The experience, injury, and associated outcomes for each TBI survivor are complex
and unique. Each case must be treated on an individual basis: viewing and treating the
survivor and family (and other support persons) based on findings.
Impacts are functional, psychological,
social and extend to family and friends.
Functional Impacts of TBI
- Impaired Mobility
- Paralysis (partial or full)
- Quadriplegia - paralysis of the whole body
- Paraplegia - paralysis of the lower half of the body
- Hemiplegia - paralysis of one side of the body
- Hemiparesis - weakness of one side of the body
- Spasticity - an inappropriate sustained contraction of muscles.
- Balance - may see ataxia or loss of ability to coordinate smooth movements, regain
balance, or keep upright posture
- Gait - way of walking - may be disturbed in rate, rhythm and balance
- Impaired Body Functions
- Swallowing difficulties - difficulty recognizing, manipulating, or controlling
foods or liquids and swallowing them safely. Aspiration or choking may be a problem.
- Temperature control - due to injury to the brainstem areas, the body may chill or
- Changes control of body functions (bowel and bladder, sexual functioning, hunger)
- Person may have difficulty controlling bowel or bladder either through physical control
or cognitive awareness of need and place to relieve themselves.
- Sexual functioning and behaviors can be disrupted due to injury to the brainstem
centers for desire and cognitive awareness of socially appropriate actions.
- Impaired Sensory Experiences
- Vision: Person may have discrete blind spots in the visual field. May have visual
distortions due to lesions in the visual association areas.
- Hearing: Sounds are interrupted due to injury to the areas for reception and
association of sound in the temporal lobes of the brain.
- Smell: Sense of smell can be lost or disturbed due to pulling or shearing on the
olfactory nerve during the injury.
- Taste: Taste can be distorted and changed due to pulling and shearing on the
cranial nerves responsible for taste (C5 & C7).
- Touch: Decrease or change due to parasthesias
- Impaired Communication (and examples)
- Speaking (ex., A 22 year old male with severe slurring of speech and drooling. He
is unable to be understood by anyone outside his immediate family. He uses a word
communication book and an electronic device to be understood and to use the phone.)
- Expressing thoughts and ideas (ex., An 18 year old female with moderate word
finding and sentence structure problems. Listeners require several repeats of the message
to understand what she intends.)
- Understanding language (ex., A 17 year old male with injury to the temporal lobes
needs many repeats, restatements and visual aids to understand simple directions and
- Decreased everyday use of language (ex., A 19 year old college freshman has such a
struggle and is so self-conscious about her speech, that she rarely attempts to express
her thoughts and ideas. She is thought to be aloof.)
- Impaired Cognitive Functions and examples
- Attention/Concentration (ex., A man is unable to complete a task at work in a
reasonable amount of time. He is distracted by the activities and noises around him.
- Memory (ex., A woman is unable to recall information given to her about carpooling
plans for the coming week to her daughters school.)
- Decision making (ex., When shopping at a local department store, a man is unable
to weigh the pros and cons of buying one of two expensive tools - and therefore, purchases
- Executive functioning (ex., A woman is unable to plan and structure her day at the
office and, therefore, completes nothing during the day.)
- Organization (ex., A student has difficulty following the class schedule of
assignments and class attendance. He is unable to organize his time and efforts.)
- Judgment (ex., A man went out and bought two cars in the same day at different car
dealerships. He bought one for himself and one for his son. He knew he bought two cars,
but he was unable to determine that he could not afford them.)
Psychological Impacts of TBI
- Depression: As people become aware of the severity of the injury and recognize
changes, they may suffer periods of depression
- Frustration Tolerance: Decrease in ability to control anger and agitation. Also
reveals decreased attention/concentration abilities.
- Anger, tantrums and mood swings: Shows poor impulse control and frustration
associated with impairments. Mood swings may be seen as the body attempts to reestablish
balance. Mood changes may be quite rapid and appear unprecipitated by environmental
- Impulsivity: When a person has difficulty controlling impulses. Impulsive people
are impatient and fail to think before acting.
- Loss of former identity: Awareness of changes in ability may affect self-esteem;
expectations and sense of self are changed by TBI.
- The Invisible Disability: Because so many of the impairments are not
on the surface and physically visible, but interfere with behavior they may be interpreted
Social Impacts of TBI
- Impact on the family members (parents, siblings, caregivers)
- The family may have difficulty in processing the impact of the injury on the
family member and the family as a whole. They may need to hear information repeatedly, and
have written information for later use
- May benefit from support groups, information sources
- May need time alone
- May need the opportunity to vent
- Isolation for the child and family
- Loss of friends and peer support
- Transportation barriers
- Accessibility issues
- Community Reintegration