Families of Veterans with Mild Brain Injury

 How Families Deal With TBI in Veterans

By Carolyn Rocchio

Mild brain injury is a real problem for families

Many service members and veterans have returned from war with undiagnosed mild brain injuries or concussion.  Greater emphasis is now being placed on case management and coordination of services for service members and veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom after sustaining traumatic brain injury in response to the July 12, 2006 report from the Department of Veterans Affairs Office of Inspector General (1). This need was reinforced by testimony before the House Veteran’s Affairs Subcommittee on September 28, 2006 with the presentation of alarming data about the large numbers of blast injuries resulting in changes in neurosensory deficits (2).

Traumatic brain injury has become the “signature” injury of Operation Enduring Freedom and Operation Iraqi Freedom. As of January 2006, the Department of Defense reported more than 11,852 returning wounded had exposure to blast injuries (2). It is reasonable to conclude that many additional service members/veterans who have been exposed to blasts without bodily injury are later experiencing classic signs of mild brain injury.

Mild brain injury is a significant problem in the general population in this country as well. According to data from the Centers for Disease Control and Prevention 1.1 million Americans are seen annually in emergency departments with mild brain injury and countless numbers are never screened or diagnosed.(3)

Coming home isn’t always easy

Many service members/veterans return home with the expectation that their lives will resume as they were prior to deployment. Such is not the case for many who have been exposed to blasts. Without information and resources to guide and support the service member/veteran and family, a “mild” brain injury can take a serious toll on the family. It is critical that service members/veterans be screened for a mild brain injury when exposed to blast injury and given appropriate follow up and treatment. Equally important is educating the family members who will ultimately become the support team once the veteran completes treatment. Families must be made aware of the nature and consequences of mild brain injury and provided with tools to provide support in the months and possibly years to follow.

Social workers should be aware of informational resources to assist families being seen in VA facilities, both inpatient and outpatient. Many educational resources and publications exist to educate families. In turn, families must be taught how to access community resources and be prepared for changes and characteristics common to mild brain injury. Some of the more common characteristics that may be present on discharge or develop later include:

  • headache
  • fatigue
  • dizziness
  • memory problems
  • sleep disorders
  • problems concentrating
  • ringing in ears
  • irritability
  • visual changes
  • sexual dysfunction
  • sensitivity to light, sound and odors

Even though some or many of the characteristics above may exist, the overall appearance of the individual can still be unchanged unless there are other physical injuries. This appearance of well-being can be misleading for family members, friends, and others. Even the service member/veteran is not always aware of the less visible cognitive changes. This can lead to frustration when the family is not patient and supportive.

A mild brain injury can be tricky to diagnose

Mild brain injury is often difficult to diagnose as changes in brain structure are seldom captured by CT or MRI scanning. This lack of physical evidence of an injury can result in labeling the individual as “faking” or malingering, when in fact there have been molecular changes in the brain that affect how the individual thinks and acts. A neuropsychological assessment is the key piece of information that can explain how the injury has affected the individual’s functional capabilities. Ideally the service member/veteran, family members and the neuropsychologist should meet to discuss the findings and establish ways the family can support and promote emotional well being of the service member/veteran and other family members.

All members of the family undergo a difficult adjustment once the service member/veteran returns home. There may have been many role reversals with family members assuming new responsibilities while the service member was deployed. After a brief honeymoon period, when everyone is delighted that the service member has returned, things can go down hill very rapidly. This can happen when others see the subtle changes, but do not understand the cause. At this point, it is not uncommon for the service member/veteran to develop a secondary emotional response to these changes. This can create new problems, that without professional intervention, may escalate into family dysfunction and even violent behaviors. This secondary emotional response often becomes even more disabling than the original insult when support is not available. This can lead to a psychiatric referral that further exacerbates this issue. Persons with mild brain injury often describe themselves as feeling “crazy” because they do not understand the changes they are experiencing.

Risks at home

Families need to be extremely vigilant when there are small children in the home. Irritability and impaired behavioral control can result in children becoming the target of the service member/veteran’s temper when seemingly minor interactions become emotionally charged. Older children may need help understanding why the parent who was once loving and supportive becomes moody and irritable for no apparent reason.

Trying to return to work can be fraught with problems. While the initial return to a job may be met with exhilaration and a sense of camaraderie with old colleagues, problems may surface over time. The service member/veteran may find things that were once easy are now far more difficult. The pace of work is slower. Fatigue is a major factor. Interaction with coworkers can become argumentative and problematic.

Seizure activity can develop some months or even years after a blow to the head. Often these seizures are not convulsive, but more likely to be partial complex temporal lobe seizures which manifest as a change in behavior. The service member/veteran may complain about foul odors, become more sensitive to light or sound, pace the floor and even have hallucinations. Any symptoms should be reported with a follow up evaluation to determine if seizure activity is present.

What can be done to lessen these problems?

Carolyn RocchioStructure is important for reestablishing a daily routine. Military personnel have one advantage in that they are very disciplined and used to taking orders from others. Until the routine is going smoothly at home, the spouse, parent or significant other may need to be the authority figure and help set up a structure. It is not uncommon for a brain injury to affect a person’s ability to initiate a daily routine. This can be particularly difficult when moving from the highly structured military regime back to a more relaxed home setting.

Some helpful strategies for family caregivers include:

  • Use day planners, post it notes, and written lists to minimize problems related to memory loss.
  • Use watches with alarms, egg timers or electronic timers to keep track of time related tasks.
  • Organize all possessions, shelves, drawers, etc with everything in an assigned place to prevent the frustration of locating lost or misplaced items.
  • Build in time for relaxation, meditation and/or yoga and Tai Chi to reduce stress.
  • Encourage social interaction, but make sure all friends, families and others are aware of the service member/veteran’s persistent problems and ways to interact more successfully.
  • Find support groups. The assurance of others with similar residual affects of mild brain injury can be extremely important. Some VA centers with brain injury programs sponsor such groups. Information about community based support groups for individuals with brain injuries and their families can be obtained by contacting the Brain Injury Association of America at 800-444-6443 for referral to the group nearest the family.
  • Plan time each day for rest or a nap to offset the effects of long term fatigue. Many will experience disrupted sleep and may require medication to insure restful sleep occurs.
  • Model calm when things become emotionally charged. In the event that violence is an issue, make sure family members leave the area to avoid being injured until calm is restored.
  • Seek professional help from a person familiar with mild brain injury in planning the work environment to ensure a successful return to work.
  • Ask about the use of alcohol and nonprescription drugs before discharge. Alcohol and street drugs can have negative effects when medications are prescribed for conditions such as seizures. In general, any use of alcohol has an exaggerated affect on a person with brain injury. Use of alcohol and other substances is best reinforced if guidance is provided in discharge summaries so family members can rely on professional direction in written form.
  • Ask about driving safety due to changes in perception, judgment, visual, and attention deficits. Driving should not be resumed until the service member/veteran is evaluated by a Certified Driving Educator, where emphasis is more on cognitive functions than the mechanical ability to operate a vehicle.

Summary

Mild brain injury can create significant disruption in the lives of the person with the injury as well as members of the family. To insure a more successful recovery, it is critical that there be a thorough assessment to determine what areas of the brain have been injured and the effects on everyday functioning. Additionally, once cognitive deficits have been identified, it is important that strategies to compensate for these deficits be developed. Lastly, family education and resources must be provided. A well informed and supportive family is the major component of successful community reentry.

References:

 (1) Health Status of and Services for Operation Enduring Freedom, Operation Iraqi Freedom Veterans after Traumatic Brain Injury Rehabilitation. Report Number 05-01818-165. VA Office Office of Inspector General. Washington, DC , July 12, 2006.

(2) Zamperi, Thomas. Chrm. Director Government Relations, The Blind Veterans Association. Testimony: The House Veterans Affairs Subcommittee. September 28, 2006.

(3) Langlois J, Rutland-Brown W, Thomas K. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004.

Recommendation reading

Mild Traumatic Brain Injury WorkbookMild Traumatic Brain Injury Workbook

By Douglas J. Mason, Psy.D

Workbook for adults, veterans and families on mild traumatic brain injury and concussion symptoms with strategies and exercises for improving attention, memory and executive functions.

 

BRAINLASHBrain LASH

By Gail Denton, Ph.D.

Book helps adults and families understand mild brain injury symptoms with strategies for physical, cognitive and emotional changes after concussion.

 

 

 

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3 responses to “Families of Veterans with Mild Brain Injury”

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