Solutions for our Future

Mar 11

The Last Thing on Your Mind
Susan H. Connors
President/CEO, Brain Injury Association of America
March 26, 2009

Brain injury is the last thing on your mind until it’s the only thing. Just ask the family of Broadway actress Natasha Richardson or the estimated 360,000 service members returning from Iraq and Afghanistan with a traumatic brain injury (TBI). Better yet, ask the 1.4 million children and adults who sustain brain injuries in the United States each year.

A traumatic brain injury (TBI) is a blow or jolt to the head that can temporarily or permanently diminish a person’s physical abilities, impair cognition, interfere with emotional well-being and wreak financial havoc. All but about 50,000 people survive their injury each year. For many of them, the brain injury is not an outcome; it is the beginning of a lifelong disease process.

Individuals with TBI may experience memory loss, concentration or attention problems, slowed learning and difficulty with planning, reasoning or judgment. Emotional and behavioral consequences include depression, anxiety, impulsivity, aggression and thoughts of suicide. Physical challenges after TBI may include fatigue, headaches, problems with balance or motor skills, sensory losses and seizures. Brain injury causes or accelerates neurologic and neuroendocrine disorders, musculoskeletal and sexual dysfunction, and incontinence. It also impacts circulatory and respiratory systems.

Poor outcomes after TBI result from shortened length of stays in both inpatient and outpatient medical settings. Public and private payers point to a lack of evidence-based research as a primary reason for coverage denial of medically-necessary treatment. This is the first of many intersections between academia and advocacy for people with brain injury.

Since 1987, the U.S. Department of Education’s National Institute on Disability and Rehabilitation Research (NIDRR) has sponsored a network of TBI Model Systems Centers to demonstrate the benefits of a coordinated system of neurotrauma and rehabilitation care. Currently there are 16 Model System Centers operated in collaboration with leading teaching hospitals and research universities.

Each Model System Center contributes to the nation’s only non-proprietary longitudinal database on who is injured and what treatments yield the best outcomes. The centers are a key source of evidence-based medicine and serve as a proving ground for future researchers. Many centers provide training and technical assistance to Department of Veterans Affairs (VA) hospitals and military installations in their regions. Unfortunately, funding for the TBI Model Systems is threatened, just as is the funding for the Rehabilitation Research and Training Centers and field-initiated investigations within NIDRR’s “health and function” research portfolio.

Similarly, the National Institutes of Health (NIH) invested a paltry $59 million—less than .05 percent—of its funds on traumatic brain injury research in 2008. In contrast, $664 million was awarded for obesity research. While both conditions represent significant public health problems, the disparity in awards results from a lack of seed funds available to brain injury researchers. Such funds are needed to support preparatory work that is required for larger NIH grants. Simply put, brain injury researchers are shut out before the game begins. To stem the tide of anticipated shortages in allied health professions and increase the competence, confidence and compensation levels of young professionals who wish to pursue a career in the brain injury field, the Brain Injury Association of America’s (BIAA) Academy of Certified Brain Injury Specialists is partnering with universities across the country to offer graduate coursework to allow physical, occupational and speech therapy as well as rehabilitation counseling students to become certified brain injury specialists.

Fortunately, many students with brain injuries have the stamina and cognitive skills necessary for successful postsecondary education. Katherine Kimes from South Carolina is just one of many success stories. After a severe brain injury from a T-bone car crash, Katherine completed high school and undergraduate studies. She then entered The George Washington University’s Center for Education & Human Services in Acquired Brain Injury, which now offers both master’s and doctoral degrees in transition special education with an emphasis in acquired brain injury. As part of her training, Katherine authored a fact sheet on the differences in learning styles for students with TBI. Armed with this tool and other resources available from BIAA, institutions can start now to prepare for an influx of service members with TBI who will seek higher education as part of their transition plan to civilian life.

Founded in 1980, the Brain Injury Association of America (BIAA) is the oldest, largest and only nationwide brain injury advocacy organization. As the voice of brain injury, BIAA is dedicated to increasing access to quality healthcare and raising awareness and understanding of brain injury through advocacy, education and research.

Katherine Kimes