Aging After Brain Injury: BrainLine Talks with Dr. Steven Flanagan

Aging After Brain Injury: BrainLine Talks with Dr. Steven Flanagan

BrainLine sat down with Dr. Steven Flanagan to talk about the issues of aging after a traumatic brain injury. Dr. Flanagan is professor and chairman of the Department of Rehabilitation Medicine, New York University School of Medicine, and the medical director of the Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center.

Are there any increased risks as people age after a brain injury?

We think the answer is yes. Although aging after a brain injury has not been terribly well studied to date, some research, including a study conducted in 2008 by the Institute of Medicine, has suggested that people with brain injury are at an increased risk of seizures. We have also found that people with poorly controlled seizures are at a higher risk of dying at an earlier age than people without brain injury-related seizures.

Studies also suggest that the more physically disabled a person is post-injury, the more likely he is to have a shorter life span. This is common sense. For example, if a person has trouble swallowing or can’t exercise at all post-injury, he will more likely have medical complications earlier on in life than someone who can move around, stay physically healthy, and swallow without problems.

Medical evidence also suggests that after a moderate or severe brain injury, a person is more likely to develop Parkinson’s disease or Parkinson-like symptoms. The same is true for the development of dementia. That being said, the medical evidence to date shows an association between brain injury and these problems, not a direct cause and effect.

For people with a mild brain injury, there is little evidence of any association between brain injury and developing Parkinson’s or early-onset dementia.

Are there symptoms to watch for? If so, which ones in particular?

That is a tough question because everyone is different. Symptoms can differ across the board but can include anything from depression to problems with balance. But if a person has more significant physical or cognitive problems that resulted from a moderate or severe brain injury, he should get checked by his doctor on a regular basis, meaning once or twice a year; and his doctor should be someone who specializes in or has experience with traumatic brain injury.

People with what’s called “complicated mild brain injury” — a mild brain injury with symptoms that don’t resolve quickly or that remain chronic — should also check in with their doctor periodically.

What can people do to protect their health after a brain injury? Are there long-term health problems that may crop up?

This is an important question because people who live with long-term effects from brain injury often forget that they have other parts of their bodies to look after. Everyone — with or without a brain injury — should do “upkeep” tests like pap smears and mammograms for women, prostate exams for men, colonoscopies at 50 years old, cholesterol checks, and so forth. They should also maintain a good diet and fitness regimen.

It’s easy for people with brain injury to focus solely on their brain and the long-term issues that persist from their injury; however, it’s crucial not to forget about the rest of the body.

A person with brain injury should also make sure his doctor keeps signs and symptoms of Parkinson’s disease and early-onset dementia on the radar screen. Again, brain injury is not a cause of these other diseases, rather an association.

How does a brain injury affect cognitive issues as a person ages?

This has not been well studied at all and is difficult to answer. Some studies suggest that people with moderate to severe brain injury have accelerated cognitive decline as they age. But, again, this has not been proven.

Ideally, we need to have a long-term study that looks at how brain injury affects cognition as a person gets older. For example, if we could study the cognitive skills of people with brain injury versus those without brain injury at 30 years of age and then at 60 years of age, we would probably learn a great deal. However, that kind of study is almost impossible because it is hard to follow people for so many years.

That said, people with brain injury, especially those with long-term cognitive issues, should stay in touch with their doctor, preferably a physician knowledgeable about brain injury.

How does a brain injury affect physical issues as a person ages?

Folks with brain injury who have chronic problems with balance, for example, may need to schedule periodic sessions with a physical therapist or an occupational therapist. Sometimes these “tune ups” bring people back to a safer level of function. As we get older, our sensory system changes, more so for people who may have had their sensory system disrupted or damaged from a brain injury. Therefore, we need to pay more attention to how we move and do things. Balance can get worse and our bones and muscles weaker, making it harder to move safely through the world. So, getting a therapy here and there can be incredibly helpful not just physically but also emotionally, for one’s self-confidence.

How does a brain injury affect emotional or behavioral issues as a person ages?

Behavioral problems are part of what separates people with brain injury from others in rehabilitation medicine. Many behavioral and emotional problems that are a result of a brain injury can be chronic, and the severity of these problems can fluctuate over time. Depression is a significant risk. Anxiety and other mood disorders can also persist. People who have a hard time multitasking or concentrating tend to be vulnerable to frustration, anger, and depression.

We are not sure if the risk of these types of emotional or behavioral issues ever goes away entirely after a brain injury. Data show, for example, that there is an increased risk of depression for people with brain injury even years after an injury.

What do you tell people who are concerned about developing Alzheimer’s disease or early-onset dementia after a brain injury?

We definitely don’t know all the answers about Alzheimer’s disease, especially as it relates to brain injury. There is ongoing research on many fronts related to Alzheimer’s, but, to date, we don’t have any definitive answers. However, studies suggest that there is an association between genetics and developing the disease and between brain injury and developing the disease. Again, there is an association with severe brain injury, not a cause and effect. That is an important distinction.

It’s important to remember that most people in general do not get Alzheimer’s. The best thing to do is to stay focused on staying physically active, socializing with supportive friends and family, getting out and staying involved in the world, and keeping our minds sharp and engaged.

More and more studies are being conducted about contact sports and progressive brain injury. What is chronic traumatic encephalopathy, and what should we be doing to protect young athletes?

For years, we have known about a type of neurodegenerative disease that may affect amateur and professional boxers, known as dementia pugilistica. Symptoms and signs of dementia pugilistica can develop progressively over a long period of time. Chronic traumatic encephalopathy, or CTE, may be similar and may be seen in more and more athletes who play contact sports like football or ice hockey. How much can the brain take, after all? It makes sense that a football player who is hit time and time again and who suffers multiple concussions could develop some sort of neurological trauma. The research that is being done on CTE is important, but it needs to be followed up with more research.

I think the increased awareness about traumatic brain injury is very helpful as is the awareness that a person doesn’t have to lose consciousness to sustain a concussion. This awareness will help everyone — from young athletes and coaches to soldiers serving in Iraq and Afghanistan. Everyone, including healthcare professionals at all levels, needs to know that brain injury is not necessarily a benign event and sometimes symptoms do not go away.

How long do you follow up with a patient after a brain injury?

For most of my patients, they remain my patients for life. I never discharge them. For those with moderate to severe brain injury, once their active rehab or restorative therapy is over, I follow up with them approximately one to two times a year. When they are still in rehab, I am actively involved and check in with them about once a month or so.

For my patients with mild brain injury — unless they make a full recovery and are symptom-free within the first three months post-injury — I also follow up with them once or twice a year.

I find it important to follow up once or twice a year with patients to make sure the therapy and/or medications are still appropriate for them. For example, a patient may no longer need the same amount of an anti-depressant or a sleep aide as his life settles back into a new normal. Or maybe a patient needs more physical therapy for balance or strength. Recovery is a life-long endeavor for many people with brain injury, and we want to make sure they are getting the right care at every step along the way.

What type of long-term medical follow-up do you recommend for people with brain injury? Which specialists should they see, and how often?

When necessary, I refer my patients to specialists like endocrinologists, psychiatrists, or neurologists. I also make sure that all my patients have a primary care doctor to ensure that they are doing the “regular” health maintenance checks like cholesterol tests, pap smears, and colonoscopies.

Why is long-term follow up important for people with brain injury?

In a nutshell, long-term follow up is important for people with brain injury because they can be more susceptible to the effects of aging, like depression or physical and cognitive changes that naturally come with age.

Does having a brain injury put a person at greater risk for other health problems? Of dying at a younger age?

Depending on the severity of the injury and the associated long-term consequences, some people may be at risk for certain health problems. Certainly, if people are less physically active or emotionally unhealthy, they are more susceptible to age-related effects — from problems with balance to depression. The stronger people’s bodies, minds, and spirits are — whether they have a brain injury or not — the more effectively they will postpone the effects of aging … and enjoy life.

Dr. Steven Flanagan is professor and chairman of the Department of Rehabilitation Medicine, New York University School of Medicine, and the medical director of the Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center. He has served on medical advisory boards of many national and international committees and has presented at scientific meetings both nationally and internationally, most notably on topics pertaining to brain injury rehabilitation.

Posted on BrainLine December 22, 2009. Reviewed July 27, 2018.


Comments (115)

I had a wreck in 1985, 5 weeks and a day I came out of the coma. 9 days later, I began remembering, kind of, from day to day. My Neurologist, did not make plans for me to see him on a regular basis. Nor were there plans made to see any doctor, on a more regular basis than check ups and such. Furthermore, I rarely see any doctor, more than now and again when I am sick. 4 times in the last 6 years, maybe. I am 50 now.

I had a mild or moderate TBI 10 years ago at age 50. I don't have great Dr's. I wish I did. I don't have the greatest support from siblings either; I wish I did. I know most of my success came from myself and the determination to survive.

Still to this day I have issues with being overwhelmed or overstimulated. My psycho neurologist who only tested me said, that I was above average and superior in many tests leading to the one problem: I still maintained my high intellectual capabilities which makes people think I am okay all the time. But I know I am not.

I continue to push my brain so that the part that was damaged is compensated by the other portions of my brain. That leads me to success and to understand when to stop when overloaded or flooded.

Most people who knew me before professionally not family I say, see the difference but they say, my empathy and compassion remain the same. How interesting is that?

My husband had a skydiving accident when he was 30 years old before we met. He suffered a traumatic brain injury to his frontal lobe among almost dying. He was home bound for 9 months and his mom had to take care of him. I met him 6 years later and he told me he had to learn how to re socialize again and ended up losing a lot of friends. Now he is 46 and my question is that I have seen a lot of impulsiveness from him over the years and making decisions that are very black and white. He is very sensitive toward everything I have said in the past and has held a grudge. We are currently separated now because he has put up a guard toward me with stuff I have said in the past. Which most people would forgive and forget. He also drinks on top of this brain injury. He says he feels emptiness toward me now. Is this due to his brain injury? I feel like he has no empathy or lack of emotion and it has gotten worse over the years. He refuses to see a doctor. I want him back but not if he feels emptiness toward me and shows lack of emotion. Anyone have any suggestions?

There is a comment from a somewhat bitter perspective of becoming a caregiver. Many of us become caregivers to ones we love. When dealing with subjective observations like say the PTSD sufferer is incapable of empathy, that is a POV or shared POV. Sure a consensus could be had, and an argument made for having unequal sense of empathy toward one another. Still, I like to believe there is something to work with. A glossary of things you can do is at One of a few methods not mentioned on that page is deep brain stimulation or DBS, which I will likely try to look into. There is a small encouraging study of using MDMA (ecstasy) for treating this population. Best of Luck All

Just a couple of observations for the difficulties leading to a complete fall out. Indeed if your questions could be answered a surge of mental and physical recovery could be made in this concern. The relationship to trust and times his guard is up is telling. He has heard a replaying of commentary that is not unlike a nightmare from the previous view of himself, which maybe the resemblance he can hold onto. Keep from a pile up on his sensibilities by a unique perspective of considerable qualities to enjoy about him. Though these seem everyday pleasantries you are defining him in a set of attributes he hasn't heard for sometime. I don't know of intimate details other then distinct areas effected and plausible means around or living with some deficits, as he's making an effort, may as well feel he does well. Of course these's meds to consider while still healthy. That's assuming he got to your good graces in some manner. Should he overcome self doubt, he wants to feel you've made the right decision in letting him back. So far as empathy toward you, I feel that is a perceptual conundrum not easy to overcome as he has felt this toward many fleeting aspects of his former life. It occurs that couples do have to find new ways into the later half of relating. Don't know the first about that myself. You describe my worst fears of intimacy, so I wish only the best. N ps said I'd keep short, and not the case, sorry, but have to do your own edit. Hope something to glean.

My husband suffered a severe frontal lobe brain injury 16 years ago. My advice to you would be let your friend go. You won’t ever be loved the way you need to be loved. Not that he doesn’t want to but with a TBI like he has he can’t feel this love for you. My husband can’t make good decisions so if left unattended will get hurt or hurt someone else. He is 70 now. Your life will be all about him so talk to a Doctor and understand you will be his caregiver for rest of his life. Is this something you want to take on?

I have suffered two different severe TBIs in my life. I am now 51 but endured a fractured skull at the age of 9. I then went on to play high school football as a middle linebacker, suffered several concussions during my years of football, and at the age of 19 I was involved in an auto accident which caused a subdural hematoma. I was given a 10% chance to live, but here I am.

I went on to get my diploma and eventually received a BS in electrical engineering. However, I have since had to stop working as I have begun to suffer symptoms which I cannot control. I feel a sense of fog nearly always. My sleep patterns are awful. I have a number of symptoms, but the worst by far is my inability to stay calm in the face of adversity.

When something happens that would simply bother a normal person, I feel as though a rush of adrenaline has been released in my body. My hands shake, I sweat, I get very aggressive and, quite honestly, I have started to scare even me as I've aged. I am uncertain where to go or what to do at this point. I have had 5 major surgeries since the accident, only one brain surgery, but I have a bad knee and a bad shoulder which requires me to take pain medication.

I have reduced the medications I was taken down to only 2, whereas I have been on 11 medications at once before. However, without pain meds I am nearly incapacitated and I require a dose of alprazolam to assist with anxiety. I do not know where to go from here. I do not know if I have CTE, early onset dementia (I doubt, as I am still cognitively competent) but I am finding it harder and harder to deal with society.

I intentionally do not own a firearm for obvious reasons. I do not want to hurt a stranger for something as dumb as cutting me off in traffic and I do not want to destroy my family by doing something even more stupid.

Anyone out there with a TBI at least 10 - 20 years old who has learned how to deal with life on life's terms, I would be forever grateful for the human contact. I need to speak to someone who has a visceral understanding of the hell in which I am writhing in as I type this. For anyone willing to communicate with me regarding these issues, I would truly owe you a debt of gratitude.

Nearly 30 years post TBI that changed my life but did NOT get the medical care it/I needed.
I was in college - sustained the injury in a bad boating accident during an athletic event. I was shuffled off the property where the accident happened and left alone in my dorm room for 3 days before being found by an angry lab partner who thought I had just been blowing class off. I was unconscious in my dorm room.It was later discovered I had a skull fracture. I had a host of immediate issues that were treated while I was in the hospital - but then I was left on my own to figure out how to resume my life - which was never the same. TBIs were not talked about back then.
I STRUGGLED to get back to school and finish. I was overwhelmed by everything. Too much information, noise, lights... I had uncontrolled emotions - rage, anxiety, doubt... I can't begin to cover it in this post - but your post resonates with me.
I sustained a concussion several years ago - which set me back tremendously. I was NOT recovering and it caused me, out of fear and desperation, to start looking for some kind of help.

I've been going to neurofeedback for several years. I am improving and am now tapering off medications and continuing to improve. I am sleeping at night. I am able to stop the overwhelmed, overloaded, over-stimulated cascade of events in my brain and body.

This has saved my life and improved the quality of it beyond measure. I wish I had found this treatment decades ago. Regardless of where you are located - you can see if you can find similar resources near you.

A neurologist I knew casually told me I had something like ADD. This was around 9 years after my head injury. The medicine he suggested was one that has an off-label use in addition to its anticonvulsive effects. Several months after adding it, I noticed I can interact about sensitive issues without immediately “flying of the handle”. Good that you have tapered down your meds, but maybe you should add something back.

Hi Daivd (good name!), I can feel your angst in your words. I am 17 years post my frontal lobe TBI that left me in inpatient hospitalization for 6 months, and I'm still recovering I feel. I agree wit the last commenter that you should absolutely seek out mental healthcare - it has been a godsend to me.

I have not personally experienced what you have (I came to this site for a relative), but what you are describing sounds somewhat like panic attacks. A good doctor or mental health care provider could help you get a better diagnosis and help with treatment. Good luck sorting this out!

Please help me my vision is so blurry headache light hurts my eyes car ran over me 1983 I was on motorcycle coma two weeks football wrestling and motocross my life now is post it’s everywhere and I still forget what doc or test can help me I have passed out twice and one time got my fingers in a table saw

I had a real bad fall as a minor causing me anger issuses as an adult.

On December 23, 2018 I will be 8 years post TBI. I have multiple health issues now, some are because I ignored things like blood sugar and blood pressure, heart rate because of major depression and anxiety.
Several very important things that I may suggest are, when you are seeing a doctor that says that people post TBI don't have any special health issues to watch for, WALK OUT OF THE OFFICE. They are ignorant!
Second is see a endocrinologist. I see mine every 3 months. Hormone levels etc. are different post TBI. A warning that even many endocrinologist's are ignorant about post TBI issues.
Third, find a local TBI support or like we say "SURVIVOR" group. We don't sit around and wine about the TBI but rather have fellowship with people that speak our language. Discussions, picnics, parties etc. A TBI group is so important because you learn that you are a normal TBI Survivor.

I should be happy I am not alone. It has been 5+ years and I'm just getting worse. But I am not bad enough to get/deserve help. Had I not made it, everybody I care about would be better off. Now I'm not the only one suffering. I do hope others get better instead of worse.

6 years post injury
I completely understand you. Everyone hoped I would not and shortly after discharge I began to understand and I joined them. One failed attempt and a coward at known unfailables, I exist.

Don’t give up. My husband had his TBI in 1995. He was only 26. It forever changed our world. He became fully disabled 3 yrs ago. Find a good support group in your area. Never give up. He had to learn to walk and talk again and also had to get help for anger, which is common with brain trauma. He is 51 now and I a glade for every day we get to spend together.

I had a severe brain injury in 1985, age 21. Left me blind in one eye, no sense of smell, nerve damage in left hand. I am now 54, with fibromyalgia, arthritis, depression. I have no medical care b/c I cannot afford it. Got fired from my job largely because of my health and age. But I have been denied disability. So what is someone like me supposed to do? I am deteriorating at what seems to be an accelerated rate.

I suffered a severe traumatic brain injury on June 1995. Over 30 years ago. I am extremely lucky to have little difficulties. I was seeing doubles moving my head but about 5 years ago the doubles disappeared. I have taken part in many TBI events in my area. Will anything happen as a result of my accident many years ago? Please help....

I had an anoxic brain injury in 2009. I spent 2 weeks I'm a coma and I'm a vent. I went to neurological rehab for 5 months in patient which was excellent.
Post injury and rehab I do have some issues. Short term memory loss. I lose everything, and have problems with time, 30 minutes to some is 5 minutes to me. You must carry on to get better day by day. I was 46 and now 55 and I will never stop moving forward with God's grace and mercy.

My sister had a closed head injury 42 years ago that has left her left side with impairment that has progressively gotten worse with age, as well as the mentality of about a 2nd grader. What we are having an issue finding now is what kind of assisted living or care facility we can find for her that will understand the brain injury as well as the aging process, as there is a difference. There doesn't seem to be too much information on the web, that details or provides information on how to find the 'right care' for a person aging that also has experienced TBI.

Has anyone else had any luck?

My husband fell out of the back of a moving truck when he was 10-11 and had a TBI that had some effects. He was paralyzed on the left side of his body, he had to relearn everything, and his mood changed. Over time and with therapy he made a good recovery but has always had some issue with balance, he would never be able to pass a field sobriety test if it was given. He has been forgetting more, which I have noticed for a while but he is just starting to notice it himself. He had a recent episode while he was driving where he was aware of what was going on, but he completely forgot how to drive. He had to take a wild guess and luckily picked the brake instead of the gas. His grandmother does have Alzheimer's Disease and his dad has been showing progressive symptoms, but he won't go see a neurologist. He does get a little more agitated with things than most people do. He and I have been together for nearly 11 years and he has not been seen once in relation to his TBI. During the time of us being together, he was in a MVA that resulted in a concussion (this was about 4-5 years ago, about when the forgetting started to progress). It is my assumption that once he recovered he was not taken for any follow-up care. I work in the medical field and understand how important follow-up care is. I can't seem to get him or anyone in his family to understand that, except his brother who is an ICU nurse. I am concerned about him.

hello, i just happen to run into this site looking for information on if you have brain damage do you have to take meds for the rest of your life as i do since the year 2000, i was in a head on collision car accident at 3 years old, (i was born 1970) that left me with a depressed scull fracture and a broken collarbone, also we were hit so hard that i was knocked out on impact for 6 days, i had to have surgery if i was to survive i have cognitive disorder, mild depression, anxiety, learning disorder, and it has been rough on me as i got older and i was told i could still have problems from the accident in my adult life, i think i am beginning to find that out

I had a road traffic accident in may 2008 where I had a brain hemorrhage and was in a coma for 31 days. After a span of 4 years, i had a cardiac arrest in nov 2012, docs operated me and installed an ICD near my heart. Recently that is in sept 2017 my heart beat rose to more than 400 beats per minute. Docs think it is because of my head injury. I'm not sure, please answer me.

Yes it can, Like your self i had a car accident and had epidural hematoma, coma for 7 days and my heart beats 160 to 180 that,s more than 2 times the rate. I do know that A fast heart beat after a TBI can be normal...

I was in a coma for over 2 weeks from encephalitis when I was a little over 2 years old , I was off the bottle before I went into a coma but when I came home I was back on the bottle I had to learn how to walk again and talk again , I am now 56 years old and I don't feel right I have memory loss , I have a temper , worse than usual , I have blurred vision ,I have a hard rime keeping focused I don't do the thing that I used to love to do all the time , fishing , camping and I can't even play with the kids anymore so I suffer from depression too. I also have scoliosis the pain is terrible , it always have bothered me but not to the extreme it has the last 5 or so years and it's getting worse, but I wanted to know is that my brain goes to my spinal cord could this be causing more pain for me seeing I had both of these issues in my life, I have read where people suffer from scoliosis and there pain is already terrible but with my TBI that I had when I was a kid ,be effecting me neurologically today I still work everyday but in reality I should and could be considered disabled , its just been getting harder for me to function anymore , I thought my whole life that I was normal but now I am not sure what normal even means and I know that other kids were in comas too from measles and they have reported issue with there TBI and I also had a concussion at the age of 9 or so , I always had problems with my legs my whole life , when I was a kid I would be running and they would just give out , always seemed like I always had to work twice as hard as other kids to accomplish the same things but I am very concerned what's going to happen with me next week, next month and next year
I have rode horses all my life. When I was 12 to 13 years of age I had 2 seizures. Doctors put me on medication and I was able to out grow or just not having them. Although, through my life I have had a few head injuries. Being bucked off horses and landing on my head. Sometimes knocked out. So, my question is what symptoms should I watch for?
I was rear ended approx 8 yrs ago - tbi 4 months ago my nuerologist to a picture of My brain and and said I have dramatic shrinking brain- and typically saw this type of deteriorating in people at least 20 yrs older than me?? Is the shrinking brain related to the previous TBI ? Thank you!!
My boyfriend was beaten and left with TBI. Now age 53 I wonder as he gets older will he start getting worst with memory physical activities.

My 12 year old son , who incurred his brain injury 10 years ago, has much support and insistence in our home. Currently, he takes CoQ10 30 mg twice daily, Alpha Lipoic Acid 100 mg twice daily, one multi-vitamin by New Chapter called Perfect Calm at night, one multi-vitamin by New Chapter called Perfect Energy in the morning, and Viva Fish Oil 2,200 mg with one half dose in the morning and one half dose at night. To note, my pharmacist guides me with all these choices and doses.

We have seen improvement with our son with use of each of these supplements and vitamins. Since the vitamins contain essential herbs, they should not be taken with certain meds. gives a very clear direction about which herbs interfere with certain meds. With surgeries, anesthesia, and antibiotics, the vitamins and maybe even the supplements should be discontinued for the duration. Also, TBI survivors rebuild synapses when they learn, exercise, and read which has been done with my son daily for ten years, and he measures at grade level in all subjects but math, takes all tests independently, and can now handle a timer for a stress factor.

There are many alternative and complimentary health interventions that help greatly with TBI symptoms - with documented research. See discussions of energy medicine (emcompassing acupuncture, acupressure, yoga, chi gong, tai chi, Eden Energy Medicine, Healing Touch, Reiki among others) and energy psychology.

my 14 yr old daughter was involved in a car accident and recieved a severe tbi ..diffuse axonal injury . glascow scale of 3 upon arrival to hospital vie med flight. two months later she walked out of the hospital without any medications . She is very exhausted all the time and it has been two years . Her brain however seems to be better than before ,. SHe is in school with accelrated classes and in the honor society . Everyone thinks she is fine . What I cant get anyone to understand is that while she may be very book smart , her physical being has changed ,. She suddenly gained alot of weight . She went from a size 6 to a 13 very rapidly . I have asked over and over about getting her hormones checked or thyroid checked and all im told is that it is probably because she isnt as active . But she wasnt really an active girl before the accident . I get so frustrated with people who dont listen and i am fearful something is wrong they are not addressing .

If they gave her anti convulsants and antidepressants in the hospital then some of them can cause severe weight gain!

My son incurred his moderately severe TBI when an uninsured motorist over compensated to the left at 60 mph on a country road with a 45 mph speed limit, hitting our car as we waited to take a safe turn. Luke got all the impact from our car crash. He had a CSF leak; lost all speech for 18 months; had a sensorineural hearing loss of his right ear with profound deafness; and struggled behaviorally, socially, and cognitively.

When he was 9 years old, he was diagnosed with precocious puberty by a Children's Endocrinologist in Birmingham, AL. His symptoms included a 20 lb. weight gain and a 5-inch gain in height in six months. His testosterone measured at nearly a 17 year old level. With Lupron 30 mg injections given once every three months, he now measures in the 75th percentile for weight and 93rd percentile for height. He has gained very little height and no weight during treatment, and his 20-lb. weight gain was never lost. He was placed on these injections because his genitalia would have looked like a grown man's by 11 years old, and his growth plates were going to close five years prematurely.

I would advise you to investigate further and find a pediatrician who is well-experienced with patients who have TBI (which I am sure is not an easy find).

My daughter sustained a broken neck and left frontal lobe closed head injury 22 years ago. She's now 41. She's had numerous episodes since the time of the car accident. Different meds at times which have kept her level. For the last year though her behavior has changed dramatically. She's not the same person anymore. Has all the symptoms of ABI. Verbal and physical aggression, swearing, irritability, anxiety and depression. She has difficulty organising everyday activities. She's been seen by Mental health and both her and her psychiatrist have diagnosed ABI. Sadly she won't see me or any of her family. If she does she yells and abuses us. ABIOS have stated there's no rehab available for her as the accident was 22years ago. The Psychiatrist, Mental health and ABIOS have all said leave it to Community service to help her. Difficulty is she's not willing to let anyone help. Interestingly ABIOS have said it is odd that these symptoms have appeared all these years later. Reading all your letters obviously this isn't correct. I feel so devastated and helpless.

I am by no means an expert in TBI, so please do not let anything I may say offend you or be mistaken as medical advice. I work in the field of catastrophic injuries and have assisted multiple brain injured persons with their medical care for years following their injury. I would like to comment that a brain injury changes the lives of all the family members - forever. Everyone has to rescript their lives to adjust to the changes inflicted by the injury event. Yet, the person with the actual injury is the only one that receives treatment. I know your sacrifices and adjustments probably went unrecognized or were treated as if it was expected you would rearrange whatever was necessary to accommodate the brain injury. I want to acknowledge all you gave, gave up, put off, let go or otherwise adjusted in your life/hopes/dreams/plans to provide the best environment for your daughter. I realize you must feel helpless since your daughter will not listen to you and the available resources are very limited. I'm sure you feel anger and frustration at the medical community's lack of response to your request for help as well. It has to be overwhelming for an unsolvable problem to be handed to you to figure out and make better. I commend you for your efforts to intervene and find help for your daughter. In my humble opinion, it sounds as if your daughter may be experiencing some type of mental crisis. I have never seen the return of a group of symptoms once a brain injury has healed; especially not after such a long period of time. Once the brain has "healed" from the injury, it has formed new pathways for information to travel. The changes we notice to a person's demeanor, personality, preferences, responses, humor, etc. are probably due to the disruption of the brain's previous pathways used for processing information along with changes in their memories, perception, attention, mood, etc. Our brains are amazing in that it forms new pathways for handling the mass of information fed into it by sensory input. We may be slower at first as the brain tentatively maps the new road, but repeated use allows us to become quicker. The rebuilding of pathways allows us to continue as members of society. But those new paths are different than the previous pathways and result in a "different" person. The long term effects of TBI on the brain's function have not been studied, so very little can actually be cited as proven or used as an expert resource. I do not know what is meant when you say she has all the symptoms of an ABI. Those symptoms vary from injury to injury. The symptoms you do provide would be in line with a "behavioral" patient - a person that no longer exerts the same level of control over their actions or emotions. But if these symptoms have just presented now, after 22 years, it would be difficult to associate them with the original brain injury. Does she believe she acts this way? Are these new behaviors? Has she experienced these symptoms in the past? Were these behaviors controlled with a medication regimen? Has she quit taking the medications? Have different/new medications been prescribed? It is probably difficult to get any information from her regarding this matter and you cannot legally act on her behalf unless she is in danger of harming herself or others. I'm sorry to say, there isn't much you can do at this point. Let her know you are available to talk, visit, assist her if she desires, reiterate this to her as often as possible without becoming a pest, and wait for the situation to change. I realize this does nothing to help with the problem, but it allows you to let the problem go until there comes a time you can help her. Best of luck.

Amazing response. You just helped me so much, sitting here feeling (17 years post TBI) that my brain was some sort of ticking time bomb because of my injury.

Again, thank you for clearing that up.

I am a 61 year old woman who had a cerebellar astrocytoma when I was 18, my senior year of high school. I too still struggle with anxiety, depression, loss of balance, double vision etc. I guess I've lived with these health issues most of my life but have learned to cope with them mainly through diet and exercise. I can't do strenuous exercise, yoga and Pilates are excellent to help with balance and my mental health! I can't take much medication my system is very sensitive. I know what everyone on this website may be feeling and want to let everyone know that exercising and faith in God or a higher power is imperative!! Even a little bit! I hope this helps at least one person! God be with you all!!!

I have a dear friend who was in a major car accident when he was a teenager. I am interested in learning more about post trauma brain injuries as an aging adult. I am really trying to understand certain behaviors that I feel stem from the head trauma. What is the best resource that I can use to learn more about this?

I was 24 when I had moderate to severe tbi. I'm 35 now, feels like after around 2 years since the 2 week coma, I'm completely recovered. I cannot see with one eye but it's because in the accident the eye nerve was cut by face bones. Depression, anxiety and etc.? Who doesn't have it? Especially nowadays. All of us have had different level of recovery which depends on many factors and especially age. My doctor told me if I would've be 25 the recovery would be different. Good luck!

I'm in this same situation. I fell 15 ft out of a tree when I was six and cracked my skull open. I was in intensive care for months. Now I'm 32 and I experience bad migraines, eye pain, lack of energy, problems with balance, depression, and anxiety. Just started happening here lately.

I'm sorry to hear of this, I was in a wreck with a brain injury and in a coma for a month. I don't have any of the issues that you mention. The issue that I have to live with is that my brain stopped developing at 19. So basically my mind will think I'm 19 for the rest of my life.

Not sure the point in sharing here. I was hoping for answers :( 31 years ago, my motorcycle and a truck got in a fight. The motorcycle slammed me into the truck, broke most every bone in my body, then I flew 90 feet in the air, head first into the pavement. Fractured skull. TBI. Etc. Learned how to walk, how to talk, how to think, all over again. I was 17. And mentally, I felt 17 for the next 20 years. Now I feel like I'm 25. Meaning that my brain has not ever caught back up to my now 48 year old body. My body aged, my brain didn't. I eventually recovered enough to get into management and leadership roles. Just an old kid. I've always had some form of depression since the accident. Occasional suicidal thoughts. About 5 years ago, I snapped. I screamed at a friend because I was mad at her. Prior to this event, I was always able to contain my anger. But I acted horribly. Unlike me. And I've been doing this more and more often. I was a long term type employee. Now I can barely keep jobs I like. Because I'll blow up at something stupid. I'm on meds. Doesn't help. Now, I'm starting to feel like I'm losing my mind. I'm not right, and I don't know what's happening to me. On the outside, one may not know, that on the inside, I'm dying. And I want to die. But I don't want to die. See? And I'm feeling like everyone is against me, even my friends. I can't think straight. I've gotten worse over the years and each year seems twice as bad as the previous. I don't know what made me snap 5+ years ago, but I do feel like I'm losing my mind, because of my TBI. I yelled at and lost a woman I love, because I can't control this. I've lost many jobs in the last 5 years. And I almost never lost a job before. Help.

Ever think about counseling? maybe a social group where you can be around other people who are going through what you are, and i even bet you would make a few friends like a big brother to eachother :)

I am glad I got to read your post. I also had a TBI 34 years ago and a concussion 24 years ago. I also just snapped about 5 years ago with very similar experiences. I have't found any real help or anyone to connect with about this. If you have found a direction to get more help, please share. I am sorry for your pain and I definitely relate to the bewilderment. I hope to hear from you. L

I'm 53 years old. I had a head injury when I was 6 years old. My skull was cracked and I was in a coma for 3 weeks. Now I suffer with depression, anxiety and loss of memory. Thank you for this article. I could never find the truth behind my depression, and the lack of ability to retain information. but now it makes sense.

Thank you so much for this article, it's really helpful. I had a concussion when I was four and was in a coma for six months. I'm now 39 and have been living a normal life so far, as I'm able to work and live independently. However, I still have problems with anxiety and depression, as well as worrying about the long term effect of my injury as I age. Your advice is very useful. Again, thank you!!

My uncle fell from a ladder while painting outside and suffered a brain injury, this was back in 2012. Sadly he now has little time left in this world and I will miss him dearly. They said he would not make it originally four years ago but he fought hard. After all the physical therapy, occupational therapy and rehabs. Numerous test and examinations I think his body is tired. He suffered frontal lobe damage both sides. During his recovery diabetes, high blood pressure and seizures appeared, blood clots on his brain and body aches from the fall. About a month ago he suffered a stroke and he could no longer eat so they put in a feeding tube. He now has pneumonia and is not expected to make it till his birthday this month. I cared for my uncle after his injury until June of this year and he had a clean bill of health and the doctors told me he had no issues as long as he took his meds daily! Guess they were so wrong..... I will always love him. Keep my family in your prayers

My husband suffered a traumatic brain injury after falling off a roof at work on 8/1/11 as well as left pelvic ring fracture with two pins in his lower back and other injuries including a lacerated spleen. As per a Neurologist he suffered left frontal lobe damage.  I hate to report he has been getting slowly worse over time. Even with physical therapy his balance starting getting bad which resulted in more falls and a few more hospitalizations. He has developed swallowing problems and after a swallow test was diagnosed with dysphasia. He has also had speech and OT therapies. I have to puree all of his foods. He has lost a lot of weight. He is now 64 years old and has to be with an aid all day as he can not stay alone and I work full time. He is not the big strong man who went to work that day more than five years ago and he is not the same person. 

I’m so sorry. People do not understand that you are now living with a different person. This is not the man you married. It’s so difficult for a wife. I know. Good luck