While traumatic brain injuries (TBIs) can vary greatly, in terms of severity and the recovery, they can impact every facet of an individual’s life. If you or someone you love has been diagnosed with a TBI, it’s important to understand these injuries differ, in terms of severity, as well as the different treatment options, and the length of time it can take to recover from a brain injury. Being informed is the best way to cope with a TBI. What is a TBI?
A traumatic brain injury refers to an injury to the brain tissue. These injuries occur as a result of rapid and forceful blows or bumps to the head, rapid and forceful jolts to the body, or a penetrating trauma. The rapid and forceful motion causes the brain to bounce around or twist within the skull, which can cause bruising, bleeding, and even the shearing of axons (nerve fibers). These changes to the brain can cause a variety of symptoms. These symptoms can range in severity, and can impact the way in which an individual thinks, learns, acts, feels, and sleeps.
Typically, a patient’s brain swells in response to the initial trauma. This swelling can cause the brain tissue to push against the interior of the skull, which can cause additional bleeding, and can reduce the circulation of blood in the brain. If treatment is not administered, the swelling can starve parts of the brain of oxygen, as well as other essential nutrients, which can cause brain cell death. Of all the different symptoms that are associated with brain injuries, cell death is usually the most common.
Traumatic brain injuries vary in severity. Generally, the level of severity is what medical professionals generally use to classify TBIs. In order to determine the severity of the damage, doctors utilize the Glasgow Coma Scale (GCS), a scoring system that is used as a tool to assess a patient’s level of consciousness after a traumatic brain injury.
This system is comprised of 15 points, and each point measures a patient’s performance in three main areas, including verbal response, eye response, and motor response. In order to calculate a patient’s GCS, health care professionals will first score him or her on these three main areas. When a number for each main area has been determined, the three numbers will be added together. The sum of these numbers indicates the patient’s Glasgow score. The higher the sum of the three key areas, the higher the patient’s score, and the less severe his or her injury is; conversely, the lower the sum of the three key areas, the lower the patient’s score, and the more severe his or her injury is/ Though every brain injury is different, typically, TBIs are classified as follows:
- Persistent vegetative state: Glasgow score of 3 points
- Severe TBI: Glasgow score of 4 to 8 points
- Moderate TBI: Glasgow score of 9 to 12 points
- Mild TBI: Glasgow score of 13 to 15 points
In addition to the above-mentioned categories, health care professionals also group TBIs into two main categories. These categories include:
- Closed brain injuries. With these types of injuries, the skull is not injured; rather, the brain is damaged as a result of shifting, bouncing, or twisting in the skull.
- Open brain injuries. Open brain injuries occur either when the skull bone breaks, and the broken bone penetrates the brain, or then a foreign object, such as a bullet, penetrates the skull and brain tissue.
There are several types of TBIs that can occur within these two groups, including:
- Concussions. The most common type of brain injury, concussions are considered a mild TBI; however, they can still be severe. Concussions can occur when a strong force strikes the head, and the force causes the brain to collide with the skull. Symptoms can range from mild to severe, and in some cases, can cause life-long complications. The longer the symptoms persist, the greater the chance of long-lasting complications. Additionally, successive concussions can also increase the risk of lasting complications.
- Contusions. A contusion is bruising, or mild bleeding, on the brain. Often, contusions heal on their own; however, if they do not, they can be removed surgically. The size, the affected area, and the length of time it lasts will determine the type of damage a contusion can cause.
- Intracranial hematomas. A hematoma occurs when a blood vessel ruptures, which caused blood to collect either in the empty spaces in the skull or within the brain tissue. There are three types of brain hematomas, including epidural, subdural, and intraparenchymal. The first two occur when blood vessels rupture, while the third type occurs when blood pools within the brain.
- Diffuse injuries. Microscopic changes within and are scattered throughout the brain can occur following a TBI, and sometimes, these changes are not visible on imaging scans. Known as diffuse brain injuries, this category of injuries can occur without or without associated mass lesions.
- Diffuse axonal injuries. This injury describes the impaired function and gradual loss of axons. Axons are the long extensions of nerve cells that allow the cells to communicate with one another. If the axons are harmed, the messages that neurons send will be disrupted, which will result in the loss of function.
- Intracerebral hemorrhage (ICH). An ICH refers to bleeding that occurs within the tissue of the brain.
- Ischemia. Occurring as a result of reduced blood flow to the brain, ischemia is a kind of diffuse injury.
- Linear skull fractures. Cracks or simple breaks in the skull are referred to as linear fractures, and can accompany a brain injury.
Traumatic brain injury treatments vary and depend on several factors, including the type and severity of the injury. The patient’s age and health status before the injury occurred may also be taken into consideration when determining a treatment protocol.
To illustrate, if the only impact of the TBI was mild bruising, the patient will likely be able to recover at home with rest, and can return to normal activities within a few days. If, however, the patient’s injuries were more extensive, treatment will likely require more effort and take more time. It is important to remember, though, that even in severe cases of TBI, recovery is possible. Typically, treatment will focus on activating the neuroplasticity of the brain. Neuroplasticity describes the brain’s ability to reorganize neural pathways, which allows undamaged parts of the brain to take over the function from damaged parts. In other words, the goal of neuroplasticity is to help help a patient’s brain regain function following a TBI.
To further illustrate, the following is a breakdown of the different treatment options that can be used to help patient’s recover following traumatic brain injuries.
Typically, for mild TBIs and concussions, other than rest and medications to manage pain, such as headaches, no other treatment is needed. With that said, however, a patient who has been diagnosed with a mild TBI or a concussion should be closely monitored for any persistent, worsening, or new symptoms. Follow-up appointments with a doctor may be necessary, and the doctor will let the patient know when he or she can resume normal activities. Relative rest, or limiting the amount of physical and cognitive activities, in the first few days following a mild TBI or concussion, will likely be recommended; although, limiting mental and physical activity completely is not recommended, as doing so could worsen the condition.
For patients who are diagnosed with mild and severe TBI, as indicated above, treatment is usually more intensive and takes more time. A brain injury attorney can help you obtain the treatment you require and assist by referring you to healthcare providers. The type of treatment will vary and is determined on a case-by-case basis, but may include one or more of the following:
- Prompt emergency care. Following a moderate or severe TBI, prompt emergency medical care is necessary and essential. This medical care involves ensuring the patient is receiving adequate oxygen and blood supply to the brain, maintaining his or her blood pressure, and preventing additional injury to the head and/or neck. Patients who suffer severe injuries may also have additional injuries that needed to be treated, and health care professionals will concentrate on reducing the risk of secondary damage that could occur as a result of inflammation, reduced oxygen supply to the brain, or bleeding.
- Medications. To reduce the risk of secondary damage to the brain following a mild or severe TBI, medications may also be necessary. These medications may include:
- Coma-inducing medications. Drugs that induce temporary coma may be used, as a comatose brain doesn’t need as much oxygen to function. This can be particularly beneficial if the blood vessels are compressed by increased pressure in the brain, and thus, are unable to supply the brain cells with the oxygen and nutrients that are necessary.
- Anti-seizure medications. Patients who sustain a mild a severe TBI can experience seizures, particularly in the first week post-injury. Seizures can cause additional brain damage, and to prevent the risk of seizures and additional damage, anti-seizure medications may be administered.
- Diuretics. Diuretics are designed to reduce fluid levels in the bodily tissues, thereby increasing a patient’s urine output. Intravenous diuretics may be given to patients with mild or severe TBI to help minimize pressure within the brain.
- Surgical procedures. In some cases of severe TBI, emergency surgery may be necessary in order to reduce the risk of additional damage to the brain. Surgical procedures may be used to address the following TBI-related complications:
- Hematoma removal. Bleeding that occurs within or outside of the brain can cause hematomas, or a collection of blood clots. These clots can apply additional pressure to the brain, which can cause further damage.
- Bleeding within the brain. If bleeding in the brain occurs following a head injury, surgery may be necessary in order to stop the bleeding.
- Skull fractures. If an injury causes moderate to severe skull fractures, surgery may be necessary in order to remove pieces of the skull that have either penetrated the brain, or to prevent brain penetration.
- Pressure relief. In moderate and severe cases of TBI, pressure can build up inside the skull. Depending on the extent of the pressure, surgery may be necessary. A surgical procedure, involves either draining the accumulation of cerebrospinal fluid, or creating a window in the skull in order to create more room for the swollen brain tissue.
- Rehabilitation. The majority of patients who suffer moderate and severe TBI will require rehabilitation to correct the complications that have occurred as a result of their injuries. For example, patients can lose basic skills following a TBI, such as talking and walking, and rehabilitation can help them regain these skills. Typically, therapy will start in the hospital and after the patient is discharged, therapy can continue at an inpatient rehabilitation center, a residential rehabilitation facility, or via outpatient services. The kind and the duration of the therapy varies from patient to patient, and depends on the severity of the injury, as well as the part of the brain that was injured. Examples of rehabilitation specialists that can help mild and severe TBI patients include the following:
- Occupational therapists. Professionals who help patients learn, relearn, and enhance the skills they perform in their everyday activities.
- Physical therapists. These therapists can help patients regain or improve their mobility and relearn movement patterns, such as balance and walking.
- Speech and language therapists. For patients whose speech has been affected by a TBI, speech and language therapists can help them regain their communication skills or use communication devices.
- Neuropsychologists. These professionals assess cognitive impairment and performance, help patients manage their behaviors, and teach them coping strategies, as well as provide psychotherapy, if needed, to improve psychological and emotional well-being.
- Rehabilitation nurses. These professionals offer ongoing rehabilitative care and services, and assist them with their discharge plans after leaving the hospital or rehabilitation facility.
- Recreational therapists. These therapists can assist patients with time management, as well as leisure activities.
- Vocational counselors. Vocational counselors assess patients’ ability to return to work following a TBI, and assist them with finding appropriate work opportunities.
Generally speaking, the more severe the injury, the longer it will take the individual to recover. For patients who suffer a mild TBI or a concussion, typically, it takes a few days or weeks to make a full recovery; however, for patients who have sustained moderate or severe brain injuries. The following is a general overview of the recovery timeline for the average patient.
Within the first two months following a TBI, patients may remain unconscious, and should begin to regain consciousness as their brain starts to heal. As they regain consciousness, patients will go through the first three stages of recovery, which include:
- Coma, the deepest state of unconsciousness, which is marked by unresponsiveness, even when stimulated.
- Vegetative state, during which patients may appear awake at times. The eyes may open and close, for example; however, they aren’t aware of their surroundings, but rather, the reactions are the result of automatic response.
- Minimally conscious state, in which the patient will have a reduced sense of awareness. They may respond to stimuli, such as touch, and may follow basic instructions; however, responses are usually inconsistent. When the patient becomes more alert and is able to respond to external stimuli on a consistent basis, they are considered to have “emerged” from a minimally conscious state. Following this state, recovery can progress at a faster rate; however, significant levels of assistance will still be necessary.
During the later stages of recovery, TBI patients usually make the most significant gains. The following are some of the gains that patients may be expected to make between 3 and 12 months after a TBI.
3 to 6 Months Post-TBI
Because the brain is in a heightened state of plasticity in the first six months post-TBI, a patient will make notable gains, and the impact of these gains will be visible. As such, the most significant gains are usually made within the first three to six months of TBI recovery. After this period, it may seem as if progress stalls. This is known as a “plateau” and it is very common in TBI recovery; however, it’s essential for patients to continue with their therapy program; otherwise, they can lose any gains that were made, and moreover. It’s important to note that plateaus are only temporary and patients who preserve will begin to make improvements again.
6 months to 2 years
As TBI patients continue with their treatment protocols, they will usually reach milestones in their recovery journey. The following are some of the key milestones that are usually made within this timeframe:
- Six months. Within 6 months, about 60 percent of TBI patients are able to walk again.
- One year and after. About 64 percent of TBI patients make significant cognitive and speech gains within one year post injury.
- Two years and after. Within two years and beyond, many TBI patients make a complete recovery or almost a complete recovery. It is important for patients and their loved ones to remember, however, that diligence is essential in order to achieve gains, because with diligence and determination, TBI victims can make significant gains.