Changes in Perspectives of Disability Among Patients, Staff, and Relatives During Rehabilitation of Brain Injury

Relatives, treatment staff, and brain-injured individuals often have widely different perspectives about the nature and magnitude of dysfunction following brain injury, and these appear to have consequences for psychosocial adjustment and rehabilitation. To permit us to assess these differences, 28 seriously brain-injured individuals completed a behavioral competency rating scale along with standard measures of neuropsychological, emotional, and psychological functioning before and after a 6-month intensive rehabilitation program. Relatives and members of the treatment staff independently completed the same rating scale. Three comparison groups were formed retrospectively on the basis of staff-patient differences in perceived dysfunction. Group 1 patients and staff members rated similar levels of dysfunction both before and after rehabilitation. Group 2 and Group 3 patients, by comparison with staff members, greatly underestimated their initial levels of dysfunction. Over the course of rehabilitation, the perspectives of Group 2 patients and staff aligned, while Group 3 patients became more emotionally distressed and their perspectives actually diverged from those of staff. Early vocational outcome was related to level of neuropsychological and psychosocial functioning at the end of rehabilitation, but not to final staff-patient differences in perspective. The sources of these different perspectives and their implications for rehabilitation treatment are discussed.