Examining the Nature of Resilience and Executive Functioning in People with Brain Injury and People with Multiple Sclerosis

Author: Nivashinie Mohan

Mohan, Nivashinie, 2011 Examining the Nature of Resilience and Executive Functioning in People with Brain Injury and People with Multiple Sclerosis, Flinders University, School of Medicine

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Abstract

This study describes, identifies, measures and nurtures traits of resilience and executive functioning in two groups of participants, (a) ten with traumatic brain injury; 6 males, 4 females, (Mean Age = 42 years, SD =6.23) and (b) ten with Multiple Sclerosis, 3 Males, 7 Females (M =44, SD = 10.80). Participants who fulfilled the selection criteria underwent a six month individualized psychosocial intervention. The intervention was based on principles of person centred and cognitive behaviour therapy. Skill building exercises, problem solving training, appropriate management of mood disorders and support for building social networks were fundamental components of the intervention. Outcome data were collected using the Resilience Scale (Wagnild & Young, 1993), the Dysexecutive Functioning Questionnaire (DEX) (Wilson, Alderman, Burgess, Emslie, & Evans, 1996), and Goal Attainment Scaling (GAS) (Kiresuk & Sherman,1968) on three occasions; (01) baseline, (02) post intervention and (03) at six months follow up. Supporting data were obtained through case studies, medical records, psychological reports, interviews and participant observation. Statistical analysis of scores (Spearman Correlation Coefficient) indicates that there was a significant correlation between executive functioning and resilient behaviours. As resilience improved for the MS group, so did executive functioning abilities. Significant improvements in resilience scores post intervention (Wilcoxon Signed Rank) were reported by both groups. However, due to the severity of cognitive impairments in participants with TBI, an increase in DEX scores post intervention was not obtained. Despite low scores, significant behavioural changes were identified. Amongst them was the ability to set and persist at tasks, set goals, demonstrate insight and the ability to problem solve. Successful achievement of personal goals was dependent on the availability of support. Only then, were resilient behaviours more perceptible in both groups. Resilient behaviour was also dependent on mood states. When experiencing sustained personal equilibrium,(ie an optimistic and resilient state) participants were better able to respond to feedback, make decisions and plan activities. Given the right circumstances and support, even the most impaired participants (impaired because of serious frontal lobe damage for people with TBI or people with primary progressive MS experiencing considerable pain and loss of mobility) were capable of resilient behaviour which in turn, was motivating for them and inspiring for their family and friends.

Keywords: Resilience,Executive Functioning,Traumatic Brain Injury,Multiple Sclerosis,Psychosocial Intervention,Person Centred Approaches,Cognitive Behaviour Therapy
Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2011
School: School of Medicine
Supervisor: Brian Matthews