For thousands of traumatic brain injury (TBI) survivors, however, the real journey begins after they are discharged.
TBI occurs when an external force causes brain dysfunction, typically from violent blows, jolts, or penetrating injuries to the head. Locally, this most commonly happens during high-speed vehicle collisions, where the brain moves violently within the skull, creating mild to severe TBI.
It is important to note that even “mild” TBI, often called concussions, can have profound long-term effects. Meanwhile, some patients with severe initial injuries make remarkable recoveries. What determines the outcome isn’t always the initial severity, but how quickly treatment begins and how the brain responds over time.
Consultant neurosurgeon Dr Low Siaw Nee sees the full spectrum of these injuries daily. “Motorcyclists are at the highest risk compared to passenger vehicle occupants when it comes to the severity of injuries sustained,” she said.
“The most common types we see include concussions, diffuse axonal injuries, contusions, intracranial hemorrhages, and skull fractures.”
Low also frequently encounters patients with combined neurological injuries. “In some cases, we might be dealing with both brain and spinal cord trauma simultaneously, which complicates both the immediate treatment and long-term recovery picture.”
When it comes to TBI specifically, what sets it apart from other injuries is fundamental. While a broken bone may heal predictably, recovery from TBI follows no standard timeline, with factors such as age and existing health conditions playing crucial roles.
“Our brains have no ‘spare parts’ – the brain equals the person,” Low stated. “TBI may change who the person is in terms of personality, judgement and relationships, and families may struggle more with these changes than with physical weakness.”
Unlike a cast or a crutch that would signal an injury on the outside, brain complications are hidden from view. A TBI survivor may look completely normal on the outside while struggling with profound internal changes that affect their quality of life.
These complications often emerge gradually, sometimes months after the initial injury, catching patients and families unprepared.
Low has observed this pattern countless times in her practice. “Within the first two weeks, the focus is on survival and visible injury. After three months, cognitive and emotional problems start to emerge – and within the first year, these issues can become more apparent,” she highlighted.
“At one to two years, we see long-term adaptation, with invisible complications often persisting. Beyond two years, brain plasticity continues but at a slower pace, with increased risk of long-term depression, caregiver burnout, and social isolation.”
Understanding when to worry becomes crucial for families navigating this journey. Normal recovery fluctuations are temporary and mild, such as fatigue after physiotherapy or emotional mood swings, especially within the first month.
More serious neurological complications that require immediate attention can encompass sudden, progressive, or completely new symptoms, such as worsening headaches, vomiting, weakness, numbness, speech difficulties, drops in consciousness, confusion, or seizures.
Through the recovery period, the question families ask most frequently is perhaps the hardest to answer: when can life return to normal?
For Low, recovery is like planting a tree after a storm – it can grow back, but slowly and sometimes not completely. “Every brain injury is different,” she emphasised. “We assess each stage based on physical, cognitive, and emotional abilities, as well as complications such as seizures, cognitive fatigue, or stress.”
Check back in tomorrow for part two of this article, which discusses recovery from TBI.