Understanding Traumatic Brain Injury (TBI)

Traumatic brain injuries (TBIs) are head injuries that occur from violent blows, hard jolts, or severe bumps to the head. When it is a non-penetrating TBI, it is called a closed head injury. In addition, TBI can occur from a penetrating brain injury, for example, a gunshot wound to the head.

A traumatic brain injury damages brain tissue and disrupts normal brain functions. A diffuse injury affects large areas of the brain while a focal injury is limited to a specific area. Diffuse axonal injury (DAI) is one of the most common types of brain injuries and refers to widespread damage to the white matter of the brain. Damage to brain cells can result in short- and long-term health complications.

TBI affects people of all ages and is a major cause of disability and death.

Common Causes of TBI

Traumatic brain injuries are usually the result of head trauma from:

Falls
Motor vehicle crashes
Violence, including assaults, domestic violence, child abuse, and shaken baby syndrome
Firearm-related penetrating injury, such as a gunshot wound to the head.
Sports-related injuries from contact sports, high-impact sports, and extreme sports (for example, boxing, football, soccer, baseball, hockey, lacrosse, skateboarding).
Combat injuries during active military duty, for example, due to penetrating wounds and severe blows to the head from explosions, blast injuries, shrapnel, debris, collisions, or falls.

Types of TBI

Healthcare providers classify traumatic brain injuries as mild, moderate, or severe based on the duration of mental status changes and loss of consciousness:

Mild TBI: Less than 30 minutes.
Moderate TBI: 30 minutes to 6 hours.
Severe TBI: More than 6 hours.

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Symptoms and Diagnosis

Mild TBI Symptoms (Concussion Symptoms)

Physical symptoms can include:

Fatigue
Drowsiness
Dizziness
Headache
Nausea
Vomiting
Speech problems
Loss of balance
Low blood pressure

Sensory symptoms such as:

Blurred vision
Tinnitus (ringing in the ears)
Taste changes
Changes in smell
Increased sensitivity to light and sound

Mental, behavioral, and cognitive symptoms such as:

Feeling dazed
Confusion
Disorientation
Loss of consciousness (passing out)
Memory problems
Trouble concentrating
Mood swings
Anxiety and depression
Changes in sleep patterns, including insomnia (difficulty sleeping) or hypersomnia (excessive sleeping)

Learn more about how to know if you have a concussion.

Moderate to Severe TBI Symptoms

Moderate or severe TBI causes many of the same symptoms as mild TBI, but they are more severe and longer-lasting. Symptoms of severe injuries include:

Loss of consciousness lasting more than 30 minutes
Persistent or worsening headaches
Repeated bouts of nausea and vomiting
Dilation of one or both pupils
Drainage of clear fluid from the ears or nose
Sleeping more than usual
Numbness in the fingers and toes
Poor coordination
Slurred speech
Recurrent seizures or convulsions
Slowed thinking
Memory problems
Severe confusion
Unusual behaviors such as combativeness, aggression, or agitation

Find out How Long Does a Concussion Last?

Diagnostic Procedures for TBI

Serious TBI is a medical emergency and requires quick assessment and treatment to prevent further injury to brain tissue. First responders and healthcare providers use the following to diagnose TBI and assess TBI severity.

Glasgow Coma Scale

Glasgow Coma Scale (GCS) is a 15-point scale that doctors and emergency personnel use to assess a person’s level of consciousness, brain function, and severity of traumatic brain injury. The total GCS score is based on motor response, verbal response, eye-opening, duration of loss of consciousness, and post-traumatic amnesia. A lower GCS score indicates more severe injuries.

Imaging Studies

People with suspected traumatic brain injuries undergo a computerized tomography (CT) scan of the brain in the emergency room. This allows doctors to obtain detailed images of the brain using X-rays. A CT scan can identify hemorrhage (bleeding), hematomas (blood clots), skull fractures, contusions (bruising of brain tissue), and edema (swelling of brain tissue).

Healthcare providers may request other imaging tests, such as magnetic resonance imaging (MRI). This test uses powerful magnets to produce detailed images of the brain. MRI scans are usually done after a patient’s condition has stabilized and if symptoms do not improve.

Intracranial Pressure

Swelling inside the skull from a traumatic brain injury can lead to increased intracranial pressure, which can cause further damage to brain tissue by placing pressure on the brain. Doctors can insert a small pressure-sensitive probe through the skull to monitor the intracranial pressure.

Blood Tests

Healthcare providers do routine blood tests such as complete blood count, electrolyte levels, and blood glucose levels in TBI patients. In addition, there are biomarkers that can tell doctors about the severity and prognosis (outlook) of TBI after the initial trauma, such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-1), and tau proteins.

Importance of Early Detection

Severe TBIs are medical emergencies and require prompt medical attention. In people with mild injuries, early diagnosis and treatment can limit the damage caused by a traumatic brain injury.

Treatment for Traumatic Brain Injuries

Treatment for Mild TBIs

Mild traumatic brain injuries do not usually require any specific treatment other than physical and mental rest. However, a person with a mild TBI should be monitored carefully by family members at home for a few days while they recover. Any persistent or worsening symptoms should be promptly reported to the health care provider. Treatment recommendations for mild TBI may include:

Over-the-counter pain medications such as Tylenol (acetaminophen) to treat symptoms such as headache
Limiting physical activity for a few days
Limiting mental (cognitive) activities
Returning to the normal routine slowly

Treatment for Moderate or Severe TBIs

Emergency care to ensure adequate blood supply, oxygen supply, maintain blood pressure, and prevent further injury.
Treatment for infection, inflammation, bleeding, or hypoxia (reduced oxygen supply to the brain).

The healthcare team may also use medications to limit brain damage, such as:

Antiepileptic drugs to prevent seizures.
Coma-inducing drugs to reduce the brain’s need for oxygen.
Diuretics (water pills) to remove fluid from the body and reduce pressure inside the skull.

Emergency surgery for people with moderate or severe TBI may include:

Removal of hematoma (blood clot).
Repair of skull fractures.
Surgery to stop bleeding in the brain.
Creation of a window in the skull to relieve pressure inside the brain.

Long-Term Treatment Options: Rehabilitation Programs and Services

Most people with a moderate or severe TBI require rehabilitation to regain basic skills and the ability to perform activities of daily living.

Long-term therapy usually starts during the patient’s hospital stay and continues at an inpatient rehabilitation unit and then an outpatient rehabilitation program. Rehabilitation services typically include:

Physical medicine and rehabilitation to coordinate overall care.
Physical therapy to improve mobility, flexibility, balance, and gait.
Occupational therapy to learn or relearn skills necessary for daily activities.
Speech and language therapy to improve communication and learn to use assistive devices if needed.
Neuropsychology to learn coping strategies to maximize cognitive performance.
Psychotherapy to improve emotional well-being and mental health.
Social work and case management services to access resources and services, make decisions, plan care, and assist family members.
Rehabilitation services for discharge planning from the hospital and transition to an inpatient rehabilitation facility or outpatient rehabilitation program.
TBI specialist to coordinate care and support the patient and family during recovery.
Recreational therapy for leisure activities.
Vocational counseling to facilitate return to work.

What Are The Long-Term Effects of Traumatic Brain Injury?

Effects on Consciousness in Severe Traumatic Brain Injury

Coma (unconsciousness).
Vegetative state (unaware of surroundings with minimal responses).
Minimally conscious state (some awareness of self and environment).
Brain death (it is called brain death when there is no measurable electrical activity in the brain and there is a dependence on breathing devices to stay alive).

Physical Health Complications from the Primary Brain Injury

Headaches
Vertigo (dizziness)
Seizures or convulsions
Hydrocephalus (buildup of fluid in the brain)
Infections due to penetrating injuries
Blood clots, stroke, and other problems due to damage to blood vessels

When physical symptoms persist for more than a few weeks to months, it is called persistent post-concussive syndrome.

Sensory Complications From Cranial Nerve Damage

Facial muscle paralysis
Changes in taste
Loss of smell or changes in smell
Ringing in the ears
Hearing loss
Vision changes such as blurred vision, double vision, or blind spots
Swallowing problems
Numbness, tingling, itching, or pain in the skin
Dizziness and trouble with balance
Poor hand-eye coordination

Cognitive Difficulties

Memory problems
Trouble learning new things
Problems with reasoning and judgment
Trouble paying attention or concentrating
Difficulties with problem-solving and decision making
Trouble multitasking and organizing

Communication Problems

Dysarthria (trouble speaking)
Difficulties understanding what others are saying
Problems with writing
Difficulty organizing thoughts
Trouble following directions or taking turns
Difficulty participating in conversations
Problems understanding nonverbal cues

Behavioral Changes

Disinhibition or lack of self-control
Poor awareness of abilities
Risky behaviors
Trouble behaving appropriately in social situations
Anger outbursts

Emotional Symptoms

Psychiatric disorders like anxiety, depression, or post-traumatic stress disorder
Irritability
Anger
Mood swings
Lack of empathy for others

Link to Degenerative Brain Diseases

Research suggests that people with severe traumatic brain injuries may be at an increased risk of degenerative brain diseases, such as Alzheimer’s disease, Parkinson’s disease, and dementia pugilistica (a type of dementia that occurs in boxers due to repeated blows to the head).

Life After TBI: Challenges and Adjustments

Strategies for coping with traumatic brain injury include:

Joining support groups to talk about challenges, receive emotional support, and learn from the experiences of others.
Making lists and notes to help remember important events and tasks.
Following a consistent routine and keeping things in their place to reduce confusion and forgetfulness.
Taking regular breaks at school or work.
Making appropriate changes to accomplish tasks, such as having more time allotted during tests at school.
Staying focused on tasks requiring mental concentration and avoiding distractions such as loud music.

Prevention and Risk Factors

Who is at Risk for TBI?

People of all ages can suffer traumatic brain injuries, but those at highest risk include:

Young children under 4 years of age.
Young adults between 15 and 24 years of age
Older adults above 60 years of age.
Males of all ages more than females.

Preventative Measures and Safety Tips

The following tips can help to prevent head injuries from a motor vehicle accident:

Always wear a seat belt.
Place small children in a child safety seat or booster seat that is appropriate for the child’s size and weight.
Wear a helmet while riding a motorcycle.
Never drive under the influence of alcohol or drugs.
Be aware of your surroundings and avoid using devices like a phone or tablet while walking or crossing the street.

Fall prevention tips:

Place a non-slip mat in the shower or bathtub.
Install grab bars in bathrooms.
Install handrails on both sides of a staircase.
Remove area rugs that may be tripping hazards.
Ensure proper lighting in hallways and staircases.
Keep your home clear of clutter.
Get regular eye checkups.
Get regular exercise to maintain balance.

Tips for preventing sports injuries:

Wear the right gear, such as a helmet when riding a bicycle, snowmobile, skateboard, or all-terrain vehicle.
Wear appropriate head protection during contact sports, skiing, skating, snowboarding, and horse riding.

Role of Advocacy and Awareness

Advocacy and awareness are important because they help people with traumatic brain injuries (TBIs) get the resources they need and improve their quality of life.

People with traumatic brain injuries can advocate for themselves to overcome barriers to a better life, such as better healthcare, accommodations at work or school, and legal representation. They can also work with organizations and governments to ensure their needs are met, and they are not discriminated against. Family and caregivers can also advocate for their loved ones by providing support, access to resources, and communication tools.

Awareness campaigns and educational interventions can help the public understand the symptoms and long-term consequences of TBIs. This can help dispel myths and misunderstandings about TBIs.

Current Research and Resources

Latest Updates on TBI Research

The National Institute of Neurological Disorders and Stroke (NINDS) conducts clinical trials and research on traumatic brain injury. Researchers are currently exploring the following:

Neuroplasticity, which is the brain’s innate ability to heal itself and adapt.
Diagnostic criteria for chronic traumatic encephalopathy in athletes with repeated traumatic brain injuries.
Clinical biomarkers to aid in the diagnosis of traumatic brain injury and differentiate between mild traumatic brain injury and severe traumatic brain injury.

Community Resources and Further Information for Medical Professionals and Caregivers

Support Systems for People with TBI

Frequently Asked Questions

Can A Person Fully Recover From a Traumatic Brain Injury?

Yes, a person can fully recover from a traumatic brain injury (TBI), but the level of recovery depends on the severity of the injury and other factors.

Mild TBI: Most people recover most or all of their brain function within three months.
Moderate TBI: Most people recover most or all of their brain function, but may need therapy or other services.
Severe TBI: Recovery is difficult to predict and can be a long or lifelong process. Some people regain consciousness within a few days or weeks while others may have impaired consciousness for months or years. Every severe traumatic brain injury is different and follows its own timeline.

What Is Life Like After Traumatic Brain Injury?

Most people recover fully from a mild traumatic brain injury and return to normal life. However, moderate or severe traumatic brain injury can lead to a lifetime of physical, emotional, behavioral, and cognitive changes which can affect a person’s ability to function in daily life.

Is TBI a Permanent Disability?

Traumatic brain injury can be a permanent disability, depending on the severity. A mild TBI typically causes short-term symptoms and is not usually a permanent disability. But moderate or severe TBI can cause long-term or lifelong TBI-related complications that can result in permanent disability.

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