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There are more than 5.3 million people in the U.S. who are living with a permanent brain injury-related disability, according to the Brain Injury Association of America. Roughly 65% of injuries sustained are caused by falls or from being struck by or struck against something.

Understanding Brain Injury

A brain injury can influence everything from movement to memory and even emotions. They can happen at birth or as a result from an illness or trauma, but recovery is possible, and life with a brain injury, while challenging, can be positive and meaningful.

There are different ways to define a brain injury — they can be described as traumatic or non-traumatic, and depending on the severity of the injury, there can also be varying degrees — mild, moderate or severe.

Traumatic Brain Injuries

A traumatic brain injury (TBI) is caused by a blow to or penetration of the head, commonly caused by falls, sports injuries, car accidents, being hit on the head or an assault.

The most common type of TBI is a concussion, accounting for hundreds of thousands of hospital visits each year. Concussions can range from mild to severe and can cause life-long damage if left untreated, especially for those who suffer frequent concussions, like athletes.

“Following a concussion, people should seek treatment if they had loss of consciousness and/or if they are experiencing persistent symptoms such as headaches, nausea/vomiting and confusion,” says Laura B. Ngwenya, MD, PhD, director of the Neurotrauma Center at the University of Cincinnati Gardner Neuroscience Institute and associate professor in the Department of Neurosurgery and Neurology & Rehabilitation at the UC College of Medicine.

Other common types of TBIs include:

• Contusion.
• Diffuse axonal injury.
• Skull fractures.
• Subdural hematoma.

TBIs can cause different symptoms for different people, depending on the severity of the injury and which part of the brain was injured.

For Derrick Davis, something that he loved changed his life in a split-second accident.

“I was 22 in my last year at Cincinnati State Technical and Community College as an audio and video production student,” says Derrick. “I was filming a video for class and some of the scenes required us to be on a moving vehicle. I tried to dismount while it was still moving, and I didn’t stick the landing at all.”

Derrick hit his head on the pavement. He then spent three days in the UC Medical Center Intensive Care Unit (ICU), before being moved to the neurological floor for further observation. He spent his first week or so in a wheelchair and remembers only flutters of nurses and other aids helping him walk around the floor, relearning how to balance.

“The word traumatic isn’t in [TBI] on accident,” Derrick says. “The victims are scared and confused. I had many sleepless nights coming to terms with the fact that my act of carelessness could be my final bow.”

Non-Traumatic Brain Injuries

A non-traumatic brain injury, often referred to as an acquired brain injury (ABI), is a type of brain injury resulting from internal factors. Unlike a traumatic brain injury caused by physical trauma to the head, an ABI is a result of an illness or condition within the body.

Non-traumatic injuries can be caused by a lack of oxygen (hypoxia) or no oxygen (anoxia). Without blood flow and oxygen, cell death and damage occur, and time is of the essence. The more time someone spends without oxygen, the greater likelihood of a brain injury moving from a mild state to moderate or even severe.

Some common types of non-traumatic brain injuries include:

• Drug overdose.
• Electric shock.
• Heart attacks.
• Infectious disease.
• Severe seizures.
• Stroke (hemorrhage, blood clot).
• Tumors.

Recovering from a Brain Injury

Immediate Treatment

Immediate treatments for a brain injury patient greatly depend on the type and severity of the injury.

“When a brain injury patient first arrives to UC Health, they are assessed by our team of providers who perform an exam, obtain blood work and order imaging of the head. If there is blood in the head because of the brain injury, additional imaging is ordered, and sometimes patients undergo procedures, including surgery,” Dr. Ngwenya explains.

Once these treatments are completed, patients are then often admitted to the hospital for monitoring. A very important part of treatment is preventing further brain injury – that’s why doctors are highly focused on treating patients in the initial hours and days after injury to monitor and treat any continued damage.

Kourtney Hurst was in a car accident in January 2017, and suffered a subdural hematoma, a broken neck and clavicle, a leg fracture, multiple facial fractures, punctured lungs and dissected carotid arteries. She immediately underwent brain surgery at UC Medical Center, and awoke days later, faced with the task of relearning how to walk, eat and live her normal life.

Nearly five years later, after multiple rounds of therapies and a high-risk pregnancy, Kourtney went back to school to earn her Bachelor of Science in nursing, so she can inspire patients in a new way.

“I still talk to and see many of the first responders and nurses that cared for me at UC Health. They were my angels during the worst moments of my life and turned into the family that motivated me to work hard and climb impossible mountains,” says Kourtney.

The Brain’s Adaptation Process after an Injury

Injuries can disrupt the chemical balance in the brain, which causes cognitive and behavioral changes. However, the brain may fix the chemistry over time, and there's a chance that functioning can dramatically improve.

While neurons in the brain can't regenerate, and injuries often lead to tissue death and structural damage, brain cells that survive can change themselves to make up for the loss. The brain can learn to reroute information and function around the damaged area. This rewiring phenomenon is called neuroplasticity, and rehab therapies may complement and speed up the process, though recovery time depends greatly on the severity of the injury.

Coma and Minimal Consciousness

Not all patients with a brain injury are comatose, but some may experience a coma following a severe brain injury. A coma is an altered state of consciousness in which the body is not able to respond to the surrounding environment. The depth and time spent in a coma vary depending on the location and severity of the injury. Some patients emerge from a coma with minimal impact, while others may experience significant disabilities.

Later Stages of Recovery

Recovery from severe injury can be a lifelong journey of treatment and rehabilitation. As the brain and other body systems stabilize, the injured person will most likely be dependent on others. Eventually, short conversations are possible, followed by self-sufficiency with certain everyday routines. Still, functions like problem-solving or remembering details can remain compromised, and the person may not be able to plan for themselves. Depending on the injury, some individuals will remain at this level.

However, others can progress, and there's a big difference between their state immediately after the injury and six months down the line. Gradual improvements can occur for years, and independent living is achievable. Life after a brain injury may never be the same as before but adjusting and living a fulfilling life is possible.

“After I was in a less fragile state, I went to Daniel Drake Center for Post-Acute Care for cognitive tests and different therapies,” says Derrick. “It was about six weeks before I had the mental capacities to even drive again.”

Derrick initially shut down after his TBI — pushing everyone away, so no one would be sad should something happen again.

“It took plenty of patience from friends and family, and amazing role models helped me come to terms with myself,” he says.

Now, five years after his TBI, Derrick works with iHeart Radio, managing quality and talents across the country through the rock stations, and keeping the content within Federal Communications Commission (FCC) standards.

“I’m still Derrick Davis, but I’m the me that 2016 Derrick dreamed of being,” he says. “It took some time and plenty of coming to terms, but I’m a Derrick who figured out how to love himself enough to take life seriously.”

What Kind of Therapy Works Best?

“No brain injury is the same, and recovery will be different for everyone,” says Kourtney. “Long-term changes and a new normal will look different for each person, but just because an injury isn't visible it doesn't mean that it isn't very real.” Despite her grim outlook in January 2017, she proves that with the right therapy, patients can return to a new normal.

Treatment depends on the affected areas of the brain and what the injured person needs. A combination of the following rehabilitation therapies may restore functions and provide essential coping mechanisms:

• Speech and language therapy to enhance communication and manage swallowing abilities.
• Physical therapy to improve mobility and coordination.
• Occupational therapy to improve skills needed for daily living, work and community ability including bathing, dressing, cooking, household chores, computer work and even visual training.  
• Psychological counseling to address the mental trauma of the injury and its consequences. 
• Cognitive therapy to work on memory, focus, learning and judgment.

Dietitian visits can also provide a customized diet to promote brain health.

Improving Speech after a Brain Injury

The speech and language pathologist provides training in compensatory strategies and exercises to:

• Target respiratory support for speech.
• Strengthen oral motor and coordination.
• Improve language skills.
• Provide tools and assistive technology to both patients and caregivers to maximize effective communication.

Learning to Read Again After a Brain Injury

Acquired dyslexia, also known as alexia, can occur following a TBI. Occupational and speech therapists target the language skills needed for reading and provide a variety of treatment techniques. These include:

• Tactile/kinesthetic treatment where tracing letters on hands helps with letter recognition.
• Sounding out letters and letter combinations.
• Reading slowly for a short amount of time and building up endurance to avoid symptoms.
• Covering up text around the sentence.

Learning to Drive Again After a Brain Injury

Learning to drive after a brain injury can be different for individuals. Some, whom have had mild injuries, may need to take a few days or weeks to recover from their symptoms and improve their response time. Others may have a more prolonged path to resuming driving, requiring months of training to regain motor skills and underdoing driving-specific rehabilitation.

The goal of brain injury rehabilitation is to help improve function and independence, while improving the overall quality of life — physically, emotionally and socially. Throughout rehab, it's vital to celebrate the small but substantial progress milestones. Positive reinforcement can aid in recovery by boosting self-esteem and promoting independence.

Kourtney and Derrick: More Than Their Brain Injury

The Brain Injury Association notes that many people with brain injuries have their lives defined for them. Since their accidents, both Kourtney and Derrick have proved that they are more than their brain injury.

“I am a big believer in maintenance therapy and keeping my brain, and life in general, in check,” says Kourtney. “I have good days and bad days but each one of them is a blessed day.”

Brain injuries are not visible, which can make them difficult to understand. Yet, each person affected has their own story.  

“To those on the outside looking in, have patience, not pity,” says Derrick. “We’re in the process of becoming someone new and we have cooler stories for our autobiographies, but we’re still the friend, coworker and relative you knew and loved before. I’m lucky enough to say I survived my injury, and even luckier to be able to say something that should have killed me filled me with more life than I originally had and took for granted.”

The Neurotrauma Center at the UC Gardner Neuroscience Institute

When life is at stake — from a fall to a motor vehicle crash — our highly trained neurotrauma team is ready to treat even the most complex conditions with the fastest and most extensive critical care in the region.

Call 513-475-8990 for more information or to schedule an appointment.