Relationship and family breakdown following acquired brain injury: the role of the rehabilitation team

Abstract

Although the literature documents the considerable problems acquired brain injury causes for the survivor's family and close relationships, and the corresponding significantly inflated rate of separation and divorce, few papers offer practical solutions. The objective of this paper is to respond to this gap in the literature by presenting some of the problems raised for the rehabilitation team when a family separates, and some suggestions for ways in which these problems could be overcome. The literature is reviewed briefly, followed by reflections and suggestions which are based on this review and on clinical experience. The discussion indicates that there are a number of practical dilemmas raised for the rehabilitation team when a family already involved in the rehabilitation process starts to break up. Some specific suggestions for addressing these issues are made; further research is needed to evaluate their effectiveness.

Improving Client-Centered Brain Injury Rehabilitation Through Research-Based Theater

“…Families are particularly vulnerable in the immediate postdischarge period. Their isolation increases during the “fade-out” of professional support and intervention at a time when the “full scale” of the extent and permanency of injury is becoming increasingly known (Webster, Daisley, & King, 1999, p. 596).…”

“…In this regard, "After the Crash" filled a particularly pressing need for professional training in family intervention (Lefebvre et al, 2007). Given that rates of breakups, separations, and divorce are higher in the TBI population than for the noninjured population, and are higher than those of the married, common-law or noncohabitating partners of other types of catastrophic injury (Webster et al, 1999), the involvement of rehabilitation professionals in family intervention appears crucial.…”

Families’ Experiences Living with Acquired Brain Injury: “Thinking Family”—A Nursing Pathway for Family-Centered Care

“…Predominantly, the literature has consistently reported ramifications of ABI on families as negative; with prolonged exposure to stress and strain and harmful effects on families' social, emotional, structural, and financial functioning; role changes; and challenges to core values and resources in families [ 14 , 54 – 62 ]. Rather, the findings of this study offer a counterbalance to these bleak reports.…”

Acquired Brain Injury, Social Work and the Challenges of Personalisation: Table 1

“…Loss of capacity for empathy, increased egocentricity, blunted emotional responses, emotional instability and perseveration (the endless repetition of a particular word or action) can create immense stress for family carers and make relationships difficult to sustain. Family and friends may grieve for the loss of the person as they were prior to brain injury ( Collings, 2008 ; Simpson et al ., 2002 ) and higher rates of divorce are reported following ABI ( Webster et al ., 1999 ). Impulsive, disinhibited and aggressive behaviour post ABI also contribute to negative impacts on families, relationships and the wider community: rates of offending and incarceration of people with ABI are high ( Shiroma et al ., 2012 ) as are rates of homelessness ( Oddy et al ., 2012 ), suicide ( Fleminger et al ., 2003 ) and mental ill health ( McGuire et al ., 1998 ).…”