Traumatic Brain Injury: who to see and what helps

Traumatic Brain Injury · Kitchener, Waterloo & Cambridge

A traumatic brain injury (TBI) is damage to the brain caused by something from outside the body, such as a blow, bump or jolt to the head. This page is about moderate to severe injuries and the long recovery after hospital; Canadian guidance for that stage recommends repeated practice of real tasks, exercise once you are medically cleared, and help with fatigue, mood and the return to work. CARESPACE’s services are support alongside your physician and brain injury team, not a replacement for them, and most people start with a physiotherapist. After a new blow to the head, check the emergency signs below first.

What a traumatic brain injury is

Brain Injury Canada describes a brain injury as any damage to the brain that occurs after birth and is not related to a congenital or degenerative disease. A traumatic one comes from an outside force. A concussion is a mild traumatic brain injury that does not show on routine scans, and it has its own page; “mild” describes the injury, not its effect on daily life.

Rehabilitation after a moderate or severe injury runs from early care in hospital, through inpatient and outpatient programs, into the community, and the Canadian guideline describes the outpatient and community stage as specialized too. CARESPACE is not a specialized brain injury program. Our services can add to that care once you are home and medically cleared for activity.

Effects of a brain injury

• Physical: trouble with mobility and balance, headaches, fatigue, pain, and changes in vision and other senses
• Thinking: problems with concentration, memory, decision-making, reading and writing, and communication
• Emotional: new or different emotions, including depression, anxiety and anger
• Behavioural: risky or impulsive behaviour, strain in relationships, and isolation
• Sleep and energy: fatigue and sleep disorders, which everyone with a TBI should be assessed for

Causes

Falls, motor vehicle collisions, sports injuries, assault (including intimate partner violence), gunshot wounds and blasts. Falls are the leading cause among seniors, and sports and recreation among people aged 5 to 19. In Waterloo Region that can be an icy driveway in January, a hockey rink or a highway.

After a blow to the head: when to call 911

Call 911 if someone has hit their head and any of the following apply. The list combines the emergency list from the UK’s NHS, put in Ontario terms, with the red flags published by Parachute Canada.

• They were knocked out, cannot stay awake or keep their eyes open, or are becoming less alert
• A seizure
• A severe headache, or one that keeps getting worse
• Vomiting more than once
• Neck pain or tenderness
• New numbness, weakness, tingling or burning in the arms, legs or any part of the body
• Problems with vision (including double vision) or hearing
• Problems with walking, balance, understanding, speaking or writing
• Growing confusion; becoming more restless, agitated or combative; or a change in behaviour, such as being more irritable or distracted or losing interest in things around them
• Clear fluid coming from the ears or nose, bleeding from the ears, bruising behind the ears, or a black eye without a blow to the eye
• A head wound with something inside it, or a dent in the head
• They fell from more than 1 metre or 5 stairs, or hit their head at high speed, such as in a road collision
• A child under 1 year old with a bruise, swelling or large cut on the head

If the person is unconscious, do not move them or remove a helmet, in case the spine is injured too.

The NHS list for urgent same-day advice translates in Ontario to this: go to an emergency department or urgent care clinic the same day, and do not drive yourself, if after a recent head injury you have vomited once, feel dizzy, take a blood-thinning medicine or have a condition that thins your blood, had been drinking alcohol or taking drugs when it happened, or have any other symptom that worries you. Nobody at CARESPACE can rule out a serious head injury.

Depression can follow a brain injury. If you or the person you care for is thinking about suicide, do not wait for an appointment.

If you are in crisis or thinking about suicide, help is available right now.

• Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
• Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
• Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner if symptoms of a head injury last more than two weeks, or if you are not sure it is safe to drive or to go back to work, school or sport.

What the evidence says about rehabilitation after TBI

• The guideline behind this list. The Canadian living guideline for adults aged 18 to 65 with moderate to severe TBI, from INESSS and the Ontario Neurotrauma Foundation. It does not cover concussion. Each recommendation carries an evidence level: A means at least one meta-analysis, systematic review or adequately sized randomized trial; B means comparison studies or small trials; C means mainly expert opinion.
• Rehabilitation should continue in the community. People with ongoing disability should have timely access to specialized outpatient or community rehabilitation (level B), and should be able to come back to it as their needs change, based on needs and goals and not on time since the injury (level C).
• Practise specific tasks, repeatedly. Repetitive training of tasks such as sit-to-stand, reaching and balance is recommended (level B), people should get the chance to practise motor skills outside therapy sessions (level A), and gait re-education is recommended (level C).
• Exercise is recommended. Exercise training is recommended for cardiorespiratory fitness (level A). Guided programs of aerobic, strengthening and balance exercise should be offered once you have medical clearance, at an intensity that does not interfere with daily responsibilities (level B).
• One thing that adds nothing. Gait training with partial body-weight support does not provide added benefit over conventional gait training (level B).
• Fatigue and sleep: non-drug options first. Cognitive behavioural therapy for insomnia, light therapy, regular exercise, energy conservation and sleep hygiene should be considered before medicines (level B).
• Mood. Cognitive behavioural therapy adapted for TBI and mindfulness-based cognitive therapy adapted for TBI should each be considered for depressive symptoms (level A). CBT combined with motivational interviewing may be used for anxiety (level A).
• Work. A gradual return should be planned, with a start date, a schedule for adding hours and days, limits and accommodations (level B). Peer support should be available to the person and the family (level B).

What stays with your physician and brain injury team

None of the following is provided at CARESPACE. Diagnosis, scans, and medicines for sleep, mood, spasticity or seizures belong to your physician, specialist and pharmacist. So does driving: a person with a moderate to severe TBI who wants to drive again should be assessed by a physician or health professional experienced in brain injury, in line with local law, and should have a comprehensive driving assessment.

How each CARESPACE service supports recovery from TBI

Physiotherapy

A physiotherapist can assess balance, walking, strength and the movements you find hard, and build repetitive practice of those tasks with a program to continue at home. Exercise for fitness and strength can be added once you are medically cleared, and the plan should take account of any orthopaedic injuries from the same accident. Motor therapy after a brain injury should be designed and supervised by a professional with neurological expertise (level C), so ask when you book whether a physiotherapist with experience of brain injury is available.

See our physiotherapy team →

Occupational Therapy

An occupational therapist can build an individualized life-skills plan, train compensation strategies, and suggest changes to the home environment that support daily tasks. The same profession can assess for equipment, teach energy conservation, and help plan the gradual return to work or school with the employer or school involved.

See our occupational therapy team →

Speech-Language Pathology

After a brain injury, communication is assessed together with attention, memory, language and the social use of language; the term is cognitive communication. A speech-language pathologist can provide the individualized therapy recommended for it: strategy training, training for the people you talk with most, and practice in real-life situations (all level A).

See our speech-language pathology team →

Counselling & Psychotherapy

CARESPACE counsellors, who are Registered Psychotherapists and Registered Social Workers, offer cognitive behavioural therapy, the approach supported for low mood and anxiety after TBI. The recommendation is for therapy “adapted for TBI”, so ask when you book whether a counsellor with experience of brain injury is available. A diagnosis of depression and any medicine for it belong to your physician.

See our counselling team →

Kinesiology

Once you have medical clearance, and in consultation with your physician or physiotherapist, a kinesiologist can run a guided program of aerobic, strengthening and balance exercise at an intensity that leaves enough energy for the rest of your day, and keep it going after physiotherapy has ended.

See our kinesiology team →

Where most people start

See a physiotherapist first if balance, walking or strength is the main problem; assessment and treatment both begin at that visit. Start with an occupational therapist if daily tasks, memory strategies or the return to work are the bigger issue.

How your team works together

Your physician and brain injury team lead, and what you do here should fit around their program. Let each practitioner know who else is involved and what they have asked of you, so the total stays within your energy. Families need peer support and written information of their own.

Browse by service: physiotherapists, occupational therapists, speech-language pathologists, counsellors and kinesiologists.

What to expect at your first visit

1. Before you come. Gather your hospital or rehabilitation discharge summary, a list of your medicines, and any activity limits or clearance your physician has given. Bring someone who knows your history if memory is a problem.
2. The injury and your days now. You may be asked how and when it happened, what rehabilitation you have had, how you sleep, how far your energy goes in a day, and what you most want to get back to.
3. Movement. A physiotherapist can check balance, walking, strength and how you manage the tasks you name.
4. Treatment that day. A physiotherapist starts at the first visit, and you leave with a plan.

What you can do at home

• Practise the skills you are working on between sessions.
• Keep up regular exercise once you are cleared for it.
• Protect your sleep and spread demanding tasks through the day; fatigue is an effect of the injury.
• Look for peer support, for you and for your family.
• Ask your physician before driving again.

Outlook

There is no fixed timeline. How a person recovers depends on the severity and location of the injury, age, earlier injuries, existing conditions and access to treatment, and Brain Injury Canada notes that no system can accurately predict the outcome for an individual. That is why rehabilitation is tied to needs and goals and not to the calendar.

Support after a traumatic brain injury in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Kinesiology in Kitchener and Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Kinesiology in Waterloo and Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge and Counselling in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is a concussion a traumatic brain injury?

Yes, at the mild end. Concussion symptoms usually last up to four weeks, though they can last longer, and the recommendations on this page were not written for it. See our concussion page.

Is exercise safe after a brain injury?

Once your physician has cleared you, yes: exercise training is recommended, at an intensity that does not get in the way of your daily responsibilities, and guided programs are the recommended way to start.

When can I drive again?

After a moderate or severe injury, only once a physician or health professional experienced in brain injury has assessed you and you have had a comprehensive driving assessment.

Why am I so tired all the time?

Fatigue is a recognized effect of a brain injury. It should be assessed along with sleep, because a sleep disorder can also be behind changes in thinking and behaviour, and non-drug steps such as sleep habits, energy conservation and regular exercise are considered before medicines.

Where can I get support after a brain injury in Kitchener?

CARESPACE offers Physiotherapy in Kitchener, Counselling in Kitchener and Kinesiology in Kitchener. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• INESSS and Ontario Neurotrauma Foundation. Clinical Practice Guideline for the Rehabilitation of Adults with Moderate to Severe Traumatic Brain Injury. Living guideline hosted by KITE, University Health Network; first released 2016, sections used here last updated 2023. Scope and evidence levels.
• Brain Injury Canada. Traumatic brain injury and Statistics.
• NHS. Head injury and concussion. Reviewed May 2025.
• Parachute Canada. Concussion.
• Government of Canada. Concussion: symptoms and treatment. Modified April 2025.

Related conditions

Concussion
Vertigo
Insomnia
Neurological Conditions

Ready to book?

Book online with a physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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