Quality of Life after Traumatic Brain Injury: Perspectives of Adult Siblings

Every 15 seconds, someone in the United States incurs a traumatic brain injury (TBI) (Brain Injury Association of America, 2004 [BIA]). This injury is often called the "silent epidemic" given its lack of public attention despite being so common. However, this appears to be changing given increased media coverage on returning Iraq veterans injured by improvised explosive devices. Basu (2006) highlighted the fact that Veterans for America estimated that 10 percent of military serving in Iraq have incurred a TBI. Beyond the Iraq conflict, TBI continues to be a disability that affects a broad cross section of American society. The National Institutes of Health [NIH] (1999) noted that the most common ages to experience a TBI are from 15 to 24 years of age and over the age of 65 years. Men are twice as likely to incur a TBI compared to women. Persons of color are more likely to experience TBI than Whites. Finally, the NIH pointed out that those with some college experience are less likely to acquire a TBI than those with only a high school education. Cunningham, Chan, Jones, Kamnetz, and Stoll (2005) also noted that there is a positive correlation with TBI and lower socioeconomic resources. The operational definition of quality of life can be quite diverse. Quality of life can be referred to as life-satisfaction, well-being, happiness, adjustment, functional status, health status, and value of life (Frank-Stromborg, 1988). According to the frequently cited World Health Organization's (WHO) definition, the quality of life construct incorporates "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns" (Billington 1999, p.3). Therefore, it incorporates one's perception of his/her physical health, psychological state, level of independence, social relationships, personal values and beliefs, and interaction with the environment (Chandra & Ozturk, 2005). Another aspect of quality of life can be defined as a more narrow and specific subset of the overall general quality of life construct that has received significant attention in medicine and allied health disciplines--health-related quality of life, (HRQOL). An example of a frequently used and cited measurement on HRQOL is the Medical Outcome Study Short Form-36 (SF-36; Ware & Sherbourne, 1992). The SF-36 encompasses a variety of general and health-related quality of life constructs including physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, mental health, energy/fatigue, bodily pain, general health perception, and general perception of health over the past year. Assessment with this more focused approach to quality of life assessment typically measures individuals' perceptions of daily functioning and well-being in physical, social, and psychological domains (Elliott, Renier, & Palcher, 2003; Vickrey, Hays, Hermann, Bladen, & Batzel, 1993). Health only represents one of the many components that people consider when evaluating their quality of life. Therefore, an increasingly accepted method of QOL assessment of both the health status as well as a multidimensional and subjective assessment of quality of life becomes imperative and necessary in the evaluation of clinical care, intervention, and disability functioning. Quality of Life Following TBI Although there are many life-changing impacts of TBI, evidence exists to support that persons with TBI can function positively post-injury. Surprisingly, only a handful of research has empirically examined the positive aspects of quality of life for persons with TBI (e.g., Kincaid, 1998; Steadman-Pare, Colantonio, Ratcliff, Chase, & Vernich, 2001). Extant research finds that the persons with TBI who are able to adjust most successfully to their injuries, as indicated by perceived positive quality of life (Berger, Leven, Pirente, Bouillon, & Neugebauer, 1999) and life satisfaction (Corrigan, Bogner, Mysiw, Clinchot, & Fugate, 2001), are able to maintain supportive social relationships and engage in productive lifestyles and activities. …