Understanding the role of family in NPR, assessment

Role of family in holistic rehab (2)

• Vital supporters who are a core pillar of recovery

• Form a collateral relationship with the clinical team, and do no enter a traditional doctor-patient relationship

Three-tiered support scheme for patients (3)

• Tier 1 (Primary Caregivers): The immediate frontline supporters (e.g., spouse or primary parent) who manage daily care and home routines.

• Tier 2 ('Second String' Supporters): Extended family members, close friends, or relatives who step in to offer respite, instrumental help, and emotional backup.

• Tier 3 (Community Sources): External support networks, including peer support groups, advocacy organizations, and community services.

Purpose of three-tiered support scheme (1)

• Prevents tier 1 caregivers from experiencing burn out

Philosophical pillars of family-based intervention (3)

• Awareness

• Acceptance

• Realism

5 layers of culture that need to be integrated for success (not so vital to remember)

1. Culture of Origin: The family's race, ethnicity, language, traditional power structures, and cultural beliefs regarding illness, disability, and caregiving duties.

2. Neurorehabilitation/Milieu Culture: The operational norms, routines, and collaborative expectations of the rehabilitation centre.

3. Brain Injury Culture: The shared language, challenges, and identity formed within the broader community of ABI survivors and caregivers.

4. Therapists' Cultures: The personal background, professional training, and implicit biases of the clinical team.

5. Mainstream/Majority Culture: Broader societal values, legal frameworks, and community expectations

How families are evaluated: 2 domains (names)

• Structural dimensions

• Process variables

Structural dimensions examples (2)

• High cohesion vs fragmentation

• Clear vs poor boundaries

Example of process variable (1)

• Receptive engagement vs defensive resistance

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Manifestation of caregiver strain (name)

• Catastrophic reaction by proxy

What is catastrophic reaction in ABI patients?

• Challenging reactions by patients when they become overwhelmed by task failure

  • E.g. verbal outbursts, aggression, social inappropriateness

What is a catastrophic reaction by proxy, then?

• When caregivers are suddenly overwhelmed with and confronted by the stark reality of their loved one’s permanent deficits

Triggers, emotional symptoms, and behavioural manifestations (few examples for each)

• Triggers: Observing persistent memory failure, functional dependency during daily activities, loss of driving privileges, inappropriate social behaviour, or the realisation of endless vigilance.

• Emotional Symptoms: Severe feelings of panic, helplessness, embarrassment, intense grief, frustration, anger, or feeling utterly overwhelmed.

• Behavioral Manifestations: Minimising the patient's struggles, blaming clinical staff or external factors for setbacks, extreme defensiveness toward constructive feedback, shutting down, or hiding the patient's difficulties from extended family and friends