Recognizing traumatic brain injury as a chronic condition could foster better life-long care

An MRA brian scan of a recent traumatic brain injury patient showing a brain contusion and hemorrhage.

© Richman Photo - stock.adobe.com

A commentary published in the Journal of Neurotrauma calls for traumatic brain injury (TBI) to be recognized as a chronic condition. Authors suggest that despite the high incidence of TBI in the U.S.—with an estimated 2.8 million Americans suffering TBIs each year—health care and insurance coverage predominantly focus on the acute phase of the condition, typically the first 12 months following the initial injury, and there aren’t many post-acute care options.

A significant number of people living with TBI feel the effects for years following the initial injury, so it’s important for the condition to be categorized as chronic, rather than acute. The authors propose that the coordinated care models that they, and others, have developed, be adapted to improve communication and integration between brain injury specialists and primary care physicians. With improved long-term communication methods, TBI survivors would see improvements to long-term care, along with stronger patient and family support.

“Acknowledging [TBI] as a chronic condition and providing coordinated care will make a difference to patients, their families and to how the health care system operates, in several ways,” Kurt Kroenke, M.D., of the Regenstrief Institute, the Indiana University (IU) School of Medicine and senior author of the commentary, said in a news release. “It recognizes that, for many patients, it’s not over after 12 months and, importantly, provides these patients with a place of care, where they can be monitored and helped over many years.”

Kroenke elaborated that, by recognizing TBI as a chronic condition and using coordinated care models, physicians can support self-management for both the patient and their family. He also explained that, because there is a limited number of brain care specialists equipped to handle cases of TBI, changing how TBI is classified would facilitate stronger collaboration between the specialists and the primary care clinicians who will continue to oversee care past the acute period. “Collaborative care models, which we at Regenstrief Institute and others have developed, provide patients living with chronic conditions with the support and coordinated are they need. Medicare recently recognized TBI as one of 18 chronic conditions, hopefully others will follow,” Kroenke said.

In older adults, TBI is commonly caused by falls, blunt trauma (particularly in sports-related injuries), firearms, motor vehicles and assaults. Damage in TBI can vary, either confined to one area of the brain, or over a widespread section. Recovery, and therefore approaches to management, depend on the size, severity and location of the damage, age of the patient at the time of initial injury and injury history.

The Centers for Disease Control and Prevention (CDC) reported over 69,000 TBI-related deaths in the U.S. in 2021. Although TBI can affect anyone, the CDC identifies racial and ethnic minorities, service members and veterans, homeless individuals, those in correctional and detention facilities, survivors of domestic violence and those in rural areas as populations more likely to be affected by the condition.

According to the study, classification of TBI as a chronic condition would encourage those with TBI to adjust their overall lifestyles to support wellness, seek additional education and resources in support of their condition and would foster better relationships with their primary care physicians, who would treat their condition as an ongoing one, requiring consistent management, rather than moving past the issue in 12 months. Also, in the U.S., additional public health resources are allocated to addressing chronic conditions, specifically through health insurance plans like Medicare and Medicaid.

“We can improve life after brain injury with a more proactive approach and longer-term view of brain injury as a chronic and dynamic condition. This approach anticipates changes over time and incorporates strategies to optimize healthy living with coordinated care that is individualized for the lifetime needs of those living with brain injury,” Flora M. Hammond, M.D., co-author of the commentary, covalt professor of physical medicine and rehabilitation and chair of the Department of Physical Medicine and Rehabilitation at the IU School of Medicine, said.

The commentary’s authors concluded the abstract by emphasizing that, “Recognition of TBI as a chronic condition would not only focus more resources on problems associated with living with brain injury but would also enhance both the public and professionals’ awareness of how to optimize the health and well-being of persons living with the effects of TBI.”