Understanding Traumatic Brain Injury (TBI) and Road to recovery!

Prathima A R

Your brain is the conductor of your body’s symphony, orchestrating every thought, emotion,
and movement of yours with absolute precision. Imagine a sudden pause and disruption to its
rhythm as a result of a sudden jolt to the head. That is what happens when a traumatic brain
injury (earlier called as head injury) occurs.

Traumatic Brain Injury (TBI) occurs when a strong external physical force is applied to the
head, disrupting brain’s normal functioning. This can result from a sudden blow, jolt, or
penetrating injury to the head. TBI can be mild (like a concussion), moderate or severe, causing
long term impairment in one’s cognition, emotions and behaviour.

How does a TBI happen?

TBIs can occur due to

1. Motor Vehicle Accident – Most common cause of TBI in our country.
2. Falls (especially in young children and older adults)
3. Sports-related injuries
4. Workplace accidents
5. Assaults or violence

Sometimes, brain may be affected inside skull, even if no external wound is visible. Depending
on severity of TBI and its consequences, some recover quickly and others can have long term
difficulties or even can have a permanent disability.

Pathophysiology of TBI: what happens inside the brain during TBI?

When brain sustains a sudden intense impact, different physical forces cause the brain to move
or shake inside the skull. These accelerating and decelerating forces can cause:

• Cerebral contusions (bruising of brain tissue)
• Edema (Swelling of brain that can further increase pressure inside skull, leading to secondary damage)
• Diffuse axonal injury (Damage to brain neural connections due to shearing forces)
• Hemorrhages and Hematomas (Bleeding in or around brain)

These pathophysiological changes can disrupt neural pathways, leading to significant
impairment in various domains of our functioning.

Consequences of TBI: How It Affects the Brain and Daily Life

TBI can lead to a range of neurological, cognitive, emotional, and social disturbances that impact an individual’s ability to function independently.

Physical Impairments

1. Headache and pain
2. Difficulties with gait, motor coordination and balance
3. Sensory motor issues (Visual disturbances, hearing impairment, slurring of speech, difficulties with using limbs, loss of sensation etc)
4. Sleep and appetite issues

Cognitive Impairments

1. Slowed processing speed (taking longer to think, poor reaction time)
2. Poor attention and concentration (Reduced attention span, distractibility)
3. Reduced language production and comprehension (difficulty speaking, understanding instructions or conversations, word finding difficulties, reduced reading and writing abilities)
4. Executive dysfunction (Impaired decision-making, reduced cognitive flexibility, disorganization, and problem-solving)
5. Memory disturbances – Difficulty remembering recent events or learning new information

Emotional and Behavioural disturbances

1. Depression and anxiety – Increased feelings of sadness, worry, and emotional distress
2. Irritability and aggression – Lower frustration tolerance, poor emotional control
3. Emotional lability – Rapid mood swings or exaggerated emotional responses
4. Apathy or lack of motivation – Reduced interest in daily activities and social interactions.

Social and Interpersonal Difficulties

1. Difficulty interpreting emotional and social cues, difficulty in perspective taking.
2. Interpersonal conflicts – Difficulties in maintaining relationships due to impulsivity or personality changes
3. Social withdrawal – Avoiding interactions due to frustration, embarrassment, or low confidence

The combined impact of these deficits often leads to reduced independence, poorer quality of life, low self-esteem and poor socio-occupational functioning. 

Neuropsychological Rehabilitation: Road to recovery

The brain has an amazing ability to adapt, rewire and reorganize itself after injury, a process called neural plasticity. With structured, goal directed and tailor-made rehabilitation offered by a qualified and experienced professional, individuals can regain lost abilities (partially or fully), develop compensatory strategies, and improve their overall functioning. The extent to which recovery is possible, depends on various personal, clinical and social factors. Every journey of recovery is unique in nature.

Key Approaches in Cognitive Rehabilitation

• Attention and concentration – cognitive exercises with gradually increasing task complexity
• Memory training – Internal strategies, Mnemonics, using external aids (notebooks, alarms, apps) and memory drills
• Executive function training – Teaching strategies for planning, decision-making, and problem-solving
• Speech and language therapy – Improving word retrieval, sentence formation, and comprehension

Music-Based Cognitive Interventions: A Powerful Tool for Brain Recovery

Music based interventions are emerging as a scientific approach in ameliorating TBI sequalae. Because music engages and activates multiple brain regions implicated in cognitions and emotions, it is proven that both active and passive structured music exercises can induce neural plasticity and improve overall functionality.

How Music Enhances Recovery:

• Helps in reducing physiological arousal and pain
• Improves gait and motor coordination thereby promoting motor recovery
• Boosts attention and enhances executive functioning.
• Promotes speech and language recovery
• Regulates emotions and mood.
• Enhances ability to learn and recall. 

Other approaches in neuropsychological rehabilitation.

• Functional skills approach and Behaviour management
• Individual Psychotherapy – Cognitive behavioural therapy (CBT), Acceptance and commitment therapy (ACT)
• Social skills training
• Relaxation techniques (Guided imagery, mindfulness)
• Family Psychoeducation and psychotherapy 

Take home message: Tips for Caregivers

1. Caregivers play a vital role in helping individuals with TBI recover, adapt to daily life and integrate with community. Here are some key strategies:
2. Patience is the key – Recovery is a gradual process; avoid rushing or pressuring the individual
3. Use simple, clear communication – Give one instruction at a time and allow extra processing time.
4. Avoid criticisms or negative expressed emotions. Try to encourage and reinforce the efforts or initiatives taken by the individual.
5. Establish a structured routine - Keep the routine predictable to avoid confusions.
6. Modify environment to suit person’s needs and disabilities.
7. Promote independence in individuals through creative approaches.
8. Encourage participation in cognitive and leisure activities – Games, reading, and puzzles aid rehabilitation
9. Use music to stimulate engagement – Playing familiar songs or encouraging singing/play instrument can improve mood and memory
10. Seek support– Caregiving individuals with TBI is challenging and can induce burn out/enhance stress.
11. Prioritise self-care whenever feasible, take breaks and seek support.