Traumatic Brain Injury A to Z - Frequently Asked Questions

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Becoming an Advocate

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Caregivers are often called upon to advocate for their loved one with TBI. Tracy explains that being an advocate means speaking out on behalf of someone or something that you believe in.
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Becoming an Advocate

Tracy
Welcome back everybody. It’s so good to see you.  Okay. Let’s start with an update from each of you. Tell me how things are going. What’s happening with you Megan?

Megan
Oh well Clayton’s doing okay, I think. Overall, the doctors seem really pleased with his progress, but I’m still scared. He can open his eyes now, and he can move his fingers and his toes. He hasn’t said any words yet, but he squeezes my hand to communicate. It’s just hard not knowing what to expect. I don’t know if he’s ever going to be himself again…

And he’s not sleeping much, which really worries me and I’m just so tired all of the time. But they did find a place for me at the Fisher House, so at least I’m not in the hotel anymore. And the families at the Fisher House have really just taken me under their wings, so I don’t feel so alone. And that’s such a good thing.

I mean with Clayton, I just want to help but I don’t know what to do.

Tracy
Well Megan, it’s great that they got you into the Fisher House. Let’s talk about a few things that you can do for Clayton as he’s waking up.

First, you might want to just ask him to follow a few simple commands like open his eyes, look at you. Give him one direction at a time, and be sure to give him plenty of time to respond.

Oh another thing you can do is tell him the date and time each time you’re in the room, that will help get him get oriented.

Julie
For Sam, we brought in pictures of family and friends, and some of his favorite music so that his surroundings were more familiar when he woke up.

Michelle
When Tom started waking up, they told us to talk to him, even though we didn’t know if he could hear us.

Travis
I felt kinda weird talking to him at first, but then I just started telling him about football and stuff.

Tracy
That’s great, Travis. Megan, does that… does that seem to help?

Megan
It really does, I mean just being here helps me. And I listen to Julie and Carl, and I know there’s hope.

Julie
There is always hope. Can I tell you a little bit about Sam’s story? When we got back to the states from Landstuhl, the doctor said to both of us “do you believe in miracles?” And we said yes… And then he said, “well you may want to pray for one because there’s a chance he’s not going to make it.”

And I said to him, “You don’t know that. Don’t tell me that my son isn’t going to make it. You just do what you can do now to keep my son alive.” 

Carl
I’ve never seen my wife so mad. And the doctor looked at us and said, “if your son makes it, it’s possible that he’ll be hooked up to a breathing machine. You may have to open his eyes for him in the morning, and close them for him at night. That may be best that you can hope for.”

And Julie looked at him and said, “you just do what you need to do.” And two weeks later Sam opened his eyes for the first time. And three weeks later he was taken off the ventilator and has never been on one since.

Julie
And now, 6 months later, he’s home. And yes, things are very different than they were before his injury. And we have had to make a lot of adjustments, and things will never be back to the way they were. We just have a new definition of normal, now.

Tracy
Thanks Carl. Thanks Julie. You know that is so encouraging. You know, Megan, you have to remember that every TBI is different, but the truth is that with the passage of time, you know a lot of patience, a really strong support system, most TBI patients will go on to lead fulfilling lives. It’s… It’s like Julie said, you may have a new definition of normal. I can’t stress enough the importance of holding on to hope,

Michelle
I think it’s great that you stood up for what you believed in, Julie. I’m not sure I have enough strength to do that. I’ve always been the quiet type. I’m not comfortable asking anything from anybody.

Tracy
You know lots of people are uncomfortable with this, Michelle, but as a caregiver, you’ll be called upon to be an advocate for Tom. You know like Julie and Carl did for Sam, you’re an advocate when you speak out on behalf of someone or something that you believe in.

Advocacy begins when you first meet that health care team. You know right away, try to learn as much as you possibly can from them about TBI and the treatment plan for your family member. And find out about the DoD and the VA medical systems you know how to use those services. Once you understand the facts, you’ll be so much better able to communicate with everybody involved.

One thing to remember, you know you’ll be talking with the health care team on a regular basis. There are going to be times when you feel frustrated, just remember, they are doing the best at what is, you know at times, a very difficult situation. You know, it’s fine for you to help the team get to know your loved one. Tell them stories, stories about the person, personality, things like that.

But do keep in mind that diplomacy is critical. It’s really important to your role as a caregiver. You don’t want to be perceived as though you’re trying to tell one of the members of the team how to do their job, because that… that usually doesn’t work out very well. Instead, you want to talk to that person as a concerned family member. You know explain your worries. Explain it, stay calm, speak to them calmly, respect them.

Julie
You know this is really important. As caregivers, we came to know Sam’s treatment plan the best. We knew when something was working well or when something was just wrong. So we had to learn how to share our concerns, and to ask questions about any procedure that we weren’t familiar with.

Megan
I’ll sure try. I’ve just always feel really intimidated around authority figures. I always feel like I’m not as smart as the doctors.

Carl
Well, Megan, there’s just no way that they could know Clayton the way you do, so right now you need to be his voice…about his medical care and other things, too. If you find that you’re having difficulty resolving issues, there are other people that you can talk to, such as a Patient Advocate or an Ombudsman.

Tracy
Exactly right Carl. It’s important that each of you feel comfortable asking questions about their care, about benefits, about anything that you’re not clear on. Okay, why don’t we take a short break to catch our breath, and we’ll pick up again in a moment. Okay.

Frequently Asked Questions

What are Common Physical Effects of TBI?

  • Headaches
  • Sleep Changes
  • Fatigue/Loss of Stamina
  • Dizziness
  • Balance Problems (Tendency to Fall)
  • Sensory Changes
More information - Managing Physical Effects of TBI

What Physical Effects May Be Less Common?

  • Spasticity
  • Hemiparesis, Hemiplegia
  • Bladder/Bowel Changes
  • Changes in Swallowing and Appetite; Weight Loss or Gain
  • Visual Spatial Problems
  • Apraxia
  • Seizures
  • Heterotrophic Ossification
More information – Managing Physical Effects of TBI

What are Common Cognitive Effects?

  • Confusion
  • Slowed Speed of Processing
  • Attention Problems
  • Difficulties with Memory
  • Planning and Organization Problems
  • Difficulty with Decision Making and Problem Solving
  • Confabulation
More information – Managing Cognitive Effects of TBI

What are Common Communication Effects?

  • Does Not Speak Clearly
  • Problems Starting a Conversation
  • Word Finding Problems
  • Reading Comprehension
More information – Managing Cognitive Effects of TBI

What Communication Effects Are Less Common?

  • Dysarthria
  • Interrupting or Having a Hard Time Taking Turns in Conversation
  • Topic Selection
  • Writing
  • Non-Verbal Communication Issues

More information – Managing Cognitive Effects of TBI


What Are Common Behavioral Effects?

  • Frustration, Increased Anger/Aggressiveness
  • Impulsivity or Difficulties in Self-Control
  • Poor Judgment
  • Reduced or Lack of Initiation
  • Repetitive Behaviors (Perseveration)
  • Less Effective Social Skills
  • Changes in Sexual Behaviors
  • Lack of Self-Awareness
More information – Managing Cognitive Effects of TBI

What Are Common Emotional Effects?

  • Depression
  • Increased Anxiety
  • Mood Swings (Emotional Lability)
  • Changes in Self-Esteem
More information – Managing Cognitive Effects of TBI

Will our lives ever get back to normal?

The course of recovery after TBI depends on several factors. Your lives may return to “normal” or you may need to learn to adjust to a “new normal.” It can take time to adapt to the life changes after TBI. Although many problems will improve in time, some symptoms may persist throughout the person’s lifetime. Research has shown that many people who experience TBI do lead a life they find satisfying, even if it is not exactly the life they had prior to the injury.


How Should I Organize Medical and Military Records?

A notebook that includes sections for:
  • Personal information – This includes important facts, such as your service member/veteran’s Social Security number, military service record, emergency contacts, and allergic reaction to medications.
  • Military service papers – Keep copies of military service records, etc.
  • Medication log – Write down all the drugs taken, dosages, dates, side effects, and problems.
  • Medical reports, tests, scans – Ask for copies of all reports, scans, and tests, and file them in this section of the notebook. Put CT and MRI scans of the brain on a CD. Keep these to share with future providers.
  • Notes and questions – Include a three-hole punched notepad in your notebook. You can use it to take notes and then insert the sheets in the right sections.
  • Resources and information – This is the place to keep all the forms and information you have received at appointments.
  • Calendar of appointments – Use a calendar with enough room to write all of your appointments.

You may want to keep another notebook or file with the records needed to apply for medical and family benefits or Medical Evaluation Board/Physical Evaluation Board (MEB/PEB). (See Module 4 for more information about the MEB/PEB.) This file will help when you apply for financial aid, a job, or more medical care. When you are not using this file, keep it in a locked place to keep it safe.

This file could include:

  • Social Security card, military records, and insurance cards
  • Power of Attorney
  • driver’s license, birth certificate, marriage certificate
  • school and work records
  • tax returns and assets.


How Can I Tell My Child about TBI?

Communicate in an age-appropriate way what has happened to your family member with TBI. Protecting your children by withholding information may backfire. Children have active imaginations that may create a scenario worse than reality.
More information - Helping Your Children Cope


What Can I Do If Caregiving is Just Too Much?
Have a back-up plan for finding temporary or more permanent residential care for your family member with TBI. Discuss quality of life issues with your family and health care professionals. Your choices may include:
Give others permission to care for your loved one. Seek assisted living facilities and board and care homes—for those who have difficulty living alone but do not need daily nursing care. Consider nursing homes, also called skilled nursing facilities—for individuals who need 24-hour nursing care and help with daily activities. Skilled nursing care can also be provided at home by nurses you hire. Check with your case manager(s), VA liaison, and/or military liaison for residential care benefits that may be available to your family member with TBI.


What Can I Expect When My Family Member Comes Home?
Moving back home is an exciting step in the recovery process! Although the transition to home is certainly positive, it is important to be aware that it may also be stressful at times. Some families report that during the first few days or weeks at home, their family member regress and need more time to adapt to a new environment, even if it’s a familiar one. It is helpful to add structure and consistency right away at home by scheduling activities and rest breaks much like the schedule observed in rehabilitation. Recreational and occupational therapists are your best allies in this effort and they will work closely with you to practice community re-entry.
More information - Preparing for the Transition Home & Transitioning Home


What is the Family and Medical Leave Act?

The Family and Medical Leave Act (FMLA) provides service members/ veterans and their spouses who are employed by companies with 50 or more employees with up to 26 weeks of unpaid leave per year to care for a seriously-injured service member without losing their jobs or health care insurance.
For the most current information: www.dol.gov.
For More Information – LINK to Scene 14 - FMLA


What Temporary Housing is Available for Caregivers?
If your service member/veteran is being treated at a military treatment facility (MTF) or a VA Polytrauma Center, you may be able to stay nearby for free or at a low cost.
Housing for family members includes:

  • Malone House at Walter Reed
  • Navy Lodges
  • Fisher Houses at the VA Polytrauma Centers.
Nonprofit organizations may also make some apartments near treatment centers available to families at little or no cost. Check with your POC to find out what temporary housing is available where your family member is being treated.
More information - Addressing Everyday Issues


 

Related Information:
How to Advocate
Glossary
Frequently Asked Questions
"In the very beginning, I didn’t want to know anything because I was so scared. But a little while later… the doctors would throw out tidbits to me, like he might never speak again and he might never walk again… but I couldn’t understand why. So then I wanted to understand the part of the brain that was injured and why he was having these symptoms or why he was having this diagnosis." -  Patty H.

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