Family-centered neurorehabilitation: A necessary shift in traumatic brain injury management

Traumatic brain injury (TBI) continues to represent a growing public health crisis in low- and middle-income countries, including India.^[1] Despite the steady advances in neurosurgical care, neurocritical management, and functional rehabilitation, the psychosocial dimension of recovery remains vastly underrecognized. In this context, the study by Shetty et al.,^[2] featured in the current issue of the Journal of Neurosciences in Rural Practice, brings long-overdue attention to an area of neurotrauma care that is both complex and neglected: The psychosocial needs of people living with TBI and their non-injured spouses. The findings of this exploratory study are unsettling but not surprising. They force us to reckon with the reality that TBI is not merely an individual clinical event; it is a deeply relational trauma that disrupts the social, emotional, sexual, and economic ecosystems of the household. The study, using a qualitative approach, distills six core themes: Educational needs, sexual issues, behavioral challenges, suicidal ideations, diminished well-being, and life disturbances. Each of these categories, supported by subthemes and narrative accounts, offers a textured portrait of the lived experience of TBI survivors and their partners.

Most injured persons in the study were young males with subdural hematomas associated with road traffic accidents. Their spouses, often women from lower socioeconomic rural backgrounds, found themselves abruptly transitioning into full-time caregivers, financial managers, and emotional regulators of the household. This demographic profile shows us a broader epidemiological trend where TBI disproportionately affects working-age men, while caregiving responsibilities fall on women, often without formal training, support, or systemic recognition. In other words, the burden is compounded by poverty, low health literacy, limited access to mental health services, and entrenched gender norms.

Shetty et al.^[2] offer important information because injury to the brain does not end with discharge from the neurosurgical unit. For many families, it marks the beginning of a protracted psychological emergency. The injured partner often grapples with irritability, changes in sexual behavior, and episodes of suicidal ideation, while the non-injured spouse navigates new roles, chronic uncertainty, fatigue, and the slow erosion of relational intimacy. In many cases, these experiences unfold without a correct follow-up and the absence of structured psychosocial care and minimal acknowledgment from healthcare providers. This editorial posits that the clinical model of neurotrauma care in India, and much of the Global South, remains acutely underprepared to address these invisible sequelae. We believe that it is mandatory to rethink the structure of care along several dimensions and not just the dominant biomedical paradigm, centered around diagnosis, surgery, and stabilization.

First, the scope of discharge planning must be reconfigured, and the education about brain injury, recovery trajectory, behavioral changes, and support mechanisms must be made integral to the discharge process. Families must leave not just with prescriptions and physiotherapy dates, but with clarity about what changes to expect, how to manage them, and whom to contact when difficulties arise.

Second, psychosocial screening must be institutionalized into follow-up protocols. The findings suggest that issues such as depression, role fatigue, and sexual dysfunction are not episodic but persistent. The absence of trained psychiatric social workers or clinical psychologists in neurosurgical outpatient departments is a glaring gap. Integrating these professionals into routine neurorehabilitation teams could radically improve identification and support for at-risk families.

Third, there is a need to normalize and validate caregiver distress. Caregiving, particularly spousal caregiving in TBI, is often idealized as noble but is, in fact, a source of chronic emotional strain. The non-injured spouse’s health and well-being must be viewed as essential–not supplementary–to patient outcomes. We suggest that tertiary care centers should include services for caregivers, such as peer support, counseling for couples, and short-term relief programs, in other words, ensuring that patients will receive the support needed to maintain their vital role in the patient’s recovery and well-being.

Fourth, the findings underscore the need for context-sensitive, culturally grounded interventions. When we check the available literature on caregiver burden and post-TBI, this comes from Western contexts, with little resonance in Indian sociocultural realities where family structure, stigma, and health-seeking behaviors differ significantly. Tailored interventions must be developed with the input of Indian families, drawing on indigenous coping models, spiritual frameworks, and local networks of support.

Fifth, this study urges us to reimagine “recovery” not as a return to pre-injury functionality, but as a shared, negotiated process involving adaptation, renegotiation of roles, and rebuilding identity for both partners. The presence of suicidal ideation and emotional burnout among caregivers must be viewed as clinical red flags, no less urgent than physical complications in the patient.

From a policy perspective, these insights call for a broader inclusion of psychosocial rehabilitation in state-supported trauma programs, insurance frameworks, and medical curricula. The Mental Healthcare Act (2017) and the Rights of Persons with Disabilities Act (2016) in India provide a potential legal basis for integrating mental health and rehabilitation services into neurotrauma care, but implementation remains uneven.^[3] As this study shows us, the needs are real, the suffering is quiet, and the gaps are wide. However, the opportunity to humanize care, to listen, and to respond is right in front of us. There is a need to expand the scope of neurosurgical care to psychotherapy as without addressing the psychosocial ruptures caused by TBI, our interventions remain incomplete. The road forward will require collaboration between neurosurgeons, social workers, psychologists, rehabilitation specialists, and policy makers. It will also require humility to recognize that healing cannot be measured solely in Glasgow Coma Scale scores or radiological reports, but also in the quality of relationships, emotional recovery, and the everyday resilience of families navigating life after trauma. Here, the role of empathy from the healthcare team toward the patient and their family is important. We must widen the aperture of care, seeing not just the injured brain, but the disrupted lives around it.