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

A window into the reality of families living long term with challenging behaviours after a TBI

Challenging behaviours are a long-term burden for people with traumatic brain injury (TBI) and their families. Families frequently shoulder the responsibility alone, but little is known about the strategies they use to manage these behaviours. This study aimed to 1) identify the coping strategies used by people with TBI living in the community and their family caregivers to manage challenging behaviours; and 2) describe the similarities and differences between strategies used by people with TBI and caregivers. In this qualitative descriptive design, individual semi-structured interviews were conducted with adults with TBI and their caregivers and were inductively analyzed. The sample included 10 dyads and two triads, totalling 12 caregivers (8 women) and 14 individuals with TBI (6 women; 21.71 ± 10.84 years post-injury). Participants' strategies were proactive (prevention), reactive (response), or retroactive (aftercare). Most strategies were described by caregivers. Some of them were effective and lasting, others not, reflecting how they adapted their approaches over time. Families put in place various strategies in their life's journey, such as giving feedback or adapting the environment. Despite these strategies supporting long-term community living, the need for ongoing support is underscored, as crises may still occur, impacting families' quality of life.

Family-oriented interventions for adults with acquired brain injury and their families: a scoping review

OBJECTIVE

This scoping review sought to describe the literature on the different types of interventions to support families of patients with acquired brain injuries (ABIs) and their outcomes.

INTRODUCTION

Acquired brain injuries are among the leading causes of disability in adults worldwide and have physical, cognitive or/and behavioral consequences not only for the patient, but also for the family. Several support interventions have been proposed in different contexts at different phases of recovery with various levels of evidence, yet no synthesis is available to date.

INCLUSION CRITERIA

We included studies that focused on family members of patients suffering from ABI. The concept under review included any type of intervention or action oriented to support families of patients with ABI, in any care setting. We included all published qualitative and quantitative designs, including those in the gray literature.

METHODS

A three-step search strategy was performed. Searches were conducted in eight major databases, MEDLINE, PubMed, Embase, CINAHL, PsycINFO, Cochrane, JBI Database of Systematic Reviews and Implementation Reports, Web of Science in April 2017, and seven databases for unpublished studies in November 2017. This review was limited to studies published in English and French since January 2007. Additional studies were searched amongst reference lists of all included articles.

RESULTS

We included 89 studies, 19 secondary studies (systematic reviews n = 13, other type of reviews n = 6) and 70 primary studies (experimental studies n = 20, quasi-experimental studies n = 33, other designs n = 17). Even if heterogeneity was found in the characteristics of the 64 selected interventions, emotional support and education were highlighted as the main core components for family-oriented interventions. Mental health and burden were the two most prevalent outcomes found in this scoping review. Interventions targeted families and patients together in 56% of the cases or families alone.

CONCLUSION

This scoping review provides an actual state of the current evidence available for families of patients with ABI. Extended and heterogeneous literature was found, showing the growing interest for considering ABI as a family issue in recent years. However, the overall level of evidence found indicates that more research is still needed to determine key components to intervene within this specific population.

Community-based interventions for adolescents following traumatic brain injury: A systematic review

BACKGROUND

Chronic impairment following childhood traumatic brain injury has the potential to increase risk of negative outcomes. This highlights potential value in community-based rehabilitation programs.

OBJECTIVES

To identify research studies examining existing intervention programmes available in community-based rehabilitation to adolescents following TBI to assist with the transition back into the community.

METHODS

A systematic review of community-based interventions was conducted across different national contexts. All included studies involved a clinical population with TBI, aged 11 to 25 years inclusive. Risk of bias was rated for each included study.

RESULTS

Seventeen studies were identified for inclusion in the review, of these eleven distinct interventions were found. The quality of evidence was largely weak and highly variable.

CONCLUSION

The results suggest some improvement in adolescent outcomes following community-based interventions, however higher quality evidence is needed to support specific interventions.

Caregiver outcomes and interventions: a systematic scoping review of the traumatic brain injury and spinal cord injury literature

Aim:

To identify factors reported with negative and positive outcomes for caregivers of the traumatic brain injury and spinal cord injury cohorts, to investigate what interventions have been studied to support carers and to report what effectiveness has been found.

Methods:

Scoping systematic review. Electronic databases and websites were searched from 1990 to December 2015. Studies were agreed for inclusion using pre-defined criteria. Relevant information from included studies was extracted and quality assessment was completed. Data were synthesised using qualitative methods.

Results:

A total of 62 studies reported caregiver outcomes for the traumatic brain injury cohort; 51 reported negative outcomes and 11 reported positive outcomes. For the spinal cord injury cohort, 18 studies reported caregiver outcomes; 15 reported negative outcomes and three reported positive outcomes. Burden of care was over-represented in the literature for both cohorts, with few studies looking at factors associated with positive outcomes. Good family functioning, coping skills and social support were reported to mediate caregiver burden and promote positive outcomes. A total of 21 studies further described interventions to support traumatic brain injury caregivers and four described interventions to support spinal cord injury caregivers, with emerging evidence for the effectiveness of problem-solving training. Further research is required to explore the effects of injury severity of the care recipient, as well as caregiver age, on the outcome of the interventions.

Conclusion:

Most studies reported negative outcomes, suggesting that barriers to caregiving have been established, but not facilitators. The interventions described to support carers are limited and require further testing to confirm their effectiveness.

Single Participant Studies in Positive Behaviour Support for Parents of Individuals With Brain Injuries

Three single participant studies examined effects of in-home parent-implemented Positive Behaviour Support (PBS) interventions on behaviour of individuals with brain injuries. Parental and independent observations of morning routine behaviour or problem behaviour (viz., noncompliance during meals or morning routines, yelling, kicking, swearing, and so on) were taken during baselines and PBS interventions, which consisted of person-centred functional assessments of behaviour, emphasis on changing behavioural antecedents, parent participation in assessing, treating, and evaluating behaviour change, and in-home parent coaching and support. Results show decreased problem behaviour or improved morning routine behaviour, which corroborate and add to the few studies that applied similar parent-implemented interventions. Future comparative studies between PBS and out-patient interventions are indicated.