Traumatic Brain Injury factsheet

Introduction

An acquired brain injury (ABI) is a brain injury that happens after birth. 

This factsheet is about traumatic brain injury (TBI), which is caused by a blow or trauma to the head.

TBI does not include: 

  • congenital brain conditions – like lissencephaly and genetic disorders that a child is born with
  • non-traumatic brain injuries – from infections like meningitis.

Other types of ABI can include:

  • brain infections - meningitis and encephalitis
  • stroke or brain bleeds
  • hypoxia - lack of oxygen to the brain from near-drowning accidents, heart issues and long seizures
  • metabolic disorders – problems with how the body changes food into energy
  • exposure to toxins – like lead, carbon monoxide, drugs and alcohol.

In Australia, the most common causes of TBI are: 

  • motor vehicle and bike accidents
  • falls
  • sports injuries.

TBI can be:

  • Focal – in one area, often from a direct hit to the head. This may cause a skull fracture and bruising to the brain.
  • Diffuse – spread through the brain, often caused by shaking or strong movement, like in a car accident. This affects the brain’s nerve connections and is called a diffuse axonal injury. Because it is more widespread, the damage can affect more of your child’s abilities.

A child can have both types of injury at the same time.

 Signs and symptoms

TBI can affect a child in different ways:

Physical ability

  • weakness
  • poor balance and coordination
  • awkward movement
  • tiredness
  • headaches
  • slowed reactions
  • sensitivity to light or noise.

Thinking skills

  • trouble with:
    • memory
    • attention
    • concentration
    • planning
    • learning
    • finding the right words to use.
  • forgetfulness
  • slower thinking.

Emotions

  • mood swings and unstable emotions
  • lack of motivation to do things
  • anxiety
  • depression.

Behaviour

  • irritability
  • aggressiveness
  • frustration
  • trouble with change
  • rigid thinking.

Diagnosis

It can take time to understand how serious a TBI is and what the long-term effects might be.

Your child’s doctor will look at:

  • how long your child was unconscious for
  • how long your child experienced post-traumatic amnesia (PTA)
  • their Glasgow Coma Scale (GCS) score
  • brain scan results.

In children under two, a TBI may be diagnosed as cerebral palsy, depending on:

  • how severe the injury is
  • the long-term effects.

Post-Traumatic Amnesia (PTA)

PTA is the time after a brain injury when your child:

  • feels confused or disoriented
  • has trouble forming new memories.

PTA can last for hours, days or weeks, depending upon how severe the brain injury is. 

How long PTA lasts helps to show how serious the injury is:

  • less than 24 hours – mild TBI
  • 24 hours to seven days – moderate TBI
  • more than seven days – severe TBI. 

Glasgow Coma Scale (GCS)

The Glasgow Coma Scale (GCS) is used soon after an injury to check how aware and responsive your child is.

It measures three things:

  1. Eye response - how easily they open their eyes in response to pressure, like a pinch or a poke
  2. Verbal response - how well they understand and answer simple questions
  3. Movement response - how well they follow instructions or move in response to pressure.

Each part gets a score, which is added up. A lower score usually means a more serious injury. The test can be repeated to check for changes over time.

Brain scans

A CT or MRI scan can show bleeding or damage in the brain.

 Treatment

TBI causes brain cells to die. These cells can’t grow back, but nearby cells may try to make new connections. These new connections are not as strong as the original ones.

Recovery is different for every child. It is usually fastest in the first weeks and months, but can continue for years.

Most children will need therapy or support at different times in their development, especially during growth or major changes like starting or changing school.

Your child will be supported by a team of health professionals, such as:

  • case managers - help coordinate your child’s care and services
  • rehabilitation specialists – doctors who plan and manage your child’s rehab program
  • clinical nurse consultants - senior nurses who support recovery and provide expert care
  • clinical neuropsychologists – psychologists who test thinking, memory and behaviour to guide treatment
  • clinical psychologists – psychologists who help with emotions, behaviour and mental health after a TBI
  • cognitive therapists – help your child with memory, attention and problem-solving skills
  • occupational therapists – help your child with everyday tasks at home, school or in the community
  • physiotherapists – help improve movement, strength and coordination
  • social workers – support your family with emotional, financial and practical needs
  • speech pathologists – help with communication, language, and swallowing problems.

These professionals work with your family, school and local services to support your child.

Management

Stages of recovery – The Rancho Los Amigos Scale

Children recover from TBI at different speeds. Recovery is usually quicker early on, then slower over time. 

A child who has been in a coma will usually recover slowly after they are conscious again.

The Rancho Los Amigos Scale is used to describe the stages of recovery after TBI.

Your child may: 

  • go through all or just some stages
  • spend different amounts of time in each stage
  • show signs from more than one level at a time
  • stop at a level in their recovery.

The Rancho Los Amigos Scale

Stage 1: No Response

  • in a coma, where the brain is not working at its normal level
  • appears to be in a deep sleep
  • no response to stimulation like light, sound or touch.

Stage 2: Generalised Response

  • brain is starting to recover
  • starts to react to loud noises or painful sensations by making noise or moving arms and legs
  • movements may be slow and irregular
  • may still appear mostly in a deep sleep.

Stage 3: Localised Response

  • moves away from pain and discomfort, like injections
  • may turn towards sounds or try to watch people
  • may follow simple instructions like “close your eyes”.

Stage 4: Confused – Agitated

  • behaviour can change to restless, loud, confused, agitated
  • may try to get up and wander, not knowing where they are going
  • needs close supervision
  • attention span is short, may forget things that have happened
  • more aware of what is going on but cannot make sense of it all.

This stage can be distressing for children and their families. It is important to remember that your child cannot control this behaviour.

Stage 5: Confused – Inappropriate

  • usually calmer
  • can do simple tasks for themselves
  • can become upset easily if overstimulated or unable to do something
  • starting to speak more clearly, but may say inappropriate things.

Stage 6: Confused – Appropriate

  • may still have confusion
  • behaviour is more appropriate
  • can start to show they are remembering simple things, like the names of staff looking after them
  • can focus longer in therapy and work longer at tasks.

Stage 7: Automatic – Appropriate

  • can do everyday tasks and activities with only a little help
  • can learn but may be slower and harder than before
  • becomes tired easily.

Stage 8: Purposeful – Appropriate

  • can remember recent and past events
  • better understands what happened to them
  • may feel upset about their injury
  • thinking, concentration, memory and social skills may be different to before the TBI.