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Traumatic brain injuries and concussions can have devastating impacts on our personal relationships, causing both physical and emotional strain for all parties involved. The person that suffered the brain injury may experience difficulty communicating their symptoms or experiences, which may lead to feelings of loneliness, anxiety and depression. Fatigue, low energy and other physical side effects may also impact a person’s ability or desire to spend time with loved ones.[i]

For the partner or spouse, struggling to deal with post-concussion or TBI symptoms can be extremely challenging and can significantly impact their psychological well-being. They may feel emotionally unsupported, frustrated with the extra demands placed on them or over-burdened by financial pressures that may arise from reduced employment hours or ongoing rehabilitation costs.

While there is no clear-cut link between TBI and marital breakdowns, studies have shown that partners are less satisfied in their relationships post-TBI.[ii] In order to preserve and nurture personal relationships, consider the following:

IDENTIFY THE CHANGES

It is crucial to be upfront with your partner about the changes they are witnessing and/or experiencing following a TBI. Survivors must communicate their post-TBI symptoms to members of their support system in order to receive proper rehabilitation and maintain healthy relationships. This includes detailing cognitive decline, psychological and physical consequences, dizziness or balance problems, nerve damage and fatigue or drowsiness. Maintaining open lines of communication will help to ensure that survivors are given the appropriate level of support without accompanying feelings of resentment from caregivers.

For the spouse, unfamiliar personality traits may develop as the brain injury survivor learns to deal with their new reality, leaving them to feel as if they are “married to a stranger.” While a person may look the same, spouses can often feel a profound sense of loss or grief because their partners act and feel much different than they did pre-TBI. These feelings intensify if there are aggressive tendencies or anger control problems, which are common if there is damage to the brain’s frontal lobe, the part of the brain that governs personality and impulsivity.[iii] While it may be easier for the caregiver to recognize these changes than to resolve them, identification and communication is key to finding targeted solutions from appropriate medical professionals.

REASSESSING ROLES

Role reversals are quite common in relationships where one person has suffered a concussion or TBI. For example, if the partner who manages household finances or childcare experiences a TBI, they may be forced to step back from these duties during recovery while their spouse assumes the responsibility. For the partner accustomed to being the breadwinner, a TBI may force them to move into lower paying jobs, reduce their employment hours or give up working altogether. This poses significant challenges for both the mental psyche of the TBI survivor as well as the partner who must find a way to cope with the reduced income while dealing with added medical costs.[iv]

These types of role reversals can strain marriages and create friction within the family dynamic. It is important to identify where these role changes occur and discuss openly with your partner. Couples must also be cognisant of the fact that one partner may not handle issues the same way as the other. Withholding judgement and criticism while supporting your spouse in this new role is key to improving your relationship.[v]

UNDERSTAND THE TREATMENT PLAN

No matter the severity of the TBI or concussion, patients and anyone within their support system, including their spouses, should be kept apprised of the treatment plan and anticipated timeline for recovery. This information should be provided at the initial assessment and throughout the rehabilitation process, with education tailored to the patient’s medical history. The treatment plan should include education on symptoms and expected outcomes, reassurance about the likelihood of a full recovery, the path to a gradual return to activities and techniques to manage stress.[vi]

Treatment plans vary and may include physical, occupational, cognitive and/or speech therapy, as well as psychological or vocational counselling.[vii] For those suffering from balance or gait issues, the PoNS Treatment™ may be the recommended approach. PoNS™ is an innovative non-surgical medical device that delivers mild electrical stimulation to the nerves of the tongue, which connect with the nerves in the brain to help restore balance and gait. This 14-week program combines PoNS™ with therapeutic activities and has been shown to improve balance in a clinical trial at a success rate of 74 per cent.[viii] Communicating these treatment details and potential success rates is key to managing expectations and educating spouses or partners on how best to achieve a full recovery.

CONSIDER PROFESSIONAL INTERVENTION

Seeking external support when learning to cope with post-TBI symptoms can be extremely helpful for couples trying to navigate this new terrain. In most communities, there are active support groups for both survivors and caregivers that are easily searchable online or through a doctor’s recommendation. Web-based chat groups can also be an excellent option for people with accessibility or transportation-related challenges. Local brain injury associations will also be able to recommend support groups or counsellors in the area.

It is important to note that if you are seeking professional intervention, look for a counsellor or psychotherapist with experience dealing with brain injuries. 

[i] National Resource Center for Traumatic Brain Injury. “What Happens to Relationships After Brain Injury?” Brainline, www.brainline.org/article/what-happens-relationships-after-brain-injury (March 6, 2020)

[ii] Riley, Gerard. “The Partners Experience of Traumatic Brain Injury and its Recovery.” Concussion. Dec. 2016.

[iii] Gan, Caron. “Behavior and Personality Changes After TBI.” Brainline. www.brainline.org/video/behavior-and-personality-changes-after-tbi (March 6, 2020)

[iv]   Rocchio, Carolyn. “Challenges, Changes, and Choices: A Brain Injury Guide for Families and Caregivers.” Brain Injury Association of America. /www.biausa.org/downloads/brain-injury/Guide%20for%20Families%20and%20Caregivers.pdf (March 6, 2020)

[v] Godwin, Emilie, Jeffrey Kreutzer and Stephanie Kolakowsky-Hayner. “Relationships After Traumatic Brain Injury.” Model Systems Knowledge Translation Center. https://msktc.org/tbi/factsheets/relationships-after-traumatic-brain-injury (March 6, 2020)

[vi] Marshall S, Bayley M, McCullagh S, Berrigan L, Fischer L, Ouchterlony D, Rockwell C, Velikonja D, et al. Guideline for Concussion/Mild Traumatic Brain Injury and Prolonged Symptoms: 3nd Edition (for Adults 18+ years of age). Ontario Neurotrauma Foundation, 2018. 

[vii] “What are the treatments for TBI?” Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/treatment (March 6, 2020)

[viii] Helius Medical Technologies. Data on File. 2019 Post Hoc Analysis – Long Term Treatment Trial – Responder rate – Pharma Data Associates 2. Tyler M, et al. Arch Res Rehabil Clin Transl. 2019; 1(3-4):10026.