The Carer’s Way Ahead: Is an On-Line Program to Manage Challenging Behavior Post Traumatic Brain Injury in the Home Effective?

Skye McDonald, University of New South Wales, Sydney, Australia
Travis Wearne, University of Western Sydney, Sydney, Australia
Kimberley Wallis, University of New South Wales, Sydney, Australia
Jill Newby, University of New South Wales, Sydney, Australia
Grahame Simpson, University of Sydney, Sydney, Australia
Paul Gertler, University of Sydney, Sydney, Australia
Samantha Grant, Inspire Rehab and Psychology, Sydney, Australia


Traumatic Brain Injury (TBI) can result in challenging behaviour changes but carers often lack support to manage these once they return home.  To address this we developed “The Carers Way Ahead”  (CWA) consisting of seven on-line modules – two educational, four focused on specific behaviours, i.e. anger, apathy, disinhibition and social difficulties and one on carer self-care. In these, graphics depict four families and a psychologist providing tips and advice.  In this study we conducted a randomized controlled trial to determine whether CWA was effective for improving carer well-being and reducing the severity and frequency of challenging behaviours

Participants and Methods:

38 carers (mainly parents, spouses or siblings) of adults with TBI participated.  Following initial assessment of mood, carer strain and extent of challenging behaviours, they were randomly allocated to active treatment or waitlist (N = 19 respectively).  During active treatment participants worked through the modules and could also engage with a clinical psychologist who reinforced the messages and provided additional support.  The same measures were administered after the program was completed.


The treatment group demonstrated significant improvements in depression, anxiety and stress relative to those in waitlist. Both groups improved in reported carer strain (i.e. no treatment specific effect). No treatment effects were found in the number or severity of challenging behaviours.


An on-line resource such as CWA seems to be beneficial for improving carer well being even in the absence of a demonstrable change in overt challenging behaviours on the part of the person with TBI.

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: executive functions
Keyword 2: personality
Keyword 3: caregiver burden