Traumatic brain injury (TBI) is considered the signature wound of the Iraq and Afghanistan conflicts. The large number of military personnel returning with TBIs has necessitated major changes in the ways in which the Department of Defense and the Veterans Health Administration treat these injuries. Although family members and caregivers are to receive education about TBI as early as possible in the treatment process, many families find that they need additional and ongoing support.
It is important that family members understand some of the basic issues related to TBI and develop familiarity with the online resources available to them. Also, specific problem-solving strategies that have been useful to others caring for someone with TBI may benefit family members of military personnel who have incurred TBI.
A TBI is a direct blow or jolt to the head, a penetrating head injury, or a disruption to the function of the brain caused by exposure to external forces such as blast waves. TBI often results in changes in neuronal activity that affect the physical integrity, metabolic activity, or functional ability of the individual. However, not all blows to the head or exposure to external forces result in TBI. An excellent resource that families can use to learn more about TBI is the Center of Excellence for Medical Multimedia (CEMM) Virtual Library TBI website. Working through the educational materials about caregiving available in the CEMM TBI caregiver’s program may be particularly helpful.
TBI can cause short- or long-term changes in thinking (e.g., memory, reasoning); sensation (touch, taste, smell, pain); language (communication, expression, understanding); emotion (depression, anxiety, mood changes); and behavior (fatigue, agitation, impulsiveness, social inappropriateness). The severity of TBI can range from mild to moderate to severe. Mild TBIs often are described as concussions, and sometimes professionals use the terms mild TBI and concussion interchangeably. The term post-concussive syndrome is used to describe problems a person may experience following a mild TBI. The majority of TBIs incurred by active-duty military personnel are mild TBIs.
Approximately seven of every 10 TBIs incurred by military personnel are due to blasts. TBIs incurred by military personnel differ from those incurred by people in the civilian sector in several ways, and these differences contribute to the difficulty medical professionals have experienced treating military personnel with TBI. Although mild TBIs are common and can be associated with a variety of symptoms immediately following the causal event, most resolve quickly, sometimes within minutes or hours. Many civilians who experience a mild TBI may not require medical attention. Consequently, we have little research following civilians over time after they have experienced a mild TBI. However, active-duty military personnel may face repeated exposures to blast injuries in theater and, therefore, may experience several mild TBIs during their service. In addition, other injuries may accompany blast and combat exposure; these include posttraumatic stress disorder (PTSD), amputation, burns, and chronic pain from muscular-skeletal injuries. In sum, it is important to remember that no two TBIs are alike. Each person with a TBI exhibits symptoms unique to his or her injury (or injuries), and the TBI affects his or her cognition, emotions, behavior, and physical health in individual ways.
We know it is essential that families learn as much as they can about brain injury and the possible problems that a person may experience following TBI. It may be difficult to determine, however, which problems are due to a brain injury and which may be caused by other factors or symptomatic of other problems. As a general rule, for example, the following symptoms are associated with PTSD and not TBI: flashbacks, hypervigilance, nightmares, and “re-experiencing” a traumatic event. In contrast, headaches are not associated with PTSD but can be a problem after TBI. If PTSD symptoms occur, it is important to seek mental health treatment.
To solve TBI-related problems, it is important to have access to information and learn about the various issues that may accompany TBI. It may be helpful to break down the problem-solving process into the following steps:
During the problem-solving process, remember to recognize your own emotional reactions as important cues. Negative emotions, such as depression and anxiety, can be disruptive and often are associated with negative thoughts and pessimism. Success breeds positive emotions. Don’t be impulsive or careless: Be thoughtful and deliberate. See a problem as a challenge, and use positive self-statements. Think rationally, looking for resources and asking questions as needed.
The following worksheets may be helpful as you identify patterns of problems in thinking or other areas (such as anxiety or insomnia), devise a problem-solving plan, and build effective problem-solving skills:
For additional TBI resources for patients and families, go to eXtension TBI. For a detailed description of how to be an expert problem solver, check out the online webinar recording of Be an Expert Problem Solver! Caregiving and Coping with Traumatic Brain Injury.
Timothy R. Elliott, Ph.D., ABPP, Texas A&M University