Changing relationships: Acquired Brain Injury, family functioning and the experiences of significant others.

Purpose: Acquired Brain Injury (ABI) affects both patients and families. This thesis portfolio aims to increase knowledge exploring post-ABI family life, using contrasting methodologies. Two papers are presented; an exploration of the relationship between post-injury neurobehaviouiral (NB) presentation and family functioning (FF), followed by an analysis of subjective experiences for spouses and partners of ABI patients. Design: A systematic review is presented exploring the relationship between NB change and FF. Broad search terms were applied across three databases, with fifteen studies reviewed. Data extraction and quality assessments are presented. In contrast, the empirical study adopted Interpretative Phenomenological Analysis (IPA). Nine women, whose significant other had experienced an ABI, took part in semi-structured interviews regarding their experience of realisation of change. Analysis was conducted both within and across accounts, with a reflective journal maintained for transparency. Results: FF mediated the relationship between NB change and caregiver distress, meaning the distress potentially triggered through NB change can be explained through FF. Within NB, behaviour concerns were most predictive of FF, however the differing degrees of detail within the definition and measurement of “neurobehavioural change” are considered. The IPA derived four main themes; “pushed apart by brain injury”, “bravery to face lingering awareness and emotions”, “lost and trapped in an unsolvable maze” and “unfolding events leading to new perceptions”. Each included two subthemes. Conclusions: Post-ABI changes elicit a multitude of experiences, including relational disconnect and feeling trapped. Notably though, distress can also be predicted by quantitative measurement. Clinical applications include keeping the whole family in mind when considering ABI sequelae and promoting longer-term support to couples. Further studies could address specific NB aspects to increase predictive accuracy, while extensions of the empirical study could explore underlying internal processes, potentially using Grounded Theory

The experiences of wives following acquired brain injury (ABI). A qualitative analysis exploring realisations of change following the ABI of a “loved one”.

The experiences of family members following Acquired Brain Injury (ABI) are well established, with spouses in particular facing multiple relational and personal changes. Qualitative studies have analysed accounts pertaining to a range of sequelae, however, “change” itself has yet to be addressed. This study explored the experiences of realisation of change for married women living with their husbands following ABI. Nine participants took part in semi-structured interviews focussing on becoming aware of changes in both their spouse and themselves post-injury. An Interpretative Phenomenological Analysis (IPA) was completed, arriving at two overarching themes; “bravery to face changes” and “lost and trapped in an unsolvable maze,” with accompanying subthemes. Participants generally experienced realisation of change gradually, in some cases finding strategies to control their exposure to distress. They often referred to “acceptance,” which held varied meanings, and metaphors appeared to aid personal meaning making. Relationship changes generated both dilemmas and the feeling of being trapped. Overall, this study contributes greater insights into the experiential mechanisms underpinning realisation of change in spouses after brain injury