People after TBI may experience impairments in one or more of the following four areas:

1. motor-sensory
2. communication
3. cognitive, and
4. behavioural/psychosocial domains.

1. Motor sensory impairments

Most people make a good physical recovery after TBI with only 25% experiencing permanent long term physical impairments.

Some motor sensory impairments that may remain include:

• Paralysis - may be more prominent on a particular side of the body (L or R sided weakness).
• Incoordination - may be the result of damage to the motor co-ordination (cerebella) region of the brain
• Visual impairments - one of the most common motor-sensory impairment after TBI.
• Changes in smell and taste
• Loss of sensation to touch - may be dangerous eg in the kitchen if the person can't feel heat, water too hot in the shower

42% of a series of 103 patients followed up in Melbourne still reported visual difficulties at 5 years post-injury (Olver et al. 1996)

However, only 3% of a series of 175 people with TBI needed to use wheelchair for mobility at 2 years post-TBI (Ponsford et al. 1995)

2. Communication

A range of communication impairments have been reported after TBI.

Aphasia refers to the disruption in one or more of the communication skills including understanding speech, speaking, remembering names, reading, writing, and so on. It is not due to physical problems with speaking / writing such as problems with muscles. Rates of aphasia ranging between 2% and 30% have been reported after TBI. (McDonald et al.,1999)

Dysarthria refers to communication problems following damage to the brain stem, which can result in physical problems in the production of speech, swallowing difficulties and drool (saliva) control. Some degree of dysarthria could be found in up to 34% of people with severe TBI at 5 years post-injury (Olver et al., 1996)

People with TBI can also experience impairments in social or pragmatic communication. This can result in poor ability to take turns, maintain eye contact, difficulty coming up with topics of conversation, overly familiar, disinhibited remarks, standing too close etc.

3. Cognition

A range of cognitive impairments have been reported after TBI.

Attention
Attention problems range from shorter span of attention to difficulties concentrating over time or poor attention to detail and being distractible. Therefore, it may be difficult for someone to sit and watch a movie, or to attend to a conversation in a crowded, busy environment. Up to 34.1% of people may have reduced or a slowing of information processing (Tate et al., 1991).

Memory
Memory problems can include difficulties in learning new information, forgetting information quickly. Forgetting appointments or future plans. Memory problems are the most commonly reported cognitive impairment after TBI. Between 56.5% and 74% of people with TBI may report changes or difficulties with memory (Ponsford et al., 1995; Tate et al. 1991)

Higher order thinking
People may have a number of difficulties in this area: dealing with complex ideas, being very rigid or perseverative in their approach (this is like having a piece of chewing gum on your finger and not being able to get rid of it). Up to 40% of people may have difficulty in thinking flexibly after a TBI (Tate et al., 1991).

Planning and organising
People may have a number of difficulties in this area. For example, cooking a meal becomes a disaster because the steps were not done in the correct order. A lack of self-monitoring means that it can be hard for people to learn from their mistakes. Up to 48% of people with TBI reported some planning problems (Ponsford et al., 1995).

Reasoning
People’s thinking may be very concrete, and they may have difficulty with abstract concepts.

4. Personality/behavioural changes

A range of personality/behavioural changes have been reported after TBI. 60%-80% of relatives will report changes of these types over periods up to 15 years post-injury (Thomsen, 1984)

Drive
People appear as lethargic or inert. Every thing seems to take enormous effort. Families often mistake this for laziness.

Control
People may be disinhibited or impulsive. Also, they may have problems with temper control.

Emotion
People may be unrealistically happy, or have flattened affect (e.g. not respond emotionally to either good or bad news), or maybe be labile, laughing or crying for little or no reason.

Insight
People may be unaware of their limitations or have unrealistic goals or expectations.

Self-centredness
People may become very self-centred and demanding, have difficulty empathising with other peoples' needs and points of view. Families often describe this as "childlike" behaviour.