Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury.

Abstract

Relatives, treatment staff, and brain-injured individuals often have widely different perspectives about the nature and magnitude of dysfunction following brain injury, and these appear to have consequences for psychosocial adjustment and rehabilitation. To permit us to assess these differences, 28 seriously brain-injured individuals completed a behavioral competency rating scale along with standard measures of neuropsychological, emotional, and psychological functioning before and after a 6-month intensive rehabilitation program. Relatives and members of the treatment staff independently completed the same rating scale. Three comparison groups were formed retrospectively on the basis of staff-patient differences in perceived dysfunction. Group 1 patients and staff members rated similar levels of dysfunction both before and after rehabilitation. Group 2 and Group 3 patients, by comparison with staff members, greatly underestimated their initial levels of dysfunction. Over the course of rehabilitation, the perspectives of Group 2 patients and staff aligned, while Group 3 patients became more emotionally distressed and their perspectives actually diverged from those of staff. Early vocational outcome was related to level of neuropsychological and psychosocial functioning at the end of rehabilitation, but not to final staff-patient differences in perspective. The sources of these different perspectives and their implications for rehabilitation treatment are discussed.Facilitating recovery from serious brain injury is a complex and poorly understood rehabilitation enterprise. It requires an understanding of each individual's particular physical, cognitive, emotional, and interpersonal strengths and weaknesses. Our knowledge of rehabilitation strategies appropriate for serious brain injury is rapidly increasing (

Returning to productive activities: Perspectives of individuals with long-standing acquired brain injuries

“…That is, individuals with more accurate self-awareness are more likely to have favourable productive outcomes, namely employment. However, this relationship has not been consistently reported [30][31][32][33][34].…”

Emotional distress and awareness following acquired brain injury: An exploratory analysis

“…Hoofien et al's [16] study may be considered supportive of this suggestion, as could an early study by Fordyce and Rouche [19]. The latter authors looked at changes in awareness over the course of a rehabilitation programme.…”

“…Each question has four possible responses, which are scored on a scale from 0-3. Based on normative data, anxiety and depression ratings can be classified as: normal (0-7), mild (8-10), moderate (11)(12)(13)(14)(15) and severe (16)(17)(18)(19)(20)(21). Anxiety and depression subscales can be aggregated to provide an overall score.…”

Disorders of awareness in neuropsychiatric syndromes: An update

“…Prigatano and Altman [37] found no relationship between admission GCS scores and later lack of awareness in TBI, although others have found a significant inverse correlation between admission GCS score and later impaired awareness (ie, the more severe the injury, the greater the unawareness) [38,39]. Clinicians working to rehabilitate individuals with TBI report that unawareness is a major factor in determining longterm functional recovery, including eventual return to work [40][41][42][43]. These data provide strong, though not unqualified, evidence of a positive association between deficits in awareness and poor employment outcome following TBI.…”