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QUALITY OF LIFE 4 YEARS AFTER TRAUMATIC BRAIN INJURY

QUALITY OF LIFE 4 YEARS AFTER TRAUMATIC BRAIN INJURY. MASTERPROJECT 2005 Vivi Nielsen Master in Rehabilitation Mail address: vivinielsen@hotmail.com Charge Nurse, Department of Neurorehabilitation/TBI Unit, Glostrup Hospital. BACKGROUND. Due to Ministry of Health’s recomendations in 1997

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QUALITY OF LIFE 4 YEARS AFTER TRAUMATIC BRAIN INJURY

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  1. QUALITY OF LIFE4 YEARS AFTER TRAUMATIC BRAIN INJURY MASTERPROJECT 2005 Vivi Nielsen Master in Rehabilitation Mail address: vivinielsen@hotmail.com Charge Nurse, Department of Neurorehabilitation/TBI Unit, Glostrup Hospital

  2. BACKGROUND • Due to Ministry of Health’s recomendations in 1997 Two wards were established nationally to centralise and coordinate the care of patients whom have aquired a Severe Traumatic Brain injury (TBI). • Our Traumatic Brain Injury Ward opens September 1st 2000 at Hvidovre University Hospital. • Results was good, for example 55% where discharged to their home. • Is there quality of life for the individual person?

  3. OBJECTIVE and PROBLEM DEFINITION • To investigate the quality of life four years after a TBI and to use this knowledge in the rehabilitation of future patients • What is quality of life for a person, who has been through four years of rehabilitation after a severe TBI, and how does the rehabilitation influence the experienced well-being?

  4. DESIGN & METHOD • A quantitative questionnaire study with SF-36 (health related quality of life) • And a qualitative study with life stories/interviews – where the phenomeological approach is used in my analysis, as well as the hermeneutical approach with coping, quality of life and rehabilitation theories.

  5. Empirien and fact • First year at the TBI Ward – in the period Oct. 1st 2000 to Sept. 30th 2001 – 39 patients. • Average age: 36 year • 79 % are men • Average length of stay in the ward: 125 days • Post traumatic amnesia period average is 122 days • Questionnaire sent to 33 – answering procent 72,7%

  6. Comparing SF-36 year 1, and normal men between 34 -44 year.

  7. Conclusion SF-36 • Significant difference with First year patients compared with 34-44 year - old men in the general population, except on the question of their general health. Here the patients showed a positive rating of their health. • Compared with other research results, the patients displayed a higher level of health-related quality of life at HH, except in the psycological area. • No proof that rehabilitation at HH is better, due to lack of information.

  8. Theories • Definition of Rehabilitation • Empowerment • Coping • Salotogenetic philosophy, Antonowsky • Quality of life – well-being theory

  9. QUOTE FROM A LIFE STORY • Female, 18 :- ” I am not a product of this accident, I am a human being, that has experienced an accident,and that has formed me into a different person, not necessarily worse, in fact not at all, because many of the inhibitions that I had before the accident, have been taken away from me, they have been put on a shelf, so there are a lot of thing`s that have become easier for me”

  10. QUOTE FROM A LIFE STORY • ”When I worked together with Sunshine, (a horse) I had to concentrate 100%, and that meant, that Sunshine was better than medicine, because it wasn’t me, not a chemical reaction, that blocked all out, but myself shutting out negative thoughs…. It was me and Sunshine, that resolved it, so that I put a lid on the shock after the accident and gained the excess energy needed to concentrate og becoming human again, get a life again”

  11. LIFE STORY - quote • Male, 30: ” – to read these things after my accident – that was great – that is quite logical, that has really been a shortcut i my rehabilitation, that others should remember – somehow – if it is possible. It is obvious, that it brings back things again, especially when one has had some motorways in the brain destroyed, they are not prioritised, because the brain needs to spend energy of certain things, like for example to walk or speak again – that one still brings these things forth, one is aware, that it is important that one tries, isn’t it?”

  12. Conclusion on the Life Stories • Both experience their life situation as a tough battle towards a better life. • Both are still involved in their rehabilitation today, 4 years after TBI. • Both have been suicidal and have experienced depressions and periods of self-destruction. • There has been a lack of therapeutical support and coordination in their rehabilitation process. • They have different coping abilities • Both express a better quality of life today than before the accident – despite their fight against the system.

  13. Better quality of life after TBI? • MAYBY BECAUSE THEY COMPARE QOL WITH THE BEGINNING OF THERE ACCIDENT? • OR • DO THEY APPRECIATE LIFE MORE AFTER THE ACCIDENT?

  14. PERSPECTIVES • There is a lack of coordination between the different phases of the rehabilitation process. • Maybe one can predict the individual’s coping abilities through some form of scoring. • Consider more therapeutical support to persons over the age of 30 – in accordance with Antonovsky’s Theory • More attention on depression • Focus on quality of life in the ”after-discharge visit” one year later

  15. Thank you

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