Traumatic brain injury (TBI) refers to damage to the brain caused by an external physical force such as a car accident, a gunshot wound to the head, or a fall.

A TBI is not caused by something internal such as a stroke or tumor, and does not include damage to the brain due to prolonged lack of oxygen (anoxic brain injuries).

What is acute inpatient rehabilitation?

Acute inpatient rehabilitation (rehab) is an intensive form of medical rehabilitation in which patients receive three or more hours per day of core therapies (physical therapy, occupational therapy and speech therapy) overseen by a physician specialized in rehabilitation with around the clock nursing care. This team of physicians, nurses and therapists work together to restore function after traumatic brain injury. Research has shown that participating in inpatient rehabilitation after injury increases the likelihood of discharge to home and decreases risk of mortality among trauma patients, most of whom sustained TBI.

Consciousness is an awareness of one’s self and surroundings. Brain injury can cause disorders of consciousness (DOC). Some injuries are mild; they may cause minor changes in consciousness such as brief confusion. Severe injuries can cause permanent unconsciousness.

Alcohol and traumatic brain injury (TBI) are closely related. Up to 50% of adults with TBI were drinking more alcohol than is recommended before they were injured. People who were over age 60 when they had their TBI were less likely to drink too much before their injury, but those who did had worse outcomes. Although many people initially drink less after a TBI, starting to drink again increases their chances of having worse outcomes. By 2 years after the injury, we find that more than 40% start drinking again.

People with traumatic brain injury (TBI) often have problems with balance. About half of people with TBI have dizziness and loss of balance at some point in their recovery. When you are dizzy, you may have vertigo (the feeling that you or your surroundings are moving) and feel unsteady. You may also feel faint or lightheaded.

Many factors determine how bad your balance problem is, including:

• How severe your brain injury is.
• What part of the brain was injured.
• If you have other injuries along with your TBI. For example, in a car crash, you could have a TBI, neck injury, and broken ribs and legs. All of these injuries will affect your ability to keep your balance.
• Some medications can have an effect on your balance.

Memory and Traumatic Brain Injury

• Memory problems are very common in people with moderate to severe TBI.
• TBI can damage parts of the brain that handle learning and remembering.
• TBI affects short-term memory more than long-term memory.
• People with TBI may have a tough time “remembering to remember. ”This means remembering to do things in the future, such as keeping appointments or calling someone back when you’ve promised to do so.
• People with moderate to severe TBI may not remember the incident surrounding the injury.
• With the help of certain strategies, people with TBI can learn to work around memory problems and get things done every day.

Pain is an unpleasant sensation that can range from mild to very severe. Pain is very personal; two people can have the same type and amount of pain and have very different reactions to it.

Pain is usually considered chronic when it lasts more than three months. Many people with traumatic brain injury (TBI) have chronic pain at some time or other.

What is Cognition?

Cognition is the act of knowing or thinking. Some thinking abilities that can be affected by TBI include:

• Attention and concentration
• Processing and understanding information
• Memory
• Planning, organizing, and assembling
• Reasoning, problem-solving, decision-making, and judgment
• Monitoring and watching behavior to ensure that it is socially acceptable
• Communicating thoughts or ideas in ways that others can understand

Cognition after TBI

This factsheet discusses common difficulties with cognition (or thinking) that some individuals have after a TBI and presents some tips that may help reduce these challenges.

Recovering from concussion

Most concussion symptoms resolve within hours to days or a few months. Recovery is usually faster when a person gets some rest for a short period of time (e.g., a couple of days) and gradually returns to their activities and responsibilities over a week or so. Complete rest is not recommended, and instead, light exercise and mental activity may actually improve recovery. A small number of people may take longer to recover and need specific treatments. They could include specific support at work or school for a short period of time such as days or a few weeks while they recover.

Driving is an important part of a person’s independent lifestyle and integration into the community. Because we take our driving skills for granted, it is easy to forget that driving is the most dangerous thing we do in our everyday lives. A brain injury can affect the skills needed to drive safely. If and when an injured person may safely return to driving should be addressed early in recovery. The injured person, family members, and health professionals should all be included in this important decision. If anyone has concerns that that driving may put the injured person or others in danger, health professionals may recommend pre-driving testing.

The way people experience or express emotions may change after a traumatic brain injury (TBI). While this can be distressing for family members and friends, many strategies can help manage these emotional concerns after TBI.

Why is fatigue important?

When you are fatigued, you are less able to think clearly or do physical activities. If you are overwhelmed by fatigue, you have less energy to care for yourself or do things you enjoy. Fatigue can have a negative effect on your mood, physical functioning, attention, concentration, memory and communication. It can interfere with your ability to work or enjoy leisure activities. It can make activities such as driving dangerous.

Headache is one of the most common symptoms after traumatic brain injury (often called “post-traumatic headache”). Over 30% of people with moderate to severe TBI report having headaches which continue long after injury. An even larger percentage people with mild TBI complain of headache.

What changes can be expected after a TBI?

Feeling irritable or angry from time to time is common for most people, but a TBI may cause changes that make these feelings more of a problem.

After traumatic brain injury (TBI), many couples find that their relationship with each other changes dramatically. These changes are very personal and can be very emotional for both people in the relationship. This factsheet will help couples understand some of the common changes they may notice in their relationship after TBI. Also, suggestions are given for ways that couples can address some of the more difficult changes they are experiencing.

Although some of the relationship changes after TBI are difficult and can be painful, there are many things that couples can do in order to enjoy each other and their relationship in new, positive, and meaningful ways.

Parental involvement is critical when a young person is returning to school after a traumatic brain injury (TBI). Parents have the most knowledge about their child and are deeply invested in their daughter’s or son’s well-being and future. Often parents become advocates to ensure that all essential supports are in place to enhance their child’s successful return to school. Parents may also be a go-between to make sure all the necessary medical information has been provided so the school can design the best plan for the student. If the student is close to exiting school, vocational rehabilitation professionals may also be involved.

Changes in sexual functioning are common after TBI. If you are experiencing sexual problems, there are things you can do to help resolve these problems. The information in this factsheet describes common sexual problems after TBI and ways to improve sexual functioning.

How common are sleep problems following a TBI?

Many people who have brain injuries suffer from sleep disturbances. Not sleeping well can increase or worsen depression, anxiety, fatigue, irritability, and one’s sense of well-being. It can also lead to poor work performance and traffic or workplace accidents. A review of sleep disorder studies and surveys suggest that sleep disorders are three times more common in TBI patients than in the general population and that nearly 60% of people with TBI experience long-term difficulties with sleep. Women were more likely to be affected than men. Sleep problems are more likely to develop as the person ages.

A traumatic brain injury (TBI) can change a person in many ways. As a caregiver of a person with a TBI, you may feel stressed or overwhelmed in this role. You are not alone; these feelings are normal. Using strategies to manage stress may help you take care of yourself.

Depression is a common problem after TBI. About half of all people with TBI are affected by depression within the first year after injury. Even more (nearly two-thirds) are affected within seven years after injury. In the general population, the rate of depression is much lower, affecting fewer than one person in 10 over a one-year period. More than half of the people with TBI who are depressed also have significant anxiety.

People with traumatic brain injury (TBI) may experience challenges in voting due to a range of impairments in physical, hearing, vision, communication, cognitive, emotional, and behavioral function. Obstacles may include registering to vote, remembering to vote, accessing transportation, physically navigating the polling place, understanding ballot design, and utilizing technologies for voting. All that on top of deciding who to vote for! The information here is intended to help people with brain injury overcome such obstacles.