When your loved one sustains a brain injury, some of your earliest questions are likely to be, “how bad is it?” “Can they recover?” and “What does recovery look like?” While brain injury recovery is different for everyone — and therefore requires highly personalized care — answering the first question will help you and your loved one’s care team determine the possibilities of rehabilitation. In this article, we take a look at the symptoms that distinguish severe brain injury from milder cases — and explain why an interdisciplinary approach to rehabilitation results in the best outcomes.
What differentiates a mild from a severe brain injury?
Severe brain injuries are among the most complex medical conditions. They often result in significant physical, cognitive, and emotional challenges that not only affect the individual, but also the families and caregivers who accompany them throughout the recovery journey.
The term “severe” refers to cases involving damage to significant portions of the brain, as well as profound impairment of brain function. Loss of consciousness exceeding 24 hours and long-term or permanent disability are hallmarks of severe brain injury, whereas less catastrophic injuries result in relatively minimal long-term deficits.
The most common causes of severe brain injury include:
Traumatic brain injury (TBI)
TBI results from collision with an external force, such as a blow to the head or sudden acceleration or deceleration. Motor vehicle crashes, falls, sporting accidents, and work-related injuries are common causes of TBI. TBIs range in severity, with the most serious cases producing deep and widespread damage to brain tissues.
Stroke
Also referred to as a “brain attack,” strokes occur when blood flow to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Severe strokes can cause significant damage, including permanent physical and cognitive impairments.
Anoxic and hypoxic brain injury
Anoxic brain injury refers to the complete interruption of oxygen flow to the brain, whereas hypoxic brain injury involves a decrease in oxygen supply. Causes may include cardiac arrest, near-drowning, suffocation, and severe asthma attacks. Anoxia and hypoxia can be fatal, as even a few minutes without oxygen can result in significant and lasting brain damage.
Infections and inflammation
Conditions such as encephalitis, a bacterial or viral infection of the brain, and meningitis, an infection causing inflammation of membranes surrounding the brain and spinal cord, can lead to severe brain injury if left untreated. Children under the age of 12 and adults with weakened immune systems are at high risk of experiencing both conditions. 2
Tumors
Whether malignant or benign, tumors can cause damage to brain tissue, particularly if they grow quickly or exert pressure on sensitive areas. Advanced age, exposure to radiation, and certain genetic conditions (such as tuberculosis sclerosis, neurofibromatosis, and Turner syndrome) can increase the risk of developing a brain tumor. 3
What are the symptoms of severe brain injury?
Severe brain injury can lead to a wide range of cognitive, physical, and psychological symptoms that evolve as patients progress through the stages of brain injury recovery. Problems with memory and problem-solving, physical limitations, and erratic behaviors are among the most common effects of life-altering brain injury.
Cognitive impairment
Profound brain damage can affect a wide range of mental functions. Individuals may struggle with memory, attention, and problem-solving, making it difficult to complete basic activities of daily living. Judgment and decision-making abilities can also be impaired, leading to challenges in assessing situations accurately or making safe choices. For example, patients may overestimate their physical strength and attempt to walk without assistance, leading to falls and secondary injuries. Cognitive processing speeds can also be significantly delayed, which can cause confusion and frustration for caregivers. Indeed, 20-second response times are not unheard of among patients recovering from brain injury. These cognitive challenges can severely limit functional independence and psychological wellbeing.
Physical limitations
Severe brain injuries can lead to a variety of physical limitations, depending on the region and extent of tissue damage. Weakness or paralysis, often localized to one side of the body (a condition known as hemiparesis), is a common outcome. Individuals may also experience significant coordination and balance issues, making activities such as walking and standing difficult or impossible. Speech difficulties (referred to as dysarthria) and swallowing challenges (dysphagia) are also common complications. A personalized treatment plan, including rehabilitation and skilled therapies, can help patients regain functionality and improve their quality of life.
Behavioral and emotional changes
In addition to the cognitive and physical challenges associated with brain damage, psychological changes are also extremely common. Individuals may experience mood swings, irritability, and impulsiveness, making interactions with caregivers more unpredictable and challenging. Depression and anxiety are also quite common, as patients may struggle to come to terms with the reality of life after brain injury. Personality shifts may also occur, resulting in behaviors that were atypical prior to injury. These changes impact everyone in the patient’s ecosystem, including family, friends, and primary caregivers. Professional psychological counseling and behavioral therapies can foster healing and adjustment over time.
Sensory deficits
Severe brain injuries can radically alter the way individuals perceive the world around them. Common issues include vision and hearing impairments, which can range from partial loss to complete blindness or deafness, depending on the location and severity of the injury. Recognizing familiar objects and people can also become challenging, especially when areas of the brain responsible for processing visual or auditory information are affected. Changes in taste, smell, and touch perception may also occur, altering the way individuals experience flavors, scents, and textures. Such sensory disruptions often require specialized therapy to help patients adapt and regain as much function as possible.
The road to brain injury recovery
As traumatic as these symptoms can be for patients and caregivers, brain injury recovery is possible. In the earliest stage of recovery — which is marked by disorders of consciousness including coma, unresponsive wakefulness syndrome, and minimal consciousness — the goal is to minimize the brain’s reactions to the injury. Inflammation and contractures induced by sympathetic overactivity can cause lasting secondary damage that limits the individual’s ability to achieve greater functionality later on.
Once patients have entered the third stage of brain injury recovery (known as post-acute recovery), they are capable of engaging in neuropsychological evaluations that reveal the full extent of cognitive and behavioral deficits. The results of this testing will give you and your loved one a better idea of what’s possible in rehabilitation. According to Nexus Rise Program Medical Director Courtney Toomey, MD, every mind has a different capacity or “cognitive reserve” prior to brain injury, which is one reason why outcomes vary widely among patients with similar injury profiles.
In more than 30 years of helping individuals rise from life-altering brain injuries, we have seen patients make remarkable strides when surrounded by supportive caregivers and interdisciplinary care teams. Since almost all brain injury patients are considered medically complex, it is essential to find a treatment team comprised of medical, behavioral, and rehabilitation experts working in concert to create a personalized plan for your loved one.
Looking for a post-acute care option for a brain injury patient? Contact us to learn more about the Rise Program.
