Pediatric Center for Comprehensive Care

Traumatic Brain Injury (TBI)

What is traumatic brain injury (TBI)?

Traumatic brain injury (TBI) happens when a sudden violent event damages the brain. It's a common cause of disability and death in adults. Almost half of TBIs are from falls. Other common causes of TBI are motor vehicle accidents, violence, and sports. The damage may be just in 1 area of the brain. Or it may be in more parts of the brain. The severity of a brain injury can vary. It may be a mild concussion. Or it may be a severe injury that results in coma or death.

What are types of TBI?

TBI includes a variety of types of injuries to the brain.

A TBI may be either of these:

Closed brain injury. This is when there is an injury to the brain but no break in the skull. It is caused by a fast forward or backward movement and shaking of the brain inside the hard skull. It can result in bruising or tearing of brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents, falls, and in sports. Brain injury in babies can be caused by a form of child abuse where a baby is shaken hard. It is known as abusive head trauma. It is also called shaken baby syndrome.
Penetrating brain injury. This injury is when there is a break in the skull. An object such as a sharp tool or a bullet pierces the brain.

And it may be either of these:

Primary brain injury. This is when injury to the brain is complete at the time of impact. This happens at the time of the motor vehicle accident (MVA), gunshot wound, or fall.
Secondary brain injury. This is when changes happen hours or days after the primary brain injury. There are a series of tissue changes in the brain. These cause more damage.

What is diffuse axonal injury (DAI)?

The brain has long connected nerve fibers called axons. Diffuse axonal injury is the tearing of these nerve fibers. This can happen when the brain suddenly shifts inside the hard skull. It can cause a minor concussion. Or it can cause a mild to severe coma if many parts of the brain are affected. The changes in the brain are often so small they may not be seen on a CT or MRI scan.

What are the symptoms of TBI?

Some brain injuries are mild. Symptoms go away over time with proper care. Others are more severe. These may cause permanent disability. The long-term results of brain injury may need lifelong care. Symptoms of brain injury may include the below.

Types of problems	Symptoms
Problems with thinking	Coma Confusion Short attention span Memory problems Trouble solving problems Problems with judgment Can't understand abstract concepts Loss of sense of time and space Less awareness of self and others Can't follow more than 1- or 2-step commands
Problems with movement	Paralysis or weakness Spasticity (tightening and shortening of the muscles) Poor balance Less endurance Can't plan motor movements Delays in getting started Tremors Swallowing problems Poor coordination
Problems with senses	Changes in hearing, vision, taste, smell, and touch Loss of feeling or more feeling in body parts Left- or right-side neglect Trouble understanding where limbs are in relation to the body Vision problems
Problems with speech and language	Trouble speaking and understanding speech (aphasia) Trouble choosing the right words to say (aphasia) Trouble reading (alexia) or writing (agraphia) Slow, hesitant speech and less vocabulary Trouble forming sentences that make sense Problems identifying objects and their function Problems with reading, writing, and ability to work with numbers
Problems with daily life	Trouble knowing how to do some common actions, like brushing your teeth (apraxia) Trouble with dressing, bathing, and eating Problems with organization, shopping, or paying bills Can't drive a car or operate machinery
Problems with social contact	Trouble with social skills and relationships Trouble making and keeping friends Trouble understanding and responding to social interaction
Physical changes	Tiredness Changes in sleep patterns and eating habits Dizziness Headache Loss of bowel and bladder control
Personality or psychiatric changes	Not caring about things Less motivation Mood ups and downs Irritability Anxiety and depression Temper flare-ups, aggression, cursing, quick frustration Inappropriate sexual behavior
Traumatic epilepsy	Epilepsy can happen with TBI. It's more common with severe or penetrating TBI. Most seizures happen right after the injury, or within the first year. But epilepsy can also happen years later.

Types of problems

Symptoms

Problems with thinking

Coma
Confusion
Short attention span
Memory problems
Trouble solving problems
Problems with judgment
Can't understand abstract concepts
Loss of sense of time and space
Less awareness of self and others
Can't follow more than 1- or 2-step commands

Problems with movement

Paralysis or weakness
Spasticity (tightening and shortening of the muscles)
Poor balance
Less endurance
Can't plan motor movements
Delays in getting started
Tremors
Swallowing problems
Poor coordination

Problems with senses

Changes in hearing, vision, taste, smell, and touch
Loss of feeling or more feeling in body parts
Left- or right-side neglect
Trouble understanding where limbs are in relation to the body
Vision problems

Problems with speech and language

Trouble speaking and understanding speech (aphasia)
Trouble choosing the right words to say (aphasia)
Trouble reading (alexia) or writing (agraphia)
Slow, hesitant speech and less vocabulary
Trouble forming sentences that make sense
Problems identifying objects and their function
Problems with reading, writing, and ability to work with numbers

Problems with daily life

Trouble knowing how to do some common actions, like brushing your teeth (apraxia)
Trouble with dressing, bathing, and eating
Problems with organization, shopping, or paying bills
Can't drive a car or operate machinery

Problems with social contact

Trouble with social skills and relationships
Trouble making and keeping friends
Trouble understanding and responding to social interaction

Physical changes

Tiredness
Changes in sleep patterns and eating habits
Dizziness
Headache
Loss of bowel and bladder control

Personality or psychiatric changes

Not caring about things
Less motivation
Mood ups and downs
Irritability
Anxiety and depression
Temper flare-ups, aggression, cursing, quick frustration
Inappropriate sexual behavior

Traumatic epilepsy

Epilepsy can happen with TBI. It's more common with severe or penetrating TBI. Most seizures happen right after the injury, or within the first year. But epilepsy can also happen years later.

Can the brain heal after TBI?

Most studies suggest that once brain cells are damaged, they don't regrow. But recovery after brain injury can take place. In some cases, other areas of the brain make up for the injured tissue. In other cases, the brain learns to reroute function around the damaged areas. Healthcare providers can't predict the amount of recovery at the time of injury. It may be unknown for months or even years. The rate of recovery varies. It depends on the amount of inflammation and damage. Recovery from a severe brain injury often takes long-term treatment and rehab. (See below.)

What is coma?

Coma is when a person is not awake or aware for a period of time. A person may move around or respond to pain. Or they may not move or respond at all. Not all people with brain injury are in a coma. The type and length of a coma vary a lot. It depends on where and how severe the brain injury is. Some people come out of coma and have a good recovery. Others have problems that cause ongoing issues with daily life.

TBI rehabilitation (rehab)

Rehab after a TBI starts soon after the injury. The success of rehab depends on many things, such as:

Type of the TBI
How severe it is
Type of problems the TBI has caused
How severe those problems are
Overall health
Family support

Rehab helps to improve the person's abilities at home and in the community. The goal of brain injury rehab is to help the person get to the highest level of function and independence. And rehab programs work to help the overall quality of life.

Types of brain injury rehab programs include:

Acute rehab
Subacute rehab
Long-term rehab
Transitional living
Behavior management
Day-treatment
Independent living

Type of rehab work	What it helps with
Self-care skills, including activities of daily living (ADLs)	Eating, grooming, bathing, dressing, and sexual function
Physical care	Nutritional needs, medicines, and skin care
Mobility skills	Walking, transfers, and self-propelling a wheelchair
Communication skills	Speech, writing, and other types of communication
Cognitive skills	Memory, focus, judgment, problem-solving, and organizational skills
Socialization skills	Interacting with people at home and in the community
Vocational training	Work-related skills
Pain management	Medicines and other ways of managing pain
Psychological testing and counseling	Thinking, behavioral, and emotional issues
Family support	Adapting to lifestyle changes, help with financial concerns, and discharge planning
Education	Education and training about brain injury, safety issues, home care needs, and adaptive methods

Type of rehab work

What it helps with

Self-care skills, including activities of daily living (ADLs)

Eating, grooming, bathing, dressing, and sexual function

Physical care

Nutritional needs, medicines, and skin care

Mobility skills

Walking, transfers, and self-propelling a wheelchair

Communication skills

Speech, writing, and other types of communication

Cognitive skills

Memory, focus, judgment, problem-solving, and organizational skills

Socialization skills

Interacting with people at home and in the community

Vocational training

Work-related skills

Pain management

Medicines and other ways of managing pain

Psychological testing and counseling

Thinking, behavioral, and emotional issues

Family support

Adapting to lifestyle changes, help with financial concerns, and discharge planning

Education

Education and training about brain injury, safety issues, home care needs, and adaptive methods

The TBI rehab team

The brain injury rehab team helps the injured person and their family. They help set goals for recovery. The team may include any of these:

Neurologist/neurosurgeon
Physiatrist
Internists and specialists
Rehabilitation nurse
Social worker
Physical therapist
Occupational therapist
Speech-language therapist
Psychologist/neuropsychologist/psychiatrist
Recreation therapist
Audiologist
Dietitian
Vocational counselor
Orthotist
Case manager
Respiratory therapist
Chaplain