Traumatic Brain Injury and Head Trauma: Symptoms and Rehabilitation
Traumatic brain injury (TBI) is damage to the brain caused by an external force, such as a fall, traffic accident, sports injury or assault. It ranges from mild concussion to severe injury with prolonged coma, and it is a major cause of death and disability across all ages [1].
Severity and symptoms
Severity is usually graded with the Glasgow Coma Scale, the duration of unconsciousness and post-traumatic amnesia, and imaging findings.
- Physical: headache, dizziness, weakness on one or both sides, balance and coordination problems, spasticity, seizures
- Cognitive: attention, memory, processing speed and planning problems
- Emotional and behavioural: irritability, mood changes, depression, personality change
- Sensory: visual problems, sensitivity to light or noise
After a mild TBI, most people recover within weeks, but some have persistent symptoms that need structured management [3].
Further reading: the guide “Acquired Brain Injury” and the articles Walking After Spinal Cord Injury: Prognosis by Injury Level and Robotic Physiotherapy and Rehabilitation: Who Benefits and How It Works.
Rehabilitation after TBI
Rehabilitation starts in intensive care, once the patient is stable, and continues through inpatient and outpatient phases. A multidisciplinary programme is recommended for adults with acquired brain injury [2]. It may include:
- Physiotherapy for mobility, balance and walking
- Occupational therapy and cognitive rehabilitation
- Speech, language and swallowing therapy
- Management of spasticity and heterotopic ossification
- Psychological support for the patient and family
See also From intensive care to rehabilitation and Hypoxic brain injury.
What a traumatic brain injury is
A traumatic brain injury (TBI) is damage to the brain caused by an external force, for example a fall, a traffic accident, a sports injury or an assault. The injury may be focal (a bruise or bleed in one area) or diffuse (widespread stretching of nerve fibres, called diffuse axonal injury). Secondary damage can follow in the hours and days after the injury, caused by swelling, bleeding, low oxygen or low blood pressure; acute hospital care focuses on preventing this.
Typical recovery course
Recovery usually follows a sequence. After a severe injury, a person may pass through a period of coma, then a phase of reduced awareness, then post-traumatic amnesia (a confused state in which new memories are not stored and behaviour may be restless). The length of post-traumatic amnesia is one of the useful indicators of severity. Physical recovery is often faster than recovery of memory, attention, planning and behaviour. Improvement is most marked in the first months, but meaningful gains in independence, social life and work can continue for a year or longer.
Rehabilitation assessment
The physical medicine and rehabilitation (PM&R) assessment covers consciousness and orientation, movement, balance and coordination, spasticity (muscle stiffness), swallowing, communication, vision and hearing, cognition (memory, attention, executive functions such as planning and self-control), mood, behaviour, sleep, headaches, fatigue, bladder and bowel, and the family situation. Goals are set together with the patient and family and reviewed regularly.
Treatment options in general terms
- Physiotherapy and occupational therapy for strength, balance, walking and daily activities, planned by your physical medicine and rehabilitation specialist and the physiotherapist.
- Cognitive rehabilitation: training attention and memory, external aids (diaries, phone reminders, checklists) and strategies for planning and problem solving.
- Speech and language therapy for communication and swallowing.
- Behavioural and psychological support, including structured routines and help for the family to respond to irritability or impulsivity.
- Management of headaches, sleep problems, spasticity and fatigue, with medication where appropriate.
- Vocational rehabilitation for a graded return to study or work.
After acute hospital care, the whole process is best led and advised by a PM&R physician, who coordinates the team across hospital, outpatient and home phases.
Home safety and what families can do
- Provide a calm, structured environment with a predictable daily routine.
- Use memory aids: a calendar, notebook, labelled drawers and phone reminders.
- Supervise medication, cooking and financial matters if judgement is affected.
- Remove trip hazards and supervise stairs and bathing while balance is reduced.
- Avoid alcohol, which can worsen cognition, mood and seizure risk.
- Do not allow driving until it has been cleared by the treating doctors in line with local rules.
- Look after your own well-being and seek support from carer groups.
When to consult your PM&R specialist
Seek review if there are new seizures, worsening headaches, increasing confusion or sleepiness (which can be an emergency), changes in behaviour that are hard to manage, falls, swallowing problems, or difficulties returning to work or study. At home, consult a PM&R specialist, who can guide therapy and support treatments.
Frequently asked questions
How long does recovery from a head injury take? It depends on severity. Improvement can continue for months and, in severe injuries, for years.
Can personality changes improve? Behavioural and emotional changes often improve with time, structured routines and psychological support.
Is a mild head injury (concussion) the same as a TBI? Yes, concussion is a mild TBI. Most people recover within weeks, but some have persistent headaches, dizziness, fatigue or concentration problems that benefit from assessment and a graded return to activity.
Why does my relative behave differently after the injury? Damage to the frontal areas of the brain can affect self-control, motivation and emotions. These changes are part of the injury, not a deliberate choice, and often improve with time, structure and support.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Maas AIR, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022. PMID: 36183712
- Turner-Stokes L, et al. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev. 2015. PMID: 26694853
- Silverberg ND, et al. Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Arch Phys Med Rehabil. 2020. PMID: 31654620