A longitudinal analysis of family needs following traumatic brain injury.

The present investigation assessed 38 family members' perceptions of unmet, partly met and met needs following the brain injury of a relative. Follow-up data was collected at two time intervals averaging 6 and 24 months post-injury. There was no significant difference between the proportion of needs rated as important or very important at time I or II. Highly ranked needs included requests for information, clear and honest explanations from professionals, reassurance, respite care, educational and social activities for the patient, emotional support, financial counseling, and advice about community resources. Relatives rated nearly half of the 40 needs as not met at either time. A significant difference was noted in the proportion of un met/partly met needs within each factor scale at time I and II. A larger number of Emotional Support and Involvement with Care needs were reported as not met at time II. Needs for Professional Support were more frequently reported as met at time II. For both time periods, Health information needs were generally perceived as met while needs relating to Instrumental Support were largely unmet. The findings are discussed in light of implications for treatment and long term adjustment to injury related changes.

A multi-center investigation of neurobehavioral outcome after traumatic brain injury.

Outcome of 295 rehabilitation patients with mild, moderate, and severe brain injury was investigated prospectively at five regional medical centers using the Neurobehavioral Rating Scale. Mean factor scale scores were generally low. with the cognition mean highest and the excitement mean lowest. Regardless of scale, the most significant neurobehavioral difficulties were related to memory, insight, attention, alertness, fatigue, and blunted affect. Conversely, problems rated as least severe included hallucinations, guilt, excitement and lability of mood. Approximately 9% of the sample had at least a moderate problem with agitation, an item on the excitement scale. The general pattern of mean factor scale elevations was consistent with other studies. No relationship was found between injury severity and neurobehavioral characteristics. The relatively low incidence of neurobehavioral problems may reflect recovery and effective interdisciplinary management.

Alcohol and drug use among young persons with traumatic brain injury.

The pre- and postinjury patterns of alcohol and illicit drug use of 87 persons with traumatic brain injury ages 16 to 20 were examined. Follow-up data were collected at two time intervals averaging 8 and 28 months postinjury. A comparison with large-sample studies revealed that patients had preinjury drinking patterns similar to those in the general population. A review of data provided evidence of a decline in alcohol use at initial follow-up; however, preinjury and second follow-up alcohol use patterns were similar. Analyses suggested that drinking quantity and frequency increased over time, perhaps eventually returning to postinjury levels. A review of the literature and the findings of the present investigation indicate that men and persons with a history of preinjury heavy drinking are at greatest risk for long-term alcohol abuse postinjury. Postinjury illicit drug use rates remained relatively low, falling below 10% at both follow-up intervals. Among persons taking prescribed medications, 17% reported moderate or heavy drinking at second follow-up.

Neuromuscular and somatic problems of post-acute brain injury patients.

Information regarding traumatic brain injury sequelae in a sample of 503 traumatic brain injury patients was obtained using the Neurobehavioral Functioning Inventory (NFI). Data revealed that motor dysfunction was more frequently reported than somatic difficulties. Analyses of variance indicated that unemployed patients experienced significantly more motor problems than patients working 40 or more hours per week. No differences in the incidence of somatic complaints, headaches, or muscular pain were found between employed and unemployed patients. Data suggests that long-term, interdisciplinary rehabilitation may be cost effective, especially when viewed in the context of successful employment.

Alcohol use after traumatic brain injury: concordance of patients' and relatives' reports.

OBJECTIVE: To investigate bias and concurrent validity of patients' alcohol use reports by examining concordance with relatives' reports. DESIGN: Using a quasiexperimental static group comparison design, alcohol use was examined at 1 year after injury. Chi-square analyses, t tests, and a Fisher exact probability test were conducted to investigate the relationship between patients' and caregivers' reports on measures of alcohol use. SETTING: Medical center outpatient clinic. PARTICIPANTS: 175 adult patients with traumatic brain injury and 175 family informants. Inclusion criteria were: patient older than 18 years of age and completion of self-report and family member versions of questionnaires. The full range of brain injury severity was represented. MAIN OUTCOME MEASURES: Quantity-Frequency-Variability Index (QFVI; Cahalan and Cisin, 1968); Brief Michigan Alcohol Screening Test (B-MAST; Porkorny et al, 1972). RESULTS: A high rate of concordance, typically greater than 90%, was noted between patients' and relatives' reports on each of the alcohol use measures. Chi-square analyses revealed no significant differences (p > .05) between patients' and relatives' reports for the QFVI or the B-MAST. Inspection of the data found lesser rates of agreement for persons with severe injuries. Chi-square analyses revealed no differences based on family members' relationship to patients or whether they lived together or apart. However, a Fisher exact probability test (p < .03) for the QFVI indicated higher agreement rates for spouses relative to parents. CONCLUSIONS: The results do not support the hypothesis that patients underreport drinking and that their reports are inconsistent with those of caregivers. The high levels of concordance are consistent with those found in similar research studies involving alcoholic populations. Results suggest that patients' reports should be given higher credibility and should not be routinely dismissed in favor of information provided by families. However, more caution is necessary when collecting information from persons with severe injury.

Level of care options for the low-functioning brain injury survivor.

During the early stages of recovery from severe brain injury many patients are comatose or minimally responsive. Rehabilitation for these low-functioning survivors traditionally includes acute medical care and transfer to a skilled nursing facility or acute rehabilitation. Concerns have been expressed that customary treatment options are ineffective, costly, or both. In response, 'intermediate'-level programmes designed to provide effective, cost-efficient rehabilitation have emerged. The purpose of this paper is to provide information regarding outcome of severe brain injury and the early rehabilitation needs of survivors. Common characteristics, advantages, and disadvantages of various intermediate programmes, including 'subacute' and 'transitional' rehabilitation, are discussed and contrasted.

Family needs after traumatic brain injury: a factor analytic study of the Family Needs Questionnaire.

The present investigation examined the empirical and theoretical validity of an instrument developed to assess family members' perceptions of needs following the brain injury of a relative. The Family Needs Questionnaire (FNQ) consists of 40 items reflecting commonly reported family needs. The development of the items was based on the literature describing family reactions to brain injury and other medical disabilities. A principal-components factor analysis was executed based on the FNQ responses of 178 family members. A six-factor solution was selection as the best fit for the data, yielding the following independent subscales: (1) Need for Health Information; (2) Need for Emotional Support; (3) Need for Instrumental Support; (4) Need for Professional Support; (5) Need for a Support Network; and (6) Need for Involvement with Care. Further analysis indicated at least adequate internal reliability for each scale. Overall, the measure appears to offer unique information relevant to family members' needs after brain injury.

Interrelationships between crime, substance abuse, and aggressive behaviours among persons with traumatic brain injury.

Professionals have suggested that aggressiveness, substance abuse, and criminality contribute to poor outcomes after brain injury. There is considerable research regarding post-injury aggressive behaviour, but limited information concerning criminal behaviour and alcohol use patterns. With a sample of 327 patients varying in severity of traumatic brain injury, the present investigation examined alcohol use patterns, arrest histories, behavioural characteristics, and psychiatric treatment histories. Relative to the uninjured population, analysis revealed relatively high incidence of heavy drinking, both pre- and post-injury, among patients with a history of arrest. Increases in abstinence rates were found regardless of arrest history. In addition, a history of arrest was associated with a greater likelihood of psychiatric treatment. Findings also indicated relatively high levels of aggressive behaviours. Discussion focuses on implications for evaluation, rehabilitation, and future research.