This is a chapter from the Family Caregiver Curriculum, Module 2: Understanding the Effects of Traumatic Brain Injury and What You Can Do to Help.
1. Why is my service member/veteran with TBI so tired all the time?
People with TBI tire easily for good reasons. First, all thinking takes mental energy.
In a person with a brain injury, thinking activities take two to three times more energy than they do for someone without a brain injury. This is a
major reason for fatigue.
After a TBI, a person’s natural day/night cycle may be disturbed. Your service member/veteran with TBI may not be able to achieve the necessary deep sleep that allows someone to wake up feeling refreshed. He or she may also wake up many times during the night.
Help your family member to organize the day through the use of a calendar or notebook. This helps him or her avoid mental fatigue. (See Chapter 3 to learn more.) Keep daily activities on a regular schedule. Encourage your service member/veteran to make important decisions in the morning when mental energy is highest.
Finally, set up a sleep routine that includes going to bed and getting up at the same time every day. If fatigue persists, talk to the health care team. Medication can help regulate sleep patterns.
2. Why is my service member/veteran with TBI angry much the time?
During recovery, your family member will learn about how TBI has changed his or her life.
He or she may feel frustrated and angry about these changes. Remain calm. Help your family member to recognize when he or she is becoming angry or frustrated. Encourage him or her to ask for a break or some space to calm down. Praise your family member when he or she uses anger management strategies.
3. Why is my service member/veteran more emotional?
Neurons in the frontal lobe of the brain control the expression of emotion. These are often damaged during a TBI. Your service member/
veteran may start laughing or crying, and be unable to stop easily. Likewise he or she may feel emotions, but be unable to express them. These symptoms usually lessen over time as the brain heals.
4. Why does my service member/veteran seem so insensitive and hurtful?
Your family member may seem insensitive and hurtful at times because he or she has less self-control over thoughts and behaviors.
This self-control is located in the frontal lobe of the brain. Damage to the frontal lobe may cause someone to just say things, without thinking about their effect on other people.
People with frontal lobe damage have a hard time understanding another person’s point of view. They also have a hard time multi-tasking. For example, it’s hard for people with TBI to respond to conversation and monitor what they are saying at the same time.
People with injury to the parietal lobe may have visual-spatial problems. This can make it hard to “read” the nonverbal feedback they are receiving from others.
You can help your family member learn to be more aware of the feelings of others. First, let your service member/veteran know what you are feeling; don’t expect him or her to read your expressions. Second, if your service member/veteran blurts out an unkind statement, suggest to him or her: “That’s an inside thought, not an outside one.” Finally, work with your health care team to help your service member/veteran learn how to conduct simple negotiations.
Remember, it’s the injury, not you, that is causing this behavior. If you find that it is having an effect on your self-esteem, please seek help through support groups, counseling, etc.
5. My service member/veteran used to have a lot of “get up and go.” Why is he or she so passive now, just sitting around unless I tell him or her what to do?
Both fatigue and damage to the frontal lobe of the brain affect a person’s “get up and go.” (See Lack of Initiation on page 70.) You can help your family member by setting a regular daily routine. Organize larger tasks into a series of smaller ones. Provide choices for activities from which your family member can choose. This can increase motivation and initiation.
6. I no longer have a spouse; I have another child in the family. How can I restore my marriage?
A spouse’s role after his or her partner has a TBI will often change. See Module 3 for suggestions about how to make the caregiving role an easier one.
Help your spouse with TBI become as independent and active as possible. See a marriage counselor if there are sexual problems. Talk to the doctor about medication to address physical problems that get in the way of intimacy.
7. 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.
8. How long is the psychological recovery going to take?
There are two recoveries to consider: the physical and the psychological.
Physical recovery (spontaneous healing of the brain) usually occurs in the first few years after the injury, depending on many factors.
The psychological recovery from TBI — learning to feel good about oneself and one’s life--takes time as well. It may take longer than the physical recovery.
There are members of the health care team who will see you both through the recovery process and can guide you. In addition, some people find that it is helpful to talk with others who are sharing some of the same experiences.
See more information included in Module 2: Understanding the Effects of Traumatic Brain Injury and What You Can Do to Help.
The Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans provides comprehensive information and resources caregivers need to care and advocate for their injured loved one and to care for themselves in the process. The Guide was developed by the Defense Health Board, the Defense and Veterans Brain Injury Center and the Department of Veterans Affairs.
Click here for a pdf of the full guide, or see it here on the DVBIC site.