FAC T SHEET FOR PROVIDERS

A Health Campaign of Uniformed Services University, www.usuhs.edu, and theCenter for the Study of Traumatic Stress, Bethesda, Maryland, www.CSTSonline.org

Traumatic Brain Injury:

Helping Service Members and Families in Need
A significant number of U.S. troops
disorder. Like other combat injuries,
deployed to Iraq and Afghanistan have
TBI has a recovery trajectory thatA significant number of U.S. troops
suffered from traumatic brain injuries
depends on the severity of injury.
deployed to Iraq and Afghanistan have
(TBI) ranging from mild (mTBI) toWhile not life-threatening, mTBI
suffered from traumatic brain injuries
moderate to severe; estimates range
can produce a number of symptoms
from a low of 180,000 to a high of(see below) that concern patients and(TBI) ranging from mild (mTBI) to
360,000, which represents 10% to 20%
families, and may even suggest othermoderate to severe.
of the roughly 1.8 million who haveconditions.
served. While the vast majority of TBI
Moderate to severe TBI (suggested
has been mild in the form of concussion, some 45,000 toby prolonged loss of consciousness and/or amnesia
90,000 troops have suffered moderate to severe TBI whose
after the event) presents serious practical and emotional
effects can last a lifetime and dramatically alter the lives ofchallenges for families. Because of the widespread nature
the wounded and their families and children.
and prevalence of TBI, especially mTBI, healthcare
TBI in theatre can result from blast exposure, gunshot
and primary care providers should be alert to its
wounds and shrapnel, falls, and motor vehicle accidents.
potential presence and its implications for families.
It often coexists with other serious injuries, to include loss
This Courage to Care provides an overview of mTBI,of limb, sight or hearing, burns, and psychiatric conditions
care recommendations, and key psychosocial issues forsuch as depression, anxiety, and posttraumatic stressfamilies and children dealing with more severe TBI.
Symptoms of mTBI (Concussion)
The majority of mTBI resolve within a year, sometimes
sooner. Symptoms can appear days, weeks, or months
after the injury. It is important to convey that healing takes
patience and time. More severe or prolonged symptoms
may indicate the presence of other conditions such as
posttraumatic stress disorder, depression, or substance abuse,and may require further evaluation and treatment.
■ Headaches and/or dizziness■ Excessive fatigue (tiredness)■ Problems with concentration or memory■ Irritability■ Sleep problems■ Balance problems■ Ringing in the ears and/or vision changes

Patient Care Recommendations■ Get plenty of sleep at night and avoid overexertion

during the day■ Return to normal activities gradually■ Avoid activities that can lead to another brain injury■ Avoid alcohol as it can slow brain recovery■ Write down things to remember important things/details■ Place commonly used items (e.g., car or house keys) inthe same place■ Focus on doing one activity at a time

Moderate to Severe TBI: Implications for Families
TBI presents a range of behavioral challenges thatfamilies must deal with over time. Understanding some ofthese issues and asking direct questions about the impact of
the injury on the non-injured spouse and their children isimportant.
Continued

■ Injury as grief and loss: When you talk about theimpact of moderate to severe TBI, the service member
is not who they used to be. There is grief and loss ofthe service member not being able to return to thedevelopmental pathway that had been there before theinjury. There are memories of how the person used tofunction with direct comparison to present abilities.

■ Inappropriate behaviors: TBI involves primarily thefamily who must manage the injured service member’s
potentially inappropriate behaviors in public. Thesemay include lack of inhibition, anger, and outbursts, aswell as the other extreme — withdrawal, apathy, anddepression.

■ Implications for children: The resulting changes

a parent with TBI may demonstrate (changes inpersonality, irritability, or withdrawal) can be confusing
to a child. Younger children may assume they are
responsible for the problems they see, or even that theirinjured parent no longer loves them. Efforts should
be made to reduce children’s exposure to outbursts.
Talking to children can help, i.e., explaing that “Dadis grumpy and angry because his brain was hurt. He
sometimes says or does things he doesn’t really mean.”■ Social isolation: This may be an issue due to the■ Family management: For most injuries, it is going to

be about overcoming and adapting to the injury. In thecase of severe and moderate to severe TBI, the focus
should be on the partner’s ability to help the injured
service member.

Healthcare providers in military and civilian settings
are increasingly aware of the prevalence and effect of TBI
amongst military and civilian personnel deployed to Iraqand Afghanistan. In the case of mTBI, it is important tocommunicate self-care, expectation of recovery, and thepotential, if symptoms persist, to be something other thanor in addition to mTBI. Moderate to severe TBI will havean enduring impact on families who need to understandthe critical challenges in order to cope and overcome theburden of care.
Resources■ Mild Traumatic Brain Injury: Pocket Guide forClinicians:
https://www.publichealth.va.gov/docs/exposures/TBIpocketcard.pdf■ Defense and Veterans Brain Injury Center: 			

https://dvbic.dcoe.mil/

exhausting caregiving responsibilities and fear over how
the TBI patient is going to behave. Part of the focus
needs to be to help the family avoid social isolation andengage in the community and available supports.

Courage to Care is a health promotion campaign of Uniformed Services University
and its Center for the Study of Traumatic Stress (CSTS). CSTS is the academic
arm and a partnering Center of the Defense Centers of Excellence (DCoE) for
Psychological Health and Traumatic Brain Injury.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org