Traumatic Brain Injury
What is a Traumatic Brain Injury?
The CDC defines a traumatic brain injury (TBI) as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Everyone is at risk for a TBI, especially children and older adults.
Symptoms of Traumatic Brain Injury
Traumatic brain injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later.
Physical complications
Sometimes, any or several of these symptoms might linger for a few weeks to a few months after a traumatic brain injury. This is currently referred to as persistent post-concussive symptoms. When a combination of these symptoms last for an extended period of time, this is generally referred to as post-concussion syndrome.
Traumatic brain injuries at the base of the skull can cause nerve damage to the nerves that emerge directly from the brain (cranial nerves). Cranial nerve damage may result in:
- Paralysis of facial muscles or losing sensation in the face
- Loss of or altered sense of smell
- Loss of or altered sense of taste
- Loss of vision or double vision
- Swallowing problems
- Dizziness
- Ringing in the ear
- Hearing loss
Intellectual problems
Many people who have had a significant brain injury will experience changes in their thinking (cognitive) skills. It may be more difficult to focus and take longer to process thoughts. Traumatic brain injury can result in problems with many skills, including:
Cognitive problems
- Memory
- Learning
- Reasoning
- Judgment
- Attention or concentration
Executive functioning problems
- Problem-solving
- Multitasking
- Organization
- Planning
- Decision-making
- Beginning or completing tasks
Communication problems
Language and communications problems are common following traumatic brain injuries. These problems can cause frustration, conflict and misunderstanding for people with a traumatic brain injury, as well as family members, friends and care providers. Communication problems may include:
Cognitive problems
- Difficulty understanding speech or writing
- Difficulty speaking or writing
- Inability to organize thoughts and ideas
- Trouble following and participating in conversations
Social problems
- Trouble with turn taking or topic selection in conversations
- Problems with changes in tone, pitch or emphasis to express emotions, attitudes or subtle differences in meaning
- Difficulty understanding nonverbal signals
- Trouble reading cues from listeners
- Trouble starting or stopping conversations
- Inability to use the muscles needed to form words (dysarthria)
Behavioral changes
People who've experienced brain injury often experience changes in behaviors. These may include:
- Difficulty with self-control
- Lack of awareness of abilities
- Risky behavior
- Difficulty in social situations
- Verbal or physical outbursts
Emotional changes
Emotional changes may include:
- Depression
- Anxiety
- Mood swings
- Irritability
- Lack of empathy for others
- Anger
- Insomnia
Sensory problems
Problems involving senses may include:
- Persistent ringing in the ears
- Difficulty recognizing objects
- Impaired hand-eye coordination
- Blind spots or double vision
- A bitter taste, a bad smell or difficulty smelling
- Skin tingling, pain or itching
- Trouble with balance or dizziness
Degenerative brain diseases
Research suggests that repeated or severe traumatic brain injuries might increase the risk of degenerative brain diseases. But this risk can't be predicted for an individual — and researchers are still investigating if, why and how traumatic brain injuries might be related to degenerative brain diseases.
A degenerative brain disorder can cause gradual loss of brain functions, including:
- Alzheimer's disease, which primarily causes the progressive loss of memory and other thinking skills
- Parkinson's disease, a progressive condition that causes movement problems, such as tremors, rigidity and slow movements
- Dementia pugilistica — most often associated with repetitive blows to the head in career boxing — which causes symptoms of dementia and movement problems
Rehabilitation
Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities.
Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation is different for everyone, depending on the severity of the brain injury and what part of the brain was injured.
Rehabilitation specialists may include:
- Physiatrist, a doctor trained in physical medicine and rehabilitation, who oversees the entire rehabilitation process, manages medical rehabilitation problems and prescribes medication as needed
- Occupational therapist, who helps the person learn, relearn or improve skills to perform everyday activities
- Physical therapist, who helps with mobility and relearning movement patterns, balance and walking
- Speech and language pathologist, who helps the person improve communication skills and use assistive communication devices if necessary
- Neuropsychologist, who assesses cognitive impairment and performance, helps the person manage behaviors or learn coping strategies, and provides psychotherapy as needed for emotional and psychological well-being
- Social worker or case manager, who facilitates access to service agencies, assists with care decisions and planning, and facilitates communication among various professionals, care providers and family members
- Rehabilitation nurse, who provides ongoing rehabilitation care and services and who helps with discharge planning from the hospital or rehabilitation facility
- Traumatic brain injury nurse specialist, who helps coordinate care and educates the family about the injury and recovery process
- Recreational therapist, who assists with time management and leisure activities
- Vocational counselor, who assesses the ability to return to work and appropriate vocational opportunities and who provides resources for addressing common challenges in the workplace
