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 A tender touch. A gentle kiss. An intimate evening behind closed doors. When a person is recovering from TBI, these are the personal moments that don't often occur between couples.
For people with TBI, rehabilitation and recovery focuses on restoring cognitive function, memory and ability to accomplish basic activities of daily function. Intimacy and sexual relations with a spouse or partner may not be high on the list of priorities. However, this aspect of a relationship is a key component of re-establishing the social and emotional connection between partners, said Teri Sommerfeld, MHA, RN, CHN, an administrator at Rush University Medical Center, Chicago.
But the time to discuss such a personal topic should be directed by the patient or - as is the situation in many cases - the partner or spouse, Sommerfeld said. Nurses and other members of a multidisciplinary TBI team - psychologists, occupational and physical therapists, case managers - should be prepared to address questions and provide strategies to deal with this issue.
"We operate from a multidisciplinary team, and it's a whole team issue. One member of the team may develop a different type of rapport with the patient," which makes it easier to open up about the topic of sexuality, Sommerfeld said.
Determining Severity
TBI is a life-altering event where, in an instant, a person's feelings, memory, mental ability and capacity to respond to circumstances - the very components of one's personality - change abruptly. And damage to the brain doesn't respond like other injuries. Place a cast on a broken arm or leg, and the bones heal. Surgery and time can repair a torn knee ligament. But with TBI, a person may never be the same again, so coping strategies become the focus of recovery.
Every year, approximately 1.5 million people experience a TBI, and more than 5.3 million people live with a TBI-related disability, according to the CDC. Common causes of TBI include vehicle crashes, falls and strokes. The young and elderly are at highest risk.
Since no brain injury is the same and people respond at different rates, it's impossible to determine hard-and-fast timetables for recovery. Signs, symptoms and severity of an individual's TBI may not surface for weeks or months.
TBI can be classified as mild or severe. The category determination depends on several factors, such as the severity of the initial injury, number of functions affected, and the rate and progression of recovery.
Mild TBI. A brain injury is considered mild if a person experiences loss of consciousness, disorientation and confusion for fewer than 30 minutes. The consequences can produce cognitive problems such as headaches, difficulty thinking, memory problems, attention deficits, mood swings and frustration.
Signs and symptoms can include fatigue, visual problems, sleep disturbances, poor ability to concentrate, loss of balance and depression. People may also take longer to process information, be sensitive to light and experience nausea (www.traumaticbraininjury.com).
Severe TBI. With severe brain injury, loss of consciousness lasts longer than 30 minutes, and memory loss after the injury stretches past 24 hours. The damage and deficits are more drastic. The person can have speech problems and limited arm and leg function, as well as major cognitive deficits and emotional imbalance.
For many people with severe TBI, long-term rehab may be necessary to maximize function and independence. Even with mild TBI, the consequences to a person's life can be dramatic.
When classifying TBI as mild or severe, clinicians should consider the impact of the injury as it affects areas such as cognition, speech and language, and vision. Cognitive deficits range from poor attention span and concentration to reduced ability to process information and impulsivity.
Speech and language issues can create slurred speech, and problems reading and writing. With vision, a person can have problems judging distance, involuntary eye movements, or partial or total vision loss.
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