How to Survive Traumatic Brain Injury

Three Parts:Understanding TBIGetting a DiagnosisGetting Treatment

Traumatic Brain Injury (TBI) is most often an acute event, similar to other injuries. Since the brain defines who you are, the consequences of a brain injury can affect all aspects of your life including the personality. The global incidence rate of TBI is estimated at 200 per 100 000 people per year, though this rate is uncertain and a likely underestimate. According to the World Health Organization, TBI will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 million people affected annually by TBI, the burden of mortality and morbidity that this condition imposes on society, makes it a pressing public health and medical problem.

Part 1
Understanding TBI

  1. 1
    Know the difference between brain injury and other injuries. A brain injury is different from a broken limb or a punctured lung. An injury in these areas limit the use of a specific part of the body, but your personality and mental abilities remain unchanged. Most often, these body structures heal and regain their previous function.
    • Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar injuries may be very different.
    • Symptoms of brain injury may appear right away or in contrast to other injuries, may not be present for days or weeks after the injury.
  2. 2
    Know the common causes. The top three causes of TBI are:
    • Car accidents
    • Firearms
    • Falls
  3. 3
    Be familiar with the types.
    • Open head injury:
      • Results from bullet wounds, etc.
      • Usually causes focal damage
      • Results from penetration of the skull
      • Effects can be just as serious as closed brain injury
    • Closed head injury:
      • Occurs from a slip and fall, motor vehicle crashes, etc.
      • Results in focal damage and diffuse damage to axons
      • Effects tend to be broad (diffuse)
      • There's no penetration to the skull
    • Deceleration Injuries:
      • The skull is hard and inflexible while the brain is soft with the consistency of gelatin. The brain is encased inside the skull. When the skull moves through space, it's in a phase of acceleration. The rapid discontinuation of this action when the skull meets a stationary object (deceleration) causes the brain to move inside the skull. The brain moves at a different rate than the skull because it is soft. Different parts of the brain move at different speeds because of their relative lightness or heaviness. The differential movement of the skull and the brain when the head is struck results in direct brain injury, due to diffuse axonal shearing, contusion and brain swelling.
  4. 4
    Know the effects. Most people are unaware of the scope of TBI or its overwhelming nature. TBI is a common injury and may be missed initially when the medical team is focused on saving the individual’s life. The effects of TBI can be mild, moderate or severe.
    • Mild - A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes.
      • While MRI and CAT scans are often normal, the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration.
      • These injuries are commonly overlooked. Even though this type of TBI is called mild, the effect on the family and the injured person can be devastating.
      • Mild TBI is also known as Concussion, Minor head trauma, Minor TBI, Minor brain injury or Minor head injury.
      • Mild TBI is the most prevalent type of TBI, and is often missed at time of initial injury.
    • Moderate - Here, the loss of consciousness is greater than 30 minutes
      • Physical or cognitive impairments are present midway between the mild and the severe variety which may or may not resolve
      • Benefit from Rehabilitation more often than not
    • Severe - Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury for more than 24 hours.
      • The deficits range from impairment of higher level cognitive functions to comatose states. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems.
      • Individuals with severe TBI can be left in long-term unresponsive states.
      • For many people with severe TBI, long-term rehabilitation is often necessary to maximize function and independence.
      • The range of injuries and degree of recovery can be very variable and differs on an individual basis.
  5. 5
    Know the symptoms.
    • Possible symptoms for mild TBI include:
      • Fatigue
      • Headache
      • Nausea
      • Loss of smell
      • Sensitivity to light and sounds
      • Getting lost or confused
      • Slowness in thinking
      • Visual disturbance
      • Memory loss
      • Poor attention/concentration
      • Sleep disturbance
      • Dizziness/loss of balance
      • Irritability and emotional disturbances including feeling of sadness
      • Seizures
    • Possible symptoms of severe TBI include:
      • Cognitive deficits like confusion and impulsiveness including difficulties with attention, concentration, memory, speed of processing, language processing, and executive functions.
      • Speech and language problem including failure to understanding the spoken word (receptive aphasia), difficulty speaking and being understood (expressive aphasia), slurring of speech, speaking very fast or very slow, problems reading, and problems writing.
      • Sensory problems like difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination.
      • Perceptual problem like the integration or patterning of sensory impressions into psychologically meaningful data.
      • Problems related to vision, like partial or total loss of vision, weakness of eye muscles and double vision (diplopia), blurred vision, problems judging distance, involuntary eye movements (nystagmus), and intolerance of light (photophobia).
      • Problems related to hearing, like decreased (or loss) of hearing, ringing in the ears (tinnitus), and increased sensitivity to sounds (hyperacusis).
      • Problems related to smell, like loss or diminished sense of smell (anosmia).
      • Problems related to taste, like loss or diminished sense of taste.
      • Seizures - the convulsions associated with epilepsy that can be of several types and can involve disruption in consciousness, sensory perception, or motor movements.
      • Possible physical changes like paralysis, or spasticity, chronic pain, disturbed control of bowel and bladder, sleep disorders, loss of stamina, changes in appetite, disturbed regulation of body temperature, and problems with menstruation.
      • Possible disturbances in the social and/or emotional areas including dependent behaviors, emotional lability, lack of motivation, irritability, aggression, depression, disinhibition, and denial of the problem/lack of awareness.

Part 2
Getting a Diagnosis

  1. 1
    See a doctor. A detailed clinical and neurological examination is important and will bring out evidence of brain injury.
    • Brain imaging with CAT scan, MRI, SPECT and PET scan may be useful.
  2. 2
    Be prepared to be tested by a neuropsychologist and various therapists as well. Cognitive evaluation by a neuropsychologist with formal neuropsychological testing is required.
    • Evaluations by physical, occupational and speech therapists can help clarify the specific deficits of an individual.
  3. 3
    Get evaluated using Glasgow Coma Scale. This is the gold standard in diagnosing the condition and its stages. This test is based on a 15 point scale for estimating and categorizing the outcomes of brain injury on the basis of overall social capability or dependence on others. The test measures the motor response, verbal response and eye opening response with these values:
    • I. Motor Response
      • Obeys commands fully
      • Localizes to noxious stimuli
      • Withdraws from noxious stimuli
      • Abnormal flexion, i.e. decorticate posturing
      • Extensor response, i.e. decerebrate posturing
      • No response
    • II. Verbal Response
      • Alert and Oriented
      • Confused, yet coherent, speech
      • Inappropriate words and jumbled phrases consisting of words
      • Incomprehensible sounds
      • No sounds
    • III. Eye Opening
      • Spontaneous eye opening
      • Eyes open to speech
      • Eyes open to pain
      • No eye opening
    • The final score is determined by adding the values of I+II+III. This number helps medical practitioners categorize the four possible levels for survival, with a lower number indicating a more severe injury and a poorer prognosis:
      • Mild disability (13-15)
      • Moderate disability (9-12)
      • Severe Disability (3-8)
        • Coma: unconscious state. No meaningful response, no voluntary activities
      • Vegetative State (Less Than 3)
        • Disturbed Sleep wake cycles
        • Arousal, but no interaction with environment
        • No localized response to pain
      • Persistent Vegetative State:
        • Vegetative state lasting longer than one month
      • Brain Death
        • No brain function (Specific criteria needed for making this diagnosis).

Part 3
Getting Treatment

  1. 1
    Know the details of available treatment. There are many different kinds of treatments available for patients of Traumatic Brain Injury (TBI)
    • Initial Treatment stabilizes the individual immediately following a traumatic brain injury
    • Rehabilitative Care Center Treatment helps restore the patient to daily life
    • Acute treatment of a Traumatic Brain Injury is aimed at minimizing secondary injury and life support
    • Surgical Treatment may be used to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimize swelling and pressure
  2. 2
    Understand how supportive care is provided for unconscious TBI patients. The medical staff providing supportive care for the unconscious individual is highly trained and understands how to care for traumatic brain injury (TBI) patients.
    • TBI patients are monitored with equipment for breathing, heart rhythm, blood pressure, pulse and intracranial pressure
    • Sometimes the unconscious individual cannot breathe without assistance. The airway is maintained and breathing occurs through special tubes that help maintain oxygen in the blood. It may be necessary to suction, as to remove thick secretions and keep the air tube clean.
    • The tube may be located in the mouth or in the neck. If it is in the neck, it is called a tracheostomy tube. Either tube will need to be cleaned daily. A pulse oximeter measures the amount of oxygen the patient is receiving through a device that resembles a finger splint
    • After head trauma, seizures can occur. Dilantin is the usual medication administered through the IV to prevent seizures. A tetanus shot should also be given.
    • Fluid is administered through the IV for nutrition and liquid. The unconscious person cannot eat or drink safely. The need for nutritional support using parenteral (IV) or enteral solutions (a tube placed in the stomach) is determined by a registered dietician and the doctor
    • A urinary catheter is put in the bladder for urine collection. The individual is not aware of the need to use the bathroom. The catheter attaches to a bag hanging from the side of the bed
    • It is important to maintain the unconscious patient’s blood pressure through IV fluid and medication. Ideally, the blood pressure should range close to 90/70 mm of Hg
    • The patient is turned and positioned in bed to prevent bedsores because most unconscious people cannot move independently
    • The unconscious person may have a compression device wrapped around the legs that resembles a plastic tub mat. This device prevents blood clots. Daily injections are also given to prevent blood clots
    • In moderate to severe TBI patients, the intracranial pressure is constantly monitored and kept under check.
  3. 3
    Understand the path to recovery. Recovery from a Traumatic Brain Injury (TBI) varies based on the individual and the brain injury. Attempts at predicting the degree of TBI recovery remain mostly unsuccessful, and crude. Recovery can be seen months, and even years, after the initial injury. Devastating and fatal injuries can be easier to ascertain than other injuries.
    • The following are the indicators the medical team uses for prognosis:
      • Duration of Coma. The shorter the coma, the better the prognosis
      • Post-traumatic amnesia. The shorter the amnesia, the better the prognosis
      • Age. Patients over 60 or under age 2 have the worst prognosis, even if they suffer the same injury as someone not in those age groups
    • Recovery of brain function is thought to occur by several mechanisms. Some common theories:
      • Diaschisis. Depressed areas of the brain that are not injured but linked to injured areas begin functioning again
      • The function is taken over by a part of the brain that does not usually perform that task
      • Redundancy in the function performed so another area of the brain takes over
      • Behavioral substitution. The individual learns new strategies to compensate for deficits.


To prevent TBI,

  • Always wear a seatbelt while in a motor vehicle.
  • Use an appropriate child safety seat or a booster, when applicable.
  • Never drive under the influence of alcohol or drugs.
  • Always wear a helmet when on a bicycle, motorcycle, scooter, snowmobile and other open unrestrained vehicles.
  • Wear a helmet when participating in contact sports.
  • Wear a helmet when horseback riding.
  • Wear a helmet while skiing, snowboarding, skating and skateboarding.
  • Always use the rails on stairways.
  • Provide adequate lighting, especially on stairs for elderly people, people with poor vision or who have difficulty walking.
  • Place bars on windows to prevent children from falling.
  • Sit on safe stools.
  • Do not place obstacles in walking pathways.
  • Keep guns locked in a cabinet.
  • Store guns unloaded.
  • Store ammunition apart from guns.


  • One of the consequences of TBI is that the person may not initially realize that a brain injury has occurred.

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Categories: Injury and Accidents