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Addressing Family Needs

Addressing Family Needs

Tracy
Okay. Everybody set? Okay, we’re going to continue talking about the family. Now you know, everyone in the family is affected by their loved one’s TBI, and everyone’s role within the family can change.

Carl
That’s true Michelle, Julie and I have seen how difficult TBI can be for a family. We’ve seen it first hand, not only in our family, but in some of the other families we’ve met. But you know, I think times of trouble can also pull families together, making them stronger than ever.

Tracy
Right, Carl, absolutely. That’s what we’re going to cover next - - how to build those stronger family ties during your loved one’s recovery. You know, you may not be able to preserve all your previous family routines, but you can create some new ones. That goes back to that “new normal” you know that we talked about before.

So, try to set aside some time each week for your family to have fun together, move the family focus away from the TBI. Have a family meeting, explain that you plan to hold a family time every week, you know ask for ideas on what to do, when to do it. And members of the family can take turns choosing activities. Try activities that everybody in the family can enjoy. Oh you know board games, taking a walk, taking a run together, baking cookies.

Along with that family time, you can schedule some one on one time with each member of the family because kids… kids really need to have that alone time with their parents. It helps them to feel appreciated. You know it helps them to feel heard. Plan a date with each child - - a shopping trip maybe, or movies, story time. Schedule it on a regular basis. That could be monthly, could be weekly, depending on how many children you have, and what your schedule is like.

And finally, think about those family rituals. Keep them on a schedule as much as possible.

You know, sometimes it’s easier to deal with the stress of TBI by finding and building on your family’s strengths. Remember there is no perfect family, so think about areas that you would like it to be stronger, and discuss those with the rest of the family. It can help if you choose one area that you can work on together.

Megan
I’ve been working on something like that lately. Over the past few weeks, I’ve been getting to know Clayton’s parents and brothers much better because we’ve spoken on the phone so often. And his older brother is trying to arrange to come out here to help me, at least until Clay gets out of the hospital. And it’s just funny, because Clayton and I have been pretty independent since we got married. We haven’t really communicated with either side of our families very much.

And now I’m realizing just how much we need them. I don’t think I appreciated Clay’s family enough before all this happened.

Tracy
You know that’s a good point, Megan. When a family member is recovering from a TBI, the support of the family becomes particularly important.

Carl
You can say that again. Of course, Julie and I had each other when Sam got hurt, but our other kids and their spouses really helped. Even though they live all over the country, they offered us moral support and they listened to us when we needed to talk. Our daughter and her husband came out a couple of months after Sam was injured, just to give me and Julie a break.

Michelle
Since Tom was injured, I’m also finding out how strong our family is, not just me and the kids, but our extended family, too.

Tracy
You know that’s great. There are some family strengths that you can build on as your loved one recovers.

Megan
What kind of strengths do you mean, Tracy?

Tracy
Well, family strengths can include things like caring for and appreciating each other. Michelle, I get the feeling that you do a pretty great job of that with your kids. Commitment is another strength. It involves that devotion, that dedication to the family.

Communication is another important family strength. Keep in mind that when you’re discussing something as emotionally charged as the care of an injured family member, there can be a lot of confusion and misunderstandings. Those can easily occur. So remember to listen carefully when another person is telling you how they feel. Try re-stating what they just said to see if you understand their position correctly.

Julie
Yeah. This became really important to Carl and I when we were taking turns at the hospital. We were both so tired, that we found that we could easily misunderstand each other, especially when we were talking about what the doctors had told one of us. Repeating things back really helped.

Tracy
That’s it exactly - - active listening. It sounds like you two were doing a great job of working together, which that’s another way to strengthen the family. Sharing tasks, decision-making that will help things run much more smoothly. When important decisions need to be made, all the family members should share their points of view.

Again, be flexible.  You've got to be open to change. Those are also key elements to the strength of the family. Now a TBI in the family means that roles and responsibilities will shift. Learning to manage change can be a challenge, but it can be done.

Now, for those of you who don’t have family here to help you, or living nearby, another source of strength involves community ties. Keeping close ties with your neighbors and the larger community can be extremely helpful in trying times.

Michelle
Those are great suggestions, and Travis, Emily and I will keep working on it. Another family related issue is that I’ve run into some challenges with Tom’s family. Nothing major, it’s just sometimes I feel that his father is second guessing my choices about Tom’s health care. It’s tough, because his dad isn’t here to talk with all of the doctors, and I’m probably not doing a great job passing on what I learn. Still, decisions have to be made.

Tracy
Yeah, unfortunately, that’s fairly common, Michelle. You know spouses and in-laws may disagree about who is the best caregiver and where care should be provided. But remember that everyone is under a great deal of stress. Try to talk openly about each person’s point of view. Seek that professional guidance if you’re not able to resolve the issues yourselves.

Megan
Yeah, I’ll definitely keep those things in mind as I get to know Clayton’s family, and communicate with my own parents. And I know that talking openly is so important, but there are some things that are really tough to talk about. You know…things that are just really hard to share with other people, especially my in-laws?

Tracy
Anything that we can help you with there?

Megan
Well, this is really awkward, but… I’ve just been thinking about the future and doing some reading about TBI. And I love Clay more than anything in the world, but I don’t know what kind of relationship we’ll eventually have, or if we’ll be able to have a relationship at all - - I don’t know how everything is going to affect all of our family plans.

Michelle
I think I understand what you’re trying to say, Megan. I know that I don’t feel comfortable talking to people about sex or what’s going to happen, especially in the early stages. But it’s a big concern for me, and for some of the other wives I’ve met.

Megan
Yeah me too. I’m just really worried about that, especially because we don’t have any kids yet. So it could mean...who knows...no kids ever? I don’t know…everything is just so uncertain…
 
Tracy
Just know that your concerns are perfectly natural. Some people with TBI may lose interest in sex. This can be because of biological changes or medications. You know over time, these can improve, but if you’re concerned about intimacy, don’t hesitate to talk with your provider about it.

Another concern that can be a challenge for spouses of TBI patients involves the changes in the relationship. It can be very, very difficult to go from the role of a lover, or a partner, to the role of caregiver. I know one wife told me that she felt more like a mother than a wife to her husband, and she found that you know particularly frustrating.

So I do encourage you to seek counseling, you know if you feel that you need it. Military family advocacy programs and other on-base support programs can provide a resource for counseling. I really do urge you to take advantage of the resources. But most of all remember this, there’s nothing to be embarrassed about.

Okay, well, I know we’ve covered a lot of ground today, so this… this is a good time to break. Does anyone have any other questions? Anything to talk about?

Okay. Again, most of all, I ask you to take good care of yourselves this week. Feel free to call me. Send me an email if you need to, any questions you have. And have a good week. Be kind to yourselves. Okay.

Preserving Marriage or Relationship

Preserving Marriage or Relationship
Everyone in the family is affected by TBI. As the primary caregiver, your role within the family has changed. The role of your family member with TBI may also have changed. Role changes can be emotionally demanding.

Other challenges include learning how to balance work, family, and your own needs, in addition to caring for someone else. Changes in finances, social life, and relationships also add stress to the family.

Conflict among family members regarding the care and treatment of the injured family member may also occur.

Addressing family needs means paying attention to family members’ emotional needs and addressing them.

How Can I Build on My Family’s Strengths?
You can learn to cope with the stress of TBI by finding and building on your family’s strengths. No family is perfect.

Think about your family’s strengths. Then think about areas that you would like to be stronger. Discuss these with family members and choose one area that you can work on together.

Family strengths include:

  • Caring and Appreciation 
  • Commitment: One way to build commitment is to create and maintain family traditions. 
  • Communication: It’s important to keep lines of communication open. Active listening is important. When the other person is telling you how he/she feels, try re-stating what he/she just said to see if you understand his/her position correctly.
  • Community and Family Ties: Keeping close ties with relatives, neighbors, and the larger community can provide useful sources of strength and help in trying times.
  • Working Together: Sharing tasks and decision-making will help your home run smoothly. When important decisions need to be made, all family members should share their points of view.
  • Flexibility and Openness to Change: A TBI in the family means that everyone’s roles and responsibilities will shift. Learning to manage change can be a challenge, but it can be done.

Use “I” statements to share your feelings, rather than “You” statements. For example, if you’re upset because your brother didn’t show up to drive you to the hospital on time, you might say: “I feel upset when you are late to pick me up. I am anxious to get to this important medical appointment on time so that I have the doctor’s full attention” instead of, “You are always late.”
The former states your feelings; no one can argue about your own feelings. The latter attacks the other person, making him or her feel defensive and more inclined to argue with you.

How Can I Preserve My Marriage or Relationship?
TBI can affect the dating or marital relationship, just as it affects other areas of family life.

In addition to the stress that caregiving may bring, the spouses of people with TBI may lose the intimacy with their partner that they once enjoyed.

Following a TBI, your service member/veteran may experience effects of the injury that may affect your relationship. There are possible physical, cognitive, emotional, and behavioral effects of TBI. Most of these changes improve over time.

People with TBI may lose interest in sex, become impotent, or may not be able to have an orgasm. This is often due to biological changes or the medications that they may be taking. This is a common effect of TBI so do not hesitate to talk with your provider about this.

Some people with TBI may show their sexual interest in ways that are not socially acceptable. They may misinterpret social or vocal cues and therefore behave inappropriately.

Seek professional counseling, if you need it. All marriages go through ups and downs; there is no stigma in seeking help. Military family advocacy programs and other on-base support programs provide a resource for counseling and help.

Other Ways TBI May Affect the Family

Spouses and in-laws may disagree about who is the best caregiver or where care should be provided.

If you are experiencing this kind of family conflict, you may need to advocate on behalf of your loved one with TBI to other members of the family.

Keep in mind that every family member involved in this type of conflict loves the family member with TBI and wants the best for him or her.

Remember that everyone is under a great deal of stress. Try to talk openly about each person’s point of view.

Seek professional guidance if you are unable to resolve the issues yourselves.

Caring for your loved one may make existing family issues worse. If you find you are having difficulty with treatment decision making, you can get advice from a member of the health care team.

Glossary

A-D   E-H   I-L   M-P   Q-Z

Absence Seizures – A non-convulsive generalized seizure when a person may appear to be staring into space with or without jerking or twitching movements of the eye muscles. These seizures may last for seconds, or even tens of seconds, with full recovery of consciousness and no confusion. People experiencing absence seizures sometimes move from one location to another without any purpose.

Abstract Thinking – Being able to apply abstract concepts to new situations and surroundings.

Acceleration – To increase speed and/or change velocity.

Alopecia – A condition of a loss of hair or baldness.

Amnesia – A loss of memory. Amnesia can be caused by brain injury, shock, fatigue, repression, illness and sometimes anesthesia.

Angiogram – A procedure in which a dye is injected through a thin tube into a blood vessel. Special x-ray pictures are taken, allowing your health care provider to view the blood vessels of the brain, heart or other part of the body. Also called an arteriogram for arteries or venogram for veins.

Anorexia – A loss of appetite, especially when prolonged over time.

Anosmia – The decrease or loss of the sense of smell.

Anoxia – Absence of oxygen supply to an organ.

Anoxic Brain Injury – Injury to the brain due to severe lack of oxygen. This usually happens when blood is unable to flow to the brain due to certain injuries,bleeding, or cardiac arrest.

Apraxia – The loss or impairment of the ability to perform complex coordinated movements despite having the desire and the physical ability to perform the movements.

Arthralgia – Joint pain or stiffness in a joint.

Ataxia – The inability to coordinate the movement of muscles. Ataxia may affect the fingers, hands, arms, legs, body, speech, or eye movements.

Axons – Also known as nerve fibers, an axon is a long, slender projection of a nerve cell, or neuron, that conducts electrical impulses away from the neuron's cell body or soma. Axons are the primary transmission lines of the nervous system.

Basal Ganglia – The deep brain structures that help start and control voluntary movements and postures.

Bipolar Disorder – Also known as manic-depressive illness, bipolar disorder is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function.

Blast Injuries – Injuries that result from the complex pressure wave generated by an explosion. The explosion causes an instantaneous rise in pressure over atmospheric pressure that creates a blast over pressurization wave. Injuries to organs surrounded by fluid, such as the brain and air filled organs such as the ear, lung and gastrointestinal tract are common.

Brain – The main organ of the central nervous system (CNS). It is divided into the cerebrum, brainstem, and cerebellum. The brain regulates virtually all human activity.

Brain Stem – The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brainstem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).

Cerebellum – The portion of the brain (located in the back) that helps coordinate movement.

Cerebral Hypoxia – The inadequate oxygen supply to brain tissue. Mild or moderate cerebral hypoxia is sometimes known as diffuse cerebral hypoxia. It can cause confusion and fainting, but its effects are usually reversible.

Cerebral Spinal Fluid – A colorless fluid that is found around and inside the brain and spinal cord, offering some protection and cushioning the brain.

Cerebrum – The largest part of the brain. It is divided into two hemispheres, or halves. It controls motor, sensory, and higher mental functions, such as thought, reason, emotion, and memory.

Chronic Subdural Hematoma – An "old" collection of blood and blood breakdown products between the surface of the brain and its outermost covering (the dura).

Closed Head Injury – Injury to structures within the skull or the brain that do not result in an opening in the, such as a direct blow to the head or a blast. Injuries may range from a mild concussion to potentially fatal.

Coma – A state of unconsciousness from which the person is not aware of the environment nor able to perform voluntary actions.

Computerized Axial Tomography, or CT or CAT Scan – A painless procedure in which x-rays are passed through the affected area at different angles, detected by a scanner, and analyzed by a computer. CT scan images show bones and blood collections more clearly than conventional x-rays. The computer can combine individual images to produce a three-dimensional view.

Concussion – A blow, jarring, shaking or other non-penetrating injury to the brain which causes a temporary decrease in normal brain activity.

Consciousness – The state of awareness of the self and the environment.

Contusion – A bruise. In terms of brain injury, a contusion refers to bruising of the brain tissues.

Coup-Contrecoup – An injury to the brain that occurs when an impact or violent motion brings the head to a sudden stop, causing injury to the impact site and the opposite side of the brain. This is also known as an acceleration / deceleration injury.

Cranium – Skull.

Deceleration – To reduce speed or go more slowly.

Diffuse – Widely spread.

Diffuse Axonal Injury, or DAI – Widespread injury of large nerve fibers (axons covered with myelin).

Diffuse Brain Injury – Injury to cells in many areas of the brain rather than in one specific location.

Diplopia – Seeing two images of a single object; double vision.

Dura Mater – The outermost of three membranes protecting the brain and spinal cord. It is tough and leather like.

Dysarthria – Difficulty in forming words or speaking them because of weakness of the muscles used in speaking. Tongue movements are usually labored and the rate of speaking may be very slow. Voice quality may be abnormal, usually excessively nasal; volume may be weak; drooling may occur.

Dyskinesia – Involuntary movements most often seen in the arms or legs.

Electroencephalograph, or EEG – A test that measures electrical activity of the brain that is recorded from electrodes placed on the scalp.

Epidural Hematoma – Bleeding into the area between the skull and the dura mater.

Euphoria – An exaggerated or abnormal sense of well-being not based on reality.

Executive Functions – The ability to formulate and carry out plans effectively. These functions are essential for independent, creative and socially constructive behavior.

Expressive Aphasia – also known as Broca’s aphasia. A difficulty in expressing oneself in speech and writing. Characterized by knowing what one wants to say but being unable to find the words to say what is being thought. There is lack of spontaneous speech, words are often labored over and sentences are short and incomplete.

Focal Brain Injury – Damage confined to a small area of the brain. The focal damage is most often at the point where the head hits an object or where an object, such as a bullet, enters the brain.

Frontal Lobe – The front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions."

Generalized Tonic-Clonic Seizures – A seizure involving the entire body. It is also called a grand mal seizure. Such seizures usually involve muscle rigidity, violent muscle contractions, and loss of consciousness.

Glasgow Coma Scale – A scale used for measuring level of consciousness. Scoring is determined by three factors: eye opening ability, verbal responsiveness, and motor responsiveness. The scores range from lowest level of responsiveness a 3 to highest level of responsiveness a 15.

Hematoma – A collection of blood caused by the rupture or tearing of blood vessels.

Herniation/Herniated –Compression of brain tissue caused by high pressure inside the skull that can lead to death if not aggressively treated.

Hypertension – The medical term for high blood pressure.

Hypotension – The medical term for low blood pressure.

Hypoxia – Decreased oxygen levels in an organ, such as the brain.

Intracranial Pressure (ICP) Monitor – A monitoring device used to determine the pressure within the brain. It is used to assess potential complications resulting from increased pressure exerted on the brain.

Impaired Initiation – The diminished ability to take the first step in beginning an action.

Improvised Explosive Devices, or IEDs – An IED can be almost anything with any type of material and initiator. It is a “homemade” device that is designed to cause death or injury by using explosives alone or in combination with toxic chemicals, biological toxins, or radiological material. IEDs can be produced in varying sizes, functioning methods, containers, and delivery methods. IEDs can utilize commercial or military explosives, homemade explosives, or military ordinance and ordinance components.

Intracerebral Hematoma – Collection of blood inside the brain tissue.

Intracerebral Hemorrhage – A subtype of intracranial hemorrhage that occurs within the brain tissue itself. Intracerebral hemorrhage can be caused by brain trauma, or it can occur spontaneously in hemorrhagic stroke.

Intracranial Pressure, or ICP – The amount of pressure inside the skull resulting from the brain tissue, cerebrospinal fluid and blood volume. This pressure normally ranges from 0-10 mm Hg.

Limbic System – A group of structures deep within the brain that are associated with emotion and motivation.

Lobe – A part of the brain located in each of the two hemispheres. Each hemisphere of the cerebrum is divided into four sections known as the frontal lobe, the parietal lobe, the occipital lobe, and the temporal lobe.

Magnetic Resonance Imaging, or MRI – A test that uses a powerful magnet linked to a computer to make detailed pictures of soft tissues inside the body.

Meninges –The covering of the brain that consists of three layers: the dura mater, the arachnoid mater, and the pia mater. The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system.

Mild Traumatic Brain Injury, or mTBI – Also referred to as a concussion, mTBI involves a disruption of brain function caused by trauma. This disruption is characterized by, but not limited to, a loss of consciousness for less than thirty minutes, and posttraumatic amnesia lasting for less than 24 hours, and a Glasgow coma Scale of 13 – 15.

Military Acute Concussion Evaluation, or MACE – A standardized mental status exam that is used to evaluate concussion in theater. This screening tool was developed to evaluate a person with a suspected concussion.

Myalgia – Pain in one or more muscles.

Neurocognitive – Of, relating to, or involving the brain and the ability to think, remember or process thoughts.

Neurons – A nerve cell that can receive and send information by way of connections with other nerve cells.

Neuropsychology – A science that combines the study of the brain’s structures and functions with psychological processes and human behaviors.

Neuroradiological Tests – Tests using computer-assisted brain scans. These tests allow providers to visualize the brain. Tests may include: CT Scan, MRI, Angiogram, EEG, SPECT Scan, PET Scan, DTI Scan.

Neurotransmitters – Chemicals found within the brain that are released from a neuron which transmit signals from neuron to neuron across gaps called synapses. These chemicals either excite or inhibit specific reactions, such as in motor neurons, the neurotransmitter causes contraction of muscles through stimulation of muscle fibers.

Nystagmus – Involuntary, usually rapid movement of the eyeballs (side to side or up and down).

Occipital Lobe – The occipital lobes are found at the back of the brain. These lobes receive signals from the eyes, process those signals, allow people to understand what they are seeing, and influence how people process colors and shapes.

Ocular – Relating to the eye.

Open Head Injury – Trauma to the brain that occurs from a skull fracture or penetrating injury.

Parietal Lobe – The part of the brain that is involved with movement, and with the processing of signals received from other areas of the brain such as vision, hearing, motor, sensory and memory.

Penetrating Head Injury – A brain injury in which an object pierces the skull and enters the brain tissue.

Perseveration – The repeated and uncontrollable use of the same words or actions regardless of the situation.

Photophobia – An intolerance to light; or a painful sensitivity to strong light.

Positron Emission Tomography, or PET Scan – a specialized imaging technique that uses an injection of a short-lived radioactive substance and special CT scans. PET scanning provides information about the body's chemistry not available through other procedures. Unlike other imaging techniques that look at structures of the brain, PET looks at the energy use of different parts of the brain.

Post Deployment Health Assessment, or PDHA – The military’s global health screening that occurs when a unit or service member returns from an overseas deployment. The purpose of this screening is to review each service member's current health, mental health or psychosocial issues commonly associated with deployments, special medications taken during the deployment, possible deployment-related occupational/environmental exposures, and to discuss deployment-related health concerns.

Post Deployment Health Reassessment, or PDHRA – A second assessment used 3-6 months following redeployment or return of service members from overseas deployment. PDHRA extends the continuum of care for deployment related heath concerns and provides education, screening, assessment and access to care.

Post Traumatic Stress Disorder, or PTSD – A condition where memories of traumatic events are re-lived after the fact.

Post-traumatic Amnesia, or PTA – The inability to remember things following a traumatic event. Memory loss caused by brain damage or severe emotional injury.

Rancho Los Amigos Scale of Cognitive Functioning – A scale used to follow the recovery of the TBI survivor and to determine when he or she is ready to begin a structured rehabilitation program.

Receptive Aphasia – Also known as Wernicke’s aphasia characterized by difficulty understanding spoken words. The aphasic individual themselves have difficulty interpreting and categorizing sounds and speak in what is referred to as a “word salad” with random words put together unintelligibly to form sentences.

Seizure – Uncontrolled electrical activity in the brain, which may produce a physical convulsion, minor physical signs, thought disturbances, or a combination of symptoms. Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity throughout the brain.

Seizures – A sudden or severe change in behavior due to excessive electrical activity in the brain. Many types of seizures cause loss of consciousness with twitching or shaking of the body. Occasionally, seizures can cause temporary abnormal sensations or visual disturbances.

Shaken Baby Syndrome – A severe form of head injury that occurs when an infant or small child is shaken forcibly enough to cause the brain to bounce against the skull, causing brain injury.

Single-photon Emission Computed Tomography, or SPECT Scan – Test that uses the injection of a weak radioactive substance into a vein, followed by pictures taken with special cameras. This test is similar to a PET scan and provides information on the energy being used by the brain.

Skull Fracture – A break, split or crack in the skull.

Subdural Hematoma – Bleeding confined to the area between the outer-most covering of the brain (dura) and the brain.

Temporal Lobes – Temporal lobes are located at about ear level, and are the main memory center of the brain, contributing to both long-term and short-term memories. The temporal lobe is also involved with understanding what is heard, and with the ability to speak. An area on the right side is involved in visual memory and helps people recognize objects and faces. An area on the left side is involved in verbal memory and helps people remember and understand language. The back area of the temporal lobes helps people interpret the emotions and reactions of others.

Thalamus – A part of the brain that is primarily responsible for relaying sensory information from other parts of the brain to the cerebral cortex.

Tinnitus – “Ringing in the ears" or another noise that seems to originate in the ears or head.

Traumatic Brain Injury, or TBI – An injury to the brain as the result of trauma to the head.

Whiplash – An injury to the neck caused when the head is violently thrown back and forth such as in a rear end car collision.

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:
Preserving Marriage or Relationship
Other Ways TBI May Affect the Family
Glossary
Frequently Asked Questions
"It had been 15 months and he had slowly improved. But he couldn’t talk. He’d kind of start trying to mouth words, but he just couldn’t talk. And so, on October 21st, 2005, I’ll never forget that morning. I came in to the bedroom and I said, Fred, how are you doing?’ And he said, ‘Fine.’ Okay. I think he just talked to me. So I just turned around and went back into the kitchen, got his breakfast, came back in and thought, okay, let me try this again. I said, ‘Fred, how are you doing?’ And he said, ‘Fine.’ It wasn’t a lot at first, but he could talk." -  Denise G.

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