The Relationship between Thinking Skills and Need for Supervision One Year after Injury

Past Studies

Past Studies demonstrate that traumatic brain injuries can affect the way an individual thinks, acts, and feels. Thinking skills and behavior problems can cause individuals greater limitations in the home environment, workplace, and in social situations than do physical limitations. Individuals with brain injuries that have impaired thinking skills (memory, problem solving, etc.) and behavioral problems may need supervision by another person for daily activities and safety awareness. The amount and type of supervision can vary from person to person. Past studies indicate that there is a relationship between the caregiver’s reported stress level and the amount of supervision they need to provide over time. Although supervision can be a significant lifestyle change for both individuals with brain injuries and their caregivers, the amount of research is limited about this subject.

This Study

This study analyzed information from the 17 Traumatic Brain Injury Model Systems’ databases for 563 adults with traumatic brain injury. The researchers examined the individuals’ level of supervision ratings and neuropsychological test results at one year after their traumatic brain injuries. Neuropsychological tests assess the way the brain processes information for thinking skills, emotions, and behavior. A subgroup of 452 of these individuals who did not have physical limitations at their one-year follow-up was studied as well. The 563 individuals with brain injuries were two-thirds white and almost three-quarters male, with an average age in the mid-thirties. About half of them were single and 64% were employed at the time of their injury. About one third of the individuals had a high school education or GED and about another third had less than a high school education. This group sustained mainly moderate to severe traumatic brain injuries caused mainly by vehicle crashes, falls, and violence. At one year after their brain injuries, 29% of the total individuals were employed, 83% were living with relatives or significant others, and 13% were living alone. About 69% of the total individuals did not require supervision from another person. For the subgroup of individuals without physical limitations, those who were ethnic minorities, unemployed before their injuries, and had less than a high school education were more likely to require supervision at one year after their brain injuries. For both groups, lower neuropsychological test scores were associated with a greater need for supervision. Among the neuropsychological tests, those measuring mental flexibility, and the ability to solve problems were related more strongly to supervision compared to tests of learning and memory. Overall, the individuals’ educational levels prior to injury were more likely than their neuropsychological scores to be a predictor of supervision requirements. The researchers suspect that individuals with higher levels of education prior to their brain injuries may have a greater range of thinking skill abilities that enabled them to learn and adapt better after traumatic brain injuries.

Who May Be Affected By These Findings

Individuals with brain injuries, their families and loved ones, healthcare providers, researchers

Caveats

In this study, a higher percentage of ethnic minorities than non-minorities with traumatic brain injuries reported needing supervision. The researchers state it is important to consider that it is common in some ethnic minority subcultures for extended families to care for their family members with chronic illness and disability. The researchers question if cultural differences could account for the higher rates of supervision reported for ethnic minorities and they suggest that such cultural considerations be considered in future studies.

Bottom Line

Lower neuropsychological test scores were associated with a greater need for supervision. Overall, the individuals’ educational levels prior to injury were more likely than their neuropsychological scores for predicting supervision requirements. About one third of the individuals in this study required supervision one year after their traumatic brain injuries..

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