According to the Centers for Disease Control and Prevention (CDC), traumatic brain injuries (TBIs) are the leading cause of death and disability for children and young adults in the U.S., with 50,000 dying every year.

TBIs are often referred to as a “silent epidemic” because they frequently go undetected on MRI and CT scans, and medical providers usually don’t have a baseline of comparison for assessing cognitive function, particularly for mild TBIs where symptoms tend to emerge later in the recovery process.

The Brain Injury Association of America states that someone in the U.S. suffers a TBI, which includes concussions, every 9 seconds. An estimated five million Americans are living with disability related to TBI, with an unknown number going undiagnosed every day.

“Brain injuries can be missed during medical evaluations because they may lack physical symptoms like bruising, bleeding, or swelling, and imaging often doesn’t reveal mild TBI,” said Dr. Crystal Cobos, Director of the Head Injury & Concussion Clinic at Institutes of Health (IOH).

“Evaluation often relies on the subjective reporting of patients who typically have reduced insight into their neurological symptoms,” says Cobos. “Because so many cases are undiagnosed and symptoms are frequently linked to other conditions, particularly behavioral changes, a ‘silent epidemic’ has emerged.”

Brain injuries can result in a wide range of physical and cognitive symptoms, including headache, blurry vision, dizziness, fatigue, nausea, and problems with focus, memory, and reasoning.

Symptoms of delayed recovery from TBI can include depression, anxiety, sleep disorders, fear avoidance, and emotional dysregulation.

“Delayed recovery occurs when a person continues to experience high levels of symptoms and disability after the anticipated healing time has passed,” stated Dr. Gabriel Dawson, SVP of Systems, Analytics, and Compliance at Institutes of Health (IOH).

“When significant levels of symptoms continue beyond three months, their condition is considered chronic,” he added. At that time, a biopsychosocial evaluation should be performed to understand best all the factors impeding their recovery.

In the context of an evidence-based, biopsychosocial model, the rehabilitation team aims to comprehend the patient’s experience with their injury and the medical assessment to guide interventions more effectively. TBI can impact a wide range of functions, so a transdisciplinary approach to biopsychosocial treatment is preferred. This approach facilitates improved communication and integration across disciplines, leading to more comprehensive care.

“It is challenging to address one specific deficit in isolation when the whole system is impacted,” said IOH Speech Language Pathologist Jemelie Koda.

“The patient’s overall experience has a larger impact on functioning than the diagnosis
alone,” she continued. “If you consider a patient with light sensitivity and vision changes, for example, it is challenging to meaningfully address other important goals, like reading comprehension, visual attention, or screen tolerance.”

The CDC reports that TBIs cost the U.S. roughly $37.8 billion every year, which includes $4.5 billion in hospital care and other services. TBIs also account for $20.6 billion in injury-related work loss and disability and $12.7 billion in lost income from premature death.

TBIs remain among the most challenging and expensive injuries to treat within the workers’ compensation system. However, with the right approach, these conditions can be significantly improved, and disability can be reversed. Early intervention and specialized treatment are vital to achieving the best results. Selecting specialty healthcare providers, visiting their facilities, and making well-informed referrals to enhance clinical outcomes is crucial.

“When evidence-based treatment of TBI is delayed or inaccessible, outcomes suffer, and long-term disability rises significantly. A shift in cultural understanding is required to prevent unnecessary suffering. We have effective programs and services to address the many factors that influence brain injury and related disability, and we need to apply them through an integrated approach tailored to each patient,” explains Dawson.

Using a biopsychosocial model, a transdisciplinary team of specialty care professionals can effectively treat the various functional areas affected by an individual’s TBI. This approach leads to the best clinical outcomes and reduces long-term healthcare costs and utilization.