Investigating the Impact of Traumatic Brain Injury on Caregiver Life Satisfaction: A Key Element of Successful Community Participation

*Wheeler, S., **Motsch, J., **Schlosnagle, L., **George, C., *Ingram, Z., *Charlier, C.
West Virginia University School of Medicine Department of and Applied University, Medicine, Human Performance and Applied Exercise Science (Occupational Therapy Division), ** The Center for Excellence in Disabilities at West Virginia University

Introduction
Approximately 1.56 million Americans sustain a TBI each year and, of the 290,000 people hospitalized following their injury, 45% will have a disability one year after their injury. As length of inpatient rehabilitation following TBI continues to decrease and limitations of inpatient rehabilitation become increasingly recognized, the transition from hospital to home will continue to place considerable importance on caregiver participation in the rehabilitation process. The role of the caregiver after TBI can become an overwhelming source of stress for the individual and entire family system, including the individual with the brain injury (Lefebvre, Cloutier, & Levert, 2008) . The effects of TBI are reciprocal, with the well-being of the person with TBI affecting the well-being of the family, and the well-being of the family affecting the well-being of the individual with the brain injury (Vangel, Rapport, & Hanks, 2011). One of the strongest predictors of emotional distress among individuals with TBI is life satisfaction of the caregiver. Thus, rehabilitation providers, insurance companies, governments, and society as a whole can benefit from a greater understanding of factors contributing to caregiver life satisfaction after TBI.

Conclusions
The findings of the study point to the importance of communitybased interventions to address social functioning and executive cognitive functions of persons with TBI. Additionally, the results suggest the need for community supports for caregivers who may be prone to burnout over time.

Results
Results indicated statistically significant inverse relationships between caregiver life satisfaction and both time since injury and the adjustment subscale score of the MPAI. The MPAI adjustment score rates looks at symptoms of the individual with TBI including impaired self-awareness, inappropriate social interactions, anger, depression, and anxiety. No significant relationship was found between TBI related motor, speech, memory impairments and caregiver life satisfaction. The results support the notion that severity of injury and time since injury are both related to decreased life satisfaction of caregivers.

Studies have shown that persons with TBI whose caregivers felt they had good social support were less adversely affected by their cognitive deficits, injury severity, and low levels of family behavioral control than persons whose caregivers felt low social support. Additionally, couples are more likely to describe their relationship positively when a) they receive support from family and friends, b) they had a strong relationship before the injury, c) they had had prior knowledge or experience relevant to disability, d) had positive communication, and e) had other supports and coping skills such as spirituality, humor, and the ability to accept change (Gill, Sander, Robins, Mazzei, & Struchen, 2011).
By recognizing factors associated with caregiver quality of life, healthcare providers are better able to implement supports and education programs to prevent burnout. While this study focused on TBI, its methods and findings can assist researchers looking to expand their understanding of caregiver issues and community participation pertaining to other clinical populations.

Methods
This study was a collaborative effort between the Center for Excellence in Disabilities at West Virginia University and the Occupational Therapy Division of the West Virginia University School of Medicine. Study subjects were caregivers of family members with moderate to severe TBI living in the community. Caregivers completed three questionnaires: a demographic sheet, the Satisfaction with Life Scale (SWLS), and the Mayo-Portland Adaptability Inventory (MPAI-4). Data were collected to determine relationships between TBI symptoms, barriers to community participation, available supports, and caregiver life satisfaction. Completed questionnaires were received from a total of 31 family caregivers from across West Virginia.

References
Months since Injury MPAI Overall Score MPAI Abilities Subscale MPAI MPAI Adjustments ParticiSubscale pation Subscale r = -.388 * r = -.252
Gill, C., Sander, A., Robins, N., Mazzei, D., &Struchen, M. (2011).Exploring experiences of intimacy from the viewpoint of individuals with traumatic brain injury and their partners. Journal of Head Trauma Rehabilitation, 26(1), 56-68. Lefebvre, H., Cloutier, G., & Levert, M. (2008). Perspectives of survivors of traumatic brain injury and their caregivers on long-term social integration. Brain Injury, 22, 535-543. Vangel, S., Rapport, L., & Hanks, R. (2011).Effects of family and caregiver psychosocial functioning on outcomes in persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 26(1), 20-29.

Life r = -.447 * r = -.133 Satisfaction

r = .055

*p < .05