Activities of daily living

Most people with TBI have the ability to carry out the activities of daily living. A study of 103 people with TBI in Melbourne (Olver et al., 1996) found that at 5 years post-injury

• 81% were independent in light domestic chores (e.g. meal preparation)
• 72% were independent in heavy domestic chores (eg gardening)
• 70% were independent in shopping and banking.

Work

Rates of successful return to work vary considerably. For people with TBI with severe injuries, the Melbourne study found that only 40% of people were employed at five years post-injury (Olver et al.,1996).

Leisure pursuits

Many people either lose all their leisure activities or have to change activities. The Melbourne study found that at five years post-injury, 63% of people with TBI had had to make changes to the sort of leisure activities that they had enjoyed prior to their injuries (Olver et al., 1996).

Marriage or relationship

A Sydney study found that at six years post-injury, 55% of marriages had broken down (Tate, Lulham, et al.,1989). For marriages that do stay together, there can still be a number of changes, for example, the loss of the sexual component of the relationship.

Friendships

The Melbourne study found that at five years post-injury, 50% of people with TBI reported that they had lost friends and become more socially isolated since the injury (Olver et al.,1996).

Psychological reactions

People with TBI can experience a range of differing psychological reactions. This can include depression, anxiety, low self-esteem and thinking about suicide. Between 30–40% of people can experience periods of depression. Almost 1 in 5 people will attempt suicide after a TBI (Simpson& Tate, 2002).

Impact on family

The majority of people with a brain injury are discharged from an acute rehabilitation unit to return to their parents or partners. This often produces enormous changes and stress for the family unit as well as for individual family members. In the Sydney study, more than 90% of people returned home to their family (Tate et al.,1989).

Many families find it a rewarding experience to provide support for a family member with TBI. However, it other cases, it can be extremely stressful.

Sources of stress can relate to:

• Family members having to give up work, and being financially worse off
• Increased level of conflict due to temper control problems
• Family members (especially partners) having to take on new roles if partner with TBI no longer able to play these roles (e.g. financial manager, home maintenance, disciplinarian with children, etc.)
• Family members who play a caring or support role losing touch with their own social networks, becoming more socially isolated
• Family members experiencing grief or depression mourning for the person “they knew before” the TBI
• Family members experiencing post traumatic stress if they witnessed or were involved in the accident that caused the injury.