TBI Staff Training: SELF-STUDY: Module 12 - Working with Families after Traumatic injury: An Introduction

A family's experience - Jonathan and his mother (Video 7 mins)

Here is one family's experience.

Jonathan was hit by a car when he was 12 years old. He had a severe traumatic brain injury. At the time of the injury he had a very poor prognosis. He is now in his mid 20's living with his family.

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As you watch the video jot down key points from the journey.

Key points from the Jonathan's family's journey

What are the key points from the journey?

Check your answers here

Before the accident

Jonathan 12 years old at the time

Average
Normal
Bright
Boisterous
Playing outdoors
Riding his bike
Playing musical instruments
High achiever

The injury

Crossing road on Sunday afternoon
Hit by a car speeding down the hill
Found minutes later
Blood
The nightmare began
Wasn't expected to survive

Intensive care for three weeks

Extremely severe traumatic brain injury
Poor prognosis

Sydney children hospital for 5 months

Prognosis was very poor at 5 months

Brought him home

Hospital services were being cut back
We felt we needed to do more
We develop an 8 hour per day home based program physio therapy, occupational therapy and speech retraining program
Supported by the out patients system

15-16 years of age

Discharged from the Children's Hospital but he wasn't able to go to an adult service because he wasn't old enough
We didn't fit in any where
Out patient from Melbourne hospital - travel to Melbourne every three months
Gradual return to school

As an adult

Slow speech
Movement issues
Fine motor shakes

The emotional impact (Video 3 mins)

The first 50 seconds of this video are the same as the introductory video in Section 12.1. Jonathan's mother goes on to provide further detail about the emotional impact in the remainder of the video.

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As you watch the video jot down key aspects of the emotional impact.

What are key aspects of the emotional impact?

Check your answers here

Life turned upside down

Life turned upside down in a split second
My husband didn't cope terribly well at first
My other son shifted from pillar to post because I was in the hospital with Jonathan for five months
Enormous strain on the family unit

Holding it together steering it though

My role the navigator of the ship
Had to hold it together and steer it through
Find things for each member of the family to contribute
Never knew what Jonathan's potential was

Shock and grief

I came to terms with it straight away
Was in shock for a while, never in denial
Grief is a stage you just keep going though
Even 13 years later it still hits you sometimes -
For what may have been, what you have lost, what he has lost

Reached a happy place

We have reached a happy place but it has taken a long time to get there
Highs of lows of adjustment and re-adjustment
Coming together as a family

Needed help / accepted help / part of a team

Need everyone helping you
Need s sacred circle involving family, friends, therapists and clinicians.
It has to become a team

The research evidence

Overall

Many families adapt well and show amazing strength once the initial shock and distress have passed. This is true both of families supporting someone with a traumatic brain injury (TBI) or a spinal cord injury (SCI).
Long term family distress does not seem to be related to the severity of either a TBI or SCI

Traumatic Brain Injury

Up to 50% of families supporting a relative with TBI go through some period of anxiety or depression.
During the inpatient phase anxiety is more noticeable. Further down the track after discharge, feelings of depression seem to be more noticeable.
Some studies have found that spouses have a harder time when their partner sustains an injury than parents do when an adult child is injured. However other studies have found no difference in the distress experienced by parents or spouses.
The distress of families decreases when the family member feels that they have good social supports

Spinal Cord Injury

Up to 50% of families feel psychological distress in the period leading up to the discharge of their relative with SCI. However by 1 year post-discharge, this can have dropped to under 20%.
Up to 25% of partners feel as if they experience a heavy burden of care in supporting their spouse with a SCI.
Partners who marry someone with a SCI are generally more satisfied with the relationship than spouses whose partner sustained a SCI.
Over the longer term, spouses who did not have to play a significant carer role with their partner were generally less depressed

Answer the following question?

What percentage of families go through periods of anxiety and depression in supporting
their relative after traumatic injury

Internal and external challenges impacting on adjustment

In adjusting to traumatic injury there are:

internal challenges (like feeling loss of control)
external challenges (like finances and support networks).

What are examples of internal challenges?

Here are some examples

Internal factors which impact on adjustment include:

Outlook
Flexibility
Ability to access support
Communication style
Feeling loss of control
Privacy
Hope

What are examples of external challenges?