Addressing Family Needs After TBI

How Can I Build Stronger Family Ties?

Everyone in the family is affected by traumatic brain injury (TBI). Your role within the family has changed and 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.

Set time aside each week for your family to spend some fun time together and move the family focus away from TBI. Try these ideas with your family:

• Have a family meeting. Explain that you plan to hold a family time every week and ask for ideas for when and what to do (if family members are old enough to participate). Family members could take turns choosing activities.
• Turn off your TV and your cell phone, and shut down your email during family time. Your goal is to interact with and enjoy each other.
• Try activities that everyone in the family can enjoy. This might include doing things like playing board games, taking a walk or run, or baking cookies. Find activities where everyone in the family can play a role.
• In addition to family time, schedule some individual time with each family member. Children need to have time alone with their parent(s). This helps them feel heard and appreciated. Plan an activity with each child—a shopping trip, movies, story time—and schedule it in on a regular basis.
• To build closer family ties, encourage children to play simple games with their injured parent. Such games may also help the injured parent practice skills to help in recovery.

How Can I Communicate with My Family Member with TBI

You can learn to cope with the stress of TBI by finding and building on your family’s strengths. No family is perfect.

• Remember, it’s important to keep lines of communication open.
• Practice active listening: Try restating what your family member has told you to see if you understand his/her position correctly.
• Think before you speak; hurtful words are hard to take back.
• Avoid negative communication. If you get frustrated, take a deep breath or count to 10 to get the conversation back on a healthy track.
• Take turns listening and speaking to one another — do not interrupt. Instead, write down what you are thinking and wait until it is your turn to speak again.
• Stay on topic and avoid bringing up past discussions. Effective communication stays relevant and works to resolve the current issue.
• 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.

What Can I Expect When My Family Member Comes Home?

For most of us, a normal and fulfilling life usually includes things like living independently, spending time alone, working, attending school, volunteering, driving, doing household chores, parenting, dating, and participating in social and leisure activities of our choosing.

For a person who has recently experienced a TBI, some or all of these activities may not be possible right away. There is always hope for the future.

There is no way to prepare yourself for what lies ahead. With time, most people with TBI and their families successfully adjust to life at home.

Some families report that during the first few days or weeks at home, their family member actually seemed to have taken a step or two backwards. Your family member with TBI needs more time than he or she used to in order to adapt to a new environment, even if it’s a familiar one.

Returning to the community, to family, to a familiar setting requires thoughtful planning to ensure that the transition goes smoothly. It is important that you work closely with the rehabilitation team to prepare a discharge plan.

Skills that your service member/veteran acquired or relearned in rehabilitation do not easily transfer into a home setting without a great deal of support and reinforcement. The therapy team will spend weeks to months preparing you and your family member for this step.

You will all have many opportunities to practice and to identify what the challenges might be BEFORE you go home.

Individuals with TBI prefer structure. They adjust better and thrive when there is some routine and predictability to their days. It is helpful to add structure right away at home by scheduling activities and rest breaks.

Over time, as everyone adjusts to being home and your service member/veteran continues to recover and gain skills, the need for so much structure may lessen and more flexibility will be possible.

Your family member may be concerned that he or she cannot easily make comfortable relationships with other people because of the cognitive and communication effects of TBI. You may be worried that he or she will behave inappropriately or unsafely because of reduced judgment or impulsivity.

Role plays potential social situations with your family member with TBI before he or she ventures into community settings. This helps in understanding appropriate behavior.

You may also find it useful to help your family member with TBI prepare for and organize trips into the community. Recreational and occupational therapists are your best allies in this effort and they will work closely with you to practice community reentry.

Can My Family Member with TBI Drive?

Driving is a key mark of independence in our society. Your family member may be eager to get behind the wheel again. It is important to remember safety behind the wheel is not only a concern for your loved one, but also for others on the road.

A professional should evaluate your family member’s ability to drive. This evaluation is usually done by an occupational or physical therapist, a neuropsychologist, or a certified driving evaluator.

It’s important to keep in mind that:

• As cognitive skills improve, driving skills may be reevaluated. Many people with TBI do eventually return to driving and drive safely. Driving skills affected by TBI can be improved through training that focuses on visual scanning, attention skills, and spatial perception.
• In some situations, the loss of skills needed to drive safely may prevent the person from driving again. When this occurs, it is important for the doctor or another appropriate professional to ensure that the family member with TBI and other family members understand the reasons.
• The family must be diligent about enforcing the “no driving” rule. For example, you may need to keep close control of the family’s car keys.
• If your family member cannot drive a motor vehicle safely, there are other transportation options. Public transportation (bus, train, subway) may be available.
• Resources for transportation to medical facilities for appointments, obtaining medications or other needs may be obtained from a variety of sources, such as the Department of Veterans Affairs, Medicaid, Community Transportation Association of America or Disabled American Veterans.
• Consider driving assistance from family members, friends, church or community groups.

Should I Be Concerned About Alcohol of Drug Use?

Some people with TBI turn to alcohol and/or drugs to help them cope with the effects of their injury. After a TBI, the brain is more vulnerable to the effects of alcohol and drugs, so the person will feel these effects much more quickly.

Alcohol and other non-prescription drugs can slow down the recovery of your service member/veteran with TBI in the following ways:

• make it harder for the brain to heal
• interfere with thinking processes that are already slowed down
• interact negatively with prescription medications
• increase aggressive and socially inappropriate behaviors
• increase balance problems
• promote other risky behaviors
• create greater risk for seizures
• increase problems with the law for public drinking
• cause addiction
• cause problems with friends and family
• worsen feelings of depression and anxiety

To take an active role in helping your service member/veteran with TBI avoid alcohol and drugs, you might:

• Talk with him or her about readiness to change drinking or drug use. Help your family member make a list of pros and cons of using substances.
• Spend time with family and friends who are supportive of your service member/veteran not using substances. Minimize time with those who are not supportive.
• Avoid high-risk situations, such as people or places that your service member/veteran associates with drinking or using drugs.
• Develop a plan to help your service member/veteran cope with tempting situations, such as leaving the situation or calling a supportive friend.
• Explore new social circles or environments that do not involve drinking.
• Encourage learning of new ways to deal with stress.
• Remove alcohol and other dangerous substances from the home.
• If your service member/veteran has recently quit using substances, talk openly with him or her about the possibility of using again in the future and stress that one “slip” does not need to mean a return to regular use. Encourage use of support systems to help avoid a full relapse.
• Locate a local Alcoholics Anonymous group or treatment program if advised by your health care team.

How Can My Family Member Avoid Another TBI?

Repeated blows or injuries to the head can further damage the brain. (Think of boxers, football players and other professional athletes who have become disabled due to multiple TBIs.)

For this reason, it is best for people with TBI to exercise caution and avoid another TBI, if possible.

You can help your service member/veteran with TBI avoid another injury by:

• safeguarding your home as directed by the health care team
• insisting on the use of safe practices (e.g., wearing seatbelts in the car)
• following the recommendations of the health care team on activity restrictions (e.g., no contact sports).

A good rule of thumb is: If they make a helmet for an activity (biking, downhill skiing, rollerblading, motorcycle riding, etc.), everyone should wear one.