systems Behavior Scale (FrSBe), cognition, and activities of daily living in a large neurologic sample. Applied Neuropsychology: Adult, 23(2), 125–132. https://doi.org/10.1080/23279095.2015.1012759

Chen

S.-W.

Chippendale

(2018). Leisure as an end, not just a means, in occupational therapy intervention. The American Journal of Occupational Therapy, 72(4), 1–5. https://doi.org/10.5014/ajot.2018.028316

10.

Cohen

West

Aiken

(2002). Applied multiple regression/correlation analysis for the behavioral sciences. Taylor & Francis Group. http://ebookcentral.proquest.com/lib/nyulibrary-ebooks/detail.action?docID=1222653

11.

Fancourt

Aughterson

Finn

Walker

Steptoe

. (2021). How leisure activities affect health: A narrative review and multi-level theoretical framework of mechanisms of action. Lancet Psychiatry, 8(4), 329–339. https://doi.org/10.1016/s2215-0366(20)30384-9

12.

Fisk

Ritvo

Ross

Haase

Marrie

Schlech

(1994). Measuring the functional impact of fatigue: Initial validation of the fatigue impact scale. Clinical Infectious Diseases, 18(Suppl. 1), S79–S83. https://doi.org/10.1093/clinids/18.supplement_1.s79

13.

Fraas

Balz

M. A.

(2008). Expressive electronic journal writing: Freedom of communication for survivors of acquired brain injury. Journal of Psycholinguistic Research, 37, 115–124. https://doi.org/10.1007/s10936-007-9062-y

14.

Funayama

Nakagawa

Nakajima

Kawashima

Matsukawa

Takata

Kurose

(2022). Apathy level, disinhibition, and psychiatric conditions are related to the employment status of people with traumatic brain injury. American Journal of Occupational Therapy, 76(2), 7602205060. https://doi.org/10.5014/ajot.2022.047456

15.

Gibbs

Wilkie

Jarman

Barker-Smith

Kemp

Fisher

(2022). Riding the wave into wellbeing: A qualitative evaluation of surf therapy for individuals living with acquired brain injury. PLOS ONE, 17(4), Article e0266388. https://doi.org/10.1371/journal.pone.0266388

16.

Gould

Ponsford

Johnston

Schönberger

(2011). Predictive and associated factors of psychiatric disorders after traumatic brain injury: A prospective study. Journal of Neurotrauma, 28(7), 1155–1163. https://doi.org/10.1089/neu.2010.1528

17.

Goverover

Genova

Smith

Chiaravalloti

Lengenfelder

(2017). Changes in activity participation following traumatic brain injury. Neuropsychological Rehabilitation, 27(4), 472–485. https://doi.org/10.1080/09602011.2016.1168746

18.

Goverover

Johnston

M. V.

Toglia

DeLuca

(2007). Treatment to improve self-awareness in persons with acquired brain injury. Brain Injury, 21(9), 913–923. https://doi.org/10.1080/02699050701553205

19.

Grace

Malloy

P. H.

(2001). Frontal systems behavior scale (FrSBe): Professional manual. Psychological Assessment Resources.

20.

Hammond

Perkins

Corrigan

Nakase-Richardson

Brown

O’Neil-Pirozzi

Zasler

Greenwald

(2021). Functional change from five to fifteen years after traumatic brain injury. Journal of Neurotrauma, 38(7), 858–869. https://doi.org/10.1089/neu.2020.7287

21.

Hart

Brenner

Clark

Bogner

Novack

Chervoneva

Nakase-Richardson

Arango-Lasprilla

J. C.

(2011). Major and minor depression after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 92(8), 1211–1219. https://doi.org/10.1016/j.apmr.2011.03.005

22.

Homaifar

Brenner

Gutierrez

Harwood

Thompson

Filley

Kelly

Adler

(2009). Sensitivity and specificity of the Beck Depression Inventory-II in persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 90(4), 652–656. https://doi.org/10.1016/j.apmr.2008.10.028

23.

Hunt

A. W.

Turner

G. R.

Polatajko

Bottari

Dawson

D. R.

(2013). Executive function, self-regulation and attribution in acquired brain injury: A scoping review. Neuropsychological Rehabilitation, 23(6), 914–932. https://doi.org/10.1080/09602011.2013.835739

24.

International Business Machines. (2020). IBM SPSS statistics for windows (Version 27.0) [Computer software].

25.

Janke

M. C.

Son

J. S.

Payne

L. L.

(2009). Self-regulation and adaptation of leisure activities among adults with arthritis. Activities, Adaptation & Aging, 33(2), 65–80.

26.

Kant

Duffy

Pivovarnik

(1998). Prevalence of apathy following head injury. Brain Injury, 12(1), 87–92. https://doi.org/10.1080/026990598122908

27.

Kelly

J. R.

(2019). Leisure identities and interactions. Routledge.

28.

Kim

Thapa

(2021). Intensity of leisure-time physical activity and dimensions of mental well-being: A reciprocal approach using parallel latent growth curve modeling. Journal of Physical Activity and Health, 18(2), 165–174. https://doi.org/10.1123/jpah.2020-0300

29.

Klimova

Valis

Kuca

(2017). Cognitive decline in normal aging and its prevention: A review on non-pharmacological lifestyle strategies. Clinical Interventions in Aging, 12, 903–910. https://doi.org/10.2147/cia.S132963

30.

Krch

Frank

L. E.

Chiaravalloti

N. D.

Vakil

DeLuca

(2019). Cognitive reserve protects against memory decrements associated with neuropathology in traumatic brain injury. Journal of Head Trauma Rehabilitation, 34(5), E57-E65. https://doi.org/10.1097/htr.0000000000000472

31.

Kuykendall

Tay

(2015). Leisure engagement and subjective well-being: A meta-analysis. Psychological Bulletin, 141(2), 364–403.

32.

Lane-Brown

Tate

(2009a). Interventions for apathy after traumatic brain injury. Cochrane Database of Systematic Reviews, 2009(2), CD006341. https://doi.org/10.1002/14651858.CD006341.pub2

33.

Lane-Brown

Tate

(2009b). Measuring apathy after traumatic brain injury: Psychometric properties of the Apathy Evaluation Scale and the Frontal Systems Behavior Scale. Brain Injury, 23(13–14), 999–1007. https://doi.org/10.3109/02699050903379347

34.

Lengenfelder

Arjunan

Chiaravalloti

Smith

DeLuca

(2015). Assessing frontal behavioral syndromes and cognitive functions in traumatic brain injury. Applied Neuropsychology: Adult, 22(1), 7–15. https://doi.org/10.1080/23279095.2013.816703

35.

Marsiske

Lang

F. B.

Baltes

P. B.

Baltes

M. M.

(1995). Selective optimization with compensation: Life-span perspectives on successful human development. In Dixon

R. A.

Bäckman

(Eds.), Compensating for psychological deficits and declines: Managing losses and promoting gains (pp. 35–79). Lawrence Erlbaum Associates.

36.

McDonald

Genova

(2021). The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood. Handbook of Clinical Neurology, 183, 235–260. https://doi.org/10.1016/b978-0-12-822290-4.00011-6

37.

Mitchell

Veitch

Passey

(2014). Efficacy of leisure intervention groups in rehabilitation of people with an acquired brain injury. Disability and Rehabilitation, 36(17), 1474–1482. https://doi.org/10.3109/09638288.2013.845259

38.

Nalder

Hartman

Hunt

King

(2019). Traumatic brain injury resiliency model: A conceptual model to guide rehabilitation research and practice. Disability and Rehabilitation, 41(22), 2708–2717. https://doi.org/10.1080/09638288.2018.1474495

39.

Niemeier

Perrin

Holcomb

Nersessova

Rolston

(2013). Factor structure, reliability, and validity of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury population. Rehabilitation Psychology, 58(1), 51–63. https://doi.org/10.1037/a0031612

40.

Paggi

Jopp

Hertzog

(2016). The importance of leisure activities in the relationship between physical health and well-being in a life span sample. Gerontology, 62(4), 450–458. https://doi.org/10.1159/000444415

41.

Pagulayan

Hoffman

Temkin

Machamer

Dikmen

(2008). Functional limitations and depression after traumatic brain injury: Examination of the temporal relationship. Archives of Physical Medicine and Rehabilitation, 89(10), 1887–1892. https://doi.org/10.1016/j.apmr.2008.03.019

42.

Pew Research Center. (2019). Americans 60 and older are spending more time in front of their screens than a decade ago. https://www.pewresearch.org/fact-tank/2019/06/18/americans-60-and-older-are-spending-more-time-in-front-of-their-screens-than-a-decade-ago/

43.

Pigati

Righetti

Dourado

Nisiaymamoto

Saraiva-Romanholo

Tibério

(2022). Resilience improves the quality of life and subjective happiness of physiotherapists during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 19(14), 8720. https://doi.org/10.3390/ijerph19148720

44.

Popescu

Anghelescu

Daia

Onose

(2015). Actual data on epidemiological evolution and prevention endeavours regarding traumatic brain injury. Journal of Medicine and Life, 8(3), 272–277.

45.

Rabinowitz

Chervoneva

Hart

O’Neil-Pirozzi

Juengst

Hoffman

(2020). Heterogeneity in temporal ordering of depression and participation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 101(11), 1973–1979. https://doi.org/10.1016/j.apmr.2020.05.026

46.

Reid-Arndt

S. A.

Nehl

Hinkebein

(2007). The Frontal Systems Behaviour Scale (FrSBe) as a predictor of community integration following a traumatic brain injury. Brain Injury, 21(13–14), 1361–1369. https://doi.org/10.1080/02699050701785062

47.

Schiehser

Delano-Wood

Jak

Matthews

Simmons

Jacobson

Filoteo

Bondi

Orff

Liu

(2015). Validation of the Modified Fatigue Impact Scale in mild to moderate traumatic brain injury. Journal of Head Trauma Rehabilitation, 30(2), 116–121. https://doi.org/10.1097/htr.0000000000000019

48.

Scott Jones

. (2019). Learn to use the eta coefficient test in SPSS with data from the NIOSH quality of worklife survey (2014). https://doi.org/10.4135/9781526474681

49.

Sherer

Davis

Sander

Caroselli

Clark

Pastorek

(2014). Prognostic importance of self-reported traits/problems/strengths and environmental barriers/facilitators for predicting participation outcomes in persons with traumatic brain injury: A systematic review. Archives of Physical Medicine and Rehabilitation, 95(6), 1162–1173. https://doi.org/10.1016/j.apmr.2014.02.006

50.

Sherer

Nick

T. G.

Sander

A. M.

Melguizo

Hanks

Novack

T. A.

Tulsky

Kisala

Luo

Tang

(2017). Groupings of persons with traumatic brain injury: A new approach to classifying traumatic brain injury in the post-acute period. Journal of Head Trauma Rehabilitation, 32(2), 125–133. https://doi.org/10.1097/htr.0000000000000207

51.

Sigurdardottir

Andelic

Roe

Schanke

(2014). Identifying longitudinal trajectories of emotional distress symptoms 5 years after traumatic brain injury. Brain Injury, 28(12), 1542–1550. https://doi.org/10.3109/02699052.2014.934285

52.

Skidmore

E. R.

Whyte

E. M.

Butters

M. A.

Terhorst

Reynolds

C. F.

III . (2015). Strategy training during inpatient rehabilitation may prevent apathy symptoms after acute stroke. PM R, 7(6), 562–570. https://doi.org/10.1016/j.pmrj.2014.12.010

53.

Stamm

T. A.

Cieza

Machold

Smolen

J. S.

Stucki

(2006). Exploration of the link between conceptual occupational therapy models and the International Classification of Functioning, Disability and Health. Australian Occupational Therapy Journal, 53(1), 9–17. https://doi.org/10.1111/j.1440-1630.2005.00513.x

54.

Sumowski

Wylie

Gonnella

Chiaravalloti

Deluca

(2010). Premorbid cognitive leisure independently contributes to cognitive reserve in multiple sclerosis. Neurology, 75(16), 1428–1431. https://doi.org/10.1212/WNL.0b013e3181f881a6

55.

Tate

R. L.

Wakim

Sigmundsdottir

Longley

(2020). Evaluating an intervention to increase meaningful activity after severe traumatic brain injury: A single-case experimental design with direct inter-subject and systematic replications. Neuropsychological Rehabilitation, 30(4), 641–672. https://doi.org/10.1080/09602011.2018.1488746

56.

Toglia

Johnston

M. V.

Goverover

Dain

(2010). A multicontext approach to promoting transfer of strategy use and self regulation after brain injury: An exploratory study. Brain Injury, 24(4), 664–677. https://doi.org/10.3109/02699051003610474

57.

Trevorrow

Gustafsson

Hodson

(2024). Leisure engagement among people living with acquired brain injury: A scoping review. OTJR: Occupational Therapy Journal of Research, 44(2), 263–277. https://doi.org/10.1177/15394492231221962

58.

Winter

Moriarty

Short

(2018). Beyond anger: Emotion regulation and social connectedness in veterans with traumatic brain injury. Brain Injury, 32(5), 593–599. https://doi.org/10.1080/02699052.2018.1432895

59.

Wise

E. K.

Mathews-Dalton

Dikmen

Temkin

Machamer

Bell

Powell

J. M.

(2010). Impact of traumatic brain injury on participation in leisure activities. Archives of Physical Medicine and Rehabilitation, 91(9), 1357–1362. https://doi.org/10.1016/j.apmr.2010.06.009

60.

World Health Organization. (2001). International classification of functioning, disability, and health: ICF (Version 1.0). https://search.library.wisc.edu/catalog/999977181002121

Examining Leisure Re-Engagement and Its Relationship With Self-Regulation After Traumatic Brain Injury: A Cross-Sectional Study

Abstract

Plain Language Summary

Keywords

Get full access to this article

References