Understanding the full spectrum of traumatic brain injury (TBI), its short- and long-term effects, and ways to treat or minimize those effects is an active area of research for the NICHD.
Institute Activities and Advances
A large portion of NICHD research on TBI is supported through the TBI and Stroke Rehabilitation (TSR) Program within the National Center for Medical Rehabilitation Research (NCMRR). Within the Division of Intramural Research (DIR), the Program on Pediatric Imaging and Tissue Sciences also conducts research on ways to evaluate TBI using imaging technology. For more information about this work, read the Program’s section of the DIR’s 2012 annual report at http://annualreport.nichd.nih.gov/ppits.html.
The TSR Program has supported several projects on treatment for TBI. A variety of treatments are known to promote recovery from the physical, emotional, and cognitive problems TBI may cause. The types and extent of treatments depend on the severity of the injury and its specific location in the brain. Some of these findings are described below.
Treatment for Mild TBI
Mild TBI, sometimes called concussion, may not require specific treatment other than rest. However, it is very important to follow a health care provider's instructions for complete rest and gradual return to normal activities after a mild TBI. If a person resumes normal activities and starts experiencing TBI symptoms, the healing and recovery process may take much longer than if he or she had followed the health provider's instructions. Certain activities, like working on a computer and concentrating hard, can tire the brain even though they are not physically demanding. The person with the concussion might need to reduce these kinds of activities or might need to rest between periods of such activities to let the brain rest. In addition, alcohol and other drugs can slow recovery and increase the chances of re-injury.1
Children and teens who may have sustained a concussion during sports should stop playing immediately. They should not return to play until a health care provider who is experienced in evaluating concussion confirms they are ready. Re-injury during recovery can slow healing and increase the chances of long-term problems. On rare occasions in which a person gets another concussion before healing from the first one, permanent brain damage and even death may result.2
Emergency Treatment for TBI
In most cases, emergency care focuses on stabilizing the patient and promoting survival. This care may include ensuring adequate oxygen flow to the brain, controlling blood pressure, and preventing further injury to the head or neck.3 Once the patient is stable, other types of care for TBI and its effects can begin.
Surgery may be needed as part of emergency care to reduce additional damage to the brain tissues. Surgery may include:
- Removing clotted blood. Bleeding in the brain or between the brain and skull can lead to large areas of clotted blood, sometimes called hematomas (pronounced hee-ma-TOH-muhz), that put pressure on the brain and damage brain tissues.3
- Repairing skull fractures. Setting severe skull fractures or removing pieces of skull or other debris from the brain can help start the healing process of the skull and surrounding tissues.4
- Relieving pressure in the skull. Making a hole in the skull or adding a shunt or drain can relieve pressure inside the skull and allow excess fluid to drain.5
Medications may be used to treat symptoms of TBI and to lower some of the risks associated with it. These medications may include, but are not limited to:
- Anti-anxiety medication to lessen feelings of nervousness and fear
- Anticoagulants (pronounced an-tee-koh-AG-yuh-luhnt)to prevent blood clots
- Anticonvulsants (pronounced an-tee-kuhn-VUHL-suhnt) to prevent seizures
- Antidepressants to treat symptoms of depression and mood instability
- Diuretics (pronounced dahy-uh-RET-ikz) to help remove fluid that can increase pressure inside the brain3
- Muscle relaxants to reduce muscle spasms
- Stimulants to increase alertness and attention6
Researchers continue to explore medications that may aid recovery from TBI. For example, an NICHD study is investigating the effectiveness of citicoline, a drug that may help protect neurological functioning.7 Read more about the citicoline study.
Therapies can help someone with TBI relearn skills such as walking or cooking, or develop strategies for self-care, such as making lists of the steps involved in getting dressed. Rehabilitation can include several different kinds of therapy for physical, emotional, and cognitive difficulties. Depending on the injury, these treatments may be needed only briefly after the injury, occasionally throughout a person's life, or on an ongoing basis.
Types of therapies for TBI
Most people with a moderate to severe brain injury will need some type of rehabilitation therapy to address physical, emotional, and cognitive issues from the TBI. Therapies will likely include relearning old skills or learning new ways to make up for lost skills. A treatment program should be designed to meet each person's specific needs and to strengthen his or her ability to function at home and in the community.8
Therapy usually begins in the hospital and can continue in a number of possible settings, including in a skilled nursing facility, at home, in a school, and in an outpatient program at a clinic. Therapy can be brief or long-term, depending on the type of injury, and it may need to change over time. Rehabilitation generally involves a number of health care specialists, the person's family, and a person who manages the team,8
Types of rehabilitation therapy may include:
- Physical therapy. This treatment works to build physical strength, coordination,and flexibility.
- Occupational therapy. An occupational therapist helps a person learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing.
- Speech therapy. This therapy works on the ability to form words and other communication skills as well as how to use special communication devices if necessary. Speech therapy can also include evaluation and treatment of swallowing disorders (dysphagia).
- Psychological counseling. A counselor can help a person learn coping skills, work on relationships, and improve general emotional well-being.
- Vocational counseling. This type of rehabilitation focuses on a person's ability to return to work, find appropriate opportunities, and deal with workplace challenges.9,10
- Cognitive therapy. This includes activities designed to improve memory, attention, perception, learning, planning, and judgment.11
For many people with TBI, cognitive therapy is among the most common types of rehabilitation.
Other Activities and Advances
- The NICHD supported the TBI Clinical Trials Network and its efforts to conduct large-scale randomized clinical trials on various aspects of and treatments for TBI. The Network no longer receives funding from the NICHD, however analysis of data from its projects is still ongoing.
- The NICHD provides several Resources Related to TBI (PDF - 47 KB) to assist patients and families with finding the services or care they need. Please note that this list is not comprehensive, but is intended to provide a starting point for those looking for information and assistance.
- Centers for Disease Control and Prevention. (2010). Concussion: Feeling better. Retrieved May 24, 2012, from http://www.cdc.gov/concussion/feel_better.html [top]
- Centers for Disease Control and Prevention. (2012). Concussion in sports. Retrieved May 24, 2012, from http://www.cdc.gov/concussion/sports/response.html [top]
- National Institute of Neurological Disorders and Stroke. (2012). Traumatic brain injury: Hope through research. Retrieved May 24, 2012, from http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm [top]
- American Association of Neurological Surgeons. (2011). Traumatic brain injury. Retrieved June 13, 2012, from http://www.aans.org/Patient Information/Conditions and Treatments/Traumatic Brain Injury.aspx [top]
- MedlinePlus. (2010). Subdural hematoma. Retrieved June 13 , 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/000713.htm [top]
- Brain Injury Association of America. Living with brain injury: Treatment. Retrieved May 24, 2012, fromhttp://www.biausa.org/brain-injury-treatment.htm [top]
- National Institute of Child Health and Human Development. (2011). Brain injury awareness month: NICHD research on traumatic brain injury (TBI).Retrieved May 24, 2012, from http://www.nichd.nih.gov/news/resources/spotlight/Pages/031510-TBI.aspx [top]
- National Institutes of Health. (1999). NIH consensus development conference statement: Rehabilitation of persons with traumatic brain injury. Retrieved May 24, 2012, from http://www.nichd.nih.gov/publications/pubs/TBI_1999/Pages/NIH_Consensus_Statement.aspx [top]
- Mayo Clinic. (2010). Traumatic brain injury. Retrieved May 24, 2012, from http://www.mayoclinic.com/health/traumatic-brain-injury/DS00552/DSECTION=treatments-and-drugs [top]
- American Academy of Family Physicians. (2010). Traumatic brain injury: Treatment. Retrieved May 24, 2012, from http://familydoctor.org/familydoctor/en/diseases-conditions/traumatic-brain-injury/treatment.html National Institute of Child Health and Human Development. (2011). Brain injury awareness month: NICHD research on traumatic brain injury (TBI).Retrieved May 24, 2012, from http://www.nichd.nih.gov/news/resources/spotlight/Pages/031510-TBI.aspx [top]