The caregivers and families of severely injured veterans, many of whom have traumatic brain injury and blast injury, face ongoing emotional and financial pressures. There are thousands of unpaid caregivers, mostly parents, spouses and siblings, who assist vets injured in Iraq and Afghanistan, as they struggle to get through each day.

I hope the information I am providing in this article will be meaningful and helpful to a family or traumatic brain injury survivor with some similar issues as Bill. I remember that when this journey began five years ago, I had a difficult time finding information and direction. We have been able to learn about Assistive Technology and incorporate it into our daily lives.

Traumatic brain injury is the leading cause of disability among children and youth. Students returning to school with traumatic brain injuries may have an entire range of physical, cognitive, behavioral, social and emotional challenges. Exposure to education can aid in the recovery of these functions. Much as schools promote learning, recovery is a re-learning process, so it is important for educators in the school system to provide support and services.

I began training for my first triathlon in 2008 at age 44, encouraged by my wonderful Pediatric Nurse Practitioner colleagues in Neonatology at the University of Iowa Hospital and Clinics. On May 24, 2008, I began to bike ride 14 miles with my dear friend, Angie Cookman, on a trail in Coralville, Iowa. We came to an area with a large downward and upward hill; we were not speeding and were both wearing helmets. At the bottom of the hill there was a six-foot section of water and mud. I unfortunately hit the muddy area and was thrown 25-30 feet and hit concrete on the right side of my head. The helmet was cracked all the way through on the right side for 1-2 inches. I immediately passed out and started bleeding from my right ear and nose.

There is an overlap between traumatic brain injury (TBI) and violence which is an important yet little understood problem. The exact number of violence-related TBIs each year is not known, but the CDC estimates 11% of TBI deaths, hospitalizations and emergency room visits combined are related to assaults.

The transition from childhood to adolescence is fraught with many physical and emotional changes. It can be a difficult time for the child and parents alike. Most families experience a period of major adjustment to the child’s changing mannerisms, quest for privacy and greater independence. When a child experiences a brain injury, either at a younger age or during this period of transition, it commonly creates many more problems than a child arriving at this age without a brain injury.

One of the common consequences of traumatic brain injury (TBI) is sexual dysfunction. Unfortunately addressing sexual issues as a component of rehabilitation is often overlooked for a variety of reasons.

“Sexuality is an integral part of the human experience” (Sander). We are all sexual beings and sexuality is part of our life experience. Social mores and cultural differences make sexuality a taboo issue in some societies. Many therapists and other direct care providers in hospital and rehabilitation settings are untrained about sexuality and persons with disabilities. Their personal values often interfere with their ability or comfort level discussing the topic. When sexuality is overlooked as part of rehabilitation, sexual dysfunction can become an issue that is very difficult for families to understand. Social isolation, common for persons after TBI, limits opportunities for developing meaningful relationships.

With nearly half of all marriages in the U.S. ending in divorce, it’s been widely reported for many years that the rate of divorce is even higher among couples when a spouse has a brain injury. Divorce rates ranging from 48% to 78% are commonly given.

Why do many persons with brain injury have trouble developing and maintaining relationships? It may be due to changes in their ability to read and express emotions. This is essential for communicating and connecting with other people and for sustaining close relationships. Research into the expression and interpretation of emotions by survivors is examining new areas for brain injury treatment and recovery.

A wife describes the mixed emotions of becoming her husband’s caregiver after his traumatic brain injury changed their lives and their family. As Irene Young entered the new world of caregiving, she became responsible for managing his care, providing emotional support, measuring progress in slow steps, and maintaining hope for recovery. As the parent of a young daughter and the spouse of a survivor of brain injury, she learned the importance of changing expectations, setting goals, finding time, and finding a balance.