Understanding TBI, Part 4: The Impact of a Recent TBI on Family Members and What They Can Do to Help with Recovery Thomas Novack, PhD and Tamara Bushnik, PhD , Model Systems of Knowledge Translation Center Page 2 of 2

Provide structure and normalcy to daily life

• Establish and maintain a daily routine - this helps the person feel more secure in their environment.
• Place objects the person needs within easy reach.
• Have the person rest frequently. Don’t let the person get fatigued.
• Be natural with the person and help them to maintain their former status in the family. Communication is important to the person’s recovery. Although they may not be able to speak, they should continue to be involved in as normal a social world as possible.
• Include the person in family activities and conversations.
• Keep a calendar of activities visible on the wall. Cross off days as they pass.
• Maintain a photo album with labeled pictures of family members, friends, and familiar places.

Provide support in a respectful way

• Try not to overwhelm the person with false optimism by saying statements like “You will be alright” or “You will be back to work in no time.”
• Point out every gain the person has made since the onset of the injury. Avoid comparing speech, language or physical abilities prior to the injury with how they are now. Look ahead and help the person to do the same.
• Treat the person as an adult by not talking down to them.,
• Respect the person’s likes and dislikes regarding food, dress, entertainment, music, etc.
• Avoid making the person feel guilty for mistakes and accidents such as spilling something.
• If the person has memory problems, explain an activity as simply as possible before you begin. Then as you do the activity, review with the person each step in more detail.

Avoid over-stimulation - Agitation can be heightened by too much activity and stimulation.

• Restrict the number of visitors (1 or 2 at a time).
• Not more than one person should speak at a time.
• Use short sentences and simple words.
• Present only one thought or command at a time and provide extra response time.
• Use a calm, soft voice when speaking with the person.
• Keep stimulation to one sense (hearing, visual or touch) at a time.
• Avoid crowded places such as shopping malls and stadiums.

Safety Tips
The person who has confusion or impaired judgment may be unable to remember where dangers lie or to judge what is dangerous (stairs, stoves, medications). Fatigue and inability to make the body do what one wants can lead to injury. Therefore it is very important that a brain injured person live in an environment that has been made as safe as possible. The following are some safety guidelines to use in the home:

• Keep clutter out of the hallway and off stairs or anywhere the person is likely to walk. Remove small rugs that could cause tripping or falls.
• Remove breakables and dangerous objects (matches, knives, and guns).
• Keep medications in a locked cabinet or drawer.
• Get the doctor’s consent before giving the person over-the-counter medication.
• Limit access to potentially dangerous areas (bathrooms, basement) by locking doors if the person tends to wander. Have the person wear an identification bracelet in case he or she wanders outside.
• Keep the person’s bed low. If they fall out of the bed, you may want to place the mattress on the floor or install side rails.
• Make sure rooms are well lit, especially in the evening. Night-lights can help prevent falls.
• Have someone stay with the person who is severely confused or agitated.
• Keep exit doors locked. Consider some type of exit alarm, such as a bell attached to the door.
• Consider a mat alarm under a bedside rug to alert others if the person gets up during the night.

Things that can be more dangerous after a TBI and should be resumed only after consulting a health care professional: contact sports, horseback riding, swimming, hunting or access to firearms, power tools or sharp objects, riding recreational vehicles, and cooking without supervision.

Individuals with brain injury should receive permission from a health care professional prior to using alcohol or other substances at any point after their injury. Also, NO DRIVING until approved by your doctor.

More in the Understanding TBI series

• Understanding TBI, Part 1: What happens to the brain during injury and in early stage of recovery from TBI?
• Understanding TBI, Part 2: Brain injury impact on individuals’ functioning
• Understanding TBI, Part 3: The recovery process

Understanding TBI was developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the Mayo Clinic TBIMS, Baylor Institute for Rehabilitation, and from Picking up the pieces after TBI: A guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002). Copyright © 2010 by University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

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