The Stages of Traumatic Brain Injury Recovery

Every year, around 2.5 million Americans sustain a traumatic brain injury. While many recover fully from such injuries, it’s also possible for them to result in long-term disability or death. [1] Acquired brain trauma is the second most prevalent disability in the United States, affecting an estimated 13.5 million Americans. [2]

For those who have experienced a traumatic brain injury—or have a loved one who has—and are now searching for alternative forms of treatment, this page provides a wealth of vital information. Among the topics discussed here are TBI levels of severity, stages of recovery, and treatment options, including transcranial magnetic stimulation offered by Brain Therapy TMS to support recovery from traumatic brain injuries.

What is Traumatic Brain Injury (TBI)?

Traumatic brain injury (TBI) occurs when a sudden trauma—an impact, blow, or jolt to the head—causes damage to the brain. The severity of a traumatic brain injury can range from mild to severe. A mild concussion may result in temporary confusion and a headache.

A severe traumatic brain injury can be fatal or cause permanent disability. [3] The most common causes of traumatic brain injuries are falls, motor vehicle accidents, and assaults.

TBI Mechanisms

The human brain is nestled within the skull and floats in a bath of cerebrospinal fluid. This fluid keeps the brain buoyant and cushioned. Under normal circumstances, the space between the edges of the brain and the skull remains relatively constant.

However, any time the head is subjected to an outside force—an impact or even strong shaking—the brain moves around and may be damaged as it bangs into the skull or is punctured by an object that penetrates the skull.

Some injuries resulting in TBI are closed-head: with no externally visible damage. For instance, when the skull undergoes a sudden change of direction—e.g., a whiplash movement—the brain slams into one side of the skull, and often rebounds to impact the opposite side of the skull. These are known as coup and contrecoup injuries.

Other injuries leading to TBI involve an object that has depressed or broken through the skull from the outside and damaged the brain underneath. Some injuries are localized to a small portion of the skull/brain. Others are more diffuse: covering a larger area of the brain.

In all cases of injury resulting in a traumatic brain injury, the protection typically provided to the brain by the skull and/or cerebrospinal fluid has been breached by an outside force.

Levels of TBI Severity

Traumatic brain injuries are classified as mild, moderate, and severe. The more severe the brain injury is, the more severe the corresponding symptoms and functional deficits.

Regardless of their apparent severity, head injuries should always be taken seriously. What seems to be a mild injury—a little bump to the head—could potentially be fatal if the brain is bleeding undetected. So, it’s always best to err on the side of caution and safety and receive care from a medical professional.

Mild Traumatic Brain Injury

A mild TBI (mTBI) is also known as a concussion. About 75% of traumatic brain injuries are concussions or other forms of mild traumatic brain injury.

A person with a mild TBI typically remains conscious after the head trauma. If they experience a loss of consciousness, it will only be for a few seconds or minutes.

Concussions are common sports injuries. Often an athlete who has suffered a concussion will seem disoriented but then get up and continue to play. They may not even realize they had a concussion.

Symptoms of a concussion may be subtle enough that they go undetected until they begin to interfere with activities of daily living. Symptoms of mild traumatic brain injury may include:

  • Headache
  • Dizziness
  • Nausea
  • Blurred vision
  • Tinnitus
  • Insomnia
  • Depression
  • Anxiety
  • Mood swings
  • Impaired balance
  • Sensitivity to light and sound
  • Decreased concentration and attention span
  • Decreased speed of information processing
  • Decreased ability to learn new things and recall
  • Loss of memory for events immediately before or after the injury

Moderate Traumatic Brain Injury

Someone with a moderate TBI may have lost consciousness for a few minutes to a few hours. If conscious, they will often appear extremely groggy and lethargic. Their eyes might remain open only in response to stimulation.

While a mild concussion often doesn’t appear on a medical imaging test, a moderate TBI generally produces abnormal CT, PET, or MRI findings.

People with moderate TBI may experience a worsening headache, repeated vomiting, increased confusion, and slurred speech for several days or weeks. Other physical, cognitive, and behavioral impairments could last for months or be permanent.

Severe Traumatic Brain Injury

A severe traumatic brain injury usually involves prolonged unconsciousness or coma that lasts for days, weeks, or months.

Along with coma or loss of consciousness, symptoms of severe traumatic brain injury may include:

  • Headache that gets worse
  • Dizziness that gets worse
  • Continual nausea or repeated vomiting
  • Lack of coordination
  • Trouble with balance
  • Slurred speech
  • Increased confusion, restlessness, or agitation
  • Dilation of one or more pupils
  • Loss of vision in one or both eyes
  • Numbness or tingling in arms or legs
  • Severe behavioral or mood changes
  • Attention and memory problems
  • Convulsions or seizures
  • Inability to wake up from sleep

Some people with severe TBI are left with permanent physical, cognitive, or behavioral impairments.

Early Stages of Traumatic Brain Injury Recovery

Recovery from a traumatic brain injury can be described in ten stages, based on the Rancho Los Amigos Levels of Cognitive Functioning. [4]

Stages 1-4 encompass the initial stages of recovery from TBI. This is what someone who has suffered a traumatic brain injury may experience during the first few weeks following the injury as they begin the recovery process.

Stage 1. Coma (No Response: The person appears to be in a deep sleep)

After a severe TBI, a person may remain in a coma for a while. Comas are considered brain injury recovery since they allow the brain to begin its healing process.

A coma may directly result from traumatic brain injury. However, a coma can also be medically induced as a strategy for helping to reduce the swelling and intracranial pressure caused by the injury.

While in a coma, the person is unconscious, does not respond to visual stimulation or sounds, and cannot communicate or show emotional responses.

Stage 2. Vegetative State (Generalized Response: Person reacts inconsistently and not directly in response to stimuli)

Comas and vegetative states are often believed to be the same, but they can be distinguished. While a person in a vegetative state is not fully conscious, neither are they completely unresponsive. Instead, there are certain neurological responses that become apparent.

The person has sleep-wake cycles and regains some of their reflexes. They may startle or briefly orient to visual stimulation and sounds. They may react to loud noises or pain. Such responses signal that the brain has begun to heal itself.

Stage 3. Minimally Conscious State (Localized Response: Person reacts inconsistently and directly to stimuli)

When a person recovering from TBI begins to communicate and react purposefully, they have entered the third stage of recovery: the minimally conscious state.

Such a person is now partially conscious. They will likely drift in and out of consciousness. When aware, they have limited awareness of their surroundings.

For instance, they know where sounds and visual stimulation are coming from. They can reach for objects and occasionally respond to instructions. At times, they may be able to vocalize and express emotion.

Stage 4. Post-Traumatic Amnesia (Confused/Agitated: The person is highly agitated and confused)

Once a person can communicate verbally and nonverbally and consistently respond to instructions, they have entered the fourth stage of traumatic brain injury recovery.

In this stage, the individual experiences a severe state of amnesia. This includes retrograde amnesia: the inability to remember past events. It also includes anterograde amnesia: the inability to form new memories. During this phase of recovery, the person has no memory of where they are or how they got there; and they’re unable to recall day-to-day events as they’re happening.

The individual may also exhibit erratic, aggressive, or inappropriate behavior. Such behavior results from a loss of inhibition that occurs immediately after emerging from an extended period of unconsciousness (in a coma and vegetative state).

Later Stages of Traumatic Brain Injury Recovery

The initial four stages of recovery generally take a few months to pass through. Once post-traumatic amnesia is resolved, doctors often recommend that the person recovering from TBI go to a rehab facility or return home to continue their healing process through its final six stages.

Stage 5. Confused/Inappropriate, Non-agitated (Person is confused and responses to commands are inaccurate)

During this stage of TBI recovery, the individual is still confused by their surroundings and has trouble focusing. Their responses to questions and commands are inaccurate and nonsensical.

Stage 6. Confused/Appropriate (Person is confused and responds accurately to commands)

During this stage of recovery, the person can follow instructions and engage in brief conversations. However, they still have significant memory problems and trouble focusing. They lack awareness of their physical and cognitive impairments and corresponding safety concerns.

Stage 7. Automatic/Appropriate (Person can go through a daily routine with minimal to no confusion)

At this stage of TBI recovery, the person can follow a schedule and complete daily routines with supervision. However, they still have difficulty planning or initiating activities. So they’re not yet able to live independently.

Stage 8. Purposeful/Appropriate (Person has functioning memory and is aware of and responsive to their environment)

By the eighth stage of recovery, the person’s self-awareness and memory have greatly improved. Social interactions can still be challenging, and reaction times are a bit slow. Unexpected situations may still present problems, but the person is cultivating coping strategies. The TBI survivor can now live on their own with minimal help from others.

Stage 9. Purposeful/Appropriate (Person can go through the daily routine while aware of the need for stand-by assistance)

When they’ve entered the ninth stage of recovery, the person can complete familiar and unfamiliar daily activities; and ask for help when necessary. They can also recognize and respond to the needs of others.

Stage 10. Purposeful/Appropriate (Person can go through a daily routine but may require more time or compensatory strategies)

By the final stage of TBI recovery, the person has fully recovered and is again functionally independent. They can initiate new tasks, plan, and adjust to unexpected circumstances. Their cognition may still be a little slower than average, but they’ve learned how to compensate.

It’s important to note that not every TBI survivor will progress through all ten of these recovery stages. Some people may plateau at an earlier level—depending on the specifics of their injury. Luckily, there are treatment modalities to help facilitate the fullest possible recovery from brain injury.

How Common are Traumatic Brain Injuries?

Traumatic brain injury (TBI) is a major cause of death and disability in the United States, contributing to about 30% of all injury deaths. [5]

Each year about 2.5 million individuals in the U.S. experience TBIs. Of these, around 50,000 result in death, and over 80,000 lead to permanent disability. [6]

In 2020 in the U.S., there were over 64,000 TBI-related deaths. That’s around 176 TBI-related deaths per day. [7]

According to the Centers for Disease Control and Prevention, traumatic brain injury is a contributing factor to a third of all injury-related deaths in the U.S. [8]

The leading causes of TBI are:

  • Falls (28%)
  • Motor vehicle crashes (20%)
  • Being hit by or colliding with an object (19%)
  • Assaults (11%)
  • Others (12%)

Who Suffers from TBI?

People from all walks of life experience traumatic brain injuries. There are, however, certain demographic trends:

* Males are twice as likely to sustain a TBI than females. This gender disparity may be because men engage in more high-risk activities (e.g., extreme sports) than women. And men experience industrial injuries at a higher rate than women.

* Riding a motorcycle (even with a helmet) is one of the leading causes of TBI. So people who ride motorcycles are at a higher risk of TBI than those who don’t.

* Infants are especially vulnerable to brain injury because the fontanelle (aka “soft spot”) in the skull doesn’t close until they are 8-15 months old.

* Elderly people who are susceptible to falls are vulnerable to TBI.

* The data also suggests that some groups are at greater risk of dying from a TBI or experiencing long-term health problems after the injury.

Examples of groups who are more likely to be affected by TBI include: [9]

  • Racial and ethnic minorities
  • Service members and veterans
  • People who experience homelessness
  • People who are in correctional and detention facilities
  • Survivors of intimate partner violence
  • People living in rural areas

How Can TBI Be Treated?

Not every concussion (mild TBI) requires extensive rehabilitation. Most TBIs don’t need comprehensive rehabilitation. But if TBI symptoms linger, treatments and rehab can offer effective tools and strategies to complete the healing process.

Early intervention and management of mild traumatic brain injury is the most effective means of reducing the level of disability experienced by the injured person. [10]

People with moderate traumatic brain injury can recover well with the support of rehabilitation—or successfully learn to compensate for their disabilities.

Long-term rehabilitation and treatment specifically designed for brain injuries are almost always necessary for those who have suffered a severe TBI. The good news is that people with severe TBI can significantly improve their condition, including a return to a life similar to what they had before the injury.

Activating Neuroplasticity

A vital component of progressing successfully through the ten TBI recovery stages is activating neuroplasticity—the brain’s ability to heal and transform. The human brain can repair its neural connections and reassign functions to undamaged parts of the brain. Neuroplasticity allows people to regain cerebral functions even after a serious brain injury.

One reason therapy is recommended during the early stages of recovery is because neuroplasticity is activated through intensive repetition of therapeutic activities. Completing a therapy exercise, again and again, builds new neural networks and may repair those that have been damaged via injury. A person recovering from TBI may participate in physical, occupational, and speech therapies to address different recovery areas.

Once the person returns home, it’s essential that they continue practicing the exercises learned during therapy. There are home therapy devices and apps that can guide the person through therapeutic exercises in a more engaging way. These can be helpful supports for ensuring consistency.

Common Therapies for Traumatic Brain Injury

Common therapeutic modalities for traumatic brain injury include:

  • Cognitive therapy
  • Speech and language therapy
  • Physical therapy to improve standing, walking, and movement
  • Occupational therapy to regain activities of daily living such as dressing, bathing, balancing a checkbook, cleaning the house, making meals, etc.
  • Counseling for emotional support and relationship skills
  • Assistive technologies—such as walkers, wheelchairs, memory aids, etc.—to increase independence

Since TBI recovery may extend for many months or years, it’s crucial for those who have experienced a traumatic brain injury to continue to engage in therapy and explore a variety of treatment modalities.

Find Treatment for TBI with TMS Therapy

The excellent news about traumatic brain injury is that it can be treated with proven interventions and therapeutic modalities. A person who has sustained a TBI can activate the healing potential of neuroplasticity years or even decades after the original injury.

Brain Therapy TMS in San Diego, California, is a recognized leader in providing Transcranial Magnetic Stimulation to aid recovery from traumatic brain injuries. Our TMS Center utilizes the latest TMS tech to resolve mental and neuropathic disorders without medication.

TMS is a proven breakthrough therapy that heals specific areas of the brain that are impaired by brain cell dysfunction. The end result is a significant improvement in mood, function, energy, focus, and general well-being.

Please feel free to contact us for a complimentary consultation.

Sources

  1. [1] Centers for Disease Control and Prevention. (2014). Report to Congress on Traumatic Brain Injury in the United States: 
 Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.
  2. [2] Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. National Center for Health Statistics. Vital Health Stat. 2012;10(252).
  3. [3] Frequently Asked Questions. Brain Trauma Foundation.
    https://www.braintrauma.org/faq
  4. [4] Understanding TBI: The Recovery Process. Brainline.
    https://www.brainline.org/article/understanding-tbi-recovery-process
  5. [5] Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
  6. [6] Frequently Asked Questions. Brain Trauma Foundation.
    https://www.braintrauma.org/faq
  7. [7] Get the Facts about TBI. Centers for Disease Control and Prevention.
    https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
  8. [8] Centers for Disease Control and Prevention. (2014). Report to Congress on Traumatic Brain Injury in the United States: 
 Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.
  9. [9] Health Disparities and TBI. Centers for Disease Control and Prevention.
    https://www.cdc.gov/traumaticbraininjury/health-disparities-tbi.html
  10. [10] McCrea MA. Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment. New York, NY: Oxford University Press; 2008.

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