Recovery From a Traumatic Brain Injury

Getting the help you need can take lots of coordinating and leg work

Marah Stets

Reviewed by

Rachel Lazarus, Ph.D.

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En español

Published February 05, 2024

Kintla Striker smiling next to a small body of water years before her traumatic brain injury

Yoga and mindfulness teacher Kintla Striker is navigating recovery from a traumatic brain injury to get back to her joyful self, shown in this 2016 photo.

Courtesy Sam Striker

Barely 36 hours after learning of her adult daughter’s sudden death, Kintla Striker fainted in the middle of the night on the bathroom floor. Her husband, Sam, found her unconscious. He nudged Striker awake and she vomited. Unable to stand, walk or speak, she shook her head “no” when he asked if she had hit her head, and he carried her to bed.

When she awoke several hours later, Striker, then 56, vomited again and could barely walk. A massive headache and pain at the back of her head suggested that she had hit hard when she fell. A CT scan at the local emergency room showed no bleeding in her brain. So she went home with instructions to rest in a dark room, stay off screens and follow up with her doctor in a few days.

But there was no time to rest. During the next week — it was late June 2022 — the Strikers flew to Michigan, where her daughter had died, then back to their home in Charlottesville, Virginia. Kintla Striker struggled with a constellation of symptoms, including severe migraines, brain fog, dizziness, blurred vision, balance issues, trouble focusing and problem solving, short- and long-term memory issues, sensitivity to sounds and light and trouble taking deep breaths.

At a follow-up visit about four weeks after the injury, her doctor, an experienced general practitioner, seemed like “a deer in headlights,” Striker says. As they reviewed her list of symptoms, the doctor asked if she could discern, “how much of this is grief and how much is head injury?” Striker replied that she didn’t know, but she guessed it was primarily grief.

“I couldn’t assess myself well at all,” says Striker, a yoga and mindfulness teacher and researcher who specializes in treating traumatic stress. The doctor suggested she see a therapist. Striker left the office without a care plan for most of what she was experiencing. The next several months held repeated lessons about how challenging it is to find well-informed, consistent care for traumatic brain injury, or TBI.

Striker’s experience is not unusual. There is no clear treatment protocol for TBI, primarily because the symptoms are so wide-ranging. That makes both diagnosis and treatment of a brain injury unusually difficult.

As a result, doctors often struggle with TBI treatment, as few general practitioners are well-versed in brain anatomy and function, let alone have extensive experience dealing with TBI cases. What has emerged is that the optimal solution for TBI treatment is a coordinated, multispecialist approach to “triangulate” the challenges and treatments. That, however, can be hard to get in many health care settings.

Dealing with a mixed bag of symptoms

“Follow-up of patients with milder forms of [TBI] is particularly deficient,” wrote Geoff Manley, M.D., professor of neurosurgery at the University of California, San Francisco, and colleagues in a 2023 editorial in the journal Injury. And for older adults, “the standard of care is really too low,” says Matthew Peters, M.D., associate professor of psychiatry and behavioral services at Johns Hopkins University School of Medicine.

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.

Kintla Striker had to do the legwork to find specialists to address her TBI symptoms. To help make your path a little easier, you can use this list. Start at the top and work your way down. Try to find someone to be your coordinator, to connect you with specialists who can address your specific symptoms.

Primary care provider/geriatrician
Brain Injury Association of America. Lists resources in every state, the District of Columbia and Puerto Rico
National Brain Injury Information Center (call 800-444-6443 or email braininjuryinfo@biausa.org). Connect with a brain injury specialist who can answer questions and help you find local resources for support and rehabilitation.
American Academy of Physical Medicine & Rehabilitation has a tool for finding a physiatrist and/or a multidisciplinary clinic near you.
Local physical therapy practice

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.”

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.

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Marah Stets is a freelance health, lifestyle and food writer based in the Washington, D.C., area.

Rachel Lazarus, Ph.D. is a neuroscientist at AARP who specializes in cognitive aging and brain injury.