Signs and Symptoms of Traumatic Brain Injury

Physical

• Changes in bowel and bladder function
• Changes in level of consciousness, ranging from brief loss of consciousness to coma
• Dizziness
• Fatigue
• Headaches
• Impaired movement, balance, and/or coordination
• Motor speed and programing deficits (dyspraxia/apraxia)
• Nausea
• Pain
• Reduced muscle strength (paresis/paralysis)
• Seizures
• Vomiting
• Unequal pupil size or dilation

Sensory–Perceptual

Auditory and Vestibular

• Auditory dysfunction from injury to the outer ear, middle ear, inner ear, and/or temporal lobe, resulting in
  • central auditory dysfunction;
  • difficulty hearing speech in noise;
  • dizziness, vertigo, and/or imbalance (see ASHA’s Practice Portal page on Balance System Disorders);
  • hypersensitivity to sounds (hyperacusis);
  • loss of postural stability/control;
  • tinnitus (see ASHA’s Practice Portal page on Tinnitus and Hyperacusis); and/or
  • transient or permanent hearing loss

Visual

• Changes in perception of color, shape, size, depth, and distance
• Changes in visual acuity
• Double vision (diplopia)
• Problems with visual convergence and accommodation
• Sensitivity to light
• Visual field deficits/visual neglect

Other Sensory–Perceptual Sequelae

• Gustatory—loss of taste
• Olfactory—inability to recognize smells
• Tactile—sensitivity or defensiveness to touch; changes in perception of pain, pressure, and/or temperature

Cognition

Attention

• Difficulty with divided and/or selective attention
• Impaired sustained attention for task completion or conversational engagement
• Reduced attention span

Executive Functioning

• Difficulty with the following:
  • decision making
  • flexibility
  • goal setting
  • initiation and self-monitoring
  • judgment
  • planning and organization
  • reasoning and problem solving
  • strategy selection

Information Processing

• Increased response latencies
• Reduced processing speed (e.g., of rapid speech and/or complex language), resulting in confusion and/or slow responsiveness

Memory and Learning

• Encoding and consolidating elements into short-term memory, which can negatively affect new learning
• Deficits in working memory that negatively affect following directions, consolidation of new information, and/or summarizing information
• Difficulty retrieving information from memory
• Posttraumatic amnesia (PTA)—anterograde or retrograde

Metacognition

• Anosognosia—being completely unaware of deficits
• Reduced insight for monitoring one’s strengths, weaknesses, functional abilities, problem situations, and so forth

Other Cognitive Deficits

• Cognitive fatigue
• Deficits in orientation to self, situation, location, and/or time (this typically resolves once a person clears PTA)
• Impaired spatial cognition that can affect one’s ability to navigate and ambulate; this is specifically notable if visual disturbances (e.g., hemianopsia) or neglect also may be present

Language

Pragmatic/Social Communication

• Difficulty initiating conversation and maintaining topic
• Difficulty interpreting or using nonverbal communication (e.g., tone of voice, facial expression, body language)
• Difficulty taking turns in conversation
• Difficulty making inferences
• Overly verbose responses in conversation
• Tangential speech

Spoken Language

• Anomia or word retrieval deficits
• Decreased ability to formulate organized discourse or conversation
• Difficulty following directions
• Difficulty formulating fluent speech
• Difficulty understanding abstract language/concepts
• Tendency to perseverate in verbal responses
• Tendency to use tangential speech
• Use of incoherent or confabulatory speech

Written Language

• Difficulty comprehending written text, especially text that includes complex syntax and/or figurative language
• Difficulty planning, organizing, writing, and editing written products

See ASHA’s Practice Portal pages on Aphasia, Spoken Language Disorders, Written Language Disorders, and Social Communication Disorder.

Speech

• Apraxia of speech (motor programming)
• Aprosodia and/or dysprosody marked by deficits in intonation, pitch, stress, and rate
• Dysarthria characterized by articulatory imprecision and/or vowel distortions
• Hypernasality secondary to paresis or paralysis of velopharyngeal muscles involved in speech

See ASHA’s Practice Portal pages on Acquired Apraxia of Speech and Childhood Apraxia of Speech.

Voice

• Aphonia/dysphonia resulting from intubation, tracheostomy, or use of a mechanical ventilator
• Laryngeal hyperfunction/hypofunction marked by abnormal pitch, poor control of vocal intensity, or changes in vocal quality (e.g., hoarseness, strained–strangled voice, glottal fry)
• Neurogenic phonatory abnormalities resulting from injury to sensory or motor innervations to the vocal folds
• Psychogenic phonatory abnormalities (e.g., related to posttraumatic stress disorder)

See ASHA’s Practice Portal page on Voice Disorders.

Feeding and Swallowing

• Oral and/or pharyngeal dysphagia
• Feeding/swallowing difficulties due to cognitive impairment (e.g., poor attention or arousal, reduced insight, limited attention)

See ASHA’s Practice Portal pages on Pediatric Feeding and Swallowing and Adult Dysphagia.

Behavioral and Emotional

• Agitation, aggression, and/or combativeness
• Alexithymia—difficulty identifying emotions of self and others
• Anxiety
• Apathy and/or lack of motivation
• Changes in affect—overemotional, overreactive, or emotionless (i.e., “flat affect”)
• Changes in sleep patterns (e.g., insomnia or hypersomnia)
• Depression
• Disinhibition and/or poor self-regulation
• Emotional lability—rapid and extreme shifts in mood or affect
• Excessive drowsiness
• Feeling of disorientation or “fogginess”
• Heightened sensory sensitivity with exaggerated reactions to perceived threats (hypervigilance)
• Impulsivity
• Irritability
• Reduced frustration tolerance