A Guide to Occupational Therapy for TBI (Traumatic Brain Injury)
A traumatic brain injury (TBI) is a condition caused by a traumatic event that results in physical damage to the brain. Common causes of TBI include motor vehicle accidents, falls, and explosive blasts.
Traumatic brain injury is a leading public health concern across the world. Over 1% of the US population is living with a TBI-related disability1 — with that percentage projected to keep growing in the next decade.2 TBI is linked to long-term cognitive dysfunction, disability, substance abuse, and mental health concerns like depression.3
Physical therapy and occupational therapy help individuals affected by TBI regain lost motor skills and daily function. This guide will provide an overview of the symptoms, causes, diagnosis, treatment, and prevention of TBI.
- Understanding Traumatic Brain Injury
- Symptoms of Traumatic Brain Injury
- What are the Most Common Causes of Traumatic Brain Injury?
- Diagnosing TBI
- What to Expect from Physical Therapy and Occupational Therapy
- The Stages of TBI Rehabilitation
- Preventing TBI
- Is It Time to Seek Treatment?
A traumatic brain injury occurs when something external, such as a blow to the head or an object penetrating the skull, damages the brain. TBI can range from mild (concussion) to severe (coma). The severity of TBI depends on the extent of damage and which areas of the brain were affected upon impact.
Regardless of severity, deficits can linger chronically long after an injury occurs (one year and far beyond). Newer theories have also demonstrated that a brain injury can continue to cause neurological degenerative changes for years, or even decades, to come.4
The symptoms of mild to severe TBI can vary in intensity and duration depending on the severity of the injury. Around 80% of TBIs are considered mild.5 Typically, TBI will result in physical, cognitive, and emotional changes.
Symptoms may involve any of the following (ranging from least disruptive to most debilitating):
- Blurred vision
- Slurred speech
- Memory loss
- Difficulty concentrating or paying attention
- Sensory deficits (vision, hearing, smell)
- Difficulty with speech (motor and cognitive related)
- Mood swings and irritability
- Anxiety or depression
- Motor deficits (paralysis, tremors, balance, etc.)
If you sustain a head injury, please seek medical care immediately.
The most common causes of TBI include motor vehicle accidents, assault, gun-related injury, and falls. Let's review what the top causes are based on the two most commonly affected age groups:
- Adolescents ages 15 to 19 are most likely to sustain a TBI from an automobile accident, sports activity, or by being struck in the head.5
- Adults aged 65 and older are the most affected age group for TBI, with the biggest risk factor being falls. Particularly in the aging population, falls continue be a growing concern and cause of TBI.2
Risk Factors for TBI
Besides certain age groups, there are also behaviors and conditions that can increase the risk of sustaining a TBI. These include:
- Participating in contact sports or high-speed activities (like riding a motorcycle or skiing)
- Not wearing protective gear (such as helmets and seatbelts)
- Alcohol or drug use
- Certain medical conditions (seizure disorders, cardiac diseases)
- Males are two times more likely to sustain a TBI than females5
- Excessive degenerative changes with age, such as poor balance, bone health, vision changes, and cognitive deficits
- Military personnel
- A victim of domestic violence or abuse
Unfortunately, a large number of TBI cases go undiagnosed each year. Diagnosing a mild to moderate TBI can be difficult to diagnose because symptoms may not appear immediately after an injury. It is important to monitor for any changes in motor, cognitive, and emotional functions that may arise after an injury or fall has been sustained.
For severe cases, a trip to the emergency room is typical. At the hospital, doctors will likely use imaging scans (CT/MRI) to assess the physical damage caused by the injury. In particular, they are looking for secondary tissue damage such as hemorrhage, edema, vascular injury, and increased intracranial (skull) pressure.
Additional neurological tests, such as cognitive and speech assessments, may be used to further understand the extent of damage. Plus, your doctor will closely monitor your symptoms for changes, as development can be latent.
The Need for Integrative Care
With moderate to severe cases where there are clear deficits present, an integrated approach is important. A team of healthcare professionals will help to optimize recovery potential at all stages. The treating team will likely include a range of professions including: neurosurgeons, primary care providers, physical therapists, occupational therapists, neuropsychologists, social workers, and speech language pathologists.
The goal of physical therapy and occupational therapy following a TBI is to help the patient regain as much function and independence as possible, while also prevent the risk of further neurodegeneration.4 Every patient is different, so the specific treatment plan will be tailored to the individual.
Research is lacking in the TBI space, making most treatment recommendations based off of other neurological disorders, such a stroke. In general, treatment strategies that are utilized include sensory stimulation, casting/splinting, exercise or aerobic training and functional or adaptive skill training. More specific treatments that you may encounter include proprioceptive neuromuscular facilitation (PNF), mirror therapy, and the Bobath technique.
Where you begin your recovery process will depend on the severity of your ongoing symptoms and functional deficits. For moderate to severe cases (that typically starts at the hospital), you can expect to follow a continuum of care similar to the following:
Acute Care/Inpatient Rehabilitation
Following TBI, patients typically require at least a few days in the hospital for close medical monitoring and management. At this time, physical therapists will play an important role in bed positioning to reduce the risk of bed sores, gentle exercise (in bed or seated, if appropriate), and other comfort measures. For patients with more severe deficits, they may be transferred to an inpatient rehabilitation facility (IRF) for daily intensive therapy services where they will work with physical therapy, occupational therapy, and speech therapy.
After being discharged from the hospital or IRF, patients continue their recovery through a variety of options. These include home therapy, outpatient therapy, or continued intensive care in a skilled nursing setting. The number of therapy sessions and frequency will be determined by the patient's progress, tolerance for activity, and insurance coverage.
Community Reintegration and Long-term Management
The final stage of post-TBI rehabilitation doesn't have a defined beginning or end. Rather, it focuses on helping the patients return to their daily life and routines. This includes things like returning to work, getting back behind the wheel, or adjusting to any permanent changes in physical (and cognitive) function. Patients will also need to continue monitoring their health long-term and managing any new risk factors to prevent long-term complications.
This final stage is often neglected due to exhaustion of insurance funding or a lack of progress that an insurance company deems "significant" enough to continue. Yet, remember that even small gains in function can greatly improve your quality of life. It's important to set goals with your care team that are realistic and attainable to help you stay motivated throughout your recovery.
An important component of managing TBI is not just treatment, but prevention. Some things you can do reduce your overall risk include:
- Wear a helmet while on a bicycle, all-terrain vehicle or horse
- Make your home safer by installing handrails in the bathroom, removing tripping hazards, and keeping walkways well lit
- Avoid horseplay and roughhousing that could lead to head injuries
- Follow the rules of whatever recreational activities you participate in
- Exercise to promote agility and mental acuity for reducing the risk of falls
- Educate teens (and other adults) about avoiding high risk activities, including driving distracted or under the influence of drugs or alcohol
- Prioritizing mental health with professional support for issues like depression, anxiety, and more — to reduce to risk of self-inflicted injury and suicide
- Be able to diffuse disputes or fighting, particularly among family, that could otherwise escalate to assault
- Provide access to safe houses in communities for family members to take a time-out and prevent the incidence of assault
If you or someone close to you has experienced a TBI, it is important to seek medical attention immediately. With the right management and treatment — including physical therapy and occupational therapy — you can reduce symptoms, improve function, and get back to your favorite activities and daily routine.
No matter how long ago you experienced a head injury, if you are dealing with symptoms, there are therapy treatments that can address your impairments and help improve your quality of life — even if it's yeas later.
Once you are post-acute and need further support for lingering symptoms, a CityPT clinician can be an excellent guide in continuing your recover journey. Book an appointment.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Zaloshnja E, Miller T, Langlois JA, Selassie AW. Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005. J Head Trauma Rehabil. 2008;23(6):394–400. https://journals.lww.com/headtraumarehab/Abstract/2008/11000/Prevalence_of_Long_Term_Disability_From_Traumatic.5.aspx ↩
Chan V, Toccalino D, Omar S, Shah R, Colantonio A. A systematic review on integrated care for traumatic brain injury, mental health, and substance use. PLoS One. 2022 Mar 3;17(3):e0264116. doi: 10.1371/journal.pone.0264116. PMID: 35239715; PMCID: PMC8893633. https://pubmed.ncbi.nlm.nih.gov/35239715/ ↩
Sharma, B., Changoor, A.T., Monteiro, L. et al. The scale of neurodegeneration in moderate-to-severe traumatic brain injury: a systematic review protocol. Syst Rev 8, 332 (2019). https://doi.org/10.1186/s13643-019-1208-0 ↩ ↩2
Georges A, M Das J. Traumatic Brain Injury. [Updated 2022 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459300/ ↩ ↩2 ↩3