title: Role of contextual factors in the rehabilitation of adolescent survivors of traumatic brain injury: emerging concepts identified through modified narrative review.
abstract: BACKGROUND
  Recently research in traumatic brain injury (TBI) intervention has identified the benefits of contextualized, embedded, functionally based approaches to maximize treatment outcomes. An essential component of contextualized intervention is the direct and purposeful consideration of the broader context, in which the person with TBI functions. However, systematic consideration of contextual factors remains limited both in research and clinical practice.
  
  
  OBJECTIVE
  The purposes of this modified narrative review were (1) to provide a succinct review of the available literature regarding the contextual factors that are specific to adolescent survivors of TBI, one of highest incidence groups for brain injury; (2) to connect these contextual factors to the direct long-term management of TBI and to identify their potential impact on outcome; and (3) to highlight areas that are open to research and clinical advances that could enhance positive outcomes for adolescent survivors of TBI. The framework of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; 2007) was used as a foundation for this review.
  
  
  METHODS
  A systematic literature search was conducted using databases and hand searches. A total of 102 articles were originally identified. Twenty-five original research articles, eight review papers and four expert opinion papers met inclusion and exclusion criteria and were included in the final review.
  
  
  RESULTS
  The body of research specifically focused on contextual factors is an emerging area. Early findings indicate that a focus on the direct modification of contextual factors is promising for the facilitation of positive outcomes long into the chronic phase of management for adolescences who have survived a TBI. The contextual factors included in this review were the overall ability of the school to support a student post-TBI, family psychosocial risk (sibling/sibling relationships/stress/burden/support), coping style (TBI survivor and their caregivers), and socioeconomic status of the family. Given the promise of these findings, research and clinical application efforts should be focused on identifying well-prescribed rehabilitation paradigms that capitalize on the modification of contextual factors throughout the recovery process.
  
  
  CONCLUSIONS
  The results of this modified narrative review provide an initial summary of the available evidence for addressing contextual factors in the rehabilitation process for adolescents with TBI. This is an area that is wide open for both systematic research and clinical application and holds potential to improve long-term outcome for survivors of adolescent TBI.
authors.affiliation: Department of Psychological Sciences, Program in Communication Sciences, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Angela Hein
authors.initials: AH
authors.lastname: Ciccia
authors.affiliation: Department of Communication Sciences and Disorders, McGannon Hall, St. Louis, MO, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Threats
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012917:Social Adjustment; D012931:Social Environment; D012944:Social Support
keywords: ICF; adolescence; contextual variables; speech-language pathology; traumatic brain injury