Treatment of Traumatic Brain Injury (TBI)
For the most part, it is not currently possible to repair the damage caused by a TBI. So, the initial focus of treating this type of injury is to stabilize the injured person in order to minimize subsequent damage. Initial medical treatment goals include insuring proper oxygen and blood flow to the brain and body, stabilizing blood pressure, and treating any problems or conditions affecting other parts of the body (besides the brain) that have arisen because of the injury. People with severe TBI may require surgery to address hematomas (pooling of blood outside of the blood vessels) and/or contusions (bruises) affecting brain tissue.
After individuals with TBI have been stabilized, the typical treatment plan generally involves efforts to teach patients how to cope with their specific injury-related symptoms. Some medical professionals suggest that the first two years post-injury are the most crucial time in terms of healing; most people will experience the majority of their recovery gains during this time period.
The treatment of TBI may be complicated by the presence of Post Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder in which a person has developed debilitating symptoms in response to witnessing atrocity, violence, true horror, and/or the death of another or near death of oneself. PTSD causes affected people to continually re-experience intrusive and horrifying memories of the traumatic event, to engage in avoidance behavior designed to get them away from things that trigger or remind them of their trauma memories, and to develop an exaggerated startle response and chronically heightened anxiety. PTSD is associated with depression and anxiety symptoms, memory and attention deficits, sleep problems, and other emotional disturbances. For more information about PTSD, please visit our Post Traumatic Stress Disorder topic center .
The best therapy for patients recovering from TBIs is often found at comprehensive head injury treatment programs offering a wide range of treatment services necessary for promoting optimum recovery. Such programs are generally staffed by:
- Physical Therapists, who help patients regain physical abilities they may have lost, possibly including the ability to walk or to use their limbs (or prosthetic devices), to regain their coordination, flexibility, and range of motion, and to address pain and stiffness
- Occupational Therapists, who help patients relearn how to perform the deceptively simple activities of daily living people must do in order to care for themselves, such as getting dressed, eating, making and keeping appointments, and planning their day
- Speech and Language Therapists, who help patients relearn how to speak, read, write, and understand language, as well as rebuild cognitive abilities such as attention, memory, organization, planning, and sequencing skills
- Neuropsychologists, whose testing of patients' functional abilities helps the health care team identify specific areas of cognitive functioning that require specific rehabilitative efforts, and then measure progress towards addressing deficits
- Psychotherapists, who help patients learn psychological methods for coping with the inevitable emotional, behavioral, and interpersonal problems that result from their injuries and subsequent loss of functioning, and with difficulties they experience adjusting to disabilities
- Psychiatrists, who prescribe psychoactive medications that help patients to better manage their cognitive, emotional and behavioral symptoms
- Social Workers, who help patients and their families identify assistive services and financial and medical benefits that patients may be entitled to or eligible for receiving
An unfortunate truth about the modern American health care system is that such services are enormously expensive to provide and only partially covered by the majority of health insurance plans. Consequently, the full package of beneficial TBI rehabilitative care is generally out of reach for many Americans.
The extent to which patients may expect to recover most or all of their lost functioning due to a TBI varies, depending on the severity of the injury, and the quality of treatment they receive. Some people who experience a TBI are able to regain most of their pre-injury functioning and return to their pre-injury lives. Others will recover only partial functioning, and need to modify their lifestyle (e.g., by changing jobs or receiving work accommodations; by structuring their time differently; by using memory and cognitive aids, etc.) in order to function. Still other people end up experiencing permanent and disabling losses of function which require them to make more significant alterations in how they live. For example, some individuals who have experienced a severe TBI lose their ability to live independently and may need to move to an assisted living community or nursing home. Such patients may require ongoing services and assistance for the rest of their lives.