Family Needs After Traumatic Brain Injury: Implications for Rehabilitation Counselling

Mixed methods study to understand the experiences of adults with acquired brain injury and their family members who receive specialised rehabilitation

BACKGROUND AND AIM

Rehabilitation therapy is a key part of the recovery pathway for people with severe acquired brain injury (ABI). The aim of this study was to explore inpatients' and their family members' experiences of a specialist ABI rehabilitation service.

METHODS

A cross sectional, prospective mixed method study was undertaken at a metropolitan specialist ABI rehabilitation unit in Victoria, Australia. All inpatients and their family members of the service were invited to complete a satisfaction survey. Employing purposive sampling, semi-structured interviews were conducted with inpatients and/or their family members.

RESULTS

In total, 111 people completed the satisfaction survey and 13 were interviewed. High levels of satisfaction with the specialist service were reported; the majority of inpatients (74%) and family members (81%) rated the overall quality of care received in the service as 'high' or 'very high'. Interviews revealed four main themes: (i) satisfaction with rehabilitation services, (ii) inconsistent communication, (iii) variable nursing care, and (iv) strengths and weakness of the rehabilitation environment. Overall, important components of a positive experience were being involved in decision making and discharge planning, effective communication and information processes, and being able to form therapeutic relationships with staff. Key sources of dissatisfaction for inpatients and family members related to inconsistency in care, accessing information about treatments in a format easily understood, and communication.

CONCLUSION

Specialised rehabilitation is valued by inpatients and their family members alike. The findings highlight the importance of exploring inpatient experiences to optimise service delivery in a tailored, specialised rehabilitation programme.

Is the "Family Glass Cabin" Useful to Safely Allow Inpatient-Caregiver Interaction in the COVID-19 Era? A Pilot Study on Severe Acquired Brain Injury

Acquired Brain Injury (ABI) is a life-changing event that can have a devastating impact on all aspects of a person’s functioning. Patients with ABI present several behavioral problems that have worsened during the COVID-19 pandemic. This study aimed at investigating the role of a “Family Glass Cabin” (FGC) both in improving cognitive function and communicative abilities of people with ABI and in potentiating the mental health of their caregivers. Fifteen subjects affected by ABI and their caregivers were enrolled in this experimental study. Training was performed through the FGC and was based on either psychoeducational sessions for the caregivers or cognitive stimulations for the patients. The participants attended biweekly meetings for 12 consecutive weeks. Each participant was assessed by means of a complete psychometric and clinical battery, before (T0) and after (T1) the training. We found significant changes in all patients’ outcomes, including global cognitive function and communication abilities (p < 0.01), as well as an improvement in caregivers’ well-being. Our data suggest that the physical presence of the caregiver in the rehabilitation setting, using a safe setting such as the FGC, can be a valuable means to increase ABI patients’ functional recovery and reduce caregivers’ anxiety and emotional burden.

Social work-generated evidence in traumatic brain injury from 1975 to 2014: A systematic scoping review

The International Network for Social Workers in Acquired Brain Injury (INSWABI) commissioned a systematic scoping review to ascertain the social work-generated evidence base on people with traumatic brain injury (TBI) of working age. The review aimed to identify the output, impact and quality of publications authored by social workers on this topic. Study quality was evaluated through assessment frameworks drawn from the United Kingdom National Service Framework for Long-Term Conditions. In the 40-year period from 1975 to 2014, 115 items were published that met the search criteria (intervention studies, n = 10; observational studies, n = 52; literature reviews, n = 6; expert opinion or policy analysis, n = 39; and others, n = 8). The publications could be grouped into five major fields of practice: families, social inclusion, military, inequalities and psychological adjustment. There was a significant increase in the number of publications over each decade. Impact was demonstrated in that the great majority of publications had been cited at least once (80.6%, 103/115). Articles published in rehabilitation journals were cited significantly more often than articles published in social work journals. A significant improvement in publication quality was observed across the four decades, with the majority of studies in the last decade rated as high quality.

A Clarion Call for Social Work Attention: Brothers and Sisters of Persons With Acquired Brain Injury in the United States

This article presents a clarion call for increased social work attention to the needs of siblings of persons with acquired brain injury (ABI) in the United States. The article overviews how siblings are psychosocially affected, how they provide care to the injured brothers and sisters, and how they personally develop as a result of their experiences. The article highlights the fact that social workers and other professionals often overlook the needs of siblings of persons with ABI and makes an appeal for social workers to advance clinical practice and research to benefit this often neglected population.

A Survey of Multidisciplinary Clinicians Working in Rehabilitation for People with Traumatic Brain Injury

Little is known about clinicians’ experiences in rehabilitation for people with traumatic brain injury (TBI). This survey study aimed to investigate clinicians’ scope of practice, perceived barriers to practice, factors influencing confidence levels and professional development preferences. Participants included 305 clinicians (88% female, 97% aged 20–60 years) from psychology (28%), occupational therapy (27%), speech pathology (15%), physiotherapy (11%), social work (6%), rehabilitation medicine (3%) and nursing (3%) disciplines. Survey results indicated that goal setting, client or family education, and assessment for rehabilitation, were the most common activities across all disciplines (>90%). Client-related barriers, family-related barriers and client–therapist relationship barriers were more frequently selected than workplace context and professional skill barriers (p <.05). Clinicians working with clients with mild TBI reported significantly fewer barriers (p< .05); yet, they were less confident in overcoming barriers than clinicians working with clients with more severe TBI (p< .001). Clinicians with fewer years of experience (<2 years) reported significantly lower confidence in overcoming barriers than clinicians with 2–10 years and >10 years of experience (p< .01). The most commonly selected professional development areas included new interventions and therapies, translating rehabilitation research into everyday practice and client specific topics. These findings provide a unique multidisciplinary perspective on clinicians working in TBI rehabilitation in Australia. Understanding of the perceived barriers to practice and professional development needs may guide training and support initiatives for clinicians which, in turn, may enhance the quality of brain injury rehabilitation.

The Rehabilitation Needs of Adult Siblings of Persons With Traumatic Brain Injury: A Quantitative Investigation

This study examined the post-injury rehabilitation needs of 158 adult siblings of persons with traumatic brain injury (TBI) in the United States. The mean age of participants was 37.0 years (SD= 10.0 years), and their ages ranged from 19 to 72 years. A total of 120 (75.9%) of the participants were female. Participants completed the Family Needs Questionnaire (FNQ) (Kreutzer, 1988), which measures the unique needs of families following TBI. The FNQ counts the types of needs rated as important and the frequency in which those needs have been met. Data were analysed via hierarchical multiple regression analysis with the number of met needs set as the outcome variable. A total of 15 predictor variables assessed direct and indirect markers of caregiving related stresses corresponding to position in the Pearlin stress process model. Participants indicated that health information was the most important need while needs for involvement with care were the most often met. Results also indicated that participant feelings of more restrictions in valued family activities and perceptions of greater cognitive-behavioural impairments with their injured siblings were associated with lower number of met rehabilitation needs. Participants reported that the use of effective coping behaviours and access to social support were associated with higher numbers of met rehabilitation needs. Findings suggest adult siblings share similar needs to parents and spouses (i.e., the most common primary caregivers) and require professional attention and support following TBI.

Positive Person–Environment Factors as Mediators of the Relationship Between Perceived Burden and Quality of Life of Caregivers for Individuals With Traumatic Brain Injuries

The purpose of this study was to determine whether personal (caregiving mastery and problem-solving coping) and environmental (social support and professional and community support) caregiver resources mediate the relationship between caregiver perceived burden and quality of life (QOL). The sample consisted of 108 caregivers recruited from support groups who were predominantly White women. The majority of care-recipients had a severe head injury. Measures administered were the Interpersonal Support Evaluation List, the COPE, Family Needs Questionnaire, Modified Caregiving Appraisal Scale, and the World Health Organization Quality of Life–Brief Version. Results showed that social, professional, and community supports mediate the link between perceived burden and QOL. Caregivers of persons with traumatic brain injury frequently face elevated levels of burden, stress, and depression. Positive personal and environmental support, particularly social support, professional/community supports, and mastery, could lessen the negative impact of caregiving burden on QOL of the caregiver.

Quality of professional services following traumatic brain injury: adult sibling perspectives

This study examined the quality and availability of professional supports provided to individuals with traumatic brain injury (TBI) and their families from the perspective of a national sample of 267 adult siblings. Using a constant comparative approach to text analysis, the authors analyzed what siblings perceived to have been beneficial or in need of improvement with regard to the TBI professional services provided to their injured brother or sister and their family. The siblings' comments suggested that the system-level response to TBI serving injured people and their families was inadequate, that many professionals lacked the skills and understanding to provide effective services, and that professionals did not provide sufficient information to the people with TBI or their families. However, most siblings endorsed a positive view of at least one of the professional services provided. Clinical, advocacy, and research implications of these findings are discussed.

Community-based Rehabilitation Needs: Perceptions of Individuals with Brain Injury and Their Families in the Midwestern United States

This study investigated the rehabilitation and services needs, rehabilitation goals and barriers of individuals with brain injury (n = 81, males = 59%, females = 41%, age range 18 to 87), and their family members (n = 19; females = 75%, age range 18 to 65), (ethnicity = white = 89%). Data were collected using a survey instrument and focus group interviews. A descriptive analysis of the quantitative data was conducted, while content analysis was used to analyse the qualitative data. Results suggest that individuals with brain injury and their families experience many unmet needs across the domains of employment, independent living, financial resources and housing. Family involvement was found to be important to community participation after brain injury.

Future Concerns Among Families Following Brain Injury in the United States: Views from the Brain Injury Association of America State Affiliates

The objective of this study was to examine brain injury professionals’ perspectives on the future concerns of families of persons with brain injuries in the United States of America. A total of 28 persons in leadership positions with the Brain Injury Association of America (BIAA) participated. Through qualitative data analysis of an open-ended question in an electronic survey containing both qualitative and quantitative questions, participants identified future concerns related to future caregiving responsibilities, financial concerns, living arrangements, recovery, access to professional care, relationships and employment. The findings indicate that many families are unprepared to meet the future care and support needs of their injured family members.

Depression and grief in Spanish family caregivers of people with traumatic brain injury: the roles of social support and coping

PURPOSE

To examine the associations between social support, coping responses and depressive and grief symptoms in caregivers of people with traumatic brain injury (TBI).

METHODS AND PROCEDURES

A cross-sectional study of Spanish primary caregivers of individuals with TBI. The study included 223 caregivers (72.2% female and 26.9% male).

MAIN OUTCOMES

Measures administered included the Family Needs Questionnaire, the Texas Revised Inventory of Grief, the Centre for Epidemiological Studies Depression Scale and the Responses to Stress Questionnaire.

RESULTS

A structural equation model indicated that secondary control coping (e.g. acceptance and positive thinking) was associated with less grief and depressive symptoms, whereas primary control coping (e.g. problem-solving and emotional expression) and disengagement were associated with more symptoms. Emotional and instrumental supports were directly associated with less depressive symptoms. In addition, emotional and professional supports were associated with symptoms through the use of primary control and disengagement coping.

CONCLUSIONS

These results indicate that future interventions with families should improve social networks of emotional, instrumental and professional support, as well as help caregivers to develop adaptive coping strategies, such as acceptance and positive thinking.

Future Concerns of Adult Siblings of Persons With Traumatic Brain Injury

This study examined future concerns conveyed by adult siblings who provided regular caregiving support to their brothers and sisters with traumatic brain injury (TBI). The authors surveyed a national sample of 280 adult siblings of persons with TBI. Using a constant comparative approach to text analysis, the authors analyzed responses to the question “What are your concerns regarding the future for your sibling with TBI?” Common themes of such concerns were related to the caregiving siblings' roles as future caregivers and their perceptions of the quality of professional care provided to their injured family members. Also, participants endorsed concerns for their injured siblings' independence, recovery, and relationships with family and friends. Clinical, advocacy, and research implications of these findings are discussed.