About TBI

Return to Learn/ Return to Play:  Concussion Management Guidelines

Brain Resource And Information Network

Signs & Symptoms

Traumatic brain injuries are the leading cause of disability and death in children and youth in the United States. According to the Center for Disease Control, a Traumatic Brain Injury (TBI) is caused by a bump, blow or jolt to the head that disrupts the normal function of the brain. TBI frequently results from motor vehicle crashes, falls, and other instances when the head is hit and the brain is forced against the hard walls of the skull. The Individuals with Disabilities Education Act defines a traumatic brain injury as:  

“An acquired injury to the brain caused by an external physical force resulting in total or partial functional disability or psychosocial impairment or both that adversely affects a child’s educational performance.”

This definition applies to both open and closed head injuries resulting in impairments in one or more of the following areas: 

  • Cognition
  • Memory
  • Language
  • Attention
  • Reasoning
  • Abstract thinking/learning
  • Judgment
  • Emotions
  • Problem solving
  • Sensory, perceptual, and motor abilities
  • Changes in behavior
  • Physical functions
  • Information processing
  • Speech
  • Seeing and/or hearing
  • Planning/initiation
  • Visual processing (i.e. reading)
TBI in Young Children Signs & Symptoms
TBI In Young Children, Signs & Symptoms Tool

Impact of Traumatic Brain Injury:

As brain injuries range from mild to severe, so can the changes that result from the injury. 

Physical disabilities:  difficulty speaking, seeing, hearing, and using other senses. May experience frequent headaches. These individuals may have trouble with fine motor skills (i.e. writing/drawing). Gross motor skills such as balance may be affected.

Difficulties with thinking:  Difficulties with short-term and long-term memory often occur. May have difficulty concentrating and only be able to focus attention for shortened amount of time. These individuals may think slower and have trouble talking and/or listening to others. Difficulties with reading, writing, planning, judgment, sequencing and understanding may occur.

Social, behavior, or emotional problems:  These signs may include sudden mood changes, anxiety, and depression. May have difficulty relating to others. These individuals may have decreased motivation and inability to control their emotions.

This type of injury can change how the person acts, moves, and thinks, and learns in their everyday environments (i.e. school).   The etiology of TBI is closely associated with age and gender. Children younger than 5 years tend to be injured in falls, motor vehicle crashes, and by adults inflicting violence. Those between ages 5 and 15 are most commonly injured on bicycles, skateboards, horses, as pedestrians, and during sports activities. After 15 years of age, motor vehicle crashes becomes the most common cause of TBI. 

Many TBIs occur as we engage in our everyday occupations - playing, driving, biking, bathing, cleaning, or competing in sports.  These injuries can occur at home, during practice, or in the community. The way we perform these occupations, the equipment used and features of the environment may contribute to prevention or risk of TBI. Brain Injuries may range from mild, moderate, and severe.


Mild Traumatic Brain Injury:

A Mild traumatic brain injury (MTBI), commonly called concussion, is often diagnosed following a blow to the head with or without brief disruption of consciousness. MTBI are defined as

  • any period of loss of consciousness
  • any loss of memory for events immediately before or after the accident
  • Any alteration in mental state at the time of the accident (e.g. feeling dazed, disorientated, or confused)
  • Loss of consciousness of 30 minutes or less
  • 13-15 on the Glasgow Coma Scale*

Post concussive symptoms such as tiredness, irritability, headache and sensitivity to noise have a disruption in executive functions, impairment in daily activities and participation, decreased ability at school, changes in relationships, psychosocial impairment and decreased perceived health. Approximately 75% of total TBIs in the U.S. suffer a mild traumatic brain injury or concussion each year.

Moderate Traumatic Brain Injury:

A moderate traumatic brain injury occurs when the individual is:

  • unconscious for more than 20-30 minutes but less than 24 hours
  • Post traumatic amnesia* (memory loss after event) lasting 24 hours to 7 days
  • Glasgow Coma Scale** of 9-12

There may or may not have been skull fractures, contusions, or bleeding. This type of brain injury is likely to show on a brain scan or imaging device. In children, a moderate brain injury may result in physical weakness, cognitive or communication impairments, difficulty learning new information, and psychosocial challenges. https://www.cbirt.org/

Severe Traumatic Brain Injury:

A severe traumatic brain injury occurs when:

  • a patient is in a coma for more than 24 hours
  • Post traumatic amnesia* lasting 7 days or longer
  • Glasgow Coma Scale** of 8 or less 

About 80% of children who sustain a severe brain injury will have multiple physical, cognitive, cognitive-communicative, social, emotional, and behavioral problems that are long lasting. Some difficulties may not appear until later in the child's development, when greater levels of planning and abstract thinking are required for successful functioning in school and at home. https://www.cbirt.org/


*Post-traumatic amnesia (PTA) is the single best measurable predictor of functional outcome in the research literature. PTA is the length of time from the injury to the moment when the individual regains ongoing memory of daily events. Evidence suggests that the duration of PTA is correlated with individual outcomes. Longer PTAs are associated with poorer long-term cognitive and motor abilites and a decreased ability to return to daily occupations (i.e. school). 

**The Glasgow Coma Scale (GCS) is the traditional method used by healthcare providers to assess level of consciousness following a TBI. The three behavioral areas assessed in the GCS are motor responses, verbal responses, and eye opening. The three values are scored separately and can also be totaled for the Glasgow Coma Score (GCS).

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