A traumatic brain injury or head injury is acquired brain damage usually caused by a blow or violent impact to the head, which could also be due to the brain being penetrated by an object that directly injures it. A minor traumatic brain injury can temporarily affect the brain neurons and lead to the appearance of symptoms. A more severe traumatic brain injury can leave long-term consequences, and may be due to haematomas or haemorrhages, contusions or injuries to the neurons caused by stretching and twisting.

Although there are many factors that can cause a brain injury, today the main cause is still traffic accidents (over 50% of cases). Less frequently, falls, sporting accidents and violence are other causes of this type of head injury. Traumatic brain injuries in children are a common reason for attending an accident and emergency department. Although most do not lead to serious consequences, traumatic brain injuries are the main cause of death and disability in children over the age of 1 in developed countries. It is estimated that 1 in 10 children will have a significant TBI throughout their childhood. In these cases, a personalised assessment is needed to come up with the most appropriate treatment plan.

Symptoms and consequences of a traumatic brain injury

Other physical and/or psychological symptoms can appear, depending on the degree of severity of the traumatic brain injury. When somebody suffers a minor traumatic brain injury, the signs and symptoms can appear straight after the traumatic effect or days or weeks later:

• Loss of consciousness for some seconds or minutes
• State of lightheadness, confusion or disorientation, without losing consciousness
• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Problems speaking
• Difficulty sleeping or sleeping more than usual
• Dizziness or loss of balance
• Sensory problems such as blurred vision, buzzing in the ears, unpleasant taste in the mouth or changes in the sense of smell
• Sensitivity to light or sound
• Cognitive symptoms, such as memory or concentration problems
• Changes in mood and mood swings
• Depression or anxiety

When the traumatic brain injury is moderate or severe, the following problems may be seen:

Altered state of consciousness. A moderate or severe traumatic brain injury may cause prolonged or permanent changes in the patient’s state of consciousness, awareness or responsiveness. The different states of consciousness are:

• Coma. A person who is in a coma is unconscious, unaware of what is happening, and unable to respond to any stimulus. This is due to generalised damage to all parts of the brain. After a period of time which usually varies between a few days and a few weeks, a person can come out of a coma or may pass into a state known as unresponsive wakefulness.
• State of unresponsive wakefulness. In this situation, a patient with altered consciousness can open and close their eyes, produce sounds, respond to reflexes or present some types of movement, but there is no awareness of the environment or of themselves. It is possible that a state of unresponsive wakefulness can become permanent, although, in general, people develop a minimally conscious state.
• Minimally conscious state. This is a disorder in which consciousness has been severely altered, although with some evidence of awareness of self or environment. This is sometimes a state of transition from a coma or state of unresponsive wakefulness to a situation in which cognitive functions are severely affected but now with the ability to interact with their environment and take part in multidisciplinary neurorehabilitation treatment programmes.

Neuropsychological alterations. Many people who have suffered a significant brain injury experience changes in skills that affect cognition, behaviour and emotions. The main cognitive problems that could appear are:

• Orientation
• Attention and concentration
• Memory and learning
• Executive functions
• Capacity of judgement

Changes in behaviour:

• Difficulties with self-control
• Lack of awareness of skills
• Risky behaviour
• Difficulty in social situations
• Physical or verbal impulses

Emotional changes:

• Depression
• Anxiety
• Changes in mood
• Irritability
• Lack of empathy
• Rage
• Insomnia

Communication problems. Language or communication problems are common after a traumatic brain injury.

• Difficulty understanding
• Difficulties with speaking or writing
• Inability to organise thoughts and ideas
• Problems to follow the thread of conversations and participate in them
• Problems with changes in intonation, tone or emphasis to express emotions, attitudes or subtle differences in meaning
• Difficulty to understand and interpret non-verbal signals
• Inability to use the muscles needed to form words (dysarthria)

Impaired movement ability. A severe traumatic brain injury may lead to paralysis or loss of strength in the extremities or trunk, or in controlling the head. Impaired coordination of movement or balance may also appear, leading to difficulties with basic everyday tasks like eating, washing or dressing, as well as getting around independently.

Sensory problems. As an example, a traumatic brain injury may cause a patient to experience persistent buzzing in the ears, blind spots or double vision, a bitter taste in the mouth, difficulty smelling, itching or tingling on the skin, as well as dizziness or difficulty keeping balance