Lt. Soper talks with a patient about traumatic brain injury at Naval Hospital Beaufort. (Photo courtesy of Lt. Soper)

Tips for Making a Comeback After Traumatic Brain Injury

By Lt. Ana Soper, PhD, staff neuropsychologist, Naval Hospital Beaufort, S.C.

Soper 3March is Brain Injury Awareness month, and a time to remember our service members and their families affected by brain injury. As an active duty Navy neuropsychologist working with those affected by TBI,  I’ve developed several tips to help service members and their loved ones during their recovery:

1)  Stay positive. No one said this recovery process would be easy, but staying positive can only help.  Brain changes from TBI can actually lead to decreases in motivation and goal-directed activity.  Realize that your brain is doing this but that you don’t have to be defined by it. There are many people out there who have experienced a brain injury, and have gone on to have success related to their job, school, and personal lives after brain injury. The way you talk and think about your recovery affects the way you feel about it, so it’s important to keep moving forward.

2)  You are not alone. There are many people just like you, recovering from a TBI. Don’t isolate yourself, a tendency that can come after a brain injury, and make sure the people you do spend time with treat you with dignity and respect. If you’re part of a group therapy setting, you can find others to share your recovery with who understand what you are going through. If you would like to start group therapy or meet one on one with a supportive professional, start with your primary care doctor or the mental health department, both of whom will likely know what resources are available in the hospital for people who have experienced brain injuries. There are many psychologists out there like me who are waiting to help.

3)  Think like a detective. Become Sherlock Holmes and start deducing what causes your symptoms and makes them better or worse, without over thinking them. For example, are your memory problems more severe when you are tired or after drinking alcohol?  I recommend that you keep track of your memory lapses including what led up to the memory lapse and what helps you redirect your focus and get back on track. If you can track it, you can change it. 

4)  Brain injuries are like fingerprints — each one is different.  Your recovery will strongly depend on whether your injury is “mild, moderate, or severe,” which depends on how long you were unconscious and other factors occurring at the time of injury. While almost everyone recovers from a single concussion or mild brain injury within days, the time it takes to heal also depends on the number of brain injuries one has experienced in a lifetime, and other conditions that may exist. For cognitive symptoms that stick around, it can be beneficial to have a neuropsychological assessment to better understand what contributes to symptoms and recommendations.

Lt. Soper talks with a patient about traumatic brain injury at Naval Hospital Beaufort. (Photo courtesy of Lt. Soper)
Lt. Soper talks with a patient about traumatic brain injury at Naval Hospital Beaufort. (Photo courtesy of Lt. Soper)

5)  Relaxation strategies promote the brain’s readiness to learn and remember.  Relaxation strategies are very beneficial to people diagnosed with TBI because stress literally causes changes in brain functioning, particularly memory and attention functioning. Anxiety, which interferes with attention and concentration after TBI, will make symptoms related to any neurologic condition worse. I always recommend doing some brief relaxation techniques before starting a task. Mindfulness meditation has been repeatedly shown to decrease worry and there is now some good initial support that it improves attention and concentration, too. Many people report that managing stress has improved memory and concentration! 

6)  Develop personal mottos or key words that cue you to stay on track or complete tasks.  These mottos help trigger your memory about what you need to do. Some examples I have seen used are, “do it, write it, or forget it,” “be here now,” “stop, relax, refocus,” and “KPW” (for keys, phone, and wallet, which I use personally when leaving the house).

7)  Keep your family and loved ones involved in your recovery process. Family members play a critical and often under-appreciated role in recovery after brain injury. TBI doesn’t just affect the service member: it involves those close to them who may also be going through a grief and acceptance process in coping with changes. Many families have found counseling to be vital in adjusting to brain injury as a couple or family. 

It’s also important to prevent caregiver burnout by making sure that caregivers take time for self-care.  I recommend a free guide called “Taking Care of Yourself While Caring for Others,” and other similar booklets available through the Defense and Veterans Brain Injury Center’s website at http://www.dvbic.org/material/taking-care-yourself-while-caring-others.   

8)  Consider the benefits of cognitive rehabilitation. This is a treatment used to help individuals compensate for memory, attention, and other thinking problems. One focus of cognitive rehabilitation is helping you organize your physical environment to increase productivity and attention. Around the country there are many inpatient and outpatient programs for individuals with TBI. One such program is the National Intrepid Center of Excellence for traumatic brain injury and psychological health in Bethesda, Md., which is tailored toward the needs of service members. 

Soper 2For individuals with mild to moderate brain injury who are local to Naval Hospital Beaufort and whose symptoms can be treated in the outpatient setting, I offer a four session “Brain Boosters” group.  People can also choose to participate in this group as part of a broader, 5-day outpatient stress management program. I hope this group will serve as one model for service delivery in a smaller hospital system. The Brain Boosters group serves as an introductory course on how to compensate for cognitive symptoms (learning, memory, attention and concentration problems) impacted by brain injury (or even stress alone).  The group is adapted from the latest research on what strategies we know works to help compensate for cognitive difficulties. I teach rules of good calendar use, how to remember items you need to bring with you and future appointments, how to remember conversations, and ways to keep focused. 

For those who are affected by a brain injury, please remember you are not alone and there are so many resources and strategies to help you better understand and compensate for brain injury, and to aid you and your loved ones along the journey to recovery. Assessment and treatment for TBI are available, they work, and we want to help you! 

Recommended Resources:

1)  Brainline.org – website with caregiver tips

2)  Brain Injury Survival Kit:  365 Tips, Tools, and Tricks to Deal with Cognitive Function Loss.  by Cheryle Sullivan.  (2008).  Demos.

3)  How to Help Someone With Brain Injury (website from the Mayo Clinic).:

4)  Overcoming Grief and Loss after Brain Injury.  By Drs. Janet Niemeyer and Robert Karol.  (2010).  Oxford University Press.

5)  The Stranger in Our Marriage:  A Partner’s Guide to Navigating Traumatic Brain Injury.  By Dr. Colleen Morgan.  (2010).  Peppertree Press. 

6)  Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and Their Families.  By Dr. Keith Armstrong and others.  (2005). Ulysses Press. 

7)  Once a Warrior–Always a Warrior: Navigating the Transition from Combat to Home–Including Combat Stress, PTSD, and mTBI.  By Charles Hoge.  (2010). GPP Life.