as possible, while constrained by reduced health care funds and time with the patient.

The Role of Families

Family members, dedicated caretakers, or paraprofessionals provide an important support system to individuals with cognitive or behavioral deficits due to TBI, as discussed in Chapter 3. This support system also plays an important role in the rehabilitation process (Sohlberg and Mateer 2001). The changed cognitive or behavioral functioning caused by brain injury not only affects the injured individual, but also places enormous demands on families. Emotional stress, perceived burdens of caretaking, and disrupted family functioning as well as unmet needs of other members of the family may contribute to unhealthy family communication or functioning.

Because rising health care costs and the costly nature of neurorehabilitation have led to shorter inpatient stays, outpatient rehabilitation is an important component of therapy, one that relies on a support person for the injured individual (Harrison-Felix et al. 1996; Kreutzer et al. 2009; Sander et al. 2002). Successful rehabilitation requires cooperation, participation, and encouragement from the patient’s support network for success; ongoing activities may include providing transportation, monitoring or maintaining finances, implementing leisure activities, providing emotional support, and reinforcing newly learned behaviors to compensate for brain injury-related deficits (Jacobs 1988). Long-term treatment efforts require collaboration among the providers, their clients, and the clients’ families (Levack et al. 2009). Garnering family support throughout the treatment process captures a unique resource to maintain treatment effects, provide generalization from clinical applications to real-life situations, and facilitate ongoing recovery (Kreutzer et al. 2003; Malec et al. 1993). These partnerships can help ensure realistic treatment goals considering the expertise, needs, and concerns of client and family (Sohlberg and Mateer 2001).

Family stress and unhealthy family communication and roles can hinder the rehabilitation process; potential barriers arise to successful rehabilitation outcome when a family member does not align with treatment goals or objectives of the entire team (i.e., patient, clinician, and family) (Levack et al. 2009; Sander et al. 2002). Constructive family functioning has been associated with greater improvement in persons with TBI, lessening overall disability and increasing employability. Ideally, family members or caretakers act as facilitators to the brain-injured individual’s care and recovery. Evaluations of CRT interventions sometimes include or require a family member or caregiver to participate in the study, because of the unique capability of caregivers to help translate clinical practices to real-world applications. For example, a provider may demonstrate use of a journal or

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