Due to the nature of Traumatic Brain Injuries (TBI), family members play a crucial role in the rehabilitation of a wounded warrior. Indeed, some estimates indicate that as much as 80 percent of the total lifetime care that is provided to a TBI victim is given by that individual’s family. Thus, it is essential that family members have the tools they need to provide the best care possible. While full rehabilitation may not be a possibility for some individuals, educated family members will be able to drastically increase the likelihood of meaningful improvement in a wounded warrior’s quality of life.

The rehabilitation process can be a long and grueling one depending on the nature of the TBI. The main objective of this process is to help the injured individual manage and overcome the difficulties associated with the injury. This often involves the use of specialized treatment plans catering to the individual's needs. However, a treatment plan can be successful only through the best efforts of medical personnel, family members, and the injured person.

What is Traumatic Brain Injury?

TBI is a commonly associated with a blow or jolt to the head. While this could be caused by a broad range of events, it is often linked to injuries sustained during combat operations, particularly in Iraq and Afghanistan. The Global War on Terrorism has exposed soldiers to the frequent use of improvised explosive devices (IED) by hostile combatants. The concussive force of these explosions and the physical impact that often results may lead to a TBI. As the brain is a very delicate organ, any type of damage can cause negative external effects. These effects can make every day life extremely difficult. For a more thorough analysis of TBI and its causes see Veteran’s Guide to Traumatic Brain Injury. In most cases, a wounded warrior who suffers a TBI will require rehabilitation to assist in the recovery process.

What Role Can I Play in the Rehabilitation Process?

While some wounded warriors will receive around-the-clock medical treatment at a healthcare facility, the majority of those suffering from a TBI will return home. This means that you, as a family member, play a crucial treatment role:

• In a hospital setting you may be called on to provide important information about former personality traits and abilities that will better enable medical personnel to identify the effects that a TBI is having.
• You may be asked to provide personal items to aid in memory recovery.
• In severe cases, you may be called upon to learn how to assist the injured warrior in essential bodily functions.
• In less severe cases, your assistance may come in the form of participation in the speech therapy process, or helping your loved one relearn certain tasks.
• You may be called on to keep track of the wounded warrior’s rehabilitative progress thereby providing vital information to medical professionals.
• You may be eligible for the new  VA "caregiver" program, which provides a stipend and access to support and health insurance if you are caring for an eligible veteran at home. More information about that new program is available here.

Read more below about identifying symptoms

Where Can I Learn More about Being a Family Caregiver?

Recognizing the vital role that family plays in the rehabilitation process, Congress has passed the National Authorization Act of 2007. This law mandates “coordinated, uniform, and consistent training curricula to be used in training family members in the provision of care and assistance to members and former members of the Armed Forces with traumatic brain injuries.”  Accordingly, the Surgeon General has created a series of guides for family caregivers to help train you on the various problems that are associated with caring for a person with a TBI:

• Module 1 provides general information about TBI and its implications for the human brain.
• Module 2 explores the effects of TBI and what can be done to alleviate those problems.
• Module 3 discusses your role as an advocate, as well as other issues such as guardianship, power of attorney, and various relationship factors.
• Module 4 outlines the services and benefits available to TBI victims.

In addition, a separate guide the Caregivers Companion outlines military structure, medical terms, and lists the various medical professionals that you can expect to encounter during the rehabilitation process. These guides are available at the Center for Excellence in Multimedia Medicine’s (CEMM) website, The Journey Home, a project of the U.S. Surgeon General’s office. The website also contains a video collection designed to provide support and advice to family caregivers and caregiver journals that are very useful for keeping track of the rehabilitative progress of a loved one.

The Brain Injury Association is a valuable resource, providing extensive coverage of TBI. They also sponsor a family helpline at 1-800-444-6443.

The Defense Veterans and Brain Injury Center also posts some excellent advice for family caregivers, and provides a referral service for those who believe their loved one may be suffering from a TBI and in need special care. DVBIC can be reached at 1-800-870-9244 or online. DVBIC also maintains an informational website, Brainline.org, where family members can watch webcasts on TBI. 

Other useful websites

Family Caregiver Alliance - more useful information for family caregivers
Afterdeployment.org - provides assessment tools to help family members evaluate their relationships, as well as workshops and videos to assist in solving potential problems
Brain Injury Information Network - online support group, including chat rooms

What about Depression, PTSD, and other Risks Associated with Traumatic Brain Injury?

Aside from the direct physical complications associated with TBI, families should be aware of additional risks - namely, behavioral disorders and depression. A variety of factors are at play with regard to these complications. Among those factors are conditions such as Post Traumatic Stress Disorder (PTSD), which is also associated with traumatic events. In addition, a wounded warrior can be overwhelmed by the intense stress that he is experiencing. The TBI victim may be transformed from a state of health to, in some cases, a state of almost total debilitation. These changes can have a drastic impact on the individual's mental state.

The mental state of an injured person can lead to a change in normal behavior, and at times that change can be for the worse. Evidence suggests that many military personnel suffering from psychological issues like PTSD are at increased risk of substance and/or alcohol abuse. The use of drugs and alcohol can become very appealing as a method of escaping a reality that is often too difficult to accept. As a result, behavior problems and depression are only compounded. The individual can easily and quickly spiral out of control, which may lead to legal trouble, spousal and family abuse, demotions, and even military discharge.

Why is Discharge Status Important? 

In a military environment, these changes may lead to other serious consequences. The prospect of a bad conduct discharge is a problem for a TBI victim who is suddenly displaying behavioral problems. In what some call the “military catch-22,” the individual could end up being discharged for impermissible "behavioral conduct." This may, in turn, result in a VA benefits disqulification. Thus, the very injury that caused the behavioral problem in the first place could go untreated. To read about the different types of military discharges and the implications that such a departure has on a veteran’s ability to receive benefits see Military Discharges.

Additionally, there is a current tendency in the military to discharge a member as having a "pre-existing personality disorder." Personality Disorder is a diagnosis, much like PTSD and TBI. However, a servcie member with this type of separation will not receive treatment from the VA because the VA views the personality disorder as existing prior to military service. The symptoms of TBI/PTSD and Personality Disorder are very close; the line is hard to draw. Often, the line is drawn incorrectly. To make matters worse, many of these individuals are forced to pay back their military bonuses. For a more extensive discussion of this issue see TBI and Discharges.

So What Can I Do to Help My Injured Service Member?  

In light of these dangers, it is vital that you, as a family member, closely monitor your returning loved ones for signs of a potential issue. Typical signs include:

• depression,
• difficulty controlling emotions,
• problems managing complex tasks,
• self-medicating with drugs and alcohol,
• engaging in thrill seeking behavior,
• insomnia, and
• sleep disturbances.

If any type of mental or emotional problems appear, seek medical help! This is very important. Seeking aid can highlight the problem for medical professions and secure appropriate treament for suffering individual.

Thus, it is crucial that family play an active role in monitoring the mental well-being of their loved one.

Updated January 2018