Growing Support for Treating TBI as a Chronic Disease
Two recent peer reviewed papers support the position statement adopted by the Brain Injury Association in 2009 that “Brain Injury” be treated not as static event from which patients gradually recover over time, but as the beginning of a disease process that that can cause symptoms that change over time, in some cases getting worse instead of better, and that can impact multiple organ systems.
The good news is that most people do, in fact, recover. For those who do not, however, the disease model is more consistent with the evolving research. As McCrea, Iverson, McAllister, et. al. noted in their 2009 Integrated Review of Recovery after Mild Traumatic Brain Injury, brain injury science has advanced more in the last few years than in the previous 50, causing us to change the paradigms we have used to understand both the injury and its consequences.
Research Supports Treating TBI as a Chronic Disease
The most recent paper, Traumatic Brain Injury as a Chronic Health Condition, by Corrigan and Hammond, is in the August 2013 issue of the Archives of Physical Medicine and Rehabilitation. The paper begins with the premise, based on contemporary research, that “some mild TBIs and most severe injuries” can cause permanent impairments. The usual clinical precept is that these residual effects are static once initial recovery has plateaued. The authors note, however, that data from the TBI Model Systems National Database suggests that change is more common than stability for long-term global outcomes.
The data also indicates that onset of symptoms can be delayed and progressive and that “cognitive deficits, depression, psychosis, and social isolation emerged or reemerged much later after injury.” This information has treatment implications – indicating that people may benefit from receiving periodic monitoring of the evolution of the disease process and ongoing treatment for cognitive, motor, psychological or other issues that arise.
Similar observations are made in an August 2010 abstract in the Journal of Neurotrauma, by Masel and DeWitt, Traumatic Brain Injury: a Disease Process, not an Event. The authors note that TBI can increase long-term mortality and reduce life expectancy and can be “associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation and psychiatric diseases, as well as non-neurological disorders such as sexual dysfunction, bladder and bowel incontinence, and systemic metabolic dysregulation that may arise and/or persist from months to years post-injury.”
As discussed in other posts, the accelerating research on TBI is providing more and more information on the factors that cause or predict these chronic problems, including such factors as genetics and the existence of focal lesions. The hope is that with better understanding and better ongoing treatment, the consequences of this disease can be minimized.