What to expect after a traumatic brain injury

A traumatic brain injury can lead to many changes in a person’s life. For the person or their family, there are several effects and much to learn on the road to recovery.

A traumatic brain injury (TBI) is an injury that has occurred as a result of trauma to the head. There are many different types of severe or catastrophic brain injuries and many different causes – such as falls, assaults, road traffic accidents or accidents around the home or at work.

The time following such an injury can be incredibly distressing – especially for family members and loved ones of the person with the head injury. There are often a lot of questions and, most certainly, a lot of unknowns. The road to possible brain injury recovery is one fraught with many roadblocks and difficulties. However, it’s important to look at some of the more immediate events that are in front of you and your family to better understand and focus on these crucial first steps. As such, we’ve constructed this short guide on what to expect after a brain injury.

Defining severe head injuries

According to headway.org, it’s thought that there are roughly one million people who visit Accident & Emergency departments throughout the UK every year following a head injury. Head injuries occur for several reasons such as road traffic accidents, assaults and accidents or falls at home or in the workplace. In the vast majority of these cases, people will have banged their head or had a slight fall – with temporary symptoms often being dizziness, nausea or having a relatively brief period of unconsciousness. In some cases, there may be some amnesia.

However, a severe head injury is usually defined as when someone is in an unconscious state for over six hours or when the person has experienced some level of post-traumatic amnesia (a state of confusion) that lasts longer than 24 hours. Such incidents require hospitalisation and some degree of on-going rehabilitation. People who have experienced a severe head injury can often experience some level of long-term physical or mental changes as a result of the accident, which is often linked with the length of time they spend in a coma.

Symptoms of a severe head injury

The symptoms of a severe head injury can be rather vast. They include:

  • Concussion
  • Seizures or fits
  • Difficulty with speaking
  • Unconsciousness or struggling to stay awake
  • Vomiting
  • Clear fluid or blood coming out of the nose or ears
  • Amnesia and memory loss
  • Walking and co-ordination difficulties
  • Sensory issues (e.g. double vision or hearing loss)
  • Sudden bruising or swelling around the eyes or behind the ears

If you believe someone you know may have a head injury, call 999 immediately to request an ambulance or take the person to the closest A&E department.

Diagnosis of a traumatic brain injury

According to the NHS, a CT scan will be performed on the injured person to determine if there has been a traumatic brain injury (TBI). If such an injury is identified and the person is in a coma, specialists will likely use the Glasgow Coma Scale (GCS) to determine the depth of the coma and, consequently, the seriousness of the injury.

The highest score of 15 represents someone who is fully conscious, whereas a score of 8 and below indicates that someone is in a deep coma and is unresponsive. Often a severe brain injury has occurred in those who score 3-8 on the GCS. It’s important to note that while initial scores can often be accurate indicators of severity, they are not definitive, nor do they reflect the consequences or effects that such an injury will have on a person’s life. Therefore, a person’s GCS score could be high initially, but decrease when they’re later reassessed.

Treatment for a traumatic brain injury

Treatment for a TBI happens at a hospital. Traumatic brain injury specialists there will perform a variety of functions, such as:

  • running tests to check for any further damage
  • observing any changes
  • treating other injuries you may have as a result of the accident
  • providing life support
  • performing brain surgery

While some people may be sent to continue recovery at home after 48 hours, others with more severe injuries will have a longer stay in hospital. In such cases, surgery is very likely. The type of surgery for treating problems relating to the nervous system (i.e. brain, spinal cord and nerves) is neurosurgery.

Healthcare professionals will identify the need for neurosurgery through tests and examining the results of the CT scan. While neurosurgeons do try to consult/communicate with the affected person or their family members before such surgery, the severity of the situation may require them to perform immediate life-saving surgery without discussion.

Some of the reasons behind neurosurgery being required include a haemorrhage (severe bleeding and pressure in the head), cerebral contusions (brain bruises that can develop into blood clots), a haematoma (blood clot inside the head and the resulting added pressure) and/or a skull fracture.

The primary surgical treatment in instances of severe head injury is craniotomy – a procedure that sees a hole made in the skull to provide access to the brain. As the procedure is performed under general anaesthetic, you needn’t worry about the patient feeling any discomfort or pain during the surgery. Surgeons will remove any blood clots that have formed, repair blood vessels that have been damaged and then, once the bleeding has stopped, the piece of the patient’s skull that had been previously removed will be reattached with tiny metal screws.

If there is a skull fracture, this is often left to heal itself over the next few months. In cases where there is a depressed or severe fracture, surgery may be performed to prevent possible or further brain damage. Again, this will be performed under general anaesthetic.

Following surgery, the person will recover in an intensive care unit (ICU) where they will be continuously monitored. The patient may also be placed on a ventilator to assist with breathing. Often, when the person is well enough, they’ll be moved to a high-dependency unit where their condition will be continually monitored until they are well enough to leave the hospital.

Traumatic brain injury recovery

One of the most challenging things for a traumatic brain injury patient, as well as their family and friends, is the recovery period following such an injury. It’s difficult knowing what to expect after a brain injury. Not everyone goes through the same recovery experiences as a lot can depend on the severity of the injury, associated complications and the after-effects.

In cases of more severe brain injuries, the patient may not show any signs of awareness while any swelling decreases or blood flow around the brain improves. Eventually, the patient may open their eyes and begin to communicate. Confusion and disorientation are normal, as is inconsistent behaviour – leading to some days being better than others. These stages can last for days, weeks or even months as the brain injury recovery process continues.

According to msktc.org, the majority of improvements tend to be seen within six months of the injury. These improvements will mostly be seen in the person’s coordination and cognitive abilities. Although the speed of recovery slows after the initial six months, the person will continue to regain function for years after the brain injury. Additionally, regular exercise and the avoidance of alcohol and drugs are advised to boost brain health in the long run.

Please note that the improvement rates vary from person-to-person.

Common after-effects of a traumatic brain injury

Traumatic brain injuries can affect people in different ways and often this is dependent on the severity of the catastrophic head injury. In some cases, the damage to the brain may be permanent. As such, some effects and complications are likely to arise.

These after-effects can include:

  • Brain injury effects: When the brain has been damaged as a result of an accident or incident, there can be several physical effects the affected person may experience. These effects may be sensory (e.g. blind spots and loss of taste), physical (e.g. loss of co-ordination), hormonal (e.g. hypothyroidism), mental (e.g. memory and communication abilities) and emotional and behavioural (e.g. increased irritability, changing emotions and mental health conditions). The chances of developing epilepsy also drastically increase.
  • Impaired consciousness: This is when a person is in a coma, vegetative state or is minimally conscious. This may last for weeks, months, years, or it may last for the rest of the patient’s life. Wakefulness and awareness can vary on an individual basis.
  • Infection: If a skull fracture tears the membrane surrounding the brain, bacteria may enter the exposed wound and cause infection.
  • Post-concussion syndrome: Long-term symptoms as a result of a concussion. Symptoms include persistent headaches, inability to partake in ‘normal’ day to day activities or work, nausea, dizziness, weakness, poor concentration and memory issues.

Longer-term changes

Understandably, family and friends of the person affected are often concerned about the long-term effects of a loved one’s injury. Unfortunately, not all of these questions and concerns can be answered when a patient is in the initial recovery stages, as the long-term effects of an injury aren’t always apparent. The patient’s age and health before their injury and the type of brain injury can all contribute to how well the patient will recover. If the damage is more severe, then the chances of a full or near-full recovery are lower.

Many people who experience a moderate to severe brain injury can go back to driving. However, they may find that they cannot drive as well as they used to. Some are able to return to work after their injury, although it may not be the job they had before their injury. Additionally, there is growing evidence that the long-term health effects of a TBI include an increased risk of dementia and other neurological and neurodegenerative disorders. Emotional changes such as depression and anxiety are also common. This can be due to the trauma of changes to living circumstances, career and lifestyle that can happen in the wake of such an event.

Another common change to expect is that people who have experienced a TBI may continue to need support or assistance from a professional care worker. For some, this assistance comes in the form of getting help around the house with certain tasks; for others, it’s constant, round-the-clock care.

Get the right support from Better Healthcare

Irrespective of the severity of the injury, a person who has experienced a severe head injury and a traumatic brain injury will need attention and care– often in the form of live-in care. While family and friends may try to provide this support as the person recovers, this can become rather challenging for all involved. As such, many people turn to professional carers to give their loved one the support they need.

At Better Healthcare, we provide home care and live-in care services for those who are recovering from a traumatic brain injury. Our experienced carers can help those in the early stages of traumatic brain injury recovery as well as those already living with the effects of a TBI.

Our bespoke service can be tailored to suit the individual needs and budget of the person and/or family who require this support. This can range from 24/7 live-in care in the TBI patient/survivor’s home to daily visits to with tasks such as cooking, cleaning, shopping and even medication supervision.

Whatever the case, our team of live-in care and home care professionals will aid you and your family to help you on this journey to recovery. For more on how we can help you or a loved one with our care services during the brain injury recovery process, get in touch with Better Healthcare today on 0800 668 1234 or contact one of our local offices.This post is not health advice and should not replace professional advice tailored to your specific circumstances. It is intended to provide information of general interest about current healthcare issues.

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