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Falls Are The Leading Cause of Traumatic Brain Injury in The Charleston Area

Advance With MUSC Health
March 21, 2023
A smiling Dr. Nathan Rowland with a patient.

More than 64,000 people died from traumatic brain injury (TBI) in the United States in 2020, according to the CDC.

In the Charleston area, falls are the number one cause of traumatic brain injury, according to Nathan Rowland, M.D.. Ph.D., an MUSC Health neurosurgeon and associate professor of neurosurgery. Here, Dr. Rowland discusses the causes, symptoms and treatment of and recovery from traumatic brain injury — and how MUSC Health can help. 

“By far, ground-level falls and falls from various heights are the most common cause of TBI that we see,” Dr. Rowland says. “In many cases, these patients are older and/or retired. In younger patients, we tend to see accidents involving motor vehicles, motorcycles, boats and even golf carts.” 

Traumatic Brain Injury Causes

Traumatic brain injury is classified by a patient’s symptoms: mild, moderate and severe. 

A mild TBI is when a patient has experienced a known blow to the head by any mechanism, be it a fall, car accident or some other means. “A patient who has a very mild TBI, who can answer questions, and whose CT scan doesn’t show signs of injury may not have to be admitted to the hospital,” he says. 

Moderate TBI is more frequently characterized by loss of consciousness, otherwise known as a concussion. “One of the first questions we ask the patient is, ‘Did you lose consciousness?’ A person who has lost consciousness will typically be admitted to the hospital for at least 24 hours,” Dr. Rowland says. “Many times patients will say they don’t know or are not sure if they lost consciousness. If a patient has driven or walked in and is unsure whether they lost consciousness, we consider other factors such as head imaging, lab values and their overall health condition before deciding whether and when they can be discharged.” 

Traumatic Brain Injury Symptoms

Patients with severe TBI typically are either unresponsive or cannot answer for themselves, usually because they’re in a coma or intubated to help them breathe. Severe TBI often is a result of a high-speed motor vehicle crash or some major blow to the head caused by a blunt object or fall from a roof. 

“Injuries from motorcycle accidents can be particularly serious because South Carolina does not have a universal helmet law,” Dr. Rowland says. “Unfortunately, some of the most serious injuries are self-inflicted, such as from firearms or jumping from heights during suicide attempts” he says. 

Traumatic Brain Injury Treatment

Treatments for TBI vary according to the severity, but every patient undergoes a CT scan of the head, which shows any sources of bleeding or swelling that might cause permanent neural injury, Dr. Rowland says. “We want to understand how serious this is from the perspective inside the head.” 

All TBI patients also will have a follow up with a neurosurgeon one-to-two weeks after their injury since some symptoms such as headache, forgetfulness and general malaise can be delayed. 

“That way we can refer them for the appropriate subspecialty services or treatment,” Dr. Rowland says. “Follow-up is particularly important for patients with mild or moderate TBI so that we can make sure the brain is healing properly and help make sure patients get to the appropriate specialist.” 

Symptoms of concussion can last up to six months. Headache is the most frequent and can be severe and unremitting. 

“We may have to see these patients multiple times, prescribe medication and refer them to other specialists, such as those who treat headaches or cognitive problems,” Dr. Rowland says. “Children may also need to see a therapist, especially when an injury affects school performance.” 

A range of treatments is available for patients with severe TBI, depending on symptoms. Patients may require surgery to stop sources of bleeding in the head or be put into a temporary coma to reduce swelling in the brain. 

Neurosurgeons also can remove parts of the skull for up to three to six months to allow brain swelling to subside. Once healing has occurred, they reattach the patient’s skull, which has been frozen, or, if the patient’s brain has multiple fractures and is irreparable, reconstruct the skull using a biocompatible material, Dr. Rowland says. Called PEEK, an acronym for polyether ether ketone, the material consists of a hardened chemical that mimics the hardness of the skull and allows for brain tissue to grow around it. 

Traumatic Brain Injury Recovery at MUSC Health

Once patients recover physically from severe TBI, they and their families can face a difficult road to resuming their way of life or readjusting to a new one, Dr. Rowland says.

To help ensure patients and families understand the rehabilitation process and services available to them, MUSC has recently opened the MUSC Institute for Neuroscience Discovery. 

Called MIND, the center is staffed by specialists, including Dr. Rowland, who counsel patients and families about their options and refer them to the appropriate services. 

“This is one of the most critical steps in rehabilitation,” Dr. Rowland says. “Patients with severe TBI can require acute inpatient rehab, outpatient therapy, an ongoing exercise therapy regimen, and other specialized services, some of which are not available in South Carolina.” 

Acute Inpatient Rehabilitation Therapy for Traumatic Brain Injury

Acute inpatient rehabilitation therapy in a residential center provides intensive physical and occupational therapy, as well as speech and language rehab daily for several weeks to months. Some centers also provide living space for family members. MIND hopes to partner with several out-of-state facilities, including Atlanta’s Shepherd Center, to help coordinate care for MUSC Health patients.

The MUSC Health Neurologic Rehabilitation Institute, or NRI, provides comprehensive outpatient therapy for TBI patients. The new facility includes a classroom, private rooms for speech therapy and specialized equipment to help patients work on skills that will allow them to return to work or school or resume other specialized tasks and activities.

MUSC Health’s state-of-the-art NEXT Wellness Center, located at the same site, provides customized exercise therapy programs in a gym-like setting for patients who have reached their maximum potential in outpatient rehabilitation. “An ongoing exercise regimen is important for patients so they can work toward new goals and maintain the goals they’ve achieved,” Dr. Rowland says.

Long-Term Support for Traumatic Brain Injury

For continued support, he recommends trauma and brain injury support groups that comprise individuals who have suffered and are recovering from brain injury. “A support group is an excellent way for patients to learn how to cope with some of the long-term side effects of a brain injury.” 

Regardless of where TBI patients are in their recovery, providing them with the most advanced treatment and compassionate care and helping them gain access to services are both part of MIND’s mission. 

“Our goal is to make sure that our patients’ experience is the best in the nation and that all patients are taken care of, regardless of what level of TBI they have.”


If you or someone you know has thoughts of suicide, dial 988 for the National Suicide and Crisis Lifeline. To contact a brain recovery specialist at MIND, please call 843-792-1451. Dr. Rowland sees patients at MUSC Health North Area Medical Pavilion, 8992 University Boulevard in North Charleston. To make an appointment, call 843-792-1414. The MUSC Health Neurologic Rehabilitation Institute and NEXT Wellness Center are located at 1014 St. Andrews Boulevard in West Ashley, Charleston