Traumatic Brain Injury

Common Signs and Symptoms of Traumatic Brain Injury

Symptoms of TBI vary depending on the severity and location of the injury. They may appear immediately or develop over hours or days.

Mild TBI (Concussion):

• Headache, nausea, or vomiting
• Fatigue or drowsiness
• Dizziness or loss of balance
• Sensitivity to light or sound
• Sleep disturbances
• Memory, attention, or mood changes (e.g., anxiety, depression)

Moderate to Severe TBI:

• Persistent or worsening headache
• Repeated vomiting or seizures
• Convulsions or limb weakness
• Slurred speech or profound confusion
• Dilated pupils
• Loss of coordination
• Agitation or combativeness
• Loss of consciousness, coma

Pediatric Symptoms (Infants and Toddlers):

• Unusual irritability or persistent crying
• Difficulty feeding or nursing
• Changes in sleep patterns
• Seizures or drowsiness
• Lack of interest in favorite toys or activities

Complications

Potential long-term consequences include:

• Changes in consciousness (e.g., coma, vegetative state)
• Cognitive impairments (e.g., memory, focus, reasoning)
• Physical deficits (e.g., movement, coordination)
• Mood and behavioral disorders (e.g., depression, aggression)
• Speech and communication difficulties
• Sensory processing issues
• Elevated risk of neurodegenerative diseases (e.g., Parkinson’s, Alzheimer’s)

“Types of Brain Lesions in TBI”

TBI may result in mass lesions, which are localized injuries that increase pressure within the skull. Common types include:

• Hematomas – Blood accumulation in or around the brain
• Contusions – Bruising of brain tissue
• Skull fractures or diffuse axonal injury may also be present

Diagnosis of Traumatic Brain Injury
Initial Assessment (Emergency Care):

• Stabilization of airway, breathing, and circulation (ABCs)
• Full-body examination and neurological assessment
• Use of the Glasgow Coma Scale (GCS) to determine severity
• Evaluation of pupillary response and brainstem reflexes

Imaging Tests:

• CT scan (Computed Tomography): First-line imaging to detect bleeding or fractures
• MRI (Magnetic Resonance Imaging): May be used to identify subtle injuries after stabilization

BBH Functional Rehabilitation Program
Surgical Treatment

Surgery may be necessary to:

• Remove hematomas or contusions
• Relieve intracranial pressure
• Repair skull fractures

Postoperative care is typically provided in an ICU setting.

Medical Management

Although no medications can reverse brain damage, treatment focuses on:

• Preventing secondary injuries (e.g., due to hypoxia or increased pressure)
• Managing complications and supporting vital functions

Recovery and Prognosis

Recovery is typically assessed using the Glasgow Outcome Scale (GOS):

• Mild TBI (GCS 13–15): Most patients recover fully, though some may experience temporary symptoms
• Moderate TBI (GCS 9–12): Approximately 60% recover with some degree of disability
• Severe TBI (GCS ≤8): Often associated with long-term disability or persistent unconsciousness

Program Recommendations for Traumatic Brain Injury

Rehabilitation

Rehabilitation is vital and may include:

• Physical therapy – Restoring strength and movement
• Occupational therapy – Enhancing daily living skills
• Speech-language therapy – Addressing communication or swallowing issues
• Neuropsychological support – Managing cognitive and emotional challenges

Patients with mild-to-moderate injuries often benefit the most from active rehab. Those with severe injuries may require long-term care focusing on:

• Preventing complications (e.g., joint contractures, pressure sores)
• Supporting respiratory and nutritional needs

Prevention of TBI

Preventive strategies include:

Vehicle Safety

• Always wear seat belts
• Use age-appropriate child car seats
• Avoid distracted or impaired driving

Helmet Use

• Wear helmets while biking, motorcycling, skating, or playing contact sports

Fall Prevention for Older Adults

• Install handrails and grab bars in key areas
• Use non-slip mats in bathrooms
• Ensure adequate lighting throughout the home
• Remove tripping hazards (e.g., loose rugs, clutter)

Child Safety

• Use safety gates for stairs
• Install window guards and secure rugs
• Provide shock-absorbing surfaces under play equipment
• Prevent access to balconies and fire escapes

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Program Recommendations for Encephalopathy

It is important that patients with encephalopathy undergo proper evaluation and follow-up with a neurologist. An individualized rehabilitation program may help in recovery and in minimizing long-term complications.
BBH recommends the following rehabilitation programs:

• 10-day Neuro-Rehabilitation Program
• 17-day Neuro-Rehabilitation Program

Treatment planning is based on the specific type, cause, and severity of each individual’s condition.