Nick Philbeck was going for a loose basketball when he knocked heads with another player before hitting his head on the floor.

He went to the hospital, where he was told he didn’t have a concussion, but doctors did find a malformation at the base of his skull in his cervical spine that had been undiagnosed until the injury.

About a week after the accident, Philbeck started experiencing bad headaches, nausea, muscle tremors, decreased coordination and lack of focus.

“Even though I didn’t know what was going on, I knew something was clearly wrong,” Philbeck says. “After a while of not knowing what was going on, I kind of got used to it.”

He graduated from high school and attended college, where he started having more severe symptoms. After six and a half years and seeing a series of doctors, he was finally diagnosed with a traumatic brain injury, which he was made more susceptible to from the malformation at the base of his skull.

A traumatic brain injury is an injury to brain tissue caused by a blow to the head, explains Jean Capler, a licensed clinical social worker with a specialty in working with people with brain injuries. This differs from an acquired brain injury, which can be caused by a number of factors, including stroke, lack of oxygen or heart attack. She calls it an “invisible” disease that can go undiagnosed because the side effects are often attributed to depression.

Resource Facilitation

Capler works as a local support network leader for the Resource Facilitation Program through the Rehabilitation Hospital of Indiana. She says she sees unmet needs for people with brain injuries.

Nationally, Capler says, people with brain injuries are able to return to work at about 30 to 40 percent of the time, which leaves the majority of people never successfully reentering the workplace. Part of the reason is because their brain is injured, making it hard to follow through with recommendations.

Resource facilitation is a new approach to supporting people with brain injuries who are trying to return to work or school. They make connections between factors people need to keep in mind, such as where they need to be and when and who they should communicate with. They also help create stability in other realms, such as helping to find housing or a therapist.

“Fewer people are falling through the cracks and in the first few years of doing this, we’ve improved that return to work rate up to about 68 or 69 percent with the addition of resource facilitation,” Capler says.

Continued Brain Development

Most brain injuries involve the frontal area of the brain, says Dr. Stephen Curtis, a neuroscience-trained Clinical Psychologist with a specialty in performance psychology.

“Unfortunately that’s the part of the brain where we have executive function, so making decisions, choosing among options, making good decisions can often be impaired,” Dr. Curtis says.

He says people can live with such impairments for a long time before receiving a brain injury diagnosis.

He also says brain development continues until near the end of the twenties, so damage to this area can be particularly problematic.

Role of the Caregivers

Having a brain injury is not only upsetting and challenging to the injured person, Dr. Curtis says, because family members must also make lifestyle changes.

“They have to redefine their lives, usually very quickly, around this loved one who needs support and care,” Dr. Curtis says. “I think there’s a whole family trauma in some sense that’s experienced.”

He says family members often struggle with the transitions of redefining how they should restructure their lives to support their loved one, and learning to balance their job and relationships with other family members.

“My strategy is to help people build mental strength with repetition of learning how to calm down on cue, learning how to think positively about themselves and learning how to stay visionary in their approach to living day-to-day,” Dr. Curtis says.

It’s important both the brain damaged individual and their families continue to pursue goals and not give up their lives in favor of the injury, he says.

Philbeck recognizes that recovery is a process for the caregivers as well.

“My mom can get very frustrated that she feels like she’s not able to do enough for me and if I’m struggling with anything, she feels like it’s a reflection on her,” Philbeck says.

He says support groups for family members can help them deal with the changes and prepare them for their role in the process.

IU Speech and Hearing

The Cognitive Rehab Program at IU Speech and Hearing offers support services for individuals who have experienced brain injuries and their families.

Following his injury, Philbeck experienced a “mental fog” and had trouble with cognitive decision making, problem solving, planning and organization.

“A huge help of that was going to the Speech and Hearing Clinic and working on those cognitive skills,” he says.

Laura Karcher, a supervisor of the Cognitive Rehab Program, says the type of impairments depend on where the brain injury occurs. She provides speech therapy and works with people on various cognitive communication functions, such as helping with difficulties with understanding others, memory, attention, forming complete thoughts, reading, writing and visually processing information.

“Rehabilitation after a brain injury, ideally, is a team effort,” Karcher says.

That team is made up of everyone from the emergency room following an accident all the way through outpatient rehabilitation services.

Karcher says the Cognitive Rehab Program’s role is to educate the person with injury, as well as their families, peers and coworkers. They form individual treatment plans to help individuals rebuild skills, compensate for deficits and create a new normal based on their abilities.

“An important piece of that is support from individuals who have gone through that,” Karcher says. “I can talk about statistics and what should happen and could happen, but our brain injury support group is full of individuals who have been there and experienced brain injury in one form or another.”