Traumatic brain injury

A traumatic brain injury (TBI) is a blow or jolt to the head, or a penetrating injury that temporarily or permanently disrupts your brain’s function. TBI is not hereditary, congenital or degenerative. “Brain injury” is often used synonymously with “head injury,” but this is not the correct use of the term because head injuries may or may not be associated with neurologic deficits, whereas TBI always is.

Unfortunately, TBI is a prevalent injury: According to the CDC, approximately 1.5 million people in the U.S. suffer from a traumatic brain injury each year, and currently more than 5.3 million people are living with disabilities caused by TBI. There is no “typical” person who suffers from a TBI. People across all generations and demographics can get a TBI.

A TBI is a kind of an acquired brain injury (ABI). Some acquired brain injuries are caused by internal factors such as lack of oxygen or pressure from a tumor. Examples are stroke, hypoxia, or infections like meningitis or encephalitis. Other ABI’s are caused by external factors called traumatic brain injury (TBI). These external factors can include things like bullet wounds, car accidents, or a fall. TBIs may have similar causes to concussions, but they have more severe symptoms. The top causes of TBI are: falls (47%), car accidents or being struck by a car (29%), and assault, such as with a firearm (9%).

In addition, recent conflicts overseas have increased the numbers of veterans who have experienced traumatic brain injury – more than 380,000 have been diagnosed since 2001. Military TBIs are more often associated with high-energy explosions, including blast waves, which may cause more impact to the side or back of the head.

There are three external “mechanisms” that cause traumatic brain injury. They are:

• Open head injury – injuries from bullet wounds and other penetrating objects.
• Closed head injury – a result of a fall or car crash where nothing penetrated your brain but you sustained significant head trauma.
• Deceleration injury – when your brain is shaken inside your skull, as often happens in sports injuries.

The brain is the “control center” for all human activity, including thinking, sensing, judgment, emotions, as well as breathing and moving. Therefore injuries to your brain can have a significant impact on daily functioning. Symptoms can vary based on the location and severity of the injury. Long-lasting effects of TBI can be physical, cognitive, and behavioral and emotional:

• Physical impacts – Depending on what part of the brain was injured, TBI can have varying degrees of impact on mobility and can cause spasticity (increased muscle tone that interferes with normal movement), hemiparesis or hemiplegia (weakness or paralysis impacting one side of the body more than another), ataxia (uncontrolled tremors), sensory impairment, fatigue and difficulties with speech.
• Cognitive (thinking) impacts – Depending on what part of the brain was injured, TBI can cause problems with attention and focus, memory, language (for example, aphasia or organizing your thoughts and ideas), impairment in visual-perceptual skills, initiative-taking, problem-solving, and reduced perception and empathy.
• Emotional / behavioral impacts – TBI can take an emotional and behavioral toll. Common changes seen in those with brain injury include: loss of inhibition, impulsiveness, irritability and/or aggression, obsession, apathy, and egocentricity.

Not all individuals present with physical symptoms. When this happens, TBI is often referred to as “the invisible injury” because no visible physical symptoms are obvious. Yet the language and cognitive effects of TBI can be intense.

The short answer is “yes.” The fastest improvement happens about the first six months after injury, although the rate varies from person to person. During this time, survivors of brain injury will likely show many improve­ments. There is further improvement beyond six months after injury, but this varies by person.

“There’s always hope. You have to go out and find it. Constant Therapy is one of the things that brought me back to being more me.”

– Mike Healey, Survivor of brain injury and Constant Therapy user

The good news is that improvements can still occur even years after injury. In fact, based on a survey of people with moderate to severe TBI who received acute medical care and inpatient rehabilitation services at a TBI Model System, two years post-injury, most have moved toward independence:

• Most people continued to show decreases in disability
• Over 90% were living in a private resi­dence
• One third were living with their spouse or significant other. (Source: Spaulding-Harvard Traumatic Brain Injury Model System, Model Systems Knowledge Translation Center, 2010)

After a TBI, you may receive inpatient and outpatient treatment. Initial treatment in an acute center or hospital stabilizes your system immediately following injury. Trauma staff may monitor vital functions, respond to potentially life-threatening changes and coordinate care with other hospital personnel, depending on what’s needed. Others may receive treatment from a medical team on an outpatient basis where the physician will coordinate care and refer to rehabilitation professionals as needed.

Rehabilitation is an integral part of the recovery process where treatment helps restore the functions of daily life. Some will receive treatment at an inpatient rehab care facility. The goals of this stage of care are to prevent secondary complications, restore lost functional abilities through physical, speech, and occupational therapy, and provide advice to families on what changes may be needed once you go home.  

Once home, you may receive home health therapy or visit an outpatient clinic for regular appointments, where you’ll set goals for your recovery and continue physical, occupational and speech therapy to achieve those goals. Mobile therapy apps like Constant Therapy may be used to provide customized rehabilitation programs to address cognitive issues like attention, memory, and problem solving, and speech and language issues like reading, writing, word retrieval, and auditory (hearing) comprehension.

Once in-clinic therapy stops, you can continue your therapy on your own with smartphone, Chromebook, and tablet-based apps like Constant Therapy. Published, scientific studies show the more you practice therapy like this, the more you’ll recover lost brain function.

Constant Therapy has a wealth of resources for those suffering from TBI, as well as those for caregivers of TBI patients. There are also a host of podcasts, books, and movies that can help educate you about brain injuries. 

• The Centers for Disease Control (CDC)
• The Brain Injury Association of America
• Brainline