Role change after traumatic brain injury in adults

Digital tools to support technology-enabled budget management in people with acquired brain injury: a rapid review

People with acquired brain injuries (ABI) face financial challenges that affect their daily lives. Managing finances is a crucial activity that can help avoid social isolation. However, this task becomes difficult for people with ABI because of their cognitive impairments. Recent advances in digital technology can help people with ABI manage their finances more effectively. This study aims to identify and describe available digital tools that can help ABI in budget management, and identify their effectiveness, barriers and facilitators to implementation. To address this issue, we conducted a rapid review of academic databases followed by a modified Google/Google Scholar search to identify the digital tools to support budgeting tasks (DBT) used and tested by people with ABI. Our rapid review included only two articles on the use of DBT. The first study showed that common portable electronic devices were acceptable and desirable as memory and organisational aids for people with ABI. The second study documented the development of a DBT and the perception of users (research participants) who found it appealing and user-friendly. However, for both articles, the technologies used are outdated and lack information on barriers and facilitators to using DBT. In conclusion, this literature review revealed that digital technologies have the potential to support budget management in people with ABI, but technology needs to be made available on the market to benefit the users. Further research and development are needed to create new ways to help people with brain injuries manage their budgets.

Effectiveness of web-based intervention for life-change adaptation in family caregivers of community-dwelling individuals with acquired brain injury: A cluster-randomized controlled trial

Objective

To test the effectiveness of the web-based intervention “Koji-family.net 3-day program” (KF3 PGM) for life-change adaptation in family caregivers of community-dwelling individuals with acquired brain injury (ABI).

Design

A cluster-randomized trial.

Settings

All 82 institutions for families of individuals with ABI in Japan.

Participants

Participants were 240 families at 16 different institutions for families of individuals with ABI. Inclusion criteria for participants were (1) families caring for an individual with ABI, (2) family members aged 20 years and over, and (3) the individual with ABI developed ABI when aged more than 16 years and less than 65 years.

Methods

Clusters were randomly assigned to the intervention (8 clusters, n = 120) or the control (8 clusters, n = 120) group. For the intervention group, the KF3 PGM was assigned, in addition to routine family group activities to enhance the life-change adaptation. The control group followed their daily routine and received usual services. The primary outcome was the life-change adaptation scale (LCAS); secondary outcomes were the multidimensional scale of perceived social support (MSPSS) and the positive appraisal of care (PAC) scale at the baseline, after 3 days (short-term follow-up), and after 1 month (long-term follow-up). A mixed model for repeated measures (MMRM) was applied.

Results

A total of 91 participants were enrolled. The mean age (SE) of the participants was 64.0 (9.2) years; 87.8% of them were female. The intervention group showed better improvement in the LCAS than the control group in the whole study period (F = 6.5, p = 0.002). The mean observed change in LCAS from baseline was +8.0 (SE = 2.0) at 3 days and +11.6 (SE = 2.0) at 1 month in the intervention group (F = 18.7, p < 0.001). No significant differences in MSPSS and PAC were observed among the intervention and control groups in the whole study.

Conclusions

The KF3 PGM can be an effective method of enhancing the adaptation to daily life in family caregivers of community-dwelling individuals with ABI. The results show that a potential web-based intervention in institutions for families of individuals with ABI plays a substantial, longer-term role in their support in Japan. Future studies could address the same research questions in different settings and cultures for family caregivers for even longer time periods.

Theory of mind in adults with traumatic brain injury: A meta-analysis

Studies of abnormal theory of mind (ToM) performance in adult patients with traumatic brain injury (TBI) have reported inconsistent results. Therefore, we conducted a meta-analysis to characterize ToM performance in adult patients with TBI. Random-effects models were employed to estimate the overall effect size and the differential effect sizes across different ToM aspects. Based on a sample of 28 studies (1031 patients and 865 healthy controls), the meta-analytic findings revealed that ToM was significantly impaired in adult patients with TBI compared to healthy controls (g = -1.13). Besides, patients with TBI showed significant impairments in individual ToM tasks, as well as for different stimulus modes and contents involved in these ToM tasks. A meta-regression indicated a positive association between ToM performance and Glasgow Coma Scale score. The results of the current meta-analysis suggest that the performance in ToM tasks may be a good predictor of functional outcomes in adults with TBI, which is important for the identification of targets for cognitive interventions and the development of useful training intervention programs.

Facial emotion recognition in adult with traumatic brain injury: A protocol for systematic review and meta-analysis

BACKGROUND

Traumatic brain injury (TBI) refers to head injuries that disrupt normal function of the brain. TBI commonly lead to a wide range of potential psychosocial functional deficits. Although psychosocial function after TBI is influenced by many factors, more and more evidence shows that social cognitive skills are critical contributors. Facial emotion recognition, one of the higher-level skills of social cognition, is the ability to perceive and recognize emotional states of others based on their facial expressions. Numerous studies have assessed facial emotion recognition performance in adult patients with TBI. However, there have been inconsistent findings. The aim of this study is to conduct a meta-analysis to characterize facial emotion recognition in adult patients with TBI.

METHODS

A systematic literature search will be performed for eligible studies published up to March 19, 2020 in three international databases (PubMed, Web of Science and Embase). The work such as article retrieval, screening, quality evaluation, data collection will be conducted by two independent researchers. Meta-analysis will be conducted using Stata 15.0 software.

RESULTS

This meta-analysis will provide a high-quality synthesis from existing evidence for facial emotion recognition in adult patients with TBI, and analyze the facial emotion recognition performance in different aspects (i.e., recognition of negative emotions or positive emotions or any specific basic emotion).

CONCLUSIONS

This meta-analysis will provide evidence of facial emotion recognition performance in adult patients with TBI.

INPLASY REGISTRATION NUMBER

INPLASY202050109.

Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

BACKGROUND/OBJECTIVES

An estimated 55 million individuals worldwide live with chronic disability associated with traumatic brain injury (TBI), which may include cognitive, behavioral, and social impairments. Reduced participation in social activities is common after TBI; however, few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness and to identify mediators of this association.

METHODS/DESIGN

Retrospective cohort study. Nationally representative sample of N = 724 adults over age 50 years (Health and Retirement Study). Loneliness was evaluated using the 11-item Revised University of California Los Angeles (R-UCLA) Loneliness Scale (range 11-33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, and education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index.

RESULTS

History of TBI was associated with a 1.28-point (95% CI, 0.46-2.11; P < .05; Cohen's D = 0.284) increase in R-UCLA Loneliness Scale scores after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs reported the highest loneliness scores. In the structural equation model, depressive symptoms partially mediated the relationship between TBI and loneliness. All models were adjusted for US population sampling weights.

CONCLUSIONS

History of TBI was associated with greater loneliness compared with individuals without TBI in a representative sample of US adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population.

Psychological well-being in individuals living in the community with traumatic brain injury

BACKGROUND

Well-being and quality of life issues remain a long-term problem for many individuals with traumatic brain injury (TBI). Meaningful activity is key to developing life satisfaction and a sense of contribution to society, yet individuals with TBI are often unable to return to competitive employment.

OBJECTIVE

To describe the self-reported psychological well-being of a cohort of unemployed individuals living in the community at least 1 year post TBI with low life satisfaction.

METHODS

Seventy-four unemployed individuals with low life satisfaction at least 1 year post TBI were administered measures of psychological well-being and cognitive functioning.

RESULTS

This cohort of 74 participants demonstrated cognitive impairment and elevated levels of emotional distress. Significant bivariate relationships were noted among nearly all measures of well-being, and associations were in the directions as expected. Individuals reported low life satisfaction and well-being. Two newer measures of well-being correlated with established measures used with this population.

CONCLUSIONS

Individuals with TBI living in the community who are not employed but who seek to be productive reported low life satisfaction and well-being. This study highlights the need for interventions aimed at increasing productivity and meaning in life for individuals with TBI, and a broader understanding of psychological health after TBI.

L’évaluation en ergothérapie pour contribuer à documenter l’aptitude : étude de cas

Description

Plusieurs ergothérapeutes contribuent à l’évaluation de l’aptitude à prendre soin de sa personne et à gérer ses biens, mais peu de balises encadrent cette pratique auprès d’adultes ayant subi un traumatisme craniocérébral (TCC).

But

Cette étude explorait la contribution du Profil des activités instrumentales (PAI) à la documentation de l’aptitude suite à un TCC.

Méthodologie

La réalisation des tâches du PAI par un homme de 46 ans (ML) ayant été déclaré inapte suite à un TCC sévère a été comparée à celle de huit participants témoins (âge moyen 49,3 ± 4,2 ans). Les scores au PAI, les comportements observables, et les verbalisations ont été comparés en utilisant des statistiques descriptives (moyennes et écarts-types) et des analyses qualitatives.

Résultats

Le niveau d’indépendance de ML est inférieur à celui des témoins pour sept des huit tâches du PAI ( p < 0,05), notamment pour préparer un repas chaud et faire un budget. ML se distingue par la généralisation de ses difficultés à plusieurs tâches et de la difficulté à critiquer les résultats obtenus.

Conséquences

Le PAI pourrait être utilisé lors d’une évaluation fonctionnelle visant à documenter l’aptitude.

Perceived and Valued Roles of Adults with Severe Mental Health Problems

The purpose of this article is to convey the findings of two studies related to the perception of past, present and future roles, the value attributed to these roles as well as the role patterns. Both studies were conducted with adults who have schizophrenia and are involved in a rehabilitation or work program. Data were collected from two sources: 1) secondary analysis of a study related to the methodology for validating the French translation (Hachey, Jumoorty, & Mercier, 1995) of the “Role Checklist”, (Barris, Oakley, & Kielhofner, 1988) and 2) a research project on the perception of roles and quality of life. Results showed that the dominant roles assumed by participants regardless of time were family member, friend, home maintainer and hobbyist. The most valued roles were those of friend, worker, and family member. The discussion will address the questions asked and elucidate the role patterns. The conclusion underlines the importance, for occupational therapists and health professionals, of including roles in the daily lives of their clients, taking into consideration the ones they value most highly.

Trajectories of life satisfaction after traumatic brain injury: Influence of life roles, age, cognitive disability, and depressive symptoms

OBJECTIVES

(a) Identify life satisfaction trajectories after moderate to severe traumatic brain injury (TBI); (b) establish a predictive model for these trajectories across the first 5 years postinjury; and (c) describe differences in these life satisfaction trajectory groups, focusing on age, depressive symptoms, disability, and participation in specific life roles.

RESEARCH METHOD

Analysis of the longitudinal TBI Model Systems National Database was performed on data collected prospectively at 1-, 2-, and 5-years post-TBI. Participants (n = 3,012) had a moderate to severe TBI and were 16 years old and older.

RESULTS

Four life satisfaction trajectories were identified across the first 5 years postinjury, including: stable satisfaction, initial satisfaction declining, initial dissatisfaction improving, and stable dissatisfaction. Age, depressive symptoms, cognitive disability, and life role participation as a worker, leisure participant, and/ or religious participant at 1-year postinjury significantly predicted trajectory group membership. Life role participation and depressive symptoms were strong predictors of life satisfaction trajectories across the first 5 years post-TBI.

CONCLUSIONS

The previously documented loss of life roles and prevalence of depression after a moderate to severe TBI make this a vulnerable population for whom low or declining life satisfaction is a particularly high risk. Examining individual life role participation may help to identify relevant foci for community-based rehabilitation interventions or supports.

Family Needs After Traumatic Brain Injury: Implications for Rehabilitation Counselling

Family involvement in the rehabilitation counselling process is increasingly being recognised as an important component of rehabilitation success. This may be particularly true for persons who have an acquired or traumatic brain injury (TBI). For such individuals the emotional and psychosocial functioning of their family and caregivers has been associated with a variety of functional, psychosocial, and employment outcomes. Addressing the needs of family members is an important component of providing effective rehabilitation counselling services, but one that has received little attention in the rehabilitation counselling literature. This article reviews current research on the frequently identified needs of families and caregivers of persons with TBI, the family and situational variables that have been explored for their relationship to family needs, and the extent to which these needs are met. Clinical and research implications for rehabilitation counsellors are identified.

A randomized clinical trial to determine effectiveness of driving simulator retraining on the driving performance of clients with neurological impairment

Introduction

Following a neurological event, returning to driving is an important activity contributing to improved participation within the community. The purpose of this study was to examine the effectiveness of driving simulator retraining on driving in clients with neurological impairment and to examine factors associated with treatment effectiveness.

Method

Individuals with non-degenerative brain injury were randomized to either a simulator training or control group. The simulator group received individualized training (16 sessions) using a driving simulator. The control group did not receive intervention. A blind evaluator assessed participants on the DriveAble On-Road Driving Evaluation.

Results

There was no significant difference between groups in the proportion of individuals who passed the driving evaluation (Chi2 = 0.65; p = 0.42; CI = −0.41 to +0.17). However, participants with moderate impairment who received simulator training were more likely to pass the driving test compared with those in the control group (86% versus 17%; Chi2 = 6.2; p = 0.03; CI = −1.00 to −0.30). There were no differences in pass rate according to diagnosis, gender, or for those with severe impairments.

Conclusion

Results provide clinicians with preliminary information on the potential clinical usefulness of driving simulator training. While the findings do not support simulator retraining for the group as a whole, they suggest that clients with moderate impairment have the potential to benefit.

People Under 50 With Acquired Brain Injury Living in Residential Aged Care

Objectives:The aim of this article is to describe the characteristics, needs and preferences of people under 50 with an acquired brain injury (ABI) living in residential aged care in Victoria and examine implications for service development.Participants:Sixty-one people under 50 with an ABI living in residential aged care in the state of Victoria.Measures:Care and Needs Scale, Community Integration Questionnaire, Overt Behaviour Scale, Health of the Nation Outcome Scale — ABI Version, Role Checklist, Resident Choice Scale.Results:The younger people with ABI in this study were a diverse group with a complex range of health and support needs that were not being adequately met within residential aged care. Many people (44%) required the highest level of support, indicating they could not be left alone while 26% could be left for part of the day and overnight. Most people (81%) and their support networks indicated they would like to explore moving out from residential aged care into community accommodation settings.Conclusions:This article provides clear direction for the development of services to meet the care needs of this group, to enable them to participate in the life of the community and to pursue a lifestyle of choice.

Community Integration Following Severe Traumatic Brain Injury: Outcomes and Best Practice

Community integration is often cited as the ultimate aim of rehabilitation. However, outcome studies show that following severe traumatic brain injury (TBI), many people do not return to valued life roles or reach previous levels of integration within their community. More recent research, in association with extensive clinical experience, reveals significant variability in outcomes within this group. Although some people return to productive activity and maintain a network of family and friends, others lead lives characterised by boredom and loneliness. This paper has two aims. The first is to examine TBI community integration outcome literature and selected theoretical models. The second is to describe a Community Approach to Participation (CAP), an individualised and collaborative model of community-based practice, which endeavours to address the poor outcomes identified following TBI. The CAP will be illustrated in the detailed case study of Sarah.

Comparison of People With ABI Living in Two Accommodation Settings: Shared Supported Accommodation and Residential Aged Care

Background:People with severe acquired brain injury (ABI) often require high and ongoing levels of paid support, which is sometimes provided within a shared supported accommodation service (SSA). In Victoria there are more than 140 people with severe ABI living in shared supported accommodation services who have a similar level of disability as young people with ABI in residential aged care (RAC).Objectives:The aims of this article are twofold: (1) to describe the characteristics, support needs and level of community inclusion of people with an ABI living in shared SSA in Victoria and (2) to compare the characteristics, support needs, social contact, community integration and leisure participation of this group with a group of people with ABI under 50 years old living in RAC reported in a previous study.Participants:Information was obtained from SSA managers on 128 residents with an ABI, aged under 60 years, who were living in shared supported accommodation.Measures:Questionnaires were used to obtain information about the characteristics, support needs and occupational participation of participants. Support needs were measured utilising the Care and Needs Scale (CANS).Method:Questionnaires were sent to and completed by SSA managers.Results:Of the 39 SSA managers contacted, 32 provided information about the characteristics of 128 residents with ABI living in their facilities. While 72% of SSA residents accessed the community almost everyday or more often, 40% of this sample received a visit from a friend less often than once per year. Results of the CANS indicated that the SSA group required a similar level of support to the comparison group of people with ABI living in RAC, but went outside, participated in community based leisure activities, and visited friends significantly more often. There was no significant difference between the two groups in the frequency of visits to the facility from relatives or friends.Conclusion:Although the relationship between client outcomes and accommodation is a complex one, this study suggests that the type of accommodation and support has a significant impact on the frequency of community participation experienced people with ABI and high care needs.

The Community Approach to Participation: Outcomes Following Acquired Brain Injury Intervention

Objective: To investigate the participation outcomes of individuals with severe acquired brain injury (ABI) who were provided with up to 12 months of intervention based on the Community Approach to Participation (CAP). Method: A case series study design was undertaken with a total of 85 participants from two private practices specialising in community-based, CAP rehabilitation for people with severe ABI. Inclusion criteria were the person had sustained an acquired brain injury, was aged over 18 years and had received up to 12 consecutive months of CAP input from one of the two practices within a three-year period between January 2004 and January 2007. Twenty-six of the 85 participants were an average of 343 days post injury (Early group) and 59 of the participants were an average of 10.2 years post injury (Late group). They were living in a range of community environments and residential facilities. Initial participants were identified for the study in January 2005. Data were gathered using the Functional Independence Measure (FIM™), Community Integration Questionnaire (CIQ), and Role Checklist (RC Part 1) at two time points: prior to intervention (baseline), and after a 12-month period or at discharge (TI). Within the intervention period, all participants received a customised community occupational therapy (OT) rehabilitation program based on the key principles of the CAP. Intervention focused on participation goals of the individual, and development of the associated skills that underpinned valued role performance. Results: Participants each received an average of 51.01 hours of CAP OT during the 12-month period of intervention. Considerable improvement was seen in functional independence, community integration, and role participation after intervention in both the Early and Late groups. A statistically significant increase in FIM™ and CIQ total scores was found for all participants from Baseline to T1. The number of roles in which participants engaged increased on average by almost one role per participant following intervention, from a mean of 3.06 to 3.99. Increased participation in volunteer, home maintainer, participant in organisations and hobbyist roles were most common. Conclusion: Increased functional independence, community integration, and participation in both the Early and Late groups over a 12 month period demonstrates the potential for improved participation outcomes for people with complex needs following ABI, even many years post injury.

Resumption of car driving after total hip replacement

PURPOSE

To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR).

METHODS

80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so.

RESULTS

105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability.

CONCLUSION

The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.

Helping young adult children with traumatic brain injury: the life-world of mothers

Few scholars have described the personal-social context of the maternal experience of helping young adult children who have survived a traumatic brain injury (TBI). Viewing context as life-world, we used a descriptive phenomenological method to explore the life-world of 7 mothers whose young adult children had suffered a moderate or severe TBI at least 6 months earlier. Conducting three interviews with each mother, we discerned five features of life-world: having a child who survived a TBI as a young adult, perceiving that life has really changed, having sufficient support/feeling bereft of any help, believing that my child is still able, and believing that I can help my child. Compared to the literature, findings led to more definitive practice implications about postinjury uncertainty and maternal role change. In studies with such mothers, researchers should focus on the continuity of mothering rather than the initiation of caregiving.

Emotion perception deficits following traumatic brain injury: a review of the evidence and rationale for intervention

While the cognitive disturbances that frequently follow severe traumatic brain injury (TBI) are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that a significant proportion of individuals with TBI demonstrate an inability to recognize affective information from the face, voice, bodily movement, and posture. Because accurate interpretation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area. The present review examines the literature on emotion perception deficits in TBI and presents a theoretical rationale for targeted intervention. Several lines of research relevant to the remediation of emotion perception in people with TBI are considered. These include work on emotion perception remediation with other cognitively impaired populations, current neuropsychological models of emotion perception and underlying neural systems, and recent conceptualizations of remediation processes. The article concludes with a discussion of the importance of carrying out efforts to improve emotion perception within a contextualized framework in which the day-to-day relevance of training is clear to all recipients.

Retorno à produtividade após reabilitação de pacientes deambuladores vítimas de trauma craniencefálico

Vítimas de trauma craniencefálico (TCE) freqüentemente alcançam independência nas atividades de vida diária, mas encontram limitações quanto à participação na comunidade ou no trabalho produtivo. Este estudo visou verificar o índice de retorno, após programa de reabilitação, à produtividade (estudo e/ou trabalho) de sujeitos que haviam tido TCE. Participaram 60 sujeitos deambuladores comunitários (média de idade 30,4 anos, mínima 18, máxima 53), selecionados dentre os prontuários de pacientes com diagnóstico de TCE que freqüentaram o programa de reabilitação entre 2002 a 2004 no Setor de Fisioterapia Adulto da Associação de Assistência à Criança Deficiente (AACD) em São Paulo, SP. Em entrevista, foi aplicado um questionário elaborado pela equipe da AACD. Os participantes - 51 homens e 9 mulheres - tinham sofrido em sua maioria (95%) trauma grave. Os resultados mostram que 71,7% dos participantes retomaram atividades ocupacionais ou escolares, mas apenas 38,3% estavam trabalhando por ocasião da entrevista. Embora sem significância estatística, o tempo decorrido entre o trauma e o início da reabilitação parece estar associado ao retorno à produtividade. O nível de escolaridade prévio ao trauma mostrou ter influência (p<0,01) no retorno à produtividade, alcançado por uma boa parte dos sujeitos que sofreram TCE.

Factors That Lead to Successful Community Integration Following Severe Traumatic Brain Injury

OBJECTIVE

To assess and identify predictive factors of community integration of people 3 to 15 years after severe traumatic brain injury (TBI).

PARTICIPANTS

Forty participants with severe TBI (an average of 8.8 years postinjury).

MAIN OUTCOME MEASURES

The Community Integration Questionnaire, the Community Integration Measure, and the Sydney Psychosocial Reintegration Scale. Data related to factors that may predict community integration were also collected.

RESULTS

There was considerable variation in the level of community integration. Discriminant function analyses identified the following factors as predictive of the level of community integration: severity of injury, age at the time of injury, level of disability, and challenging behavior.

CONCLUSION

Interventions that minimize challenging behavior and disability may make a significant difference to the level of community integration experienced by people with severe TBI.

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.

Quality of life after traumatic brain injury: a review of research approaches and findings11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To assess existing knowledge of quality of life (QOL) of people with traumatic brain injury (TBI) and to make recommendations for methodologic and substantive research in this area.

DATA SOURCES

Published research on QOL of persons with TBI, identified from databases, ancestry search, and the author's files.

STUDY SELECTION

Empirical, theoretical, and methodologic articles relevant to 5 areas: QOL as achievements, QOL as subjective well-being (SWB), QOL as utility, QOL experienced, and QOL measurement instruments applicable to TBI or specifically developed for people with this impairment.

DATA EXTRACTION

Selection of QOL indicators, with focus on TBI versus non-TBI differences.

DATA SYNTHESIS

Studies of QOL as achievements show that in almost all areas, people with TBI score lower than they did before injury and lower than comparisons groups. There are limited gaps in our knowledge in this area. Research into QOL as SWB shows that after TBI, people typically report, for example, somewhat lower life satisfaction and affect than do comparison groups, and that injury severity is not necessarily a predictor of SWB. There are almost no studies of QOL as utility of life after TBI.

CONCLUSIONS

Major research recommendations include: exploring the ability of TBI subjects to self-report; determining the salience of domains of life for this group; developing utility instruments that are sensitive to differences in deficits in cognition and other health and life domains; and doing qualitative studies that explore the experience of QOL.

Multicontextual occupational therapy intervention: A case study of traumatic brain injury

Cognitive deficits after a traumatic brain injury can result in significant functional limitations in all areas of daily living. An individual's ability to generalize learning may be limited, thus making it harder to live independently in the community. Assessing a client's metacognitive skills and awareness level may help to establish a baseline understanding about the supervision required and the most suitable living arrangements. This study describes a multicontextual, community re-entry occupational therapy programme directed at awareness training and compensation for cognitive problems in a 34-year-old man with traumatic brain injury. Intervention consisted of metacognitive training, exploration and use of effective processing strategies, task gradations and practice of functional activities in multiple environmental contexts. Strategies such as self-prediction, self-monitoring, role reversal and the use of checklists were used. Results after six months of intervention show improvements in the client's awareness level, enhancement of his occupational function, increased satisfaction with performance and a decrease in the level of attendant care. Additional studies are recommended to validate the findings.

The long term effects of traumatic brain injury on the roles of caregivers

This study was conducted to identify the long term effects of traumatic brain injury (TBI) on the roles of caregivers. The subjects consisted of 155 caregivers of survivors with TBI who were randomly selected from 15 midwestern state brain injury association databases. A questionnaire was developed by the researchers to determine factors affecting role changes of caregivers. The Role Checklist, by Barris, Oakley and Kielhofner, was also included with the questionnaire. Both were mailed to each selected caregiver and used for data gathering. The data obtained were analysed to determine existing trends in the data. Graphs were utilized to depict the trends that was identified. The following trends and conclusions established by this research include: (a) behavioural effects of the survivor with a TBI are associated with the number of role changes experienced by caregivers; (b) participation in support systems is associated with the number of role changes experienced by caregivers; and (c) caregivers who care for a person with a TBI in the home will show a larger number of role changes than those who do not provide direct care for a person with a TBI.

The Occupational Therapist's Role in a Transitional Living Program for Head Injured Clients

The head injured patient typically undergoes a long period of transition, beginning with acute care, moving to a rehabilitation facility, and ending with community re-entry. A key point in the total rehabilitation process is the smooth transition from a hospital- like environment to a home environment. This paper describes the role of the occupational therapist in a transitional living program at a private facility. In this program, various health professionals work with clients in a home-like environment to facilitate community reintegration. The program uses a ''real world laboratory'' to re-train clients in functional daily tasks. The overall structure of the program, types of activities used, and goals of the program are discussed.