Methodology

The purpose of this study was to offer insight into TBI from the perspective of the survivors of TBI. An analysis of educational, medical, psychological, and rehabilitative literature was undertaken to determine issues of significance with which to survey survivors of TBI. Research questions were then posed that necessitated input and response from survivors of traumatic brain injury. The research questions were:

1.  How did known medical predictors of recovery (e.g., length of unconsciousness) affect outcome as measured by work status?

Definitions.

Medical predictors studied in the sample population were hospital admission, length of hospital stay, types of head injury, period of coma or unconsciousness, CT scan results, necessity for brain surgery, and seizure activity.

Outcome is a global term used to indicate the adequacy with which a patient’s life style is resumed. Outcome can be operationally defined in various ways. For the purpose of this study, outcome was measured in terms of work outcome.

Two categories of outcome, working and not-working, were established. An analysis between the working and the not-working groups and various medical predictors was undertaken.

2.  Were cognitive and other assessments (e.g., neuropsychological) performed to evaluate the traumatic brain injury?
3.  What cognitive, emotional, behavioral, physical, executive, and perceptual motor deficits occurred as a result of TBI?
4.  What emotions and feelings about having gone through a TBI did survivors display at the time of injury and do they continue to display now?
5.  How did survivors rate providers of emotional support?
6.  What kind of rehabilitation, if any, did the TBI survivors receive?
7.  What level of satisfaction did the survivors have with the types of treatment and information they received?
8.  Were the survivors of TBI satisfied with the degree of coordination and cooperation which they perceived to exist between care-giving professionals and institutions?
9.  What kinds of accommodations, if any, did the survivors receive at school and at work?
10.  What devices did the survivors find most useful in coping with their TBI-engendered deficit areas?

 

Instruments and Procedures

 

A questionnaire, based on current information in the field and reflecting the ten research questions, was developed by the researcher. The questionnaire was reviewed by two professors of education, a neuropsychologist, and a clinical psychologist who specialized in neurology. Modifications were made based on input from the four professionals.

A pilot study was conducted in which four survivors of brain injury completed a questionnaire. A few categories within questions were added based on input from the pilot survey participants and professional advisors. For example, seizures, which had not been included as a topic in the pilot survey, were included in the final survey on the advice of a pilot survey participant. Another example was that rehabilitation selections were modified based on the input of a psychologist. Terminology and phrasing changes were also made based on input from the professional advisors.

A list of brain injury support groups was obtained from the State of California Health and Welfare Agency, Department of Mental Health, Acquired Traumatic Brain Injury Project. Several brain-injury-trauma support groups were contacted and were invited to take part in the study. The Santa Clara Traumatic Brain Injury Model Project Support Group, the East Bay Head Injury and Peer Support Group, and the Santa Rosa Head Trauma Support Group participated.

The researcher attended meetings of the support groups to explain the study to the TBI survivors and to invite them to take part in the study. The researcher then arranged a time to present the questionnaire to the individuals who were interested in participating in the study.

Evaluation of the project included a summary statistical analysis of quantitative information derived from the questionnaires. Responses for each question were transformed into a numerical format. A percentage was calculated for each response.

In conclusion, ten research issues were extrapolated from an analysis of TBI research literature. An extensive series of close-ended questions was developed to address the ten research issues. The questions were prepared in nominal and ordinal formats. The resulting questionnaire was administered to 30 adult survivors of TBI by the researcher. Complied data was coded, entered, checked, and double checked. The data file was checked for completeness, and internal consistency checks were made to ensure optimum reliability. Survey data was then analyzed by the researcher.

 

Participants

 

The volunteer subjects were 38 adult individuals who had sustained either mild, moderate, or severe head injuries. Only one person solicited declined to participate in the study. Thirty participating individuals reported having had a TBI. Eight individuals had other diagnosis such as stroke or aneurism. Since these individuals did not meet the TBI profile, their results were eliminated at the outset of compilation of data.

The age of the participants at the time of TBI ranged from two to sixty-eight years. Twenty-seven percent had been teenagers. Sixty percent were adults at the time of TBI. However, all participants had reached adulthood at the time they participated in the study. The participants reported a broad range of educational levels ranging from completion of the eleventh grade to completion of post-baccalaureate college work. Two indicated they had been special education students. The ethnicity of the sample was predominantly white, but other ethnic populations were also represented. Please see Table 1 for descriptive data.
                                                                    

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Table 1
Descriptive Data
(n=30)

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  Variable            
               
  Age at Time of TBI:       Mean: 29.5  
          SD: 16.3  
  Age at Time of Survey:     Mean: 41.1  
          SD: 14.1  
  Years Elapsed Since TBI:     Mean: 10.8  
          SD: 8.8  
               
  Education:       Mean: 14.2  
          SD: 1.8  
               
  Gender:    
N
      
   
Males:		  
20		      
    Females:   10      
               
  Ethnic Background:            
   
White		  
24		  
    African American   1      
    Asian   1      
    Native American   1      
    Other   3      
               
  Etiology of TBI:            
   
Fall		  
7
23%		    
    Falling Object   1 3%    
    Gunshot Wound   1 3%    
    Motor Accident   14 47%    
    Pedestrian Accident 3 10%    
    Other   4 13%    
               

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There was no access to medical records: therefore all information gathered was on the basis of self-report. Using the questionnaire the participants answered questions about injury severity factors such as admission to the hospital, presence or absence of skull fracture, normal or abnormal CT scan, period of coma or unconsciousness, and whether or not brain surgery was necessary. Analysis of the severity information obtained in the survey (whether or not there was a hospital admission, length of unconsciousness, etc.) suggested that there were participants who had sustained mild, moderate, and severe head injuries.

 

Assumptions

 

The major assumptions of the study were:

  1. The participants had sustained a TBI.
  2. The participants had sufficient cognitive presence to participate in the questionnaire interview process.
  3. The participants provided candid, accurate information.
  4. The participants were representative of different (mild, moderate, and severe head injured) substrata within the population.




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