NeuroRehabilitation - Volume 22, issue 1

Authors: Sander, Angelle M.

Article Type: Introduction

DOI: 10.3233/NRE-2007-22101

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 1-2, 2007

Authors: Rivera, Patricia | Elliott, Timothy R. | Berry, Jack W. | Grant, Joan S. | Oswald, Kimberly

Article Type: Research Article

Abstract: Objective: To test the hypothesis that ineffective problem-solving abilities would be significantly predictive of risk for depression in caregivers of persons with traumatic brain injury (TBI) after controlling for caregiver burden, caregiver health and demographic characteristics. Design: Correlational and logistic regression analyses of cross-sectional data. Participants: 57 women and 3 men (M age of caregivers = 51.4, SD = 10.1) caring for a relative with a TBI. Main outcome measure: Centers for Epidemiologic Studies – Depression scale (CES-D). Results: Twenty-nine caregivers (48.3%) had CES-D scores that met the …criteria for risk of depression. An ineffective approach to problem solving, characterized by negative, avoidant, and careless/impulsive styles, and self-reported caregiver physical symptoms were significantly predictive of caregiver depression regardless of length of time caregiving, perceived burden, or demographic variables. Conclusions: Caregivers of persons with TBI who report physical health problems and who exhibit ineffective problem solving area at greater risk for depression, regardless of the time they have spent in their role as a caregiver. Show more

Keywords: Caregivers, depression, traumatic brain injury

DOI: 10.3233/NRE-2007-22102

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 3-8, 2007

Authors: Sander, Angelle M. | Davis, Lynne Cole | Struchen, Margaret A. | Atchison, Timothy | Sherer, Mark | Malec, James F. | Nakase-Richardson, Risa

Article Type: Research Article

Abstract: The objective of the current study was to determine the relationship between race/ethnicity and caregivers' coping, appraisals of the caregiving role, and distress after traumatic brain injury (TBI). Participants were 195 caregivers (75% white; 25% black/Hispanic) of persons with TBI who were admitted to comprehensive inpatient rehabilitation at one of three participating centers and were followed up at 1 year after injury. Caregivers completed interview and self-report questionnaires, including the Ways of Coping Questionnaire, Caregiver Appraisal Scale, and Brief Symptom Inventory. Compared to whites, blacks/Hispanics reported lower levels of education, lower annual household income, and were more likely to be …caring for an extended family member. After adjusting for relationship to the person with injury, age, education and income, race/ethnicity significantly predicted caregivers' use of the coping strategies distancing and accepting responsibility. Blacks/Hispanics made greater use of these strategies compared to whites. Blacks/Hispanics also showed more traditional beliefs regarding the caregiving role. Race/ethnicity was not predictive of distress. However, an interaction was noted between race/ethnicity and caregiver ideology. For Blacks/Hispanics, more traditional ideology was associated with increased distress. Future research using a larger sample of non-whites and including measures of acculturation is warranted. Show more

Keywords: Traumatic brain injury, caregiving, race/ethnicity

DOI: 10.3233/NRE-2007-22103

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 9-17, 2007

Authors: Boschen, Kathryn | Gargaro, Judith | Gan, Caron | Gerber, Gary | Brandys, Clare

Article Type: Research Article

Abstract: Family caregivers of individuals with acquired brain injury (ABI) and other chronic disabilities typically experience long-term adjustment difficulties within the entire family system. Interventions to assist parents and spouses are rare, and for siblings and offspring even more so. Among the few existing interventions, only a very small number have been evaluated in any scientifically sound manner for effectiveness in alleviating stress and burden. A highly targeted literature search of family caregiver intervention studies identified 31 articles, only four of which were in brain injury, which met specific inclusion criteria. Randomized controlled trial studies of six types of family caregiver …interventions were systematically assessed for their quality of design and evidence of effectiveness. The results revealed a body of literature lacking in methodological rigor. At present there is no strong research evidence supporting any specific intervention method for family caregivers of individuals with ABI or any of the other chronic condition groups surveyed, although an abundance of anecdotal, descriptive, and quasi-experimental support exists in the rehabilitation literature. This conclusion points to the need for launching new pilot studies and rigorous evaluations of caregiver intervention effectiveness, some of which are now emerging or in process in several locations across the United States. Show more

Keywords: Acquired brain injury, family interventions, support, literature review

DOI: 10.3233/NRE-2007-22104

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 19-41, 2007

Authors: Hanks, Robin A. | Rapport, Lisa J. | Vangel, Stephen

Article Type: Research Article

Abstract: Perception of caregiving after traumatic brain injury (TBI) has been shown to be an important part of both survivor and family adjustment. The roles of coping style, family functioning, perceived social support and the TBI survivor's functional status have not been fully examined with respect to appraisal of caregiving. This study examined these factors with respect to both positive and negative appraisals of caregiving in four main areas: perceived burden, caregiving relationship satisfaction, beliefs about caregiving, and mastery with caregiving. Sixty primary caregivers of individuals who sustained a TBI within the last 6 months to 15 years were administered the …Caregiver Appraisal Scale, as well as the Coping Inventory for Stressful Situations, a 21-item version of the Family Assessment Device, and the Social Provision Scale. These findings were examined in relation to the TBI survivor's scores on the Disability Rating Scale and the Functional Independence Measure at the same time points post-injury. Results revealed that the majority of caregivers in those with moderate to severe brain injuries experienced dissatisfaction with many aspects of caregiving, especially with respect to feelings of burden and mastery. Additionally, emotionally-focused coping, behavioral control issues with respect to family functioning, and perceived social support appear to be most highly related to perceptions of burden, whereas perceived social support alone was the strongest factor in one's perception of caregiving mastery and satisfaction with the caregiving relationship. Interestingly, caregiving ideology was most closely related to avoidance-oriented coping. These results have direct implications for the development of interventions for caregivers of persons with TBI, especially with respect for the need to assess coping style and the development of social support networks. Show more

Keywords: Caregiving, traumatic brain injury, TBI, burden of care, satisfaction with caregiving, mastery of caregiving, family functioning, social support, coping style

DOI: 10.3233/NRE-2007-22105

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 43-52, 2007

Authors: Kreutzer, Jeffrey S. | Marwitz, Jennifer H. | Hsu, Nancy | Williams, Kelli | Riddick, Amy

Article Type: Research Article

Abstract: Objective: To examine rates of separation and divorce after traumatic brain injury and identify factors relating to risk of marital breakdown. Participants: 120 persons who sustained a mild, moderate, or severe traumatic brain injury and who were married at the time of injury. Methods: Survivors were contacted between 30 and 96 months postinjury when demographic and marital status information was solicited. Injury information was obtained from medical records. Findings: A majority of patients remained married. The rate of divorce was 17% and 8% was the separation rate. People who were married longer …before their injury, victims of non-violent injuries, older persons, and persons with less severe injuries were more likely to remain married. Gender, ethnicity, educational level, time elapsed since injury, and postinjury employment status were unrelated to risk for marital breakdown. Conclusion: Research findings do not support contentions that persons with brain injury are at greater risk for divorce relative to the general population. Nor do findings suggest that males are more likely to leave injured female partners. More research is needed to assess marital quality and the potential benefits of intervention programs designed to develop and maintain mutually supportive relationships. Show more

Keywords: Brain injury, marriage, divorce

DOI: 10.3233/NRE-2007-22106

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 53-59, 2007

Authors: Charles, Nella | Butera-Prinzi, Franca | Perlesz, Amaryll

Article Type: Research Article

Abstract: Although the use of multifamily group work is well established within the mental health field, it remains an underutilised method of treatment for families affected by brain injury. This paper reports on a pilot project exploring multifamily group work with families with a parent with an acquired brain injury. Six families met for a total of 12 sessions over a period of 6 months, with session themes informed by the Bouverie Family tasks model of adaptation post-ABI. The project was evaluated using qualitative and quantitative research methods, with pre, post group and 3 month follow up measures of individual, couple …and family functioning. Parents reported generally reduced levels of personal distress at follow up but continuing high levels of marital and family dysfunction. Children were generally reported to be well functioning, although parents were particularly concerned about the impact of family disruption and violence on their children. Families were unequivocally positive about their participation in the group with benefits including reduced feelings of shame and isolation, provision of mutual support, increased understanding of brain injury, sharing of difficult experiences and movement from blame to compassion. Further research is warranted on the specific applications of multifamily group work with acquired brain injury. Show more

Keywords: Family trauma, multifamily group work, acquired brain injury

DOI: 10.3233/NRE-2007-22107

Citation: NeuroRehabilitation, vol. 22, no. 1, pp. 61-76, 2007