Global Requirement to Reframe the Traumatic Brain Injury Picture

Global Requirement to Reframe the Traumatic Brain Injury Picture

According to research published in the Journal of Neurosurgery, an estimated sixty-nine million people worldwide sustain a Traumatic Brain Injury (TBI) each year.¹

In Europe, approximately seventy-five thousand people die per year from TBI, which doesn’t express the numbers of people in terms of morbidity.²

Traditionally TBI has been viewed as an event. Much has been written over the years about how rehabilitation for a brain injury cannot be compared to or treated in the same terms as other traumatic/physical injuries.

Despite this, protocols for treating non-life-threatening brain injury often follow similar procedures as other types of trauma. Consideration is often not given to the longevity of symptoms, progression of disease, or damage to executive and cognitive function.

There are new ways of looking at things that need to be integrated into the TBI picture. We need to reframe the way we think about traumatic brain injury!

In the words of Ciaran Scott Hill, “A TBI is an event followed by a disease-like cascade of progressively destructive secondary mechanisms.”²

An article by Brent E. Masel and Douglas S DeWitt published in the Journal of Neurotrauma, says, “…the perception exists that patients with a TBI require little further treatment and face no lasting effects on the central nervous system or other organ systems.”³

While campaigns increase awareness of problems, other subtle means often create the impetus for change.

In the case of TBI, this is precisely what has happened.

Over recent years, there has almost been an explosion in the amount of research undertaken in brain injury outcomes and effects. While pathology and consequences have long been understood in neuropsychology with well-evidenced rehabilitation processes focused on rewiring the brain, the pathways to this help are not always clear or available.

The historical provision of treatment and support pathways for differently diagnosed groups has created many unmet needs, particularly in those termed the ‘walking wounded.’

The research ‘explosion’ is primarily based on integrations and findings from studies into neurodegenerative disease, and has also been driven by investigations into sports concussion.

While science is trying to find out if the ‘secondary injury,’ the biochemical cascade that causes a neuroinflammatory response,  is amenable to intervention, millions of people continue to struggle alone without support. This website is deigned to provide the information and strategies people need.

Despite desperate attempts to be understood and get help, individuals are still misjudged, misunderstood and dismissed by their doctors.

The latest research shows that brain injury is not an ‘event’ trauma but is a neurological disease – we need to start seeing it as such.


Masel and DeWitt:

“In fact, TBI is a chronic disease process, one that fits the World Health Organization definition as having one or more of the following characteristics: it is permanent, caused by non-reversible pathological alterations, requires special training of the patient for rehabilitation, and/or may require a long period of observation, supervision, or care.”³

Without a doubt, the urgency to educate medical practitioners and to create rehabilitation services for everyone, whilst challenging, is absolutely essential.

Healthcare protocols also need adapting urgently and new technology-based service provisions put in place. A number of organisations are currently working on the development of integrated systems.

While we are waiting for medical protocols to change, and science to tell us at which stage post-injury it is safe to use neuroprotection, and if this is the best way to prevent progression and longevity of neuroinflammation, there are other things people can do to support their at-home rehabilitation.

See Positive Health and Self-regulated Learning for more details.

Because the secondary injury or biochemical cascade is a complex process, the most important thing to understand is that as well as having destructive effects, there are also beneficial ones which prepare the brain for neuroplasticity and repair.

For this reason, it is important to discuss nutritional and lifestyle interventions with your doctor before making changes.

References:

(1) PubMed Estimating the global incidence of traumatic brain injury – PubMed (nih.gov) Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018 Apr 1:1-18. doi: 10.3171/2017.10.JNS17352. Epub ahead of print. PMID: 29701556.

(2) Neuro Trauma 18 01 Molecular aspects of TBI by Ciaran Scott Hill from Instant Help on Vimeo Ciaran Scott Hill, Neurosurgery Registrar & Honorary Senior Lecturer, London

(3) PubMed Masel BE, DeWitt DS. Traumatic brain injury: a disease process, not an event. J Neurotrauma. 2010 Aug;27(8):1529-40. doi: 10.1089/neu.2010.1358. PMID: 20504161.

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