Traumatic Brain Injury

Introduction

The goal of this infosheet is to help those on campus understand the challenges students (and even staff and faculty) with a Traumatic Brain Injury (TBI) may face. Please note that this infosheet is not meant to provide medical advice, but an educational resource.

What is a Traumatic Brain Injury?

TBIs are defined as any brain injury that is caused by an outside source, whether it is a blow, bump, or jolt to the body or head.¹ It can be an open injury (penetrating TBI) if it pierces the skull and breaches the protective layers of the brain, or a closed injury (non-penetrating or blunt TBI) if the force on the head or body is strong enough to move the brain within an intact skull to cause an injury.¹ TBIs are primarily caused by sports-related injuries, falls, motor vehicle accidents, and assault.² The majority of TBI cases are considered to be a mild TBI (mTBI), with concussions being the main type.³ This infosheet will primarily focus on non-penetrating TBI.

TBIs fall under the category of Acquired Brain Injury (ABI), which is injury to the brain that has occurred after birth.² Non-traumatic brain injuries also fall under ABI, but they are injuries due to internal factors such as strokes, infectious diseases, or aneurysms.^1,2 The diagram below summarizes the classification:

The severity and chronicity of TBI symptoms depends on severity of the injury or how often the injury occurs.⁴ For example, someone who has repetitive mTBI due to sports or intimate partner violence may experience chronic and worsening symptoms.⁴

The table below outlines some of the symptoms people may experience.^5,6

Physical Symptoms	Somatic Symptoms*	Cognitive Symptoms
Convulsions Seizures Headaches Sensitivity to light and sound Sleep problems Issues with balance.	Nausea Headaches Changes in hearing and/or vision Dizziness Fatigue.	Difficulty with executive functioning such as: Issues with memory Planning, Concentration, RetentionFocus

* Physical symptoms that can worsen with emotional distress

Prevalence

The 2022 National College Health Assessment reported the prevalence of TBI and concussions in Canadian schools as well as how it impacted students academically⁹:

Effect on Students

Students with a TBI can find navigating academic life on campus difficult, especially if they are not getting additional support from their accessibility and accommodation services. Their quality of student life experience is also based on their injury, their access to health care, insurance, financial security, and their social support system. A non-exhaustive list of experiences are outlined below¹⁰:

• Spending more time reviewing their class materials compared to pre-injury
• Difficulty remembering and focusing in class
• Having to sacrifice things to get to the level of student they were pre-injury (ex. Sacrificing sleep or time with friends due to needing more time to study)
• Feeling overwhelmed in class
• Having a hard time making decisions
• Having difficulty with personal relationships, such as keeping up with friends or attending plans due to the mental energy it takes to do them
• Having difficulty managing time and multi-tasking
• Fatigue from doing things that require mental energy (such as conversations, making decisions, etc.)
• Discontinuing school due to the severity of the TBI

CALL OUT BOX: Non-penetrating TBIs are often difficult to navigate due to its invisible nature of the symptoms. If an individual looks like they are functioning the same as they used to pre-injury, people around them tend to misunderstand how challenging it is.⁷ This can lead to feeling emotionally isolated, facing stigma and encounter difficulty in acquiring accommodations and support.⁸

Students often feel grief over the changes that occur post-injury.¹¹ This includes:

• Not being able to do certain things the same way they used to pre-injury (Ex: contact sports, reading due to visual sensitivity, cooking due to decision making, etc.).
• Loss or changes in relationships
• Impact on life and career plans
• Changes in independence

Additionally, students with a TBI can also experience stress and frustration adjusting to their new life. This can be especially challenging if they have to navigate experiences such as:

• Stigma from peers, professors, doctors, or family
• Lack of accessibility and accommodations within and outside of school
• Delayed or lack of access to healthcare within and outside of school
• Difficulty financially supporting themselves

Mental Health Impacts

TBIs are associated with various adverse health outcomes, including mental health conditions and substance use dependency.¹² TBIs can worsen pre-existing mental health conditions, but also bring about new symptoms of anxiety, Post-Traumatic Stress Disorder (PTSD), depression, as well as anger and mood changes.¹² Studies have shown:

• More symptoms of depression over the past 2 weeks among students with a history of repetitive mTBI compared to students with no history of mTBI.¹³ These symptoms include withdrawn behaviour, feelings of hopelessness and inadequacy.
• Anxiety, mood, and substance use disorders were the most common psychiatric diagnoses among individuals who have moderate to severe TBI. They often occur at the same time and are most prevalent in the first-year post-injury.¹⁴
• There is a higher risk for depression post-injury among female TBI patients compared to male TBI patients.¹⁵
• The risk of a mental health condition is increased by factors such as how grief is managed, the direct impact of the TBI, strengths and personality pre-injury, coping methods, and levels of social support.¹⁶

Supporting Students with a TBI

Students with a TBI can lead a fulfilling life despite their injury with the right supports, education, and awareness. Some key things that students are encouraged to integrate into their lives are:

• Prioritizing rest and sleep
• Structuring regular routines throughout the day as a way to manage day-to-day tasks (meal planning, scheduled exercise, etc.)
• Tracking daily activities to assess how things like sleep, appetite, stress, and mood are changing (this can be helpful when talking to a health care provider if there are concerns)
• Having a strong and flexible social support system
• Setting up professional supports such as therapy, medical check-ins and considering medications if suitable.

Some key actions for post-secondary campuses to embed:

• Spaces that are friendly for students with light, smell, and sound sensitivities (Ex: Low light rooms, sound proofing, prohibiting fragrances in the room)
• Trainings for staff and faculty on the role of accessibility and accommodation services
• Universal Design for Learning within classrooms
• Resources for faculty and teaching assistants to refer to if they have a student with a TBI and how best to navigate courses and assignments based on their ability
• Co-designing supports and programs with students who have TBI to better support them.

Resources

The following resources are suitable for student, staff and faculty to learn more about TBI and concussions, how best to understand what someone with TBI may go through, and some potential ways to help someone with a TBI or concussion.

• Concussion Guidelines by Parachute

The concussion guidelines by Parachute provide an overview on identifying and managing a concussions.

• Brain Injury Canada

Brain Injury Canada provides education, awareness, and ways to connect with supports for anyone with a TBI or anyone supporting someone with a TBI. Their section on Stories of Brain Injury provides insight on the lived experience of those with a TBI.  

• Brain Injury Recovery Toolkit by Keep Your Head Up

Keep Your Head Up provides a toolkit on brain injury and recovery. It is not meant to replace medical advice but instead provides ways to navigate day-to-day life for anyone with a brain injury. It includes sheets to build goals, track symptoms, build a routine, and more.

• Introduction to Acquired Brain Injury Online Training by Acquired Brain Injury Partnership Project

The Acquired Brain Injury Partnership Project based in Saskatchewan provides a training series for service providers, healthcare workers, brain injury survivors, and caregivers to learn about the effects of a brain injury, including strategies on adapting and recovering from the injury. Modules include topics on mechanisms of recovery, behavioural interventions, seizure education, and more. This is not meant to substitute medical advice.

• Connecting Perspectives: Insights on IPV and Concussion from Lived Experience & Expertise

This webinar hosted by the TRANSCENDENT Concussion Research Program provides insight on concussions from Intimate partner violence (IPV) and the importance of IPV education.

CICMH Resources

• Accessibility and Accommodations Toolkit
• Trauma-Informed Practice & Care Toolkit
• Impact of Chronic Health Conditions on Student Mental Health Toolkit[JP1] 
• Intimate Partner Violence
• Emotional Regulation
• Loneliness & Connection
• Boundaries
• Rest and Sleep
• Anger and Mental Health

References

1. Traumatic Brain Injury (TBI) [Internet]. National Institute of Neurological Disorders and Stroke. [cited 2025 Nov 27]. Available from: https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
2. Brain Injury Association of America. ABI vs. TBI: What is the difference? [Internet]. Brain Injury Association of America. 2025 [cited 2025 Nov 27]. Available from: https://biausa.org/brain-injury/about-brain-injury/nbiic/what-is-the-difference-between-an-acquired-brain-injury-and-a-traumatic-brain-injury
3. Public Health Agency of Canada. Traumatic brain injuries – Canada.ca [Internet]. 2024 [cited 2025 Nov 27]. Available from: https://health-infobase.canada.ca/brain-injuries/
4. Vynorius KC, Paquin AM, Seichepine DR. Lifetime Multiple Mild Traumatic Brain Injuries Are Associated with Cognitive and Mood Symptoms in Young Healthy College Students. Frontiers in Neurology [Internet]. 2016 Oct 31;7:188. Available from: https://doi.org/10.3389/fneur.2016.00188
5. Howlett JR, Nelson LD, Stein MB. Mental health consequences of traumatic brain injury. Biological Psychiatry [Internet]. 2021 Oct 4;91(5):413–20. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8849136/
6. University of Utah Health. Long-Term effects of traumatic brain injury. University of Utah Health [Internet]. 2025 Feb 20 [cited 2025 Nov 27].Available from: https://healthcare.utah.edu/healthfeed/2025/02/long-term-effects-of-traumatic-brain-injury
7. The Invisible Injury [Internet]. Concussion Alliance. [cited 2025 Nov 27].Available from: https://www.concussionalliance.org/the-invisible-injury
8. Brain Injury Association of America. Brain injury as a form of invisible disability – Brain Injury Association of America [Internet]. Brain Injury Association of America. 2024. Available from: https://biausa.org/public-affairs/media/brain-injury-as-a-form-of-invisible-disability
9. National College Health Assessment III: Canadian Reference Group Data Report Spring 2022 [Internet]. American College Health Association; 2022. Available from: https://www.acha.org/wp-content/uploads/2024/07/NCHA-III_SPRING_2022_CANADIAN_REFERENCE_GROUP_DATA_REPORT.pdf
10. Kennedy MRT, Krause MO, Turkstra LS. An electronic survey about college experiences after traumatic brain injury. Neurorehabilitation [Internet]. 2008 Dec 19;23(6):511–20. Available from: https://doi.org/10.3233/nre-2008-23607
11. Grief [Internet]. Brain Injury Canada. 2025 [cited 2025 Nov 27]. Available from: https://braininjurycanada.ca/en/mental-health/grief/
12. Howlett JR, Nelson LD, Stein MB. Mental health consequences of traumatic brain injury. Biological Psychiatry [Internet]. 2021 Oct 4;91(5):413–20. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8849136/
13. Vynorius KC, Paquin AM, Seichepine DR. Lifetime Multiple Mild Traumatic Brain Injuries Are Associated with Cognitive and Mood Symptoms in Young Healthy College Students. Frontiers in Neurology [Internet]. 2016 Oct 31;7:188. Available from: https://doi.org/10.3389/fneur.2016.00188
14. Alway Y, Gould KR, Johnston L, McKenzie D, Ponsford J. A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury. Psychological Medicine [Internet]. 2016 Feb 12;46(6):1331–41. Available from: https://pubmed.ncbi.nlm.nih.gov/26867715/
15. Oyesanya TO, Ward EC. Mental Health in Women with Traumatic Brain Injury: A Systematic Review on Depression and Hope. Health Care for Women International [Internet]. 2015 Jan 30;37(1):45–74. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5746345/
16. Mental health and ABI [Internet]. [cited 2025 Nov 27]. Available from: https://www.abipartnership.sk.ca/education/Mental-Health