Slipping on ice. Falling off a bike. Taking a spill while water skiing. Even missing a step on the stairs. These everyday accidents can lead to concussions or undetected traumatic brain injuries (TBIs).
March is Brain Injury Awareness Month, which makes it a good time to highlight just how common – and serious – these injuries can be. As the weather warms up, many people are ready to head outdoors, fix up their homes, and enjoy recreational activities. But along with those activities comes risk. A head injury can happen in seconds, and the effects may last much longer.
Amy Zellmer, founder of Faces of TBI and the #NOTINVISIBLE campaign, knows firsthand. After falling on the ice in 2014, she became a strong advocate for TBI awareness and survivor support. While children and athletes often get the attention, adults are also at risk. TBIs contribute to about 30 percent of all injury-related deaths in the U.S., and many survivors face symptoms that are overlooked or misdiagnosed. As Zellmer’s website puts it: “Every single concussion is a brain injury.”
What is a TBI?
Each year, Americans experience an estimated 1.6 to 3.8 million sports- and recreation-related concussions, according to the Centers for Disease Control and Prevention (CDC). And those numbers are probably low, since so many injuries go undetected or unreported. For decades, concussions weren’t taken seriously, which means many adults who fell from a tree, played tackle football, or were in a car accident years ago never got the right treatment.
A TBI happens when a bump, blow, or jolt to the head disrupts how the brain works. Not every head injury causes a TBI, but even mild ones – commonly called concussions – can cause a temporary change in brain function. More severe TBIs may lead to memory loss, ongoing symptoms, and long-term health problems.
Here’s why: the brain floats inside the skull, cushioned but not fixed in place. On impact, it can crash forward into the skull, bounce back against the rear, or even twist on the brain stem. This can lead to bruising, bleeding, nerve damage, or more severe trauma. TBIs can also happen without a direct hit to the head – for example, through whiplash or shock waves from an explosion. In fact, blasts are a leading cause of TBI in active-duty military members and are often linked to PTSD.
Falls, Recreational Activities Top the List for Head Injuries
Sports-related concussions often make headlines, but they’re far from the only cause of TBIs. According to the CDC:
- In 2013, nearly 50 percent of all TBI-related ER visits, hospitalizations, and deaths in the U.S. were from falls.
- Older adults are more at risk. Falls account for nearly 4 in 5 TBI-related emergency visits, hospitalizations, and deaths in adults over 65.
- Falls are also the leading cause of TBI-related deaths among seniors. Practical fall prevention strategies can go a long way in lowering this risk.
Still, a fall can happen to anyone: slipping on ice, tripping over a rug, stumbling on a ladder, or catching a foot on a cord or toy.
Sports and recreational activities also add risk. According to U.S. Consumer Product Safety Commission data, these activities cause the most head injuries treated in ERs:
- Bicycling
- Football
- Baseball and softball
- Basketball
- Water sports (diving, surfing, water skiing, etc.)
- Off-road vehicle (ATVs, go-karts)
- Soccer
- Skateboarding and scootering
- Gym and health club activities
- Winter sports (skiing, snowboarding, sledding snowmobiling)
Signs and symptoms of TBIs
One of the biggest challenges with TBIs is that symptoms don’t always show right away. A person may “look fine” but feel off. Symptoms can also come and go, making them easy to dismiss. That’s why any head injury should be taken seriously, and family and friends should watch closely for changes in the days and weeks that follow.
Symptoms may include:
- Cognitive: brain fog, trouble concentrating, difficulty remembering, confusion
- Physical: headaches, blurred vision, dizziness, nausea or vomiting, balance problems, fatigue, sensitivity to noise or light, seizures, “seeing stars”
- Emotional: irritability, sadness, anxiety, mood swings, aggression
- Sleep: sleeping more or less than usual, or trouble falling asleep
- Hormonal: changes in blood sugar or hormone regulation, which may cause depression, anxiety, mania, or apathy
- Digestive: changes in gut health, motility problems, or increased gut permeability
Recovery Guidance: What to Expect After a TBI Diagnosis
Hearing that you or a loved one has a traumatic brain injury (TBI) can feel overwhelming. The most important first step is to give the brain time to heal and to follow a clear, structured plan guided by healthcare professionals. Here’s how to navigate the early days after a diagnosis and prepare for the weeks ahead.
The Immediate Phase: Rest and Support
The first few days after a concussion are critical for recovery. During this phase, the brain needs complete downtime to begin healing. Parents and caregivers should focus on rest and simple routines to provide structure and reassurance.
- Rest is essential: Both physical and mental downtime are needed—limit screen time, avoid reading or loud noises, and minimize physically demanding activities.
- Establish a routine: Regular sleep and meals help provide structure while the brain resets.
- Medical guidance matters: Always check in with your neurologist, physician, or rehabilitation specialist for a personalized recovery plan. Bring a list of symptoms or concerns to every appointment.
Supporting Recovery Every Day
Once you’ve given your brain time to rest, light activity can help it recover — as long as symptoms are closely monitored. This stage is about balance: gently reintroducing movement while respecting your body’s limits.
- Light movement: Short walks or gentle stretching may be reintroduced under guidance.
- Brain breaks: Stop and rest if symptoms return or worsen. Don’t rush recovery.
Rehabilitation Exercises for TBI Recovery
Daily rehabilitation—both physical and cognitive—is a key part of regaining function and independence after a TBI. Even at home, simple exercises can make a significant difference. For example, safe prehab exercises can help build strength and support recovery.
Physical Exercises
Before starting any new exercise, consult with your therapist or doctor. These movements are common in post-TBI care:
- Seated Marching: Sit tall and slowly lift one knee, then the other, as if marching in place.
- Shoulder Abduction: Slowly raise arms your arms out to the side, then lower them back down.
- Trunk Flexion/Extension: Sitting tall, gently lean forward and then return to upright.
Balance Exercises:
- Weight Shifts: Stand tall and gently lean weight from one foot to the other.
- Heel-to-Toe Walk: Take slow steps in a straight line, putting one foot directly in front of the other.
Cognitive Exercises
Brain training can help improve memory, concentration, and processing speed:
- Journaling: Daily notes or lists help memory and focus.
- Brain Games: Puzzles, crosswords, Sudoku, or apps designed for cognitive training.
- Spaced Retrieval: Practice recalling information at increasing time intervals.
Speech and Language Practice:
- Practice saying short stories or word lists aloud.
- Use reminders, lists, or smartphone alarms to support memory and communication.
At-Home Care Tips: Supporting Recovery Between Appointments
- Create a Safe Space: Remove tripping hazards and keep areas well lit.
- Track Progress: Record symptoms, fatigue levels, and smart wins daily.
- Stay Connected: Gentle conversation, shared meals, or music can boost mood.
Daily Self-Care:
- Drink plenty of water and eat nourishing foods.
- Regular, gentle movement (as able) helps circulation and keeps muscles active.
TBI Management Strategies for the Long Haul
Recovering from a TBI is often a marathon, not a sprint. Here’s how to keep making progress and stay safe:
Lifestyle & Symptom Management
Recovery doesn’t happen overnight. Long-term progress requires tracking symptoms, avoiding reinjury, and pacing daily activities.
- Monitor symptoms: Track headaches, dizziness, or mood changes. Share changes with your medical team.
- Prevent reinjury: Avoid risky activities—such as climbing ladders or contact sports—until cleared by your healthcare provider.
- Pace yourself: Space out demanding tasks and rest as needed.
Returning to Normal Activities
Getting back to work, school, sports, or social activities should happen step by step. Gradual reintegration reduces the risk of setbacks and helps you regain confidence.
- Work or school: Return gradually, starting part-time or with lighter duties as needed.
- Exercise: Increase activity slowly and back off if symptoms flare.
- Therapy: Keep regular appointments with physical, occupational, or speech therapists to track progress and set new goals.
Remember: Every TBI journey is unique. Progress may be slow, but small, consistent steps add up over time. Stay patient, seek support, and celebrate every bit of progress along the way.
Ways to Protect Yourself
A TBI can harm the brain in many ways and result in unconsciousness, coma, brain bleeds and clots, inflammation, memory loss, permanent disability, and even death. It’s not something to take lightly.
- Take precautions to protect your brain when it comes to recreational sports and daily activities:
- Be vigilant, especially when walking on ice or downstairs
- Wear good shoes with sturdy, slip-resistant outsoles
- Watch for trip hazards
- Keep your hands free to brace yourself for falls and use hand railings.
- Invest in a good helmet and wear it when playing sports such as football, hockey, bicycling, skiing, or snowboarding
A helmet won’t prevent every concussion or TBI, but it can help reduce the risk of serious injuries like skull fracture. In fact, a study presented at the American Academy of Neurology’s 2014 annual meeting found football helmets reduced the risk of traumatic brain injury by only about 20 percent compared to no helmet – but they did protect against skull fractures and bruising from linear impacts. In other words: a helmet is worth wearing, even if it’s not a cure-all.
What Should You Do if You Suspect a Concussion or TBI?
If you or someone you love has a head injury, don’t wait and see if symptoms go away. Seek professional care right away. Call 911 or visit the emergency department if there’s loss of consciousness, confusion, a major cut or bruise, or unusual behavior. It’s better to be safe than sorry and suffer the consequences of undetected TBIs.
At Ivy Rehab, we offer specialized concussion management and assessments to help you recover and safely return to the activities you enjoy.
Article Reviewed by Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA is a practicing physical therapist and a partner and Director of Clinical Services at Ivy Rehab Network. Deur is board certified as a geriatric clinical specialist and certified exercise expert for aging adults with more than 35 years of clinical experience. She is certified as an aquatic and oncology rehabilitation specialist and serves as adjunct faculty at Central Michigan University and Grand Valley State University.
