Transcript Skelton & Joschko, 2003, Functional Outcome

Functional Outcome Profile:
Assessing Brain Injury Impact
on Survivors & Family
Ron Skelton, Ph.D.
Michael Joschko, Ph.D.
Psychology, University of
Victoria
Neuropsychology Services,
QACCH
Vancouver Island Health Authority
[email protected]
For Presentation:
web.uvic.ca/psyc/skelton/
[email protected]
Premises





1
Traumatic brain injury (TBI), stroke and other acquired brain
injuries (ABI) have variable outcomes affecting many areas,
each to a different degree.
Recovery from TBI or stroke takes years, often requiring
extensive rehabilitation.
Rehabilitation professionals need a way to find out which are the
areas in greatest need of rehabilitation, to improve daily
functioning and lessen the impact of the brain injury on family
members (carers).
To discover where people are having problems, you should ask
them. However, they may not be able to recall all problems on
their own and may need to be asked about specific areas.
Rehabilitation should be able to demonstrate gains to clients,
family and funders.
Functional Outcome Profile Design




The FOP is a 90-minute structured interview of
survivors and co-resident family member (carer)
It covers wide range of everyday functioning,
activities and quality of life, based ICDH-2 and
consultation with Rehabilitation Professionals.
It solicits ratings of problem frequency and impact
on survivor and significant other, but only in areas
where problems are acknowledged.
Provides a detailed, quantitative overview for
clinicians to identify needs and track gains and
losses over time.
2
Study Methods


12 pairs of ABI survivors and family members
interviewed 3 times at 6-month intervals
Ratings on Visual-analog scales of frequency,
impact, satisfaction, and importance


Impact of problem rated as impact on self by
both survivor and significant other, providing
measure of “carer burden”.
Questions


48 new questions, oriented to problem areas
(35), activities (3), quality of life (10)
17 areas covered by Scales of Independent
Behaviour – Revised ® (SIB-R)

Levels of independence/dependence (14),
Problem Behaviour (3)
Proportion of
Responders
0.5
-
FOP Areas
Gross-Motor
Fine-Motor
Social Interaction
Language Comp.
Language Expres
Eating&Meals
Toileting
Dressing
Pers Self-Care
Domestic Skills
Time&Punctuality
Money & Value
Work Skills
Home/Com.Or'n
Internalized PB
Externalized PB
Asocial PB
0.9
Attention,dur
Attention,div
Impulsivity
Disorient.Time
Way finding
Memory,antero
Memory,retro
Learning tasks
Organiz,behav
Judgement
Organiz,cogn
Initiation
Coping
Confusability
Info Proc Speed
Sensory systems
Emotional Rx'ty
Intrusions:thot
Fatigue
Sleep/Wake
Mood
Social life (sat)
Medical,injury
Health (Sat)
Leisure(TV)qnt
Leisure(other)qnt
Leisure Sat
Work,quant
Work,Sat
Confidence
Pain
Pain meds
Psychotropics
Med side-effects
Recr Drugs
Meds/drug prob
Independ,Activ.
Safety,by others
Safety,by Self
Relats,Family
Physical_Intimacy
Barriers
Insight,by others
Insight,by self
Other prob behv
Life Satisfaction
Good things
Results
4
Problems were reported in all areas of the FOP and SIB-R,
by survivor, significant other, or both.
Green is Good
Yellow is Bad
1.0
Yes, problem
75%
SELF
0.8
0.7
0.6
No problem
25%
0.4
Sig.
Other 0.3
0.2
0.1
SIB-R Areas
FOP Areas
Good things
Insight,by self
Other prob behv
Life Satisfaction
Barriers
Insight,by others
Relats,Family
Physical_Intimacy
more often than others.
Independ,Activ.
Safety,by others
Safety,by Self
Recr Drugs
Meds/drug prob
Psychotropics
Med side-effects
Confidence
Pain
Pain meds
Work,quant
Work,Sat
40%
Montly
Leisure(other)qnt
Leisure Sat
Memory Problems
Daily
Medical,injury
Health (Sat)
Leisure(TV)qnt
Mood
Social life (sat)
Fatigue
Sleep/Wake
Sensory systems
Emotional Rx'ty
Intrusions:thot
Confusability
Info Proc Speed
Hourly
10%
Initiation
Coping
60%
Organiz,behav
Judgement
Organiz,cogn
Hourly
Memory,retro
Learning tasks
Way finding
Memory,antero
Significant
Other
Attention,div
Impulsivity
Disorient.Time
Median Reported
Frequency
Attention,dur
Results
5
Ratings of Problem Frequency show that some problems occur
Green is Good .
Yellow is Bad
100%
Never
90%
Montly
SELF
Weekly
80%
Daily
70%
Hourly
Constantly
Never
50%
More than
Weekly
30%
Weekly
Daily
20%
Memory Problems
More than Hourly
Constantly
0%
Fatigue
FOP Areas
Psychotropics
Toileting
SIB-R Areas
Asocial PB
Externalized PB
Internalized PB
Home/Com.Or'n
Work Skills
Money & Value
Time&Punctuality
Domestic Skills
Pers Self-Care
Dressing
0.2
Eating&Meals
c
Language Expres
Language Comp.
Social Interaction
Fine-Motor
Gross-Motor
Good things
Life Satisfaction
Other prob behv
Insight,by self
Insight,by others
Barriers
Physical_Intimacy
Relats,Family
Safety,by Self
Safety,by others
Independ,Activ.
Meds/drug prob
Recr Drugs
Med side-effects
0.3
Pain meds
Pain
Confidence
Work,Sat
Work,quant
Leisure Sat
Leisure(other)qnt
Leisure(TV)qnt
Health (Sat)
Medical,injury
Social life (sat)
Mood
Sleep/Wake
0.1
Intrusions:thot
0.6
Emotional Rx'ty
Sensory systems
Info Proc Speed
Confusability
Coping
Initiation
Organiz,cogn
Judgement
Organiz,behav
Learning tasks
Memory,retro
Memory,antero
Way finding
Disorient.Time
Impulsivity
Attention,div
Sig.
Other
Attention,dur
Results
6
Ratings of problem impact, activities, and satisfaction show that brain injury
impacts all areas, and affects both survivors and significant others.
Green is Good
Yellow is Bad
1.0
0.9
SELF
0.8
0.7
Sensory problems
impact Survivor
Outcome
0.5
0.4
SIBR is not sensitive In
this population
Survivor's emotional reactivity
impacts Significant Other
-
7
Results
FOP shows that in many areas, outcome of brain injury was worse for
family members (red bars) than survivors (yellow bars).
Differences between impact on survivors and significant others.
1.0
Good
0.9
Sensory
Problems
0.8
0.7
0.6
Outcome
0.5
0.4
0.3
Divided
Attention
Pain
Coping
0.2
0.1
Red Bars = Impact is greater on Significant Other
Yellow Bars = Impact is greater on Survivor
r(37) = .51, p < .0011
Bad
Attention,dur
Attention,div
Impulsivity
Disorient.Time
Way finding
Memory,antero
Memory,retro
Learning tasks
Organiz,behav
Judgement
Organiz,cogn
Initiation
Coping
Confusability
Info Proc Speed
Sensory systems
Emotional Rx'ty
Intrusions:thot
Fatigue
Sleep/Wake
Mood
Social life (sat)
Medical,injury
Health (Sat)
Leisure(TV)qnt
Leisure(other)qnt
Leisure Sat
Work,quant
Work,Sat
Confidence
Pain
Pain meds
Psychotropics
Med side-effects
Recr Drugs
Meds/drug prob
Independ,Activ.
Safety,by others
Safety,by Self
Relats,Family
Physical_Intimacy
Barriers
Insight,by others
Insight,by self
Other prob behv
Life Satisfaction
Good things
0.0
Average differences between Self- and significant other-ratings, with the top and bottom of the bars showing the
ratings given by each, and the colour of the bar indicating the direction of the difference.
8
Results
FOP frequency and outcome ratings were sensitive to change over
time, but SIBR was not.
1.0
Visit 3
0.8
Visit 2
0.6
Sig. Other
0.7
Self
Outcome
0.9
Visit 1
0.5
Problem Frequency
Outcome
SIB-R
Conclusions



9
All 12 pairs reported the FOP interview to be worthwhile,
revealing.

One parent said that looking at everything together like this
helped them to see how many positive things were happening
in their son's life.

All areas were endorsed by interviewees, and no additional
areas were suggested.
The FOP provided a comprehensive overview of survivor’s
rehabilitation needs to improve daily functioning and lessen the
burden on family members.
So, FOP is a promising tool for

Identifying rehabilitation targets

Tracking change over time (For clients, therapists, and funders)
Current Research
10

We are shortening the administration time by
reducing the number of items required to assess
independence, behavior problems, and certain
areas of activities of daily living.

We have added a component to specifically
identify areas of greatest concern.

We are testing the FOP in multiple clinical settings
for its utility to rehabilitation professionals
(Neuropsychologists, Occupational Therapists,
Physiotherapists, Social Workers, Speech
Pathologists, and Physiatrists).