Helping families and marriages impacted by TBI

Caring for service members and veterans impacted by traumatic brain injury has become an increasingly urgent national priority. A new publication from the Defense and Brain Injury Center and innovative programs offered through VA Hospitals in collaboration with PAIRS Foundation help caregivers and families address the impact of TBI, promote healing, and strengthen marital resilience.

“Traumatic brain injury (TBI) is a major public health problem in the United States. In 2006, the Centers for Disease Control and Prevention reported that TBI is more prevalent than cases of multiple sclerosis, HIV/AIDS, and breast cancer combined. Due to the present conflicts in Iraq and Afghanistan, members of the United States Armed Forces are one of the largest populations at risk for TBI. Of the service members medically evacuated for battle-related injuries from Iraq and Afghanistan to Walter Reed Army Medical Center, 33 percent had traumatic brain injury (as of March 2009). “

Col Michael S. Jaffee, MD
National Director
Defense and Veterans Brain Injury Center

Traumatic Brain Injury (TBI) is the leading injury among U.S. forces serving in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]).  As a result of the frequent use of improvised explosive devices (IEDs) in these wars, service members have been exposed to blasts and other injuries that led to an increasing number of TBI injuries among those returning from deployment.

According to a recent publication of the Defense and Veterans Brain Injury Center, among service members evacuated from OEF/OIF to Walter Reed Army Medical Center in 2003-2007 because of injuries, 30 percent had a TBI. The Army reported that 88 percent of TBIs among soldiers were mild. Six percent were moderate and another six percent were severe.

No two brain injuries are exactly alike. Some people who have a TBI recover quickly, others take much longer. Some will have very few longterm effects. Others will face lifelong challenges. The effects vary from person to person. Recovery from a TBI may be measured in weeks, months, or years. Strong interpersonal relationships and the consistent support of spouses, family members and significant others are vital to adjusting to the “new normal” that can result from TBI and promote long-term healing.

While the impact varies from person to person, TBI often includes physical, cognitive, communication, behavioral and emotional symptoms.

Physical effects

• sleep
• fatigue
• dizziness
• balance
• sensory changes

Cognitive effects

• confusion
• slowed speed of processing
• attention problems
• difficulty with memory
• planning and organization problems
• difficulty with decision making and problem solving
• confabulation

Communication skills

• does not speak clearly
• problems starting a conversation
• word finding problems
• problems following a conversation
• reading comprehension problems

Behavioral and emotional

• frustration, increased anger/aggressiveness
• impulsivity or difficulties in self-control
• poor judgment
• reduced or lack of initiation
• repetitive behaviors (perseveration)
• less effective social skills
• changes in sexual behaviors
• lack of self-awareness
• depression
• increased anxiety
• mood swings
• changes in self-esteem

In 2009, PAIRS Foundation began actively collaborating with the Charlie Norwood VA Medical Center to help couples impacted by visible and invisible wounds resulting from a service member’s combat deployment, including Post Traumatic Stress Disorder and Traumatic Brain Injury. The collaboration was recognized by the Veterans Administration as “Best Practice in Marriage Enrichment.” Weekend retreats are designed to measurably strengthen attachment, bonding, communication, emotional understanding and expression, and improve conflict resolution skills.

“PAIRS is changing the lives of returning combat veterans and their spouses.”

Ron Craddock
Chief of Chaplain Services
Charlie Norwood VA Medical Center

“PAIRS systematically works toward developing participants’ emotional iteracy, including the capacity for vulnerability and empathy that is often impaired after combat deployment. We have seen remarkable results through tears and testimony from the veterans and spouses who participate.”

Mitchell S. Tepper, Ph.D., M.P.H.
The Center of Excellence for Sexual Health
The Satcher Health Leadership Institute
Morehouse School of Medicine, Atlanta, Georgia

Weekend retreats conducted by PAIRS National Faculty, VA Chaplains, counselors and others trained and certified by PAIRS Foundation add layers of resilience to couples, marriages and families during the often lengthy healing for injuries suffered in combat deployment. Enhancing interpersonal relationships is critical to addressing the impact of TBI on behavioral/emotional issues, communication, and improving the impact of related interventions throughout the treatment process.

The Defense and Veterans Brain Injury Center has published a Guide for Caregivers of Service Members and Veterans which is available for download. For more information on PAIRS Professional Training and services for couples impacted by visible and invisible wounds, visit sacredtrust.pairs.com, e-mail sacredtrust@pairs.com, or call (877) PAIRS-4U (724 7748).

PAIRS Foundation, a 501(c)(3) nonprofit, is one of the nation’s oldest and leading providers of relationship skills training. In 2006, PAIRS was awarded a multi-year, multi-million dollar grant from the U.S. Department of Health and Human Services, Administration for Children and Families, to provide marriage education classes and relationship skills training to couples, singles and high school youth in South Florida. To date, over 5,000 people have participated. Extensive research on the program, as well as research conducted in collaboration with Charlie Norwood VA Medical Center, has shown consistent, positive results for couples in all stages of relationship. Weekend programs and multi-week classes, as well as online classes, are open to active-duty, guard and veterans. A calendar of upcoming events is available online.