Traumatic brain injury (TBI) has long-term and often devastating impacts on a family, especially the spousal caregiver, and of course the head injured person. There is ample evidence that the spouse or partner caring for an individual with a TBI, experiences significant emotional distress, and psychological and physical morbidity. The difficulties encountered by caregivers have a dramatic effect upon rehabilitation, especially during in-home recovery, and is believed to account for a greater part of the difference in the level of physical, mental, and social restitution gained in patients with similar amounts of brain damage.{923} Clinical experience indicates that patients with strong family support progress further than those without family involvement. There is strong evidence that support provided to caregivers improves their well being, as well as that of the care recipient. We are proposing to evaluate a telecommunications network, that has been designed to aid the caregiver in ways that will lesson her morbidity, improve her support for the TBI partner, and improve recovery for the TBI person. The overall goal of this proposal is to evaluate the cost- effectiveness of this telecommunications network at improving both the quality of life and well-being of TBI caregivers, and the recovery of their TBI partners. The, termed the Trauma Recovery Support System (TRSS), will consist of a central computer system connected via modem to a personal computer in the caregiver's home. Users will be able to access via the Internet special modules and communication services to help them cope with their new roles as caregivers and with accompanying social isolation. These modules will be an on-line discussion group, and """"""""ask an expert questions"""""""" function, a database of previously asked questions with answers, a database of community resources, and a reference library. Increasing emphasis on lower cost, non-institutional care alternative demand new approaches to delivering health services, providing support and follow-up care, and monitoring patient status and progress, while inexpensive telecommunication technologies provide a means. TBI patients and their caregivers were selected as the first target for this intervention because of the great potential for benefits to this population, including reduced need for and total cost of health services consumed during recovery, increased access to appropriate health and social services, and improved health status and well-being. The high potential for positive impacts on this population stems from the high costs of recovery, the extreme stresses placed on caregivers during recovery, and the long recovery period. This population has also been chosen because it needs during in home recovery are generalizable to other illness populations. It is thus expected that the results from this work will provide insights for expanding this Internet based service to other populations of patients and their caregivers, including home ventilator patients, those with multiple sclerosis or Alzheimer patients, and those suffering from spinal chord injury. The telecommunication system's effectiveness will be evaluated using a randomized controlled experimental design. For a period of 6 months the experimental subjects will be linked in their homes to the network via a personal computer and standard phone line. On-going monitoring of subjects' network usage patterns will complement measurement of the System's impacts, on quality of life, health status, and services utilization.
