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How to develop a new relationship path after a TBI

A pair of hands clasped together Air Force Capt. Spencer Crandall and his wife Kristen hold each other’s hands during a marriage retreat in Charlotte, North Carolina in 2012. (Photo by Human Performance Resources by CHAMP at USU.)

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Traumatic Brain Injury

When you or your partner suffer a traumatic brain injury (TBI), changes to your relationship are likely. Both of you might experience a range of emotions as you adapt to new expectations in your relationship, but you can weather the changes. TBIs can occur without warning, and the path to recovery isn’t always clear, which can add strain to your romantic relationship.

Shifting roles and changing emotions

The uninjured partner is likely to shift into a caregiving role after a TBI. This can be fulfilling and frustrating for both of you. It’s likely neither of you expected one would have to intensely depend on the other as sometimes happens after a TBI. However, it’s also an opportunity to show commitment and gratitude toward each other on a regular basis.

Still, these new roles can leave you both feeling isolated at times. That’s why it’s important to garner external support. Caregivers need a break to take care of themselves every so often. Encouragement from other family members and friends can help as you or your loved one recover from a TBI together. You both can’t make it through this process alone, or by only depending on each other. Reap the benefits of getting comfortable asking others for help because it could provide some well-needed relief.

You might feel a sense of loss or grief about your relationship as a couple, which can be similar to the grief felt after the death of a loved one. You also might grieve future plans that now have to be canceled or adjusted. And you might mourn for the couple you once were.

Your view of future goals and dreams probably needs to be modified or abandoned, and that’s hard. These feelings are normal, and talking about them with your partner, other trusted confidants, or a professional therapist can help.

The “new” us

After a TBI, work toward establishing a new understanding of what it means to be a couple in your current circumstances. Strive to answer, “Who are we now?” together. Build new rituals as a team, find novel ways to manage frustrations, and redistribute responsibilities at home.

A TBI survivor might not be able to handle detailed, more tedious jobs such as paying bills or balancing your family budget. Get creative about how you can reassign roles, so you’re both still involved and feel engaged in your partnership.

Learn more

Lastly, educate yourselves about what recovery after a TBI looks like. Understanding the typical changes in behavior, mood, and personality of someone who has experienced a TBI can help. Reach out to the Defense Centers of Excellence Outreach Center with your TBI questions. It’s still possible to build strong family and relationship ties after a TBI—it just might look different than you initially planned.

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NICoE Brain Injury Awareness/March 2021Events

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The National Intrepid Center of Excellence (NICoE) is hosting a number of virtual events throughout March 2021 in observance of Brain Injury Awareness Month.

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Progressive Return to Activity After Concussion Video

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The PRA is an evidence-based, easy-to-use approach to help providers return service members with mild TBIs back to duty safely. TBICoE researchers have found that, if medical providers completed a two-hour, in-person training on the use of the PRA, their patients saw an overall reduction in symptoms after one week, one month, and three months, when compared to patients treated by providers who had not received the training.

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Brain Injury Awareness Month "Be TBI Ready" Infographic

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March is Brain Injury Awareness Month. Be TBI Ready. A traumatic brain injury—or TBI—is a blow or jolt to the head that disrupts the normal function of the brain. The severity of the TBI is determined at the time of the injury and may be classified as: mild, moderate, severe, or penetrating.

During Brain Injury Awareness Month, TBICoE and the MHS will promote the theme “Be TBI Ready” — recognizing that health care providers and others in the military community need to be aware of the latest educational trainings, research, fact sheets, and other available resources to prevent, diagnose, and treat TBI.

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Returning to Duty After Concussion

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What's the best way to recover from a concussion? Returning to duty too soon after a concussion can lead to prolonged symptoms, decreased readiness, poor marksmanship, accidents and falls, and increased risk of more concussions. Progressively increasing activity in a step-wise manner can help you resolve your symptoms and return to duty safely. Ask your primary health care provider about TBICoE's Progressive Return to Activity to help you return to duty as quickly and safely as possible. Visit health.mil/TBICoE.

This TBICoE infographic gives an overview of the risks of returning to duty too soon after a concussion and explains how a progressive increase in activity can help get you back to duty safely. Returning to duty too soon after concussion can lead to prolonged symptoms, poor marksmanship, decreased readiness, accidents and falls, and increased risk of more concussions.

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Progressive Return to Activity Following Acute Concussion/Mild TBI Provider Training

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The TBICoE revised the Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation (PRA) and this updated provider training slide deck. The trainings objectives will help providers to identify the key changes to the updated 2021 PRA; explain the rationale for using a PRA protocol for service members post-concussion; understand the criteria for progression following a concussion or mild traumatic brain injury; identify appropriate activities at each stage of progression; understand how to apply primary care management strategies and specialty referral considerations to treat concussed service members who are not progressing as expected; utilize the Tri-Service Workflow mild TBI Alternate Input Method Form to document the PRA in the Armed Forces Health Longitudinal Application.

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Progressive Return to Activity Following Acute Concussion/Mild TBI

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The 2021 Progressive Return to Activity (PRA) Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

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March 2021 Toolkit

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March is nationally recognized as Brain Injury Awareness Month, with the goal of increasing traumatic brain injury (TBI) awareness and improve health care providers’ ability to identify, care for, and treat all those who are affected by TBI. A TBI is a blow or jolt to the head that disrupts the normal function of the brain. According to the Defense Health Agency Traumatic Brain Injury Center of Excellence, 430,720 service members have been diagnosed with a first-time TBI since 2000. The toolkit also contains information on patient Safety Awareness Week, National Nutrition Month and many other graphics and messages you can use for holidays and observances during March.

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Sleep After Concussion

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Sleep After Concussion. Service members with TBI report 3 times more sleep problems. TBIs can happen anywhere, only 16.9 percent of TBIs happen while deployed. Visit health.mil/TBIFactSheets to learn more about sleep problems and how to improve them

"Sleep After Concussion" is intended for patients and caregivers of those who have sustained a TBI. The infographic reviews general information of sleep-related concerns and points towards additional educational resources.

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While he was deployed, retired Army Sgt. 1st Class Victor Medina was in a vehicle that was hit by an explosive device. He sustained a traumatic brain injury (TBI) that severely impaired some of his physical functions and ability to speak. Medina’s wife, Roxana Delgado, continued her pursuit of a Ph.D. in health sciences and became his caregiver. As they adjusted to a life neither one of them had imagined, their marriage became a new kind of partnership.

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TBI Champion Gary Moran

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SGM Gary D. Moran shares his TBI recovery story, and tips for talking to kids about TBI.

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