Understanding Brain Injuries

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May 23, 2018

By Mackenzie Simmons, ATC

Every year, the Brain Injury Association of America hosts National Brain Injury Awareness Month in March. This year’s theme was Change Your Mind, which focused on educating the general population about what causes brain injuries, what the recovery process is and how families are able to be supportive to those people who have endured a brain trauma.

Brain injuries can occur from many different mechanisms, including collisions (in sports or vehicles), strokes, overdoses or aneurysms. Here are some important facts about brain injuries in the United States:

  • Ÿ Someone in the United States sustains a brain injury every 9 seconds
  • Ÿ More than 3.5 million children and adults sustain a brain injury each year
  • Ÿ In the United States, 137 people die every day due to a brain related injury
  • Ÿ At least 5.3 million people living in the United States are affected by a traumatic brain injury related disability
  • Ÿ The most common cause of brain injuries are falls. Other causes are infectious disease, near drowning, strokes or seizure disorders

This blog focuses on acquired brain injuries, which are injuries developed after birth; these injuries are not hereditary, congenital or degenerative. There are 2 types of acquired brain injuries—traumatic and non-traumatic. Traumatic brain injuries are caused by an external force, such as falls, assaults, car accidents, sports injuries, gunshot wounds, child abuse or military injuries. On the other hand, non-traumatic brain injuries occur from a stroke, meningitis, encephalitis, seizure, tumor, toxic exposure, drug overdose or metabolic disorders. These all come from an internal force that causes damage to the brain.

When most people hear about head injuries, they automatically think of a concussion. However, there are many more categories of brain injuries patients or athletes could be experiencing. A short description of each follows below:

Brain Injury


Diffuse Axonal Injury

Caused by shaking or strong rotation of the head or by rotational forces; can present with different functional impairments depending on where the injury occurs

Concussion/Mild Traumatic Brain Injury (mTBI)

Caused by a direct blow to the head, violent shaking of the head, whiplash or gunshot wounds; most common type of brain injury; can cause permanent or temporary damage


Bleeding on the brain, caused by a force to the head; large contusions may need to be surgically removed

Coup-Contrecoup Injury

Contusions that are both at the site of the impact and the opposite side; brain moves and hits the other side of the skull

Second Impact Syndrome

Occurs when a secondary mTBI occurs before the previous one heals; more likely to cause brain swelling and widespread damage

Penetrating Injury

Caused by the impact of a bullet, knife or other object that forces fragments from an object into the brain

Abusive Head Trauma (Shaken Baby Syndrome)

Results in aggressive whiplash, which ruptures the blood vessels between the brain and skull, causing bleeding

Locked-In Syndrome

Rare neurological condition where a person cannot physically move any other part of their body, aside from their eyes

In athletics, concussions are the most commonly seen traumatic brain injury. The following is a summary of concussion symptoms, return to play protocols and return to learn protocols. Every concussion is different—some have symptoms that are hard-to-see, while others have rather obvious symptoms.

Certain patients will feel the symptoms immediately and others have a delayed onset. The symptoms may start to resolve after a few days or might last for a couple weeks. If the symptoms have not improved after 2-3 weeks, it is important to schedule an appointment with a physician who specializes in sports medicine or concussion management. Below is a table that shows the differing signs and symptoms that affect the cognitive/physical, emotional and sleeping aspects:





Feeling in a “fog”



Trouble falling asleep

Can’t follow conversations

Can’t recall injury

Easily agitated

Not sleeping soundly

Difficulty concentrating and/or remembering



Sleep cycle disturbed

Slowed reaction times



Not feeling rested

Difficulty learning

Sensitivity to light and/or sound

More impulsive

Sleeping more

While there are many concussion symptoms that are normal to experience, there are also some red flags what warrant immediate referral to the nearest emergency department. Sometimes these symptoms have an immediate onset and other times the symptoms will have a gradual onset. Some of the red flags are worsening headaches, repeated vomiting or nausea, slurred speech, unequal pupils, loss of consciousness or convulsions/seizures.

After a traumatic brain injury, a patient may have difficulty completing his/her normal activities of daily living. For someone who is still in school, a concussion or other brain injury may put a person extremely behind in their homework and tests. It is important that the doctor outlines an exact plan of returning to school in a slow, gradual manner. All teachers, administrators, healthcare personnel and family members need to be on the same page to ensure the patient is getting all the help he or she may need. The basic outline of the return to learn protocol is listed below:

  • Ÿ Complete rest phase—should last for 1-3 days. Avoided activities include cell phone use, computer use and video games. Activities that can be encouraged include yoga, light meditation, light stretching activities and breathing exercises.
  • Ÿ Light thinking phase—listening to calming music, playing familiar games. Expanded exercise activities.
  • Ÿ Return to school phase—start with a modified school day, either attending just a couple classes or starting with a half day. All involved staff members should be involved in the planning process of accommodating the student athletes.

Also, the athlete will need to go through return to play protocol after being diagnosed with a concussion. This protocol may vary somewhat from state to state. However, the patient should be mostly asymptomatic by the time physical activity is started. Through the progression of the protocol, the athlete needs to remain symptom free to ensure that the exercise is not causing the patient to become worse in their recovery.

  • Ÿ Phase 1—It is recommended the athlete do a daily symptom check to monitor progress of healing. An athlete does not need to have his/her neurocognitive or motor function skills tested at this time. The athlete may not be attending school and there should be no physical activity.
  • Ÿ Phase 2—Athlete may underdo light exercise at <70% age-predicted maximal heart rate. This may include walking, jogging or biking.
  • Ÿ Phase 3—Sport specific activities without contact. This will vary by sport.
  • Ÿ Phase 4—Non-contact training involving others. This will vary by sport.
  • Ÿ Phase 5—Unrestricted training. Full practice allowed.
  • Ÿ Phase 6—Return to Play (should have doctor clearance before this)

All brain injuries should be taken seriously. It is important that each patient should be treated with appropriate and compassionate care from all healthcare professionals, family members and friends. It is time to de-stigmatize the negative connotation around head traumas and provide the injured with the support and attention they need to make a full recovery. Make an effort to Change Your Mind about patients who may have had a traumatic brain injury and ensure you are following the proper procedures to support their return to learn and return to play.


Notebaert, A. J., & Guskiewicz, K. M. (2005). Current Trends in Athletic Training Practice for Concussion Assessment and Management. Journal of Athletic Training, 40(4), 320–325.

“The Voice of Help, Hope and Healing.” Brain Injury Association of America, 1 Feb. 2018,

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