Traumatic Brain Injuries: What you should know


In this article:

  • Millions of Americans live with a lifelong disability due to traumatic brain injury.

  • Symptoms of brain injuries aren’t always obvious from the outside but can result in significant changes in behavior or mood.

  • An expert from the Swedish Neuroscience Institute talks about what it’s like to live with a brain injury for patients and families.

Did you know that 5.3 million children and adults in the U.S. are living with a lifelong disability because of a traumatic brain injury? Brain injuries are often hard to understand and diagnose.  To learn more, we spoke with John Benson, M.D., a physiatrist (also known as a physical medicine and rehabilitation doctor) at Swedish Neurological Rehabilitation, part of the Swedish Neuroscience Institute.

Q&A with Dr. Benson

Dr. Benson explains what a brain injury is, what it’s like to live with one, common myths and ways to reduce the stigmas surrounding brain injuries.

Q: What is a brain injury?

A: A brain injury is any type of event that harms the brain’s ability to work normally.  

There are a few main types of brain injuries:

  • Traumatic brain injury: These brain injuries happen when an external force hurts the brain. TBI can result from an object hitting the head. Or if the head strikes against something. Falls or car accidents are common causes of TBIs.
  • Penetrating brain injury: These are a sub-type of TBI. They happen when a foreign object enters the brain. An example might be a gunshot wound, where a bullet goes through the skull and to the brain.
  • Acquired brain injury: These are brain injuries caused by something other than external trauma. Causes may include tumors, lack of oxygen (anoxic injury), stroke, infections, multiple sclerosis or other autoimmune conditions, or other diseases.

The symptoms and effects of a brain injury vary by person and situation. Sometimes, symptoms show up right away or weeks later. People with brain injuries can have physical pain. They also can have changes in thinking, mental health, and behavior.

Because symptoms vary so much, brain injury is often a misunderstood neurological disease.

Q: How does a brain injury affect a person’s life? 

A: A brain injury can literally affect any part of a person’s life. Injury to the brain can cause paralysis, loss of sensation or changes in vision, problems thinking or remembering, dizziness or balance difficulties, headaches, neuroendocrine abnormalities, seizures and alterations in mood and behavior. People with brain injuries can develop difficulty processing stimuli in the environment. This means they quickly become overwhelmed, which can lead to social isolation.

One of the most challenging aspects of surviving a brain injury is that there may not be any outward sign of injury or disability. This can lead to misunderstandings or misconceptions by friends, family or an employer about changes a person is experiencing related to the injury. For example, people with TBIs are often extremely tired. They may need more than 12 hours of sleep each night. Suddenly, they may not perform as well at work, or they can’t make it through a full workday. To an employer, that can be hard to understand.

Sometimes a person with a TBI may have an altered personality. For example, if a person was loud and boisterous before their TBI, and now they are quiet and reserved, it could be due to a part of their brain being injured. This type of change can be especially hard for families, who can feel like they have to get to know their loved ones again. 

Q: What’s the experience like for a loved one of someone with a brain injury?

A: I tell patients and families that the injured person isn’t the only one who experiences the effects of the brain injury. Patients often report feeling like a different person while they are recovering. Personality changes, shifts in familial roles, lower energy levels, pain and other symptoms impact how the injured person interacts with others in their social circle. It’s challenging for loved ones to navigate the recovery process with the patient. I will never forget when a patient’s husband tearfully told me that he felt like he “finally had his wife back” after a several-year recovery period.

TBIs can change how a person acts, responds, feels emotions and remembers information. The brain controls so much. Depending on where the brain injury happens, it can have different effects. Many people experience severe depression – either because part of their brain that controls emotions was damaged or because they’re dealing with other changes. Treatment with therapy or medication can, in some cases, get people back to feeling like themselves again.

Q: We hear a lot about chronic traumatic encephalopathy. How does CTE fit in with the discussion of brain injury?

A: I have been receiving more questions about CTE in the last several years. It’s gained visibility in the media and general population. CTE is a somewhat recently described neurodegenerative disorder. This means the cells in the central nervous system in our brain stop working over time. We think CTE is caused by repeated brain injury or trauma. Symptoms may start decades after the initial exposure to trauma. 

We hear about CTE a lot in the context of sports-related head trauma. Especially with injuries like concussions (though you don’t have to have had a concussion to have CTE). CTE has gotten a lot of news attention from outlets like New York Times and BBC, talking about CTE in the context of professional football.

Truthfully, there is more that is unknown than known about CTE. At this point, we don’t know how much trauma causes CTE. Does age or stage in development at the time of trauma matter? What role do genetics or other health conditions play? CTE is an active area of research on a worldwide scale. Hopefully, we will know much more in the coming years. 

Q: Are there ways to protect ourselves from brain injury?

A: I tell patients and families to do everything they can to lower the risk of a TBI. For children, you and your child should always wear a helmet during activities where falls or collisions are likely. Families also must decide if they want their kids to play contact or collision sports. The risk for injury is certainly higher than if you avoid these activities. But there are also positive experiences from participation.

For older adults, falls are the most common cause of TBIs. To prevent falls, regular exercise can help make balance and coordination stronger. Remove any trip hazards or anything that may make you likely to slip. And make sure there are handrails and places to grab for support.

Other ways healthcare providers, patients and loved ones can help prevent and protect against brain injury include advocating for safer streets and sidewalks, improved safety rules and health protocols for youth and professional sports, firearm injury prevention, fall prevention programs and addressing the opioid epidemic.

Q: Why is Brain Injury Awareness Month in March important? What are some common myths or stigmas surrounding brain injury?

A: Brain Injury Awareness Month brings attention to a major public health issue. An estimated 1.7 million new brain injuries occur every year. These injuries are responsible for billions of dollars in medical care and lost production. And they can be devastating to the quality of life for both the injured person and those close to them. 

Many of the injuries are preventable. So, increasing awareness is a way we can hopefully lessen the impact of brain injury. A lot of people still don’t fully appreciate the effects of brain injury since you often can’t see them on the outside. This can make recovery more challenging for patients. 

I think one of the most misunderstood and under-recognized areas of brain injury is the association with mood disorders. It is very well-described in brain injury literature that patients frequently experience the onset of a new mood disorder or the worsening of pre-existing mood disorders after brain injury – particularly anxiety and depression.

Patients can also find it harder to control their emotions. They might have an extreme reaction or outburst at the grocery store, for example, if someone cuts them in line. Some brain injuries can dull the sense of awareness, or the filter people typically have before they express their emotions.

Identifying and treating these symptoms early can have a profound impact on the speed and direction of recovery.

How the Swedish Neuroscience Institute helps people with brain injury

At the Swedish Neuroscience Institute, neurology experts treat every type of brain injury. The Institute formed in 2004 to address the growing need for neuroscience services in the Pacific Northwest.  

The team of providers includes:

  • Neuro-Endocrinologists 
  • Neurologists
  • Neuro-Ophthalmologists
  • Neuropsychologists
  • Neurosurgeons
  • Otolaryngologists
  • Physiatrists (like Dr. Benson)
  • Physical, occupational and speech therapists
  • Sports medicine specialists

The Swedish Acute Rehab Unit at Cherry Hill treats patients in the early stages of recovery from all types of brain injury. The U.S. News and World Report recognized the facility for providing outstanding patient care.

Along with medical care, Swedish Neuroscience Institute offers several support groups for people recovering from brain injury and caregivers. Dr. Benson also recommends the Brain Injury Alliance of Washington as a community resource for patients and families. With the right treatment and support, patients and families can better understand how to live with and recover from a brain injury.

Find a doctor

If you have questions about brain injuries, contact the Swedish Neuroscience Institute. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

Additional resources 

Recovering from a health crisis, one step at a time

Is it a concussion? Know the signs.

Understanding chronic pain

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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About the Author

From deep brain stimulation to focused ultrasound to pediatric neurology, The Swedish Neuroscience Team is recognized as national experts to help people address a wide array of neurological conditions. Our goal is to provide useful and helpful advice and tips on non-surgical and surgical options to treat any disease of the mind.

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