Traumatic Brain Injury

Traumatic Brain Injury (TBI) occurs when a sudden trauma causes damage to the brain. There are two types of TBI: Closed Head Injury (CHI), and penetrating injury. A CHI occurs when the head violently and abruptly hits an object and the brain reverberates within the skull. A penetrating injury occurs when an object pierces the skull and enters the brain.

HarmesAlecAcquired Brain Injury

Another term commonly used to classify brain injuries is Acquired Brain Injury (ABI). An ABI classifies any damage to the brain acquired after birth. ABI usually affects cognitive, physical, emotional, social or independent functioning and can result from TBI, (i.e. accidents, falls, assaults, etc.) and/or non-traumatic brain injury (i.e. stroke, brain tumors, infection, poisoning, substance abuse, etc.).

Symptoms of TBI

Symptoms of TBI vary from mild to severe depending on the amount of damage to the brain. Symptoms may not be immediately evident in the case of mild injury. Symptoms may surface over the course of weeks or months after the injury. An example of a mild TBI would be a sports related concussion (i.e. got their “bell rung”, “saw stars”).

Mild Symptoms of TBI

  • May remain conscious or may lose consciousness for a few seconds or minutes
  • Hadache, fatigue, confusion
  • Lightheadedness or dizziness
  • Behavioral or sleep changes
  • Blurred vision or tired eyes
  • Ringing in ears or bad taste in mouth
  • Trouble with memory, concentration, attention or thinking

Moderate or Severe Symptoms of TBI

A person who has sustained a moderate or severe TBI may have some or all of the symptoms below. They may also have any or all of the symptoms associated with mild TBI.

  • Headache gets worse or does not go away
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Inability to awaken from sleep
  • Dilation of one or both pupils of the eyes
  • Slurred speech
  • Weakness or numbness in the extremities

Causes of TBI

In people under 75 years old, some form of transportation accident causes more than half of TBI’s. In people older than 75, falls cause the majority of TBIs. Half of all TBI incidents involve alcohol use. Blasts are a leading cause of TBI for active duty military personnel in war zones.

The leading causes of all TBIs are:

  • Falls (35.2%)
  • Motor vehicle-traffic crashes (17.3%)
  • Struck by/against events (16.5%)
  • Assaults (10%)

Treating TBI

It is imperative to see a doctor as soon as you have sustained a TBI. Little can be done to reverse the initial effects of a TBI, but consequences can become more severe without diagnosis and treatment.


TBI patients are ranked on a severity scale depending on whether or not they have a concussion or a coma.

Glasgow Coma Scale

The Glasgow Coma Scale is typically used during the first 24-72 hours or the acute care phase. This may also be classified as the unconscious/minimally conscious stages.

The Rancho Los Amigos Cognitive Scale

The Rancho Los Amigos Cognitive Scale, (Rancho) consists of ten levels of functioning and is used for ranking a TBI patient after the acute care phase.

Preventing TBI

By following general safety rules, the majority of TBI’s can be prevented:

  • Always wear a seatbelt
  • Wear a helmet during any type of potentially dangerous sport
  • Use a car seat for young children
  • Never drive under the influence of alcohol or drugs
  • Keep firearms stored and unloaded in a safe area
  • NEVER shake a baby
  • Safeguard seniors and balance-challenged people from falls:
    • Remove throw rugs
    • Install sufficient lighting
    • Encourage use of canes/walkers as prescribed by a physician or therapist

Long Term Effects of TBI

A brain injury has long-term effects. It isn't temporary like a broken arm or sprained ankle. The latest research is showing that new brain cells may be able to reproduce but this research is only in the beginning stages.

A person who has been diagnosed may have a number of the following long-term symptoms to varying degrees of severity:

Physical Symptoms

  • Loss of muscle control and/or muscle weakness or paralysis; lack of endurance and/or easily fatigued
  • Disrupted balance control
  • Problems seeing, hearing, smelling, tasting; loss of feeling & sensation
  • Difficulty eating & swallowing
  • Difficulty speaking clearly
  • Loss of bladder & bowel control
  • Headaches and/or seizures

Cognitive Concerns

  • Diminished tolerance to stimuli
    • Problems with concentration and attention
    • Difficulties with orientation
    • More easily over-stimulated
    • Easily distracted
  • Impaired judgment and reasoning
    • Difficulty with problem-solving
    • Slower thought processes
    • Diminished abstract reasoning
  • Difficulty learning new information
    • Difficulty generalizing learning
  • Problems with short and/or long term memory
    • Difficulty retrieving information
  • Diminished executive functions
    • Difficulty planning, initiating, or following through on tasks
  • Inability to manage time
    • Problems with sequencing, organizing and prioritizing
    • Trouble following directions
  • Inability to say what is meant or difficulty understanding others
    • Difficulty with language/communication (reading and spelling)

Psychosocial and Behavior-Emotional Concerns

It is important for families and caregivers to seek help for psychological and behavior changes in TBI patients. Families often bring home a family member from the hospital after a car accident and wonder if they brought home a stranger.

  • Changes in personality
  • Impulsivity and irritability
    • Diminished frustration tolerance
    • Restlessness or hyperactivity
    • Rapid mood swings
  • Low motivation
    • Depression and anxiety 
    • Withdrawal
    • Lack of self-esteem
    • Apathy
  • Anger and aggression
    • Verbal outbursts
    • Changes in control of temper
  • Rigid, inflexible
  • Denial of disability
  • Weakened impulse control
    • Problems controlling behavior in social situations
    • Poor social judgment
    • Poor social interaction
    • Euphoria
    • Absence of sensitivity to others
    • Problems forming and maintaining relationships