Return to graphic version of Understanding TBI: Part 3
Infocomic Main Characters
Mike: A teenage White man with short hair and a visible scar on his scalp.
Lewis: A middle-aged White man with short, dark hair and thick-frame glasses.
Carolyn: A middle-aged White woman with long, blonde hair, bangs, and thick-frame glasses.
Sam: A teenage White woman with blonde, shoulder-length hair. She is Mike’s younger sister.
Therapist: A middle-aged Asian woman with long, dark hair tied back in a ponytail. She wears thin-frame glasses.
Infocomic Story Description
Understanding Traumatic Brain Injury: Part 3
RECAP FROM PART 2...
Mike is home from the hospital. His emotional changes after TBI are causing his family some stress. They’re working to find ways to overcome these challenges.
CREATING A ROUTINE
Creating and following a routine can help you and your loved one feel more secure in their environment.
Mike stands near the front door and calls out, “Hey mom, can you drive me to the gym now?”
Mike’s daily routine looks like this:
- Stretching
- Eating
- Going to physical therapy
- Volunteering at the children’s hospital
- Attending a TBI support group
As Mike is recovering, he has fewer appointments. He’s replacing them with things that reinforce what he did in therapy.
Support groups can be a helpful way to connect with people who have had similar experiences.
Providing Structure at Home
There are ways to provide structure for people who’ve had a TBI (Note: Some of the suggestions that follow may not apply to your situation.):
- Create a photo album with labeled pictures of your friends, family, and familiar places.
- Place objects you need within easy reach.
- Work to maintain familiar family dynamics. For example, if a person normally got to choose a restaurant for eating out, try to continue this.
- Even if speaking is tough, be sure to include everyone in family conversations and social activities.
- Act natural.
Coping Strategies
Lewis sits at the dinner table with the whole family and says, “Well, we made it through the week.”
“TGIF!” exclaims Mike.
Carolyn says, “I think that on some level, we all kind of thought that when Mike came home, things would be back to normal. But they’re not.”
Lewis admits, “There’s so much more to do now.”
Carolyn says, “We’re all helping at home and getting Mike to his appointments. Right now, his schedule is the only one on the calendar. Could you guys add yours too?”
Lewis says, “Great idea! I can work from home a couple days a week.”
Sam says, “I’ll copy my plans from my phone right now.”
It may be helpful to adjust the roles of family members to deal with the effects of the TBI.
Carolyn says, “Let’s talk about stress. Mike’s injury has been rough on all of us. We should do some things about it. I was talking with Jeanne, and she helped me with some coping strategies.”
Mike asks, “What’s a coping strategy?”
Carolyn tells him, “Anything that you do to handle stress is a coping strategy. I’ve been going for a walk every day.”
Your loved one’s TBI has caused changes to your life. You probably haven’t been through anything like this before. So, the coping strategies you’ve used in the past may not help.
Carolyn says, “Lets brainstorm ways to deal with stressful or frustrating things.”
Mike admits, “It bugs me when people think I’m fine since I’m out of the hospital.”
Carolyn says, “I know that bothers you. Can you think of any ways to deal with that frustration?”
“I usually just make a joke,” Mike says.
“Humor is a good way to deal with stress,” Carolyn says.
“There is so much going on with school and life, that sometimes I just want to be alone,” Sam says.
“That’s a good one, Sam!” Carolyn says. “Take time for yourself.”
“I always feel great when I have a routine of going to the gym,” Lewis says.
“Exercise is a great way to deal with all kinds of things: stress, depression, and even anxiety,” Carolyn notes.
Common Coping Strategies:
- Taking time for yourself
- Keeping a regular schedule
- Getting regular exercise such as taking a 20- to 30-minute walk each day
- Taking part in support groups
- Keeping a sense of humor
- Being more assertive about getting the support you need
- Changing roles and responsibilities within the family
The best thing you can do is to be open to trying new ways of coping and finding out what works for you.
Mike leans over to grab a bowl off the table. “This curry chicken is great! Can I have some more?” As he grabs the bowl, he knocks a glass off the table.
“Crap! Why do I keep doing that?” he exclaims.
Lewis comforts him, “Don’t worry, Mike. It’s just water.”
“I know,” Mike says, “but I should have known that the glass was there.”
“Don’t be down on yourself, Mike. You’re still getting better, and you’ve already come so far!” Lewis says as he picks the glass up.
“It’s still really hard,” Mike tells him.
As he stands up, Lewis also knocks a glass over.
Mike laughs, “Ha, ha! I see what you mean, Dad! You’re right, I shouldn’t feel bummed out over little mistakes.”
Carolyn says, “He’s right. You’ve come a long way.”
Sam says, “I remember the ICU. So stressful.”
Mike admits, “I don’t remember very much of that.”
“Things are so much better now, but I’ll never forget,” Sam says.
THE FIRST WEEKS AFTER INJURY
In the first few weeks after a TBI, damage and changes to the brain often affect its ability to function. The person may not show signs of awareness, and their eyes may stay closed. Brain function often improves as swelling goes down and blood flow and brain chemistry stabilize. As brain function improves, the person with TBI tends to be more responsive.
It is hard to predict long-term outcomes based on brain scans. But the length of a coma and the duration of memory loss (post-traumatic amnesia) can help to predict how well a person will recover.
Back in the NICU, when Mike was still unconscious, his family talked with his therapist.
“We can see some of the damage to Mike’s brain on the MRI,” his therapist says.
Lewis asks, “How bad is it? When will he wake up?”
“The scans can show bruising, lesions, and blood in the skull. Some types of injuries are less intense but more spread out across the brain,” the therapist says. “It’s possible to have a scan that doesn’t show any damage, but the person still has a severe TBI and may be in a coma.”
Diffuse Axonal Injury (DAI)
Brain cells are known as neurons. They connect to each other with fibers called axons. The axons let the neurons talk to each other. Trauma to the head can harm axons by stretching or pulling them. If the injury to an axon is severe, the neuron it connects to will not survive. This happens at a microscopic level throughout the brain; you can’t see this on a brain scan.
“It’s hard to predict long-term outcomes. But Mike is more responsive to voices, which means he’s coming out of his coma,” the therapist says.
“Oh, so we won’t know until he wakes up how bad the damage is?” asks Carolyn.
Neurochemical Response to TBI
Sometimes the chemical balance of the brain is upset after a TBI. In a normally functioning brain, chemicals called “neurotransmitters” let neurons work together Groups of neurons work together to do different things. A TBI can increase or decrease the number of neurotransmitters in the brain. This changes a person’s thinking or behavior. As the chemical balance of the brain returns to normal, the person’s ability to function will improve. This usually happens within the first few weeks after TBI but can sometimes take months.
Lewis asks the therapist, “What are you doing?”
She tells him, “Right now, our goal is to manage how Mike’s brain responds to his TBI.”
Open Head Injuries
An open head injury penetrates the skull and other layers that protect the brain and exposes them to the air. A classic example of an open head injury is a gunshot wound to the head. The damage from an open head injury tends to be in a specific part of the brain. But these injuries can still be as severe as closed head injuries based on the path of the bullet or other object in the brain.
Lewis asks the therapist, “How is his brain responding?”
The therapist says, “When tissue becomes damaged, it swells. Swelling in the brain increases pressure in the skull. Too much pressure can limit blood flow to parts of the brain and cause more damage.”
Medical treatment soon after a TBI aims to control intracranial pressure, or ICP. Sometimes doctors remove part of the skull until the swelling goes down.
Sam says to the reader, “Mike started showing signs that he was coming out of his coma after 12 days. It was a few more days before he was officially awake, and he was still groggy for a while.”
Standing in front of their house with the whole family, Sam says, “But that’s behind us now. Mike’s TBI affected all of us and things won’t ever be the same, but I’m ok with that. Things would have changed anyway.”
Healing Over Time
Post Injury
Information collected by the TBI Model System study from people who had moderate to severe TBIs shows that, 2 years after their TBIs:
- 93% of people live in private homes
- 34% are living with their spouse or significant other
- 29% are living with their parents
- 34% need some type of supervision during the day or night
- 33% have a job
- 3% are students
- 29% do not have a job
- 26% are retired for any reason
Mike’s 2-Year Checkup
The therapist looks at Mike with surprise as his hair has grown back and he looks healthy. “Wow, Mike, you look great! I can’t believe that it’s already been 2 years!”
“Thanks,” Mike says. “I feel great.”
“So, I know that you’ve moved out since I last saw you,” the therapist says.
“Yeah, it’s been over a year now,” Mike tells her. “I also volunteer at a children’s hospital, and the department of vocational rehabilitation is helping me go back to school.”
He shows his therapist a picture of a girl on his phone. “I have a girlfriend! But I’m still trying to figure out who I am since my injury. So, it’s not serious.”
“That’s very insightful, Mike,” the therapist says.
“Oh!” exclaims Mike. “I did a driver’s ed ‘tune up’ with Raj, so I’m driving again!”
“I’m glad that you’re doing so well and have a good attitude!” his therapist says.
“I’ve come to terms with my new situation. Over the last couple of years, I’ve gotten closer to my family, especially Sam,” says Mike.
At the house, Sam now appears older, and says to the reader, “I would never wish for Mike’s TBI but there are positive things that came from it.”
Standing around the table where the family gathers, Sam says, “We all had to work together to help Mike. In the process, our communication has gotten better, and we have learned a lot about each other.”
Mike says, “I learned a lot about myself too!”
Carolyn says, “I think we all have.”
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 at Birmingham Traumatic Brain Injury Model System (TBIMS), 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 NIDRR, NIDILRR, ACL, ED, or HHS, and you should not assume endorsement by the federal government. Funding for this infocomic was also provided by Brain Injury Alliance of Washington; University of Washington; Veterans Training Support Center; Washington State Department of Veterans Affairs; the Washington State Department of Social and Health Services; 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.