How to Manage Recovery from a TBI (Traumatic Brain Injury)
If you or someone in your care has suffered from a traumatic brain injury (TBI), it is important to understand the injury and what steps should be taken to ensure optimal recovery. Recovering from a TBI can be confusing and difficult for the patient, but also for his loved ones. Predicting the length and extent of recovery is difficult, but there are concrete steps you can take to make the process as smooth and successful as possible. Recovery can include working with a range of therapists and making long-term lifestyle changes, depending on the extent of the injury.
Managing Initial Recovery from a TBI
See a doctor immediately.Every TBI is different. If you suspect you or a loved one has suffered a trauma involving the brain, see a doctor immediately. Not only does the potential brain injury demand immediate medical attention, but there may also be multiple other traumatic injuries for which the person should be evaluated. If there's reason for the doctor to be concerned, as with a concussion, or if the injury is severe (resulting in a coma, for example), the patient will likely be admitted to the hospital. Some TBIs will result in surgery, but most of the recovery happens in rehabilitative therapies.
- TBIs can lead to secondary complications that can be life-threatening, such as pneumonia. Always see a doctor to be sure there's no danger or this.
- Some TBIs will result in surgery, but most of the recovery happens in rehabilitative therapies.
- A patient may be released from the hospital the same day if the TBI is very minor; however, patients in comas or vegetative states may be in a medical facility indefinitely.
Determine the type of TBI.There are different types of traumatic brain injuries and different levels of severity, from mild to severe.The doctor will be able to determine the type of injury you or your loved one has experienced and work with a team to help facilitate rehabilitation and recovery. Be aware, too, that a person may experience several different types of injuries and in multiple areas of the brain. TBIs include:
- Concussion — The most common type of brain injury, a concussion may or may not result in a loss of consciousness, and may be caused by many things, from a blow to the head to whiplash. A person with a concussion may feel dazed and may have temporary or permanent damage. In some cases, a concussion may result in a blood clot, which may be fatal.
- Contusion — Usually the result of a direct blow to the head, a contusion is a bruise, or bleeding, on the brain.
- Coup-contrecoup — This is when there is a contusion at the site of impact to the head as well as one on the opposite side of the brain. This is caused when the impact is strong enough to cause the brain to slam against the opposite side of the skull.
- Diffuse axonal — This includes Shaken Baby Syndrome and injuries caused by a strong rotational force, like a car accident. The shaking causes the brain to tear, which can cause the brain to release chemicals that cause further damage. This can lead to temporary or permanent damage, coma, or even death.
- Penetration — This is when a force, such as a bullet or a knife, penetrates the skull and brain. This drives the object into the brain, as well as hair, skin, bones, and possibly other debris into the brain.
Know what to expect during initial treatment.Treatment will depend on the type and severity of the TBI, but usually acute treatment focuses on minimizing any secondary injury and stabilizing the patient. This may be done using devices used to control swelling and pressure, such as mechanical ventilation. Medications may be used to sedate the patient, control any seizures, and sometimes to induce a coma.
Get to know the rehabilitation team.Brain injuries are complicated, and recovery is almost always multifaceted. Whether the injury was a simple concussion or a much more severe injury, the patient will likely have a team of specialists working together to make sure the recovery goes smoothly. Get the names and phone numbers of each member of the team, as well the location of their individual offices, if they have them. These specialists may include:
- A physiatrist, a doctor specializing in rehabilitation
- A neuropsychologist, who tracks changes in the patient’s behavior
- A rehabilitation nurse, who provides care for the patient
- A physical therapist, who helps the patient regain physical capacities such as balance and posture
- An occupational therapist, who helps assess the patient’s ability to perform daily functions such as budgeting and cooking
Stay calm.Patients being treated for a TBI often become agitated easily and without notice. If you’re a family member or caregiver, prepare yourself for this. Remember to be patient with the person and speak slowly whenever addressing her.
- Touch can sometimes be soothing, but can also be very irritating to a person recovering from a TBI. Use the patient’s response to touch as your guide.
- If the patient’s response is confusing or upsetting to you, speak to the doctor privately for insight about what may be going on with the patient at the moment.
Take time away when angered.This is important for both the patient and his loved ones. Someone recovering from a TBI may be confused much of the time, and dealing with many changes and emotions that are difficult to deal with. If he becomes angry or irritated, or a loved one becomes frustrated while caring for him, the patient should be gently given some time alone to calm down.
- Be clear with the patient that he is being given some time and space for himself. Try to communicate that he is not being punished, or that his loved one isn’t mad at him.
Make long-term plans with a trauma social worker.A trauma social worker will help the family make a plan for handling long-term recovery. She can help the family figure out the amount of care the patient will need, and who will be responsible for it.
- The trauma social worker can help the family understand and plan for the financial aspect of dealing with the patient’s recovery.
- The trauma social worker will also aid the family in planning for the patient’s discharge from medical and rehabilitation facilities.
Managing the First Six Months after a TBI
Transition from the medical facility.Depending on the severity of the TBI, this could happen a day or two after the injury, or weeks or months afterward. Patients may be sent directly home from the hospital, or may transition to a rehabilitation facility first.
- The doctors and rehabilitation team will determine when the patient is ready to transition out, based on his health and progress.
- Be patient. Spending lots of time in the hospital can be trying, but it’s important that the patient remain under medical care and supervision until it’s definitely safe for him to return home.
Accept inconsistent progress.Recovery from a TBI is the fastest and most visible in the first six to nine months after the injury. After that, progress can slow significantly, become less apparent, or even stagnate. It can be exciting and encouraging whenever the patient exhibits signs of progress, but don’t be surprised if he sometimes regresses.
- Sometimes things that seem like signs of progress can simply be flukes, such as involuntary muscle contractions.
- The patient may be working extremely hard to recover motor skills or speech. He may have the energy to do something once or twice, but then seem to regress when he becomes fatigued from the effort it takes.
- Be encouraging and patient. The patient will likely get frustrated with the pace of his recovery. Loved ones should be gentle and let him know he is doing well and that the pace of his recovery is natural. If possible, the patient should aim to be patient with himself, too, and accept that the road to recovery may be slow.
Practice good sleep habits.A TBI can radically change a person’s natural sleep cycle. Someone who was always a heavy sleeper may suddenly be a very light sleeper. Many TBI patients wake up in the middle of the night or experience other sleep problems.
- Practice going to bed at the same time each night in a dark, quiet room. This may help sleep come more easily.
- Sleeping pills are generally to be avoided when recovering from a TBI; however, the patient’s doctor may prescribe mild antidepressants or other medications to help ease severe sleep problems.
Join a support group.For loved ones caring for someone in a long recovery, a support group can be a significant source of solace. Being someone’s sole or primary caregiver can be exhausting and very stressful. Likewise, recovering from and living with a brain injury can feel frustrating and difficult to describe to those who haven’t experienced it. Seek out a local or online support group to connect with others in your position.
- There are specific support groups for caregivers, family members, and TBI sufferers.
- Your rehabilitation center or team can likely connect you with a group if you have trouble finding one.
Do speech therapy for anomia.Depending on the severity of the injury, the patient may have trouble forming words, or recalling the right words for a situation. This can be one of the most frustrating parts of a patient’s recovery, as it limits her ability to communicate her needs and experiences.
- Make sure a speech therapist is on the rehabilitation team if speech has become a problem for the patient.
- Speech therapy can be very exhausting, even though it isn’t physically tiring. Don’t ever push a patient to practice beyond her capacity. It may make her irritated or discouraged.
Do occupational therapy.Occupational therapy helps a patient regain the skills he needs to live independently or at least with minimal care. It can cover things such as cooking, shopping, and taking care of other daily tasks.
- For a moderate to severe brain injury, an occupational therapist will likely be part of the rehabilitation team.
- Depending on the severity of the injury and the patient’s prospects for recovery, he may not be able to recover certain capacities. For example, he may require 24 hour care because he is no longer able to feed himself, drive or take public transportation, answer the phone, or do other things that allow a person to live independently.
Managing Long Term Recovery
Keep expectations realistic.This can be the most difficult part of recovery from a TBI. Of course, both the patient and her loved ones would like a complete recovery, and for it to happen quickly; however, after the initial nine months of recovery, it’s time to adjust to the way life will likely be from now on.
- If the patient has lost a significant amount of capacity or independence, both she and her family may feel it as a difficult loss, and experience the seven stages of grief.
- Doctors are still unable to predict with certainty what the length or scope of a TBI patient’s recovery will be; however, factors such as age, IQ, academic performance in school, and the location and severity of the injury are often good indicators.
- Children and teenagers often have greater prospects for long-term recovery, as their brains are more malleable and resilient than those of adults.
Implement plans for long-term care.Once the patient and his family have accepted the degree to which the patient is likely to recover, long-term strategies should be put in place. This may mean having the patient move in with family, hiring full time caregivers, or finding the patient a home in an assisted living facility. In cases where the patient has fully or almost fully recovered, he may simply need occasional assistance but be able to continue living independently.
- Cost, geography, and the ability for the family to dedicate time to the patient will all influence what the most viable long-term strategy should be.
- When possible, let the patient determine what his long-term plan will be. Begin by finding out what his personal preference is, and try to see how that might be possible.
Make the most of assistive technologies.The patient may benefit from technologies such as a wheelchair, or a specialized keyboard. These things may not be absolutely necessary, but may make life significantly easier on the patient. For example, she may have regained the ability to walk, but the fatigue it causes her may not be worth the effort.
- Ask your rehabilitation team what assistive technologies might be appropriate for long-term recovery.
QuestionDo diagnostics from MRI's give me an actual diagnosis, and would my conversion disorder be relevant?Top AnswererConversion disorders typically impact skills and abilities. A person with CD may not be able to walk or may "forget" how to speak. One of the fundamental diagnostic characteristics of a conversion disorder is that the condition cannot be explained by other illness or disease processes. MRI's don't diagnose diseases, they help detect abnormalities. A diagnosis would come from a physician who is aware of the diagnostic imaging studies and the patient's personal history (including CD) and symptom complex.Thanks!
- A TBI can change the life of the patient as well as of their families. Be prepared for a long, unpredictable recovery.
- Take time alone whenever you need to. Whether you’re the person who experience the TBI or a caregiver, you may become frustrated and tired from the recovery process. Take space to breathe and be by yourself whenever necessary.
- Even for the most minor TBIs, be sure to visit a doctor immediately. There may be complications down the road, or internal problems that aren’t immediately apparent.
- TBI often results in slower reaction time. Operating a car or heavy equipment too soon after a TBI can result in serious injury or death.
Video: Traumatic Brain Injury (TBI) in Kids
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