Choosing outcome measures

Social and institutional factors in adjustment to traumatic brain injury.

“…Dependence among people with a brain injury is further heightened by institutional barriers such as access to services, applying for and receiving governmental benefits, negotiating the transportation system, and the time and organization required to make sense of “the system.” The relationship between institutional barriers and health has been addressed with other marginalized groups such as ethnic minorities (Cummings & DeHart, 1995) and women (Koss & Woodruff, 1991), but the issues of institutional barriers to recovery from brain injury have not, to our knowledge, been articulated in the research literature. Furthermore, numerous researchers have commented on the need for consistent and reliable measures of outcomes after brain injury (e.g., Body & Campbell, 1995; Malec & Basford, 1996), and several have included measures of economic self-sufficiency and social integration as important components of outcome, yet institutional barriers to achieving these positive outcomes are not acknowledged. Many rehabilitation psychologists and clinical neuropsychologists are aware of these barriers, but the realities of living with a brain injury or other disability have been primarily articulated by activists and consumers rather than providers (e.g., Fries, 1997).…”