Coping and stress in Canadian family caregivers of persons with traumatic brain injuries.

The purpose of this study was to document the stresses reported by Canadian caregivers of persons with brain injuries and to consider the factors which serve to mediate or moderate such stress. Highest stress scores on the Holroyd Questionnaire on Resources and Stress-Short Form (QRS) were associated with Lifespan Care and Personal Burden. Although overall burden as reported on the QRS by parents and spouses did not differ from other studies, it did differ somewhat for specific types of burden. Social Support and Spiritual Support, as measured by the F-COPES, fell within the medium use category, and scores for Reframing, Mobilizing and Passive Appraisal fell within the high use category. In multiple regression analyses, client competency as measured by the Patient Competency Rating Scale emerged as a major predictor of stress associated with Cognitive Impairment, Physical Limitations, Lifespan Care, Terminal Illness Stress, Limits on Family Opportunities, and Personal Burden. In contrast, other client characteristics (e.g. Time Since Injury) accounted for relatively little variance. The results also indicate that both Refraining and Seeking Spiritual Support as coping strategies can make an important contribution to stress reduction.

Transitions to independent living after ABI.

One of the most challenging questions facing service providers and policy makers alike is the appropriate level of supervision for adults living in the community following a brain injury. In a 3-year province-wide study of people entering the community following brain injury rehabilitation, four individuals (out of 22 studied) made a transition from fully supervised living to lower levels of formal supervision during their first year in the community. The present study seeks to provide more information about these four individuals, the factors that allowed them to move to lower levels of supervision, and the perceived success of that transition. For each participant, the interviews conducted over the 1 year period in the initial study were reviewed in detail for information about independent living. In addition, each participant was interviewed again for this study, along with his significant other and three of the community programme staff who were most closely involved with his transition. To summarize, factors most salient in the success of transition included: (1) Roles and relationships of family and programme personnel; (2) staying away from drugs and alcohol; (3) availability of structured daily activities, including productive activity or community programme; (4) financial management; and (5) emotion and behaviour self-control. Secondary themes related to successful community living also included the availability of transportation and prior experience with community living since the onset of brain injury. These results offer the experience of four individuals in moving towards independent living. As such, they provide a starting point for further discussions of the process of supporting individuals to pursue the ultimate goal of independent living.

A transitional living environment for persons with brain injuries: staff and client perceptions.

Given increasing interest in social ecology and the impact of environmental factors upon rehabilitation outcomes, the purpose of this study was to begin to document the characteristics of a particular environment designed to meet the needs of persons with traumatic brain injuries. Staff and clients at the Transitional Living Centre of Kingston, Ontario (TLC), a community based post-acute rehabilitation programme providing both residential and day programmes for adults who have acquired brain injuries participated in this study by completing the Community-Oriented Programme Environment Scale (COPES). While COPES subscale scores for clients and staff were within the average range, the results of a multivariate analysis of variance indicated that client and staff perceptions of the TLC environment differed significantly on two subscales within the Personal Development Dimension (i.e., Personal Problem Orientation, Anger and Aggression) and on one subscale under the System Maintenance Dimension (i.e., Staff Control). The results of this study suggest that future research should consider the impact of staff and client perceptions on the effectiveness of the therapeutic environment of brain injury programmes.

Stability of functional outcomes following transitional living programme participation: 3-year follow-up.

The functional status and perceived problems of 21 persons with severe brain injury were reported at admission, and at 1 and 3 years post-discharge from a community-based post-acute rehabilitation programme. Functional status was measured by participation in productive activity, financial support, place of residence and level of supervision required. Improvements observed at 1-year follow-up remained stable or had improved at 3-year follow-up. Loneliness and depression, while not reported at admission, increased over time to become the two problems reported most frequently at 3-year follow-up.