The Consequences of Traumatic Brain Injury
National Institute of Health
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Rarely are the consequences of TBI limited to one set of symptoms, clearly delineated impairments, or a disability that affects only one part of a person’s life. Rather, the consequences of TBI often influence human functions along a continuum from altered physiological functions of cells through neurological and psychological impairments, to medical problems and disabilities that affect the individual with TBI, as well as the family, friends, community, and society in general.

When other, more urgent medical problems are apparent at onset, mild TBI may be masked, even though it can result in impairments. In many cases, consequences of TBI endure in original or altered forms across the lifespan, with new problems likely to occur as a result of new challenges and aging process.

The neurological consequences of TBI are many and complex, occurring throughout the neural axis. Any sensory, motor, and autonomic function may be compromised. Most of these complications are apparent within the first days or months following injury, depending on the severity of initial trauma. Some long-term sequelae include a variety of movement disorders, seizures, headaches, ambient visual deficits, and sleep disorders.

Non-neurological medical complications include, but are certainly not limited to, pulmonary, metabolic, nutritional, gastrointestinal, musculoskeletal, and dermatologic problems. The cognitive consequences of TBI are similarly broad. All of these consequences can occur singly or in combinations and are variable in terms of their effects on individuals; furthermore, they change in severity and presentation over time. In combination, they produce a myriad of functional problems. Some of the most persistent problems include memory impairment and difficulties in attention and concentration.

Deficits in language use and visual perception are common, but often unrecognized. Frontal lobe functions, such as the executive skills of problem-solving, abstract reasoning, insight, judgment, planning,information processing, and organization, are vulnerable to TBI.

Common behavioral deficits include decreased ability to initiate responses, verbal and physical aggression, agitation, learning difficulties, shallow self-awareness, altered sexual functioning, impulsivity, and social disinhibition. Mood disorders, personality changes, altered emotional control, depression, and anxiety are also prevalent after TBI.

Social consequences of mild, moderate, and severe TBI are many and serious, including increased risk of suicide, divorce, chronic unemployment, economic strain, and substance abuse. These consequences are tragic to individuals and families and place additional burdens on social service agencies, law enforcement, and the courts.

As individuals with TBI attempt to resume their usual daily activities, the environment places increasing demands on them, uncovering additional psychosocial consequences. For example, executive dysfunction may become obvious only in the workplace; behavioral changes affecting interpersonal relationships may appear after leaving inpatient care.

Spiraling adverse consequences of TBI may become apparent not only for persons with TBI but also for their significant others. Family members report depression, social isolation, and anger. Overall family functioning and relationships are disrupted. Such consequences may continue and, in some instances, worsen with age.

Children with TBI have their own set of consequences. Interactions of physical, cognitive, and behavioral sequelae interfere with the task of new learning. The effect of early TBI may not become apparent until later in the child’s development, although there is little explicit literature on the developmental consequences of TBI in infants. There may be a poor fit between the needs of children with TBI and the typical school educational programs.

Children with TBI also may have difficulties with peers due to cognitive processing, behavioral problems, or difficulty comprehending social cues. Parents are faced with significant parenting challenges, including coping with changed academic aspirations and family goals.

TBI in adolescents has been largely unstudied. It is unclear, therefore, whether the consequences they face are best described by the literature pertaining to adults or children.

The economic consequences of TBI are enormous. The annual cost of acute care and rehabilitation in the United States for new cases of TBI is estimated at $9 to $10 billion. Estimates for average lifetime cost of care for a person with severe TBI range from $600,000 to $1,875,000. These figures may grossly underestimate the economic burden of TBI to family and society because they do not include lost earnings, costs to social services systems, and the value of the time and foregone earnings of family members who care for persons with TBI.

Access to initial care and subsequent rehabilitation for persons with TBI may depend greatly on insurance coverage, health care personnel, family and community, geographic location, knowledge of available resources, and the ability to navigate the medical care and rehabilitation system successfully.

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