The fastest improvements after suffering a TBI typically occur during the first six months after the injury. Most individuals continue to improve between six months and two years after injury, but this varies for different people and continuing improvements may not happen as fast as the first six months.
Improvements typically slow down substantially after two years but may still occur many years after injury. Most individuals continue to have some problems, although they may not be as bad as they were early after injury. Rate of improvement varies depending upon the individual and severity of the TBI.
Family members of individuals with TBI commonly have questions about the long-term effects that the injury will have upon their loved one and their ability to function in the future. Unfortunately, the long-term effects of a TBI are difficult to estimate for several reasons.
First, brain injury is a relatively new area of treatment and research, and thus health care professionals have only begun to understand the long-term effects on individuals with TBI for one, five, and ten years after the injury. Brain scans and other medical testing is not always able to reveal the extent of the injury which presents difficulty in understanding the severity of the injury at the beginning of the individual’s treatment.
Furthermore, the type of injury and extent of secondary problems drastically varies from individual to individual. An individual’s age, pre-existing conditions, and pre-injury abilities also greatly impact how well the individual is able to recover. However, research indicates that the more severe the injury the less likely the individual will fully recover. The length of time an individual 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 most common form of TBI is concussion. A concussion may result when the head or body is moved back and forth quickly, such as during a motor vehicle accident or sports injury. Concussions are often called “mild TBI” because they are typically not considered life-threatening. Most concussions occur without a loss of consciousness. However, concussions still can cause serious problems, and modern studies suggest that repeated concussions can be particularly dangerous. Recognition and proper response to concussions when they first occur can help prevent further injury or even death
Recovering from concussions
Although most individuals recover fully after a concussion, how quickly improvement occurs depends on many factors. These factors include the severity of the concussion, age, the individual’s state of health before the concussion, and how the individual’s take care of himself/herself after the injury.
Rest is a very important part of treating a concussion because it helps the brain to heal. Ignoring symptoms and trying to “tough it out” often makes symptoms worse. Only when concussion symptoms have reduced substantially, in consultation with the health care professional, should an individual attempt to slowly and gradually return to daily activities, such as work or school. If symptoms return or new symptoms arise upon becoming more active, this indicates that the individual is pushing himself/herself too hard, too early. In these circumstances, individuals should stop the activities and take more time to rest and recover. As the days go by, most individuals will gradually feel better.
GETTING BETTER: TIPS FOR ADULTS
- Get plenty of sleep at night, and rest during the day.
- Avoid activities that are physically demanding (e.g., heavy housecleaning, weightlifting/working out) or require a lot of concentration (e.g., balancing your checkbook). They can make your symptoms worse and slow your recovery.
- Avoid activities such as contact or recreational sports, that could lead to another concussion. (It is best to avoid roller coasters or other high speed rides that can make your symptoms worse or even cause a concussion.)
- When your health care professional says you are well enough, return to your normal activities gradually, not all at once.
- Because your ability to react may be slower after a concussion, ask your health care professional when you can safely drive a car, ride a bike, or operate heavy equipment.
- Talk with your health care professional about when you can return to work. Ask about how you can help your employer understand what has happened to you.
- Consider talking with your employer about returning to work gradually and about changing your work activities or schedule until you recover (e.g., work half-days).
- Take only those drugs that your health care professional has approved.
- Do not drink alcoholic beverages until your health care professional says you are well enough. Alcohol and other drugs may slow your recovery and put you at risk of further injury.
- Write down the things that may be harder than usual for you to remember.
- If you’re easily distracted, try to do one thing at a time. For example, don’t try to watch TV while fixing dinner.
- Consult with family members or close friends when making important decisions.
- Do not neglect your basic needs, such as eating well and getting enough rest.
- Avoid sustained computer use, including computer/video games early in the recovery process.
- Avoid travel as some people report that flying in airplanes makes their symptoms worse shortly after a concussion.
GETTING BETTER: TIPS FOR CHILDREN
Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:
- Having the child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
- Making sure the child avoids high-risk/ high-speed activities such as riding a bicycle, playing sports, or climbing playground equipment, roller coasters or rides that could result in another bump, blow, or jolt to the head or body. Children should not return to these types of activities until their health care professional says they are well enough.
- Giving the child only those drugs that are approved by the pediatrician or family physician.
- Talking with their health care professional about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
- Sharing information about concussion with parents, siblings, teachers, counselors, babysitters, coaches, and others who interact with the child helps them understand what has happened and how to meet the child’s needs.
CONCUSSIONS IN SPORTS
An unfortunate consequence of participating in sporting activities includes the danger of sustaining a concussion. In order to recognize and treat concussions, athletes should be carefully observed for any changes in the athlete’s behavior, thinking, or physical functioning after sustaining a blow or jolt to the body or head that results in rapid movement of the head.
When assessing a possible concussion, coaches should observe athletes for the following signs:
- Appears dazed or stunned
- Is confused about assignment or position
- Forgets an instruction
- Is unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Shows mood, behavior, or personality changes
- Can’t recall events prior to hit or fall
- Can’t recall events after hit or fall
When assessing a possible concussion, it is important to be mindful of the following symptoms that may be reported by the athlete:
- Headache or “pressure” in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light
- Sensitivity to noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems