Brain injury recovery and coping: a long road.

The road to recovery from 111 traumatic brain injury (TBI) is something of a "watch and wait" process that can sideline patients from their normal, daily functions indefinitely. There is no timetable laid out to mend our most complex vital organ once it's damaged, which can be one of the more frustrating parts of recovering from this unseen injury.

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The Defense and Veteran Brain Injury Center estimates that most cases of mild traumatic brain injury, or concussions, heal within one to three months. But the symptoms accompanying even the most mild head injuries are enough to alter a person's cognitive function, personality and behavior.

"Just within the last decade, we have seen hundreds of thousands of veterans come home with brain injuries of varying severity," said Washington Headquarters Executive Director Barry Jesinoski. "It has been difficult for the VA and the civilian medical community to respond to such a high influx of TBI patients in such a short timeframe."

It has been even more challenging, it seems, to come up with definitive answers for those suffering from these injuries and for those helping them to heal.

For Veterans

For many veterans, the signs of brain injury are easy to miss. There's just something ... a little off. It may be a slight disconnect between the thought process and speech, fuzzy recollection and trouble remembering simple things and, of course, the ensuing frustration with these difficulties

"Proper screening is absolutely crucial to ensuring an accurate diagnosis," Jesinoski said. "Another key factor is that veterans must do their part in the recovery process."

Experts in the field agree that proper diet, rest, and exercise, as well as stress reduction are key to the recovery process. "Number one, I think stress reduction is very important when you're dealing with a traumatic brain injury and concussions, at least until the patient is asymptomatic." said Dr. Ricardo Komotar, Assistant Professor of Clinical Neurosurgery at the University of Miami Hospital.

But stress reduction can be a tall order for many TBI patients. Perhaps most frustrating is the lack of a clear therapy or treatment once the injury has been properly diagnosed. Army veteran Jeffrey Hummert was injured in Iraq in 2005, and after two difficult years of fighting to stay in the service, he ultimately received a medical discharge.

His advice for fellow veterans is to stay open-minded and to keep fighting for what is important. "Keep pushing through it and come to the mindset that you're not going to let it beat you, but you have to come to that decision," said Hummert, "Your family can't do it for you. Give yourself a reason, be it your family or something else. You just can't let it steal your life."

There are suggested methods for recovering or at least improving cognitive function. Incorporating the five senses (feel, sound, sight, taste and smell) into memory-making and associating, or "hooking" new information to something already known are ways that can help patients who have difficulty with recollection.

Talk therapy is also something that, while not for every patient, can at least offer some level of stress relief. And so-called brain "exercises" that help to sharpen cognitive skills may be useful, though this has yet to be clinically verified. For other memory troubles, written reminders can be extremely useful in prompting recollection.

Today there are a number of smartphone applications that can also help keep track of family calendars, appointments, medication schedules and refill notifications. Veterans suffering from TBI may also be eligible for a personal digital assistant (PDA) from the VA, by making the request through their case manager or primary care physician.

Hummert said veterans should try to involve the whole family in the process rather than going it alone, and he advises caregivers to be understanding through the recovery. "Sometimes we do get a little angry or frustrated with everything, and sometimes it comes out at the wrong times," he explained. "There may be a time when we are dealing with something else and our priorities may not match up with yours. Know that it's not about you. Don't take it personally."

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For Caregivers

Any spouse, parent or other person devoted to the care of an injured or ill veteran can tell you the recovery process can be challenging and demanding, albeit a labor of love. For caregivers of veterans with cognitive impairments, the job can be particularly difficult.

Researchers at the Minneapolis VA medical center recently studied how caregivers of veterans with stigmatized conditions like TBI may experience discrimination or stigma-by-association. Veterans' caregivers were asked about their role in recovery in the months following rehabilitation.

"We found that generally inpatient treatment periods were more stressful for caregivers than at home," said Dr. Joan Griffin, Assistant Professor at the University of Minnesota Department of Medicine. "Once they return home, the reality of normal life sets in, and things slow down. It helps the family to realize that the patient will never really be the same again."

This truth can either make or break a family. Heather Hummert began writing about her role as a caregiver after her husband, Jeffrey, was discharged from the Army. She is now the vice president of the non-profit Family of a Vet organization, which provides resources to help veterans and their loved ones "survive and thrive in life after combat."

"You are in a new world, and it's never going to be the same. The sooner you realize that, grieve for it and accept it, the sooner you can begin to build a new life that can be beautiful, rewarding and full of possibilities," said Hummert.

As 45 percent of caregivers report spending up to 80 hours a week performing tasks for the recipient, it is no surprise that Dr. Griffin's survey shows an emotional and physical toll on their health. The intense workload, often accompanied by the need to help the veteran cope with the emotions of polytrauma and TBI (such as anger, frustration and depression), is associated with the caregiver's risk for poor health.

Those surveyed also responded to questions about experiencing caregiver feelings of strain and stress, anxiety, social isolation and depression The study revealed a distinct link between the onset of these symptoms and perceived caregiver discrimination and stigma. The researchers concluded that adequate mental health support services were necessary to stave off the stressors that could ultimately lead to poor mental health.

"As much as service members and veterans struggle with accepting help for brain injuries and emotional trauma, caregivers also find it difficult to admit the need for assistance," Jesinoski said.

Hummert echoed the study's findings. "You are going to quite possibly need counseling for yourself and even other members of your family," she said. "You need to be willing to accept that help and support, and let people help you."

Caregivers for Iraq and Afghanistan-era veterans with polytraumatic injuries are more often parents (60 percent) than spouses (35 percent). This presents completely new challenges as parents are less likely to have access to the same resources as a spouse, particularly legal access to service-connected disability income that can help to offset caregiving costs. Dr. Griffin noted this makes it possible for some caregivers to be caught in the poverty cycle as a result of their financial struggle through the veteran's recovery.

Moving Forward

In 2010, DAV applauded the passage of the Caregivers and Veterans Omnibus Health Services Act, which established a wide range of new support services for certain caregivers of eligible Post-9/11 veterans. However, it's not just veterans fresh from deployment who battle with brain injuries. The VA has seen the largest increase of post-military TBI cases with patients in their 70s and 80s, resulting from everyday household falls and accidents.

DAV also expressed concern in testimony before the House Committee on Veterans' Affairs in March 2011 that the VA had not met appropriate deadlines for implementing these expanded caregiver support services. As noted in the testimony, in the absence of family caregivers, "an even greater burden of direct care would fall to VA at significantly higher cost to the government and reduced quality of life for these veterans who have sacrificed so much."

Help is available for veterans and their caregivers, but more can certainly be done to lift some of the burdens they shoulder through the recovery process. The take-away from success stories like the Hummerts' is to find solace in knowing you are not alone.

There are thousands of other veterans and caregivers learning to adapt to the same challenges, Hummert explains. "They are here to help you too, and can be your very best network of support as you travel this journey into your new life. Life after combat isn't an end; it's a whole new beginning."