R3: Training Family Members as Paraprofessionals: Use of Distance Learning As A Training Tool for Family Members in Rural Areas
Principal Investigator: Angelle M. Sander, Ph.D.
- This project evaluated a distance learning program to train family members in rural communities to implement cognitive rehabilitation strategies in the home for persons with TBI.
- The project was conducted in collaboration with West Texas A&M University and Northwest Texas Hospital
- Participants were recruited from persons with TBI in West Texas, which is an underserved population, with minimal access to comprehensive rehabilitation services.
- Training family members to help persons with TBI to learn compensatory strategies to get around injury-related problems has the potential to improve daily functioning and quality of life, as well as reduce caregiver stress.
Research has documented high rates of unemployment, decreased financial independence, and social isolation in persons with traumatic brain injury (TBI). Impairments in cognitive abilities (e.g., memory, attention, reasoning, goal-setting) and behavior (e.g., social interaction styles, initiation, ability to self-monitor) are the major contributing factors to decreased independence and productivity. Participation in outpatient post-acute cognitive rehabilitation has been shown to help persons with TBI to improve attention, communication, memory, problem-solving, self-monitoring, and initiation. Unfortunately, many persons with TBI do not have access to post-acute rehabilitation or to any type of cognitive rehabilitation services. This is especially the case in rural areas, where few opportunities for rehabilitation exist. There is evidence that telehealth (i.e., the use of videoconferencing to provide assessment and therapy services) has utility for treating persons with TBI in rural areas. However, videoconferencing is expensive and may not be cost-effective to use on a continuous basis to provide rehabilitation to persons with TBI. It may be more cost-effective to use videoconferencing to train others to provide services to the person with injury.
Family members are often the sole source of support for persons with TBI in a variety of areas, including transportation, finances, leisure, and emotional support. Family members are in a unique position to assist the person with injury in developing cognitive strategies because they have first-hand knowledge of the everyday environment that the person with injury acts within and of the obstacles to functioning that have resulted from the injury. Family members are also in a position to make environmental modifications that can reduce barriers to maximal functioning for the person with injury. Training family members to develop and implement cognitive rehabilitation strategies and to make environmental changes for persons with TBI has the potential to maximize functioning for the person with injury. Especially in rural areas, family members may be the most effective means of ensuring that the person with injury learns and implements strategies. Training family members would also result in availability of cognitive rehabilitation techniques to persons who do not have insurance coverage for rehabilitation services.
The purpose of this study was to develop and evaluate a distance learning program to train family members of persons with TBI to implement cognitive rehabilitation strategies and environmental changes to improve the functioning of the person with TBI in the home setting. The population served by this study included persons with TBI in rural West Texas. This is an under-served population, with no access to comprehensive inpatient or outpatient rehabilitation services. The population consists primarily of white and Hispanic persons from low education and low socioeconomic backgrounds.
- Using web-based videoconferencing to train caregivers in rural areas to help persons with TBI compensate for cognitive and emotional problems related to injury is feasible and results in high levels of satisfaction for caregivers regarding new knowledge gained and confidence in helping their family members compensate for problems in their daily lives.
- Caregivers perceived long-term utility of the training, in that they continued to use information learned and continued to refer to the written educational materials that were provided.
- Difficulties encountered when implementing the study indicated that there are obstacles to providing rehabilitation services through videoconferencing in rural areas. Obstacles include caregivers’ beliefs in self-sufficiency and independence, lack of understanding and trust in research, and lack of access to technology in rural areas.
- Logistical issues, such as the time and cost involved in arranging for videoconferencing for caregivers, indicated that alternative ways of providing training should be explored, such as online workshops, educational DVDs, and Webinars.