Recovering from Mild Traumatic Brain Injury

Mary Ann Keatley, PhD, CCC and Laura L. Whittemore, Brain Injury Hope Foundation
Recovering from Mild Traumatic Brain Injury (MTBI)

The Important Role of Brain Filters

Much of the brain’s energy is used to filter out irrelevant or unnecessary information. Just imagine what it would be like with no filter on your brain. All the sounds, smells, images, and feelings would come crashing in at the same time. The overstimulation would probably paralyze you and prevent you from taking any action.

After sustaining MTBI, most of the brain’s energy is diverted to basic functioning, and little is left over for filtering or censoring. Trivial or insignificant thoughts may often have the same weight in your mind as important ones. This can make decisions difficult. You may find that your brain gets stuck on an idea or phrase that keeps replaying, and this uses a great deal of brain energy.

New sensitivities can be very challenging and baffling for the injured person and their loved ones. Going into a restaurant or store where there are fluorescent lights, background music, or a great deal of visual stimuli may cause the brain to shut down. Most people say that they want to get into a quiet place and rest their brain after that experience. That is why it is so important to plan your social activities when fewer people are around and when there is less commotion.

Hearing Problems and Hypersensitivity to Sound

As mentioned above, a common symptom of traumatic brain injury is hypersensitivity to sound. This is called hyperacusis. The auditory system becomes very sensitive to environmental noise, and you may discover that you have great difficulty going to restaurants, the grocery store, or social gatherings.

Many individuals report staying at home to avoid the assault and feelings of being overwhelmed in these noisy situations, or they may go out only at times when places are less crowded and less noisy. Any noise can assault and overwhelm a person with MTBI, including a vibrating refrigerator, heating system, or humming fan, etc.

An excellent accommodation for hyperacusis is ear filters. The actual name is ER 15/25 noise-dampening ear filters. These are custom-fitted earplugs, originally made for musicians, but they now have been adapted for individuals with traumatic brain injuries. Consult an audiologist at a speech and hearing clinic to obtain filters. Current studies show that filters can reduce overstimulation to the auditory system and allow you to participate in social situations without becoming overwhelmed. An advantage of using ear filters is that you can put them in for brief periods of time and take them out when you don’t need them. They can be made with clear materials and are therefore less visible. The ear molds for these filters are made by an audiologist, or a specialist trained in testing hearing and treating hearing problems.

The ear is susceptible to blast injuries. Unique patterns of injury occur with bombs and explosions that are seldom seen outside of combat. The eardrum or tympanic membrane may be perforated in the blast and should be evaluated with an otologic evaluation and audiometry (hearing evaluation) to determine whether there is an injury to the ear.

Eardrums can be replaced, but observational studies over the years have shown a high rate of spontaneous healing of ruptured eardrums following blast injuries. Whether a perforated eardrum heals spontaneously depends on the size and placement of the perforation.

Two types of hearing loss are associated with blast-induced injuries. One type is called conductive hearing loss, and the second type is sensorineural hearing loss. The high-frequency sounds are more likely to be affected in blast injuries. Many individuals complain of tinnitus or ringing in the ears, and it is common to have balance problems, dizziness and/or vertigo associated with perforated eardrums. It is very important to keep the ear canal dry until the eardrum has healed.

Vision Problems and Sensitivity to Light

You may notice that your eyes don’t seem to be working in the same way that they did before your brain injury. Some eye doctors specialize in vision problems resulting from an acquired brain injury. They can help diagnose visual problems related to the injury and provide exercises or special glasses to help with recovery.

Because the visual changes are sometimes subtle, you may pass them off as being related to fatigue or brain fog. Aiming and focusing the eyes are linked, and that is why objects may appear to move, be seen as double, or blur in and out. Some individuals also complain that it is difficult to focus quickly from near to far or far to near.

Vision problems and cognitive deficits may compound one another. The most common complaints related to visual problems associated with brain injuries include light sensitivity, headaches, double vision, fatigue, dizziness, difficulty reading, or loss of peripheral visual fields. You may feel a heightened sensitivity to light and may even need to wear your sunglasses inside. You may have to request that fluorescent lights be turned off. Computer and reading tasks may take longer than usual, and tend to be more confusing and tiring.

A behavioral optometrist or a doctor who belongs to the Neuro-Optometric Rehabilitation Association can perform a comprehensive vision evaluation and help you determine the best course of action. Some individuals with visual deficits can benefit from specific lenses or prisms in their glasses and/or from vision therapy.

If you have vision problems associated with MTBI, this may deplete your energy and decrease your ability to perform daily living tasks. It is unrealistic to return to work
until vision problems are addressed. If your job requires a great deal of reading or moving your eyes between the desk and a computer screen, you may find that your errors increase because of difficulty tracking. It is very important to address visual problems, as they can increase the recovery time.

Dizziness and Vertigo

Feelings of dizziness and nausea are common after a head injury. You may notice that these symptoms come and go depending on the activity you are doing. Dizziness may refer to distinct symptoms, one of them being vertigo. This is when you feel as though you are spinning, and sometimes you feel nauseated or like you may lose your balance. Researchers have discovered various causes for this symptom, such as problems with your inner ear, impairments in eye movements, clenching and grinding your teeth, tightness in the neck muscles, etc.

Dizziness may also originate from cervical neck injuries. The primary symptoms with this type of dizziness include feeling off balance, lightheadedness, and the sensation of floating. If you have what is called benign paroxysmal positional vertigo (BPPV), you may notice that you have a sudden attack of spinning when you turn over in bed, change your head position quickly, or reach for an item above your head. This usually lasts for less than a minute, but you may be left with feelings of nausea and dizziness for a longer time.

The Mayo Clinic developed a technique called canalith repositioning (1994). where the head is maneuvered in various positions to help eliminate the dizziness. This is accomplished by moving the calciumcrystals in the inner ear. Medications that can help dizziness are also available. Be sure to consult with your doctor to see if you need a referral to an ear doctor who specializes in traumatic dizziness and/or an eye doctor who specializes in traumatic vision syndrome.

Changes in Energy Reserve After Injury

Healing takes a tremendous amount of energy. The diagram in Figure 1 illustrates functioning before and after the injury. It shows how the uninjured brain can perform many activities that are physical, cognitive, and emotional throughout the day, and still have a reserve of energy. After a brain injury, it takes more energy to deal with cognitive and emotional issues, leaving little or no reserve.

The brain uses more energy than any other organ in the body. Before you were injured, you had a pool of reserve energy available when you overextended yourself. Following your injury, nearly all of your energy is required to perform the most basic functions just to get through the day. If you are continuing to work, you may find that when you get home, you must rest and not engage in other activities as before.

Your energy reserves at this point are almost nonexistent. When you push too much you may reach overload, and the extreme fatigue may cause your brain and body to shut down. This exhaustion can also amplify all of your symptoms, and cause an emotional reaction.

Almost Immediately after an injury it becomes clear that you don’t have the same amount of energy that you previously did. It is important to emphasize the need for rest and conserving energy. For a while you may be unable to do as much as you used to and may need to take time out for rest — Brain Rest. Lay down during the day for naps. Even if you don’t sleep, resting your head and lying down may make a significant difference in your recovery.

Posted on BrainLine November 20, 2009. Reviewed July 26, 2018.

From Recovering from Mild Traumatic Brain Injury: A handbook of hope for our military warriors and their families by Mary Ann Keatley, PhD, CCC and Lauar L. Whittemore. Copyright © 2009 the Brain Injury Hope Foundation. Reprinted with permission.

Comments (113)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

It's Friday evening, 6:3o pm on 25 April 2014. 3 1/2 years I fell hiking down an icy clip of a mountain.  I was 49.  I fell ~ 8 feet and was stopped by my head.  So many years later, I have such ringing in my ears after a long day on the computer that I just want to cry.  But I feel stupid. I think that if I say anything to anyone, I 'll be considered a hypochondriac and whiner.

I just want my energy back. I want to feel happy. I want to not feel everyday is a chore to get through.  At times, I want to just throw in the towel.  

Guess I'm feeling sorry for myself. In fact,  I AM  feeling sorry for myself.  Maybe tomorrow I'll feel better.

Thanks for letting me leave my troubles for tonight on the shoulders of this cyberspace.  I'll make it through .

I was riding a mountain bike downhill, was launched over my handlebars, and my head is what i landed on without being able to get my arms or anything else out to soften the blow. Was out for about 15 seconds, tons of physical pain for 1.5 years, and much of the TBI was attributed by me to pain meds and physical pain. Then the pain hugely reduced and i stopped my pain meds, THEN the reality of TBI came to light and I've been really dealing with it for only about a month plus now. It is a pain in the butt process, mainly because hardly any doctor or cognitive therapist knows the details and it is hugely misdiagnosed. Also, if you are in a managed care system I have found most doctors are busy finishing with patients to get the billings to the insurance company to help justify their job, but hardly any truly try to figure it out and help. YOU must do the research and find those that specialize in this area. Of the 10 or so docs I've seen thus far, appears only 1 truly understands and has read the latest on TBI's.

Noticed at the bottom of this page after the comments there is a supposed definition of TBI. I disagree completely with the statement that most mild TBI's go away within weeks or a very short period of time...that is post concussion syndrome, NOT a mild TBI (and most doctors think the same wrong thing). If you truly had a mild TBI, it does not suddenly go away. You might not go back to a doctor, try to ignore treatment, get coping mechanisms, improve things over time with various exercises, change the excess stimuli with ear plugs or sunglasses/brimmed caps, etc., but a mild TBI does not go away. That is our bummer in one way, but at the same time don't forget to enjoy the present moments and stimuli right in front of you that we now seem to be able to appreciate more than before - walk along a beach or river or in a forest...nature is wonderful for TBI, so is exercise, regular sleep, very little alcohol, calendaring everything daily, a TBI Support Group (lucky to have one in my area that meets twice per month), pushing your social abilities a bit more each time (longer phone conversations, longer in person conversations, more focused for longer, etc.), reduce gluten and grains and sugars from your diet (they cause inflammation to the brain and body), drink water regularly, and find a hobby or interest. Hope those help as a TBI sucks, but since it IS permanent you need to get positive and find the things you enjoy doing in life. Most of the old friends and habits will be changed to a large degree, and that is the reality we all must accept at some point to begin getting positive and moving forward with your new brain.

Anyone that is interested I have put some info on a blog I started on Blogger called "As I Stand Dying" (came up with the name when the physical stuff was real bad too, but didn't start writing until after the pain reduced and i was aware of the TBI). I put some helpful materials there and talk about the things i've experienced and things that have helped. Not super familiar with blogs and settings, but here is my link: (copy and paste)

Keep pushing forward!


Almost 10 years ago I was in a head-on collision and my life forever changed that day.  But I still have life--a very good life!  I take medication daily that adds to the quality of my life.  It is Concerta or its generic.  It is the type of medication that is prescribed for ADHD.  The first day that I took this medication I attended an all day seminar.  I was amazed at what a difference it made.  I pray that you too will find something will assist you with the many challenges that you now face.  The sooner you accept that you will never be the same person as you were before, the better off you will be.  Cherish the life that you still have!

My personal experience I had a head injury in a car wreck about 10 years ago, to this day I still have problems with light sensitivity and balance issues. I usually only keep a single small yellow light on in a room, if there is too much light (white light seems to be worse than yellow) my head will hurt which causes headaches and depending on the brightness I'll have to look away/down or squint my eyes or if it's bad enough I'll have to close my eyes completely which makes it much harder for me to keep balance. Before the injury seems like I too the ability to keep balance for granted, now post-injury it is a constant task, feels like a lot of my enegy goes to just keeping my balance. If someone were to look at me walking I doubt that would notice anything odd with my walking, but I think that's mostly because of how long I have been dealing with this problem, unfortunately though it may look like I'm walking effortlessly but if something were to happen to my sight I would fall over and be on the ground, my sight is the only thing that helps me keep my balance. If I close my eyes I will fall over, if I have something to hold onto like the back of a couch/wall I can still walk but it is definately even more of a challege than if I was able to see.

I was lucky and on the problems with hearing mine are very minimal, I lost some hearing on the side that my head hit, other than that I can hear just fine, though I have noticed since my head injury my ears don't seem to produce wax like they used to, so the inside of my ears seem to get dry and irritate me.

Probably that last and most frustrating issue I have is my mental capacity, I used to be great at math, post-injury I'm barely able to recall the order of 4 random single digit numbers which makes doing math in my head impossible, so any simple math I have to use paper and pen or if it's more than just basic addition/subtraction I have to use a calculator. Seemed like my mind was always active before hand, now feels like I'm a bit of a meat head, the thoughts in my mind are very simplistic as opposed to before where they could be pretty complex. I also constantly get similar words mixed up, even though I think the correct word I somehow will still say the incorrect word, so it has caused me to have to think about what I'm about to say multiple times just to make sure it's correct and even then it still sometimes comes out incorrectly.

My head injury happened when I was 18 so I have been dealing with this for a while, just try to not take everything so seriously, if you mess up just try to laugh it off, I know it's easier said than done but it's real easy to get down on yourself and get into a bad place, so just keep trying. I still get upset with my issues from the injury if I think too much about it can bring me to tears, but it is do-able to deal with this, you just can't expect life to go back to the way it was, you hae to re-adjust to have life is now and as you get better at coping with your issues the more you know what to expect and you'll be able to do a lot more.

my boyfriend was a passenger of a terrible motorbike accident one year ago. he suffered multiple injuries including a broken back and was in a coma for some time, although he had a good physical recovery i noticed he was coping well in certain situations concerning hes cognitive thinking. i thought i was going mad, but then i heard about tbi and found this site. weve seen a doctor and he is now having to have more ct scans. thankyou
I cried when I found this sight and began to read it. You see, I had a whiplash 2 years ago. I was sent for physical therapy, chiropractor, massage therapy, optometrist and now am left with profuse ringing in my ears, pain in the back of my head, with weird lacy light sensitivity. NO one ever told me I had a brain injury. It saddens my heart that I had to find this out on my own. My doctor told me it is a chronic soft tissue injury.
to the july 27th post about noise sensitivity, try earplugs or get special ear filters. I have been dealing with the same for almost 10 yrs and they help take some of the edge off sounds. They are not as sharp and jarring. I wear in public places - especially crowded store. Otherwise I still get dizzy and sick to my stomach. Also sleep as you can and rest frequently in quiet settings even for just a few minutes helps
i suffered a TBI in 2002 when i went thru a windshield in a head on collission, i had to learn how to talk right and think straight, i have short term memory loss and repeat things all the time,i have lost more friends because people can get annoyed with me, in november of 2012 i fell down the stairs and hit the back of my head and neck, that day i suffered a seizure in a grocery store and have never been the same, my left ear buzzes all the time and i can barely walk a straight line, i cant focus my eyes on anything and going to the grocery store is almost impossible, i get dizzy just reading the words i am typing and my vision is blurred terribly, i have had more tests then i count and seen so many doctors and noone knows what is wrong other then i have a massive brain injury from 11 years ago and i reaggrevated it recently, my hearing is fine, too good in my left ear, everything seems amplfied and the last time i went into a resturant it sounded like everyone was banging their silverware aganist glassware it was horrible, i am giving up hope to ever live normally again :(
I was in a car accident and got a concussion, I've been dealing w/severe sensitivity to sounds. . My MRI and ENT test were good- I am so angry, I can't do anything it seems. I was just prescribed risperidone- which I briefly read it was for antipsychotic! Ugh! I'm not losing my mind I'm just so angry that I can't tolerate sound. Has anyone been prescribed something that can help?
My TBI in2005 ruined so many things mainly because of loss of energy which makes me mad and depressed. I galloped race horses for a living. It was my job, my pleasure and my life! When I have energy, I can deal with my problems and my meds help a lot...but not enough! Energy loss has ruined my life and my daughter's also...she just turned 10 one week before my accident. This article is the first I have seen about energy post TBI. THX
healing wishes
May you heal I sustained a MTBI after slipping off the edge of my bathtub, hitting my head twice on the bowl...The tub is about 12, 13 or 14 inches above the floor. I stood on the edge like a fool while showering to fix a shower caddie that I nudged out of place...I had two bumps above my ear, meaning I hit my head twice..I only remember the second one. My husband and friends say I hit my head twice, since there were two separate bumps but I do not remember the first hit, nor how I got a very large bruise/hematoma on my left arm... This article is the most detailed description of all I have been experiencing for the past 3 and 1/2 months. Thank you so much.
amazing reading