A severe TBI can result in significant, long-term secondary effects that impair a person’s ability to perform activities of daily living, as well as many other tasks.
To help you and your loved ones navigate the recovery journey, this article will explain how a severe TBI is measured and what symptoms may occur.
We’ll also discuss some of the best rehabilitation methods and how long your recovery might take.
What is a Severe TBI?
A severe TBI is defined as a brain injury that results in a loss of consciousness longer than six hours, and a Glasgow Coma Scale score of 3 to 8 points. The Glasgow Coma Scale assesses symptoms such as verbal response and eye movement to determine the person’s level of cognitive function. The lower the final score, the more severe the TBI.
If the brain injury caused significant damage, your loved one may remain unconscious for some time. As the swelling in their brain decreases, they should begin to regain awareness. During this period, most patients will pass through several levels of unconsciousness. These levels include:
- Coma. The deepest state of unconsciousness. Patients in a coma are unresponsive to their environment and cannot wake up, even when stimulated.
- Vegetative State. Persons in a vegetative state may sometimes seem awake. But while their eyes can open and close, they have no awareness of their surroundings. Rather, these reactions are caused by autonomic responses.
- Minimally Conscious State. A patient in a minimally conscious state has recovered a reduced sense of awareness. They can sometimes follow very basic one-step instructions and react to stimulation (touch, sounds, light, etc.), but they will often dip back into unconsciousness.
When the patient can finally answer basic questions, doctors consider them “emerged” from the minimally conscious state. Once this occurs, the more intensive rehabilitation for their severe TBI recovery can truly begin.
How Long Will a Patient Remain Unconscious After a Severe TBI?
The duration of a coma primarily depends on the location and severity of the injury. For example, patients with brain stem injuries typically take longer to emerge from a coma compared to patients with other types of brain damage.
In general, most severe TBI patients remain unconscious for several weeks, then begin to regain consciousness. However, patients sometimes remain in a coma for months before waking up.
The faster that a person emerges from a coma, the higher their chances of achieving a full recovery. In fact, studies have shown that patients who reach a minimally conscious state within three months have a high likelihood of regaining full consciousness.
Common Effects of Severe TBI
Severe TBI can impact nearly every facet of a person’s life and impair their ability to perform basic tasks.
The following are some of the most common secondary effects of severe TBI:
- Speech difficulties. Severe TBI often leads to speech difficulties such as aphasia, which can cause problems with understanding and/or producing words.
- Swallowing problems. Another common effect of severe TBI is difficulty swallowing. Doctors call this phenomenon dysphagia.
- Sensory disorders. A severe TBI can also cause several sensory disorders to occur. The most common sensory issues after TBI include hearing loss and numbness.
- Cognitive deficits. Damage to the frontal lobe often causes severe cognitive deficits, such as difficulties with attention, memory, and critical thinking. Social skills can also become impaired.
- Vision problems. Vision is primarily processed in the visual cortex, which resides in the occipital lobe. If the visual cortex becomes damaged, visual problems such as partial blindness, double vision, or blurred vision can occur.
- Left neglect. Damage to the right hemisphere of the brain can lead to a condition known as left neglect. With left neglect, the person cannot detect objects or sounds that come from the left side of their environment.
- Muscle weakness. Depending on where the brain damage occurs, muscle weakness (or even paralysis) in the arms, legs, or trunk can occur.
- Balance problems. Whether due to muscular weakness in the trunk or legs, or some other cause (vision changes, damage to the vestibular system, etc.), balance issues are very common after severe TBI.
- Spasticity and contractures. Spasticity causes severe muscle stiffness and is a result of damaged communication between the brain and the muscles. When spasticity persists, the muscle fibers can become permanently shortened, which leads to reduced mobility, i.e. contractures.
Fortunately, it is possible to treat most of these disorders with different therapy techniques.
Methods for Severe TBI Recovery
The initial goals of severe TBI recovery are typically to regain the ability to perform activities of daily living as well as basic mobility tasks such as getting out of bed and walking. Most can accomplish this by harnessing neuroplasticity, the brain’s natural ability to repair itself after injury.
With neuroplasticity, healthy regions of the brain can take over functions from damaged areas. This allows severe TBI patients to regain skills they lost after their injury, such as the ability to speak or walk.
Neuroplasticity occurs with repetition. In other words, when you repeatedly practice an activity, your brain actually changes its structure to help you become more efficient in that action. This explains why musicians for example become more skilled at their instrument the more they practice.
The same principle applies to severe TBI recovery. The more you practice different therapeutic activities, the more you will rewire your brain to regain function.
Below are some examples of therapies that utilize neuroplasticity to boost recovery:
1. Physical Therapy (using passive neurophysiological techniques and active exercises)
Unfortunately, after a severe TBI, paralysis or severe weakness often set in. This can make it difficult to do the exercises you need to engage neuroplasticity and regain movement.
Fortunately, having a physical therapist assist you with the movement necessary still stimulates the brain and activates neuroplasticity.
With passive neurophysiological techniques, physical therapists help patients improve their arm or leg strength by supporting correct movement patterns and postures, and by moving their paralyzed limbs for them. This movement rewires the brain and re-establishes a connection between the brain and muscles.
Eventually, with enough passive exercise, you should be able to start exercising with more independence again. At this point, your physical therapist will switch to having you perform more active exercises (where you are initiating the movement yourself, possibly with light assistance or supervision from the therapist), with goals of improving strength and balance and progressing towards walking.
2. Constraint-Induced Movement Therapy
Constraint-induced movement therapy is an intervention designed to prevent learned non-use after a severe brain injury.
Learned non-use occurs when a person develops methods that help them avoid using their affected muscle. For example, if a brain injury has made a patient’s right hand weaker, they might use their left hand for everything.
Unfortunately, if this persists, the right hand will continue to weaken until it is effectively useless (because the brain has not had a demand to use this hand). Therapists refer to this as learned non-use.
CIMT attempts to thwart this process by forcing the patient to use their affected muscle. The hope is that by exercising the weaker arm, neuroplasticity will kick in and the person will regain some function.
3. Occupational Therapy
While physical therapy focuses on improving your muscle strength and overall mobility, occupational therapy addresses the functional skills you need to regain independence after severe TBI.
During an OT session, you will practice many important functional tasks. Some areas of your life an occupational therapist can help you with include:
- Home management
- Social skills
- Cognitive functioning
All of this makes occupational therapy a crucial part of severe TBI recovery.
4. Speech Therapy
If your severe TBI caused cognitive deficits, aphasia, or other communication disorders, begin speech therapy right away.
A speech therapist can walk you through the various TBI speech therapy activities available. They will also show you how to retrain your brain and regain language skills.
In addition, a speech therapist can assess the cognitive skills you might struggle with after your injury.
For example, you might need to relearn how to match your voice pitch and volume with others, which a therapist can teach you. They can also help you with cognitive communication skills such as the ability to listen, pay attention, and respond appropriately.
5. Sensory Re-Education
Like most symptoms of severe TBI, sensory issues can be treated by rewiring the brain through neuroplasticity. This can allow other areas of the brain to process your senses.
The best type of therapy to help accomplish this is sensory reeducation exercises (which is typically done within an occupational therapy session). Sensory reeducation, also known as sensory retraining, is a form of cognitive-behavioral therapy that helps the brain relearn how to process sensation again.
It works by exposing patients to different sensations and helping them learn how to distinguish between them again. The therapy has proven effective at activating neuroplasticity and helping people regain feeling.
Most occupational therapists are familiar with sensory reeducation and can teach you different types of sensory stimulation activities.
Other methods that can help severe TBI patients regain sensory awareness include electrical stimulation and acupuncture.
How Long Will Severe TBI Recovery Last?
Now that we have covered some of the best severe TBI recovery methods, we can discuss how long severe TBI recovery typically lasts.
Recovering from a severe TBI can take a significant amount of time and effort. While some patients do progress quite quickly, most people will require months to years of consistent rehabilitation.
In general, the vast majority of TBI recovery occurs within the first two years. For example, according to statistics gathered from the TBI Model System Program, at two years post-injury:
- 70% of severe TBI patients live independently full time.
- Over 90% live in a private residence.
- 50% of patients learn how to drive after brain injury, though they may still have restrictions on driving at night or for long distances.
- 30% have a full-time job.
However, it’s important to note that severe TBI recovery does not end after two years. In fact, many patients continue to improve their function at five or even ten years post-injury. Therefore, if you have not made the progress you wanted after two years, do not give up hope.
Understanding Severe TBI Recovery
A severe TBI is a serious medical condition that can have a devastating effect on a person’s life.
But thankfully, with the right interventions and enough persistence, it is possible to treat these effects and regain much of your independence.
We hope this article has given you the tools you need to succeed with your severe TBI recovery, and we wish you luck on the journey ahead.
Featured Image: ©iStock/Halfpoint