In the case of traumatic brain injury, often times, loved ones are unfamiliar with the concept of concussion, much less what to expect or how to help. In such unfamiliar territory, they don’t even know what questions to ask medical personnel in order to better understand.
What is a Concussion?

Concussion is a unique injury to the brain. It can occur either from a direct blow to the head such as in a boxing match, a strike from a falling object, a fall resulting in the head striking an object, or it can occur from whiplash. Whiplash is essentially caused by a strong blow to the neck or body causing the brain to “whip” inside the skull, tearing brain tissue in the process. This can be extremely serious. What makes such injuries difficult to manage both for the patient and their loved ones is that they cannot be seen, like a broken arm or leg, thereby making it more difficult to determine what areas of functioning might be compromised.

What Symptoms Might be Experienced Following a Brain Injury or Concussion?

Symptoms experienced following a concussive brain injury vary depending on the location and severity of injury. Physical ramifications can be complex and depend on the method, location, and severity of injury. Motor functioning may be compromised, speech and language, vision, hearing, or more. Cognitive symptoms may include decreased focus, attention, and concentration, decreased processing speed, language processing, comprehension, and expression difficulties, memory encoding and retrieval difficulties, abstract problem solving and cognitive flexibility difficulty, and visuospatial problems. Emotionally, patients can experience highs and lows, depression, anxiety, anger, and frequently rapidly changing mood swings over short periods of times with personality changes that are not consistent with their pre-injury personality.

How Does a Brain Injury or Concussion Heal?

Following a concussive brain injury, significant time and rest are required for the brain to recover and heal. Sleep is extremely important, as is minimization of all stimulation to allow the brain to focus its energy on recovery. The brain cannot adequately heal and restore function when the person does too much work, either physically or mentally. Hence, it is crucial that your loved one not be allowed to return to normal activities that require them to do much work, or spend time on electronic devices that stimulate the brain (including televisions, computers, tablets, personal phones, etc.) primarily for the first month following injury, but actually until all symptoms have disappeared.

What Can We Expect from Our Loved One During Healing from a Brain Injury or Concussion?

A concussion affects not only the one who was injured. It often also has a profound effect on the entire family. Your loved one can reasonably be expected to experience many emotional ups and downs and can be expected to experience a decrease in their performance and cognitive abilities during healing. Many concussion patients try to resume their normal activities as soon as possible, not realizing the extent of their difficulties, but taking on too much too soon risks further injury and can compromise their ultimate recovery. This requires that everyone in the family needs to be patient and provide support and encouragement during the healing process.

How Can Our Family Help Our Loved One During Healing?

The most important thing for someone recovering from concussion is rest! Your patient, emotional support is also very important.

• Physical, cognitive, and emotional rest are the most essential components to your loved one’s recovery. It is extremely important to support your loved one in getting plenty of sleep at night and plenty of rest during the day. When they get frustrated at all they feel they are now unable to do, or feel unproductive, remind them that their brain is busy doing a great deal by healing and repairing, so they are actually quite busy.
• Recovery will vary, so don’t expect that your loved one’s progress will be the same every day. Concussion symptoms will vary from time to time, being less severe on one day or during some part of a day, and then becoming more severe later. The ability to see clearly may come and go. It often seems like “one step forward, two steps back” so be very patient. This is the normal progress of healing from a concussion and there is nothing you or your loved one can do about this. But the brain cannot be relaxed and anxious at the same time, so as much as possible, help your loved one remain relaxed to optimize brain recovery.
• Don’t expect your loved one to have normal reaction times, normal memory, or normal feelings. It may take longer to answer a question, or to complete a task, and at times they may be discouraged or afraid but will not want to tell you. Your emotional support at these times is very important. When they tell you they can’t do something right now, then they can’t, so change your expectations.
• Offer to help by writing down things for your loved one that they are having a hard time remembering.
• Check in with your loved one a few times each day to see what you can do to help.
• This is not a time for your loved one to make decisions. Support them by gently encouraging them to put off decisions of any kind until they are better. The family can rally to make day-to-day decisions for now when your loved one cannot perform as usual.
• Family members must step up (as appropriate) and take on some of the things your loved one usually does such as meal preparation, housecleaning, planning, making checklists, running errands, paying bills, etc.
• As they heal, encourage them to take on normal activities progressively, a little at a time, never all at once. Use gentle reminders to help your loved one restrict their physical and cognitive activities when they try to do too much too soon.
• On days when your loved one must meet responsibilities outside the home, offer extra support at home.
• Understand that your loved one may not recognize that their emotional reactions are outside the scope or degree for what is normal for them and their situation. It is important for you to stay calm and rational even when they do not or cannot.
• It is crucial that as a loved one of a concussion survivor, that you realize that your loved one is not intentionally taking their frustration out on you. They feel out of control over just about every aspect of their life. If they realized how their reactions were affecting you, they would likely feel very guilty. Be as compassionate and understanding as possible, and if you need to, take a break in order to keep your own perspective. You have the ability to keep your wits about you, when, because of their injury, they likely do not.

In a recent radio episode, Dr. Lori Spohr and I, as neuropsychologists, discuss the advances in traumatic brain injury over the last 30 years, the biggest struggle for traumatic brain injury sufferers and their caregivers, how the TBI patient can still hold on to hope, and what they can do to help maintain good self-care in the recovery process. Find out more about that episode here: Hope After Traumatic Brain Injury.