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BRAIN INJURIES: 

Prevention, Rehabilitation, 

and Community Living

Brain injuries can result from events like falls, car crashes, attacks, sports injuries, 

and explosions or blasts. Avoiding these events, if possible, is an important way to help 

prevent brain injuries. Brain injuries can affect all parts of a person’s life, including growth 

and development, health, emotions, relationships, employment, money and health care 

management, keeping a household, movement, and daily activities. If someone has a brain 

injury, evaluations, treatments, and supportive services are available. These services can help 

individuals to improve their abilities and live as independently as possible in their communities. 

TRAUMATIC BRAIN INJURY 

A traumatic brain injury (TBI) is an injury to the 

brain caused by a sudden force, blow, or jolt to the 

head or by an object penetrating the brain. People 

can get a TBI when there is some force that 

reaches the brain, like:

■ An object hits the head, such as a bat or a fist 

during a fight

■ The head hits an object, such as the 

dashboard in a car accident or the ground in 

a fall 

■ A nearby blast or explosion rapidly moves a 

person’s head

With a TBI, the brain’s normal functioning 

changes, and people may:

■ Become suddenly confused 

■ Have a gap in their memory

■ Lose consciousness briefly

■ Go into a coma

TBI commonly damages the front parts of the 

brain. This happens because the brain sits inside 

the skull in a way that the frontal areas of the 

brain are the most vulnerable to injury, regardless 

of where the head injury occurs. These frontal 

areas of the brain are vital to a person’s ability to 

think, plan, feel, and act. 

The initial severity of TBIs can be mild, moderate 

or severe. Most TBIs are mild and are also 

known as concussions. People with a mild TBI 

may have a period of confusion, memory loss 

or unconsciousness, but these symptoms may 

last only for a few seconds to minutes. Early 

symptoms of mild TBI may include: headache; 

confusion; dizziness; problems seeing or tolerating 

light; problems with hearing or ringing in the 

ears; loss of smell or taste; tiredness; changes 

in sleep; irritability; apathy; and trouble with 

thinking, learning, or remembering. People with a 

more severe TBI may have long-term headaches; 

nausea and vomiting; seizures; coma; dilation of 

one or both pupils of the eyes; slurred speech 

and inability to speak; problems with movement; 

persistent memory and emotional problems; and 

confusion, restlessness, or agitation. 
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CONCUSSION

Each year, about 75% of TBIs that are treated in a hospital or 

emergency department (ED) are concussions or mild TBIs. Recovery 

from these injuries usually occurs quickly (in 1-2 weeks), but even if 

early symptoms continue, most people are back to full functioning 

by 3 months. A small number of people (<5%) who have a single 

mild TBI can have some ongoing symptoms for a year or more.

People who have had more than one TBI, even a mild one, are more 

likely to experience persistent symptoms following their injury. 

Early management by an experienced clinician or team of clinicians 

is key to recovery. If several TBIs occur within hours, days, or 

weeks, the result can lead to severe problems, including coma, 

confusion, or even death. Thus, changing activity and behavior to 

prevent repeated injury is vital after an initial TBI.

The symptoms of a concussion can be hard to tell from symptoms 

people commonly have (such as headache, tiredness, and memory 

difficulties). For the first several days or even weeks, people with 

concussions, their family members, and even their doctors may not 

notice problems. The person may look fine overall, even though 

acting or feeling differently. The Centers for Disease Control 

and Prevention (CDC) discusses these symptoms on its website 

at http://www.cdc.gov/concussion/get_help.html. The two fact 

sheets, including one in Spanish, and a brochure for consumers are 

short and easy to read. 

The Brain Injury Association of America has a toll-free number 

for its National Brain Injury Information Center (NBIIC), at 

1-800-444-6443. This number will direct callers to information 

and resources available in their state. 

TRAUMATIC BRAIN 

INJURY STATISTICS 

Traumatic brain injury is 

a major, often avoidable, 

cause of death and 

disability in the United 

States. At least 5.3 million 

Americans are living with 

disabilities related to a 

serious brain injury. Of all 

the people in the U.S. who 

die from an injury, about 

30% die from an injury that 

involved a TBI. TBIs are 

the leading cause of death 

and disability in people 

younger than 45. 

EARLY 

MANAGEMENT 

BY AN EXPERIENCED 

CLINICIAN OR TEAM 

OF CLINICIANS

IS KEY TO 

RECOVERY
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PREVENTION OF TRAUMATIC BRAIN INJURY

There are many ways to reduce the chances of experiencing a TBI:

■ Correctly use seat belts in a motor vehicle.

■ Install and use age-appropriate car seats correctly.

■ Never drive while under the influence of alcohol, 

drugs, or emotional distress. 

■ Wear a helmet when: 

• Riding a bike, motorcycle, snowmobile, scooter, or allterrain vehicle 

• Playing a contact sport, such as football, ice hockey, 

lacrosse, or boxing 

• Using in-line skates or riding a skateboard 

• Batting and running bases in baseball or softball

• Riding a horse

• Skiing or snowboarding 

■ Make living areas safer by: 

• Child-proofing homes

• Removing tripping hazards such as throw rugs and clutter in 

walkways 

• Using nonslip mats in the bathtub and on shower floors 

• Installing grab bars next to the toilet and in the tub or 

shower for older adults 

• Installing handrails on both sides of stairways

• Improving lighting throughout the home

• Exercising regularly, under a doctor’s guidance, to improve 

lower body strength and balance 

The CDC has a number of educational programs on preventing 

brain injury for people of all ages at: http://www.cdc.gov/

TraumaticBrainInjury/index.html. Among the programs are several 

about sports injury and concussion that target school audiences. 

CDC also offers an online program for professionals and consumers 

that provides information about preventing TBI among older adults 

at http://www.cdc.gov/traumaticbraininjury/seniors.html.

The National Institutes of Health (NIH) has a website for older adults 

about causes of, risks for, and prevention of falls. Please see 

http://nihseniorhealth.gov/falls/aboutfalls/01.html.

Falls are the leading cause 

of TBIs for children and older 

adults. Falls cause 55% of the 

TBIs in children younger than 

14. Falls cause 81% of TBIs 

in older adults. In 2010, about 

2.5 million hospital ED visits, 

hospitalizations, or deaths 

were related to TBI in the 

United States. Among TBIrelated deaths in 2006–2010:

■ Men were about three 

times more likely to die 

than women.

■ Death rates were highest 

for people age 65 years 

and older and falls were 

the leading cause of 

death for persons age 65 

years or older.

■ Motor vehicle crashes 

were the leading cause of 

TBI deaths for children and 

young adults (age 5-24).

■ Assaults were the 

leading cause of TBI 

death for the youngest 

children (age 0-4).
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RECOVERY FROM TBI

Health care workers can assess the severity of an initial TBI 

and the symptoms that occur afterwards. Over time, they 

can test specific areas of functioning, such as speech and 

language, cognition, behavior, and physical skills. These help in 

understanding the effects of a TBI and the types of services a 

person needs.

For most people, the milder a person’s initial TBI, the better 

recovery over time. However, even a mild TBI can have a more 

complicated recovery for someone who has not healed from a 

previous one or has had other things happen to the brain (such 

as psychological stress or alcohol abuse). Recovery is best during 

the first weeks and months after the injury and more gradual 

after 3-6 months. 

The rate of recovery from the injury is usually related to how 

severe it is. People with mild injuries tend to recover more quickly 

than those with moderate to severe injuries. Those with moderate 

to severe injuries may have a prolonged period of confusion and 

inability to function. Those with severe injuries may have long 

periods of initial unresponsiveness (coma). People can take longer 

to recover when they have had a previous TBI, even if that previous 

injury were a mild TBI. Recovery may be slower among adults over 

age 55.

Sometimes people have problems that persist and affect their 

lives after a TBI. The extent of these problems and the impact on a 

person’s life depend on how severe the injury is, where the injury 

is located, the health of the person at the time of injury and the 

person’s age. Problems that persist over time may eventually limit 

some of a person’s abilities. 

Among non-fatal, TBIrelated injuries in 2006–

2010:

■ Men had higher rates of 

hospitalizations and ED 

visits than women.

■ Hospitalization rates 

were highest among 

people age 65 years and 

older.

■ Falls were the leading 

cause of TBI-related ED 

visits for almost every 

age group.

■ Assault was the leading 

cause of TBI-related ED 

visits among persons 

15–24 years.

■ Rates of ED visits were 

highest for children age 

0-4 years.

Researchers estimate that 

the economic cost of TBI 

in 2010, including medical 

costs, was $76.5 billion. 

The costs of TBIs related to 

death and hospital use were 

responsible for about 90% 

of total TBI medical costs. 

RESTING 

AFTER A CONCUSSION OR 

TRAUMATIC BRAIN INJURY IS 

VERY IMPORTANT
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DISABILITIES

Disabilities are typically related to changes and 

limitations in:

■ Cognition 

■ Emotion and behavior control 

■ Communication

■ Sensation 

■ Motor function 

People who have had a TBI of any severity 

commonly have problems at first with cognition, 

which can include trouble remembering things, 

thinking of the right word, learning new 

information, problem solving, concentrating, 

initiating activities, organizing, making decisions, 

and doing more than one thing at a time (multitasking). 

Some people who have a TBI may have emotional 

or behavioral difficulties such as depression, 

apathy, anxiety, anger, confusion, sleep 

disruption, changes in controlling behavior, and 

mood swings. These difficulties may lead to 

impulsiveness and lack of self-control, violence, 

or inappropriate sexual activity. 

Communicating with others can be a problem for 

those with TBI. Some may have difficulty with 

understanding, speaking, writing, and interpreting 

non-verbal signals, such as body language and 

the emotional cues of others. These problems 

can lead to miscommunication, confusion, and 

frustration for persons with TBI and for those who 

spend time with them.

Some people who have experienced a TBI have 

problems with vision and hand-eye coordination 

or movement. They may bump into or drop things, 

or feel unsteady.

Some people with TBI may need medicine to 

help them cope with the mental and physical 

health problems they may experience. They are 

more likely to experience side effects from their 

medicine than those without TBI.

Increasingly, research supports the idea that long-term 

neurologic conditions can develop after a TBI. While 

these problems are rare and more commonly seen in 

those with more severe initial injuries and with 

repeated injuries, everyone should be aware of the 

higher risks and of the importance of preventing further 

TBIs. These neurologic conditions include epilepsy 

(especially after penetrating injuries), Parkinson’s disease, 

and various forms of dementia, like Alzheimer’s disease. 
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REHABILITATION 

After experiencing a moderate or severe TBI, 

people may need to be in a hospital until their 

medical condition improves. Some people need 

additional care after they leave the hospital, due 

to the effects of the TBI. Rehabilitation services 

can help people to restore or improve their 

ability to manage their lives and health care; stay 

involved with family, friends, and community; live 

at home; carry out daily activities; and find a job. 

There are many choices for rehabilitation. People 

can receive these services at home, in hospitals, 

rehabilitation centers, day programs, supported 

living programs, or other places. Persons with 

TBI, their families, and their medical teams 

should work together with their health insurers to 

identify the best rehabilitation setting.

Trained rehabilitation professionals can test 

a person’s abilities related to cognition, 

communication, language, behavior, movement, 

and management of their lives to develop a 

rehabilitation plan. Rehabilitation programs 

can involve many specialists, depending on the 

type of help a person needs. The rehabilitation 

plans can involve physical therapy, occupational 

therapy, speech and language therapy, physiatry 

(physical medicine), nursing, psychology, 

psychiatry, and social support. Initial treatment 

plans are frequently modified in response to a 

person’s progress.

Rehabilitation can also identify ways to help 

people carry out tasks and daily activities. For 

example, a person may need reminders and 

timers to help with taking medicine or eating. 

Labels may be used to aid in remembering where 

food, clothes, dishes, and other things are. 

Written reminders can be used to organize days 

and help with how to prepare food, shop, and do 

other activities. For example, a person may not 

remember how to make a sandwich, or when to 

make or eat the sandwich.

The Brain Injury Association of America (BIAA) 

has a list of rehabilitation facilities across the 

country that can help people who are looking 

for care after a TBI at https://secure.biausa.org/

OnlineDirectory/Directory/SearchType4.aspx

REHABILITATION SERVICES CAN HELP PEOPLE TO 

RESTORE OR IMPROVE THEIR ABILITY TO MANAGE 

THEIR LIVES, INCLUDING STAYING INVOLVED 

WITH FAMILY, FRIENDS, AND COMMUNITY.
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LIVING WITH A TRAUMATIC 

BRAIN INJURY

People who experience TBIs that result in 

long-term health effects or disabilities can live 

productive, quality lives in their communities. 

Some government programs can help people 

and their families with health and long-term 

services and supports. Medicare generally covers 

health and rehabilitation for older adults and 

adults with disabilities who cannot work (http://

www.medicare.gov/). Medicaid generally covers 

health and rehabilitation services, plus help with 

daily activities for those who qualify – primarily 

people of all ages with low incomes and limited 

assets (http://www.medicaid.gov/). Since states 

control who gets Medicaid services and the 

type and amount of services available, programs 

vary across the country. The Administration for 

Community Living has information about services 

and supports for people who experience disability 

at http://www.acl.gov/. The U.S. Veterans Health 

Administration can provide certain health and 

long-term services and supports to veterans with 

TBI who qualify (http://www.va.gov/health/). In 

addition, many groups are doing research that 

may help people with TBIs and their families. 

Someone who has a disability due to aging 

or a disease or injury other than TBI may also 

have a TBI. A study of adults in one state found 

that almost 40% of community-living adults 

who reported having a disability also reported 

that they had had at least one TBI with loss of 

consciousness sometime in their life.

There is growing evidence that a TBI is not just 

an isolated event; instead, a person’s brain can 

continue to change years after a moderate or 

severe TBI. Some people continue to improve, 

while others may get worse. Few stay the same. 

Healthy brain habits are good for everyone, but 

especially smart for someone who has already 

experienced a TBI. Meet regularly with your 

health care team, and take care of your health. 

For example:

■ Eat a healthy diet that is low in salt, solid 

fats, and simple sugars 

■ Avoid drinking alcohol

■ Get active and stay active every day 

■ Find time every day to relax and meditate

■ Sleep 7-8 hours each night 

■ Learn new things every day

■ Connect with your family, friends, and 

communities

A PERSON’S BRAIN CAN 

CONTINUE TO CHANGE 

YEARS AFTER 

A MODERATE OR SEVERE 

TRAUMATIC BRAIN INJURY
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ADDITIONAL RESOURCES

The Administration for Community Living 

(ACL) has a Brain Health Resource, which 

provides basic information about current, 

evidence-based information and resources related 

to brain health: http://www.acl.gov/Get_Help/

BrainHealth/Index.aspx

ACL’s National Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR) funds the Model Systems 

Knowledge Translation Center (http://www.msktc.

org/) along with the Traumatic Brain Injury Model 

Systems Center (http://www.msktc.org/tbi/modelsystem-centers). They offer consumer-friendly fact 

sheets, videos, and narrated slideshows on many 

topics related to TBI. For more general information 

on TBI: http://www.msktc.org/tbi/factsheets/

Understanding-TBI. For other topics such as 

balance, vision, and fatigue: http://www.msktc.

org/tbi/factsheets.

The Centers for Disease Control and 

Prevention (CDC) has websites and online 

programs on a variety of TBI-related topics, as 

well as links to support organizations: http://

www.cdc.gov/traumaticbraininjury.

The Departments of Defense and Veterans 

Affairs (VA) support the Defense and Veterans 

Brain Injury Center (DVBIC), which serves active 

duty military and veterans with brain injury. Call 

toll-free at 1-800-870-9244 or visit DVBIC at 

http://dvbic.dcoe.mil. 

The Air Force supports the TBI center at the 

Center of Excellence for Medical Multimedia 

(CEMM). The website contains interactive learning 

opportunities about TBI treatment and care at 

http://www.traumaticbraininjuryatoz.org/.

The Health Resources and Services 

Administration (HRSA) manages a TBI program 

that provides some funds for resources and 

protection systems for people with TBI and 

their families. More information about this 

program is at http://mchb.hrsa.gov/programs/

traumaticbraininjury/.

The NIH’s National Institute of Neurological 

Disorders and Stroke (NINDS) has a toll-free 

phone number (1-800-352-9424) that people can 

call for information about neurological disorders 

and conditions such as traumatic brain injury. 

Information also is available at the NINDS 

website, http://www.ninds.nih.gov/.

WETA, a Public Broadcasting Service member 

station in Washington, D.C., maintains http://

www.brainline.org/, a compendium of videos and 

printed material about living with TBI.

NOTES: Scientists and clinicians in CDC, 

NIDRR (now NIDILRR), NIH and VA reviewed the 

information in this brochure in 2015. References 

to non-federal government sources or sites on 

the internet are provided as a service and do 

not constitute or imply endorsement of these 

organizations or their programs by ACL or the U.S. 

Department of Health and Human Services. ACL is 

not responsible for the content of pages found at 

these sites. URL addresses were current as of the 

date of this publication.