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Last Updated on August 28, 2022 by Randy Withers, LCMHC
People often think their brain has adequate protection against the occasional head injury. Although the skull safely shelters the brain, moderate to severe damage can still occur. This TBI — or traumatic brain injury — can mean anything from a concussion to affecting function for the rest of a person’s life.
This article explains how doctors determine the severity of a brain injury and how they map a patient’s recovery. The exact details will change in each person’s unique medical case, but these pieces are essential in diagnosing patients and forming treatment plans.
What Is a Severe Brain Injury?
The U.S Centers for Disease Control and Prevention defines a severe brain injury as any head injury requiring hospitalization that may result in side effects such as:
- Memory loss
- Trouble processing thoughts
- Difficulty learning as quickly as before
- Loss of balance or coordination
- Problems with vision, speech or hearing
- Emotional swings unlike before the injury
After arriving at a hospital with a severe brain injury, doctors diagnose an acquired brain injury (ABI) as one of two types — a traumatic brain injury or non-traumatic.
A TBI changes a person’s brain functions due to closed or open impact. That could mean a patient got into a car accident and hit their head or their brain didn’t get oxygen fast enough after circulation cut off.
How Is the Severity of a Brain Injury Determined?
Figuring out the name of a brain injury isn’t enough to help a patient. Doctors must also diagnose the severity of the damage with the following methods.
1. Consider Their Patient’s Coma
Many people who experience a severe brain injury will arrive at the hospital in a coma or could require one. It can be challenging to tell the differences between coma cases by looking at a patient, so doctors use the Glasgow Coma Scale (GSC) to determine a person’s health objectively.
The GSC uses scores of one through six to rate three essential motor functions during a patient’s assessment. Those factors include:
- Eye-opening response
- Verbal response
- Motor response
How a patient reacts to these gentle tests helps doctors narrow down the duration and severity of their injury. If someone scores within three to eight points, their case is severe. Moderate injuries fall between nine and 12, while mild injuries rate between 13 and 15.
2. Note Any Post-Traumatic Amnesia
Post-traumatic amnesia (PTA) indicates a mild to moderate severe head injury. Doctors can assess this factor after a person wakes up from a coma or after being unconscious from an accident.
PTA may result in a patient having little to no short-term memory. They could struggle to recall what someone just said to them, what they had for breakfast or where they are.
Anyone with PTA can expect it to last three to four times longer than when they were unconscious or in a coma. Memory recall and retention take a while to redevelop, but they can start building it back with tips like labeling cabinets or establishing a routine. If someone has almost no short-term memory, doctors may assess it as a severe TBI.
3. Assess Internal Damage
Some might think bruising is the most prominent internal damage after a TBI, but that isn’t always the case. People can experience other injuries such as:
- Internal brain lining tears
- Burst blood vessels
- Contusions
- Hemorrhages
- Swelling
There could also be damage to other parts of the body after a TBI. Suppose the brain can’t get enough blood or oxygen to regulate organs. In that case, those body parts may not get the right amount of blood flow, movement or neuron signals to continue operating as they typically would.
A moderate to severe TBI will have more internal damage than a mild TBI. Scanning and testing with guidelines such as the GSC reveal the entire scope of a person’s injury as doctors review their case.
Internal damage can also result in mood changes, which people often overlook as a seemingly unrelated symptom. Dr. Murray B. Stein of the University of California San Diego spoke about his recent study finding one in five people will experience mental health symptoms for six months following a TBI. He explained:
“Contrary to common assumptions, mild head injuries can cause long-term effects. These findings suggest that follow-up care after head injury, even for mild cases, is crucial, especially for patients showing risk factors for PTSD or depression.”
Experts will always factor mood swings in with their internal damage assessment because it’s a key indicator of which part of the brain was most affected by the TBI. If these emotional changes remain long after the injury, a person could start going to therapy or rehabilitation to speak about their feelings and find ways to heal.
4. Factor Memory Loss
Short-term memory is part of the PTA analysis, but TBI patients can lose additional information. When someone wakes up from a coma or TBI and can communicate, doctors ask them for information regarding:
- The date
- The time
- The location
- The patient’s name
- What happened to the patient
Someone with a mild to moderate severe head injury may recall all or some of these details. Severe TBIs may erase all of this information from a patient’s brain. Time and healing could bring them back gradually over weeks or months.
What Does Recovery Look Like?
Recovery can look different for a moderate to severe TBI. At first, a patient may focus on waking up in the hospital daily, eating small meals and participating in mental exercises with a neurologist assigned to their case.
As a person gradually recovers with in-hospital support, they often go home with specific instructions to work with specialists. The care providers the patients may need will depend on how their TBI affects their mind. Someone in recovery could need help from:
- Psychiatrists
- Social works
- Speech/language pathologists
- Physical therapists
- Audiologists
- Dieticians
- Respiratory therapists
Recovery requires extensive family support to succeed — TBIs don’t go away overnight. People with traumatic brain injuries must communicate their pain levels, frustrations and successes to better experience progress.
There are also rehabilitation programs for various injury levels. A neurologist may prescribe one of them as an additional recovery tool. People often attend places like:
- Acute or subacute rehabilitation programs
- Long-term rehabilitation programs
- Transitional living programs
- Independent living programs
- Behavior management programs
Working alongside a doctor who has been with the TBI case since the injury occurred is the best way to get proper treatment. They’ll understand the depth of the patient’s situation and which services or programs would most help them recover.
Final Thoughts
After discovering more about how to determine the severity of a brain injury, it’s easier to understand their complexities. Many medical experts are ready to assist people after a mild, moderate or severe head injury because recovery looks different for everyone.
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