Components of self-awareness affecting caregiver burden: a long-term follow-up study.

OBJECTIVE: Studies utilizing the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) have commonly used the cognitive and physical domains to estimate self-awareness. This study included other aspects of self-awareness such as awareness of one's social and emotional status and daily functioning to explore their effects on caregiver burden for ABI survivors. METHODS: We studied 64 patient-caregiver pairs up to 29 years post-discharge from a holistic, milieu-oriented outpatient neurorehabilitation program. Discrepancy scores between ABI survivors' and caregivers' reports on the MPAI-4 subscales (i.e. Abilities, Adjustment, and Participation) and Total Score were used to determine self-awareness. Caregiver burden was measured using the Zarit Burden Interview (ZBI). RESULTS: Exploratory linear regression analyses revealed that caregiver burden derived from the ZBI was predicted by the discrepancy scores generated from the Abilities (p < 0.0001), Adjustment (p < 0.01), Participation subscales (p = 0.01), and Total Score (p < 0.001), respectively. Among the exploratory models generated, the Total Score model had the highest predictive value (R2 = .33) for caregiver burden. CONCLUSIONS: Measures of self-awareness should be comprehensive by considering diverse components of self-awareness. Increasing ABI survivors' self-awareness in different domains has the potential to effectively alleviate caregiver burden.

Long-term neurorehabilitation outcomes of pediatric vs. adult onset acquired brain injury.

Background: Functional outcomes of intensive neurorehabilitation for pediatric onset acquired brain injury (ABI) are understudied. The extent and pervasiveness of impairments are often uncovered years after an ABI and can worsen over time, leading to a cascade of academic, functional, and psychosocial difficulties. Objective: To examine the long-term outcomes of survivors with pediatric onset vs. adult onset ABI who completed holistic milieu-oriented neurorehabilitation up to 30 years ago. Methods: One hundred twenty-three survivors of ABI including a pediatric onset group (n = 22) and an adult onset group (n = 101) with heterogeneous neurological etiologies who attended holistic, milieu-oriented neurorehabilitation. Productivity, driving, and functional outcomes were evaluated using the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a psychosocial outcome questionnaire. Treatment for the pediatric onset group started much later than onset. Results: A one-way analysis of covariance revealed no significant differences between the two groups on the MPAI-4. At the follow-up survey, there was no significant difference between age at onset of injury and productivity status. The average follow-up time was ~8 years (SD = 6.28) from time of discharge to the time of the survey. Although there was no significant difference between the two groups for driving at the time of admission, the adult onset group was significantly more likely to return to driving after treatment. Conclusions: This study demonstrates the positive and enduring benefits of holistic, milieu-oriented neurorehabilitation for survivors of pediatric onset ABI regardless of the time between initial injury and engagement in rehabilitative therapies.

Does self-awareness influence caregiver burden?

BACKGROUND: Caregiver burden is experienced by a significant number of caregivers of survivors of acquired brain injury (ABI). It is known that self-awareness can impact functioning following ABI. However, the impact of self-awareness on caregiver burden has not been established. OBJECTIVE: To investigate the relationship between self-awareness and caregiver burden following ABI. METHODS: We studied 57 patient-caregiver pairs up to 28 years post-discharge from a post-acute comprehensive holistic milieu-oriented neurorehabilitation program. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed by survivors of ABI and their caregivers. Discrepancies in reports between survivors of ABI and their caregivers were used to determine self-awareness. Additionally, caregivers completed the Zarit Burden Interview (ZBI). RESULTS: Survivors of ABI with impaired self-awareness reported significantly higher levels of functioning than survivors of ABI with unimpaired self-awareness (p < 0.001). Unimpaired self-awareness (p < 0.001) and lower survivor self-reported MPAI-4 Total Score (p < 0.001) significantly predicted caregiver burden. CONCLUSIONS: Survivors of ABI's level of functioning and their level of self-awareness significantly impacted caregiver burden. Survivors of ABI with impaired self-awareness not only lack insight into their functional abilities but also tend to overestimate their capabilities; this likely contributes to the need for greater levels of supervision and worsened caregiver burden.

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge.

BACKGROUND: The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills. OBJECTIVES: The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors. METHOD: Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. RESULTS: The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life. CONCLUSION: The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

The relationship of neuropsychological variables to driving status following holistic neurorehabilitation.

OBJECTIVE: The main objectives of the present study were to evaluate the cognitive and driving outcomes of a holistic neurorehabilitation program and to examine the relationship between the neuropsychological variables of attention, speed of information processing, and visuospatial functioning and driving outcomes. METHODS: One hundred and twenty-eight individuals with heterogeneous neurological etiologies who participated in a holistic neurorehabilitation program. Holistic neurorehabilitation consisted of therapies focusing on physical, cognitive, language, emotional, and interpersonal functioning, including training in compensatory strategies. Neuropsychological testing was administered at admission and prior to starting driving or program discharge. Subtests of processing speed, working memory, and perceptual reasoning from the Wechsler Adult Intelligence Scale-III and Trail Making Test were included. RESULTS: At the time of discharge, 54% of the individuals returned to driving. Statistical analyses revealed that at the time of discharge: the sample as a group made significant improvements on cognitive measures included in the study; the driving and non-driving groups differed significantly on aspects of processing speed, attention, abstract reasoning, working memory, and visuospatial functions. Further, at the time of admission, the driving group performed significantly better than the non-driving group on several neuropsychological measures. CONCLUSION: Cognitive functions of attention, working memory, visual-motor coordination, motor and mental speed, and visual scanning significantly contribute to predicting driving status of individuals after neurorehabilitation. Holistic neurorehabilitation facilitates recovery and helps individuals to gain functional independence after brain injury.