By Marilyn Lash, M.S.W.

PTSD and TBI wounds wives

“We were high school sweethearts and engaged. When he found out he was going to be deployed, we had a courthouse wedding. Two days later he left for 15 months in Iraq.”

“Every time he came back from a deployment, a piece of him was missing. He’s just not the same person now.”

“My children don’t understand why he yells at them. They think he doesn’t love them anymore.”

“He never hit me before he was injured. But now there are times when I do not feel safe in our home.”

“He still sleeps with a gun in our bed.”

“He never touches me anymore. The loss of intimacy makes me feel rejected and unloved.”

These are the voices of the wives of wounded warriors. After managing the household and family during long and often multiple deployments, they are now caregivers for husbands who are living with traumatic brain injuries and post-traumatic stress disorders. Many of them are young – just in their 20s – and newly married. Many are mothers with young children; others wonder if they will ever have children now. Some hold full time jobs and find some sense of normalcy and escape in the workplace. Others are full-time caregivers for their husbands 24/7 and rarely leave home.

Military and civilians worlds – distinct but coexisting

The military culture and life is different than that of civilians. The women with husbands in the service as a career have moved many times from base to base. Their children have changed schools over and over. They have packed up, left friends, moved across country or overseas, changed jobs, and rebuilt their lives more times than many of us can imagine. This resilience is now being tested even more as their husbands return home with disabling injuries. Even now the transition from the military community to the civilian world is a lengthy and confusing process. Many of their husbands are being treated in warrior transition units and still in the lengthy process of disability determination and review by medical boards. This can take years. Meanwhile, their lives are on hold.

For others whose husbands are in the National Guard or Reserves, they bridge both military and civilian worlds and don’t quite fit into either. Many lost their jobs when they were deployed and now face uncertain futures as they try to pay the mortgage or rent. They travel back and forth for medical treatment and rehabilitation while they try to put their lives and families back together.

The emotional trauma of caregiving

Each day the wives of wounded warriors try to understand what has happened to their husbands and to their marriage and to their family. As caregivers, they are under enormous physical, emotional and financial stress. Many are experiencing compassion fatigue which is also called secondary traumatic stress. Depression, emotional swings, anxiety, sleep disorders – many wives are having these symptoms as the cumulative stress of caregiving builds over time.

Traumatic brain injury and post-traumatic stress disorder or PTSD as it’s commonly called can take a heavy toll on the individual and on relationships. Each disorder is complex but when both conditions coexist, the effects compound each other. The changes in behaviors, emotions, and cognition can be frustrating, challenging, frightening and overwhelming for spouses. Simply put, it is not only the warrior who has been injured. The home is also wounded.

Recommended Reading

Healing Together

By Suzanne Phillips, Psy.D and Dianne Kane, D.S.W.

Marilyn Lash, M.S.W. and Taryn Stejskal, Ph.D.

When someone in your family has a traumatic brain injury, feelings of stress and anxiety can be overwhelming at times. Initial worries usually focus on whether the person will survive the injury. Once the person’s medical condition has stabilized, the family’s concern then shifts to what kind of recovery can be expected. The uncertainty about the future can be very stressful for everyone. The brain is such a complex organ that recovery is hard to predict after it has been injured. This uncertainty is the basis for many fears, worries, and questions.

Know Your Signs of Stress and Anxiety

Stress feels like an overwhelming pressure that a person just doesn’t feel capable of facing or handling. Anxiety is a more severe form of stress that causes apprehension, avoidance, and fear.

Everyone experiences some stress and anxiety in their life at some time. But it is very common among families when a person has had a brain injury as this can be a life changing event for everyone.

So what can you do?

It helps to know the common signs and symptoms of stress and anxiety.  They are:

• Hard time making decisions, even small ones
• Short temper or fuse
• Less energy and motivation
• Difficulty relaxing
• Changes in appetite
• Racing thoughts
• Difficulty sleeping
• Higher body temperature or increased heart rate
• Physical complaints such as indigestion, shakiness, jaw and shoulder tension, headaches, fatigue, etc.
• Impatience and irritability
• Feeling of being alone, hopeless, and unproductive

Once you recognize the signs of stress, it’s important to manage it to prevent its negative impact on your life and health. Learning how to cope and manage stress and anxiety is a step in rebuilding your life after brain injury. Here are 6 techniques that can help.

1. Think positive about your physical health and try to do fun and stress reducing activities that you did before the brain injury occurred.
2. Deep breathing can help calm you when you begin to feel stressed or anxious.
3. Meditation helps you calm your mind and focus on productive thoughts.
4. Visualization helps you picture what you would like to happen.
5. Thought stopping helps you control your thought patterns.
6. Ending negative self talk helps you think more positively. 

There will be many challenges in your life, whether you are a survivor of a brain injury, a caregiver, or a spouse, parent, child, or sibling. Learning how to decrease, manage and control your stress and anxiety is an important step in regaining and rebuilding your lives and your future.

Recommended Reading

Stress and Anxiety after Brain Injury

By Taryn Stejskal, Ph.D.

Brain Injury Blog by Marilyn Lash

May 1, 2012

TBI and PTSD – Is there a difference?

We hear so often that, “TBI and PTSD are the signature wounds of the wars in Iraq and Afghanistan.” It’s on the news, in the papers, and featured in stories all over the media. We hear it so often, yet I still believe that the general public does not really know what it means. The wounded warriors and their families who are living with this dual diagnosis know all too well that simply getting through each day can be a constant struggle. The combination of traumatic brain injury and post-traumatic stress disorder results in a cascade of symptoms that affect not only the wounded warrior but everyone in the family as well. 

What’s TBI and what’s PTSD?

“How do you tell the difference?” That’s the question most often asked by the wives of wounded warriors whom I have met at retreats over the past 6 months. I wish there were a simple answer. Even the most skilled clinicians find it hard to answer this question. 

PTSD has some distinguishing symptoms – the flashbacks, nightmares, hypervigilance, and increased startled response are classic. What most service members, veterans, families and caregivers find most confusing and frustrating is the overlapping symptoms of PTSD and TBI. Take a look at the following list of shared symptoms: cognitive changes, depression, anxiety, insomnia, and fatigue. Cognitive changes can include a wide array ranging from difficulty with memory to slower processing, and lower attention.   

Dangers on the Road – and the Roadside

One scenario that the wives have shared repeatedly is riding in the car with their husband driving when he “lost it” or “had a meltdown” and they literally feared for their lives. Erratic driving has been increasingly reported among returning service members and veterans. Let’s take a look at how the combined effects of PTSD and TBI can lead to real dangers in the car. The wounded warrior may already be in a state of high alertness when driving as the roads in the war zones held constant dangers for roadside bombs and IEDs. Even when back home and driving in a familiar neighborhood, the sight of a blowing trash bag at the curb may heighten the warrior’s anxiety and even trigger flashbacks. If the warrior has not slept well the night before – common with both both TBI and PTSD – then he may already be on edge. Leaving the isolation and safety of the house may further increase the anxiety and sense of vulnerability for the wounded warrior. 

But some consequences of brain injury can also affect driving safety. The wounded warrior may have some changes in vision that affect the ability to see clearly, particularly areas that fall within peripheral (side view) vision. Or it may be that a hearing loss from a blast injury means that the wounded warrior driver does not hear an approaching car until it is right next to his vehicle. The persistent headaches, so common with mild brain injuries, can affect the driver’s concentration and alertness. Sensitivity to noise after a brain injury can make it hard for the driver to deal with honking horns or radios. The noise of children arguing or playing in the back seat may increase irritability and lead to distractions. The traffic helicopter overhead may be a trigger of combat memories or even flashbacks. Sensitivity to light may make it hard to adjust to sunlight or shadows on the road. The quick temper that often accompanies a brain injury may shorten the warrior’s fuse and contribute to road rage. The increased distractibility from a brain injury can lower alertness for other vehicles. It is no wonder that so many women report they were trapped in their car with their wounded warrior driving and literally feared for their lives. 

Living with both

This example illustrates that it’s not always a clear “either or” situation. Both PTSD and TBI are complex diagnoses with many overlapping effects. Being aware of their combined effects can help everyone living with the wounded warrior be alert to possible interactions. It’s not as simple as, “he’s a jerk” or “doesn’t care” or “won’t listen.” Discussing these combined effects with treating clinicians or counselors can help shed light on this. 

Recommended Reading 

Tool Kit for Veterans and Service Members on Blast Injury, Traumatic Brain Injury and PTSD

By Marilyn Lash, M.S.W. and Taryn Stejskal, Ph.D.

It’s a common belief that most marriages end in separation or divorce after a spouse has a traumatic brain injury. Certainly the physical, cognitive, social, behavioral and communicative changes caused by brain trauma can affect a couple’s relationship. These changes are just the primary losses. Additional changes, known as secondary losses, can range from loss of income, to loss of friends, jobs or careers. As roles and responsibilities formerly shared by a couple are reexamined and redistributed after a spouse is injured, the relationship between a husband and wife changes in many ways. 

There is very little scientific research on marital relationships so much is still unknown about the impact of a spouse’s brain injury on the marriage. Reasons for a marriage dissolving are always complex, but this may be even more so when one partner has a disability or impairment due to a brain injury.  So it is important to look at the findings from 3 research studies on this topic. 

• One study conducted by Thomsen in 1984 found a very high rate of 78% for marital breakdown. But it is important to note that this was a very select group of individuals who were studied. It examined only 9 couples who were 10-15 years post-injury. In addition, many of them had severe brain injuries and most were living in a residential assisted living program. So one must question how applicable these findings are today.
• The second study led by J.C. Arango-Lasprilla was more recent in 2008. It also was much larger, including 927 individuals who were injured. In contrast to the earlier study, the marital breakdown rate was only 15% within the first 2 years post-injury. This study offers much more hope for relationships to survive the stresses and challenges of daily living after a partner has been hurt. 
• The third study led by J. Kreutzer in 2007 not only found that 25% of relationships broke down but that this occurred an average of 4.1 years after a spouse’s injury. 

Research has found that several factors make a difference in whether couples stay together or separate after one of the partners has a brain injury. The highest rates of marital breakdown are found among younger couples and in shorter or more recent marriages. Another risk factor is domestic violence. Couples with a more severely injured member were also found to be at greater risk for separation or divorce. 

Much more research is needed to understand why some couples manage to stay together and others separate. But one thing is clear – research does not support the common belief that there is a much higher incidence of marital separation and divorce when one partner or spouse has a brain injury. 

Recommended Reading

Couples: Hope and Intimacy after Brain Injury

 By Taryn Stejskal, Ph.D.

By Barbara Webster

Memory is one of the biggest challenges facing many survivors after a traumatic brain injury. Memory impairments can be unsettling, frustrating and stressful. Trying to recall and perform routine functions can become formidable tasks. Changes in memory can affect everything from remembering to turn off the stove to paying your bills to keeping appointments. These challenges can be the difference in being able to live independently, succeed in school or do your job. 

By using compensatory strategies, the survivor, family and caregivers can address these challenges and be more productive. The following tips and strategies can be useful. 

Use checklists

By posting written checklists in key locations, such as by the door or phone, at your desk, and on the bathroom mirror or refrigerator, you will have visual reminders to jog your memory. You can also record verbal checklists to listen to on a tape recorder, on your computer or your smart phone so you can replay them whenever you need a reminder.

Checklists with personal care reminders for grooming and dressing can be really helpful for getting ready in the morning and getting out the door on time. These can be customized by how much detail you need. Examples are:

• Putting toiletries in plain sight
• Laying out clothing the night before

Daily life can be complicated for anyone, but it can be even more complex and stressful if you have a memory impairment after a brain injury. Some basic strategies for organizing your life are:

• Do your laundry the same day each week.
• Make a master list of monthly bills.
• Ask for and save appointment cards.
• Use different colored inks to note different types of appointments on your calendar.
• Consult a map or program your GPS before you get in the car and leave home.
• Get reverse directions as well.
• Park in the same area every time.
• Place all ingredients on the counter before you start cooking and put them away as you use them.
• Carry a timer when you have something in the oven. 

There are many aids and tool available to help individuals who have difficulty with memory. These include planners and organizers, calendars, computer programs, special applications and smart phones. Your preference may be influenced by what you feel comfortable using now and what type of reminders helped you before your injury. The key is to develop a system that works for you and your lifestyle.  

It is also important that the people who are close to you are familiar with the memory strategies and reminders that you use. This includes your family members, caregivers, close friends and any others who interact with you regularly. Consistency is important so you want to be sure that everyone uses the same strategies. 

Conclusion

Your memory may improve as your brain heals and your recovery progresses. However, many persons with moderate and severe brain injuries continue to have some challenges with memory over many years and even over their lifetime. Some final suggestions are:

• develop routines
• make lists and check them daily
• work deliberately, one step at a time
• don’t try to do everything at once
• be patient with yourself.

Recommended Reading

Memory Strategies Brain Injury

By Barbara Webster

By Marilyn Lash

I have just come back from another weekend retreat for wives of wounded warriors, led by Hope for the Homefront  and Operation Homefront.  Aptly titled, When War Comes Home – Don’t Retreat! our team of Marshele Waddell, Julia Warton, Kelly Orr, DiAnna Steele, June Morse and myself, leads a program for wives who are caregivers to husbands injured in Iraq and Afghanistan. This was the 5^th retreat we have done within 6 months and there is one more to go in 2 weeks. We’ve been to Kansas, Texas, Washington, South Carolina and Tennessee with the final retreat this year scheduled in Colorado.

Facing the emotional trauma of war

Traumatic brain injury and post-traumatic stress disorder are the most common conditions, but it’s not just their husbands who are dealing with the aftermath of war injuries. These women are living with the emotional trauma of having their husbands return from war vastly different from the person they knew before. Some of the changes are physical – amputations, burns, paralysis, broken bones, hearing losses, vision changes. Other changes are less visible – memory losses, mood swings, personality changes, frustration, irritability, anger, and disinhibitions. The symptoms of post-traumatic stress disorder or PTSD are evident in their husband’s nightmares, flashbacks, hypervigilance and emotional withdrawal.  

These women – so many of them young and newly married – have now become caregivers to their wounded warriors. This is a role for which they were not prepared and did not want. Their wish was for that their husbands return from war safe – unhurt – and for life to go on as they knew it. Instead, their husbands came home – but the comment repeatedly made is, “He is not the same person.” 

Educate, empower and encourage

This is the purpose of theses retreats. By helping the women focus on themselves rather than their husbands, they begin to explore their own needs for support, information, and help. An inventory of symptoms for secondary traumatic stress reveals that almost have compassion fatigue. Most of them are exhausted, emotionally and physically. Many question their faith. They are not only caring for their husbands and managing the household, but many are also raising children and working. The demands upon them and the stresses are constant. Their lives feel out of their control as their husbands go through the lengthy process of disability determination and transitioning out of active duty to civilian life. 

We have now met close to 200 women and the themes at each retreat are markedly similar. Their emotional trauma is evident. They are angry – at what has happened to their husbands, to their marriages, to their lives. This anger is part of their living grief – yet they don’t know how to mourn their losses since their husbands have survived. Many struggle with depression. They feel isolated and alone, even within their communities. Loss of intimacy within their marriages causes many to question their sense of worth and attractiveness as they feel rejected and unloved. Many describe life at home as “walking on eggshells” with the constant fear of “setting him off’ or “pushing his triggers.” The unpredictability of the day only adds to their anxieties. Some women admit they have been hit or beaten. Too often, this is a shameful secret they have hidden from friends and family.

Finding a New Sisterhood

The power of the weekend retreats comes in their recognition that, “I am not alone.” They find a new sisterhood among themselves. Here are women who understand as they are on the same journey. Too many of them have put aside or ignored their own well being, so each retreat helps the women develop and commit to a wellness plan for themselves. 

At each retreat we have seen the transformation from Friday night as they arrive, uncertain, anxious, and tentative. One woman admitted, “I almost turned around at every exit when I was driving here.” They come because they know they need something  – even if they do not know what it is. During the talks and workshops on Saturday, we see them start to open up, to bare their emotions, and to reach out to each other. They find they are not alone – here are other women who understand them and will support them. By Sunday, they have made a commitment to care for themselves. Many have mixed feelings about going home – they are uncertain about what they will find, how their husbands have managed in their absence, and how they will be greeted. But they have a new sense of direction and a hope that they can create a better path and future. 

You can view some great videos and clips about the women of wounded warriors and the retreats at www.whenwarcomeshomeretreats.com 

Recommended Reading

PTSD and Blast Injury in Adults and Veterans: Tips and information on trauma and brain injury

By Samantha Backhaus, PhD, Kathleen Bell, MD, Janelle Breese Biagioni, Bill Frey, PhD, Marilyn Lash, MSW, Maureen K. O’Connor, PsyD, LaShanta Petroski-Ackley, LICSW, Ron Savage, EdD, Nadia Webb, PhD, Nathan Zasler, MD

Help for Aging Survivors of Brain Injury

By Marilyn Lash

Loss of memory, difficulty recalling names, and confusion are common complaints of most aging adults. People also have changes in physical abilities as they age. For persons who have survived a traumatic brain injury and already have some impairments in their cognitive and physical abilities, concerns about aging are often magnified. Much is unknown about the long-term effects of trauma to the brain. Many survivors fear that aging will bring a further decline in their cognitive and physical abilities.

Tips for persons with a brain injury on seeking medical care as they grow older

• Get medical care. Any time you notice a change in your thinking, functioning or physical health, it is wise to seek professional help. Many medical conditions are reversible.
• Find professionals with expertise on both aging and the effects of brain injury on the aging process. This may include specialists such as neurologists who are physicians specializing in neurological disorders, physiatrists who are physicians in rehabilitation medicine, neuropsychologists who are psychologists with expertise in persons with brain injury, or gerontologists who are physicians specializing in aging.
• Share information about your brain injury. It is important to give information about the history of your brain injury to any professional who is treating you. This should include information about your overall condition since the brain injury and any recent changes you have noticed, especially with your memory and thinking. It is also helpful to bring copies of any medical records about your brain injury.
• Find rehabilitation programs or services if you have been diagnosed with Alzheimer’s disease. You may benefit from cognitive rehabilitation, emotional support and medications.
• Talk with your doctor about new medications and health supplements before taking them.

Safety tips for persons aging with brain injury

Aging brings changes in cognition or thinking as well as changes in physical abilities. A person’s strength, coordination, balance, and endurance often change. These changes with aging may pose additional challenges for the person with a brain injury whose motor skills or physical abilities have already been compromised. In addition to receiving good medical care, the following strategies can help persons with brain injuries reduce the risk of further injury as they grow older:

• Protect your head.
• Avoid action sports that can increase the odds of another brain injury.
• Wear a helmet when biking, skating, playing baseball or other sports.
• Use a seat belt in all moving vehicles.
• Watch out for activities requiring a rapid physical response or agility if they were affected by your brain injury.
• Take time to examine your choices when facing a new situation and carefully choose the best response before you react. Persons with a brain injury are often impulsive which increases the chance of accidents occurring.
• Reduce or avoid stimulating activities when you are tired. Fatigue reduces a person’s ability to think clearly and response time. This increases the risk of accidents.
• Make sure your home, work and other places you visit safe, well lit and fall-proof.
• Keep taking any prescribed medications according to your doctor’s directions, especially if you have a seizure disorder. If you have a seizure and lose your balance, fall or lose consciousness, this increases the risk of another brain injury.

These medical and safety tips can help protect you from another injury. They are a starting point for a discussion with your doctor, other professionals, and your family.

Recommended Reading

Aging with a Brain Injury

By Dr. Mary Hibbard

By Marilyn Lash, M.S.W.

Who needs to know the signs and symptoms of a concussion in children at school? The answer is simple – everybody, that’s who. A concussion is a mild brain injury. Whether a student is in elementary, middle or high school, it’s important to closely monitor the effects of a concussion and the student’s recovery.

It’s not up to just the parents, physician or coach. Everyone who has contact with the child and student can be part of the managing team in the athlete’s neighborhood. This includes coaches, athletic trainers, parents, physicians, teachers, school nurses and school psychologists. They all have a role in monitoring and helping the student’s recovery.

Appearances can be deceptive after a concussion

A student-athlete may have no visible signs of injury, but this does not mean that there has not been a concussion.The following changes are indicators that a student-athlete may have sustained a concussion and should be examined:

• vacant stare
• easily distracted
• difficulty answering questions
• disorientation
• slurred speech
• lack of coordination
• memory impairment or loss
• highly emotional
• any period of loss of consciousness 

Many people assume that a blow to the head is not serious if the child or youth does not lose consciousness. There is usually no loss of consciousness when a child or youth has a concussion. If it does occur, it is often just seconds or minutes. However, the youth’s brain can still be injured by a concussion without a loss of consciousness.

Help for the student athlete with a concussion

Many people can help a child or youth who is injured at home, at school, on the playground, during a game, or in a team sport. They are listed next.

1. Physician – It is very important for parents to always tell a child’s pediatrician or family physician about any concussion that is suspected or identified, no matter how minor it may seem. The child’s physician can advise on how to monitor a child’s recovery and determine when it is safe to resume activities. Following a physician’s advice can help a child recover and prevent another injury.
2. Parents – Parents know their child better than anyone. Any injury to a child’s head, face or jaw has the potential to be dangerous. Parents should talk with the physician about how to monitor their child immediately after the concussion. It’s also important to always check with a physician before giving any medication to a child after a concussion. Parents are in the best position to closely watch their child for any signs of change including worsening headaches, weakness, numbness or decreased coordination, repeated vomiting, difficulty waking, unequal eye pupil size, convulsions or seizures, slurred speech, increased confusion, restlessness or agitation. Any of these changes require medical attention.
3. Friends – They may be the first to noticethat “something just isn’t “right” with their friend. They may have seen their friend fall or be hit. The concussion may not have been diagnosed yet, but close friends may see changes that are signs of a concussion. Friends can help by telling parents, school nurses or athletic trainers about the changes they have noticed.
4. Teachers – There are many ways that a concussion can affect a student in school. Difficulty concentrating, remembering new information or getting along with classmates are just a few changes often seen after a concussion. Teachers can help the student during the recovery process by reducing assignments, building in rest periods, and giving more time to finish assignments or homework.
5. School nurses – The school nurse can be a helpful and informative resource for both the student as well as parents, educational and athletic staff. By identifying and recording symptoms of a concussion in a student-athlete, the school nurse can monitor the child’s progress, identify problems and communicate with parents.
6. Coaches – The coach is responsible for protecting the athlete’s health and safety whenever a concussion is suspected or has been diagnosed. Every coach should be aware of the signs and symptoms of concussion and guidelines for the student-athlete’s safe return to play. Many players do not report concussion symptoms, because they do not want to be removed from a game or practice. This places additional responsibility on coaches for awareness of any signs of concussion.
7. Athletic trainer – The athletic trainer is a valuable resource for the student-athlete, parents, and all others involved in the school system. The athletic trainer has special training about concussion and guidelines for play. By insisting on safety first and participation second, the athletic trainer can communicate and coordinate information as the student’s recovery progresses.

Conclusion

There is nothing minor about a concussion. It affects the brain and must be monitored carefully. Everyone in the child’s world and the student’s environment has an important role in the recognition of a concussion and in supporting the student’s recovery.  

For more information, see the tip card Concussion Education in the Student-Athlete’s Neighborhood by Phil Hossler.

Recommended Reading

Getting A-Head of Concussion

By Phil Hossler, A.T.C.

School Sports Concussions in Children and Teens

By Phil Hossler, A.T.C., Jeanne Dise-Lewis, Ph.D., Marilyn Lash, M.S.W., Roberta DePompei, Ph.D., Ron Savage, Ed.D.

By Bridgid M. Ruden, ARNP

My memory and speech changed after my brain injury

In May of 2008, I suffered traumatic brain injury following a bicycle accident. I needed four brain surgeries, three of which were life saving entities. The fourth brain surgery replaced my previously infected skull bone with a titanium plate. My brain has responded to this trauma by forcing epilepsy into my system. Such trauma has shocked my mind and body especially since this has changed me. Frequent denial of this experience is my way of coping. Denial clouds aspects of my acquired memory loss and therefore distorts my reality. 

Some of the most challenging aspects I continue to struggle with are aphasia and memory loss. Aphasia is the partial or total loss of the ability to communicate verbally or use written words. I required two years of speech therapy which has improved my aphasia greatly. I continue to experience aphasia in the following ways: 

• Difficulty speaking effectively and recognizing the name of basic objects, streets, animals, food, etc.
• Reading two pages slowly and losing my memory of what I just read.
• Writing accurate sentences, spelling correctly and appropriately and effectively using a computer.
• Noise greatly impacts my ability to focus, concentrate and remember the things I am attempting to complete.

In addition to aphasia, I maintain significant memory loss, which truly impacts my life experiences. Memory loss is a frequent lifelong result for traumatic brain injury survivors. Therefore, I do not feel insane for the occurrence of my situation. I am challenged to understand and remember what people say to me. The slower a person speaks to me significantly enhances my ability to understand. 

I usually forget the names of people and how I met them. In order for me to remember their name, I need to practice saying their name numerous times before it is obtained. In addition, I also have to see a person several times to understand where I met them or what they do. Sometimes I recognize the sound of their voice, potentially linking me to where I met them.  

Searching for all those lost things  

I frequently lose and forget where objects, such as a cell phone, were placed. Therefore, people have a challenging time reaching me. I have lost so many items and recently learned that I find them in the garbage can!  We have had to purchase so many cat litter scoopers! Can you guess where I found the last one? It was in the garbage! Therefore, I continue to check in the garbage for any lost items when it is not too disgusting! 

One of my most embarrassing moments occurred when I was doing laundry. I went to pull out the clothing from the washer and at the top of the clean laundry was a Playtex container that was scattered! All the tampons were still covered with plastic so naturally I tried to save them! When I got to the bottom of the clothes I found a full bag of brownie mix! At this point, I felt as if I had lost my mind, as I had no idea how or why this occurred!  

I have a tendency to forget to put the washed clothes into the dryer and place things in the dryer that I have been asked not to mechanically dry! I frequently forget to take my seizure medicine which is prescribed for the morning and evening. I do not realize that I have not taken it until later in the afternoon or early evening. A properly labeled daily medication container is used but I often forget what day it is to make sure that I took the medication! 

My memory affects my children too.  

Utter sadness is instilled at the loss of my ability to assist with homework, play certain games with my children and cook effectively. Homework was challenging even when they were in elementary school! This was embarrassing and demeaning since prior to this brain injury, I used to be a good speller and could effectively use a computer. When I play simple games with my children, I am slower than previously, forget how to play the games and usually do not win or excel in my understanding or knowledge of the game. In addition, I cannot remember what is supposed to happen tomorrow even when I heard about it the night before. I also have a tendency to burn myself when cooking and forget a recipe I knew before. I need to read a recipe several times, slowly, to comprehend it.  

Steps, seizures and driving bring more challenges

My memory loss and balance issues present themselves when I do not notice or recall uneven ground or steps. I have injured myself when I hiked on a wooded trail, walked on a sidewalk that was altered for the handicapped and when I departed from a podium. It is difficult for me to walk up and down stadium bleachers.  Once I was on a podium platform sharing my story and as I left, I thought that in front of the area was a typical step. But this area was a huge single step downward like the front area of a stage! I am frequently asked, “How did you get your bruises?” Bleeding and bruising can result from secondary side effects of my seizure medicine.

I am finally able to drive again as my seizures have not re-occurred for six months! Being able to drive gives me such joy, especially since I have three children. I often forget where I parked the car or placed the keys. To help me remember where I park when I go shopping, I tell myself over and over again where I parked and which car I drove. The electronic key that activates the horn has been very helpful to me in locating the car. My worse episode occurred as I drove the car into the garage, parked, shut the garage door and headed into the house. There was a strange noise and I didn’t know where it came from. I stepped into the garage and I gasped as the car was still running! 

Losing my sense of self worth and finding a new purpose in life

Sadness, despair and hardship surround my sense of self worth from the dynamics of my memory loss. I also lack the ability to assist with our financial issues which I easily understood previously. I no longer understand when payments are due, what we pay for and have trouble with adding and subtracting! One of the most debilitating consequences of my disabilities is that I no longer have the health care knowledge that I had previously as a Pediatric Nurse Practitioner. My health care knowledge has been significantly diminished! 

Despite the aspects of my disabilities, I have learned and achieved an experience that has returned JOY to my soul! I speak publicly to health care professionals, legislators, survivors and their advocates to share what I have experienced in the process of exploring, managing and recovering from traumatic brain injury. I have achieved validation that my struggles are typical for other survivors. I am amazed and honored that those participants who have heard my story described it as inspirational, a powerful story, personally moving, amazing testimony and beneficial and necessary for health care professionals. Over time, I have slowly and gently learned and gratefully accepted that I still have a purpose in this lifetime!

www.bridgidruden.com

http://bridgidruden.wordpress.com/

Recommended Reading 

Lost and Found  

Barbara Webster

Living Life Fully after Brain Injury: A workbook for survivors, families and caregivers 

Marilyn Lash, M.S.W.

Coping styles vary within families after brain injury

Every family has an emotional reaction when a spouse, sibling, child, or other relative has a traumatic brain injury. Each family has learned ways of coping from previous experiences with stresses, losses and changes in their lives. Some methods of coping have been productive for families in the past and helped ease not only their levels of stress and anxiety, but helped them problem solve and prepare for the future. Other ways of coping may not have been as productive for families. Some may have learned from this and changed how they cope with stress or change, while others may be stuck repeating negative patterns.

Emotional trauma of brain injury

We all know that nothing prepares families for the emotional trauma of brain injury. But we do know most people, including families, often react and cope in ways that are familiar when facing a crisis. If a strategy has helped in the past, the hope is that it will help in this new crisis. If it has not worked in the past, hopefully a different strategy will be considered. This sounds simplistic but it makes sense and it is based on patterns of human behavior. 

So if you are a family member of someone with a brain injury, you might consider thinking about how you have coped with the many changes and losses in your life. Surveys of families with a member who had a traumatic brain injury grouped their responses into five categories of cognitive, psychological, spiritual, support systems, and physical coping (DePompei, 2011).

Cognitive coping

This person looks for and uses information. Searching the internet is a common example. There are lots of ways that “cognitive copers” gather information including reading books and articles, talking with other families, attending conferences and workshops and contacting experts.

Psychological coping  

This person’s coping style uses internal positive thoughts. Examples are individuals who count their blessings, take it one day at a time, and focus on improvements and hope. Some take up a cause for prevention or public awareness or finding a cure – it may be brain injury in this case. For others, it may be breast cancer, diabetes, or some other illness.

Spiritual coping

Belief in a higher power brings great comfort to many. Those who use spiritual coping strategies may talk with clergy, read religious books, inspirational stories, or meditate. 

Support systems for coping

These people cope by reaching out to others. It may be as simple and informal as talking with friends to joining formal support groups on brain injury to participating in community groups or activities. 

Physical coping

Many people find that exercise reduces their stress and tension – it may be walking, jogging or aerobics. Others clean house, eat, cook or listen to music. 

Find what works for you

Everyone is different so it’s important to know what works for you. Most of us use several coping styles depending on the circumstances and the types of stress we are facing. By better understanding how you cope, you can take the steps to a more positive future. 

References

DePompei, R (2011). Coping Styles of Individuals and Families after Traumatic Brain Injury. Brain Injury/Professional,  8(4), 26-27. 

Recommended Reading 

Brain Injury It is a Journey

Flora Hammond, M.D. and Tami Guerrier, B.S., Editors 

Life Changes: When a spouse or partner has a brain injury