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Family and Care Givers

From "Understanding Traumatic Brain Injury" by Richard H. Adler

When someone close to you has a brain injury, it can be hard to know the best way to help. Individuals with brain injuries may deny that anything is wrong, but a family member or close personal friend can tell that something has changed. Your family member’s ability to communicate may be affected if the traumatic injury resulted in damaged areas of the brain that control speech, comprehension, and the ability to use words to make sentences and express ideas. Changes in your family member’s ability to communicate can lead to loss of friends, misunderstandings, or difficulty in school or at work. Your family member may feel frustrated, lonely, angry, or depressed. When someone close to you has a brain injury, it can be hard to know the best way to help. Individuals with brain injuries may deny that anything is wrong, but a family member or close personal friend can tell that something has changed. If you notice that a loved one has symptoms of brain injury that are getting worse or not getting better, it’s time to talk to your doctor about getting help. Reasons for getting help include:

  1. Noticeable personality changes or person gets angry for no apparent reason
  2. Person gets easily confused
  3. Noticeable and increased trouble in making decisions
  4. Problems with memory or recall
  5. Persistent or recurrent headaches
  6. Persistent fatigue

The good news is that there are many people who can help you and your family as you recover from traumatic brain injury or a closed head injury. You don’t need to do it alone. There are many others like you who have gone through this. There are organizations and resources available to you. Talk with your doctor about your concerns. Ask your doctor to refer you to a medical specialist who knows how to assess and treat traumatic brain injury patients. Your doctor should be able to help you find a healthcare provider (such as a neurologist, physiatrist, or neuropsychologist) who has special training in this area. As in most medical areas, early assessment by competent professionals who specialize in traumatic brain injury rehabilitation can help speed recovery. You should know that your doctor may refer you to a neurologist, neuropsychologist, radiologist, neurosurgeon, or specialist in rehabilitation, know as a physiatrist. Another good idea is to talk with people who may have experienced what you’re going through. Contact the Brain Injury Association of Washington at (206) 388-0900. They can put you in contact with people who can help. They provide information and put people in touch with local resources, such as support groups, rehabilitation services, and a variety of healthcare professionals.

You can find out more information about traumatic brain injury by contacting:

  • Brain Injury Association of Washington, 206-388-0900 or www.biawa.org
  • Brain Injury Association of America, national help line: 1-800-444-6443; or using their web site www.biausa.org
  • Centers for Disease Control and Prevention, web site at www.cdc.gov/ncipc/tbi

Finally, here are some practical day-to-day tips to keep in mind when communicating with a TBI survivor (not all situations will apply to a given person):

  1. Establish and maintain a daily routine - this helps your injured family member feel more secure in his environment. Frequent changes may upset the person.
  2. Be satisfied with short-term minimal improvement until they are emotionally prepared to face long-term goals.
  3. For answers regarding medical problems and degree of recovery, refer to the doctor or therapist.
  4. Give cues to aid in orientation to time, place, and reality by providing a calendar and clock. Encourage your family to write things down to help memory and organization.
  5. Be natural with your family member and help her to maintain her former status in the family.
  6. Unless your family member is too ill or impaired, include him in family affairs. Consult with him and see that he shares in family decisions as he did before. Help him to feel like the person he was before he was injured.
  7. Do not overwhelm the person with false optimism or words such as, “you will be all right...you will be back to work in no time.”
  8. Emphasize your family member’s abilities, not her disabilities in language as well as physical limitations.
  9. Point up every gain your family member has made since the onset of his injury. Do not compare his speech, language, or physical abilities prior to his injury with those of his present status. Look ahead, not back, and help your family member do the same.
  10. Treat your family member as an adult. Don’t talk down to her - causing her to feel she is acting like a child is annoying to her. She may withdraw into her shell or rebel.

A recent publication, “Communicating with an Adult after Brain Injury,” published by the Brain Injury Association of America in 2006, provides excellent tips on questions to ask yourself to improve communication with your family member. The following are some of those examples:

  • Did my family member understand what I said?
  • Did I speak slowly enough?
  • Did I give clear, step-by-step directions?
  • Did I use puns or humor that was not understood?
  • Can I help my family member understand by using pictures or writing?
  • Am I distracting my family member with too many gestures, too loud a voice, or too many pauses?
  • Is the environment too loud, congested, bright, or confusing for my family member?
  • Can I simplify this by speaking in shorter, clearer sentences?
  • Can I give a more organized explanation?
  • Have I identified other people who can help?

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