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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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In the first of TBICoE's Progressive Return to Activity (PRA) video training series, you will learn about the reasons for using a progressive return to activity process and receive an overview of the 2021 PRA algorithm and its associated tools. By the end of lesson one, providers will better understand the PRA process, and explain that process to service members diagnosed with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 2: Six Major Changes

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In this lesson we review the six major changes in the TBICoE's revised 2021 Progressive Return to Activity (PRA) Clinical Recommendation that differ from the original recommendation. The changes reflect the latest TBI research, and will make it easier for providers to manage the recovery process and return service members with concussion to full duty as quickly and safely as possible. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 3: Understanding Relative Rest

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In this lesson we explain the differences between complete rest and relative rest in a staged concussion recovery process, and provide examples of activities that promote relative rest. The revised Progressive Return to Activity (PRA) Clinical Recommendation uses the term 'relative rest' to emphasize the importance of early introduction of physical and cognitive activities that do not provoke symptoms following TBI. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 4: PRA Progression Criteria

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7/22/2021
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In this lesson, we review the criteria for advancing through the stages of the Progressive Return to Activity (PRA) Clinical Recommendation. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 5: The Six Stages of the PRA

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In this lesson, we cover the key activity objectives for each of the six stages of the Progressive Return to Activity (PRA) Clinical Recommendation and provide activity examples for each stage. Each stage is designed to gradually increase the intensity and duration of a service member's physical and cognitive activity as they advance in the PRA process. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 6: The Return to Duty Screening

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In this lesson, we cover how to perform the Return to Duty, or RTD screening, which now includes both vestibular/physical and neurocognitive examinations. The purpose of the RTD screening is to objectively measure whether a service member is ready for return to full duty. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 7: Symptom-Guided Management and Specialty Referral Guidance Tables

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This lesson covers how to use the Progressive Return to Activity, or PRA's Symptom-Guided Management and Specialty Referral Guidance tables. This lesson also details primary care management strategies for service members who are not progressing as expected in the PRA. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 8: Clinical Case Scenario

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This is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity (PRA). We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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MHS Minute March 2021

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March marked Brain Injury Awareness month in the military. We're spotlighting efforts across the MHS to combat Traumatic Brain Injury (TBI), and better understand how TBI impacts our Service members. For more information about the National Intrepid Center of Excellence (NICoE), go to walterreed.tricare.mil/NICoE For more info on the Traumatic Brain Injury Center of Excellence (TBICoE), go to Health.mil/TBICoE

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Traumatic Brain Injury Awareness

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A TBI is a blow or jolt to the brain that can be life-altering if the symptoms are not recognized. If you or a loved one experience the symptoms mentioned in this video, speak to a health care professional for more information.

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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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Sleep and TBI

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Sleep disturbances are common for service members and veterans following a mild TBI, also known as concussion.

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TBI Champions Roxana Delgado & Victor Medina

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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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TBI Champion Micah Norgard

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11/16/2020
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After 12 years as an infantryman, Norgard's biggest battle was recognizing the cumulative effects of multiple TBIs.

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