Traumatic Brain Injury and Quality of Life (2000)

Introduction-- The era of traumatic brain injury is upon us and will not go away. New methodologies to help families need to be formulated because the medical model cannot handle the long term needs of these patients. Therefore, the family is left to care for the survivor. Greater awareness is needed by family members to recognize the importance that family environment may have on the quality of life for the brain injured survivor and, in turn, the family's quality of life. Families can significantly improve the quality of life for the survivor if they embrace the characteristic of family cohesion and adaptability. Demographics A traumatic brain injury (TBI) occurs every 15 seconds in the United States and is the most frequent cause of death and disability for persons under 45 years of age (Dell Orto & Power, 1994). The majority of these persons are in the 18-30 year-old age group, from lower socio-economic levels, and habitual drug users with a history of high risk behavior (Jorge, Robinson, & Arndt, 1993). A New Challenge for Medicine The era of traumatic brain injury is only about 25 years old, and as such, is still in its infancy relative to injury sequalae and long term treatment. Prior to this era, most people sustaining significant brain injury did not survive. With the advent of superior medical technology and delivery of emergency services, it became possible to live through the injury. The result was persons sustaining traumatic brain injury were reentering society to live out their lives in full. The medical model does an excellent job of stabilizing the injured person; then generally discharges them to family members or other loved ones. However, family members and loved ones are often ill prepared to care for the survivor who often has an array of secondary complexities (Webb, Wrigley, Yoels, & Fine, 1995). The impact of the injured person's reentry into the family, and what can be done to help, is the subject of this article. Impact on Family Brain injury has a dramatic impact on the family system. The foremost family problem is the adjustment process to the survivors' personality changes and impulsivity. Secondly, the loss of memory impairs persons with brain injury to such an extent that they are embarrassed about meeting others, remembering names, and carrying on a normal conversation. These changes cause the survivor to seek isolation and endure depression which ultimately effects their family members. Together, personality changes, impulsivity and loss of memory decrease the quality of life for the brain injured person and their family. In a recent study by Gillen (1998) more than half of the families with traumatically brain injured members met the diagnosis for depression. The question then becomes what can medical professionals and social service representatives do to help families who are struggling with the caregiver role? In the case of family members, they need to be instructed on how they can provide the greatest help to their injured family member to improve the quality of life for the injured person, and therefore, the entire family (Bull, 1998). Cohesion and Adaptive Characteristics Effect Quality of Life In a 1998 study of 41 family members and 41 persons with a traumatic brain injury, see Table 1, Bull reported that cohesive and adaptive family traits were significantly correlated with an increase in the survivor's quality of life. Highly cohesive and adaptive families had survivors who scored higher in quality of life measures. The quality of life measures included: (a) the ranking of problems (Problems Checklist) usually associated with traumatic brain injury, (b) independent living abilities, and (c) social skills. These quality of life measures were then correlated with various predictors of quality of life including the family type traits: adaptability and cohesion, see Table 2. …