Think Differently About Traumatic Brain Injury: Tips for Daily Living

Blows to the head can occur from a myriad of circumstances. True, not all blows to the head will result in a brain injury, but even a “hard hit” to the head that leaves someone momentarily dazed or with headaches following soon after the hit can disrupt thinking skills for a short period of time. And, repeated blows like this may result in cumulative effects that can affect thinking skills for longer periods of time. More moderate or severe brain injuries will more likely than not leave a person with various long term cognitive difficulties. Therefore, when interacting with someone who has suffered some degree of traumatic brain injury (TBI), whether your role is family member, caregiver, friend, teacher, employer, there are important things to know and understand about those who live daily with the effects of a TBI. That's right—daily. While brain tissue heals and severity of cognitive symptoms may lessen over time, cognitive difficulties persist. As for anyone, some days are better than others.

Should you find yourself in the role of someone caring for or frequently interacting with a person with TBI, your awareness and understanding of what he or she may experience at any given time, identifying the best times to help, and knowing what types of actions are most helpful would be appreciated more than you know. For example,
  • Frequently forgetting to do something or how to get somewhere familiar is both frustrating and rather unnerving for a person with TBI. Instead of considering this behavior intentional, inattentive, or irresponsible—help with planning ahead and whenever appropriate, encourage use of smartphone or computer calendars to make lists, prompt with alarm reminders, and save directions to frequently accessed destinations. Remind the person to write down information, show understanding of what he/she wrote, and know where to access this information when needed (including remembering to bring and keep it with him/her).
  • Fatiguing more easily during the day or coping with fluctuating moods could affect social interactions, quality of performance, and motivation to participate in activities. Allowing someone with TBI to get an ample block of restful sleep at the end of his/her day and take short breaks during the day helps to avoid becoming or feeling overwhelmed. One's understanding that things that are said and done out of frustration, anxiety, or fatigue may also help prevent taking these words personally. Realize that impulsively uttered words and impulsive actions may occur more often when people are tired and not self-regulating as well as they could prior to their injury or when well-rested.
  • Conversations may wander because a person with TBI forgets the topic or is easily distracted. Finding the right words to say at the desired time may also occur. Instead of becoming impatient or disinterested, guide the speaker back to the target topic. “Tell me more about _____.”; “What were you saying about ____?”; “You mentioned earlier that Joe will be traveling to Europe. When will he be going?” Be considerate when wanting to finish sentences when words escape the speaker. Some people may want that level of assistance, but others may not.
  • Headaches and pain may interfere with just about everything at any time or all the time. The pain and discomfort are very real and can be extremely debilitating. Encourage regular practice of relaxation methods like diaphragmatic breathing (“belly breathing”), yoga, and other exercise; taking short breaks; getting adequate sleep; staying well-hydrated, avoiding nicotine and alcohol; adhering to the physician-recommended medication regimen, if prescribed.
  • Sometimes a person with TBI may not “get a joke” like they used to or may be slow to answer questions because the way information is processed has changed. Do your best to remain patient and supportive. Repeat information or the question without showing frustration on your face, voice, or body language. Explaining in simpler terms, in shorter utterances, or in short and simple written sentences will support better attention and increase the likelihood that information is understood and remembered accurately. The chance that you will receive an appropriate response more quickly also increases.
  • Making mistakes in spontaneous speech, writing, and actions and not catching these mistakes may often occur. When those who are coping with the after-effects of TBI say, “I didn't do/say that,” they may really believe that it happened that way because their attention, memory, and self-monitoring skills have been affected. Sometimes their spoken responses or actions occur so fast and without thought like a spontaneous reaction. Without awareness or attention to what is said or done, the information will not be stored very well in order to allow for later recall.
  • Falling or staying asleep may be disrupted. Poor quality or lack of sleep will affect thinking, mood, actions, and overall health, especially when sleep is problematic for long periods of time. Be supportive while helping to maintain a structured schedule and a consistent routine. Discourage drinking too much caffeine and alcohol, smoking, or taking sleep-inducing drugs. Encourage relaxation and daily exercise (an earlier in the day workout is better than a late one), participate together in a “wind-down” routine that begins at least two hours before bedtime, and encourage “belly breathing” while lying in bed.
Better outcomes for everyone will result when one knows and accepts that a person with TBI tends to process information differently than before injury and may initially understand and respond to this information inaccurately or inappropriately. After injury, the way the brain works may affect how a person thinks, feels, and acts. By taking an enlightened approach to caring for or interacting with a person with TBI—thinking differently about what is observed and experienced-- caregivers and other key roles will facilitate recovery and improvement. One will increase opportunities for effective supportive and productive interactions while avoiding further mutual aggravation, hurt feelings, and misunderstandings.
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