Project Description

Authorship

Understanding TBI as developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the University of Washington Model System Know-ledge Translation Center. Portions of this document were adapted from materials developed by the Uni-versity of Alabama TBIMS, JFK Johnson Rehabilitation Institute, Baylor Institute for Rehabilitation, New York TBIMS, Moss TBIMS, and from Picking up the pieces after TBI: A guide for Family Members, by by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

Part 1: What happens to the brain during injury and in the early stages of recovery from TBI?

What is a brain injury? 

Traumatic brain injury (TBI) refers to damage to the brain caused by an external physical force such as a car accident, a gunshot wound to the head, or a fall. A TBI is not caused by something internal such as a stroke or tumor, and does not include damage to the brain due to prolonged lack of oxygen (anoxic brain injuries). It is possible to have a TBI and never lose consciousness. For example, someone with a penetrating gunshot wound to the head may not lose consciousness.

Commonly accepted criteria established by the TBI Model Systems (TBIMS)* to identify the presence and severity of TBI include:

Damage to brain tissue caused by an external force and at least one of the following:

  • A documented loss of consciousness
  • The person cannot recall the actual traumatic event (amnesia)
  • The person has a skull fracture, post-traumatic seizure, or an abnormal brain scan due to the trauma

Causes of TBI 

Statistics from Centers for Disease Control for 2002-2006 indicate that the leading cause of brain injury is falls (35%) followed by car crashes (17%) and being struck by an object (16%). Emergency room visits due to TBI caused by falls are increasing for both younger and older people. However, if you focus only on moderate to severe TBI (those injuries that require admission to a neurointensive care unit), car crashes are the most frequent cause of TBI, followed by gunshot wound, falls, and assault.

Types of injuries 

The brain is about 3–4 pounds of extremely delicate soft tissue floating in fluid within the skull. Under the skull there are three layers of membrane that cover and protect the brain. The brain tissue is soft and therefore can be compressed (squeezed), pulled, and stretched. When there is sudden speeding up and slowing down, such as in a car crash or fall, the brain can move around violently inside the skull, resulting in injury.

Closed versus open head injury 

Closed means the skull and brain contents have not been penetrated (broken into or through), whereas open means the skull and other protective layers are penetrated and exposed to air. A classic example of an open head injury is a gunshot wound to the head. A classic closed head injury is one that occurs as the result of a motor vehicle crash

In a closed head injury, damage occurs because of a blow to the person’s head or having the head stop suddenly after moving at high speed. This causes the brain to move forward and back or from side to side, such that it collides with the bony skull around it. This jarring movement bruises brain tissue, damages axons (part of the nerve cell), and tears blood vessels. After a closed head injury, damage can occur in specific brain areas (localized injury) or throughout the brain (diffuse axonal injury).

Damage following open head injury tends to be localized and therefore damage tends to be limited to a specific area of the brain. However, such injuries can be as severe as closed head injuries, depending on the destructive path of the bullet or other invasive object within the brain.

Primary versus secondary injuries 

Primary injuries occur at the time of injury and there is nothing that physicians can do to reverse those injuries. Instead, the goal of the treatment team in the hospital is to prevent any further, or secondary, injury to the brain. Below are some primary injuries.

  • Skull fracture occurs when there is a breaking or denting of the skull. Pieces of bone pressing on the brain can cause injury, often referred to as a depressed skull fracture.
  • ƒLocalized injury means that a particular area of the brain is injured. Injuries can involve bruising (contusions) or bleeding (hemorrhages) on the surface of or within any layer of the brain.
  • ƒDiffuse axonal Injury (DAI) involves damage throughout the brain and loss of consciousness. DAI is a “stretching” injury to the neurons (the cell bodies of the brain) and axons (fibers that allow for communication from one neuron to another neuron). Everything our brains do for us depends on neurons communicating. When the brain is injured, axons can be pulled, stretched, and torn. If there is too much injury to the axon, the neuron will not survive. In a DAI, this happens to neurons all over the brain. This type of damage is often difficult to detect with brain scans.

Secondary injuries occur after the initial injury, usually within a few days. Secondary injury may be caused by oxygen not reaching the brain, which can be the result of continued low blood pressure or increased intracranial pressure (pressure inside the skull) from brain tissue swelling.

Measuring the severity of TBI 

“Severity of injury” refers to the degree or extent of brain tissue damage. The degree of damage is estimated by measuring the duration of loss of consciousness, the depth of coma and level of amnesia (memory loss), and through brain scans.

The Glasgow Coma Scale (GCS) is used to measure the depth of coma. The GCS rates three aspects of functioning:

  • Eye opening
  • Movement
  • Verbal response

Individuals in deep coma score very low on all these aspects of functioning, while those less severely injured or recovering from coma score higher.

  • A GCS score of 3 indicates the deepest level of coma, describing a person who is totally unresponsive.
  • A score of 9 or more indicates that the person is no longer in coma, but is not fully alert.
  • The highest score (15) refers to a person who is fully conscious.

A person’s first GCS score is often done at the roadside by the emergency response personnel. In many instances, moderately to severely injured people are intubated (a tube is placed down the throat and into the air passage into the lungs) at the scene of the injury to ensure the person gets enough oxygen. To do the intubation the person must be sedated (given medication that makes the person go to sleep). So, by the time the person arrives at the hospital he/she has already received sedating medications and has a breathing tube in place. Under these conditions it is impossible for a person to talk, so the doctors cannot assess the verbal part of the GCS. People in this situation often receive a “T” after the GCS score, indicating that they were intubated when the examination took place, so you might see a score of 5T, for instance. The GCS is done at intervals in the neurointensive care unit to document a person’s recovery.

Post-traumatic amnesia (PTA) is another good estimate for severity of a brain injury. Anytime a person has a major blow to the head he or she will not remember the injury and related events for sometime afterward. People with these injuries might not recall having spoken to someone just a couple of hours ago and may repeat things they have already said. This is the period of post-traumatic amnesia. The longer the duration of amnesia, the more severe the brain damage.

CT or MRI Scan Results 

The cranial tomography (CT) scan is a type of X-ray that shows problems in the brain such as bruises, blood clots, and swelling. CT scans are not painful. People with moderate to severe TBI will have several CT scans while in the hospital to keep track of lesions (damaged areas in the brain). In some cases, a magnetic resonance imaging (MRI) scan may also be performed. This also creates a picture of the brain based on magnetic properties of molecules in tissue. Most people with severe TBI will have an abnormality on a CT scan or MRI scan. These scans cannot detect all types of brain injuries, so it is possible to have a severe TBI and be in coma even though the scan results are normal.

Brain tissue response to injury 

Common Problems:

Increased intracranial pressure 

The brain is like any other body tissue when it gets injured: it fills with fluid and swells. Because of the hard skull around it, however, the brain has nowhere to expand as it swells. This swelling increases pressure inside the head (intracranial pressure), which can cause further injury to the brain. Decreasing and controlling intracranial pressure is a major focus of medical treatment early after a TBI. If intracranial pressure remains high, it can prevent blood passage to tissue, which results in further brain injury.

Neurochemical problems that disrupt functioning 

Our brains operate based on a delicate chemistry. Chemical substances in the brain called neuro-transmitters are necessary for communication between neurons, the specialized cells within our central nervous system. When the brain is functioning normally, chemical signals are sent from neuron to neuron, and groups of neurons work together to perform functions.

TBI disturbs the delicate chemistry of the brain so that the neurons cannot function normally. This results in changes in thinking and behavior. It can take weeks and sometimes months for the brain to resolve the chemical imbalance that occurs with TBI. As the chemistry of the brain improves, so can the person’s ability to function. This is one reason that someone may make rapid progress in the first few weeks after an injury.

Natural plasticity (ability of change) of the brain 

The brain is a dynamic organ that has a natural ability to adapt and change with time. Even after it has been injured, the brain changes by setting up new connections between neurons that carry the messages within our brains. We now know the brain can create new neurons in some parts of the brain, although the extent and purpose of this is still uncertain.

Plasticity of the brain occurs at every stage of development throughout the life cycle. Plasticity is more likely to occur when there is stimulation of the neural system, meaning that the brain must be active to adapt. Changes do not occur without exposure to a stimulating environment that prompts the brain to work. These changes do not occur quickly. That is one of the reasons that recovery goes on for months and sometimes years following TBI.

Rehabilitation sets in motion the process of adaptation and change. Keep in mind that formal rehabilitation, such as received in a hospital from professional therapists, is a good initial step, but in most cases this must be followed by outpatient therapies and stimulating activities in the injured person’s home.

Part 2: Brain injury impact on individuals’ functioning

A traumatic brain injury interferes with the way the brain normally works. When nerve cells in the brain are damaged, they can no longer send information to each other in the normal way. This causes changes in the person’s behavior and abilities. The injury may cause different problems, depending upon which parts of the brain were damaged most.

There are three general types of problems that can happen after TBI: physical, cognitive and emotional/ behavioral problems. It is impossible to tell early on which specific problems a person will have after a TBI. Problems typically improve as the person recovers, but this may take weeks or months. With some severe injuries changes can take many years.

Structure and function of the brain 

The brain is the control center for all human activity, including vital processes (breathing and moving) as well as thinking, judgment, and emotional reactions. Understanding how different parts of the brain work helps us understand how injury affects a person’s abilities and behaviors.

Left vs. Right Brain 

  • The brain is divided into two halves (hemispheres). The left half controls movement and sensation in the right side of the body, and the right half controls movement and sensation in the left side. Thus, damage to the right side of the brain may cause movement problems or weakness on the body’s left side.
  • For most people, the left half of the brain is responsible for verbal and logical functions including language (listening, reading, speaking, and writing), thought and memory involving words.
  • The right half is responsible for nonverbal and intuitive functions such as putting bits of information together to make up an entire picture, recognizing oral and visual patterns and designs (music and art), and expressing and understanding emotions.

Brain Areas & Associated Functions

The brain is made up of six parts that can be injured in a head injury. The effect of a brain injury is partially determined by the location of the injury. Sometimes only a single area is affected, but in most cases of TBI multiple areas have been injured. When all areas of the brain are affected, the injury can be very severe.

Six parts 

Functions 

Brain Stem

ƒƒBreathing

ƒƒHeart Rate

ƒƒSwallowing

ƒƒReflexes for seeing and hearing

ƒƒControls sweating, blood pressure, digestion, temperature

ƒƒAffects level of alertness

ƒƒAbility to sleep

ƒƒSense of balance

Cerebellum

ƒƒCoordination of voluntary movement

ƒƒBalance and equilibrium

ƒƒSome memory for reflex motor acts

Frontal Lobe

ƒƒHow we know what we are doing within our environment

ƒƒHow we initiate activity in response to our environment

ƒƒJudgments we make about what occurs in our daily activities

ƒƒControls our emotional response

ƒƒControls our expressive language

ƒƒAssigns meaning to the words we choose

ƒƒInvolves word associations

ƒƒMemory for habits and motor activities

ƒƒFlexibility of thought, planning and organizing

ƒƒUnderstanding abstract concepts

ƒƒReasoning and problem solving

Parietal Lobe

ƒƒVisual attention

ƒƒTouch perception

ƒƒGoal directed voluntary movements

ƒƒManipulation of objects

ƒƒIntegration of different senses

Occipital Lobes

ƒƒVision

Temporal Lobes

ƒƒHearing ability

ƒƒMemory acquisition

ƒƒSome visual perceptions such as face recognition and object identification

ƒƒCategorization of objects

ƒƒUnderstanding or processing verbal information

ƒƒEmotion

Physical Problems 

Most people with TBI are able to walk and use their hands within 6-12 months after injury. In most cases, the physical difficulties do not prevent a return to independent living, including work and driving.

In the long term the TBI may reduce coordination or produce weakness and problems with balance. For example, a person with TBI may have difficulty playing sports as well as they did before the injury. They also may not be able to maintain activity for very long due to fatigue.

Cognitive (Thinking) Problems 

  • Individuals with a moderate-to-severe brain injury often have problems in basic cognitive (thinking) skills such as paying attention, concentrating, and remembering new information and events.
  • They may think slowly, speak slowly and solve problems slowly.
  • They may become confused easily when normal routines are changed or when things become too noisy or hectic around them.
  • They may stick to a task too long, being unable to switch to different task when having difficulties.
  • On the other hand, they may jump at the first “solution” they see without thinking it through.
  • They may have speech and language problems, such as trouble finding the right word or understanding others.
  • After brain injury, a person may have trouble with all the complex cognitive activities necessary to be independent and competent in our complex world. The brain processes large amounts of complex information all the time that allows us to function independently in our daily lives. This activity is called “executive function” because it means “being the executive” or being in charge of one’s own life.

Emotional/Behavioral Problems

Behavioral and emotional difficulties are common and can be the result of several causes:

  • First, the changes can come directly from damage to brain tissue. This is especially true for injuries to the frontal lobe, which controls emotion and behavior.
  • Second, cognitive problems may lead to emotional changes or make them worse. For example, a person who cannot pay attention well enough to follow a conversation may become very frustrated and upset in those situations.
  • Third, it is understandable for people with TBI to have strong emotional reactions to the major life changes that are caused by the injury. For example, loss of job and income, changes in family roles, and needing supervision for the first time in one’s adult life can cause frustration and depression.

Brain injury can bring on disturbing new behaviors or change a person’s personality. This is very distressing to both the person with the TBI and the family. These behaviors may include:

  • Restlessness
  • Acting more dependent on others
  • Emotional or mood swings
  • Lack of motivation
  • Irritability
  • Aggression
  • Lethargy (sluggishness)
  • Acting inappropriately in different situations
  • Lack of self-awareness. Injured individuals may be unaware that they have changed or have problems. This can be due to the brain damage itself or to a denial of what’s really going on in order to avoid fully facing the seriousness of their condition.

Fortunately, with rehabilitation training, therapy and other supports, the person can learn to manage these emotional and behavioral problems.

 Part 3: The Recovery Process

 Common stages

In the first few weeks after a brain injury, swelling, bleeding or changes in brain chemistry often affect the function of healthy brain tissue. The injured person’s eyes may remain closed, and the person may not show signs of awareness. As swelling decreases and blood flow and brain chemistry improve, brain function usually improves. With time, the person’s eyes may open, sleep-wake cycles may begin, and the injured person may follow commands, respond to family members, and speak. Some terms that might be used in these early stages of recovery are:

  • Coma: The person is unconscious, does not respond to visual stimulation or sounds, and is unable to communicate or show emotional responses.
  • Vegetative State: The person has sleep-wake cycles, and startles or briefly orients to visual stimulation and sounds.
  • Minimally Conscious State: The person is partially conscious, knows where sounds and visual stimulation are coming from, reaches for objects, responds to commands now and then, can vocalize at times, and shows emotion

A period of confusion and disorientation often follows a TBI. A person’s ability to pay attention and learn stops, and agitation, nervousness, restlessness or frustration may appear. Sleeping patterns may be disrupted. The person may overreact to stimulation and become physically aggressive. This stage can be disturbing for family because the person behaves so uncharacteristically.

Inconsistent behavior is also common. Some days are better than others. For example, a person may begin to follow a command (lift your leg, squeeze my finger) and then not do so again for a time. This stage of recovery may last days or even weeks for some. In this stage of recovery, try not to become anxious about inconsistent signs of progress. Ups and downs are normal.

Later stages of recovery can bring increased brain and physical function. The person’s ability to respond may improve gradually.

Length of recovery 

The fastest improvement happens in about the first six months after injury. During this time, the injured person will likely show many improvements and may seem to be steadily getting better. The person continues to improve between six months and two years after injury, but this varies for different people and may not happen as fast as the first six months. Improvements slow down substantially after two years but may still occur many years after injury. Most people continue to have some problems, although they may not be as bad as they were early after injury. Rate of improvement varies from person to person.

Long-term impacts 

It is common and understandable for family members to have many questions about the long-term effects of the brain injury on the injured person’s ability to function in the future. Unfortunately, it is difficult to determine the long-term effects for many reasons.

  • First, brain injury is a relatively new area of treatment and research. We have only begun to understand the long-term effects in patients one, five, and ten years after injury.
  • Brain scans and other tests are not always able to show the extent of the injury, so it is sometimes difficult early on to fully understand how serious the injury is.
  • The type of brain injury and extent of secondary problems such as brain swelling varies a great deal from person to person.
  • Age and pre-injury abilities also affect how well a person will recover.

We do know that the more severe the injury the less likely the person will fully recover. The length of time a person remains in a coma and duration of loss of memory (amnesia) following the coma are useful in predicting how well a person will recover.

The Rancho Los Amigos Levels of Cognitive Functioning (RLCF) is one of the best and most widely used ways of describing recovery from brain injury. The RLCF describes ten levels of cognitive (thinking) recovery. Research has shown that the speed at which a person progresses through the levels of the RLCF can predict how fully a person will recover.

The Rancho Los Amigos Levels of Cognitive Functioning 

Level 1— No Response: Person appears to be in a deep sleep.

Level 2 — Generalized Response: Person reacts inconsistently and not directly in response to stimuli.

Level 3 — Localized Response: Person reacts inconsistently and directly to stimuli.

Level 4 — Confused/Agitated: Person is extremely agitated and confused.

Level 5 — Confused-Inappropriate/Non-agitated: Person is confused and responses to commands are inaccurate.

Level 6 — Confused-Appropriate: Person is confused and responds accurately to commands.

Level 7 — Automatic-Appropriate: Person can go through daily routine with minimal to no confusion.

Level 8 — Purposeful-Appropriate: Person has functioning memory, and is aware of and responsive to their environment.

Level 9 — Purposeful-Appropriate: Person can go through daily routine while aware of need for stand by assistance.

Level 10 — Purposeful-Appropriate/Modified Independent: Person can go through daily routine but may require more time or compensatory strategies.

Recovery two years after brain injury 

Based on information of people with moderate to severe TBI who received acute medical care and inpatient rehabilitation services at a TBI Model System, two years post-injury:

  • Most people continue to show decreases in disability.
  • 34% of people required some level of supervision during the day and/or night.
  • 93% of people are living in a private residence.
  • 34% are living with their spouse or significant other; 29% are living with their parents.
  • 33% are employed; 29% are unemployed; 26% are retired due to any reason; and 3% are students.

 Part 4: The impact of a recent TBI on family members and what they can do to help with recovery

How does brain injury affect family members? 

For most family members, life is not the same after TBI. We want you to know that you are not alone in what you are feeling. While everyone’s situation is a bit different, there are some common problems that many family members experience such as less time for yourself, financial difficulties, role changes of family members, problems with communication, and lack of support from other family members and friends. These are just some of the problems that family members may face after injury. Sometimes these problems can seem too much and you may become overwhelmed, not seeing any way out. Family members have commonly reported feeling sad, anxious, angry, guilty, and frustrated.

Ways to reduce stress 

Since the injury, you have likely been under a great deal of stress. A little stress is part of life, but stress that goes on for a long time can have a negative effect on the mind and body.

Stress is related to medical problems such as heart disease, cancer, and stroke.

  • Stress can make you do things less well because it affects your ability to concentrate, to be organized, and to think clearly.
  • Stress also has a negative effect on your relationships with other people because it makes you irritable, less patient, and more likely to lash out at others.
  • Stress can lead to depression and/or anxiety.

If you are under constant stress, you are not going to be as helpful to your injured family member or anyone else. If you do not take the time to rest and care for yourself, you will get fewer things done, which will lead to more stress. If you won’t do this for yourself, do it for your injured family member. They will be better off if you are healthy and rested. Here are some suggestions for ways to reduce stress and stay healthy. These things have worked for many people, but not all of them may work for you. The important thing is that you begin thinking about ways to improve your life.

Learn to relax 

Taking a few moments to relax can help you be more ready for the things you need to do. Learning to relax is not easy, especially in your current situation. There are relaxation techniques that can help you such as breathing

deeply and focusing on your breathing, stating a word or phrase that has positive meaning (e.g. peace), or visual imagery. In order to train your body and mind to relax, you need to practice often. Don’t give up if it doesn’t work right away. If you keep practicing these techniques, you will feel more relaxed in the long run, and you will find that you’re able to function better in all areas of your life.

Learn which coping strategies work for you 

No matter what was going on in your life before, the injury has caused changes. You may never have experienced anything similar to the injury, and some of your usual coping strategies may not work in your current situation. The best thing that you can do for yourself is to be open to trying new ways of coping and find out what works for you.

Some coping strategies that others have found helpful:

  • Taking time for yourself
  • Keeping a regular schedule for yourself
  • Getting regular exercise such as taking a 20- 30 minute walk each day
  • Participating in support groups
  • Maintaining a sense of humor
  • Being more assertive about getting the support you need
  • Changing roles and responsibilities within the family

Learn how to reward yourself 

Everyone needs something to look forward to. You’ll probably say, “I have no time; it’s impossible.” Just remember that you will be more ready to do the things you have to do if you take some time to do some things that you want to do. Even if you have very limited time, you can find some small way to reward yourself. Promise yourself a cup of your favorite coffee or an opportunity to watch a good TV show or read something you enjoy.

Problem-solving for caregivers 

Sometimes you may feel overwhelmed by problems. There may be so many problems that you’re not sure which one to tackle first. You can only solve one problem at a time, so pick one. Use the problem solving steps below to find a good solution. Try to choose a smaller problem to solve first. This will give you practice and make you more confident about solving bigger problems. If you deal with problems in this way, they may seem easier to handle.

Steps in Problem Solving 

I. Identify the problem: What is the problem? Define it as clearly and specifically as possible. Remember that you can only solve one problem at a time. 

II. Brainstorm solutions: What can be done? Think of as many things as you can. Don’t worry about whether they sound silly or realistic. This is the time to think about all possibilities, even the ones that you don’t think will happen. Be creative. 

III. Evaluate the alternatives: Now you will start thinking about the consequences of the ideas you came up with in Step 2. For each idea, make a list of positives on one side of the page and a list of negatives on the other side. 

IV. Choose a solution: Pick the solution with the best consequences based on your list of positives and negatives. Keep in mind that more positives than negatives is not always the best rule. Sometimes you will have one negative that outweighs many positives. 

V. Try the solution: Try out the idea you have chosen. Give it more than one chance to work. If it doesn’t work right away, try to figure out why. Was there some consequence you didn’t think of? Is there another problem in the way that could be easily solved? 

VI. If your first solution doesn’t work, try another one: Don’t give up. Everything doesn’t always work out the first time. You can learn from your mistakes; they may help you to choose a better solution next time. 

Ways family members can help the injured person 

The treatment team can provide you with guidance in how to help the person while not giving them too much or too little assistance. Attending therapy when possible and working with the therapists and nurses are the best ways to learn to help the person before discharge from the hospital.

The following recommendations are intended to help families and caregivers care for their loved one once they have returned home. Not all of the following recommendation may apply to your situation.

Provide structure and normalcy to daily life 

  • Establish and maintain a daily routine – this helps the person feel more secure in their environment.
  • Place objects the person needs within easy reach.
  • Have the person rest frequently. Don’t let the person get fatigued.
  • Be natural with the person and help them to maintain their former status in the family. Communication is important to the person’s recovery. Although they may not be able to speak, they should continue to be involved in as normal a social world as possible.
  • Include the person in family activities and conversations.
  • Keep a calendar of activities visible on the wall. Cross off days as they pass.
  • Maintain a photo album with labeled pictures of family members, friends, and familiar places.

Provide support in a respectful way 

  • Try not to overwhelm the person with false optimism by saying statements like “You will be alright” or “You will be back to work in no time.”

Point out every gain the person has made since the onset of the injury. Avoid comparing speech, language or physical abilities prior to the injury with how they are now. Look ahead and help the person to do the same. 

  • Treat the person as an adult by not talking down to them.,
  • Respect the person’s likes and dislikes regarding food, dress, entertainment, music, etc.
  • Avoid making the person feel guilty for mistakes and accidents such as spilling something.
  • If the person has memory problems, explain an activity as simply as possible before you begin. Then as you do the activity, review with the person each step in more detail.

Avoid over-stimulation – Agitation can be heightened by too much activity and stimulation. 

  • Restrict the number of visitors (1 or 2 at a time).
  • Not more than one person should speak at a time.
  • Use short sentences and simple words.
  • Present only one thought or command at a time and provide extra response time.
  • Use a calm, soft voice when speaking with the person.
  • Keep stimulation to one sense (hearing, visual or touch) at a time.
  • Avoid crowded places such as shopping malls and stadiums.

Safety Tips 

The person who has confusion or impaired judgment may be unable to remember where dangers lie or to judge what is dangerous (stairs, stoves, medications). Fatigue and inability to make the body do what one wants can lead to injury. Therefore it is very important that a brain injured person live in an environment that has been made as safe as possible. The following are some safety guidelines to use in the home:

Keep clutter out of the hallway and off stairs or anywhere the person is likely to walk. Remove small rugs that could cause tripping or falls.

  • Remove breakables and dangerous objects (matches, knives, and guns).
  • Keep medications in a locked cabinet or drawer.
  • Get the doctor’s consent before giving the person over-the-counter medication.
  • Limit access to potentially dangerous areas (bathrooms, basement) by locking doors if the person tends to wander. Have the person wear an identification bracelet in case he or she wanders outside.
  • Keep the person’s bed low. If they fall out of the bed, you may want to place the mattress on the floor or install side rails.
  • Make sure rooms are well lit, especially in the evening. Night-lights can help prevent falls.
  • Have someone stay with the person who is severely confused or agitated.
  • Keep exit doors locked. Consider some type of exit alarm, such as a bell attached to the door.
  • Consider a mat alarm under a bedside rug to alert others if the person gets up during the night.

Things that can be more dangerous after a TBI and should be resumed only after consulting a health care professional: contact sports, horseback riding, swimming, hunting or access to firearms, power tools or sharp objects, riding recreational vehicles, and cooking without supervision.

Individuals with brain injury should receive permission from a health care professional prior to using alcohol or other substances at any point after their injury. Also, NO DRIVING until approved by your doctor.

Disclaimer 

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source 

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors

Authorship

Understanding TBI as developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the University of Washington Model System Know-ledge Translation Center. Portions of this document were adapted from materials developed by the Uni-versity of Alabama TBIMS, JFK Johnson Rehabilitation Institute, Baylor Institute for Rehabilitation, New York TBIMS, Moss TBIMS, and from Picking up the pieces after TBI: A guide for Family Members, by by Angelle M. Sander, PhD, Baylor College of Medicine (2002).