Complications

     Some mild traumatic brain injury patients, and most moderate, severe, and very severe TBI patients, experience persistent neurological, cognitive, and behavioral problems due to bruises, swelling, nerve damage, and broken blood vessels caused by the injury. Long-term or permanent problems include:

Neurological

• Bleeding and/or blood clots
• Increased pressure within the skull
• Headaches
• Visual defects
• Hearing loss
• Tactile problems
• Movement disorders (see Movement Disorders for additional information)

Cognitive

• Memory impairment
• Concentration difficulties
• Problems in language use, such as:
  • Inability to find the right words (expressive aphasia)
  • Problems understanding what is said by others (receptive aphasia)
  • Severe breakdown in all language abilities (global aphasia)
• Perceptual problems
• "Executive" skills, such as problem-solving, abstract reasoning, insight, judgment, planning, information processing, initiation, and organization problems

Behavioral

• Increased risk of suicide, divorce, chronic unemployment, bankruptcy, and substance abuse
• Depression or lack of emotion
• Social isolation
• Anger or agression
• Personality changes and mood swings
• Agitation
• Disinhibition and impulsivity

Treatment Methods

Neurological Problems

1. Positioning - focuses on elevating the head of the bed slightly and keeping the neck straight to allow blood and CSF to drain from the brain and lower intracranial pressure.

2. Fluid Restriction - focuses on limiting the amount of fluid a patient receives to help control and prevent swelling of the brain.

3. Medications - include diuretics to decrease the amount of water in the patient's body and control/prevent brain swelling; steroids to decrease brain swelling; barbiturates to prevent more swelling and damage if the patient's intracranial pressure is very high and hard to control; and anticonvulsants to prevent seizures.

4. Ventricular Drain (Ventriculostomy) - a small tube placed in the ventricle of the brain and connected to a drainage bag to measure pressure inside the skull and drain CSF to help control the pressure.

5. Surgery - various procedures are performed to relieve the causes of increased intracranial pressure (craniotomy or bone flap removal) and remove blood clots (burr holds).

6. Optometric Therapy - various techniques are available to improve visual disorders, such as lenses, prisms, absorptive filters, selective occlusion, low vision aids, and vision therapy. Medications and/or surgery many also be necessary.

7. Movement Therapy - includes proper positioning, exercises, splints, casts, braces, and/or temporary motor point blocks during the early stages of rehabilitation.

Cognitive and Behavioral Problems

1. Restorative Training - focuses on improving cognitive function and includes cognitive exercises, such as computer-assisted learning, to improve attention, memory, and "executive" skills

2. Compensatory Training - focuses on adapting to the presence of a cognitive disorder, but may also have restorative effects. Includes memory books and electronic pacing systems to compensate for specific deficits and improve specific cognitive functions

3. Psychotherapy - used to treat depression and loss of self-esteem associated with cognitive dysfunction, and to emphasize emotional support, explain the injury and its effects, reduce denial, and help the patient relate to family and society. Involves individuals with TBI and family members.

4. Medications - used for a variety of disturbances associated with TBI, such as convulsions, depression, anxiety, sleep disturbances, pain, and memory. Click on Traumatic Brain Injury Pharmacology Guide for information about specific medications.

5. Behavior Modification - addresses the personality and behavioral consequences of TBI and helps retrain patients with TBI in social skills

6. Vocational Training - includes short-term and long-term supported employment and job coaching

7. Nutritional Support

8. Therapeutic Recreation, music and art therapy

9. Community-based, Non-medical Services for socialization, such as day programs, supported living programs, independent living centers. Peer support programs, etc.

10. Acupuncture and other alternative approaches