Trauma · Uncategorized

Understanding traumatic brain injury

“This made no sense to me, probably because I speak English and [had] never had a brain injury [before].”  — Tiny Fey

You’ve just spent the night in the emergency room.  Perhaps you’re the patient, or maybe the patient is someone you love, but it doesn’t matter.  The night is a whirlwind of memories, and it’s hard to separate fact from fiction.  You remember a brain scan.  You remember someone’s head aching all night long.  You remember the doctors throwing about complicated words like “dysarthria” and “diplopia,” and now all you can see is the ER discharge paperwork as they send you on your way.  It reads, “Diagnosis: Mild Traumatic Brain Injury (mild TBI).”

And you’re thinking, “What the hell is a TBI?”

Traumatic brain injury (TBI)

Millions of Americans suffer blows or jolts to the head every year, but most never need medical attention for their trauma. So what sets a TBI apart?

Three kinds of injury

A TBI starts when something hurts the brain.  The damage happens when (1) the head hits against a hard surface,  (2) something pierces the skull and hurts the brain directly, or (3) the brain is put in a position where it moves too fast and stops too quickly (like a car accident), causing injury to itself by hitting the inner skull.

“Brain injuries are like snow flakes.  No two are the same.”  –Person served family member, “On with Life”

The early symptoms

Trauma to the brain is typically followed by a period of unconsciousness.  Symptoms of TBI can occur immediately after the person awakens or take days or weeks to appear. These symptoms tend to vary according to the severity of the damage.

Early symptoms of a mild TBI include headache, dizziness, blurred vision, tiredness, and nausea.  A person with moderate to severe head trauma might also have challenges with speech, movement, and memory.  Seizures and coma are also common.  Some people with severe injuries experience brain hemorrhage; this is life-threatening and requires emergent treatment.

Long-term symptoms

Symptoms tend to improve slowly over the first year after the accident. Some people with mild head trauma return to baseline almost completely.  For others, including those with moderate level brain injuries, the symptoms can be vague but frustrating, like personality changes, impulsivity, inattention, challenges with organization & recall, poor decision-making, and hard-to-control emotions.  Chronic headaches and seizures can also occur.  Despite their injury, these individuals are usually able to carry on fulfilling relationships and live productive lives.

People with more severe trauma show improvement too, often remarkable improvement, but final outcome varies from person to person.  In addition to the characteristics seen in mild to moderate TBI’s, symptoms in advanced brain trauma can include memory problems (inability to remember what happened earlier today), speech impediments, sensory changes (like disturbed sense of touch), and difficulty with physical movements (anything from handling a pencil to walking across the room).  Seizures and headaches are also common.  If the brain injury is severe enough, the sufferer can be bound to a wheelchair and rely on others for all needs.

Types of treatment

“I’m a survivor, a living example of what people can go through and survive.” — Elizabeth Taylor

Medical interventions for TBI vary according to the severity of the injury.  Some people move on with their lives with no long-term problems and no need for treatment.  Others require years of intensive treatment.  Here are some of those interventions.

The emergency room (ER)

Typically a person with head trauma will start treatment with a visit to the ER, especially if the “accident” was bad enough.  Doctors will take a history, perform a physical exam, and order X-rays and other imaging tests.  They might do lab work if they suspect a brain bleed, underlying medical problem, or occult drugs.

Medical stabilization

The medical team usually monitor the patient overnight, assessing the injured person’s status multiple times to gauge what sort of treatment is needed.  An individual with a mild injury can probably go home the next morning with family to keep an eye on them.  They’re encouraged to return to the ER if they have any change in symptoms, like worsening headache, intractable vomiting, loss of vision, or confusion.  A person with a moderate to severe injury is usually admitted to a medical unit, stabilized, then transferred to a rehabilitation facility.

Physical and Occupational Rehabilitation.

Rehabs help people with moderate to advanced TBI’s overcome obstacles and regain function. Multiple providers provide multiple services.  Physical therapy aides with movement difficulties, and occupational therapy helps people relearn how to do every-day activities.  Speech therapy assists with problem with communication.  Doctors help with pain management and monitor the healing process.

Neurologist and psychiatrist.

Neurologists are doctors specialized in treating the brain, and psychiatrists are doctors specialized in the mind – and there’s a bit of overlap between the two.  In general, people see neurologists to help with seizures, headaches, chronic pain, and nerve damage.  They see psychiatrists for treatment related to mood problems, anger, impulsivity, inattention, insomnia, and therapy.  Patients see either for memory problems.  If you’re struggling with any of these issues, touch bases with a neurologist and/or psychiatrist.

Individual and group psychotherapy.

Living with TBI is profoundly challenging.  Individual and group therapy can improve quality of life dramatically.  Psychotherapy is usually run by a counselor, like a social worker, psychologist, or licensed clinical practitioner.  Individual therapy can help rebuild self-esteem, enhance coping skills, assist with life transitions, improve relationships, and much more.  Some people find group therapy and support groups indispensable; attendees share their experiences and learn from one another and are reminded they’re not alone.


A quick review of medications is fundamental here.  While there aren’t any pharmacological interventions to reverse brain trauma, medications have their place.  Antidepressants help with depression.  Mood stabilizers help with mood swings, irritability, and impulsivity.  Cognitive enhancers can sometimes improve memory, and ADHD medications can minimize concentration problems.  Additionally, people with TBI can also fall prey to PTSD, panic attacks, generalized anxiety, opiate use disorder, chronic headaches, and other disorders; it’s important to treat each of these individually.  Talk to your doctor about medication options.

“You don’t have to go back to who you were before your trauma.  You can go forward to become something really terrific after.” — Michele Rosenthal

That’s a quick overview of TBI and treatments.  For more information, check out the page.  This will open up in a separate window.


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