M.D. Medical Director, Psychiatrist
Traumatic brain injury (TBI) is the result of a sudden impact to the brain, and it can have lasting effects on a person’s mood, cognitive function, and overall mental health. While many people can recover from traumatic brain injury, others may struggle with long-term challenges like depression, memory issues, executive dysfunction, or personality changes.
One treatment that’s currently being explored for TBI is transcranial magnetic stimulation (TMS) therapy. This non-invasive, FDA-approved treatment has been proven to help with conditions like depression, obsessive-compulsive disorder (OCD), migraines, and post-traumatic stress disorder (PTSD), and it may also support recovery after a brain injury.
In this article, we explore how TBI affects the brain, what TBI rehabilitation looks like, and what the current research shows about using TMS therapy for traumatic brain injury.
What is traumatic brain injury?
Traumatic brain injury (TBI) happens when a sudden impact, like a blow, jolt, or penetrating injury, disrupts normal brain function. This can be the result of a fall, car accident, sports collision, or physical assault, or even an object piercing the skull and damaging brain tissue directly (as with a bullet).
TBI can range in severity:
- Mild TBI is often referred to as a concussion. It can cause temporary symptoms like confusion, headache, dizziness, or brief loss of consciousness.
- Moderate to severe TBI can lead to more serious damage, including bruising, bleeding, torn brain tissue, and long-term complications that affect thinking, mood, behavior, and physical function.
Depending on the extent of the injury, TBI damage may be focal (limited to one area) or diffuse (spread across multiple areas). For many people, recovery is possible, but for others, it can cause ongoing challenges to emotional, cognitive, and motor functions.
Different types of traumatic brain injury
Traumatic brain injuries are generally classified into two types based on how the damage happens:
Closed brain injury
This type of injury occurs when the brain is injured without anything penetrating the skull. It’s usually the result of a sudden impact or violent movement that causes the brain to shift within the skull, leading to bleeding, bruising, or tearing of tissues.
Common causes of closed brain injury are car accidents, falls, sports injuries, and shaken baby syndrome in infants. These injuries can range from mild to severe and may affect multiple areas of the brain.
Penetrating brain injury
Also known as open head injury, this occurs when an object breaks through the skull and damages brain tissue. This might happen in situations involving gunshot wounds, stabbings, or shrapnel injuries.
Penetrating injuries are often more localized but can cause significant and lasting damage.
What is primary and secondary brain injury?
Brain injury doesn’t always happen at the moment of impact. It can sometimes unfold in stages.
Primary brain injury refers to the immediate damage caused at the time of trauma. It happens suddenly and is considered complete at the moment of impact, like in a fall, car crash, or gunshout wound. The effects are usually structural and involve bruising, bleeding, or tissue damage.
Secondary brain injury can occur in the hours or days following the initial injury. It involves a series of cellular, chemical, tissue, or blood vessel changes that can cause additional damage to brain tissue over time. These secondary effects can significantly impact long-term recovery.
What are the effects of traumatic brain injury?
Traumatic brain injury can affect a person physically, emotionally, and cognitively. The severity and type of effects depend on the nature of the injury, the parts of the brain involved, and the support received during recovery. Some brain injuries are mild and symptoms fade over time, while others can cause lasting or even lifelong challenges.
Below are some of the most common effects associated with TBI:
Cognitive effects
Cognitive effects of traumatic brain injury include:
- Confusion or disorientation
- Memory loss or amnesia
- Shortened attention span
- Poor judgement or difficulty solving problems
- Trouble processing abstract ideas
- Loss of time or spatial awareness
- Difficulty following multi-step instructions.
Motor impairments
Motor impairments linked to TBI include:
- Muscle weakness or paralysis
- Poor coordination or balance
- Spasticity (muscle stiffness or tightness)
- Tremors or delayed movements
- Difficulty swallowing
- Reduced physical endurance.
Sensory and perceptual changes
TBI may cause sensory and perceptual changes like:
- Changes in vision, hearing, smell, taste, or touch
- Loss of sensation or increased sensitivity
- Trouble understanding where body parts are in space
- Double vision or reduced visual clarity.
Communication difficulties
Communication challenges associated with TBI include:
- Difficulty speaking or understanding language (known as aphasia)
- Problems reading (alexia) or writing (agraphia)
- Difficulty naming common objects or completing everyday actions
- Slow or hesitant speech
- Trouble expressing thoughts clearly.
Daily functioning
Traumatic brain injury’s effects on daily functioning include:
- Difficulty with basic tasks like eating, dressing, or bathing
- Challenges managing money, shopping, or organizing daily routines
- Inability to drive or use equipment safely.
Social and emotional difficulties
Some social and emotional challenges associated with TBI include:
- Struggles with social interactions or making/maintaining relationships
- Misreading social cues or behaving inappropriately
- Isolation or lack of interest in social activities.
Regulatory disturbances
Regulatory disturbances linked to brain injury include:
- Fatigue and sleep disturbances
- Appetite or digestive changes
- Headaches, dizziness, or nausea
- Loss of bowel or bladder control.
Mental health and personality changes
TBI can also affect mental health and personality, such as:
- Major depressive disorder or or anxiety disorders
- Irritability or mood swings
- Lack of motivation or emotional flatness
- Impulsivity, aggression, or inappropriate behavior
- Lower frustration tolerance.
In some cases, damage to brain chemistry may contribute to the development of psychiatric conditions.
Seizures and traumatic epilepsy
TBI can also increase the risk of seizures, especially after severe or penetrating injuries. These seizures may occur soon after the injury or even years later, and can range from minor episodes to full seizures. This condition is known as post-traumatic epilepsy.
Read: TMS Side Effects: All You Need to Know
TBI symptoms in children
Infants and young children may show different signs of brain injury, including:
- Changes in feeding, sleep, or play habits
- Persistent crying or irritability
- Loss of interest in toys or people
- Drowsiness or listlessness
- Seizures or developmental delays.
Can you heal traumatic brain injury?
Most research into traumatic brain injury suggests that damaged brain cells do not typically regenerate. That said, recovery can be possible, particularly for younger people.
In many cases, other parts of the brain can learn to adapt or ‘re-route’ information and function to make up for the damaged areas. This process, called neural plasticity or brain plasticity, helps the brain reorganize itself and form new neural pathways.
It can be difficult to predict exactly how much a person will recover at the time of injury, sometimes it takes months or years. Every injury is different, so each person will have a unique recovery process.
Some factors that may affect brain injury recovery include:
- The severity and location of the injury
- The age and general health of the person
- The support systems in place, including rehabilitation therapies and mental health care
- The person’s motivation and engagement in their recovery journey.
How to rehabilitate traumatic brain injury
Rehabilitating a brain injury focuses on maximizing a person’s abilities (physically, emotionally, and socially), and supporting them in returning to daily life at home, work, or school. Positive reinforcement and encouragement go a long way in promoting independence and helping build self-esteem for someone recovering from brain injury.
Head trauma rehabilitation programs might include support for:
- Self-care skills, like bathing, grooming, dressing, eating, toileting, and sexual health
- Physical care, like medications, nutrition, and skin care
- Mobility, including walking, transfers, and using mobility aids like wheelchairs
- Communication, such as speech therapy, writing, and using alternative methods to express needs
- Cognitive support for memory, attention, problem-solving, and executive function
- Social and emotional skills, such as rebuilding confidence in social interactions
- Work or vocational training to develop skills for returning to the workplace
- Pain management
- Psychological counseling to support mood changes, behavioral challenges, or emotional regulation
- Family education and support, helping loved ones adjust to changes and understand how to provide care.
See: TMS for Migraine: Benefits, Effectiveness, Precautions
What is TMS therapy?
Transcranial magnetic stimulation (TMS) therapy is a noninvasive brain stimulation treatment used to treat a range of mental health conditions, including major depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), treatment-resistant depression (TRD), and migraines.
It works by delivering gentle, targeted magnetic pulses to specific regions of the brain involved in mood, cognition, and emotional regulation. These pulses stimulate underactive neural connections to help restore more balanced brain activity without the systemic side effects of medication.
During a TMS session, patients sit comfortably in a reclining chair while a technician positions a magnetic coil against the scalp. This coil emits focused MRI-strength pulses that stimulate nerve cells in the targeted brain region (usually the left prefrontal cortex, often associated with depression and cognitive function). TMS is an outpatient treatment, doesn’t require anesthesia, and has no downtime, so patients can return to normal daily activities immediately afterwards.
There are a few different types of TMS, including:
- Repetitive TMS (rTMS): This is the most common type of TMS, involving repetitive magnetic pulses delivered over 20 to 40 minute sessions.
- Theta Burst Stimulation (TBS): This is a more rapid treatment that uses high-frequency bursts to reduce session times. A sub-type is intermittent theta burst stimulation (iTBS)
- Deep TMS (dTMS): This reaches into deeper brain structures and may be more effective for certain psychiatric or neurological conditions.
- Accelerated TMS (aTMS): This involves administering multiple sessions per day over a shorter time frame, for a more condensed treatment schedule.
Read More: How Successful is TMS Therapy?
Can TMS therapy help with traumatic brain injury?
While TMS isn’t yet considered a standard treatment for traumatic brain injury, growing research suggests it may hold therapeutic promise for certain symptoms, especially when used alongside conventional rehabilitation.
One scoping review of 30 clinical studies found that repetitive transcranial magnetic stimulation (rTMS) may help improve a range of post-TBI symptoms, including depressive symptoms, dizziness, central pain, and visual neglect. The effects were more mixed when it came to cognitive outcomes like attention and memory, and less promising for severe disorders of consciousness. That said, most studies reported that TMS was well tolerated with few serious side effects, although some isolated seizures were documented.
Another case study followed a 23-year-old woman with long-term cognitive impairments after severe traumatic brain injury to her right prefrontal region. The patient underwent 19 sessions of low-frequency rTMS treatment targeting the right dorsolateral prefrontal cortex, a part of the brain involved in attention executive function.
After treatment, she showed measurable improvements in working memory, processing speed, attention, and executive functioning. She also made significantly more progress in rehabilitation for the six months post-rTMS. The patient’s EEG results suggested improved neurophysiological activity in the prefrontal region.
These studies show that TMS therapy has potential for traumatic brain injury, however the evidence base is still fairly limited. It’s also important to note that some TBI patients have increased risk of seizures and should be carefully screened before starting rTMS. That said, low frequency rTMS is associated with reduced seizure risk and may be a safer option for patients with traumatic brain injury.
Learn More: Short-Term and Long-Term Efficacy of Accelerated Transcranial Magnetic Stimulation for Depression
Explore TMS therapy
If you or someone you know has experienced a traumatic brain injury and would like to explore whether TMS may help, our team at BestMind Behavioral Health are ready to support you. We offer this innovative treatment at our clinics in Oregon and Washington, and we’d be happy to explore whether it may be a suitable option for you.
The first step is to schedule a consultation where we can discuss your current symptoms, what’s helped in the past, and what hasn’t. We’ll then make sure that TMS is a safe and appropriate option for you based on your particular injury and circumstances. Contact our team today to learn more or book your first session with our team.
