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By: Bari Sobelson, MS, LMFT

Imagine being a Convoy Commander and waking up one morning completely unaware of the way your life will change in the next few hours. You are hit by an IED and sustain parietal lobe damage and suffer a stroke from the blast wave. Several months after your injury, you have started to realize that some of the tasks that used to be so simple are now very difficult. After eating dinner last night, you discover that you are unable to figure out which Tupperware container would fit your leftovers. A once simple task has now presented a challenge that sends you back to the place of grief you experienced right after your injury.

This is one of the many examples that Dr. Heidi Knock provided for us during our Gray Matters webinar to give us a deeper understanding of the impact TBI can have on both individuals and their families. In her daily work with individuals who have sustained these injuries and their family members, Dr. Knock recognizes the importance of reaching out and helping. The following are some of the highlights from her enlightening webinar.

Depression, Suicidality, and Suicide Attempts and TBI

Neurological Rehabilitation Institute at Brookhaven Hospital found these statistics in August 2011: 53% of individuals who sustain a TBI will suffer a major depressive episode within the first year after injury. 23% experienced suicidal ideation after their injury. 17% actually had a suicide attempt after their injury. Dr. Knock asked participants to share their thoughts on why this might be the case. Here are their responses:

  • Chronic pain (emotional, physical)
  • Might not be getting all of the answers about their injury if it can’t be seen on a scan
  • Difficulty coping with the symptoms
  • Unable to receive the help they need
  • Can’t do what they used to be able to do
  • Experiencing loss associated with the injury
  • Feel like a burden to their family may lose support because they aren’t the same person they were prior to the injury

Dr. Knock added that people who have sustained TBI will continue to run into challenges that they did not anticipate. In fact, these triggers can send them back into the grief that they may have experienced soon after their injury.


In addition to the people who have sustained the injuries, others can be deeply impacted as well. Dr. Knock shared experiences of spouses who have taken on the role of the caregiver. The following are ramifications of this transition.

  • Typically cause a great deal of conflict
  • Spouse experiences loss and frustration as well
  • Spouse shoulders a great deal of the responsibility
  • Spouse often takes symptoms personally

Loss of Identity

There is a great sense of loss for many people who have suffered TBI, especially those active duty service members.

  • Sense of betrayal from the  military
  • Identity crisis experienced, as they never envisioned themselves doing anything other than being in the military
  • Some of their skills will not translate into marketable jobs in the civilian world, making the transition of the military very difficult
  • Some people join the military to get away from bad family experiences or situations and gain support in their military families. When they leave, they lose their support system.

Intelligence and TBI

“People with brain injuries are not stupid. They have little pockets of functioning that, based on where their brain was injured, that aren’t working, but the rest of their brain can be fully intact.”

Dr. Knock shared a powerful story with us about a man who attempted suicide and suffered a TBI as a result of the attempt with a gun. While his frontal lobe was injured and he displayed many symptoms as a result of this, his IQ was still 124. This should serve as a reminder to all of us that we should continue to treat individuals in a strength-based manner, recognizing that they may need assistance in only some areas rather than all.

Rehabilitation Team

Rehabilitation teams are of great importance. Dr. Knock provided a list of people who might be included on those teams and discussed the importance of each member.

  • People who sustain TBI should get immediate attention and services
  • They should be surrounded with a team of professionals to assist in adapting to symptoms and rewiring of the brain
  • Speech Pathologists do not just work on speech (click here for more information on Speech Therapy and TBI). 
  • Physiatrist- Medical Doctor who specializes in Rehabilitation
  • Physical Therapist- Focuses on coordination, balance, etc (Click here for more information on Physical Therapy and TBI)
  • The more people on board, the better the client will function


Here are some suggestions that Dr. Knock provided for the participants.

  • Speak slowly and clearly, checking in for feedback to assess if they are comprehending
  • Keep questions simple but do not talk down to them
  • Include family/support system in sessions and groups
  • Minimize distractions
  • Keep a journal and/or write down any items for follow-up


While accommodations may not be necessary for every area, it is important to recognize and address any that are needed. As a professional, you can easily write a letter outlining the needs of each individual for them to give to their work and/or school.

  • May need to be allowed to take a time out
  • May need a note-taker for school
  • May need more structure at work

Family Involvement

Dr. Knock highlighted the importance of family involvement in the care and rehabilitation of those who have sustained TBI. She asked participants of the webinar to give their reasoning behind this.

  • The client may not be good at advocating for themselves
  • The person who is injured may not recognize their symptoms of their own needs
  • They may need assistance with following up with services, advocacy, and social skills
  • A regular PCM may not know the extent of the injury or the entire story

Dr. Knock suggested that families seek the services of a case manager through the insurance companies. This may assist with the needed services and having the services covered under the insurance.

This post was written by Bari Sobelson, MS, LMFT, Social Media and Programming Coordination Specialist for OneOp.