Traumatic brain injury (TBI) is defined as any damage done to your brain caused by an outside force that interrupts normal brain function — even if loss of consciousness does not occur. Comparatively, acquired brain injuries comprise all brain injuries caused by internal events, such as strokes, aneurysms, illness-related complications, exposure to toxins, or tumors.
According to the Centers for Disease Control and Prevention (CDC), there were about 223,135 TBI-related hospitalizations in 2019 and 64,362 TBI-related deaths in 2020 in the United States.
More information about concussions, which are classified as mild traumatic brain injuries, can be found in the Everyday Health concussion guide. But mild is a misnomer — concussions can have big consequences if left unaddressed and untreated.
Brain injuries are classified as either mild, moderate, or severe. The severity of the injury is determined using the Glasgow Coma Scale (GCS), an assessment tool that is used to measure a patient’s level of consciousness using the metrics of eye-opening, motor response, and verbal response following a brain injury. People with a mild TBI have a GCS ranging from 13 to 15, whereas a moderate TBI leads to scores in the 9 to 13 range. Severe TBI is associated with a GCS score of 8 or less.
Living with a traumatic brain injury can be difficult, but it is manageable. Whether you’re looking for medical professionals, emotional help, or advice for day-to-day living, this guide will help you manage life post-TBI.
Managing Daily Life
Although rest is essential in the beginning days and weeks following a TBI, the sooner an individual can return to daily activities and resume their previous routine — with necessary accommodations — the better. Creating and maintaining a daily schedule can help with a person’s working memory and can get them back into a routine.
TBIs often result in an increased response to stimuli and a decrease in the ability to focus. It’s important to avoid distractions and manage your expectations during your recovery. Healing from a traumatic brain injury is a marathon, not a sprint, and can take a lifetime.
“The biggest problem individuals suffering from TBIs encounter is that it is an invisible illness,” says Haley Neidich, a licensed mental health professional based in New Haven, Connecticut. “People with TBIs can be struggling significantly with cognitive, behavioral, physical, and mental health issues while appearing as if all is well on the outside.”
Exercise is an important part of recovery and can help your brain during the healing process. A 2018 review found that sustained rest from all physical activity, also known as “cocoon therapy,” is not beneficial to TBI recovery. There are many different forms of exercise you can engage in to maintain health as you recover. Some ideas are below. Not all forms of exercise are right for everyone, so talk to your doctor before starting an exercise program.
Yoga is one form of exercise that has been shown to help brain injury survivors with balance, flexibility, and muscle strength following an accident.
Initiatives such as LoveYourBrain — started by snowboarder Kevin Pearce after his own TBI in 2009 while training for the Winter Olympics — foster a mind-body connection for TBI survivors through a free, adaptable yoga program.
Moderate aerobic exercise has also been shown to help recovery from a TBI. A 2021 study of 32 young athletes found that those who were more active during their recovery period were cleared to return to their sport faster. Similarly, a small study published in 2015 found that patients with mild and moderate brain injuries who followed a vigorous aerobic exercise training program three times a week for 30 minutes saw improvements in brain cognition.
According to a 2019 study, semi-immersive virtual reality brain exercises “may be a useful approach for the rehabilitation of individuals with TBI, potentially leading to better cognitive and behavioral outcomes.”
But digital applications advertised as brain training aren’t always a failsafe plan. Therese O’Neil-Pirozzi, ScD, an associate professor in the department of communication sciences and disorders at Northeastern University in Boston, cautions: “All brain training apps are not created equal. Some have evidence to support their use for individuals with particular cognitive-communicative challenges from acquired brain injury, and many do not.”
For example, CT Speech and Cognitive Therapy was designed by speech-language pathologists to provide comprehensive exercises addressing speech, memory, and cognitive functions. But other apps were created without consulting specialists.
“Some brain training apps are introduced to brain injury survivors during their cognitive rehabilitation sessions by clinicians with whom they are working,” Dr. O’Neil-Pirozzi explains, “and then survivors continue to use these on their own following therapy discharge.”
Professional input is always advised to avoid patients from focusing on apps that haven’t been proven to show any benefits or have no evidence. If you’re interested in trying out a brain training app, talk to your cognitive rehab clinicians to determine which one is best for you.
The types of food you put into your body have a direct effect on the well-being and recovery of your brain post-injury. While some dietary suggestions have been proven to show benefits for brain health, there is no one specific diet that is beneficial for every person with a TBI.
BrainLine suggests eating small meals every three to four hours and setting a reminder alarm if your body is having problems providing signals. Those small meals should be composed of foods found in the Mediterranean diet, including:
- Protein, like fish, lean meats, nuts, and eggs
- Healthy fats and oils from avocados, seeds, and nuts
- Healthy carbohydrates found in vegetables, fresh fruits, and grains
Fatty fish are strongly advised for brain recovery since they are a great source of omega-3 fatty acids. A study published in 2017 found the consumption of omega-3 fatty acids led to improved spatial cognitive recovery and helped protect against cell death after brain injury. Other good sources of omega-3s include:
- Chia seeds
- Soy or kidney beans
Vitamin B12 is another important nutrient that is beneficial for people recovering from a TBI. According to a study published in 2019, B12 is beneficial for improving functional recovery and repairing nerves after a TBI. The vitamin can be found in the following foods:
- Fortified cereals
- Milk and dairy products
Vitamin D deficiency can also lead to worse neurological outcomes following a TBI, according to research from 2021. Vitamin D can be found in dairy products and fatty fish as well as fortified orange juice, cereals, and plant-based milks.
Gut health is an important and often overlooked factor when it comes to recovering from a traumatic brain injury. Research shows that a brain injury can lead to an imbalance of gut microbes and increase inflammation in the gut.
You can help reduce inflammation and gut damage by paying attention to the food that you eat. Harvard Health Publishing suggests cutting down consumption of processed and high-sugar foods as well as alcohol. Food sensitivities you may not realize you have can also cause inflammation. It’s worth exploring if your body is having adverse reactions to gluten, dairy, or other food groups.
As always, consult your doctor about which dietary options would best serve your specific injury.
Work or School
Whether it’s returning to a job or resuming school, it’s important for TBI survivors to have realistic expectations of their abilities and limitations. All people with disabilities are entitled to reasonable accommodations, as defined by the 1990 Americans With Disabilities Act. For example, a TBI survivor may need to alter some of their work responsibilities or may require reasonable accommodations to perform functions or tasks. The same is true for people returning to school. You may need to ease back into work or school by starting out working shorter shifts, lowering your workload, or taking frequent breaks to rest throughout the day.
To best prepare yourself for a return to work or school, talk with your doctor or therapist to find out about the types of accommodations you might need.
RELATED: TBI Survivors Share Their Journey Back to Work
Depending on the severity of your head injury, you may already have an inpatient care team. A hospital’s care team for someone with a TBI may consist of the following:
- Physiatrist (physical medicine and rehabilitation doctor)
- Speech and language pathologist
- Physical therapist
- Occupational therapist
Here are some recommendations for finding a suitable provider to fit your needs for continuing and ongoing recovery.
Physiatrists, also known as physical medicine and rehabilitation (PM&R) doctors, specialize in a variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. They usually aim for multidisciplinary, holistic care and focus treatment on function. Many physiatrists specifically specialize in brain injury medicine and lead in-patient brain injury programs.
Neurologists specialize in diagnosing, treating, and managing disorders of the brain and nervous system. This is the doctor who will complete a comprehensive evaluation, including performing a detailed neurological examination and ordering any necessary imaging studies, such as CT or MRI, or laboratory tests to come up with an interdisciplinary plan of care. A neurologist will provide medical management of many TBI symptoms, such as headaches, insomnia, irritability, or depression. Different neurologists specialize in different brain conditions — try to find one with a background in traumatic brain injury.
Depending on the areas of the brain affected, different medical interventions or measures to improve your condition will be necessary. For example, if your occipital lobe, which is located at the back of the brain and controls vision, is damaged, an ophthalmologist may be necessary. Your TBI-specialized neurologist will detect any deficits and know which specialists are needed to address them. Then, your neurologist will refer you to the appropriate doctors.
Speech and Language Pathologist
Speech therapists help patients with cognitive function, communication, and swallowing. Aphasia, the loss of ability to understand or express speech, is a common deficit, to varying degrees, in TBI sufferers. Speech therapists will help you work through it or find alternative means of communicating your thoughts.
A TBI can cause a lack of communication between the mind and body, resulting in an array of movement deficits. Physical therapists help TBI sufferers relearn movement patterns and regain balance that may have been affected by damage to their vestibular system, which is located in the inner ear and enables equilibrium.
While speech therapy focuses on your mind and physical therapy focuses on your body, occupational therapy bridges the physical and mental to help you effectively re-enter daily life and your previous routine. Depending on your interests and needs, an occupational therapist might help you find a process for managing your finances, create daily schedules, regain hand dexterity and the fine motor skills necessary to write by hand, practice cooking, or reacclimating to personal hygiene procedures.
Many occupational therapists who specialize in brain injury recovery also treat vision issues and problems with eye movements. Subtle abnormalities in eye movements that go undiagnosed can lead to difficulties with balance, reading, and headaches.
Having and recovering from a traumatic brain injury can be an alienating experience. A study from 2019 found that about 1 in 5 TBI survivors experience mental health symptoms after their injury.
Some common mental health issues that arise after a TBI include:
- Post-traumatic stress disorder (PTSD)
- Anger issues
Psychologist Specializing in TBI
If you are suffering from mental health problems following a TBI, a psychologist or therapist can help you work through any emotional difficulties you’re having with your injury. Finding a psychologist with a background in traumatic brain injury is helpful.
Your care team will have a medical social worker on hand to help you find a suitable psychologist.
Sometimes medication may be needed to help with addressing your mental health problems. Below are some drugs that may be prescribed by a doctor for common mental health issues following a TBI.
- Selective serotonin reuptake inhibitors (SSRIs) to treat depression, anxiety, and PTSD
- Carbamazepine and valproate to treat agitation and aggression
Here are some more resources to help with managing mental health in conjunction with a TBI:
- Blue Light Therapy May Help Improve Mood in People With Traumatic Brain Injuries
- When PTSD Accompanies a Concussion
- Traumatic Brain Injury Linked to Increased Risk of Suicide
People suffering from TBIs typically report difficulty with interpersonal relationships. According to the University of Washington TBI Model System, TBI survivors “often have new personality traits, challenges, fears, and limitations,” making them almost unrecognizable to the people who have been in their lives the longest.
Of course, specific types of relationships come with their own specific difficulties and ways of being handled.
While the benefit of therapy for the TBI survivor may seem inherent, therapy for the partner is important, too, to help promote understanding and compassion. It’s also important to be patient with yourself and communicate your specific needs to your partner as you recover, since they might have different expectations.
Parents or Children with a TBI
Family dynamics will likely be altered as a result of a TBI. Parents or children may not behave as they used to or maintain their former position in the family. To help all members of a family adjust to any new personality traits of their parent or child with a brain injury, it might help for the whole family to meet with your loved one’s treatment team to get a better idea of what to expect from your loved one and how best to adjust.
Family counseling might also be helpful.
Following the assessment of an individual’s affected areas in the brain, medication may be needed to treat deficits unresponsive to or inadequately addressed by therapy alone. According to the Brain Injury Association of America, some drugs that may help to treat brain injury include:
- Anticonvulsants to prevent seizures
- Anticoagulants to prevent blood clots
- Stimulants to increase attention and alertness
- Anti-anxiety medication, antidepressants, or antipsychotics to help treat mental issues
- Muscle relaxants to reduce muscle spasms
- Antispasticity medications to reduce spasticity (increased muscle tone)
- Sedatives to help with sleep issues
- Analgesics to help with pain relief
- Over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for headaches, or prescription medicines like sumatriptan (Imitrex) for migraines
Be sure to discuss the side effects of any medications with your doctor.
The last thing anyone wants to consider while healing from any injury is finances, but it’s a reality that needs to be taken into consideration.
Some costs include:
- Hospital bills
- Continued costs of rehabilitation after acute hospitalization
- Any copays
- Prescription medication
- Any recommended medical devices, such as arm crutches or gait belt
The act of managing your money may also become difficult and require external help after a traumatic brain injury.
One option is to apply for Social Security disability insurance (SSDI) while recovering. Insurance comes with Medicare if health insurance is also an issue.
If you were working while injured, depending on the circumstances surrounding your TBI, you may be entitled to worker’s compensation. If this is the case, speak with your employer, a union for your industry, or a worker’s advocacy group associated with your line of work.
A case manager or social worker can help you address the cost of care and find any necessary resources.
Every traumatic brain injury is as unique as the individual suffering from it. Although no one’s experience will be exactly the same, it’s often beneficial to read another survivor’s story and know that you aren’t alone.
Amy Kraft: Managing Insomnia Post-TBI
According to research from 2012, insomnia is a problem that affects 30 to 70 percent of TBI sufferers. In this story, Kraft discusses how she learned that her sleep issues were linked to her TBI — 17 years after the accident — and how these problems can be addressed.
Instagram Recoveries: Finding Community Post-TBI via Social Media
Traumatic brain injuries are an incredibly isolating experience. Patients often report feeling misunderstood or unable to communicate their experience. But some TBI survivors have found community and shared experiences through their Instagram accounts. This article explores 10 inspiring brain injury Instagram accounts.
The 10 Most Inspiring Instagram Accounts for Brain Injury Survivors
Back to Work: Challenges Reentering the Workplace after TBI
Many of the personal and social difficulties that stem from a traumatic brain injury factor into an individual ability to return to work. A study published in Brain Injury found that nearly 40 percent of people with TBI or a nontraumatic acquired brain injury are able to return to work after one to two years, but not all of these people are able to return to the same line of work or in the same capacity. In this article, TBI sufferers share the different routes their professional lives took as they reacclimated to the workplace.
TBI Survivors Share Their Journey Back to Work
Sometimes, your care team will connect you with studies or trials that can help in your recovery. Otherwise, clinical trials can be found via search databases through reputable organizations or hospitals, including:
When deciding whether or not to participate in a clinical trial, it’s important to assess the risks with your doctors and loved ones to determine if the benefits outweigh any risks.
News and Research
Staying up-to-date on new developments in the sphere of traumatic brain injury will give you the necessary language and knowledge to communicate your needs to doctors and loved ones.
For news and updates, visit: