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Functional Impact


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 spike fevers
    • 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 comments.)
    • 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 daughter’s 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 both.)
    • 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 factors.
  • 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 as purposeful.


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
    • Fatigue
      • May require respite care
    • Isolation
      • May benefit from support groups, information sources
    • Frustration
      • 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
    • School
    • Vocational
    • Leisure
    • Friends


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