Traumatic brain injury (TBI) is one of the most common and yet least recognized disabilities in theUSA.  TBI can occur due to a closed head injury, such as a motor vehicle accident, fall or blow to the head, or can be a result of an open head injury, such as gunshot wound or other penetrating injury.  Annually, more than 1.5 million people sustain a TBI.  While more than one million such injuries are classified as mild brain injuries, or concussions, more than 230,000 people survive severe TBI and must live with the consequences of that injury.  About 80-90,000 people experience a long term or lifelong disability, and many are unable to return to their previous level of work or school.  TBI is the leading cause of death for adolescents and children in theUSA.  It is estimated that more than 5 million individuals, more than 2% of the population, live with permanent disabilities related to TBI, and yet TBI remains largely absent from public consciousness.

Traumatic brain injury impacts all areas of life after injury.  Physically, it is not unusual to see permanent changes in motor abilities, sensory function, strength, balance, or coordination.  Injured persons often complain of sleep disruption and persistent fatigue.  Cognitively, problems often include short term memory, attention and concentration, speed of thinking, word-finding, and retrieval.  One of the most common deficits associated with TBI is in the area of executive functions.  This cognitive system, heavily associated with the frontal lobes of the brain, acts as a person’s management system.  Judgement, decision-making, organization, problem-solving, planning and multi-tasking can be impacted, leading to a marked change in the person’s ability to monitor their thought process and behavior.  Emotionally, TBI can lead to increased emotional lability, depression, irritability, anger and disinhibition.  These changes in emotional function are perhaps the most challenging to the injured person and their loved ones, as the injured person’s awareness of the changes is often limited and it seems to others that he now has a very different personality than was there before injury.  This lack of awareness, called anosagnosia, can lead to conflict and frustration when deficits seem apparent to others but are not recognized by the injured person himself.  While there are many shared characteristics, each person has his own unique pattern of strengths and weaknesses after injury that needs to be recognized and rehabilitated.

The importance of identifying and treating TBI cannot be overemphasized.  From the emergency department and acute care setting through inpatient rehabilitation and on to outpatient services, every step in the management of these injuries is a critical one.  While the physical injuries are often recognized in the early stages after injury, the more subtle cognitive and emotional changes can persist for many months and years after the injury.  These changes can affect a person’s ability to live independently, to return to work, to drive, or to make complex decisions.

Recent research has begun to reveal the importance of treating mild brain injuries and post-concussive symptoms, especially after repeated concussions.  The role of neuropsychological testing has increased to help evaluate the pattern of abilities after injury, and to aid in the development of a treatment plan and compensatory strategies.  Cognitive rehabilitation and case management remain a critical component for optimal recovery.  Support and education for families of TBI survivors is essential to minimize the conflict and social isolation that is so often a part of the long term recovery process.  TBI affects all of us, whether we are aware of it or not, and we need to focus our efforts on improving awareness and services for the survivors of these devastating injuries.

Contributed by Dr. Shannah Biggan, Ph.D., ABPP,
Neuropsychology Ltd

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