Abstract:
Many people with moderate and severe TBI continue to display significant cognitive and behavioral disruption following acute medical care and formal rehabilitation. Behavioral problems can produce adverse psychosocial, vocational and intra-familial effects that can threaten their community tenure and personal sufficiency. People who remain dependent on families or other and those who experience significant role disruption in post-injury life are especially susceptible to these effects. Research suggests that these disruptive events often occur a year or more post-injury at a time when there is no longer active involvement with rehabilitation programs and professionals who are trained to address these challenges. Caregivers rarely have the skills necessary to manage these complex challenges and sustain family equilibrium on a long-term basis. As a result, caregiver systems may become overburdened and fragmented. Most survivors of TBI and their caregivers find that once they are out of the acute medical “rehabilitation system” it is difficult to find help, which further exacerbates problems and increases stress. Many researchers have underscored the importance of caregiver education and training to assist individuals with TBI to achieve stable, long-term community integration. However, little systematic data have been reported on the efficacy of such programs. In an earlier study, the investigator reported the results of a small three year program called Natural Setting Behavior Management (NSBM), which involved the use of a community-based approach to teach persons with TBI and their caregivers how to implement and sustain behavior management programs. While results of this pilot project demonstrated its value, findings were limited by small sample size, lack of a control group, and restriction of the sample to individuals with severe brain injury. The present project expands the NSBM methodology to a less severely impaired population of persons with TBI and uses a more rigorous methodology to test efficacy. We will also clarify the critical elements of the educational and therapeutic interventions.
The general objectives of the study are to refine and test the Natural Setting Behavior Management (NSBM) project and to develop training and educational materials for dissemination. NSBM is a mobile team approach that seeks to educate individuals with TBI and their family/caregiver system how to implement and sustain home-based behavior management programs. The efficacy of the model in reducing target behavior problems is being tested as well as hypotheses related to the impact of the program on caregiver stress and quality of life.