Understanding Traumatic Brain Injury

If you or someone you love has suffered a Traumatic Brain Injury, you may feel lost in a sea of doctors, hospitals and medical terms. For service members returning from Iraq and Afghanistan, TBI is one of the most common injuries. Blasts cause many of these injuries, but TBI can also result from automobile or other accidents. The following information will help you understand TBI and the symptoms and treatments available to help along the road to recovery.

Types of TBI

Brain injury is caused by a blow to the head strong enough to damage the brain. Closed head injuries — where a person receives an impact to the head from an outside force, but the skull doesn’t fracture or displace — are often caused by blasts from improvised explosive devices. Penetrating brain injuries result when a piece of bone or a foreign object penetrates the brain.

The severity of a TBI can range from a mild concussion to a more severe injury that significantly disrupts brain function and can cause long-term or permanent problems.

  • Mild TBI – The mildest form of TBI includes concussions. Recovery is usually a matter of just a few weeks or, in some cases, a few months. Although the injury is not life threatening, the long-term effects of mild TBI can be troublesome. Each injury is different, so be sure to get an evaluation if you think you may have suffered an injury.
  • Moderate to severe TBI – Moderate and severe brain injuries are often marked by a period of unconsciousness. Patients with severe TBI may remain unconscious for an extended period of time. In many cases, the patients don’t remember the incident and may have long-term amnesia. Severe brain injuries can be debilitating, and the road to recovery can be long. Rehabilitation is often necessary.
  • Related injuries – Service members with brain injuries may suffer with other, more life-threatening, injuries. Diagnosing and assessing the brain injury may have to wait until the other injuries are treated. In many cases, TBI symptoms overlap symptoms of post-traumatic stress disorder, making treatment more complicated.


Because each brain injury is unique and the severity of the injuries can vary widely, the symptoms are different from one patient to the next. Many patients with TBI look and sound normal, but may have trouble with day-to-day functioning. The injury can affect a patient’s movement, language and emotions. For families, the personality changes can be the most difficult to understand. TBI symptoms include the following:

  • Headaches – Mild to severe headaches are common with TBI patients. Usually, they become less severe with time.
  • Dizziness – Problems with balance may make it difficult for TBI patients to walk or even sit up for an extended period of time.
  • Excessive tiredness and problems sleeping – A TBI patient’s sleep pattern may be disrupted by the injury, making it difficult to get a good night of sleep. Also, patients often feel tired from all the effort they are putting into their rehabilitation.
  • Problems concentrating or paying attention – Many patients have to learn to focus on just one thing at a time. For former multitaskers, this can be frustrating.
  • Memory problems – Short-term and long-term memory can be affected by a brain injury. Many patients can’t remember the incident or immediately afterwards.
  • Vision problems – Some patients have problems with double vision or blurred vision. This should be evaluated by a clinician.
  • Weakness in the extremities – TBI patients who experience weakness may have trouble with day-to-day tasks, like taking a shower or shaving.
  • Seizures – Many TBI patients run a risk for seizures, but the risk decreases steadily as they recuperate.
  • Personality changes – A brain injury can affect the portions of the brain that influence emotion and behavior. It can lessen emotional control, changing the patient’s behavior. TBI patients can sometimes become:
    • Overemotional – Many patients may have trouble controlling their emotions. Tears of joy or anger are common.
    • Angry – Many patients get angry easily. They may have a difficulty controlling their emotions or they may be frustrated with the difficulties they face with everyday tasks.
    • Insensitive – Their injuries may have reduced their ability to filter out private thoughts, so they respond with inappropriate statements. Many patients have trouble identifying facial expressions or other non-verbal signs, making it hard for them to gauge someone else’s emotions.


Different screenings are used to assess a brain injury so treatment can be effective. The tests look at physical functioning, thinking, emotions and behavior. They include the following:

  • Neurological exam – Usually the first assessment, a neurological exam includes a series of questions and simple commands.
  • X-ray – An X-ray allows medical staff to look at the bones surrounding the brain and any foreign objects that may be causing injury.
  • Computed Tomography scan – A CT scan produces a three-dimensional image that is more detailed than a traditional X-ray.
  • Magnetic Resonance Imaging  – Radio waves are used to take pictures of the soft tissues in the brain. For an MRI, the patient must lie still on a table inside a long tube.
  • Angiogram – A dye is inserted into the blood, allowing doctors to evaluate damage to the blood vessels. The test can take up to three hours.
  • Intracranial Pressure Monitor – A small tube inserted into the head lets doctors measure the pressure inside the brain. This procedure is done for patients with a severe TBI.
  • Electroencephalogram  – Electrodes are attached to the head, allowing medical personnel to track electrical activity in the brain.

Treatment and rehabilitation

TBI patients are often treated at specialized rehabilitation treatment centers. These centers have the appropriate medical staff and equipment to care for the physical, cognitive, and emotional injuries that can be involved in a TBI.

  • Treatment facilities – The Defense and Veterans Brain Injury Center is a collaboration of the Department of Defense and the Department of Veterans Affairs. The program serves military members and veterans with TBI by offering state-of-the-art medical care and educational programs. The DVBIC Headquarters are in Washington, DC. Visit the DVBIC website for a listing of treatment facilities. You can also visit the website for the Defense Centers of Excellence for more information about TBI. DCoE also has a 24-hour outreach center staffed by professional consultants with expertise in psychological health and TBI.
  • Multidisciplinary treatment – A multidisciplinary treatment approach is necessary in order for patients to reach their full recovery potential. This means that brain injury patients will work with a team of health care providers, who help assess and treat the different symptoms associated with their brain injury.
  • Individualized treatment plans – A medical team works together to come up with an individualized treatment plan to address all aspects of the patient’s injury. The treatment is customized for each patient, depending on the type of injury.
  • Rehabilitation – The goal of the rehabilitation process is to help people regain the most independent level of living possible. Depending on the extent of the injury, rehabilitation can last from several months to several years. Medical staff will set short- and long-term goals and establish treatment based on the patient’s individual needs.

What family members can do to help

As the family member of a patient with a TBI, you may feel shocked, confused, and even angry. These feelings are all normal. Family members should try to learn as much as they can about their loved one’s injury so they can help make important decisions on care and treatment. Here are more steps you can take to help with your loved one’s recovery:

  • Help your loved one keep to a schedule. Following a daily routine will help your loved one master daily skills and avoid confusing situations.
  • Avoid situations with lots of people. You may have friends and family who want to visit your loved one. Try to avoid situations where several people will be talking at once.
  • Do one thing at a time. Help your loved one stay on track and focused by presenting only one task at a time and allowing him or her the time he or she needs to complete it.
  • Ask for help. Whether you need help making a difficult decision, filling out paperwork or whether you just need someone to talk to, don’t be afraid to ask for help. Family members and friends can be a great source of comfort during this difficult time.