What are the treatments for traumatic brain injury (TBI)?

Mild TBI, sometimes called concussion, may not require specific treatment other than rest. However, it is very important to follow a healthcare provider’s instructions for complete rest and slow return to normal activities after a mild TBI. If a person returns to their normal activities too soon and starts experiencing TBI symptoms, the healing process may take much longer. Certain activities, such as working on a computer and concentrating hard, can tire the brain even though they are not physically demanding. A person with a concussion might need to reduce these kinds of activities or take frequent breaks to let the brain rest.

In addition, alcohol and other drugs can slow recovery and increase the chances of re-injury.¹ Re-injury during recovery can slow healing and increase the chances of long-term problems, including permanent brain damage and even death.²

Emergency care generally focuses on stabilizing and keeping the patient alive, including making sure the brain gets enough oxygen, controlling blood and brain pressure, and preventing further injury to the head or neck.³ Once the patient is stable, other types of care for TBI can begin.

Sometimes surgery is needed as part of emergency care to reduce damage to the brain. Surgery may include:

• Removing blood clots or pools. Bleeding in the brain or between the brain and skull can lead to large areas of clotted blood, sometimes called hematomas. These areas of clotted or pooling blood put pressure on the brain and can damage brain tissues.¹
• Repairing skull fractures. Setting severe skull fractures or removing pieces of skull or other debris from the brain area can help start the healing process of the skull and surrounding tissues.³
• Relieving pressure inside the skull (called intracranial pressure or ICP). Increased pressure from swelling, blood, and other things in the skull damage the brain. A TBI patient’s ICP is monitored during emergency care. In some cases, making a hole in the skull or adding a shunt or drain is needed to relieve pressure inside the skull and allow excess fluid to drain.⁴

Medications can help treat symptoms of TBI and lower the risk of some conditions associated with it. Some medications are useful immediately after a TBI, while others treat symptoms and problems related to recovery from TBI some time after the initial injury. These medications may include:

• Anti-anxiety medication to lessen feelings of nervousness and fear
• Anticoagulants to prevent blood clots and improve blood flow
• Anticonvulsants to prevent seizures
• Antidepressants to treat symptoms of depression and mood instability, also called mood swings
• Diuretics to help remove fluid that can increase pressure inside the brain¹
• Muscle relaxants to reduce muscle spasms and to relax constricted muscles
• Stimulants to increase alertness and attention⁵

Researchers continue to explore medications that may aid recovery from TBI.

Therapies can help people with TBI recover functions, relearn skills, and find new ways to do things that take their new health status into account. Rehabilitation can include several different kinds of therapy for physical, emotional, and cognitive difficulties and for a variety of activities, such as daily self-care, driving, and interacting with others. 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.

Therapy usually begins in the hospital and can continue in a number of places, including rehabilitation hospitals, skilled nursing facilities, homes, schools, and outpatient programs. Rehabilitation generally involves a number of healthcare specialists, the person’s family, and someone who manages the team.⁶ They often work together to design a treatment program to meet a person’s specific needs and to improve his or her abilities to function at home and in the community.

Rehabilitation therapy may include the following⁷:

• Physical therapy to build physical strength, balance, and flexibility and to help restore energy levels
• Occupational therapy to learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
• Speech therapy to improve the ability to form words, speak aloud, and use other communication skills; can include instruction on how to use special communication devices and treatment of trouble swallowing, called dysphagia
• Psychological counseling to learn coping skills, work on interpersonal relationships, and improve general emotional well-being; can include medication and other ways to address chemical imbalances that may result from TBI
• Vocational counseling to help a patient return to work and community living by finding appropriate work opportunities and ways to deal with workplace challenges
• Cognitive therapy to improve memory, attention, perception, learning, planning, and judgment