Symptoms of traumatic brain injury (TBI) tend to be primarily related to cognitive or thinking deficits involving the frontal and temporal brain areas as a result of biomechanical forces that involve the bone and soft tissue of the head. Motions of acceleration and/ or deceleration result in various brain injuries from skull fracture to hematomas to contusions to cerebral swelling to diffuse axonal injury; changing brain processes and producing alterations on a cellular level. Such alterations leave individuals at risk for early onset dementia and increased immune system vulnerability. There can be coup-contrecoup injury involving brain areas that did not sustain a direct blow. As a result of the complexity of these changes that occur on a cellular level over time it is not unusual to find delayed cognitive changes years post-injury. Diffuse cellular changes can result in increased brain sensitivity to secondary ischemic insult. Molecular events such as elevated cytokines, changes in neurotrophic factors can result in increased oxidative stress which affects the brain even further in a continual cascade of events. Even mild TBI (when there is no skull fracture, no diagnosed concussion or loss of consciousness) can create the above scenario.

It is important not to dismiss an injury just because there are no observable deficits immediately following that injury. It is not uncommon for people to find that they have significant memory problems six months or longer after a brain injury has occurred. Depending upon their job status and a host of individual variables, people may not become immediately aware of a memory problem. Understandably, those recovering from a traumatic injury would not want to acknowledge cognitive deficits that may confirm compromised functioning. Generally individuals who have sustained a brain injury would rather pick up the pieces of their life and move on, forgetting this traumatic event as quickly as possible. Finally, I summarize the words of my professor in one of my first classes in brain injury, What we know about the brain today clearly changes tomorrow. Mild head injury or any head injury cannot be dismissed as non-significant without neuropsychological evaluation completed post-injury and repeated successively over a period of several years.

Symptoms of TBI:

The executive reasoning, frontal processes have the following jobs to perform in the brain:

  • The supervisory system
  • The communication manager
  • The director of operations

The temporal or memory processes have the following jobs to do in the brain:

  • Register new information into short and eventually long term memory
  • Create memory compartments for retrieval (recall), recognition, or storage (long-term or delayed memory recall) to occur.

The following common executive reasoning symptoms can be readily observable when frontal processes are impaired:

  • Difficulty making any kind of decision, from ordering in a restaurant to setting priorities for the day
  • Knowing what you want to do but being unable to accomplish the task due to being continually distracted by something else
  • Difficulty starting anything, a general lack initiative, decreased spontaneity and productivity, loss of ambition and overall general apathy
  • Problems prioritizing attention, determining the importance or relevance of any given event
  • Difficulty determining what is important in life and what is not important, focusing on inconsequential items or issues
  • Chronically confused, distracted by irrelevant information on a continual basis, the busier the environment, the worse this becomes
  • Easily overwhelmed by too much information, feeling constantly bombarded by information from internal thoughts and the external environment (with the tendency to confuse these two sources of information)
  • Difficulty differentiating reality from internal thoughts, internal thoughts leading to increased emotional lability (reactivity)
  • Suspicious, paranoid thoughts regarding the actions of others
  • Tendency to bounce from one uncompleted topic or sentence making everyday conversation confusing and frustrating
  • Tendency for misconstrued or misperceived conversations
  • Diminished ability to regulate emotions, to modulate or control
  • Increased emotional sensitivity and fragility despite a hard shell on the outside
  • Difficulty adjusting behavior to the environmental setting
  • Sundowner’s syndrome, things become worse at night
  • Difficulty benefiting from feedback to fix mistakes or errors
  • Difficulty generating alternative solutions to problems
  • Problems seeing or understanding sequential order
  • Difficulty anticipating consequences of one’s behavior
  • Difficulty planning ahead for events
  • Difficulty predicting the future, if this… then that
  • Deficient self-awareness and difficulty appreciating the impact upon others
  • Difficulty taking the emotional perspective of another person to understand their feelings
  • Rigid thinking, difficulty thinking in a flexible manner leads to becoming stuck or perseveration
  • Tendency to maintain assumptions once they are made without considering other perspectives
  • Difficulty with the integration of concepts to generalize and apply newly learned concepts
  • Tendency to be more concrete, difficulty with the abstract
  • Daily fatigue due to energy needed to get through the day

The following common symptoms can be readily observable when memory/temporal processes are impaired:

  • Forgetting day-to-day things such as appointments, objects, relying more upon notes to remember
  • Forgetting to turn items off from the lights to the stove or the iron. Missing directions, forgetting a turn in a route taken everyday or skipping a step in the completion of a routine task.
  • Short term memory, loss of details of everyday events
  • Difficulty recalling tasks completed at work, promises made, papers sent, jobs completed, phone messages, task instructions, mistakes become frequent
  • Lack of awareness of time, poor time management
  • Emotional lability or flattened emotional state
  • Increased depression that is brain driven
  • Difficulty temporally integrating events and actions limits decision-making skills using future tense

Emotional symptoms that commonly accompany a brain injury:

  • Overall deepened emotionality, becoming overly sensitive and emotionally reactive without rhyme or reason
  • Behavior is unexplained, often bizarre and unrelated to life events
  • Disorientation, confusion and emotional outbursts that are not remembered
  • Easily frustrated, restless and agitated
  • More quiet and introverted
  • Trauma related to the accident, accentuated by dreams and difficulty with sleep onset
  • Feeling highly stressed
  • Feeling nothing and not caring about anything
  • Socially uncomfortable and acutely aware of emotional reactions towards others
  • Acting more immature
  • Increased paranoia
  • Loss of inhibition, former personality returns if extreme
  • Lack of insight in terms of emotional impact upon others and the consequences
  • Poor personal regulation
  • Difficulty with social cues and subtleties of social conversation
  • Blunting of emotions or more melodramatic
  • Loss of a sense of self, loss of one’s personal history, beliefs and values

Physical symptoms that are more often seen following a traumatic brain injury:

  • Daily headaches
  • Excessive tiredness, drained of energy
  • Fluctuating appetite
  • Muscles tired
  • Hearing problems, ringing or buzz in ears
  • Balance problems.
  • Poor coordination for sports, poor reaction time
  • Problems seeing, blurring of vision, visual neglect
  • Vertigo
  • Continual, unrelieved pain
  • Poor sleep due to pain

We offer a cognitive/brain training program at United Psychological Services for TBI, targeting executive reasoning, memory and visual perceptual processes, see article on Non-Medical Treatment of any Brain Injury or Dementia offered on this website.