Care for Traumatic Brain Injuries (TBI)

What is a traumatic brain injury?

Traumatic brain injury is an injury to the brain that results in significant neurological involvement that creates physical injury to the brain. There are four main types of injuries suffered to the brain. Many times traumatic brain injury, or TBI, is the result of a closed head injury, when the brain tissue forcefully hits the skull, and it can cause increased intra-cranial pressure, bruising, bleeding, tissue damage or an excess of fluids around the brain.

Midsection of a nurse taking blood pressure and pulse of patientAnother possible cause of TBI is any penetrating injury suffered to the skull. This occurs when any object enters into the cranial cavity. Penetrating injuries often occur as the result of a car accident, or a gunshot wound. Going without oxygen for a period of time, even a few minute span, can result in an anoxic injury to the brain. When your brain is deprived of oxygen, brain cells will quickly die off and the damages can affect the entire brain. The final cause for TBI is due to toxic chemical agent exposure to brain cells. Any time a toxic chemical crosses the blood brain barrier, brain cells can be damaged or killed.

How is the severity of TBI determined?

The degree of injury to brain will vary from case to case and can range from mild to moderate to severe. The severity and location of the damage will affect how greatly the neurological system is impacted, which will then regulate the functioning of other body systems. Following the initial injury, the Glasgow Coma scale is used to determine the responsiveness of the individual. For long term prognosis, the utilization of the Glasgow Outcome scale will help predict how likely it is that the individual will return to their normal level of functioning, or not. The lower the rating on the Glasgow Coma scale indicates a greater amount of damaged has occurred.There are similar scales used to determine level of consciousness and responsiveness which all help indicate the severity of the injury suffered. It is not usually evident until the rehab process how greatly the individual will be affected on a long term basis.

What are the characteristics of TBI?

The symptoms of TBI are going to vary greatly with each individual and the severity of their damage, but some main characteristics include a decreased level of consciousness, impaired response to stimuli, decrease in muscle tone, increased pressure within the cranial cavity, and the body’s inability to perform vital functions without assistance. Oftentimes following the initial injury, the individual may fall into a deep sleep known as a coma which can last from days to even months depending on the severity. Patients who suffer from a TBI may spend a significant amount of time in an intensive care unit in order to just maintain vital functions.

How much does a person recover from TBI?

Some people can completely recover from a mild traumatic brain injury. Others may suffer few impairments that may not even be noticeable. However, many times following mild to moderate injury, significant deficits will remain with the patient for life. How the individual is affected is going to depend on the area of the brain that suffered damage.

Immediately following injury there is a time period that can last from weeks to months known as spontaneous recovery, during which the brain works hard to repair damaged neurons. Some people may require assistance for the rest of their life with daily functioning. Many cases will exhibit a return of functional skills even years following the injury.

What is involved with rehabilitation from TBI?

Middle Aged Man Lying In Hospital BedRehabilitation needs to begin immediately. The first phase of rehabilitation will focus on the promotion of the body’s own natural processes to restore function. It is in this early phase that problematic areas are documented which will later become the focus of long-term rehabilitation. Oftentimes is the case where individuals may have to relearn basic skills such as getting dressed, eating, bathing and grooming. When problems are encountered during recovery adaptive processes are learned by the individual in order to adjust to their new level of functioning. The brain is astonishingly resilient and people may continue to gain more functions and have a return of abilities for years to come.

Is there a cure for TBI?

There is no cure for all cases of TBI, but oftentimes a person will recover from TBI with little to no deficits. Therapeutic and rehabilitation services will continue as long as necessary, sometimes for life in order to gain their highest level of functioning and improvement.

Can a coma be permanent?

A coma is defined as a state in which a person’s response to stimuli is greatly impaired. Even if a person is not in a complete coma following the initial injury, there can be a long term alteration to consciousness which is known as a “persistent vegetative state” for people that never recover. It is not completely understood how much a person hears, sees or understands while they are in a coma.

Does medication therapy help TBI?

Many patients will remain on medications following a TBI for a wide variety of reasons. Medication therapy can relieve or even end seizures, bipolar disorders, panic conditions, mood disorders, pain, sedation, headache, aggression, and more issues dealt with by those who have suffered traumatic brain injuries.

What is the typical home management for TBI?

Doctor treats female patient with stethoscope. Medicine.Depending on the degree of injury and long lasting effects, home management of TBI will vary from person to person according to the areas in which they need assistance. Home management can include a wide variety of care activities, including assistance with activities of daily living such as eating, grooming and bathing. Nurses and nursing assistants can visit a patient in the home setting to provide skilled nursing tasks and medical management as needed. The patient may also qualify for physical and occupational therapy services in the home setting as well.

Is at-home patient care appropriate?

As most issues surrounding patients who have suffered from traumatic brain injury, this will vary from person to person. Many people can be easily managed at home who have suffered from TBI, while other cases are much more complex and the individual needs more, sometimes even 24-hour skilled nursing care.

Is my loved one safe at home?

Many people are safe to be taken care of at home following a TBI, especially if they suffered a mild brain injury. For people who suffered a moderate to severe TBI more care may be necessary. So depending on the availability of a loved one or skilled personnel to care for the person, in-home care may or may not be a possibility.

What assistive devices are available for in the home?

There are many different types of adaptive equipment that can be purchased to help assist your loved one in the home. You can purchase shower chairs, bedside commodes, hospital beds, adaptive rails and handle bars, raised toilet seats and so many more products that will help your loved one live at home.

How do I know what level of care is appropriate for my loved one?

Whoever lives directly with the individual will understand how much time and skill is involved with taking care of the person who suffered from a TBI. It is important to discuss care options with the physician caring for the person as they will have a thorough understanding of the specific needs of the patient.

Does my loved one need full-time nursing care?

The sad truth is that many people who have suffered from TBI require an extensive amount of care. Sometimes, this care is more than what is safe or possible to be provided by a family member. If this is the situation your loved one will need to look into options for full-time nursing care.

What types of full-time care facilities are available?

When exploring options for full-time nursing care for your loved one there are many choices to consider. There are assisted living communities that provide some care and assistance, but not total medical assistance and there are also many different options for facilities that deliver around the clock skilled nursing services.

Is my loved one appropriate for assisted living?

Depending on the individual’s level of functioning, your loved one may be an appropriate candidate for an assisted living facility. These establishments give your loved one assistance in many areas while still allowing them to maintain a certain level of independence and privacy with an apartment styled building.

Will insurance/Medicare pay for a nursing home stay?

If your loved one who suffered from a TBI requires a short nursing home stay for rehabilitation services, this type of stay is usually covered by Medicare or insurance companies. When it comes to long term nursing home placement it will depend on your insurance or Medicare/Medicaid coverage if this service will be covered. Medicaid does have policies in place that provide nursing home care for individuals with disabilities that require full-time skilled care.

How do I know which nursing facility is right for my loved one?

When looking at your options for a skilled nursing facility be sure to explore all of your choices by taking a closer look at many different facilities. All places will vary in services and amenities they offer so be sure to get a list of everything available at each place so that you can find the most appropriate facility to meet all the needs of your loved one.

How to talk to my loved one about 24 hour nursing care?

This may be one of the hardest conversations you may have to have, but it is important to be open and honest with your loved one about the transition into a nursing facility. Keep them as involved as they are mentally capable of in all aspects of the decision as this will create a sense of security and help them feel more comfortable with this difficult decision.

Contributing Authors

Kelli Wilson, RN

Kelli is a Registered Nurse with over 19 years of experience in long term care nursing homes. Though the years she’s worked up to Assistant Director, and Director of Nursing. Kelli has been involved in admissions, discharges, and arranging home care. She’s also familiar with Medicare/Medicaid requirements and how to preform pre-authorizations.

Latest posts by Kelli Wilson, RN (see all)

    James Conte, RN, BS Nursing, BS Pharmacology

    James is a Registered Nurse with a BS in Nursing, a BS in Pharmacology, and a BS in Electrical Engineering. He brings with him many years of experience working in Long Term Care facilities, and as a Registered Nurse in an Intensive Care Unit. His familiarity with nursing and emergency care provides an invaluable perspective on managed care.

    Latest posts by James Conte, RN, BS Nursing, BS Pharmacology (see all)

      Miranda Booher, RN, ACLS Certified, BLS Certified, Tx Certified

      Miranda’s strongest area of expertise is nursing. She has worked as a registered nurse for over 6 years with 4 years experience on a pediatrics and orthopedic surgical unit and 2 years as a travel nurse, working in critical care and healthcare informatics.

      Latest posts by Miranda Booher, RN, ACLS Certified, BLS Certified, Tx Certified (see all)

        Carolyn Falconer-Horne, Ph.D. Candidate

        Currently working towards her Ph.D., Carolyn is a licensed and certified speech-language pathologist with over 15 years of experience working in rehab hospitals, long term care facilities, and skilled nursing facilities.

        Latest posts by Carolyn Falconer-Horne, Ph.D. Candidate (see all)

          Last Updated October 14, 2014
          Last modified: November 19, 2016