A review published in the magazine Journal of NeurotraumaIt calls for traumatic brain injury to be recognized as a chronic condition, just like diabetes, asthma, depression and heart failure.

To provide comprehensive care for traumatic brain injury across individuals’ lives, the authors propose coordinated care models that they and others have developed, tested, and applied to various populations (including older adults, individuals living with depression, and post-intensive care survivors). – Will be adapted to improve communication and integration between brain injury specialists and primary care physicians, including physical medicine and rehabilitation clinicians, providing better long-term patient care for traumatic brain injury survivors and greater support for both patients and their families.

The incidence of traumatic brain injury (often referred to as TBI) is increasing in the United States, and it is estimated that approximately 2.8 million Americans suffer a traumatic brain injury each year. The healthcare system and insurance coverage focus heavily on the acute phase of the condition, usually the first year after the injury sustains. However, for a significant portion of those living with traumatic brain injury, the effects are long-lasting and last a lifetime. But post-acute care options are often pretty bleak.

Traumatic brain injury most often results from falls (especially in older adults), blunt trauma (especially sports-related injuries), firearms, motor vehicles, or assaults. Damage may be limited to one area of ​​the brain or may occur over a larger area. Many factors affect recovery, including the extent, severity, and location of the brain injury, as well as the individual’s age and previous brain injuries.

According to the Centers for Disease Control and Prevention, populations more likely to be affected by traumatic brain injury include:

• racial and ethnic minorities
• service members and veterans
• people experiencing homelessness
• Persons in penal execution and detention facilities
• survivors of intimate partner violence
• people living in rural areas

Comment authors observe that many clinicians believe that residual impairments due to traumatic brain injury are stable once initial recovery subsides and do not expect significant changes for the remainder of a person’s life. In contrast, the review authors write that the long-term course of traumatic brain injury involves waxing and waning and thus may be better described as dynamic rather than static. Accordingly, they call for traumatic brain injury to be evaluated and managed as a chronic condition.

Recognizing traumatic brain injury as a chronic condition and providing coordinated care will make a difference in patients, their families, and the functioning of the healthcare system in several ways. “It recognizes that for many patients the disease is not over after 12 months and, importantly, it provides a place of care where these patients can be monitored and helped for many years to come.”

Review senior author Kurt Kroenke, MD, Regenstrief Institute and Indiana University School of Medicine

“Recognizing TBI as a chronic condition and using coordinated care models supports the important role of self-management for both the patient and their family. These two steps facilitate collaboration between a limited number of brain care specialists and the primary care clinicians who often oversee care. Regenstrief Institute “The collaborative care models we and others have developed provide patients living with chronic conditions with the support and coordinated care they need.”

Dr. Kroenke notes that Medicare’s definition of a chronic condition opens the door to change in how traumatic brain injury is managed long-term and could guide health systems to better integrate brain injury specialists — who are in short supply — with primary care providers. through collaborative models of care. It could also encourage health insurers to cover the care some survivors need for many years.

“We can improve life after brain injury with a more proactive approach and a longer-term view of brain injury as a chronic and dynamic condition. This approach anticipates changes over time and includes strategies to optimize wellness through individualized coordinated care across the lifespan. Those living with brain injury needs.” said comment co-author Flora M. Hammond, MD, Covalt Professor of Physical Medicine and Rehabilitation and chair of the Department of Physical Medicine and Rehabilitation at IU School of Medicine.

“Recognizing TBI as a chronic condition will not only focus more resources on the problems associated with living with brain injury, but will also increase awareness of both the public and professionals about how they can optimize the health and well-being of people living with the effects of brain injury TBI,” he concludes his comment.