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 email@example.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 firstname.lastname@example.org.
QUESTIONNAIRE for a TBI Caregivers SPEAK OUT!
1. What is your name? (last name optional)
2. Where do you live? (city and/or state and/or country) Email? (optional)
3. What is the brain-injury survivor’s relationship to you? How old was the survivor when he/she had the brain injury? What caused your survivor’s brain injury?
4. On what date did you begin care for your brain-injury 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 brain injury? 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 the hospital; when the survivor returned home; etc.)?
9. Was your survivor in a coma? If so, what did you do during that time?
10. Did your survivor have rehab? If so, what kind of rehab (i.e., inpatient and/or outpatient and occupational, physical, speech, and/or other)? How long was the rehab? Where were you when your survivor was getting therapy?
11. What problems or disabilities of your brain-injury 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-brain-injury life?
14. What do you enjoy most in post-brain-injury life?
15. What do you like least about brain injury?
16. Has anything helped you to accept your survivor’s brain injury?
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 caregivers of brain-injury survivors? Do you have any other comments that you would like to add?