- Guest article by Steve Shears MSc, Dip HG, Dip PST, MBACP (Accred)
Many people in the UK are admitted to or treated at hospital every year following accidents.
Often these accidents have involved or included a traumatic head injury to with or without short periods of impaired consciousness. In many cases people are discharged following examination. They are given information leaflets about watching out for further physical symptoms of concussion developing.
In other cases there are physical injuries to other parts of the body as well. These injuries may have had to be treated first. Patients are given information about head injury symptoms and are sent home.
In most cases these patients will be fine after a few weeks post-discharge and any residual head injury symptoms related to the head injury will have resolved. These head injury symptoms are often called ‘post-concussion syndrome’ when they persist for longer than would be expected.
Of course if you are the person with a minor head injury you can experience these symptoms as more than minor.
It would really help if you and your partner/spouse inform yourself about what can be expected. Ideally you would have her/his support!
Here are the most common symptoms following a head injury:
All enough to cause you to feel depressed and anxious.
But.... there is hope! I can't wait for you to watch this video...
Your partner might comment that you are different than you were before the accident. She/he may claim that you are irritable more often, losing your temper or being impulsive.
You might want to argue about this, because you don't think you have changed that much! You get irritated by all the fuss and you just want to get back to work and get on with your life.
As a partner or spouse of someone with post-concussive syndrome following a minor head injury, you might wonder why your partner doesn't appear to see that their behaviour has changed. He/she seems to take your observations personally. It might feel that you are not living with the person you knew before the accident.
Your reaction to what has happened depends to some extend on what your relationship/marriage was like before you partner had the accident.
If you can identify yourselves in all of this then it might help to know that this is quite normal for someone with post-concussive symptoms. The brain has had a disruption of its’ network and things are not quite working like they used to.
Sadly, the problem could be even worse if your partner or spouse has played a contact sport. See Elly's article on Chronic Traumatic Encephalopathy - CTE and your relationship.
The good new is that in the majority of cases with a mild brain injury that after a few months you both might notice that things are settling down. The brain starts to reorganise its’ network a bit.
However, it is probably best to avoid the temptation to return to work in the first few weeks. There may be a price to pay in terms of fatigue. Because your brain is still recovering, it requires more effort to do things that you used to take for granted.
Needless to say if you are both living with these sorts of symptoms for a significant period of time it may put strains upon your relationship and in some cases it might be advisable to speak to a counsellor who understands minor head injury and post-concussive syndrome.
I have been a working therapist for 22 years. The last 5 years I have been working with couples where one partner has experienced a brain injury. I have helped couples to understand the effects of brain injury and the impact it has on their relationship.
I am also a trained psychosexual therapist. I can help when the sexual side of your relationship has been affected by the symptoms of brain injury.
We can work together to help you both find ways of reducing the impact the post-concussive syndrome. Your relationship will be hugely helped by my expert advice on better strategies for communication under these challenging circumstances.
Imagine what it would be like to experience the relief of talking to someone who understands this condition! Together we can make progress in dealing with something that has turned your world upside down.
Headway, the Brain Injury Association, suggests that if these symptoms persist for more than two weeks then you and your partner should consult your GP. It may be a good idea to take Headway’s downloadable 'Minor head injury discharge advice' factsheet with you.
If these post-concussive symptoms persist for a significant period of time then you may be referred to a head injury specialist, such as a neurologist or a neuropsychologist for further examination.
If you are suffering from prolonged symptoms or you have had a more severe head injury, you may also require traumatic brain injury rehabilitation. This specialist rehabilitation treatment will help you relearn memory or thinking skills. It can also help you to develop effective strategies to compensate for lost skills.
Counselling and other forms of psychological support such as Cognitive Behavioural Therapy should also be a part of an overall approach to helping you with brain injury rehabilitation. The emotional side of your recovery is very important too.
As I indicated before it really helps to have good information about the nature of minor brain injury and post concussive syndrome. It goes some way to helping you to understand the after-effects of brain injury. It can really dispel some of the uncertainty about the condition.
You may both find this fact sheet about how the brain works helpful. It will give you a little bit more of an understanding how the injury can have such a wide-ranging physical and psychological effect.
Depending on the cause of the injury, you may also find it helpful to inform yourself about the symptoms of PTSD.
As a partner/spouse you may be able to understand and tolerate better the more physical symptoms of post concussive syndrome such as fatigue.
However, the cognitive problems (thinking skills, memory and concentration) and changes in personality can be much more difficult to cope with.
You will be aware of and often at the receiving end of irritability, angry outbursts and impulsivity. That can be really difficult to cope with.
It can be difficult to distinguish aggressive outburst on account of the head injury from the calculated, manipulative, deliberately abusive behaviour you would be subjected to in an abusive relationship. And, of course, there can be an overlap.
So, read Elly's article on the signs of an abusive relationship to be able to be clear about the latter.
Remember, regardless of the causes of aggressive behaviour, you do have a right to feel safe in your relationship!
We could say that we are our brain. In that context the changes in cognitive skills and behaviour perhaps become less surprising. However, it can be really frustrating to deal with on a day to day basis - for you as well as your partner.
This is particularly so when perhaps the brain injury has affected your partner's ability to fully appreciate the impact of their altered behaviour on you.
Many of us struggle with seeing our behaviour the same way our partners do even without a brain injury! So imagine how much more difficult it is if the very areas of the brain that govern your ability to appreciate how you are behaving has been affected.
The question your partner may need to ask of his/herself is:
“if this lack of insight thing is part of brain injury, then do I need to listen a bit more carefully to what my partner is saying when he or she says my behaviour is affecting them negatively?”
Of course as a partner of someone with post-concussive syndrome following a minor brain injury, you can get hugely frustrated too.
Your attempts to communicate with your partner can falter easily. Your partner does not always appreciate or understand your point of view about what it is about his/her behaviour that you find unacceptable.
It really does not help to criticise your partner in this way:
It is better to just point out the behaviour and the consequences of it:
Direct confrontation and criticism is hard enough to handle when you don't have a head injury. Now your partner has cognitive problems and difficulties with insight, attacks are even more likely to cause aggravation.
For more information, see: Dealing with criticism.
In the first instance it would help to allow your partner to make their own discoveries about what might be causing them to become agitated or aggressive.
For instance, multiple sources of stimulation in a room such as the TV being on loud, people talking, children crying and the telephone ringing can be very confusing and agitating following a brain injury.
The both of you might normally have taken all that noise in your stride. However, following a brain injury it can be a source of irritation and outbursts in post-concussive syndrome.
You could get your partner to rate their levels of distress when exposed to these situations - as they are actually happening. A simple 1 to 10 scale could be used or a Green-Amber-Red scale might also work.
So finding out about things together is far more helpful than telling your partner what they are being triggered by. It may give you both a chance to work together to create a calmer, less stimulating environment. This will go a long way to reduce trigger points that have the potential to result in angry outbursts.
A lack of insight makes it more difficult for your partner to appreciate the need to learn the trigger points of their anger outburst following a minor brain injury. However, hopefully you and your partner will get to a point where you both know when he/she starts to ‘lose it’.
A great tip is to agree signs between you. You can then discreetly signal your partner/spouse, when you become aware of behaviours that might precede a full-blown melt down. Signs might be your tapping the end of your nose or a meaningful hand gesture that symbolises the need to calm down.
Your partner will at some point start to recover his or her insight into their trigger points. He/she can then also learn to become aware of changes in his/her body at the early stages of anger, such as tense muscles.
Here are some helpful strategies, as part of the treatment, to try and avert an outburst. Allow him/her to find what works for them:
Your partner also may become better at recognising the part that their thoughts play in causing them to become agitated.
As part of their brain injury rehabilitation, he/she can learn evaluate either the reality of them. Then they can decide on whether they need to act on them or to become upset about them. Actually ... this counts for you too!
What needs to be relearned is that anger is just an emotion. It tells us we need to do something about what is angering us.
You can help your partner (and yourself if need be) to learn that he/she has some choices in their responses to that emotion.
Here is a great video about the impact of a brain injury on a relationship/marriage.
Headway (The Brain Injury Association): managing anger for families and carers
Image courtesy of: Nina Matthews Photography