Recovery From a Traumatic Brain Injury

Falling is “by far the most common way that older individuals hit their heads,” and although they should be closely monitored in the hours and days after injury, it’s fairly rare “to be seen by any sort of specialist” after a head strike. This is in spite of the fact that a mild TBI, sometimes called a concussion, can cause disabling health problems. Having multiple symptoms like those Striker experienced is the norm, according to a 2022 TBI report from the National Academy of Sciences. And those symptoms can persist for months and years after the injury.

When assorted post-TBI symptoms require several health care providers, it helps to have one “quarterback” of the care team, a health provider who can advise and connect the patient with other providers to get helpful treatments. The primary care doctor often fills this role, even though extensive TBI care is not a standard part of their training. For a head injury, Peters says, geriatricians are more likely to be up to date on why and how to monitor an older person.

Those having trouble finding a provider experienced in treating TBI can contact their state chapter of the Brain Injury Association of America or call or email BIAA’s National Brain Injury Information Center. Greg Ayotte, BIAA’s director of consumer services, sees two common situations among older adults. First, a person falls and hits their head and has another injury, such as a broken bone. While doctors attend to the other issues, “the brain injury is overlooked,” he says. Second, “brain injury issues are deemed to be ‘dementia’ or some other age-related cognitive impairment, and no follow-up is suggested.”

Several paths to treatments

Peters says he’s happy to see TBI care beginning to take place in multidisciplinary fall clinics, often overseen by a physiatrist. These doctors are trained in physical medicine and rehabilitation and are familiar with physical therapists, occupational therapists, speech-language pathologists, behavior therapists and other specialists. Though not yet widespread across the country and not as highly regulated as other medical clinics,  the “rehabilitation framework” of multidisciplinary clinics aims to achieve “improvement, even if that doesn’t get you to a ‘cure,’ ” Peters says.

In November 2023, Striker visited the Concussion Care Centre of Virginia in Richmond, one of those multidisciplinary clinics, for an evaluation with Jacqueline Theis, a neuro-optometrist. Theis specializes in helping patients with visual problems due to traumatic brain injury and other neurological injuries and diseases.

Striker’s appointment with Theis was more than a year after the TBI occurred in June 2022. But Theis says the length of time since injury should not dissuade anyone from seeking treatment. “There is this adage out there that one year post-brain injury [is] as good as you’re gonna get,” she says. “That’s gotta go.”

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When people think there’s no hope for improvement, they don’t bother seeking treatment. She acknowledges that the eyes “will get better faster” if treatment begins closer to the injury. But most people Theis and her colleagues take care of were injured months or years earlier. “Just because they’re years out,” she says, “doesn’t mean they don’t get better.”

A person’s age should not be weighed too heavily, either, Theis says. When her patients over 65 worry they’re too old to improve, she tells them that if they can find the time to do rehab, it’s worth it. Telehealth can help make ongoing care more accessible. Theis says that her initial exam is best done in person and that she’s candid with her patients that she can’t do everything on a video call that she could do in person, but she can still do a lot. Brain injury rehabilitation sometimes involves many appointments over a long stretch of time. Telehealth makes that kind of commitment possible, increasing access to specialized practitioners like Theis, especially for people who don’t live near large metropolitan areas or need to count on others for a ride.

A creative mix of therapies

In some parts of the country, the practitioners best positioned to help aren’t necessarily medical doctors. Many rural areas have excellent physical therapy groups that are likely to be familiar with good local occupational therapists and speech language pathologists who can help guide a TBI patient’s recovery, Peters says.

They may not have specific training in brain injury rehabilitation, but “they’re boots on the ground and they’ll actually know who to direct you to” and can come up with a plan, he says. “It usually only takes one good provider to start building your team out.” Every patient is going to look a little bit different, he says, so to put together a care plan, practitioners need “to be creative and innovative and thoughtful.”

Long before her own injury, Striker brought a similar multidisciplinary mindset to her own work helping people recover from traumatic events, such as combat-related trauma, sexual assault and unexpected loss. She sees many overlaps with TBI recovery. She calls her journey, now stretching into year two, “self-driven” and “sometimes financially challenging.” Reflecting on what has been most helpful, Striker cites the things that she learned from her research to help others recover from traumatic stress. She does mindful movement, practices gratitude, gets sufficient sleep, water and nutrition, spends time in nature and with friends, and especially with her husband, Sam.

She wants other people recovering from mild TBI to know that “pushing yourself a little is not going to break your brain, even though that’s exactly how it feels.” One of her most significant improvements is that it now takes much less time for her to recover from rehabilitation exercises. The key for her has been learning to balance tasks that may increase symptoms in the short term with restorative rest. Above all, Striker feels empowered not to dwell on what happened, but rather to focus on what she is going to do in the future.