Significant other burden and factors related to it in traumatic brain injury

Psychometric properties of the Danish version of the Caregiver Burden Scale: Investigating predictors and severity of burden after stroke, spinal cord injury, or traumatic brain injury

OBJECTIVE

To investigate (i) psychometric properties of the Danish version of the Caregiver Burden Scale, (ii) predictors of burden in caregivers of persons with stroke, spinal cord injury, or traumatic brain injury, and (iii) severity of caregiver burden, and compare level of severity of burden in caregivers of persons with stroke, spinal cord injury, or traumatic brain injury.

DESIGN

Cross-sectional study.

PARTICIPANTS

Pooled sample of 122 caregivers.

METHODS

Psychometric properties including internal consistency, floor and ceiling effects, inter-item and item-total correlation were investigated using the Caregiver Burden Scale. Severity of burden was compared using Fisher's exact test and ANOVA, and predictors of burden were investigated using multiple linear regression models.

RESULTS

The total burden score exhibited good internal consistency (α = 0.93), with no floor or ceiling effects. Longer time as a caregiver was a significant predictor of higher total score. The majority (52.2%) reported a low level of caregiver burden (below cut-off of 2.00). Mean scores on the Caregiver Burden Scale were not significantly different among caregivers across diagnostic groups. Differences were found when comparing spinal cord injury caregivers with brain injury caregivers (traumatic brain injury and stroke, collectively), χ2(2) = 6.38, p = 0.04, as spinal cord injury caregivers were more likely to report low levels of burden.

CONCLUSION

Good psychometric properties were reported, and most caregivers reported a low level of burden, and longer time as a caregiver was associated with higher burden. Consequently, the Caregiver Burden Scale is a valid measure to use when measuring burden in caregivers of stroke, spinal cord injury, and traumatic brain injury patients.

Predictors of caregiver burden in caregivers of individuals with traumatic or non-traumatic brain injury: A scoping review

BACKGROUND

Caregivers of individuals with traumatic (TBI) or non-traumatic (nTBI) brain injuries are at risk of significant caregiver burden. Consequently, it is crucial to examine predictors of caregiver burden to enable early identification and intervention.

OBJECTIVE

To examine predictors of caregiver burden in caregivers of individuals with TBI/nTBI.

METHODS

A scoping review was conducted in the bibliographic databases PubMed, EMBASE (Ovid) and APA PsycInfo (EBSCO). Search terms included: 'acquired brain injur*', 'traumatic brain injur*', 'brain injur*', 'non-traumatic brain injur*', or 'stroke*' combined with 'burden', 'caregiver burden', 'perceived burden', or 'caregiver strain'. The search was limited to articles written in English and published in academic journals between 2000 and March 2022. EndNote was used to manage the references and identify duplicates.

RESULTS

Twenty-four studies were included. Care recipient-related predictors of caregiver burden included more severe injuries, functional disabilities (including decreased physical and neuropsychological functioning), and worse mental health. Caregiver-related predictors included more time spent caregiving, worse mental health, and unmet needs. For several predictor variables, evidence was mixed or vague.

CONCLUSION

The results highlight which caregivers are at risk of caregiver burden and point to several areas of potential intervention to prevent caregiver burden. Future research should explore the relationship between characteristics of the caregiver and caregiver burden, including coping style, problem-solving techniques, and personality, as these have been sparsely investigated and are potentially modifiable through intervention. Further research is needed to elucidate if burden can be prevented by interventions targeting caregivers at risk. Addressing these gaps may clarify the link between caregiver burden and predictor variables and assist in development of interventions that may prevent burden.

Joint Video Self-Modeling for Persons With Traumatic Brain Injury and Their Partners: A Case Series

Purpose Individuals with traumatic brain injury (TBI) experience impairments to self-regulation and social communication that strain relationships. Video self-modeling (VSM) provides visible and audible, tangible evidence of what they do well and what could improve. Conducting such training in the context of authentic exchanges with their everyday partners may support positive change in social communication. The present investigation sought to evaluate indices of improved social communication. Method A mixed-methods design was employed for this case series investigation. Quantitative measures include pre- and postoutcomes on goal attainment scales (GASs) and measures of conversational effectiveness. Qualitative measures include responsiveness to video-supported prompts, conversational behaviors, and metacognitive statements. Results Participants perceived gains on GAS of 3-4 SDs, as well as perceived improvements on the La Trobe Communication Questionnaire. Those gains were validated by gains on the adapted Measure of Participation in Conversation and Measure of Skill in Supported Conversation. Individuals with TBI and their partners reached consensus on most goals and postintervention La Trobe Communication Questionnaire ratings. Participants made accurate judgments about their behaviors at a high rate, given video review. Conversational behaviors and use of metacognitive statements varied across participants and conversational contexts. Field notes and session transcripts provide evidence that both dyads increased internalization of VSM goals and purpose. Conclusions Joint VSM shows promise as a method for eliciting accurate self-assessments among individuals with TBI and their close partners. Both dyads perceived positive gains in interactions within and outside their dyads. Furthermore, joint VSM and GAS appear to improve self-awareness and internalization of VSM goals and purpose.

Factors Influencing Burden in Spouse-Caregivers of Patients with Chronic-Acquired Brain Injury

In this cross-sectional study, we assess associated factors of burden in spouse-caregivers of patients with acquired brain injury (ABI) in the chronic phase. 35 spouse-caregivers (71% female, mean age ± SD: 55.7 ± 11.1y) of patients with mild/moderate ABI (29% female, mean age ± SD: 57.5 ± 10.7y), admitted to the intensive rehabilitation unit of the Institute S. Anna (Crotone, Italy) between January 2013 and December 2017, were contacted 2 years postinjury and asked to complete a series of questionnaires. The outcome measure was the Caregiver Burden Inventory (CBI) test, while several demographical and clinical data were considered as predictive factors. Two years after injury, a high level of burden was reported in 34.2% of spouse-caregivers. Stepwise multiple linear regression analyses revealed that caring for a patient with more severe disability (as measured by the Barthel Index scale) and the family life cycle (from the initial phase of engagement to marriage with adult children) explain the vast majority of variance for higher caregiver burden. The functional clinical status and the stages through which a family may pass over time were identified as areas in which the spouse-caregiver of ABI patients experienced high levels of burden in the chronic phase.

Investigating the adaptation of caregivers of people with traumatic brain injury: a journey told in evolving research traditions

PURPOSE

To examine how conceptualizations of caregiver adaptation to traumatic brain injury have changed over time. The objectives were to identify research traditions, adaptive outcomes assessed in these traditions, and psychosocial variables associated with adaptive outcomes.

METHODS

A meta-narrative review was conducted on 29 identified articles published over a 25-year period (1990-2015).

RESULTS

Four traditions were identified with varying storylines. Burden/Strain (1990-1999) focused on adjustment as the absence of a negative state. Appraisal/Coping (2000-2005) recognized that caregiving experiences could be both positive and negative. In Quality of Life (2006-2011), there was increasing recognition that both personal and contextual factors influence adaptation. Resiliency (2012-2015) used the term "resiliency" as an organizing framework for a broad group of variables and assessed resilience, quality of life, community re-integration, and life/marital satisfaction.

CONCLUSIONS

These storylines reflect an evolution from problem-based to strengths-based conceptualizations, from interest in crisis to considering adaptation as a process unfolding over time, from quantitative to qualitative methods, and towards more holistic views of adaptive outcomes. Variables significantly associated with outcomes across the traditions included social support, reframing and positive appraisal, and behavior strategies. Implications concern the need for longitudinal studies, measurement of environmental factors, and the development of best practices.IMPLICATIONS FOR REHABILITATIONResearch studies on the adaptation of caregivers for people with TBI have evolved from a focus on burden, to coping and quality of life, and most recently to resiliency.It is important to assist caregivers of people with TBI to obtain social support, find positive ways of viewing their experiences, and take part in respite and enjoyed activities.Service providers can help caregivers by adopting a strengths-based perspective to help them recognize available resources, supports, and opportunities.Since caregiver adaptation changes over time, service providers should pay attention to changes in family circumstances and the mental health of caregivers.

Severity of military traumatic brain injury influences caregiver health-related quality of life

PURPOSE/OBJECTIVE

To examine the influence of traumatic brain injury (TBI) severity on the health-related quality of life of caregivers providing care to service members/veterans (SMV) following a TBI. Research Method/Design: Thirty caregivers (90.0% female; 70.0% spouse; age: M = 39.5 years, SD = 10.7) of SMVs who sustained a mild, moderate, severe, or penetrating TBI were recruited from Walter Reed National Military Medical Center and via community outreach to participate in one of six focus groups. Caregivers were classified into 3 TBI severity/caregiver groups: (a) moderate/severe/penetrating TBI caregiver group (n = 11); (b) mild TBI caregiver group (n = 10); and (c) equivocal TBI caregiver group (n = 9). Thematic analysis using a constant comparative approach was conducted with qualitative analysis software to identify common themes across the 3 severity/caregiver groups.

RESULTS

Eleven themes emerged: no time for self/needs last (83.3%), poor physical health (80.0%), increased stress/anxiety (76.7%), social isolation/loneliness (66.7%), lack of access to services (50.0%), impact on family life (46.7%), sleep issues (46.7%), finances/employment (36.7%), depression (30.0%), exhaustion (30.0%), and anger (16.7%). Exploratory pairwise comparisons revealed a higher proportion of the moderate/severe/penetrating TBI group endorsed 7 of the 11 themes (no time for self/needs last, increased stress/anxiety, impact on family life, sleep issues, finances/employment, exhaustion, anger, and increased stress/anxiety) compared with the other 2 groups.

CONCLUSIONS/IMPLICATIONS

It is important that caregivers of SMVs receive long-term support in their caregiving and parenting roles. Further work is required to understand the challenges caregivers experience in accessing services they need and how to effectively meet their needs across the care continuum. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Sociocultural Factors Influencing Caregiver Appraisals Following Traumatic Brain Injury

OBJECTIVE

To investigate the association of the sociocultural variables race/ethnicity, education, and poverty level to caregivers' positive and negative appraisals following traumatic brain injury.

DESIGN

Survey.

SETTING

Community.

PARTICIPANTS

Caregivers (N=344; 216 white; 69 black; 39 Hispanic) of persons with complicated mild to severe TBI at least 1-year postinjury.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Modified Caregiver Appraisal Scale (M-CAS); Zarit Burden Interview (ZBI).

RESULTS

Black caregivers reported lower levels of perceived burden on both the M-CAS and the ZBI. Black and Hispanic caregivers reported more traditional caregiver ideology (caregiving as a responsibility) than did whites. Greater poverty was associated with higher burden on the M-CAS, lower caregiver satisfaction, and less mastery. Higher education was associated with higher burden on the ZBI and with lower caregiver mastery.

CONCLUSIONS

Treatment professionals should be culturally sensitive to the different perspectives that caregivers may have based on sociocultural factors. Sociocultural factors should be considered in research investigating caregiver outcomes, including appraisals.

Preparing Adolescents for Life after School (PALS) Project: A Randomised Controlled Trial of a Coaching Intervention for Young People with Acquired Brain Injury

Introduction: Existing resources to support adolescents with acquired brain injury (ABI) in transition from school to the ‘adult world’ are variable. This study evaluated an intervention using a coaching approach to support adolescents during this transition phase.

Method: The study design was a parallel-group randomised controlled trial (RCT). Participants (n= 43) aged 14–19 years were randomised to intervention (n= 21) or no-intervention control (n= 21) conditions. The intervention group received six coaching sessions over an average of 22 weeks. Outcome measures evaluated changes reported by the adolescent (satisfaction, emotional functioning and hope) and their parent (participation, behaviour and support needs).

Results: Relative to baseline, there was no significant improvement for those in the intervention group in comparison to the control group on any of the outcome measures.

Conclusion: The results of this RCT do not support coaching as an intervention for adolescents with ABI.

A Randomized Controlled Pilot Study of a Manualized Intervention for Caregivers of Patients With Traumatic Brain Injury in Inpatient Rehabilitation

OBJECTIVE

Investigate effectiveness of a 5-session manualized intervention for addressing needs of caregivers of persons in acute traumatic brain injury (TBI) rehabilitation.

DESIGN

Prospective, pilot randomized controlled trial.

SETTING

Inpatient brain injury rehabilitation unit, level 1 trauma center.

PARTICIPANTS

Patients (N=93) with moderate-to-severe TBI and their family members were enrolled in the study with 42 randomized to the treatment group, 51 to the control group.

INTERVENTION

Five-session manualized caregiver intervention with educational, stress and anxiety self-management, coping, and emotional support components.

MAIN OUTCOME MEASURES

Family Needs Questionnaire-Revised, knowledge assessment, Zarit Family Burden Scale, and Brief Symptom Inventory-18 were collected at pretreatment, posttreatment, and 3-month follow-up.

RESULTS

Treatment group caregivers showed an increase in met needs for emotional, instrumental, and professional support, and brain injury knowledge from baseline to posttreatment, whereas controls did not. Between-group differences were significant for only emotional support needs. Treatment effects were not sustained at 3-month follow-up.

CONCLUSIONS

Caregivers of persons undergoing acute TBI rehabilitation may benefit from interventions that target their unique needs. Caregivers may require additional and longer-term supports to sustain treatment benefits.

Exploration of Factors Related to Depressive Symptomatology in Family Members of Military Veterans With Traumatic Brain Injury

Traumatic brain injury (TBI) is a family affair, affecting those with the injury and their families. Psychological distress, often measured as depression or depressive symptoms, is highly prevalent among family members. Predictors of depression in family members of civilians with TBI have been examined, but predictors of depression in family members of military veterans have received very little research attention and are poorly understood. To address the knowledge gap, this study explored factors related to depressive symptoms in family members of veterans in the United States, using an ecological framework. Baseline data from 83 family members were used. Family members with higher caregiver burden, presence of a veteran with posttraumatic stress disorder (PTSD), and greater financial difficulty experienced significantly more depressive symptoms. Findings suggest that efforts to support family members and decrease their depression should aim to reduce caregiver burden and financial difficulty, and help family members cope with veteran PTSD and TBI. Family-focused interventions are needed.

Characteristics and Concerns of Caregivers of Adults With Traumatic Brain Injury

OBJECTIVE

To describe the characteristics of caregivers of adults with traumatic brain injury (TBI) and their concerns in the first months after community discharge of the TBI survivor.

DESIGN

Secondary analysis of data collected during a parallel-group randomized controlled trial.

SETTING

Community.

PARTICIPANTS

A total of 153 consecutively enrolled caregivers of adults with moderate to severe TBI discharged to the community following acute and/or rehabilitation care at a Level I trauma center with 71 caregivers in the treatment group identifying concerns as part of the intervention procedures.

MAIN MEASURES

Caregiver demographics, caregiver-survivor relationship characteristics, caregiver activity changes, and concerns targeted by caregivers for education and problem-solving via biweekly phone calls.

RESULTS

Thirty-nine percent of caregivers were spouses and 35% parents. Sixty-five percent lived in the same house as the survivor preinjury with 86% in touch daily to several times per week. Concerns targeted by more than one-third of caregivers related to managing their emotional adjustment, strategies for getting things done, managing survivor emotions and behaviors, and engaging in healthful habits.

CONCLUSIONS

Caregivers of TBI survivors targeted personal concerns relating to their own emotional adjustment and participation as well as concerns relating to symptoms and recovery of the TBI survivor to address through education and problem-solving.

Family caregiving of individuals with traumatic brain injury in Botswana

Background The impairments that affect survivors of TBI impact the person's independence, and family members frequently have to take on a caregiver role. This study examined the experience of caregiving for individuals with TBI in Botswana and its impact on psychological distress in caregivers. Methods Using a mixed methods study design, qualitative data from semi-structured interviews were thematically analyzed and triangulated with data regarding functional status from the Structured Head Injury Outcome Questionnaire and the Hospital Anxiety and Depression Scale (HADS). Results The study included 26 participants with moderate to severe TBI, and a total of 18 caregivers were recruited. Caregivers commonly reported receiving limited information regarding their relatives' injuries and management methods. Heavy caregiving demands were placed on them, with little support from the healthcare system. A significant proportion of caregivers experienced anxiety and depression, which was associated with lower functional independence in their injured relative. Somewhat more spouses than parents reported clinically significant anxiety levels. Other consequences of caregiving included social isolation and limited support from the wider community as well as financial difficulties. Despite these stresses caregivers tended to accept their caregiving role. Cultural factors such devotion to their families and faith and belief in God moderated burden and distress. Conclusions Carers of individuals with TBI in Botswana face significant challenges. Rehabilitation efforts need to take these into account. Specifically, more information and support needs to be provided to survivors and their families. Psychological, economic and health needs of the care providers also should be addressed in the planning of rehabilitation interventions. Implications for Rehabilitation Caregivers of individuals with TBI in under-resourced countries carry much of the burden of care, face many challenges and experience significant stress. More information and support needs to be provided to survivors of TBI and their families in countries such as Botswana in a culturally sensitive manner. Psychological, economic and health needs also need to be addressed in the planning of rehabilitation interventions, which are currently non-existent in Botswana.

Factors associated with resilience among female family caregivers of a functionally or cognitively impaired aging relative in Lebanon: A correlational study

Background

Owing to the loss of autonomy associated with aging, home-dwelling older people often need the support of family and friends, particularly of a family caregiver whose demanding role can have negative health consequences. The empirical literature reports that some caregivers are resilient and continue to grow and develop, whereas others have difficulty coping with the role and suffer psychological distress.

Aims

The aim of this study was to examine the contribution of personal and contextual factors to the resilience of female family caregivers of home-dwelling functionally or cognitively impaired older people in Lebanon.

Methods

A predictive correlational design was used. The study was conducted with a cohort of 140 female primary family caregivers cohabiting with an older person aged 65 years or over. Data were collected through home-based structured interviews.

Results

Four factors were shown to be significantly associated with caregiver resilience: problem-focused coping strategies, emotion-focused coping strategies, sense of self-efficacy and caregiver meaning of caregiving.

Conclusion

The study offers potential priorities for nursing interventions aimed at promoting caregiver resilience. The results enable the creation of the foundations of a transferable contextual theory of resilience among female family caregivers in Lebanon.

Caregivers' support needs and factors promoting resiliency after brain injury

AIM

This article explores the challenges, support needs and coping strategies of caregivers of people with an acquired brain injury (ABI).

METHOD

Semi-structured interviews were conducted with caregivers (n = 20) to explore their support services received, access barriers, utility of services, needed supports, coping strategies and factors promoting life satisfaction. The team recorded, transcribed verbatim and inductively analysed all interviews.

RESULTS

Through thematic data analysis, three central themes were revealed: (a) barriers impeding quality-of-life, (b) support needed to improve quality-of-life and (c) factors enabling quality-of-life. All perspectives from the participants involved are synthesized to provide a rich depiction of caregivers' support needs and coping strategies.

CONCLUSIONS

Two specific findings of interest include a negative association between severity of brain injury and caregiver's desire to direct treatment, as well as a distinct service gap in assistance for caregivers who are caring for someone with violent/offending behaviours. This study recommends short- and long-term changes, given Australia's upcoming National Disability Insurance Scheme, to increase caregiver quality-of-life, which will ultimately affect the rehabilitation outcomes of persons with ABI.

An exploration of participant experience of a communication training program for people with traumatic brain injury and their communication partners

PURPOSE

To investigate the experiences of participants who attended communication training programs for people with traumatic brain injury (TBI) and their everyday communication partners (CP) as part of a non-randomised controlled trial.

METHOD

The participants were people with TBI and their CP, who were family members or carers of the people with TBI. Twenty-six participants (13 participants with TBI and 13 CP) completed the JOINT program, which involved participants with TBI and CP attending the program together. Fourteen participants with TBI completed the TBI SOLO training program, which did not involve the participation of a CP. Semi-structured videotaped interviews were completed by all participants at the end of the training. Using a six-step generic analysis procedure, data were categorised into topics and then subtopics to identify conceptually discrete units.

RESULTS

Participants described improvements in communication skills, the impact of improved communication skills, valuable components of the programs and components that needed changes.

CONCLUSION

The accounts of participants provided additional evidence for the effectiveness of the training programs, assisted with identifying helpful components of the training and demonstrated the usefulness of a qualitative research methodology as part of evaluating the outcomes of the clinical trial.

Changes in Functional Behaviour of Adults With Brain Injury and Spouse-Caregiver Burden With In-Home Neurobehavioural Intervention

A within-participant multiple baseline experiment evaluated effects of in-home neurobehavioural interventions on functional behaviour of 3 persons with brain injury, and their spouses' burden of care. The 6-week individualised interventions included in-home and telephone consultations. Measures consisted of functional behaviour of the injured persons, spouses' burden of care using the QRS-SF at preand postintervention and at 1 month follow-up, and social validity. Results show interventions were efficacious in improving functional behaviour, but effects on burden of care and social validity were mixed. One caregiver who presented with high levels of burden at preintervention reported reduced burden, while the other 2 who presented with low to moderate burden reported no changes.

Training Communication Partners of People With Traumatic Brain Injury: Reporting the Protocol for a Clinical Trial

This article reports on the design of a three-arm, nonrandomised controlled trial of interventions targeting social communication skills following traumatic brain injury (TBI) in adult participants. People with severe TBI were allocated to one of the three groups: the TBI group, where only the person with TBI was trained, the JOINT group where both the everyday communication partner (ECP) and the person with TBI were trained together, and a delayed treatment control condition. The trial is comparing whether including everyday communication partners in the training process provide additional benefit when compared to training the person with TBI alone; and additionally, whether training the person with TBI alone is more effective than no training. A range of primary and secondary outcome measures will be used to evaluate outcomes. Publishing the protocol prior to the results of the trial being available has several important benefits (Godlee, 2001). The original hypotheses and intentions of the research are made explicit to ensure that the process of conducting this clinical trial is transparent to readers, and so that comments may be made before results are finalised. It provides the opportunity to outline a detailed description of this intervention and methodology, or to acknowledge changes to methodology, which may assist with eventual clinical application of the intervention. This article also informs the research community of the work that is underway to promote opportunities for collaboration and reduce unnecessary duplication of research. The protocol for this trial has previously been registered on Current Controlled Trials (http://www.controlled-trials.com/ISRCTN57815281).

Functional Impairments and Caregiver Depressive Symptoms in the Context of Brain Tumour and Other Cancers: A Mediating Effect of Strain

This study aimed to examine the associations among functional impairments, strain and depressive symptoms for caregivers of individuals with brain tumour and other cancers. Sixty-three caregivers (71% female) of individuals with brain tumour (n = 27) and other cancers (n = 36) were recruited from community services. Participants rated their level of depressive symptoms and strain and the functional impairments of the individual with cancer. Overall, approximately 25% of the total caregiver sample was in the clinical range for depressive symptoms. For caregivers of individuals with brain tumour, strain was significantly related to depressive symptoms (r = .57) and the individual's functional impairments (r = –.58); however, level of depressive symptoms was not significantly related to functional impairments (p > .05). For caregivers of individuals with other cancer, level of depressive symptoms was significantly correlated with strain (r = .50) and their relatives' degree of cognitive, interpersonal and emotional difficulties (r = –.36–.46), but not with activities of daily living (p > .05). In a multivariate analysis involving all the caregivers, strain predicted depressive symptoms (R2 = .32, p < .001) after controlling for gender and cancer type. In addition, strain was found to significantly mediate the effects of the interpersonal and emotional difficulties of individuals with cancer on caregiver depressive symptoms. Overall, these findings highlight the need to develop and evaluate strategies for alleviating the role strain associated with supporting individuals with cancer.

Managing Challenging Behaviour of People With Acquired Brain Injury in Community Settings: The First 7 Years of a Specialist Clinical Service

This article provides a review of the development and clinical practice of the ABI Behaviour Consultancy (the ‘Consultancy’), a specialist clinical service that provides outreach behaviour management support across the state of Victoria, Australia, to people with acquired brain injury (ABI) and their social network (i.e., family members, friends, support workers, and therapists). The Consultancy is a small, unique service that has developed ways of providing behaviour management strategies in community settings, despite the difficulties presented by changing and uncontrolled environments. The aim of this article is to provide a detailed account of this service. Information from the first 7 years of full operation, 1998 to 2004, is presented, during which a small number of psychologists saw more than 800 clients. A detailed description is given of behaviours referred and associated risks, assessment procedures, intervention approaches, and research activity. A variety of key service aspects are detailed, including the qualifications required of specialised staff, the service funding levels, and funding and service issues. These detailed accounts of service delivery are placed in the context of several major themes: specialist versus generalist services, the deployment of targeted interventions throughout the lifespan of a brain-injured individual, the role of specialist behaviour management services in the continuum of brain-injury support services, and broader equity issues.

Experiences of care: perspectives of carers of adults with traumatic brain injury

This paper describes the results of a survey that explored the experiences of carers when accessing rehabilitative services alongside their family member with a moderate-severe TBI. The 184 carers who completed these surveys reflected retrospectively on the care they received. The results of this study indicated that 61% of the carer respondents recollected accessing inpatient rehabilitation following their acute care. However, following inpatient discharge only 33% of carers reported receiving ongoing services. One quarter of carers stated they received inadequate information while transitioning through their healthcare journey and fewer than 20% of carers recollected receiving any formal support service. The results of this study showed that as carers transitioned through the healthcare journey with their family member with TBI, health services progressively declined. As this occurred, carers' satisfaction with services reduced, while their responsibilities for caring increased. This trend is concerning given the needs of carers have been shown to change over time and increase if not addressed. This paper describes both carer experience following TBI in Australia and encourages clinicians to advocate for carers needs when planning and providing rehabilitation services.

Comparison of subjective and objective assessments of outcome after traumatic brain injury using the International Classification of Functioning, Disability and Health (ICF)

PURPOSE

The aim is to examine two aspects of outcome after traumatic brain injury (TBI). Functional outcome was assessed by the Glasgow Outcome Scale - Extended (GOSE) and by clinician ratings, while health-related quality of life (HRQoL) was assessed by the Quality of Life after Brain Injury (QOLIBRI).

METHOD

The GOSE and the QOLIBRI were linked to the International Classification of Functioning, Disability and Health (ICF) to analyse their content. Functional outcome on ICF categories was assessed by rehabilitation clinicians in 55 participants with TBI and was compared to the participants' own judgements of their HRQoL.

RESULTS

The QOLIBRI was linked to 42 and the GOSE to 57 two-level ICF categories covering 78% of the categories on the ICF brief core set for TBI. The closest agreement in the views of the professionals and the participants was found on the Physical Problems and Cognition scales of the QOLIBRI.

CONCLUSIONS

The problems encountered after TBI are well covered by the QOLIBRI and the GOSE. They capture important domains that are not traditionally sufficiently documented, especially in the domains of interpersonal relationships, social and leisure activities, self and the environment. The findings indicate that they are useful and complementary outcome measures for TBI. In rehabilitation, they can serve as tools in assessment, setting meaningful goals and creating therapeutic alliance.

Quality of life after traumatic brain injury: the clinical use of the QOLIBRI, a novel disease-specific instrument

OBJECTIVE

To report the clinical use of the QOLIBRI, a disease-specific measure of health-related quality-of-life (HRQoL) after traumatic brain injury (TBI).

METHODS

The QOLIBRI, with 37 items in six scales (cognition, self, daily life and autonomy, social relationships, emotions and physical problems) was completed by 795 patients in six languages (Finnish, German, Italian, French, English and Dutch). QOLIBRI scores were examined by variables likely to be influenced by rehabilitation interventions and included socio-demographic, functional outcome, health status and mental health variables.

RESULTS

The QOLIBRI was self-completed by 73% of participants and 27% completed it in interview. It was sensitive to areas of life amenable to intervention, such as accommodation, work participation, health status (including mental health) and functional outcome.

CONCLUSION

The QOLIBRI provides information about patient's subjective perception of his/her HRQoL which supplements clinical measures and measures of functional outcome. It can be applied across different populations and cultures. It allows the identification of personal needs, the prioritization of therapeutic goals and the evaluation of individual progress. It may also be useful in clinical trials and in longitudinal studies of TBI recovery.

Family functioning and emotional state two and five years after traumatic brain injury

Previous studies have documented poor family functioning, anxiety, and depression in relatives of individuals with traumatic brain injury (TBI). However, few studies have examined family functioning over extended periods after injury. The present study aimed to investigate family functioning and relatives' emotional state 2 and 5 years following TBI, predictive factors, and their interrelationships. Participants were individuals with TBI and their relatives, with 301 seen at 2 years and 266 at 5 years post-injury. Measures included a Structured Outcome Questionnaire, Family Assessment Device (FAD), Hospital Anxiety and Depression Scale, and the Craig Handicap Assessment and Reporting Technique. Results showed that while the group did not differ greatly in family functioning from a normative group, a significant proportion showed unhealthy functioning across most FAD subscales. Both TBI participants and their relatives showed elevated rates of anxiety and depression. There was little difference between family functioning or relatives' anxiety or depression levels at 2 and 5 years post-injury. Path analysis indicated that neurobehavioral changes in the injured individual have an impact on family functioning and distress in relatives even at 5 years post-injury. These findings indicate the need for long-term support of families with a brain-injured member.

Overview of impaired facial affect recognition in persons with traumatic brain injury

PRIMARY OBJECTIVE

To review the literature of affect recognition for persons with traumatic brain injury (TBI). It is suggested that impairment of affect recognition could be a significant problem for the TBI population and treatment strategies are recommended based on research for persons with autism.

MAIN OUTCOMES AND RESULTS

Research demonstrates that persons with TBI often have difficulty determining emotion from facial expressions. Studies show that poor interpersonal skills, which are associated with impaired affect recognition, are linked to a variety of negative outcomes. Theories suggest that facial affect recognition is achieved by interpreting important facial features and processing one's own emotions. These skills are often affected by TBI, depending on the areas damaged. Affect recognition impairments have also been identified in persons with autism. Successful interventions have already been developed for the autism population. Comparable neuroanatomical and behavioural findings between TBI and autism suggest that treatment approaches for autism may also benefit those with TBI.

CONCLUSIONS

Impaired facial affect recognition appears to be a significant problem for persons with TBI. Theories of affect recognition, strategies used in autism and teaching techniques commonly used in TBI need to be considered when developing treatments to improve affect recognition in persons with brain injury.

The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations

PURPOSE

To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research.

METHOD

Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review.

RESULTS/DISCUSSION

A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical.

CONCLUSION

Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.

Lebenszufriedenheit von PartnerInnen chronisch hirngeschädigter Menschen unter besonderer Berücksichtigung von Persönlichkeitsveränderung

Bezugnehmend auf das Prozessmodell der Pflegebelastung von Pearlin et al. (1990) wurde die Lebenszufriedenheit von 67 LebenspartnerInnen chronisch hirngeschädigter Menschen im Zusammenhang mit diversen Belastungsparametern, im Speziellen der wahrgenommenen Persönlichkeitsveränderung der hirngeschädigten Menschen, untersucht. Nahezu alle befragten ProbandInnen (95 %) nahmen eine stark negative Veränderung der Persönlichkeit ihrer hirngeschädigten PartnerInnen wahr. Die gesunden PartnerInnen lagen bezüglich ihrer Lebenszufriedenheit leicht unter dem Normbereich, wobei höhere Lebenszufriedenheit mit einer höheren Zufriedenheit in Bezug auf die soziale Unterstützung einherging. Der Großteil der Varianz von Lebenszufriedenheit wurde durch die Selbstständigkeit der hirngeschädigten Personen erklärt. Die Implikationen dieser Ergebnisse werden diskutiert.

The measurement and magnitude of awareness difficulties after traumatic brain injury: a longitudinal study

Previous research suggests that reduced self-awareness is common following traumatic brain injury (TBI). However, few studies have examined the magnitude of this problem in a sample representative of hospitalized individuals. In this longitudinal study, individuals with complicated mild to severe TBIs and their significant others (SO) were evaluated at 1 and 12 months postinjury on the Sickness Impact Profile. Awareness was measured by comparing the level of injury-related problems reported by a person with TBI and their SO. Overall, individuals with TBI did not report fewer difficulties than their SO. In contrast, they frequently reported more injury-related difficulties than their SO. As there is no commonly or universally accepted definition for differential awareness, the magnitude of underreporting and over-reporting problems is presented using four different cutoff scores. A minimum discrepancy is proposed for defining awareness difficulties that is based on the standard error of measurement of the test-retest difference of the measure. Reduced self-awareness was inconsistent across both time and functional domains. These results suggest that reduced self-awareness is not the norm at 1 or 12 months postinjury and highlight the need for a more standardized approach to the measurement and classification of self-awareness.

Beziehungszufriedenheit von PartnerInnen chronisch Hirngeschädigter

Zusammenfassung: Bezugnehmend auf das Prozessmodell der Pflegebelastung von Pearlin et al. (1990) wurde die Beziehungszufriedenheit der LebenspartnerInnen chronisch Hirngeschädigter in Abhängigkeit verschiedener Situations- und Belastungsparameter untersucht. Die Beziehungsqualität der 64 PartnerInnen wurde mit Hilfe der Paarklimaskalen (PKS) erhoben. Die psychische Belastung wurde mit Skalen der Symptom Checkliste 90-R (SCL-90-R), die alltagsbezogene Belastung mit dem Screen for Caregiver Burden (SCB) erfasst. Objektive Daten der Belastung wurden mittels eines demographischen und krankheitsspezifischen Fragebogens erfasst. Regressionsberechnungen ergaben, dass sowohl die Beziehungszufriedenheit als auch die psychische Belastung der LebenspartnerInnen ausschließlich von subjektiven Stressoren abhängig waren. Die Bedeutung subjektiver Stressoren für das Belastungserleben Angehöriger chronisch Kranker konnte somit unterstrichen werden. Die Ergebnisse verdeutlichen die Notwendigkeit angehörigenspezifischer Interventionen im Rehabilitationsprozess.

Stress and coping among families of patients with traumatic brain injury: a review of the literature

AIMS AND OBJECTIVES

This literature review aims to structure the available information on the psychological reactions of family members confronted with traumatic brain injury. The stress-coping theory and the systems theory provide the theoretical framework for this review.

METHOD

Literature review.

RESULTS

The level of stress experienced by the family members of patients who have traumatic brain injury is such that professional intervention is appropriate, even after 10-15 years. Not the severity of the injury but the nature of the injuries determines the level of stress. Partners experience more stress than parents. Children have specific difficulties. Young families with little social support, financial, psychiatric and/or medical problems are the most vulnerable. Coping with traumatic brain injury can be described in phases. The better family members can cope with the situation, the better the patient's recovery. There are functional and non-functional coping mechanisms and coping is influenced by such factors as gender, social and professional support and the possibility to have reciprocal communication or an affective relation with the patient.

RELEVANCE TO CLINICAL PRACTICE

Support from professionals reduces the stress being experienced and encourages people to cope effectively. Conflicts with professional carers should be avoided. Every attempt should be made to develop models of long-term support and care that alleviate sources of burden on relatives. Further research is necessary to develop such models.

Development and application of the Family Empowerment Questionnaire in brain injury

BACKGROUND

The present study was an ongoing development of a previous study of the Family Empowerment Questionnaire, which had already indicated a four-factor solution (Skill, Knowledge, Support and Aspiration) empowerment process among family caretakers for their family members with traumatic brain injury (TBI).

OBJECTIVE

The Family Empowerment Questionnaire was used to further explore its applicability to rehabilitation professionals through investigating differences between rehabilitation professionals' and family members' perceptions of empowerment in the rehabilitation process of persons with TBI.

METHOD AND PROCEDURES

The present study compared the 52-item Family Empowerment Questionnaire scores between 65 rehabilitation professionals with the results obtained from 211 family caretakers.

MAIN OUTCOME

Statistical analyses using the factor-based scores of the four sub-scales revealed that professionals and family members differ significantly in their perceptions regarding family empowerment in TBI rehabilitation in any of the four empowerment factors and within individual items of each factor.

CONCLUSIONS

Specific activities in which families and professionals' perceptions differed significantly should be explored further and clinical implications of the study are discussed.