By Eric A. Shore, an injury and disability lawyer for over 30 years | Last updated: August 13, 2026

A severe traumatic brain injury, or TBI, is a serious injury that changes how the brain works. Under commonly used VA/DoD severity criteria, a TBI is classified as severe when the Glasgow Coma Scale score is 3 to 8, loss of consciousness lasts more than 24 hours, or post-traumatic amnesia lasts more than 7 days. A person does not have to meet all three criteria. If different measures fall into different severity levels, the higher severity level is used.

Those medical definitions are important, but they do not tell a family what it really wants to know. Will this person recover? Will their personality change? Will they drive again? Will they be able to live independently or return to work?

I have represented hundreds of people with brain injuries over more than 30 years. Some recovered much better than their families initially feared. Others continued living with serious problems years later. One thing I have learned is that brain injuries do not all follow the same path.

How Do Severe Traumatic Brain Injuries Happen?

In my practice, I most often see serious brain injuries after motor vehicle accidents. I have represented people injured in car and truck crashes, as well as people thrown from motorcycles, bicycles, e-bikes, and scooters. When you are on a bike, motorcycle, or scooter, there is no vehicle surrounding you when you hit the pavement or another object.

Falls can cause severe brain injuries too. Someone can fall down unsafe stairs or strike their head after slipping on a dangerous surface. An accident does not have to look spectacular from the outside to cause a serious brain injury. What matters is what happened to the brain.

What Makes a Traumatic Brain Injury Severe?

Doctors do not look at only one thing when evaluating a TBI. They may consider how long someone was unconscious, how long memory problems continued after the injury, neurological findings, brain imaging, and how the person is actually functioning.

These measurements help doctors classify the initial injury. They do not tell us exactly what that person’s life will look like six months or two years later.

Recovery From a Severe TBI Can Be Difficult to Predict

I have seen enormous differences in recovery. Some of my clients have returned to their old jobs and much of their former lives. Others have returned to work but struggled with things that used to be easy. Some have never been able to return to any work.

One young woman I represented was still learning how to drive again a year after her brain injury. Driving was something she had done almost automatically before the accident. Afterward, she had to learn it again.

The CDC explains that the effects of moderate and severe TBI can be very different from one person to another and can change during recovery.

That uncertainty is difficult for families. They naturally want someone to tell them what is going to happen. Sometimes the most accurate answer is that more time, treatment, and rehabilitation are needed before anyone can know.

A Person Can Look Better Without Being Better

This may be one of the most misunderstood things about a brain injury. Someone can walk into a room, look healthy, and have what appears to be a perfectly normal conversation. That does not mean the brain has fully recovered.

A person may still have trouble remembering instructions, concentrating, finding words, making decisions, controlling emotions, or keeping up with several things at once. They may become mentally exhausted much faster than they did before.

I have seen clients who could carry on a conversation but could no longer function reliably at their former jobs. Talking with someone for ten minutes is very different from concentrating, remembering instructions, dealing with stress, and making good decisions throughout an entire workday.

Family members sometimes understand the severity of the problem before anyone else does. They see the person throughout the day, not just during a short doctor’s appointment.

Personality Changes Can Be One of the Hardest Parts of a TBI

A severe TBI can change behavior and personality. Someone may become more irritable, emotional, impulsive, anxious, withdrawn, or angry after the injury.

These changes can be extremely difficult for spouses, parents, children, and friends. The person may look the same physically but react to everyday situations very differently than before.

I have seen personality changes become as significant to a family as some of the physical injuries. They can affect relationships, parenting, friendships, independence, and the ability to work.

Families should tell the treating doctors when they see these changes. Do not assume a personality or behavior change is unimportant simply because it does not show up on an MRI.

Depression Is Common After a Traumatic Brain Injury

Depression is something I see regularly after serious brain injuries, and I take it seriously. A person may suddenly be unable to work, drive, exercise, take care of children, enjoy hobbies, remember things, or live as independently as before.

Depression after a brain injury can be related to changes in the brain, changes in the person’s life, or both. The CDC recognizes depression and other emotional changes as possible effects of moderate and severe TBI.

Depression is not a minor side issue. It can affect concentration, motivation, sleep, relationships, and the ability to function. Depression itself can become disabling.

If someone becomes depressed after a brain injury, tell the treating doctors and get appropriate treatment. Mental health treatment can be just as important as treatment for the physical effects of the injury.

A Severe TBI Can Affect the Entire Family

When someone suffers a severe brain injury, the injury often changes the lives of the people around them too. A person who was completely independent may suddenly need a spouse, parent, child, sibling, or friend to drive them to appointments, remind them to take medication, handle finances, or help them make decisions.

Sometimes those needs decrease as the person recovers. Sometimes family members continue providing substantial help years later.

The CDC reports that among people still alive five years after a moderate or severe TBI, 33% relied on other people for help with everyday activities. Among those who were working when they were injured, 55% no longer had a job five years later.

Those numbers do not predict what will happen to one particular person. They do show why families should take these changes seriously even when everyone is hoping for a complete recovery.

Ask the Neurologist About the Future

Do not only ask how the person is doing today. Ask what the neurologist and other treating doctors think may happen over time.

I would ask four basic questions:

• Which problems do you expect to improve?
• Which problems may last?
• What rehabilitation or treatment is still needed?
• Is it safe for this person to drive or return to work?

The answers may change as recovery continues. That is normal.

Also tell the doctors what is actually happening at home. If your spouse keeps asking the same question, your daughter gets lost somewhere familiar, or someone who was calm before the injury suddenly has angry outbursts, the doctors should know.

Doctors cannot evaluate a problem nobody tells them about.

What If the Person Cannot Return to Work?

A severe TBI can become a financial crisis when the injured person can no longer earn a paycheck. Depending on what happened and what coverage exists, there may be medical benefits, disability benefits, income replacement, or compensation available.

That is a separate subject, and I do not want to turn an article about severe brain injuries into an article about every possible legal claim. If a TBI makes it difficult or impossible to work, our Social Security Disability and Long-Term Disability pages explain those issues in much more detail. If another person or business may have caused the injury, our Personal Injury page explains when compensation may be available.

A lawyer cannot tell you how well the brain will heal. That is a medical question. But a neurologist usually is not the person who will tell you whether there may be insurance, disability benefits, wage benefits, or compensation available because of what happened.

Families dealing with a severe TBI may need answers to both sets of questions. Finding out what rights may exist does not mean you have decided to file a lawsuit. It means getting information before making decisions that could affect the injured person or the family.

What Is the Most Important Thing to Know About a Severe TBI?

A severe traumatic brain injury can affect far more than memory. It can change someone’s thinking, personality, emotional health, independence, relationships, ability to drive, and ability to earn a living.

After representing hundreds of people with brain injuries, I would never tell a family that I know exactly how their loved one’s recovery will turn out. I have seen people make remarkable recoveries. I have also represented people who continued living with serious limitations years later.

Get good medical care and follow through with appropriate rehabilitation. Tell the doctors what you are actually seeing at home. Take depression and personality changes seriously. Ask what they expect in the future, including whether it is safe for the person to drive, live independently, or return to work.

If the injury has also taken away someone’s ability to work or created financial or legal problems for the family, find out what help may be available. You do not need to know the name of the benefit or legal claim before asking the question.

If your family is trying to make sense of all of this and you do not know where to start, call us at 1-800-CANT-WORK. Tell us what happened and what has changed. We can help you figure out which issues may need a closer look.

About Eric A. Shore

Eric A. Shore is a personal injury and disability lawyer and the founder of Law Offices of Eric A. Shore. He has practiced law for more than 30 years and has represented hundreds of people who suffered traumatic brain injuries, from relatively minor TBIs to severe brain injuries with long-term effects.

Eric is the DISINJURY™ lawyer. He helps people when a serious injury also becomes a disability and threatens their ability to work and support themselves.

Need Help or Have Questions? Call 1-800-CANT-WORK

This article provides general information only and is not legal advice. Reading it does not create an attorney-client relationship.