Persons with TBI often have significant neurobehavioral deficits in the post-acute period after completion of inpatient rehabilitation. These deficits limit ability to return to work and independent living and result in low levels of community integration and decreased quality of life. While some persons with TBI continue to have physical impairments, there is consistent evidence that cognitive and behavioral impairments have the greatest impact on long-term outcome. A number of approaches have been developed to address these impairments. Post-acute brain injury rehabilitation programs using a multidisciplinary team to create a therapeutic milieu have been shown to be effective in returning patients to work, decreasing need for supervision, and improving community integration. Such programs focus on compensation for deficits and improved personal adjustment and relationships with family and others.
While these programs have proven effectiveness, there has been little research regarding the specific aspects of treatment in these programs that make the greatest contributions to clients' improvements. Limited research (3 studies) has suggested that therapeutic alliances between the client and the therapeutic team and between the client's family and the therapeutic team are significant factors in determining client outcome.
This research project will investigate factors that determine the quality of therapeutic alliances between post-acute brain injury rehabilitation program clients and program staff and between families and program staff. We will focus specifically on client and family perceptions of clients' functional abilities as our previous research has shown that clients, families, and rehabilitation clinician often view clients' functional abilities quite differently. We hypothesize that these differences in perceptions will be one factor that determines the quality of working alliances.
In a subsequent phase of the study, we will develop an intervention designed to improve working alliances and conduct a trial of the intervention's effectiveness in improving working alliances and, thereby, improving community integration outcomes for persons with traumatic brain injuries who have been treated in post-acute brain injury rehabilitation programs. Findings of this study will result in improved post-acute rehabilitation services for persons with traumatic brain injuries and improved outcomes. These findings will provide guidance for development of therapeutic tasks, program structures, and the nature of staff interactions with clients and families in post-acute brain injury rehabilitation programs.