Understanding TBI Part 1 (Text Alternative)

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Infocomic Main Characters

Sam: A young White woman. She has blonde, shoulder-length hair.

Mike: A young White man. He has a shaved head and a visible scar on his scalp. He is Sam’s brother.

Carolyn: A middle-aged White woman. She has blonde bangs and thick-framed glasses. She is the mother of Sam and Mike.

Lewis: A middle-aged White man. He has short dark hair and thick-framed glasses. He is the father of Sam and Mike.

Cheryl: A middle-aged White woman. She is a physical therapist, and she has long, straight blonde hair.

Jeanne: A middle-aged White woman. She is a clinical psychologist, and she has short, wavy dark hair.

Li: A middle-aged Asian woman. She is a speech and language pathologist, and she has shoulder-length dark hair.

Valentina: A middle-aged Spanish woman. She is a rehab-focused social worker. She has long, dark wavy hair.

Nurse: A young White woman. She has long blonde hair pulled back in a ponytail.

Raj: A middle-aged Indian man. He is an occupational therapist, and he has short, dark hair.

Plot

Sam is seen walking into a city hospital.

“Hi, I’m Sam! I’m at City Hospital visiting my brother Mike,” she says to the reader. “He was in a car accident. Come on, I’ll introduce you to my family.”

Sam walks into her brother’s room, where she greets her brother Mike, her father Lewis, and her mother Carolyn. Mike is resting in a hospital bed and wearing a hospital gown. Carolyn is sitting on the side of his bed, and Lewis is in a chair next to them.

Sam introduces her family to the reader. “This is Mike, and our parents Carolyn and Lewis. He’s been in the Neuro ICU (NICU) for two weeks for his Traumatic Brain Injury (TBI).”

Sam speaks to Mike. “Mike, today is a big day. You’re going to the Rehabilitation Unit!”

Mike responds, “Where are we? Can’t I just go home?”

A patient may be confused and disoriented after a TBI.

Carolyn tells Mike, “You’re at City Hospital but you’ll be able to go home soon.”

Sam says, “Therapies you’ll have in rehab will help you with your recovery.”

Recovery begins with the therapies used in a brain injury rehabilitation unit. The therapies help the brain make new connections. Patients may have physical, occupational, and speech therapy and other treatments. Remember that these changes don’t happen quickly. Hospital therapies are a good first step, but outpatient therapy and activities at home are needed after the patient is released.

Cheryl is a physical therapist. She checks physical limitations, measures how severe they are, and plans treatments and activities to help address them.

Cheryl and Mike are shown in a room with exercise equipment. Mike is in a wheelchair.

Cheryl says, “Hi Mike, our goal today is to make a plan to get you back to walking. Are you ready?”

“Yep! That sounds good,” says Mike.

Mike is moved to a therapy table. Cheryl places her hands against his legs.

“Okay Mike, I want you to hold your leg straight. I’m going to try to push it down. Don’t let me,” Cheryl says.

Mike is then shown standing between two guiding rails. He grips the rails to hold himself steady.

Cheryl says, “Now that we know which muscles need work, we can start making an exercise program. You have some balance issues, but your main physical problem is that you are weak from being in bed for so long.”

Mike is shown using a cane to walk.

Most people with TBI can walk and use their hands well within the first year of their injury.

Mike is shown laying on his stomach while he bends his legs.

The physical problems that a patient might have after a TBI usually don’t stop them from driving or being self-reliant over time.

Mike is shown catching a ball.

Some physical effects may last a while after a TBI. Problems with balance, weakness, or tiredness can mean that a person isn’t as active as before their injury.

Cheryl is seen standing next to Mike as he wipes sweat from his brow.

Cheryl says, “Great work today! I bet you’re tired!”

Cheryl then helps Mike out of the hospital in a wheelchair.

Sam says, “Let’s give Mike some space and check back in for his rehab psych appointment on Friday.”

Jeanne is a clinical psychologist. She specializes in rehabilitation. Her job is to give counseling after a TBI. She sometimes uses neuropsychological tests to measure a person’s thinking-related strengths and weaknesses after a TBI.

Jeanne is seen speaking to Mike and his whole family.

Jeanne says, “Mike, we’ve gotten the results of your neuropsych evaluation. You did well but there are a few areas where you had some difficulty.”

Mike responds, “Yeah, some of the tests were really hard!”

Jeanne says, “Well that’s ok. They’re meant to be difficult. You had some problems focusing, switching your attention between things, and processing larger amounts of information.”

Jeanne points to a graph with an arrow pointing upward. “These are common problems after a TBI. I expect that as your brain continues to heal you’ll improve in all these areas.”

Mike responds, “Oh good.”

Jeanne holds up a paper referral. “I’d like you to meet with Li; she’s our speech and language therapist. She’ll work with you on your cognitive recovery.”

After a brain injury, a person may have trouble with some of the mental activities that help them to be independent and capable in our complex world. To help us be independent in daily life, our brains process a lot of information all the time. This is called executive function. People with moderate-to-severe brain injuries often find it difficult to perform basic thinking tasks. Because of this, they might have trouble paying attention, concentrating, and remembering new things. They may also:

• Take longer to think, speak, and solve problems;
• Be upset when routines change or when there’s too much going on or it’s noisy;
• Spend too much or too little time on a task, and then be unable to switch to a different task when they find the first one difficult;
• Choose the first “solution” without thinking it through; and
• Have speech and language problems, like trouble understanding some words or finding the right ones.

SPEECH AND COGNITIVE THERAPY

Li is a speech and language pathologist. She helps people learn to speak clearly or find the right words. She also helps with other cognitive problems like organization, focus, and processing a lot of information.

Li is seen speaking to Mike. "Hi Mike, today we’re going to do some exercises to strengthen your focus, and your ability to organize information.”

Li shows Mike a chart. “We call these things ‘executive function’ because they help you be in charge of your life.”

Mike says, “I always wanted to be an executive, but I’m not sure I’m dressed for it.”

Li responds, “I can also teach you some strategies for how to deal with some of your limitations.”

Two weeks later...

Sam is seen in an elevator at the hospital. She says to the reader, “We’re getting ready for Mike to leave the hospital next week. But there is one big problem that Valentina is helping us with.”

Valentina is a rehab-focused social worker. She provides guidance and counseling to help patients find the resources they need and transition out of the hospital.

PROBLEM-SOLVING METHODS

Carolyn is seen speaking to Valentina in a room with Sam. “When Mike leaves next week, he’s going to move in with us for a while. The problem is that we don’t have an easy way to get his stuff out of his old place. We can’t afford to pay movers, don’t have the time to do it ourselves, and feel weird asking friends.”

Valentina responds, “This is a great time to go through the problem-solving method!”

Valentina points to a list, “So, here are steps in the problem-solving method. Look! You’ve already done the first two!”

The list says:

• Identify the problem and set a goal;
• Brainstorm solutions;
• List positives and negatives of each one;
• Choose the best one;
• Try it; and
• If it doesn’t work, try another one or rethink your goal.

Valentina holds up an empty chart of pros and cons and says, “Now let’s list the pros and cons of each one.”

Carolyn responds, “Now it seems so obvious. I guess I should call and ask for their help.”

If you’re new to the problem-solving method, practice with a small problem before using it on a big one.

EMOTIONAL AND BEHAVIORAL PROBLEMS

Emotions and behaviors can often change after a TBI. These changes can come from physical or chemical changes to the brain. They can also be caused by problems with thinking or paying attention. Money worries or life changes because of changed abilities can also play a part. These changes can be distressing for everyone. Fortunately, with training, therapy, and other support, people can learn how to manage these problems. It’s also important for family and friends to help patients find ways to cope.

Mike is seen shouting at Lewis while Sam speaks to the reader.

Sam says, “Since Mike has come to the rehab unit, we’ve noticed some changes in his emotions and behaviors.”

Mike finds it difficult to recognize social boundaries.

Mike is seen winking at Cheryl and saying, “So Cheryl, I’m going home soon. Do you want to go on a date with me?”

Cheryl responds, “Mike, that’s inappropriate.”

Mike sometimes says inappropriate things.

Mike is seen in his room where his bed is unmade. A nurse is standing nearby.

The nurse says, “We’d like you to start making your own bed, so you’re used to it when you go home.”

Mike responds, “Isn’t that your job?”

Mike sometimes laughs at the wrong time.

Carolyn is shown speaking to Mike while he covers his mouth. She says, “I need to visit a friend this afternoon; her mother is very ill. Why are you laughing?”

Mike responds, “I can’t help it.”

Some of the behavioral changes people may experience after a TBI include:

• Restlessness,
• Being more dependent on others,
• Mood swings,
• Irritability,
• Aggression,
• Lethargy,
• Acting inappropriately for the setting, and
• Lack of self-awareness, which could be caused by either the TBI or being in denial about the situation.

Sam is standing with Mike and speaking to the reader. She says, “Mike is almost ready to move back home, but with the changes in his behavior and abilities, we want to be sure that he is as safe and independent as possible.”

OCCUPATIONAL THERAPY

Raj is an occupational therapist. His goal is to help people be as independent as possible in their daily activities. He also finds ways to help them have meaningful and satisfying lives.

Sam is seen standing in the kitchen with Mike and Raj. She says to the reader, “Mike worked with Raj on a lot of things, from remembering how to tie his shoes to cooking safely.”

Sam is seen standing in front of their house along with her parents, Lewis and Carolyn. She says to the reader, “Before his injury, Mike was living on his own, but he’ll need to live with us for a while.”

Raj is seen speaking to Sam, Lewis, and Carolyn. He says, “So Cheryl told me that Mike’s room is upstairs?”

Sam responds, “I traded with him, he’s on the main floor now.”

SAFETY TIPS:

Some of these tips may not be necessary, but it will depend on the symptoms the person with TBI has. If you’re not sure, ask your health care provider.

• Keep clutter out of areas in use, and off stairs. Also remove small rugs that could be tripped on.
• Remove dangerous things (matches, knives, and guns).
• Keep medications in a locked cabinet or drawer.
• Ask your doctor before giving over-the-counter medications.
• If there is a risk of falling out of bed, place the mattress on the floor.
• Light rooms well. Night-lights can prevent falls.
• Do not leave someone who is severely agitated or confused, alone.
• If you live with or care for a person who tends to wander, keep doors to potentially dangerous areas (like basements) locked. You may also consider having an ID bracelet made.
• Consider attaching an exit alarm or a bell to doors to the outside of the house.

Raj is shown talking to Carolyn, Lewis, and Sam again. He says, “That’s great! It sounds like you guys are way ahead of me!”

Carolyn holds up a picture of Mike’s room and says, “Yes, Mike’s room is almost set up already.”

Raj says, “This looks really good. I do see a few things that could be changed to make it safe and easier for Mike. I’ll make a list.”

Clutter can be dangerous, but too much visual clutter can also be over-stimulating.

Sam is shown in Mike’s room. She says to the reader, “We changed some things based on Raj’s advice:”

• Placed a bowl on the dresser to hold keys and wallet,
• Organized dresser drawers,
• For some people it may be a good idea to have someone else control access to medications,
• Plugged in a night-light,
• Hung a few pictures on the walls, and
• Reduced clutter.

AUTHORSHIP AND ILLUSTRATION

This infocomic was written by Silas James and Ayla Jacob and illustrated by David Lasky, in collaboration with the Model Systems Knowledge Translation Center. Portions of this infocomic were adapted from the factsheet series titled Understanding TBI, which was developed by Thomas Novack, PhD, and Tamara Bushnik, PhD, in collaboration with the Model System Knowledge Translation Center (https://msktc.org/tbi/factsheets/Understanding-TBI). Portions of this infocomic were also adapted from materials developed by the University of Alabama Traumatic Brain Injury Model System (TBIMS), the Baylor Institute for Rehabilitation, New York TBIMS, Mayo Clinic TBIMS, Moss TBIMS, and from “Picking up the Pieces After TBI: A Guide for Family Members”, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

Source: The content in this infocomic is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this infocomic were developed under a grant from the National Institute on Disability and Rehabilitation Research (NIDRR), Department of Education (ED; grant number: Grant #H133A120028); and a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (grant number: 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this infocomic do not necessarily represent the policy of NIDIRR, NIDILRR, ACL, ED, or HHS, and you should not assume endorsement by the federal government. Funding for this infocomic was also provided by the Brain Injury Alliance of Washington; University of Washington; Veterans Training Support Center; the Washington State Department of Veterans Affairs; the Washington State Department of Social and Health Services; the Washington State TBI Council; and King County.

Copyright © 2017 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.