Soldiers returning from war with visible head injuries are easy to spot, but what about soldiers—and civilians of all ages—who have brain injuries but no external wound?
In a Cerebrum piece for us in 2008, "A Wound Obscure, Yet Serious," traumatic brain injury (TBI) specialist Wayne Gordon, Ph.D., noted that these cases of unidentified TBI were far more prevalent than people realized and offered suggestions for better awareness and treatment. He writes:
"We must develop a good way to screen for brain injury. Community agencies, health care service providers and other organizations should screen populations that are known to be at risk, such as schoolchildren, abused women, athletes, people receiving social support services, and members of the military. Similarly, within medical contexts, people who have experienced a non-brain physical trauma, such as a fall from a ladder, also should undergo screening as a precaution."
Since 2008, awareness has risen dramatically, spurred by studies of sports players and combat veterans. We know more about the neurobiology of injury [see our July 2012 Cerebrum essay by Marcela Pekna, M.D., Ph.D., and Milos Pekny, M.D., Ph.D.]. And diagnosis has made some strides, including a new checklist for military medics to use to do a rough check on brain state as close to the time of injury as possible [see our January story "Some Clues to the Prevention and Treatment of TBI"].
Awareness of the dangers to children, once thought to be relatively resilient, also has risen. Around a half-million children go to the emergency room each year after a potential traumatic brain injury, but doctors still have a hard time diagnosing it and determining its trajectory. And the little data that is available suggests that younger brains may be more susceptible to TBI-related damage than older ones, reports Kayt Sukel in our January story "Brain Injuries May Leave Lasting Marks on Children’s Brains."
Progress in treatment is less clear. Recovery from a brain injury is slow and has no obvious endpoint. Insurance money and space in treatment facilities can run out before a person has had time to heal. In his Cerebrum essay from July 2012, Repairing the Injured Brain, Mark J. Ashley, Sc.D., describes how some specific rehabilitation environments and procedures seem to encourage a stronger recovery than others. He writes:
"Care and treatment for brain injury may be required across the life span…In this new era of predetermined clinical pathways, this uncertainty creates a practical dilemma for patients, their families, professionals, and payers. We cannot yet predict what the end of recovery will look like for any given patient. We can recognize the end point only when treatment fails to produce additional recovery of function over a period of time. Nevertheless, it is clear that specialized rehabilitation environments and procedures can bring about stronger signs of recovery."