Coming Home after a Severe Traumatic Brain InjuryWhile the attending to the needs of a loved one with a traumatic brain injury is difficult, most family caregivers find the most challenging aspect is coping with the personality changes that make the person seem like a stranger. To alleviate stress and avoid burnout, experts recommend arranging for the services of a home health personal care assistant.      

While the media has addressed the prevalence of Traumatic Brain Injuries among veterans who served in Iraq and Afghanistan, the Centers for Disease Control and Prevention (CDC) most common cause of Traumatic Brain Injury (TBI) in the United States are automobile accidents, which account for 31.8 percent of the cases each year. While the elderly have the highest rate of TBI due to falls, children and teens who participate in sports are also at risk. While most cases of TBI are mild, the CDC reports 30.5 percent of the TBI cases are classified as severe and require long-term rehabilitation. According to the Brain Injury Association of America, most patients prefer home-based rehabilitation because it offers a sense of familiarity and safety that other long-term settings cannot match. While both the family and TBI patient experience joy and excitement when the injured person first comes home, caring for a family member with a brain injury has its challenges and many people find the services of a home health personal care assistant invaluable.

What is a Traumatic Brain Injury?

When a person experiences a sharp blow to the head, or when an object (such as a bullet) penetrates the skull, the trauma causes damage to the brain tissue. Most people are familiar with a concussion, which is damage to the brain caused by a hard impact to the skull. A common type of closed head injury, known as a contusion, occurs when the brain hits the back of the skull, which causes swelling and/or damage to individual nerve cells. Another TBI, called a hematoma, is the result of damage to the blood vessels in the brain, which causes bleeding. Additionally, an injury that interrupts the flow of oxygen, called anoxia, or significant decreases the level of oxygen in the brain, called hypoxia, causes the death of brain tissue. The location and the extent the brain injury, determined by either a CT scan or MRI, determines the nature of the symptoms the person experiences and their severity.

What are the Symptoms of a Traumatic Brain Injury?

One of the reasons mild to moderate cases of TBI go undiagnosed is because it can take from three to six months for the symptoms to develop. While a person who is injured in a football might be knocked unconscious for a few minutes, an individual who is in a car accident or incurs a severe blow to the head or penetrating brain injury might fall into a coma that can last just a few days or even months. In either case, most people with TBI have little to no memory of the incident that caused the injury, the moments before the accident (anterograde amnesia), or for events that occurred after the accident (retrograde amnesia). Typically, the loss of these memories is permanent

Some of the other symptoms and limitations experienced by people with TBI include the following:

  • Mild TBI Symptoms: Approximately 40 percent of people diagnosed with TBI develop a group of symptoms referred to as Post-Concussive Syndrome (PCS). People suffering from PCS experience headaches, dizziness, issues with memory and concentration, restlessness, and sleeplessness. While these symptoms tend to appear gradually in the weeks following the injury, they tend not to last more than three months.
  • Moderate to Severe TBI Symptoms: Approximately 43 percent of patients with moderate to severe TBI experience the symptoms for a year or more after the injury. Additionally, it can take as long as six months after the injury for the severity of symptoms to become evident. Some of the most common symptoms associated with  moderate to severe TBI include the following:

Cognitive Disabilities

  • Difficulty forming and retrieving memories
  • Limited ability to plan and organize activities
  • Loss of abstract reasoning ability
  • Poor judgment and decision-making

Sensory Issues

  • Impairments in eye-hand coordination
  • Ringing in the ears
  • Difficulty making meaning of what they see

Language and Communication

  • Difficulty interpreting non-verbal cues, such as facial expressions
  • Challenges with expressive and receptive language skills

Emotional, Behavioral and Personality Issues

  • Depression and anxiety
  • Prone to anger outbursts due to frustration and irritability
  • Paranoia

The Rigors of Caring for a Familiar Stranger at Home

While the rehabilitation process tends to go more quickly when a TBI is living at home with family members, many caregivers report that while their loved one looks the same, the TBI patient’s personality changes and limitations in daily activities makes it seem like a familiar stranger lives in the home. Many family members of TBI patients actually go through a grieving process as the mourn the loss of the pre-accident personality of their family member, which often compounds the stress of taking their family member to therapy and doctor’s appointments, keeping their family member from becoming bored, irritable, and restless, and providing intensive supervisor.

A home health personal care assistant provides caregivers respite by providing supervision and companionship for the TBI patient, as well as assisting the patient with daily living acts. These paraprofessional have specialized training in communicating with TBI patients effectively, behavior management and providing line-of-sight supervision. In addition to providing guidance and support to the patient in planning and organizing their daily activities, personal care assistants also provide transportation so the TBI can spend time in the community. As an active participant of the patient’s rehabilitation, personal care assistants provide a valuable service to both TBIs patient and their caregivers. You should contact a Minnesota home health care agency to see if personal care assistant (PCA) services are right for your family.