Brain Injury: Recognizing a Hidden Disability

Each year, millions of people in the United States sustain a traumatic brain injury (TBI) from falls, motor vehicle traffic crashes, collisions with moving or stationary objects, and assaults. The Centers for Disease Control and Prevention (CDC) estimates that TBI will affect 1.7 million people, resulting in approximately 1.37 million emergency room visits; 275,000 hospitalizations, and 52,000 deaths every year.

“Brain injury affects people in ways that are invisible, that no one understands, and it is often called the hidden disability,” says Beasley Allen employee Carol Stanley, who began crusading for awareness about TBI after her son, Jason, was injured during a violent crime. She is active with the Alabama Head Injury Task Force. “A brain injury is a forever life-altering experience for the TBI survivors and their family,” she says. “Many characteristics of the brain injury impairment are not always familiar, and are not obvious to the general public, medical system, education system, legal system, judicial system, law enforcement, and so on. My son’s TBI journey has taken us down all those avenues, and this is why I feel TBI education and awareness for all people is so very important.”

According to the CDC, a brain injury may be sustained in a variety of ways, but the most common causes are:

  • Falls (35.2%)
  • Motor vehicle traffic crashes (17.3%)
  • “struck by / against” events (16.5%)
  • Assaults (10%)

Another growing segment of the population that suffers from TBIs are soldiers returning from battle. In fact, TBI has been called the “signature” injury of American troops returning home from war. Studies have shown that soldiers who have fought in Iraq and Afghanistan suffer a high exposure to concussive blasts that cause these types of traumatic brain injury.

The Brain Injury Association of America explains that brain injury may affect the way a person thinks, acts, and feels. It can change everything within a matter of seconds, and its lasting effects are often much more than physical. A brain injury can damage the nerves in the brain that carry messages telling the brain what to do. It also can change some of the body’s internal function, such as regulating body temperature, blood pressure, bowels, and bladder control.

“A generation ago, people who had severe brain injury did not survive,” explains Charles Priest, executive director of the Alabama Head Injury Foundation (AHIF). “Thankfully, today, the opposite is true – about 85% are saved due to things like medical advances, improvements in roadside protocol, and the ability to monitor and control swelling of the brain. But unfortunately, the brain doesn’t heal like the rest of the body, and many people will need support and services permanently. A brain injury is forever.”

People with severe TBIs may require services such as in-home respite care, housing assistance, financial aid, physical therapy, and neurobehavioral assessment and counseling. Even people who suffer mild TBIs, such as concussions, may experience persistent behavioral challenges, including mood swings, inability to concentrate, and severe depression. These can lead to serious problems if undiagnosed and left untreated. In patients who have depression after TBI, suicidal ideation is not uncommon. In fact, the suicide rate among people with TBI is increased two to three times.

The Effects of Concussions
The physical effects of concussion are more traumatic when a person suffers repeated concussions, as can be common in many contact sports, such as football, hockey, and boxing. New studies have linked repeated concussions to Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease. In addition to memory loss and declining cognitive abilities, CTE usually manifests as depression and moodiness. The condition can lead to suicide and dementia.

In February 2011, former NFL safety Dave Duerson, a two-time Super Bowl champion who played for the Chicago Bears, took his own life, fearing he was suffering from this condition. Family members reported that he left messages before he died, asking that his brain be donated to the NFL Brain Bank, a special research arm at Boston University’s Center for the Study of Traumatic Encephalopathy that specifically examines the brains of these professional athletes. This event has shined a spotlight on the issue of repeated concussions and their effect on the brain.

As a result, there is new attention on youth sports and the relation to concussion. Sports are one of the top causes of traumatic brain injury in people ages 15 to 24, second only to motor vehicle crashes. Every year, American athletes receive an estimated 3.8 million sports-related concussions.

There also is a new focus on helmets. A number of medical authorities and other experts argue that helmets can give players a false sense of security, leading to more aggressive play and more risk taking, which, in turn, results in more concussions. This is particularly evident in football, where players are prone to hitting opponents helmet-first. But the sense of security football helmets gives players is false because they don’t protect players from the type of violent movement that causes concussions – movement of the brain inside the skull.

So, what is the solution, if not a helmet? The answer is education. Unfortunately, concussion is still not recognized as it should be among student athletes. There are new programs aimed at student athletes, their families, coaches, and schools to educate them about concussions, as well as efforts to establish better clinical guidelines for identifying concussions and establishing how to treat them, and rules about when student athletes can return to play following a concussion.

In 2010, the U.S. House of Representatives passed the ConTACT Act (Concussion Treatment and Care Tools Act of 2010), which would amend Title II of the Public Health Service Act to provide for the establishment and implementation of concussion management guidelines with respect to school-aged children. However, the bill never made it before the Senate and did not become law.

Newly proposed legislation aims to start a step earlier – before young athletes sustain any injury at all.

Sponsored by New Mexico Sen. Tom Udall and New Jersey Congressman Bill Pascrell, the Children’s Sports Athletic Equipment Safety Act would introduce tougher penalties for manufacturers that make false or misleading injury prevention claims about their helmets and other athletic equipment. The new legislation has already been endorsed by several organizations, including the NFL Players Association.

It is particularly important to protect the developing brains of our young people. According to information provided by the Brain Injury Association of America, “a brain injury actually has a more devastating impact on a child than an injury of the same severity has on a mature adult. The cognitive impairments of children may not be immediately obvious