The societal impact of such injuries is alarming. The Center for Disease Control and Prevention estimates that 5.3 million Americans have a long-term or lifelong need for help to perform activities of daily living because a brain injury. Direct medical and indirect costs for TBI are estimated at $60 billion in the United States in 2000 and projected to increase in the years ahead with advances in intensive care, trauma medicine and rehabilitation that have dramatically improved survival rates post TBI in the last 25 years.

A traumatic brain injury (TBI) is defined by the Centers for Disease Control as “a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain” (www.cdc.gov/traumaticbraininjury.org ). The severity of such brain injury may range from “mild,” where there may be a brief change in mental status or consciousness to “severe,” involving an extended period of coma, unconsciousness or amnesia after the injury. While TBI is thought to be a neurological and neurosurgical disorder, it produces a predictable cognitive and neurobehavioral clinical syndrome.

Postconcussional Disorder (PCD) is, in fact, defined as a syndrome following significant cerebral concussion resulting in quantifiable deficits in memory (learning or recalling information) or attention (concentrating, shifting focus of attention, performing simultaneous cognitive tasks) based on neuropsychological testing, and the onset, or substantial post-injury worsening of any three or more of the following symptoms: tiring easily, disordered sleep, headaches, vertigo/dizziness, irritability, anxiety/depression/affective lability, changes in personality, or apathy. The disturbances resulting from these symptoms must either have their onset following the head trauma or represent a worsening of preexisting symptoms, result in a significant decline in social or occupational functioning, and should not be better accounted for by other diagnostic categories. With more severe TBI, people may experience changes in personality, and lack self-awareness or have difficulty adjusting to their post-injury outcomes even decades after the event. While there may be residual cognitive changes following brain injury, it is the emotional, behavioral and psychosocial disturbances that form the greatest barrier to community integration and hinder the maintenance of social and family interactions, return to work, and re-establishment of quality of life.

If you or a family member have experienced a traumatic brain injury, it is important to have periodic neuropsychological testing to assess current cognitive, psychological, and emotional functioning. Neuropsychological assessment would be recommended every 12 -24 months. Follow-up testing would provide information about potential change in an individual’s functioning and to provide information about change from baseline, assist in guiding rehabilitation planning, assist with patient care planning, and to better define the course and implications of the results.