The introduction of COVID-19 to the human population around 

December 2019 has resulted in a pandemic that continues to affect 

the entire world. While research to date has focused on potential 

neurological impairment to COVID-19 patients, little attention has 

been placed on the effects of the fallout caused by COVID-19 on 

individuals who are living with brain injury. Specifically, the 

pandemic has resulted in job loss, social isolation, interruptions to 

routine, and a need to adjust previously successful compensatory 

strategies, all highlighting some of these unique challenges. The 

general population has experienced the same issues. However, 

individuals with brain injury were already experiencing these prior to 

the pandemic. Examples of this include: 

More than 70% of individuals with brain injury experience a 

deterioration in their social lives following brain injury. 

Approximately 50% of individuals with brain injury experience 

depression within the first year following brain injury; 

approximately two thirds are affected even seven years postinjury. (Headway.org: The Debilitating Impact of Social Isolation;

headway.org.uk/about-brain-injury/individuals/brain-injury-and-me/thedebilitating-impact-of-social-isolation)

The pandemic has exacerbated these issues and has challenged the 

compensatory strategies that people have developed post-injury to 

cope with their impairments. 

Brain Injury and COVID-19: 

Tips for Successful Navigation 

April 2021
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 2 

The 

Research

Researchers at the New York Traumatic Brain Injury 

Model System at Mount Sinai and the Northern New 

Jersey TBI Model System at Kessler Foundation are 

leading an effort to better understand the impact of 

the COVID-19 pandemic on those living with brain 

injury. These researchers are surveying individuals 

with brain injury and asking key questions about 

their experiences as they are navigating the COVID19 world. Some of these questions include: 

 How isolated or cut off from family and friends

are you feeling due to COVID-19?

 How disruptive has the COVID-19 pandemic

been to your everyday life?

 Since the start of COVID-19, how often have

you felt that you were unable to control the

important things in your life?

 Have you noticed any changes in your

memory and thinking, depression, anxiety, or

behavioral symptoms since the COVID-19

pandemic began?

The study—which is funded by the National 

Institute on Disability, Independent Living, and 

Rehabilitation Research (NIDILRR)—is ongoing; 

however, preliminary results suggest that the 

impact of the pandemic—including social isolation, 

disruption to daily life, and effect on cognition—is 

great for those who have lived experiences with 

brain injury. This proves true whether the person 

has had COVID-19 or not.
Most of the survey respondents to date indicate that 

they feel isolated from family and friends. 

Additionally, 92% of the respondents indicated that 

the pandemic has been disruptive to their daily 

lives, and 55% stated that since the start of COVID19 they have felt unable to control the important 

things in their lives ranging from “sometimes”, “fairly 

often”, to “very often.” 

The Traumatic Brain Injury Technical Assistance 

and Resource Center (TBI TARC), funded by the 

Administration for Community Living, sought to 

better understand how people with brain injury have 

been affected by COVID-19. To that end, TBI TARC

interviewed five members of the TBI Advisory and 

Leadership (TAL) group. The purpose of the TAL 

group is to guide the priorities of TBI TARC. TBI 

TARC asked the following questions of the five TAL 

group members: 

Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 3 

1. How has COVID impacted you personally?

2. How has COVID impacted you professionally?

3. What would you want to share with others

about your experience?

4. Are virtual supports helpful?

The goal was to understand the effects of COVID 

for these members and to gain insight related to 

how they were navigating these effects. What 

resulted is an understanding of the resiliency and 

ingenuity of these individuals. The following are 

highlights of the themes that emerged from these 

interviews.
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 4 

Common 

Themes 

Social isolation has been the biggest challenge. 

This is already a common issue for individuals with 

TBI, and further separation from family, friends and 

coworkers has been extremely overwhelming. 

Those who appear to be coping well are either 

setting up new, or attending existing, networks and 

support groups to connect with other survivors. 

These networks have largely moved to a virtual 

format. However, at least one member talked about 

forming a pod with a few friends to help reduce the 

isolation. Talking about the stress of social isolation 

has been therapeutic.

The ability to handle change is a trademark 

challenge that accompanies brain injury. The 

abrupt and monumental amount of change 

caused by the pandemic has introduced or 

heightened existing feelings of anxiety. 

Regardless of the length of time since injury,

individuals who have sustained a TBI were 

surprised at how quickly change brought about a 

feeling like “experiencing a new TBI all over again.” 

For many, this element has required accessing old 

information learned through compensatory 

strategies and putting it into practice, potentially in 

new ways, to be able to effectively cope. 
Individuals who are responsible for older adult 

dependents in their household experienced 

challenges managing healthcare needs for 

others as well as for themselves. Access to 

home health staff has been reduced, which has 

placed additional burdens on individuals with brain 

injury to manage their own healthcare needs or the 

needs of others in the household. COVID-19 has 

not only restricted access for the individual, but it 

also restricted access for those requiring outside 

care. 

For survivors with children, managing home 

school measures has been equally challenging. 

The change of having children (or spouses) at home 

all day has caused issues, and individuals with brain 

injury feel poorly equipped to manage at-home 

academic approaches. The routine of their days has 

been thrown off, which for some, has made their 

existing/usual compensatory strategies less 

effective.

Fatigue has increased, at least initially; there 

was a greater need for more rest throughout the 

day in order to cope. Medication dosage has 

been increased for emotional or physical issues 

(depression, seizures, etc.). Interestingly, a 

decrease in driving has been helpful for some in 

terms of having energy to handle other things while 

at home.

Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 5 
Although COVID-19 has resulted in more 

depression and anxiety, it has also created a 

slower pace, and there is more time to be able to 

address these challenges; more time is 

available to manage daily tasks and to explore 

academic, employment and recreational 

pursuits. 

Strong family and friend supports are critical, 

regardless of age or length of time post-injury. 

Support systems are also stressed which makes 

caregiving, at times, more challenging.

Business staff reductions and closures have 

created additional financial and emotional 

impact. Individuals with brain injury or 

partners/spouses have lost employment and have 

had changes in household income and even 

healthcare access. Individuals with TBI are 

disparately impacted economically; household 

income changes have caused additional stress and 

burden. Financial hardship has caused individuals 

to learn to be more creative (accessing food banks, 

selling clothes and other property).

There have been challenges with accessing 

support for medical needs, substance use or 

mental health counseling. Some have expressed 

that ultimately, access to therapeutic or medical 

interventions through telehealth has been very 

useful and hope that virtual health solutions will 

continue. Additionally, accessing community 

supports/programs can be helpful.

Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 6 
With the heavy reliance on technology to access 

supports virtually, individuals with TBI have had 

to become more comfortable with learning a 

variety of platforms and applications. They have 

also had to learn more about online etiquette and 

strategies for managing virtual meetings. For 

some, it is much easier to participate in virtual 

meetings when everyone can see and be seen 

rather than phone calls. Others have found it to be 

initially overwhelming and have had to incorporate a 

number of strategies to manage this. 

Coping Tips

It is important to note that just as no two people are 

alike, there is not a single set of strategies that works 

for everyone. However, the strategies presented on 

the following pages can be beneficial for many 

individuals living with brain injury. 

Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 7 
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 8 

General Strategies

 Everybody has different strengths and abilities.

Get to know your strengths and use them. If it is

difficult for you to recognize your strengths, ask

family or friends what they have observed.

 Everyone asks for help at some point. If you do

not know the answers or need help, ask

someone. It is ok to be unsure, to have needs,

and to express them.

 Being involved is important and may make you

feel better by improving social skills and

increasing social reintegration. If you are

struggling to learn how to get involved, reach out

to your local brain injury alliance, association, or

head injury foundation as they will often have

support groups, programs, or suggestions for

you.

 Creative writing, games, cooking classes, art

classes, music all can be helpful to staying busy

and expanding your experiences as well as for

positive mental health. Do not be afraid to try

something new. However, don’t push yourself too

hard if symptoms flare.

 Try to find what makes you laugh; comedy is a

healthy tool and a mood lifter that last long after

the laughter does.

 Finding things to be grateful for and focusing on

others instead of self will help. Expressing this

gratitude can be uplifting.
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 9 

 Having a routine is important. A daily schedule

can increase productivity, help manage stress,

and enable progress towards short-term and

long-term goals. Your routine might change

during the COVID-19 pandemic; be open to the

changes.

 Exercise is critical. It helps with physical and

mental health, lifting a person’s mood, improving

balance and fatigue issues, and increasing selfesteem. There are ways to stay active, no matter

your state of recovery.

 Facebook Groups, Instagram, and other social

media platforms can be incredibly helpful

resources for TBI specific information and for

uplifting/motivating you personally.

 Take time to self-reflect and try things previously

not experienced.

 Feel thankful for the things that are going well

rather than focus on issues or needs.

 Just talking about the challenges that COVID

with another person is useful.

 Resist becoming isolated. If you feel the desire to

self-isolate, tell someone.

 Remain patient and try to be more mindful.

Suggestions for mindfulness can include

intentional breathing exercises, practicing

positive affirmations, practicing guided

meditations, and connecting with nature.
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 10

 Change your perspective, for example see

having a lack of memory as a bonus: when

things are over, they can be forgotten.

 Be happy in any situation and decide how to be

happy with yourself.

 Express gratitude for your support system; that

helps everyone.

 Become a stronger advocate. Take advantage of

opportunities in community advocacy skills

building and leadership training to learn more.

 Do small things to make others smile; it will also

help your own frame of mind.

 Smile yourself! Smiling elevates mood, relaxes

the body, and reduces physical pain.
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 11

Technological Tips & Strategies

 Change phone, laptop, or platform background

colors to blue and white or greyscale which can

be easier to process and reduce eye strain.

 Manage texts and emails in small amounts rather

than all at once throughout the day if possible.

 Increase the spacing or size of documents on the

computer to make information easier to digest.

Changing your computer screen size might also

be useful.

 Apply the 20 minutes on, 20 minutes off, rule to

technology; it can help reduce cognitive fatigue.

For eye strain, consider looking away at

something that is 20 feet from you for a total of

20 seconds, and do this every 20 minutes.

 Virtual meetings can cause difficulties integrating

and prioritizing all the features at one time. It can

be a good practice to physically cover the chat

feature, or only focus on one aspect of a virtual

meeting at a time. It is difficult at times to

determine which is most important, the slides or

the speaker.

 Be aware of your surroundings and tune into

things that can create sensory distractions, such

as fans and other background items.

 During virtual meetings, ask people to minimize

their movement and backlighting (e.g., people

walking by, moving a device that jiggles the

camera).
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 12

 Use natural light when possible, or if not, bring in

incandescent lighting and turn off fluorescent

lights.

 Do not hesitate to ask for more details (notes,

outlines, recordings, other materials) before

and/or after a meeting.

 Ask others to introduce themselves and to please

refrain from using acronyms.

 Practice with your devices before joining a

meeting or call so you are fully comfortable with

the settings that work for you.
Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 13

Additional Resources Used 

by Participants

1. Accessible Technology, University of Colorado Boulder, Office of

Integrity, Safety and Compliance, 25 Mar. 2020, Zoom

Accessibility Best Practices (colorado.edu/accessibletechnology/resources/zoom-accessibility-best-practices)

2. Depression and Anxiety Resources from Friendly Harbor

Community Center (friendlyharborpueblo.org), a peer-run

organization

3. Brain Injury Association of Virginia, Going Virtual A Tip Sheet

Series: Effective Video Conferencing Tips for Persons with Brain

Injury (biav.net/wp-content/uploads/2020/08/2020.0630-GoingVirtual-Tip-Sheet-Series-Part-1-for-PWBI.pdf)

4. Brain Injury Association of Virginia, Going Virtual A Tip Sheet

Series: Hosting a Video Conference Tips for Support Group

Leaders (biav.net/wp-content/uploads/2020/08/2020.0630-GoingVirtual-Tip-Sheet-Series-Part-2-for-SG-Leaders.pdf)

5. Hammond, Flora, et al. Getting the Most out of Your Telehealth

Visits (archives-pmr.org/action/showPdf?pii=S0003-

9993%2820%2931218-1). Archives of Physical Medicine and

Rehabilitation, 102(2)

6. How to Zoom: User-friendly instructions (frnohio.org/productsmedia/). Prepared by Andrew Buck & Christine Brown (The Ohio

State University Nisonger Center Rehabilitation Research and

Training Center on Health and Function), Tracey Manz (Nisonger

Center Family Resource Network of Ohio and Aspirations), Dana

Charleton (Ohio Self-Determination Association)
o Join a Zoom Meeting from an Email Message - Part 1 of 4

(nisonger.osu.edu/wp-content/uploads/2020/04/1.-Join-aZoom-Meeting-from-an-Email-Message-Part-1-of-4-.pdf)

o Set up Sound and Video in a Zoom Meeting - Part 2 of 4

(nisonger.osu.edu/wp-content/uploads/2020/04/2.-Set-UpSound-and-Video-in-a-Zoom-Meeting-Part-2-of-4.pdf)

o Zoom Meeting Controls (Buttons) - Part 3 of 4

(nisonger.osu.edu/wp-content/uploads/2020/04/3.-ZoomMeeting-Controls-Buttons-Part-3-of-4.pdf)

Brain Injury and COVID-19: Tips for Successful Navigation 

April 2021, TBI TARC | tbitarc@hsri.org 14

7. BrainSTEPS, Online Learning for Students with Brain Injury –

2020 (brainsteps.net/_corbs/ about/BrainSTEPS.Adjustments.

Online.Learning.pdf) Academic adjustments that can be used for

students with brain injury who are participating in remote online

learning during the COVID-19 pandemic

8. Panel Presentation (youtube.com/watch?v=bABOSUTD9AU)

discussing telework for people with disabilities in celebration of

Global Accessibility Awareness Day
ABOUT TBI TARC

TBI TARC is supported by contract number HHSP233201500119I from the

U.S. Administration for Community Living, Department of Health and Human

Services, Washington, D.C. 20201. 

Email us at tbitarc@hsri.org