Family interventions after traumatic brain injury: a service example

Traumatic brain injury (TBI) often exerts a major impact upon the family with high levels of stress and distress, particularly amongst primary carers, disruption to family life style and functioning, changes in family roles, and marital and sexual difficulties. In response to the documented impact upon the family a range of family services have been advocated including family education, counselling and support. This paper outlines family services developed within a community head injury service in the UK. The family assessment programme comprises a relatives' screening questionnaire and structured interview schedules and ratings scales, some drawn from the family assessment literature, others developed within the service. Four components of family intervention are described: an annual series of educational workshops; follow-up workshops; individual family support; and specialist marital counselling. Our experience of providing these family services over the last 7 years is discussed along with the need for further evaluation of family assessment and interventions after TBI.

Driving after severe head injury: the need for assessment

This paper reports on a survey of return to driving after severe head injury. It highlights the lack of information provision, low rates of Driver and Vehicle Licensing Agency (DVLA) notification, and poor uptake of driving assessments. The findings highlight the need for liaison between head injury services and general practitioners (GPs) when assessing driving fitness.

Social adjustment after closed head injury: a further follow-up seven years after injury

A group of severely head injured patients were reassessed 7 years after injury. This group was the same as that previously reported 2 years after injury. There was no change in their physical or cognitive status; personality problems were still commonly reported but the less disabled had made further progress in returning to their former level of vocational and social activity.

Changes in self-concept following severe head injury

Twenty five severely head injured patients from two specialist neurological rehabilitation centres were interviewed on average seven months post-injury. Changes in self-concept were investigated through the completion of scales of anxiety and depression, an attitude questionnaire relating to physical disability and semantic differential ratings of Present Self, Past (pre-morbid) Self, Future Self, a Typical Person and a Typical Head Injured Person. Psychological distress in terms of anxiety and depressions was common. Patients viewed themselves as having changed substantially as a result of their head injury on a wide range of constructs, yet confidently anticipated a return to Past (pre-morbid) Self within a year, even though Past Self was rated more positively overall than a Typical Person. While differing dramatically from Past Self, Present Self was rated more positively in some respects than the concept of a Typical Head Injured Person, which was perceived as markedly different from that of a Typical Person. Whilst unrealistic expectations may initially serve to protect the profoundly disabled individual and even motivate him towards recovery, in the long run they are more likely to hamper rehabilitation and adjustment. Effective intervention calls for awareness of the patient's own perspective as well as the relatives' reactions to the overt disabilities.