In recent decades, neuropsychological rehabilitation has been accepted as an appropriate and necessary practice due to its impact on daily life (Norup, 2018; Naudí, 2018). According to Bilbao (2013), to achieve the best recovery of people, it is necessary that rehabilitation takes place in different environments, i.e., in different places, with different people and with different tasks throughout the day, taking advantage of every opportunity to perform exercises that promote rehabilitation.
Importance of the Family in Neuropsychological Rehabilitation
Neuropsychological deficits usually cause disability among those who suffer from them, which, in many cases, is reflected in a more or less strong dependence on third parties (Paúl, Bilbao & Ríos, 2011), which are usually family members (Paúl, Bilbao & Ríos, 2011; Norup, 2018). Due to which, according to Rojas (2019), both patients with brain injury and their families are affected by this situation.
Therefore, the family is one of the basic pillars of rehabilitation, since without them the team is incomplete (Rojas, 2019; Norup, 2018; Guallart & Reyero, 2013), as they act as an extension of the healthcare system, and often, they are the ones who provide the patient's long-term care, support and follow-up (Norup, 2018). As a result, according to Rojas (2019), they become an essential part of truly improving the difficulties presented by the loved one.
At the beginning of the neuropsychological rehabilitation process, the family can help to establish what is the basis that the patient has (Rojas, 2019), since, according to Norup (2018), Rojas (2019) and Guallart & Reyero (2013), it is the family members who know the affected person best and for this reason, they are a very important resource, both during and after rehabilitation.
During the process, one of the roles that the family can play is that of co-therapist (Rojas, 2019). This role involves different functions, such as teaching the patient strategies in real situations, helping him or her to apply the strategies in different contexts, promoting the generalization of treatment processes, providing visual and/or linguistic assistance, and strengthening behavior or reinforcement. Likewise, the family should be trained on how to help in different situations and how to behave. In the same way, according to Rojas (2019), they should be aware of the different procedures in order to share them with all those who are related to the patient.
Through this process, it can be seen that family members feel more satisfied just by helping the patient's improvement, thus reducing guilt, helplessness and anger that can be caused by accidents or acquired brain injuries (Rojas, 2019). In addition, according to Rojas (2019), they feel useful and become part of the solution to the problems that the patient may have.
Does the Family Need Help in the Neuropsychological Rehabilitation Process?
Although patients need the most help in order to overcome difficulties, families cannot be left aside (Rojas, 2019). In many cases, according to Norup (2018), Rojas (2019) and Naudí (2018), neuropsychological disorders have chronic consequences that lead to lifestyle changes for the entire family, not just the individual with the disease.
The care and attention of family members with a brain injury or damage involves being exposed to a series of stressful situations, such as family breakdown, social isolation, economic scarcity, physical exhaustion, among others (Paúl, Bilbao & Ríos, 2011). Therefore, according to Norup (2018), family members of brain-injured patients have an increased risk of presenting symptoms of anxiety and depression, post-traumatic stress symptoms, increased stress, tension, and decreased satisfaction with life and quality of life.
In addition to the stress that these prolonged situations can cause to family members, caregivers inevitably suffer a grieving process, since they must accept the loss of their loved ones while accepting their new characteristics (Paúl, Bilbao & Ríos, 2011). According to Paúl, Bilbao & Ríos (2011), this process of acceptance only begins when the family, generally guided and supported by the rehabilitation team, begins to suspect that many of the patient's difficulties are definitive sequelae.
To make this process as pleasant as possible for the family, coping and problem-solving skills should be taught, a space should be provided to share their own frustrations, and knowledge of available resources should be provided so that they can get help (Rojas, 2019). Similarly, according to Moyano (2016), it is important to provide emotional support, since family collaboration can contribute to rehabilitation and be a fundamental pillar and motivation in treatment.
On the other hand, the caregiver must be healthy and stress-free in order to provide quality care to their family member (Rojas, 2019), since, poor health of caregivers affects the quality of the services they provide and affects the neuropsychological rehabilitation outcomes of the patient with an injury or brain damage (Norup, 2018; Guallart & Reyero, 2013). This increases the risk of social isolation and ultimately loss of financial support (Norup, 2018). According to Norup (2018), this in turn leads to a different living situation, which can affect the caregiver's health.
This process can be described as a self-reinforcing cycle that, without intervention, can continue indefinitely (Norup, 2018). Therefore, according to Moyano (2016) and Paúl, Bilbao & Ríos (2011), the family should be understood not only as a collaborator in the therapeutic process, but also as an element to be treated, minimizing stress and any dysfunction that may arise.
How to Help the Family?
Intervention with the family of people with a damage or brain injury must take into account the different problems faced by each member and their family dynamics (Rojas, 2019). According to Rojas (2019), all this in order for the intervention to be effective and have an impact not only on patients, but also on the patient's recovery process.
Psychoeducation
The information and training tasks that make up psychoeducation provide families with knowledge and general strategies to know and understand what is happening, what is going to happen with the patient and what are the ways to make this process as bearable as possible (Paúl, Bilbao & Ríos, 2011). According to Moyano (2016), in this training it is important to make it clear that greater patient autonomy results in less overburdening of the environment and greater well-being for the affected person.
Psychoeducation aims to provide information about the damage (Rojas, 2019; Guallart & Reyero, 2013), as well as to inform about the consequences of the damage, what expectations should be held in front of the recovery process, among others (Moyano, 2016; Guallart & Reyero, 2013). In the same way, according to Paúl, Bilbao & Ríos (2011), it helps to initiate the grieving process, reducing the stress caused by uncertain factors and favoring the taking of more realistic measures.
Although families appreciate first-hand information through individual interviews, manuals about the disease can complement psychoeducation (Paúl, Bilbao & Ríos, 2011). According to Paúl, Bilbao & Ríos (2011), family meetings are often another way to promote psychoeducation and their advantage is that in addition to maximizing the use of resources, they favor the construction of support networks.
Family Therapy or Couple's Therapy
Family or couple therapy is indicated for the resolution of dysfunctions to restore the unity of the family or couple (Rojas, 2019), as well as, according to Paúl, Bilbao & Ríos (2011), to anticipate and avoid problems in those cases in which changes generate tensions that are difficult to resolve among family members, or to facilitate the grieving process when the family is stuck in a phase of acceptance.
Individual Therapy
It may be indicated to help the person to adapt and cope better with grief, however, it is generally reserved for family members who have greater difficulties in overcoming the loss, and is often complemented with pharmacological support (Paúl, Bilbao & Ríos, 2011). In the same way, according to Rojas (2019), it works on mental disorders that have been caused by the relative's accident.
Support Groups
One of the best ways to cope with the family member's situation is to find a support group (Alexandrou, 2014). Support networks are communities created by collectives whose purpose is to share information and establish connections (Paúl, Bilbao & Ríos, 2011), as well as, according to Alexandrou (2014), to help family members feel less alone, reduce stress, depression or anxiety and favor social interaction in a safe environment.
In support groups, both professionals and families provide valuable help (Bilbao, 2013). Therefore, according to Bilbao (2013), suggestions will be more effective, ideas will be more direct and understanding will be more real, because the people attending have, or have lived, the same experience.
On the other hand, facts have shown that family members who have joined support groups are more knowledgeable about existing resources, are less stressed and enjoy a higher quality of life (Paúl, Bilbao & Ríos, 2011). In the same way, according to Rojas (2019), knowing the experiences of other people can help clarify doubts that may arise throughout the neuropsychological rehabilitation process.
References
Alexandrou, S. (2014). Caring for the Caregiver: The Important Role of Family in Rehabilitation. Burke Rehabilitation Hospital. Recuperado 23 February 2021, a partir de https://www.burke.org/blog/2014/11/caring-for-the-caregiver-the-important-role-of-family-in-rehabilitation/23
Bilbao, Á. (2013). LA REHABILITACIÓN CONTEXTUALIZADA, GLOBAL Y CONTINUA. En Á. Bilbao, M. Abdelkader, C. Abreu, V. Abuín, C. Agost & J. Álamo et al., Guía de Familias. Madrid. Recuperado a partir de http://www.convivirconespasticidad.org/wp-content/uploads/2013/12/guia_de_familias_FEDACE.pdf
Bilbao, Á. (2013). PERSONAS DE NUESTRO ENTORNO COMO VÍA DE APOYO: DESARROLLO DE HABILIDADES A TRAVÉS DE LA COOPERACIÓN. En Á. Bilbao, M. Abdelkader, C. Abreu, V. Abuín, C. Agost & J. Álamo et al., Guía de Familias. Madrid. Recuperado a partir de http://www.convivirconespasticidad.org/wp-content/uploads/2013/12/guia_de_familias_FEDACE.pdf
Guallart, M., & Reyero, A. (2013). EL FAMILIAR COMO PARTE DEL EQUIPO DE REHABILITACIÓN. En Á. Bilbao, M. Abdelkader, C. Abreu, V. Abuín, C. Agost & J. Álamo et al., Guía de Familias. Madrid. Recuperado a partir de http://www.convivirconespasticidad.org/wp-content/uploads/2013/12/guia_de_familias_FEDACE.pdf
Moyano, S. (2016). El papel de la familia en la neurorrehabilitación. Grupo Casaverde. Recuperado 23 February 2021, a partir de https://www.grupocasaverde.com/2016/08/29/el-papel-de-la-familia-en-la-neurorrehabilitacion/
Naudí, C. (2018). La importancia de la familia en la neurorrehabilitación. Neurolleida.cat. Recuperado 23 February 2021, a partir de https://www.neurolleida.cat/es/asociacion/neurolleida/blog/la-importancia-de-la-familia-en-la-neurorrehabilitacion/25542.html
Norup, A. (2018). Family matters in neurorehabilitation: why, when, who, and how?. Recuperado 23 February 2021, a partir de https://www.researchgate.net/publication/323520354_Family_matters_in_neurorehabilitation_why_when_who_and_how
Paúl, N., Bilbao, A., & Ríos, M. (2011). Recuperado 11 February 2021, a partir de https://www.researchgate.net/publication/270822798_Rehabilitacion_Neuropsicologica
Rojas, M. (2019). Familia en el daño cerebral ¿cómo puede ayudar?. NeuroClass. Recuperado 23 February 2021, a partir de https://neuro-class.com/rol-de-familia-en-un-dano-cerebral-adquirido/
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