Traumatic brain injury (TBI) has become a topic of interest and concern amongst military families, especially those with loved ones previously or currently deployed to Iraq or Afghanistan. Among the causes of war-related TBI are exposure to blast, gunshot wounds and shrapnel, falls, and motor vehicle accidents. The good news is that most of these injuries are mild, and commonly referred to as “concussion.” Concussion is seldom life threatening but can result in symptoms that may interfere with one’s normal routine. Moderate to severe brain injury often occurs in combination with other serious injuries such as those involving amputations and burns. This level of TBI injury can have lasting effects that challenge service members and families over time.
Any medical condition that gains such rapid attention often results in incomplete or inaccurate information. It is important that military members and families understand the facts about TBI, especially the mild form, in order to help recognize the symptoms and provide support. It is also important that families impacted by more severe TBI understand some of its long-term implications, especially on children. This Courage to Care fact sheet describes what many are referring to as the signature wound of war — TBI. We explain mild TBI (concussion) and its symptoms to help military families identify it and seek treatment. We also describe some of the important issues for families living with more severe TBI.
Mild TBI (Concussion)
Concussion occurs when the head is hit or shaken and leaves a person dazed, confused or with loss of consciousness for a short time. In civilian life, concussion often occurs during sporting events such as a football game. Mild TBI (mTBI) is also referred to as a “closed head injury”. While concussion is seldom life threatening, it can cause serious symptoms especially for those who may have suffered multiple concussions. People who have had a concussion may say that they are “fine” although their personality or behavior may seem to have changed. Symptoms of mTBI can appear days, weeks, to months after the injury. Being aware of the symptoms of TBI can assist in the family understanding and being able to provide support:
Symptoms of TBI
- Sleep problems (either too much or too little)
- Fatigue, feeling tired all the time
- Difficulty organizing/completing tasks
- Trouble making decisions
- Sensitivity to lights/sounds
- Feeling depressed, sad
- Trouble with concentration, memory, and/or attention
- Easily overwhelmed
- Irritable, angry
- Impulsive, outbursts
Do’s and Don’ts to Speed Recovery
Just as an injury to a muscle or joint, mTBI requires the same care in order to help speed recovery.
- Get appropriate amounts of sleep and rest
- Get into a regular routine of everyday activities (such as exercise, eating regularly)
- Do one thing at a time (e.g., reduce distractions when working)
- Increase your activity slowly
- Write things down to help you remember important things
- Engage your brain in activities that require fine motor skills and use of strategy (e.g., playing an instrument, games, writing, leisure puzzles)
Don’ts, while the TBI is healing
- Engage in activities that can produce another brain injury, such as contact sports
- Drink alcohol or use excessive amounts of caffeine
- Take over-the-counter sleep medications
Healing takes patience and time. Support from family members and taking care of oneself can go a long way in assisting in recovery.
If symptoms become more severe or prolonged, it may indicate the presence of another condition such as posttraumatic stress disorder, depression, or substance abuse. If this is the case, you or your family member should tell your primary care provider.
Moderate to Severe TBI: Implications for Families
More serious TBI, often occurring along with complex war injuries, presents a number of challenges that families must deal with over time. Military healthcare providers who have worked with families impacted with moderate to severe TBI have identified some of the issues below as commonly felt by families dealing with this medical condition.
- Injury as grief and loss: With moderate to severe TBI, the service member is not who he/she used to be. There is grief and loss of the service member not being able to return to the normal individual and family routines that had been there before the injury. There are memories of how the person used to function with direct comparison to present abilities.
- Inappropriate behaviors: The family must deal with the injured service member’s potentially inappropriate behaviors in public. These may include lack of inhibition, anger, and outbursts, as well as the other extreme — withdrawal, apathy, and depression.
- Social isolation: This may be an issue due to the exhausting care giving responsibilities and fear over how the TBI patient is going to behave. It is important for the family to avoid social isolation and engage in the community and available supports.
- Implications for children: Children, especially younger children, may think they are responsible for the personality changes a parent with TBI has (irritability or withdrawal), or even that the injured parent may not love them. Protect children from outbursts and share calm, loving time with them. Talking helps. Explain, “Dad is grumpy or angry because his brain was hurt. He doesn’t mean what he often says or does.”
- Family management: With moderate to severe TBI, the management of the injured service member often must be delegated to the non-injured spouse.
The military healthcare community is engaged in research, education and treatment for TBI in both its mild and more moderate to severe forms. Here are resources to learn more about war-related brain injury.
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury