Traumatic Brain Injury Rehabilitation and Therapy

TBI/head injuries: different types, what to do, therapy options

Brain injuries are a hot-button topic these days, mainly because of the NFL and famous football players suffering from concussions.

When someone earning millions of dollars suffers from a blow to the head, it’s big news. Will he be able to play again? Will he get back on the field? Will he recover from his traumatic brain injury?

It’s always a toss-up. Brains are fragile balls of gray matter that we throw around for sport. They take a lot of abuse. And just as everyone is a unique snowflake, so is every brain injury. As doctors like to say, “When you’ve seen one concussion, you’ve seen one concussion.”

So what exactly is a brain injury?

There are many different types of brain injuries. The label you receive depends on exactly how your head was hit.

• Diffuse axonal injury: This type of injury is caused by strong shaking or severe rotation of the head (e.g., a car accident, in which physical forces cause the brain to lag behind the movement of the skull, which causes tissues and structures to tear). The torn nerve tissue disrupts the brain’s communication and chemical processes, which ultimately causes brain death.
• Contusion: This is a direct impact on the skull that can result in bleeding on the brain. If bad enough, a contusion might need to be surgically removed.
• Concussion: This is the most common type of traumatic brain injury. Generally speaking, it’s the result of force to the head – that can be whiplash, violent shaking, a gunshot or really any type of force. It can present as an open- or closed-type concussion, and because it might not show up on diagnostic imaging, it can be a diagnosis of exclusion.
• Coup-contrecoup injury: This type of injury occurs when a contusion appears both at the site of impact and at the complete opposite side of the head. The force of impact was great enough to travel to the opposite side of the brain.
• Open and closed head injuries: These are exactly what they sound like. With an “open” head injury, the skull cracks and bone shatters. This means that tissue can expand and swell. With “closed” head injuries, that swollen tissue has no place to go. That is why intracranial pressure will be monitored constantly.
• Second impact syndrome: This happens when a patient incurs a second traumatic brain injury before the effects of the first traumatic brain injury have healed.
• Penetrating injuries: An object penetrates the skull and enters the brain, such as a bullet or a nail, and leaves a trail of destruction in its wake. These objects rip their way through brain tissue and nerves, either becoming lodged or going “through and through.”
• Shaken baby syndrome: Since babies’ brains as so fragile, they are susceptible to force – such as being shaken. That whiplash-like motion is enough to cause permanent brain damage, coma or even death. Frustrated parents might shake their babies to stop them from crying, and by then it’s too late.
• Locked-in syndrome: This is a neurological condition in which the patient is truly trapped, only able to move his or her eyes and otherwise unable to move. The patient is conscious and can think, but cannot otherwise communicate.
• Anoxic brain injury: This occurs when the brain does not receive oxygen and cells begin to die.
• Hypoxic brain injury: This occurs when the brain receives some, but not enough, oxygen.

TBI statistics

Traumatic brain injuries are sadly common.

According to the Centers for Disease Control and Prevention, in 2013 there were 2.5 million visits to the emergency room related to traumatic brain injuries; 282,000 hospitalizations related to traumatic brain injuries; and 56,000 deaths related to traumatic brain injuries. 

What were the leading causes of TBIs? As of 2013, the most recent year for which data is available:

• Falls: 40.5%
• Struck by/against: 15.5%
• Motor vehicle traffic: 14.3%
• Assaults: 10.7%
• Unknown: 19.0%

How to spot a brain injury – and what to do

If you think you or someone close to you has suffered a head injury, always take it seriously. This is the brain we’re talking about! (See how to recognize a brain injury)

Monitor symptoms. Have someone else keep an eye on you if you suspect you may have a brain injury.

Watch for the following symptoms in adults:

• Slurred speech
• Nausea or vomiting
• Weakness, numbness or decreased coordination
• A headache that doesn’t go away or keeps getting worse

Get to the emergency room immediately if you notice the following:

• Become drowsy and/or can’t wake up
• Have one pupil that is larger than the other
• Begin having convulsions or seizures
• Become confused, agitated or restless
• Cannot recognize surroundings
• Have other unusual behavior
• Faint

Emergency signs for children - take them to the emergency room in the following situations:

• If they have any of the above danger signs
• If they will not stop crying
• If they are completely inconsolable
• If they will not eat or drink

What is TBI rehab and recovery like?

In very rare cases, a brain injury can unlock a hidden talent. There have been a few cases where an acquired savant has miraculously developed artistic, musical, or mathematical abilities as a result of a brain injury.

However, for the majority of TBI survivors, rehab and therapy will require time. It may be weeks, years or lifelong.

First of all - you’ve got to rest. Don’t tough it out. Don’t try to be a hero, no matter what your boss says.

Even if you think you’re fine right afterward, you’re really not. Get a doctor’s note and get into bed, kiddo.

Sleep and rest are the main prescription. You will want to avoid anything that is physically demanding or that requires mental concentration. This will make symptoms worse.

Stay away from sports for a while, don’t ride bikes and try not to operate heavy equipment. Don’t go on any roller coasters.

Basically, pretend you’re a hermit. Would a hermit drink alcohol? Probably not! You shouldn’t drink alcohol with a head injury.

Additionally, you should only take the medications that your health care provider has approved. The more you follow your doctor’s orders, the less chance the TBI will cause a long-term health problem such as epilepsy, Parkinson’s disease or other brain disorders.

If the traumatic brain injury is more traumatic, you may need to tap into a TBI rehabilitation program.

Types of TBI rehabilitation programs

A rehabilitation program might be necessary when the traumatic brain injury is pronounced. These TBI rehab programs can range from an outpatient therapy regimen to a complete inpatient registration.

Some of the traumatic brain injury rehab programs you may be able to benefit from include:

• Short-term disorders of consciousness programs for those who are semi-comatose or minimally conscious
• Stroke rehabilitation programs
• Complex concussion clinics
• Day programs
• Locomotor training
• Neurorehabilitation clinics
• Upper and lower extremity retraining clinics
• Occupational therapy
• Physical therapy
• Respiratory therapy
• Speech language therapy
• Social services
• Aqua therapy

The CDC is taking measures to reduce traumatic brain injuries

The CDC presented a 72-page report to Congress that outlined their plans both to combat traumatic brain injuries and to improve the lives of those living with them.

The CDC’s specific recommendations to Congress were:

• To improve estimates of traumatic brain injuries
  • By collecting additional clinic data
  • Calculating the number of TBIs within each state
  • Estimating the number of individuals living with disabilities caused by TBIs
  • Develop a surveillance system to monitor estimates of sports- and recreation-related concussions experienced by youth
• Enhance measures used to evaluate rehabilitation success
  • Increase patient tracking progress (electronic monitoring)
  • Develop comprehensive measures to better determine the effectiveness of rehabilitative therapies
  • Adapt promising measures within specific populations (children, adults, etc.)
• Improve TBI rehabilitation research and service delivery
  • Conduct studies to implement optimal timing, intensity and frequency of rehabilitative therapies
  • Develop better service models to connect patients and their families to the therapies they need
  • Increase alternative models for services, such as telemedicine, for patients in rural areas
  • Expand promising technologies to aid in rehabilitation.

Check out our resources to help after a brain injury. We’ve compiled several websites that might help you kick-start the healing process.