Academic journal article The Journal of Rehabilitation

Quality of Life and Adaptation for Traumatic Brain Injury Survivors: Assessment of the Disability Centrality Model

Academic journal article The Journal of Rehabilitation

Quality of Life and Adaptation for Traumatic Brain Injury Survivors: Assessment of the Disability Centrality Model

Article excerpt

TBI is a leading cause of death and disability in North America. Approximately 2.5 million Americans sustain TBIs each year; an estimated 2% of the U.S. population currently has long-term or lifelong need for help with activities of daily living as a result of TBI (CDC, 2014). The average annual cost of TBI in the United States exceeds $56 billion (Xiong, Mahmood, & Chopp, 2010). In addition to typical causes of TBI, such as car accidents, violence, and falls, the number of TBIs resulting from the war in the Middle East has continued to mount, with a total of 220,430 TBI-related injuries occurring from 2000 through 2010 (Armed Forces Health Surveillance Center, 2011).

According to the World Health Organization (WHO) criteria, TBI, although sometimes thought of as an event, is actually a chronic disease process, which health care providers should manage as such (Masel & DeWitt, 2010). The consequences of TBI include physical, cognitive, and behavioral disabilities (Ashley, 2010). Physical issues may include headaches, seizures, fatigue, and pain from additional body trauma sustained at the time of injury. Because of cognitive setbacks, such as inability to concentrate, clouded thinking, memory problems, and behavioral lability, many individuals find employment challenging after TBI. Behavioral disabilities affect interpersonal relationships when survivors exhibit altered personality dispositions, have trouble controlling anger, or use inappropriate language after injury. Life after TBI may be fragile, often resulting in loss of family, occupation, and comfort. Although many individuals are well enough to attempt reintegration into the community, this population is especially vulnerable to homelessness and incarceration (Centers for Disease Control, 2009). Together, these challenges can significantly affect QOL over the course of the survivor's lifespan (Nestvold & Stavem, 2009) and must be strategically addressed by supportive health care professionals.

Problem Statement

Living systems strive for stable states. TBI is disruptive and destabilizing to the homeostasis experienced by TBI patients prior to injury. To understand the effects of TBI on the individual's state, one must examine the destabilizing factors, the effects of destabilization, and efforts to re-establish homeostasis on QOL over time. Bishop (2005) proposed the DCM as an explanation of the relationship between the factors at risk for destabilization due to chronic illness or acquired disability and, ultimately, to QOL.

The purpose of this study was twofold. The first purpose was to examine the applicability of the DCM for explaining the QOL-based adaptation process for TBI survivors. The second purpose was to identify support needs of TBI survivors that most powerfully affect ultimate QOL.

Theoretical Framework

The DCM (Bishop. 2005) is a QOL-based model of adaptation to chronic illness and acquired disability (CIAD) that potentiates theoretical understanding and clinical application. According to Bishop (2005), adaptation at the onset of CIAD involves a multidimensional response that is unique to each individual. The model is an extension of the theory of illness intrusiveness (Devins, 1994; Devins, Binik, Hutchinson, Hollomby, Barre, & Guttmann, 1983). Bishop (2005) added to the individual's rating of importance, or centrality, of the life domain would influence QOL along with the level each domain has been impacted by CIAD. Additionally, perceived control in the life domain was proposed as a mediator between the impact of CIAD and overall QOL.

QOL is broad enough to capture changes produced by CIAD across 10 representative life domains: physical health, mental health, work or studies, leisure activities, financial situation, spousal relationship, family relations, social relations, autonomy/independence, and religious/spiritual life (Bishop, 2005; Devins et al., 1983). QOL represents the individual's subjective experience of changes within those domains and is an appropriate measure of adaptation to CIAD (Bishop, 2005). …

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