Obviously, when this degree of brain injury is involved the circumstances are much more challenging and patient needs considerably more extensive.  These situations can be very difficult and a great challenge not just for the injury victim, but the entire family.

Moderate and severe traumatic brain injuries are characterized by symptom severity according to certain prescribed criteria. Though far from precise, certain observable and measurable markers show up within 7 days of the trauma and are fairly reliable to classify brain injury severity (mild, moderate, or severe). These include the presence and duration of loss of consciousness, post-traumatic amnesia (memory loss) and the existence of abnormal brain imagery, though imaging (CT Scan and MRI) can actually be “normal” in the presence of moderate and severe brain injuries. Subsequent symptom development generally, but not always, confirms these classifications.

Criteria Used to Classify TBI Severity

Structural ImagingNormalNormal or
Normal or
Loss of Consciousness˂ 30 minutes30 minutes to 24 hours˃ 24 hours
Alteration of
Consciousness/Mental State
A moment to 24 hours˃ 24 hours˃ 24 hours
Post-traumatic Amnesia0-1 day˃ 1 and ˂ 7 days˃ 7 days
Glasgow Coma Scale
(best available score in 24 hours)

TBI – Traumatic Brain Injury
Note:  This table describes the predominant ways in which TBI severity is assessed. 


In addition to the symptoms experienced by those who sustain a mild TBI, moderate and severe brain injury victims may experience greater challenges such as:

  • Spasticity (muscle stiffness) or uncontrollable movements
  • Loss of fine motor skills, such as buttoning a shirt
  • Problems walking, talking, or swallowing
  • Seizures/Convulsions
  • Loss of control of bowel or bladder functions
  • Difficulty regulating body temperature
  • Hormonal changes
  • Paralysis
  • Difficulty thinking and remembering
  • Difficulty with social relationships
  • Difficulty in performing basic activities of daily living


Moderate to severe TBIs most often require intensive medical care. And unfortunately, a substantial percentage of those hospitalized with moderate to severe TBIs sustain impairment that leads to long-term care and disability. Care begins at the acute level, generally a short-term hospitalization, with duration depending on the severity of the injury.  Once the patient is medically stable, additional care including rehabilitation typically occurs.

A “Multi-Disciplinary Approach”

“Multi-Disciplinary” treatment and rehabilitation is the coordinated involvement of multiple diverse medical disciplines.  With moderate and severe brain injuries there is often a host of varied impairments requiring the attention of multiple different specialists.  Often, and simultaneously present, are physical impairments, cognitive impairments, and sustained affective / behavior impairments. Physical impairments likely need to be addressed by a qualified therapy specialist at the direction of a physiatrist (physical medicine and rehabilitation physician) or neurologist. 

Cognitive and behavioral issues are generally addressed by a wide variety of specialists depending on extent of injury. Every person’s needs and abilities after TBI are different. You will have a rehabilitation program designed especially for you. It is important to have a central person you can talk to and that person is often called your “case coordinator.”

Rehab can take place in various settings. You, your case coordinator, and your family should pick the setting that works best for you. Possible settings include:

  • Inpatient rehab hospital
  • Outpatient rehab hospital
  • Home-Based rehabilitation
  • A Comprehensive Day-Program
  • An Independent Living Center

Your individual program may include any or all of these treatments:

  • Physical therapy
  • Physical medicine
  • Occupational therapy
  • Psychiatriccare
  • Psychological care
  • Speech and Language therapy
  • Social support

With a multi-disciplinary approach, the following medical specialists may be involved simultaneously; Neurosurgeon, Neurologist, Physiatrist, Otolaryngologist(ENT), Neuroradiologist, Endocrinologist, NeuroOptometrist, Psychiatrist, Neuropsychologist, Psychologist, Speech-Language Pathologist, Occupational Therapist, and Physical Therapist. 

Future Medical Expenses

When litigation is involved it is critically important your lawyer  work with all treating physicians and therapists to determine the patient’s future treatment needs. All of them. These costs are often astronomical. To determine calculate total cost for litigation purposes, the services of a life care planner and economist are required. These experts working can project future treatments costs over a person’s lifetime and then calculate what amount of money it will take if set aside now to pay for those. The list of ongoing treatment needs is very long, extensive, ongoing, and includes such things as:

  • Therapies: physical, occupational, vestibular, speech and language, hormonal replacement
  • Physician appointments/monitoring
  • Prescription medications
  • Lab work
  • Brain Imaging
  • In-Home Nursing Assistance
  • Assisted Living Facilities


Brain Anatomy
Traumatic Brain Injury Overview
Texas Laws to Know
Brain Injury Litigation: Simplifying the Complexity
Featured Articles by Charlie Waters
Traumatic Brain Injury Resources