Predictors of family system functioning after brain injury

This paper reviews some of the recent empirical studies validating the Circumplex Model and describes the newly developed self-report measure, FACES III. Studies testing hypotheses derived from the Circumplex Model regarding the three dimensions of cohesion, change, and communication are reviewed. Case illustrations using FACES III and the Clinical Rating Scale are presented. These two assessment tools can be used for making a diagnosis of family functioning and for assessing changes over the course of treatment. This paper reflects the continuing attempt to develop further the Circumplex Model and to bridge more adequately research, theory, and practice.

Forty patients with very severe blunt head trauma (post-traumatic amnesia greater than or equal to 1 month) were initially examined at an average of 4.5 months after the injury. The patients were visited in their homes 2.5 years and 10-15 years after the accident and questionnaires were presented to patients, relatives and/or staff. Though physical impairment, dysarthria and defects of memory remained severe in many cases, the psychosocial sequelae presented the most serious problems. Permanent changes in personality and emotion were reported in two thirds and were especially frequent among the youngest patients. The worse overall outcome was seen in cases with severe brainstem involvement or anterior lesions or both. In spite of the great frequency of deficits long-term improvement of functional state was common and several regained at least some work capacity.

A close relative of each of 42 severely head injured patients was interviewed at 5 years after injury, following initial study at 3, 6, and 12 months. Persisting severe deficits, in some cases worse than at 1 year, were primarily psychological and behavioural, although minor physical deficits, for example in vision, were also common. Relatives were under great strain; significantly more so than at 1 year. The best predictor of strain in the relative was the magnitude of behavioural and personality change in the patient.