TBI – Survivors, Caregivers, Family, and Friends

TBI Caregivers SPEAK OUT! Questionnaire

I have developed a TBI Caregiver Interview page on my blog, Surviving Traumatic Brain Injury. My interview consists of 20 questions that can be answered easily. I hope the page will provide information, inspire other TBI survivors, and connect people.

If you’d like take part in this project, please visit my site at TBI Caregivers SPEAK OUT! – Questionnaire. You can copy and paste the questions and your answers into your email program and send your interview to me at donnaodonnellfigurski@gmail.com. I will do my best to publish every interview. (I will only edit obvious typos, punctuation, for clarity, and to fit the format.)

If possible, please send a photo to include with your interview (optional, but preferred).

You will also need to fill out the release form so I can publish your interview on my “Surviving Traumatic Brain Injury” blog.



I, ____(FULL NAME)____, on this date (e.g., 04/01/2014), ____________, give Donna O’Donnell Figurski permission to use my interview on her “Surviving Traumatic Brain Injury” blog. (Your first and last name must be included on the Release Form, even if you do not want it posted on the web.)

Please put an “X” before the statement you agree with.
____I give Donna O’Donnell Figurski permission to use my last name.
____I do not give Donna O’Donnell Figurski permission to use my last name.


Please answer as many questions as you feel comfortable with. Your answers can be very brief; but, if long, your answer should be no more than 100 words. You may send your answers to me at donnaodonnellfigurski@gmail.com.



1. What is your name? (last name optional)

2. Where do you live? (city and/or state and/or country)     Email? (optional)Questionnaire th-9

3. What is the TBI survivor?s relationship to you? How old was the survivor when he/she had the TBI? What caused your survivor?s TBI?

4. On what date did you begin care for your TBI survivor? Were you the main caregiver? Are you now? How old were you when you began care?

5. Were you caring for anyone else at that time? (e.g., children, parents, etc.)

6. Were you employed at the time of your survivor’s TBI? If so, were you able to continue working?

7. Did you have any help? If so, what kind and for how long?

8. When did your support of the survivor begin? (e.g., immediately – in hospital, when survivor returned home, etc.)

9. Was your survivor in a coma? If so, what did you do at that time?

10. Did your survivor have rehab? If so, what kind of rehab? (i.e., In-patient and/or Out-patient and Occupational, Physical, Speech, and/or Other) How long was the rehab? Where were you when this was happening?

11. What problems or disabilities of your TBI survivor required your care, if any?

12. How has your life changed since you became a caregiver? Is it better? Is it worse?

13. What do you miss the most from pre-TBI life?

14. What do you enjoy most in post-TBI life?

15. What do you like least about TBI?

16. Has anything helped you to accept your survivor’s TBI?

17. Has your survivor’s injury affected your home life and relationships and, if so, how?

18. Has your social life been altered or changed and, if so, how?

19. What are your plans? What do you expect/hope to be doing ten years from now?

20. What advice would you offer other TBI survivor caregivers? Do you have any other comments that you would like to add?



Comments on: "TBI Caregivers SPEAK OUT! – Questionnaire" (3)

  1. […] you would like to be a part of this project, please go to TBI Caregiver Interview Questionnaire for a copy of the questions and the release […]


  2. do I need to copy and paste for the interview questionnaire?


    • Hi Ian.

      Yes, you can copy and paste the interview into an email and ffill it out there. All the directions are on the page.

      What I need.

      1. completed interview

      2 Completed Release form

      3 At least 2 photos of just you.

      I’ll look forward to receiving your interview. Thanks.

      Donna O’Donnell Figurski


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