Brain injury case management: the potential and limitations of late-stage intervention--a pilot study

Abstract

The focus of this study was to be upon case management intervention with the longer-term, often insidious cognitive and behavioural problems of brain injured patients, to effect a cohesive response towards improvement of function and social/community reintegration. Ten 'in depth' case management studies were developed. Age, sex, cause of injury, time post-injury, nature of brain injury,sequelae-and consequent intervention-differed widely. Three studies are précised in this paper. There was no attempt to match or compare such a diverse group, each was accepted on the basis of need and potential benefit. Available information for each was studied. Field assessment was by the case manager who then engaged whatever appropriate resources could be mustered on behalf of the individual client. For some, this permitted access to funding for further assessments or specific inputs, for others there was nothing available other than existing statutory or voluntary agencies. For field assessment purposes, the case manager developed informal ratings of a range of disabilities within the cognitive and behavioural realms and the handicaps resulting. The assessments and nature of interventions are described, discussed and conclusions offered.

Predicting use of case management support services for adolescents and adults living in community following brain injury: A longitudinal Canadian database study with implications for life care planning

“…In 2004, Fitzsimmons reported on 51 case studies with case management intervention for persons with TBI, acknowledging brain injury case management as a “comparatively new discipline” ( Fitzsimmons, 2003 , p. 947). The lack of homogeneity with definitions also creates a problem ( Quinn et al, 2004 ).…”

“…In 2014 the Public Health Agency of Canada reported that, based on current data, the number of hospitalizations for TBI in Canada will increase 28% by 2031. Case Management (CM) has emerged as a significant health service over the past two decades ( Applebaum & White, 2000 ; Fitzsimmons, 2003 ; Quinn, Pannone, Gruman & Roja, 2004 ), as has the sub-specialty of Life Care Planning ( Masel & DeWitt, 2010 ; Deutsch & Sawyer, 1985 ; Klinger, Baptiste & Adams, 2004 ). In 2009 National Standards of Practice were identified in Canada, and CM was defined as “ ... a collaborative, client-driven process for the provision of quality health and support services through the effective and efficient use of resources.…”

Case management for acquired brain injury: A systematic review of the evidence base.

“…Ratings ranged from 0 out of 7 (41,42) indicating low methodological quality to 6 out of 7 indicating high quality (43). The majority of studies had clear research questions and appropriate methods of data collection, however some failed to clearly disclose these (40,41,42,44,45,46,47,48,49,50). Common methodological issues included poor reporting of methods of data collection and analysis, which resulted in these elements of included studies being assessed as 'can't tell' (e.g.…”

“…[Table 5 here] [Table 6 here] [Table 7 here] Measuring success in case management research and practice Six of the included studies reported on the challenges of measuring and evaluating the impact of case management for brain injury (14,15,16,28,48,49). Included reviews which explored the literature on the impact of case management on brain injury, concluded that there was no clear evidence on the effectiveness or ineffectiveness of case management for brain injury (14,15,16,49). This lack of evidence was deemed to be a result of a number of factors.…”

“…However, when evaluations were utilised they often took the form of informal feedback from families, rather than assessment through standardised measurement or agreed upon targets (28). Fitzsimmons (49), Scheinberg et al,(28), and Simpson et al,(48) agreed that there are di culties in identifying appropriate indicators and measures to evaluate outcomes of case management for brain injury, given the often diverse presentation of the condition. This has resulted in a vast array of measures being used in evaluation or the use of informal feedback, both creating challenges in demonstrating the quantitative effects of case management and strengthening its evidence base.…”