What You Should Know About a TBI

What is a TBI?

A TBI, or Traumatic Brain Injury is often referred to as a concussion and occurs when an external force causes impairment or injury to the brain. Symptoms often include headache, double vision, moving objects, poor concentration, staring, glare sensitivity, visual fatigue as well as changes to balance and coordination.

While no one is immune to sustaining a TBI, they are most prevalent amongst the youth population through sports injuries as well as the senior population due to falls. Largely due to an increased awareness, the number of TBIs diagnosed in Ontario has quadrupled in recent years. It is also important to note that individuals who have sustained a prior concussion are 2-8 times more likely to sustain another.


Immediately following a TBI, it is important to respect the acute stage of rest required for the first 48 hours including minimal stimulation. This means limiting screen time and activity followed by gradual reintroduction of activity.

Adults sustaining a TBI need a minimum of ten to fourteen days to recover while children may need a minimum of four weeks.

A multidisciplinary approach to diagnosis and treatment of TBI, including early assessment by a certified trainer at a sporting event or a first responder at the scene of an accident, can greatly improve treatment outcome. Depending on the severity of the injury, the individual may need to be transferred to hospital for immediate evaluation by a doctor where a care plan can be established.

Care plans can include short term recovery plans as outlined above, such as rest, reduction in physical activity and screen time. Care plans are most effective when long term plans are discussed as well. Long term recovery can include referrals to other health specialist such as Optometrists, Physiotherapists, Chiropractors, Naturopaths as well as other specialists who work with individuals who have sustained TBIs and can support a multifaceted diagnosis to give the individual the best possible recovery outcome.

Residual Effects

Tau is a protein that occurs naturally in our brains and helps different parts of the brain to communicate and function. Medical studies have shown that TBIs lead to damage of the brain including the development of abnormal tau. Abnormal tau causes the axons of neurons to lose their structure and break the communication pathway thus reducing function. CTE – Chronic Traumatic Encephalopathy – is a disease that is directly related to blows to the head and research has shown that in CTE patients, clumps of unhealthy tau can be found as signature evidence.

From a day to day perspective, a person who has sustained TBIs may have long term residual effects such as difficulty with sensory input. Smell, taste, sound, sight and touch can become more difficult to process. Other residual effects can include difficulty with short term memory and problem solving as well as issues with judgement, handling emotions and decision making.

“I’ve noticed frustration and stress from long term patients suffering from trauma who I help to rehabilitate from TBIs. Their frustration and stress is a result of not being able to do day to day activities without experiencing lingering symptoms that occur during or afterwards. Lack of sleep is a common symptom and is a result of the trauma and/or the anxiety created from their inability to “function” or “be normal”. It can prevent their return to all the things they want to do and need to do with their family, at work, through fitness and sports. It affects the person, their family, the people who know and care about the individual. The world around them continues to move while they have to keep the pause button pushed down. It brings them down.” Says Dr. Clarke from Merivale Vision Care in Ottawa.

What Are The 11 R’s of TBIs

As mentioned, youth and seniors are at the highest risk of sustaining a TBI and in order to reduce the impact on the lives of these individuals, there are steps that need to be taken both to treat TBIs when they occur with a strict protocol, as well to reduce the risk of TBIs by taking action steps to prevent them from occurring. Below you will find the 11 R’s of TBIs:

  • RECOGNIZE – Early recognition of TBIs through assessments that use multimodal assessment tools
  • REMOVE – Remove an athlete from play
  • RE-EVALUATE – Schedule a re-evaluation either at the hospital or MDs office using CAT scans if required or developing blood test markers to identify a TBI
  • REST – During the first 24-48 Hours (acute stage) followed by light exercise that may help to halt symptoms
  • REHABILITATE – After the acute stage
  • REFERRAL – To multidiscipline health providers
  • RECOVERY – Using established care plan
  • RETURN TO SPORT – After person returns to school, but also knowing when NOT to return to sport
  • RECONSIDER – Look at what we are doing as health professionals to ensure there are plans in place to help the pediatric and geriatric age groups
  • RESIDUAL EFFECTS – There is a need for more research and health professionals must attend continuing education course to become better
  • RISK REDUCTION – Development of equipment that can be helpful, Knowledge – Finding a balance between understanding and not being too anxious about TBI.The world of sports could still use more education on TBI assessment and prevention. Increasing awareness is central to sustainable risk reduction.