What is a brain injury?

A brain injury is any damage to the brain, sustained after birth, resulting from an external force or internal condition.

Causes of brain injury

Brain injuries can be caused by a variety of factors, including traumatic or non-traumatic causes. Acquired Brain Injury (ABI) is an umbrella term that encompasses both Traumatic Brain Injury (TBI), and non-traumatic brain injuries, also referred to as an ABI.

This animation is tailored to kids but is helpful for adults too. It talks about brain injury: what it is and how a brain injury may change your special person. Knowing all of this can help prepare you for what you may experience with your special person.

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Traumatic Brain Injury (TBI)

A TBI is caused by a blow to the head or by the brain being forced to move rapidly forwards and backwards within the skull through events such as falls, car accidents, or sports injuries. Brain tissue may be bruised, swell, bleed, stretch or tear the nerve fibers (axons).

Effects may be Temporary or Permanent and range from mild to extremely severe.

There are different types of TBI resulting in closed and open injuries, distinguished by how the injury affects the skull and brain.

An open injury, also known as a penetrating head injury, occurs when an object breaks through the skull and enters the brain.

A closed injury occurs when the brain is injured without any break in the skull, where the brain moves within the skull during the trauma, causing bruising (contusion), tearing of blood vessels (hemorrhage) and axonal shearing (diffuse axonal injury) where nerve fibres stretch, tear or break. A TBI can also be focal, meaning damage is isolated to one specific area of the brain.

Non-Traumatic (Acquired Brain Injury, ABI)

Non-traumatic causes, often referred to as Acquired Brain Injuries (ABI), include strokes, infections (like meningitis), deprivation (anoxia) or lack (hypoxia) of oxygen to the brain, brain tumours, and exposure to toxins.

Determining brain injury Severity

Predictions

Predicting the impact of brain injury can be difficult. However, several indicators are used by professionals to help understand and possibly predict the level of a person’s recovery during the first few weeks and months after a brain injury.

Duration of Coma or loss of consciousness

The Severity of a brain injury can often be gauged by the duration of time a patient spends in a Coma . The following table outlines the correlation between the length of unconsciousness and the corresponding Severity of brain injury:

Glasgow Coma Scale (GCS)

The GCS assesses changes in level of consciousness. There is some co-relation with Severity of injury and prognosis, with the GCS divided into 3 sections. Scores are from a minimum of 3 (totally unresponsive) to a maximum of 15 (responding as normal).

Paramedics will do this test at the scene of the injury, and it is usually repeated when the person arrives at hospital to determine any changes.

Post-Traumatic Amnesia Scale (PTA)

PTA is a stage of recovery after a traumatic brain injury (TBI) where a person is Disorientated or confused and unable to recall new information. PTA testing occurs over several days. The first stage tests ‘orientation’ such as remembering personal memory accurately. This must be passed successfully before proceeding to the second part, assessing ‘memory’ such as remembering new information (photos, name and gesture) consistently over 3 days.

The length of PTA has a correlation to Severity of injury and prognosis.

A person needs to pass 3 consecutive days of PTA testing (i.e. 12 out of 12) to be clinically classified as out of the PTA state. A caveat to this is for people who are more than 1 month post injury, they require 1 day of 12/12 to be classified as being emerged from PTA.

Other tests may include:

• Rancho Los Amigos (RLA) is an interactive scale used to assess how people with traumatic brain injury (TBI) are recovering, from Level 1 (unresponsive) to Level 8 (purposeful appropriate).
• Mini-mental is scored out of 30 and tests for orientation, registration, attention and calculation, recall, language and consciousness.
• Functional Independence Measure (FIM) is a scale used to measure the ability to function with independence across 18 areas: eating, grooming, bathing, dressing (upper body), dressing (lower body), toileting, bladder management, bowel management, transferring (go from one place to another) in a bed, chair and/or wheelchair, transferring on and off a toilet, transferring into and out of a shower, locomotion (moving) for walking or in a wheelchair, and location going up and down stairs, comprehension, expression, social interaction, problem solving and memory. Each area is scored between 1 (total assistance) and 7 (total independence).

Understanding the brain

Understanding the brain is essential to grasping how it controls nearly every aspect of our lives, from basic functions like breathing and movement to complex tasks like thinking, memory, and emotions. The brain is a highly intricate organ, composed of billions of neurons that communicate through electrical and chemical signals. Each area of the brain is responsible for different functions, and damage to specific parts can lead to various changes. Gaining insight into how the brain works can help us better understand brain injuries, mental health, and the ways we learn and adapt.

Click on the brain below to learn what each lobe does.

Effects of brain injury

Brain injuries can have profound and wide-ranging effects on an individual’s physical, cognitive, and emotional well-being. Depending on the Severity and location of the injury, these effects can vary from mild, Temporary symptoms to severe, long-lasting impairments. The impact of a brain injury can extend to every aspect of life, affecting not only the injured person but also their relationships, work, and overall quality of life.

Cognitive Effects

Cognition can be described as a person’s thinking skills. Common problems can vary widely and can include:

Concentration problems = such as short attention span, be easily distracted, difficulty focussing on a task especially if it is long and/or complex.

How to help?

• Minimise distractions (turn off TV)
• Encourage regular breaks
• Suggest activities that require less attention (listen to music rather than read a book)

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Slowed thinking = taking in, processing and understanding information often slows down. This means the person may be slow in responding or doing tasks.

How to help?

• Allow more time to think, answer questions or do activities
• Speak slowly and clearly

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Increased fatigue = the person may tire very quickly from thinking and doing physical tasks. When tired, other challenges may be more obvious, such as their speech may become slurred, their thinking slower, or their balance more unsteady.

How to help?

• Suggest regular breaks
• Plan rests between activities
• Track fatigue through journal to identify patterns
• Plan ahead and be realistic about what can be accomplished
• Organise time with the harder tasks done in the morning

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Memory difficulties = the person may retain old memories and well learnt skills, but most do not remember the brain injury. People can have difficulty learning and remembering new information like appointments, details of conversations, what they’ve been asked to do, or where they may have put items.

How to help?

• Talk calmly
• Repeat information
• Use a diary, whiteboard, phone or book to record important information
• Set up a regular spot for certain items to be stored
• Keep to routines
• Set up a weekly schedule with planned rest breaks
• Set up a weekly schedule with planned rest breaks

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Difficulties with problem solving and Planning = the person may have difficulty thinking of ways to solve unfamiliar problems, appear disorganised in their approach, or be unable to plan activities.

How to help?

• Break tasks into small parts
• Provide written structure or steps in order
• Give prompts
• Encourage repetition and practice
• Encourage thinking about a task before starting it

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Impaired self-monitoring = the person may break rules and not realise they have made an error. They may ‘hog’ conversations and keep talking when others are no longer interested.

How to help?

• Talk about the activity and the person’s role in it
• Provide feedback in a constructive way
• Use agreed signals (to leave)
• Encourage turn-taking

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Lack of insight, awareness and poor judgement = the person may have some or total unawareness of changes to their thinking and behaviour.

How to help?

• Give time for the person to recognise their challenges
• Provide explanations and reasoning
• Help identify realistic goals
• Ask the person for their feedback and get them to compare it to how they expected to go

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Video: Re-Building Brain Power

Watch the video below to understand how you can help your special person re-build brain power when they’ve experienced cognitive changes.

**update educational video # 2 (re-building brain power)

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Communication effects

Speech and language abilities can be significantly affected and may include problems with:

Difficulty speaking clearly and fluently = Speaking clearly and fluently is important for others to understand what we say, but brain injuries can affect this in different ways.

1. Dysarthria: This happens when the muscles used for speech are weak, paralyzed, or uncoordinated. It can make speech sound slurred, distorted, or hard to understand.

2. Verbal Dyspraxia: This occurs when there’s difficulty coordinating the movements of the tongue and facial muscles. Speech may become hesitant, effortful, and inconsistent. For example, someone might be able to say common phrases like “Hi, how are you?” but find it difficult to have a conversation. The Severity of these issues can vary. Some people might occasionally mix up sounds in longer words, like saying “telfon” instead of “telephone.” For others, producing a single sound can take significant effort.

How to help?

• Encourage a slow pace
• Use simple sentences
• Repeat or paraphrase
• Confirm your understanding
• Use visual cues (pointing, gestures, facial expressions)
• Offer alternative communication tools (writing, apps, picture cards)

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Difficulties reading and understanding speech = sometimes, a person may find it hard to understand what is said to them. In severe cases, speech can sound foreign, making conversations nearly impossible to follow. For others, the difficulty may be milder, such as trouble processing long or complex instructions. For example, they might find it easier to understand a simple request like, “get me a blanket,” compared to a more detailed one like, “head to the passage and go into the left cupboard and get a blanket from the bottom shelf”. Understanding written information can also be challenging. This might affect their ability to read signs, newspapers, books, or letters. These difficulties are known as receptive dysphasia.

How to help?

• Avoid overwhelming them
• Use simple language
• Speak slowly and clearly
• Write down important messages
• Be patient and give time

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Difficulties finding words, using sentences or writing = some people may have difficulties finding the right words during conversations or forming sentences to express their thoughts. They might pause for a long time before responding or use incorrect words or sounds. For example, they may mean “plant” but say “grass”.

Writing can also be affected in a similar way, making it hard to compose messages or letters. These challenges can cause significant frustration for some, while others may not realise that their speech or writing is unclear. This condition is called expressive dysphasia.

How to help?

• Ask yes/no questions
• Offer choices
• Repeat and clarify
• Avoid correcting them too often
• Use prompts
• Encourage alternative communication (gestures, drawings, writing)

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Difficulty Planning and organising what to say = coherent speech relies on skills like thinking, concentrating, remembering, solving problems, and organizing information logically. Difficulty in any of these areas can impact a person’s ability to communicate effectively. For example, they may struggle to recall a story they want to share or might tell it out of order.

How to help?

• Use prompts and cues
• Break down information
• Encourage pauses
• Ask specific questions
• Summarise and confirm your understanding
• Avoid interruptions

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Inappropriate social communication = when we communicate, we rely on body language and social skills like taking turns in conversations and using eye contact appropriately. These social aspects are crucial for effective interactions. However, some people may find these skills difficult. They might avoid eye contact, find it hard to start a conversation, or talk excessively. They may also have difficulty controlling their behaviour or words, which can lead to swearing or speaking without thinking.

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Physical effects

Brain injuries can lead to a range of physical effects, which might include weakness, coordination problems, balance issues, or changes in sensory perception like vision or hearing. Some individuals may experience chronic headaches, fatigue, or seizures. These physical challenges can significantly impact a person’s ability to perform daily activities and may require rehabilitation such as physical or occupational therapy to regain strength, mobility, and independence. Adjusting to these changes takes time, and having a solid support system is crucial for managing physical recovery.

How to help?

• Always check with health professionals before standing or walking with the person
• Encourage rest and social time, not just practicing physical movements
• Ask health professionals to teach you any activities you can do out of therapy time

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Behavioural effects

Behavioural changes are a common consequence of brain injury, and these can sometimes be the most challenging for both the individual and their loved ones. These changes may be subtle or dramatic and may lead to the person saying and doing things that are out of character. Behaviours may include:

Lack of initiative = the person may have difficulties getting started on a task or moving on from one task to another.

How to help?

• Take some responsibility for directing the person
• Provide verbal prompts
• Provide a written schedule
• Use aids as a reminder (watch, mobile, timer)

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Impulsiveness = the person may do things quickly and without thinking of the consequences.

How to help?

• Suggest the person slows down and thinks before speaking or acting
• Provide constructive feedback
• Consider safety like road crossing or using sharp objects (knives)

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Irritability and aggression = the person may be less able to manage frustrations and be more angry or abrupt in situations that appear out of proportion.

How to help?

• Become aware of triggers and minimise these before behaviours begin
• Consider fatigue and if it’s contributing
• Give them space
• Keep yourself safe

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Inappropriate social behaviour = the person may do or say things that are out of character or context, which may be offensive or socially unacceptable. This is often due to a lack of self-awareness or impulse control.

How to help?

• Calmly and privately address the behaviour
• Explain behaviour in a non-judgemental way
• Offer clear, simple guidance on what is acceptable
• Practice situations together

Other important factors: Behaviours may relate to changes in the person’s communication, sensitivities to environments (noise, temperature, crowds, light), changes to vision/hearing or thinking, medications, physical discomfort such as hunger, tiredness, constipation or other emotional needs not being met.

Understanding that these behaviours are symptoms of the injury, not intentional actions, is key to responding with empathy and finding effective ways to manage and modify them.

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Psychological effects

Depression, anxiety, and mood swings are common as individuals attempt to come to terms with their new reality. There may be feelings of frustration, grief, or loss due to changes in abilities and independence. These emotional challenges can affect both the individual, you and your family, and it’s important to seek psychological support to address them.

Depression = the person may experience persistent and feelings of deep sadness, hopelessness and lack of interest or pleasure in activities.

How to help?

• Listen
• Stick to a routine
• Encourage exercise
• Ask how you can help
• Help the person work through their thoughts and feelings
• Refer to a psychologist or social worker to provide support and formal counselling
• Medication may help. Speak with a Doctor

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Anxiety = the person may be excessive worry, fear or nervousness about every day situations.

How to help?

• Provide reassurance and comfort
• Find out their ‘triggers’ so you can reduce them or make them occur less often
• Talk about stressful situations in advance to increase sense of safety
• Listen
• Refer to a doctor, psychologist or social worker to provide support and formal counselling

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Mood swings = the person may experience sudden and intense changes in their emotional state, quickly shifting from feeling happy or calm to angry, sad or irritable.

How to help?

• Show understanding, patience and support
• Recognise the emotions are often beyond the persons control
• Encourage them to talk about their feelings
• Listen without judgement
• Offer reassurances and comfort
• Identify triggers and strategies to manage them (relaxation, routines)
• Create a stable, calm environment
• Suggest professional help if mood swings are becoming disruptive

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Medical issues

After a brain injury, some medical issues can present, some only emerge over time and can include:

Epilepsy

Some people with a brain injury may develop seizures, especially if they have experienced bleeding in the brain (intracerebral hematoma), a penetrating brain injury, or had brain surgery. If someone with a brain injury has a seizure, they are often prescribed medication to reduce the likelihood of another one occurring. Doctors regularly assess whether the medication should continue. It’s important to manage and control seizures, especially if the person plans to drive or operate machinery.

Headaches

Headaches are common after a brain injury, with tension headaches being the most frequent type. These can typically be managed with pain relief medications and stress management techniques. Some headaches may result from injury to the neck muscles, and physiotherapy can often help alleviate these.

Dizziness

After an injury to the brainstem and/or middle ear, some people may experience dizziness, especially when changing posture. This can impact balance. Physiotherapy exercises and medication can be helpful, but if the dizziness continues, further testing may be needed.

Changes to vision and other senses

People with a brain injury may experience various vision problems. Some may develop a blind spot in their field of vision, which can be small or extend across half of the visual field (called hemianopia). Others may experience double vision (diplopia) due to an imbalance in eye muscle movement. These visual issues typically cannot be corrected immediately (e.g., with glasses) but often improve gradually over months. Other senses, such as taste, smell, and hearing, may also be affected.

Swallowing problems

Swallowing difficulties (dysphagia) are common after a brain injury. These issues may arise from muscle weakness and incoordination, reduced consciousness or awareness, and/or difficulty controlling the eating process (such as eating too much too quickly). If needed, a speech pathologist can assess the person’s ability to eat and drink, and arrange any necessary treatments or modified diets. If the swallowing mechanism isn’t functioning properly, there is a risk of inhaling (aspirating) food, fluids, or saliva into the lungs, which could lead to a chest infection.

Incontinence

Bladder and bowel incontinence can sometimes occur as a direct result of a brain injury, but it is more commonly due to a lack of awareness of these bodily functions. As the person regains alertness and awareness, the issue often improves. In the early stages, individuals may also be more vulnerable to bladder infections, which can further affect bladder control. Nurses can help by creating routines to support the person in maintaining continence.

Alcohol and other drugs

The use of drugs and alcohol can have significant impacts on recovery and overall well-being. These substances can interfere with brain recovery, worsen cognitive and emotional symptoms, and increase the risk of further injury. Alcohol and certain drugs may also affect mood, judgment, and behaviour, making it harder for individuals to manage their condition or follow treatment plans. It’s important for those recovering from a brain injury to avoid substance use and seek professional guidance on maintaining a healthy lifestyle for optimal recovery.

Sexuality

Sexuality can be affected after a brain injury due to changes in hormone levels, emotional responses, behaviour, and physical abilities. These changes may result in shifts in libido, either a decrease or sometimes an increase. Additionally, a brain injury may make it more difficult to adjust to changes in sexual function or intimacy. In most cases, individuals can return to a fulfilling sexual life.

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Secondary Effects

Secondary effects of a brain injury refer to additional changes to a person’s life. These changes can include:

• Living situations
• Fluctuation of social supports and offering of assistance/support from friends or family
• Income and ability to work or study
• Roles and responsibilities within the home
• Relationships and family dynamics

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The early stages

Coma

Immediately after a brain injury your special person may be in a Coma where they are in a state of unconsciousness and cannot open their eyes or respond in any way to things around them. During this time, the brain is in a critical condition, focusing on healing and stabilising vital functions. For families, this period can be filled with uncertainty, fear and a sense of helplessness as you await signs of improvement. Medical teams closely monitor the patient, providing care and support with the hope that, in time, the person will begin to show signs of recovery and gradually regain consciousness. A Coma may last for minutes, hours, days or weeks.

Post-Traumatic Amnesia (PTA)

As people emerge from a Coma , they pass through a phase called post-traumatic Amnesia (PTA). PTA is a state of confusion and memory loss. During this period, the person may be disoriented, confused, unable to remember recent events, or have difficulty recognizing familiar people and places. Often, people are not fully aware of where they are and what is happening to them. People in PTA may not be speaking, or if they are, their words may not seem to make sense. Although they may remember things from the past, they usually cannot remember things happening now. In other words, there is no ‘continuous memory’ for day-to-day events.

Often, people in PTA perceive their surroundings in a distorted way and this increases their confusion and sometimes their fears. They may appear to imagine things or use items in a way that they are not meant (i.e. using their mobile phone as a hair brush). Their confusion may be worse at night or when they are tired. Fatigue is common in most people with PTA and having too much stimulation, like visitors, loud noises or TV’s can make it worse. It is recommended to keep environments calm and quiet.

PTA can cause Agitation and restlessness, resulting in pacing, wandering or intrusiveness. Behaviours can change while in PTA, where a person may respond to directions or requests in a different way than they would have before. They may also be verbally or physically aggressive.

The duration of PTA can vary, lasting from minutes, to weeks or months, and it is often used as an indicator of the Severity of the brain injury. While in PTA, it is not possible to predict ongoing functions or problems with speech, memory or Cognition . People in PTA may benefit from a specialised brain injury rehabilitation setting to access staff with relevant training, low stimulus and secure environments and behaviour support strategies. Some people in PTA are safer if they sleep on a mattress near the floor and they may need a nurse watching them continuously. People in PTA are not ready for intensive rehabilitation.

While this stage can be frightening and frustrating for both the individual and their loved ones, it is typically a Temporary condition that gradually improves as the brain heals.

Tips for family involvement:

• Keep stimulation to a minimum. Be quiet, supportive and calming
• Keep visitors to a minimum and for short periods. Check with the staff on the recommendations for your special person
• Familiar items and photos can be reassuring so bring in a few personal belongings
• Keep conversations basic and talk in a calm and reassuring way
• If you experience challenging behaviours with your special person, try to distract them or walk away for a short period. Typically, their memory difficulties will result in them not remembering what happened and they may be more settled when you return
• Encourage rests or sleeps throughout the day and during your visit. Read any physical signs of tiredness (yawning, slouched posture, heavy eye-lids) and encourage them to lie down
• Involve your special person in conversations if you are talking about them to others who are present

Learn about specific brain injuries

Scroll below to find out more about specific brain injuries.