What are the typical long-term effects?
In considering the long-term effects of TBI on the individual, it is most important to emphasize that there is no "typical" person with TBI. People who have experienced a TBI vary on many dimensions: 1) severity of initial injury; 2) rate and completeness of physiological healing; 3) types of functions affected; 4) meaning of dysfunction in the individual's life, in the context of his/her roles, values, and goals; 5) resources available to aid recovery of function; and so forth. Thus, the most important point to emphasize is that the consequences will be different for each individual injured.
In discussing possible effects of TBI, the immediate physiological recovery (which may continue over months and years) was discussed in a prior question. When the moderately or severely injured person has completed this initial recovery, the long-term functional deficits associated with TBI come to the fore. What areas of functioning may be affected by injury to the brain? Any or all of the functions the brain controls may be impacted. However, given that individuals differ greatly in their response to injury, any specific individual may experience only one, a few, or most of the possible effects. Further, a change in any of the possible areas of dysfunction, if it occurs at all, will vary in intensity across individuals - from very subtle to moderate to life threatening.
It is important to be aware also that not all functions of the individual are impacted by TBI. For example, feelings toward family, long-term memories, the ability to ski or cook, one's knowledge of the world, and so forth - all may be intact, along with numerous other characteristics of an individual, even one who has experienced a moderate to severe injury.
The possible long-term effects of moderate-to-severe brain injury are discussed in the following three questions.
How are thinking and other aspects of cognition affected?
Individuals with a moderate-to-severe brain injury most typically experience problems in basic cognitive skills: sustaining attention, concentrating on tasks at hand, and remembering newly learned material. They may think slowly, speak slowly, and solve problems slowly. They may become confused easily when normal routines are changed or when the stimulation level from the environment exceeds their threshold. They may persevere at tasks too long, being unable to switch to a different tactic or a new task when encountering difficulties. Or, on the other hand, they may jump at the first "solution" they see, substituting impulsive responses for considered actions. They may be unable to go beyond a concrete appreciation of situations, to find abstract principles that are necessary to carry learning into new situations. Their speech and language may be impaired: word-finding problems, understanding the language of others, and the like.
A major class of cognitive abilities that may be affected by TBI is referred to as executive functions - the complex processing of large amounts of intricate information that we need to function creatively, competently and independently as beings in a complex world. Thus, after injury, individuals with TBI may be unable to function well in their social roles because of difficulty in planning ahead, in keeping track of time, in coordinating complex events, in making decisions based on broad input, in adapting to changes in life, and in otherwise "being the executive" in one's own life.
With appropriate training and other supports, the person may be able to learn to compensate for some of these cognitive difficulties.
The TBI Research Center at Mount Sinai is conducting research to help people with TBI who experience cognitive difficulties. Descriptions of these studies are found at Rehabilitation Trials.
How are mood and behavior affected?
With TBI, the systems in the brain that control our social-emotional lives often are damaged. The consequences for the individual and for his or her significant others may be very difficult, as these changes may imply to them that "the person who once was" is "no longer there." Thus, personality can be substantially or subtly modified following injury. The person who was once an optimist may now be depressed. The previously tactful and socially skilled negotiator may now be blurting comments that embarrass those around him/her. The person may also be characterized by a variety of other behaviors: dependent behaviors, emotional swings, lack of motivation, irritability, aggression, lethargy, being very uninhibited, and/or being unable to modify behavior to fit varying situations.
A very important change that affects many people with TBI is referred to as denial (or, lack of awareness): The person becomes unable to compare post-injury behavior and abilities with pre-injury behavior and abilities. For these individuals, the effects of TBI are, for whatever reason, simply not perceived - whether for emotional reasons, as a means of avoiding the pain of fully facing the consequences of injury, or for neurological reasons, in which brain damage itself limits the individual's ability to step back, compare, evaluate differences, and reach a conclusion based on that process.
With appropriate training, therapy, and other supports, the person may be able to reduce the impact of some of these emotional and behavioral difficulties.
The TBI Research Center at Mount Sinai is conducting research to help people with TBI who experience depression and other mood disturbances. Descriptions of these studies are found at Rehabilitation Trials.
What other changes are likely after moderate/severe TBI?
Any of the ways we have of sensing/perceiving may be affected by TBI. Vision may be affected in many ways: loss of vision, blurred visual images, inability to track visual material, loss of parts of the field of vision, reduced depth perception, and sometimes disconnection between visual perception and visual comprehension, so that the person does not know what he or she is seeing. Changes also may occur in the senses of hearing, smell, taste, and touch; the individual may become overly sensitive or insensitive. Further, the person may have difficulty sensing the location of his/her own body in space. Other individuals with TBI may have recurring problems with balance, vertigo, and ringing in the ears.
From Mount Sinai Medical Center. www.mssm.edu.