What to Expect
Any injury to the brain is a red flag. The injury may be mild or catastrophic,
and symptoms can run the gamut from a headache to paralysis. Since the
brain is command central for the body’s nervous system, any brain
injury can affect all or some other parts of the body as well as affecting
In its normal state, the skull surrounds and protects the brain from day-to-day
bumps and jolts. Neurons are nerve cells in the brain, each connecting
with billions of other neurons, creating a vast network to carry electrical
and chemical messages throughout the body. When these neurons activate,
they facilitate and control functions such as memory, information storage,
thinking, visual images, sensory perceptions, body movement, body functions
(such as breathing, heart rate, metabolism and more), personality and behavior.
It is arguably the most complex part of the body, and scientists are still
trying to gain a better understanding of how it works.
In a normal brain, different parts control different functions, yet they
all have to work together to perform correctly. When some part of the
brain is injured, it can disrupt many functions. Think of a super highway
connecting to many other highways in different parts of the country. If
part of the super highway were to collapse, it would disrupt traffic both
near and far, depending upon the severity.
When a brain injury occurs, the disruption can show itself in many different
ways, including being unable to move parts of the body, loss of control
of body functions (e.g., bowel or bladder control, blood pressure, body
temperature), diminished cognitive abilities or changes in a person’s
personality or behavior. The degree of severity and location of the injury
determines whether these impairments are temporary or permanent.
Causes of Brain Injuries
Traumatic Brain Injury (TBI) can occur in many ways, but the top three
At this time, there is no cure for TBI. Later we will cover the various
types of treatment used today for TBI.
In addition to the top three causes, there are many other ways a brain
injury can occur. There can be open head injuries, such as an object penetrating
the skull (nails, bullets, falling tool, etc.) or a skull fracture where
pieces of the skull penetrate the brain. A closed head injury means there
is no broken skin or fracture and can occur in a fall, car accident or
an impact with an object; in a closed head injury, there is no penetration
of the skull. Other causes of brain injury include:
Diagnosing a Brain Injury
After an accident, there are symptoms that a person may exhibit if he has
a brain injury. If it’s a serious traumatic injury to the brain,
the symptoms will be very noticeable. However, a person can have a mild
brain injury and may not show any obvious signs. In these cases, it may
be necessary to do some testing to evaluate the victim. Just because it
may not be obvious, an injury to the brain may still have occurred.
With a mild brain injury, a person may experience any of the following:
- Lowered awareness of one’s environment
Other symptoms could also show up later, such as:
- Sensitivity to loud noises
- Ringing in the ears
- Lack of focus
- Continual dull headache
- Aversion to bright lights
- Visual focus impairment
Even when a brain injury is categorized as mild, it does not mean it should
be ignored or that recovery will necessarily be fast. The length of recovery
varies greatly from person to person. The brain needs to heal just as
any other injured body part needs to heal. A person may find that during
the recovery process, he or she gets tired more easily or may take longer
completing certain chores than prior to being injured.
Mild Brain Injury Diagnosis
With a mild brain injury, there is usually much less trauma than that accompanying
a more serious injury. That is why it takes more testing and assessment
to determine if the person has a brain injury. Typically, CT scans (computed
tomography), MRIs (magnetic resonance imaging), and other imaging technologies are used.
A CT scan is most often done initially, as it is more widely available,
faster and less expensive than an MRI. However, a CT scan is not as accurate
as an MRI.
Another aspect of diagnosing a mild brain injury involves an assessment
by a neurologist and a neuropsychologist. The patient will undergo standard
testing for basic sensory-motor processes as well as an assessment of
his or her cognitive functions. The evaluation process will also include
gathering information from the patient’s family regarding how the
person acted and performed in everyday activities before being injured.
Once the assessment is complete, a treatment plan will be produced. Some
people with a mild brain injury may not require hospitalization or even
be diagnosed with a brain injury. Nevertheless, the person may experience
some functional impairment, such as slower cognitive or physical abilities.
Traumatic Brain Injury Diagnosis
A severe, traumatic brain injury will usually be more evident, or at least
suspected. If any of the common symptoms listed below are observed, you
should call 911 immediately.
- Pupils are dilated or not of equal size
- Blurred vision, intolerance to bright light, blindness, no eye movement
- Loss of consciousness or inability to respond
- Watery liquid seeping from ears or nose
- Slowed breathing and increased blood pressure
- Paralysis or weakness involving parts of the body
- Slow pulse
- Sluggish, lowered energy level
- Mental confusion
- Auditory difficulties
- Reduced cognitive ability
- Irrational emotional responses
- Difficulty swallowing or speaking
- Loss of bladder or bowel control
- Numbness or tingling sensation in body
Treating Brain Injuries
Treatment for a brain injury varies widely from patient to patient. If
the injury is minor, the person may not need to be hospitalized, even
though he or she may have some difficulties in everyday activities.
For more severe brain injuries, the person will likely be admitted to the
ICU at the hospital. The patient may or may not be conscious. Depending
on what’s needed, the patient may be connected to medical equipment.
Rehabilitation for a Brain Injury
Rehabilitation after a brain injury is begun as soon as feasible. The goal
is to help the patient restore as much functionality as possible. This
could include activities such as walking, eating, speaking and dressing.
Once the patient is able, and if needed, a more intensive form of therapy
may ensue. The patient may be transferred to a facility that specializes
in this type of rehab.
Rehabilitation has the goal of tapping into the body’s natural ability
to heal itself. The brain’s remarkable capability to rewire itself
is stimulated to help the patient recover. If a function or ability is
permanently lost, rehabilitation can help the patient learn new ways to
compensate for the loss and still be able to carry out a function. Newer
and faster technologies are on the horizon due to an ever-increasing awareness
of how the brain works.
There are brain injury patients who need rehabilitation that covers a longer
period of time. Often, this type of treatment is delivered in nursing
homes or skilled nursing facilities. A brain injury patient who is able
to live at home may benefit from group rehabilitation activities during
the day at a facility specially designed for these types of patients.
Outpatient therapy is also an option for patients who have completed more
intensive therapy and still experience some degree of functional impairment.
Alternative to Mainstream Treatment for Brain Injuries
The entire area of alternative medicine and therapies is a subject of interest
to many, including increasing numbers of mainstream medical professionals.
The Brain Association of America has published a newsletter with information
and resources for those wanting to know more about the possible benefits
of alternative medicines and treatments for brain injuries. It contains
information about art therapies, massage, acupuncture, herbs, homeopathy,
osteopathic manipulative medicine, and more. A link to a back issue of
the newsletter is
Managing at Home
When a loved one has suffered a brain injury, you may have already experienced
the anxiety and exhaustion of the first hours or days in a hospital’s
ICU. It is a good day when the patient becomes more stable, cognitive
and can be detached from the equipment.
Then the rehabilitation phase begins, which can be long or short. This
is often the time when the family member or caregiver’s support
will be needed the most.
It may come as a shock to realize the full scope of what it means to take
care of someone with a brain injury. It will no doubt be a learning experience
every day. Even though the patient may have completed hospital rehab,
this does not mean that he or she has completed treatment. Ultimate recovery
can be long and unpredictable. The patient may have recovered from some
functional impairments yet experience bouts of behavioral changes that
were never before exhibited. If the injury was severe, especially to the
frontal or temporal lobes of the brain, physical and cognitive changes
for the worse may be permanent.
Depression and anxiety may color the patient’s days. The individual
could become frustrated because it’s far more difficult to plan
activities, remember things, or stay focused. Once the patient leaves
the specialized environment of a hospital or nursing facility, integrating
back into family life can be taxing. It has happened often enough that
a person has seemingly recovered from the brain injury, only to relapse
into unwanted behaviors or emotions months or years later.
The person may have resumed work, but may not be operating at the same
capacity. Impaired ability to organize, remember, and reason may all be
impacted. If the injured person did not return to work, it’s not
uncommon for boredom to set in, leading to unfavorable behaviors, such
as being too sedentary, overeating, and more isolation.
Tips for Caregivers
As the caregiver/family member, it’s a good idea to start planning
ahead for the time when the patient will come home. Hopefully you have
been involved to a good degree in the rehabilitation, giving you a clear
understanding of your loved one's capabilities and deficits. Make
it a habit to ask questions of medical professionals and keep a notebook
of relevant information. This will help you remember specific actions
to take as well as allow other caregivers to have access to this information.
The patient may need to move in with you for a while, even if they typically
live at a different location. It’s a good idea to have a room arranged
in the best way possible to facilitate independence. The injured family
member may need help with organizing belongings, including labeling drawers,
boxes, etc. Cue cards can be helpful too, laying out the steps to brush
teeth, fix a bowl of cereal, or make the bed, for example.
Helping the recovering brain injury patient stay in a good mental state
is crucial. He or she may be acutely aware of the deficits, such as slower
thinking process, loss of memory, and lowered physical abilities. Try
to keep your loved one stimulated with tolerable activities that include
simple challenges. It’s not unusual for someone to take on a job
or even resume his or her prior job. He or she could also be involved
in daily outpatient therapy. These activities keep the injured person
interacting with other individuals and contribute a great degree to the
Brain injury patients can experience “silent seizures,” even
years after the injury. These seizures are highlighted by sudden changes
in behavior, including changes in the way things taste, hallucinations,
pacing, and staring into space. Testing can determine if these are actually
seizures, caused by abnormal electrical activity in the brain. If so,
anti-seizure medication may be prescribed.
The most important element you can provide for a brain injury patient is
a predictable, structured environment. The person is relearning how to
live, and if confronted with a constantly changing landscape, this will
be very difficult.
While caring for someone with a brain injury can be daunting, especially
at first, realize that many of these patients are able to recover and
resume fulfilling lives and participate well in a range of social and
Safety Tips for Home Care
The simpler you make the environment of the brain-injured patient, the
more it will facilitate recovery. He or she may have cognitive deficits
as well as physical impairments.
This partial list will help you make it easier for the person to navigate
living quarters and help prevent further injuries.
- Keep electrical cords out of sight, such as behind furniture or along baseboards.
- Keep phones easily accessible, with important emergency numbers posted clearly.
- Remove or anchor rugs that could cause tripping.
- Smoke alarms should be mounted throughout the home and be in good operating order.
- Stairs need secure handrails.
- Grab bars should be installed in showers and near toilets
- Check the temperature setting on the hot water heater to be sure it is
on low, or not more than 120 degrees.
- Make sure lighting is adequate throughout the home.
- Keep tools out of reach unless the patient clearly is able to competently
The stress of taking care of a brain injury victim can be enormous. Your
life can turn upside down. If you have a circle of caregivers who take
turns with the responsibilities of assisting the brain-injured person,
you will function much better. Not everyone has that, however. If the
patient’s injuries are severe, he or she may not be able to carry
on a conversation, much less perform rudimentary activities without help.
All this can leave you stressed, frustrated, isolated, and depressed.
It’s very important to take care of yourself. If you are emotionally
drained, physically fatigued, and financially stressed, you are not going
to be able to provide the level of assistance that you are actually capable
of giving. There are support groups of all kinds, some of which provide
physical locations for group meetings and some that meet online. Even
if your loved one spends all or part of his or her time in a residential
facility, you will still feel the stress of caregiving, and a support
group can be an invaluable resource.
You should seek out support groups in your area for help. Look for a group
that has some structure to the meetings, and pay attention to what topics
are being talked about. Do they meet regularly? What is the stated purpose
of the group (i.e., to serve as a hub for caregivers of all kinds or to
specifically help caregivers of brain injured people)?
You should also visit a few of these support groups and probably more than
once to understand them and the attendees. Understand that these support
groups are not intended to provide therapy or counseling for caregivers.
They are to help them find solutions to problems that caregivers face.
The Brain Injury Association of Hawaii provides some resources you can
check into to find some support groups. Go to
BrainandSpinalCord.org for more information. Additional resources can be found at the
Spine Injury & Traumatic Brain Injury Resource Center.
Long Term Care for Brain Injury Victims
Recovering from a brain injury is unpredictable. For some patients, rehabilitation
may only take a few weeks or months, especially with a minor injury. For
the survivor of a traumatic brain injury, the process could take months,
years or a lifetime. Every patient is different and responds differently
to the various types of treatments available.
The goal of all therapy and rehabilitation is to get the patient back to
functioning as independently as possible. This may require a stay in a
rehab facility, with ongoing in-home or outpatient rehab treatment after
release. Other patients may need to spend their days in a day rehab facility
and return home every night. There may be re-entry programs in your community
that provide further therapies for motor, cognitive, and social skills
to help the brain injured person toward the goal of independent living
You can check with your local hospital to see if they provide in-home rehabilitation
for brain injury victims. If you get involved with a support group, you
will most likely find much helpful information through your group as well.
Technology is advancing every year, revealing new insights and strategies
for helping the brain recuperate and recover. Arming yourself with the
correct information and networking with professionals and other survivors
or caretakers will go a long way toward the goal of helping a brain injured
person live a fulfilling life.
Living with brain injury resources:
Traumaticbraininjury.com - What are the Causes of TBI?; Diagnosis; Initial Treatment
Biausa.org - Brain Injury Association of America - Diagnosing Brain Injury;
Family and Caregivers; Resource Center
Brainline.org - Choosing the Right Caregiver Support Group