Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Abstract

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM).

The interrelationship of functional skills in individuals living in the community, following moderate to severe traumatic brain injury

“…The application of a structured bathing and dressing retraining program resulted in independence after only 11 days of treatment (32). Conversely, based on our findings, we hypothesize that, if after sufficient training, a client is unable to manage the problem-solving required for independence in an IADL task, it is unlikely that the client will be able to learn to perform tasks that have greater problem-solving demands (20). What seems to be required is to reduce the onthe-spot decision-making requirements so the task becomes invariant.…”

“…It has been proposed that adequate IADL performance post TBI depends on both the individual's cognitive status and their self-awareness (18,19). In a prior publication we reported that lack of insight was associated with increased need for case management and care-support for individuals living in the community following TBI (20). To our knowledge, there have been no studies that have examined how insight relates directly to ADL versus IADL performance after TBI (18).…”

“…Data were collected as part of a larger study and the current report is a secondary analysis. A detailed description of the data-collection procedures is reported elsewhere (20). There were 141 client records derived from two independent samples of profiles provided by UK brain injury case managers from different case management companies.…”

“…In the prior paper, we found that the two samples were comparable in the frequency with which clients could accomplish ADL/IADL tasks, suggesting that the relative frequencies of independence in these skills did not occur by chance. There were no differences in the distribution of the ADL and IADL items between data sets, so the samples were combined to produce a single data set (20). The Mayo system was used to classify injury severity and only those client profiles with a definite moderate to severe TBI classification were included (21), yielding a total of 100 profiles.…”

“…The Adaptive Behaviour and Community Competency Scale (ABCCS) was designed specifically to be sensitive to the types of problems experienced by clients with TBI living in the community in the post-acute period (20,23). The ABCCS uses ordinal scales linked to concrete behavioral descriptions or a specification of the need for prompting or physical assistance, in line with the World Health Organization level of impairment and ability.…”