About Traumatic Brain Injury

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					                                 About Traumatic Brain Injury
                             LOSS OF CONSCIOUSNESS IS NOT REQUIRED
                             FOR THERE TO HAVE BEEN A BRAIN INJURY

                                Definition of Mild Traumatic Brain Injury

Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special
Interest Group of the American Congress of Rehabilitation Medicine. (J Head Trauma Rehabil
1993:8(3):86-87)

DEFINITION

A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological
disruption of brain function, as manifested by a least one of the following:

1. Any period of loss of consciousness;

2. Any loss of memory for events immediately before or after the accident;

3. Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused);
and

4. Focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does
not exceed the following:

                post-traumatic amnesia (PTA) not greater than 24 hours. - after 30 minutes, an initial
                 Glasgow Coma Scale (GCS) of 13-15; and - loss of consciousness of approximately 30
                 minutes or less;

COMMENTS

This definition includes: 1) the head being struck, 2) the head striking an object, and 3) the brain
undergoing an acceleration/deceleration movement (ie, whiplash) without direct external trauma to the
head. It excludes stroke, anoxia, tumor, encephalitis, etc. Computed tomography, magnetic resonance
imaging, electroencephalogram, or routine neurological evaluations may be normal. Due to the lack of
medical emergency, or the realities of certain medical systems, some patients may not have the above
factors medically documented in the acute stage. In such cases, it is appropriate to consider
symptomology that, when linked to a traumatic head injury, can suggest the existence of a mild traumatic
brain injury.

SYMPTOMOLOGY

The above criteria define the event of a mild traumatic brain injury. Symptoms of brain injury may or may
not persist, for varying lengths of time, after such a neurological event. It should be recognized that
patients with mild traumatic brain injury can exhibit persistent emotional, cognitive, behavioral, and
physical symptoms, along or in combination, which may produce a functional disability. These symptoms
generally fall into one the following categories, and are additional evidence that a mild traumatic brain
injury has occurred:
1. physical symptoms of brain injury (e.g., nausea, vomiting, dizziness, headache, blurred vision, sleep
disturbance, quickness to fatigue, lethargy, or other sensory loss) that cannot be accounted for by
peripheral injury or other causes;

2. cognitive deficits (e.g., involving attention, concentration, perception, memory, speech/language, or
executive functions) that cannot be completely accounted for by emotional state or other causes; and

3. behavioral change(s) and/or alterations in degree of emotional responsivity (e.g., irritability, quickness
to anger, disinhibiting, or emotional lability) that cannot be accounted for by a psychological reaction to
physical or emotional stress or other causes.

COMMENTS

Some patients may not become aware of, or admit, the extent of their symptoms until they attempt to
return to normal functioning. In such cases, the evidence for mild traumatic brain injury must be
reconstructed. Mild traumatic brain injury may also be overlooked in the face of more dramatic physical
injury (e.g., orthopedic or spinal cord injury). The constellation of symptoms has previously been referred
to as minor head injury, post-concussive syndrome, traumatic head syndrome, traumatic dephalgia,
postbrain injury syndrome and posttraumatic syndrome.

BRAIN INJURY EXPLAINED

I. What is Brain Injury?

Brain injury is an external or internal insult to the brain.

Accidents and afterbirth physiological changes, even minor incidences, can change a person's life
permanently. A blow or impact to the head, a tumor, a stroke or a disease may disturb a brains daily
functions. Any insult to the brain is referred to as a brain injury. Any problem that affects the brain creates
difficulties for the affected individual and their immediate family.

A minor impact can disrupt brain activity. Usually the person's reaction is to be dazed and confused.
Often there is total recovery. Those who continue to suffer with the consequences of head injury need
special care to facilitate in their rehabilitation. These injuries may cause subtle or even major changes in
personality and behavior in an individual, such as irritability, anxiety, depression, memory problems other
psychological and possible physical difficulties.

II. When Does a Brain Injury Occur?

A brain injury may occur at any time. There is no age, gender or sect that escapes it. Brain injury targets
those in the best of health. Brain injury happens indiscriminately. The ramifications of a brain injury can
be devastating for the individual and their family. This is why correct evaluations and rehabilitation
programs are the most important first steps.

QUESTIONS MOST OFTEN ASKED

I. What is Acquired Brain Injury?

An acquired brain injury is an injury to the brain secondary to trauma, stroke, post-surgical complications,
and/or certain disease processes (e.g., tumors, aneurysms).

II. What is Traumatic Brain Injury?
An insult to the brain caused by a direct blow to the skull via a closed or open head injury.

III. What are causes of Traumatic Brain Injury?

Many of the causes stem from accidents and assaults. Accidents that cause traumatic brain injury are
motor vehicle incidents, bullet wounds, physical assaults, physical battering, shaken baby syndrome,
domestic violence, falls, sports and recreation injuries. Consequences may include; cognitive, speech,
hearing, taste, smell, /balance/vestibular, vision, physical mobility dysfunctions, and psycho-social,
behavioral and/or emotional impairments.

IV. How can a family cope?

A family can cope by being involved with strong support groups as well as having patience and
understanding.

V. What types of rehabilitation are available to the Traumatic Brain Injured Individual?

Many New York City and Downstate hospitals offer acquired and traumatic brain injury programs, which
are covered by most insurance plans. The brain injury program includes: psychological, cognitive,
physical, vestibular, vision, vocational, speech, occupational, recreational, music therapies and support
groups for the recovering brain injury individual and their family.

TRAUMATIC BRAIN INJURY

Traumatic Brain Injury, is a silent and growing concern in this borough, the state and throughout the
country. Traumatic brain injury crosses bridges and travels through the tunnels to Manhattan and
elsewhere. A rapid motion of the head in many directions (sometimes called "whiplash") may cause
traumatic brain injury. It is also an acceleration and deceleration of the head during which the brain is
thrust back and forth at crushing speeds thus bouncing the brain off the walls of the skull. An example of
this is when you shake an uncooked egg. The sloshing sound you hear is the yoke hitting the shell.
Shake the egg hard enough, the yoke cracks and breaks. This is what happens to your brain during rapid
acceleration and deceleration. Your brain becomes injured. This is traumatic brain injury or traumatic
brain injury.

Traumatic brain injury is known as "The Silent Epidemic" because it is often unseen. Physical symptoms
often do not accompany a brain injury, therefore; the brain injury is not visible.

Traumatic brain injury may cause intellectual, emotional, social, behavioral, vocational, cognitive, visual,
vestibular, speech, hearing, and physical difficulties. Additionally, smell and taste are often affected. The
intellectual, behavioral, vocational difficulties may often affect present and care, future life styles and
personality behavior of the brain-injured recovering and recovered individual. In most instances, the
person you knew, no longer exists. A new person reemerged, a person who is unknown to you and even
to them. This person is different and will more than likely never be the person you knew and loved. They
are a different person. They are discoverers of a new individual with new potentials to be fulfilled. The
symptomatology of traumatic brain injury often shows itself immediately. Denial is the first line of defense.
The symptoms vary greatly and it depends upon the extent of the location of the brain injury. Memory
problems, learning difficulties, personality changes and physical disabilities are common and often seen
by the recovering individual family members and friends. They can either be subtle or major in nature.

1. Cognitive impairments: May be very mild to exceedingly severe. They include memory deficits (short
or long term), difficulties with concentration, slowness, thinking, attention, perception, communication,
reading, writing skills, planning, sequencing, and judgment.
2. Physical impairments: Speech, hearing, vision, and sensory impairments, headaches, dizziness,
vertigo, lack of coordination, spastically of muscles, paralyses to one or both sides, and seizure disorders
are often seen.

3. Psycho-Social/ Behavioral/ Emotional Impairments: Such impairments include fatigue, mood
swings, denial, self-centeredness, anxiety, depression, lowered self-esteem, sexual dysfunction,
restlessness, lack of motivation, inability to self-monitor, difficulty with emotional control, inability to cope,
agitation, excessive laughing or crying and difficulty relating to others.

There is no cure for traumatic brain injury, only correct rehabilitation and development of compensatory
skills, sharpened strategies and heightened techniques for the traumatic brain injured recovering
individual.

Traumatic brain injury is not a mental disorder. It is a dysfunction of the brain due to an injury. It is
covered separately by the American Disabilities Act, United States Federal Law and New York State Law.

Traumatic brain injury is an acquired brain injury and an acknowledged disability.

                           Head Injury As A Community Problem
                             Judith A. Falconer, Ph.D. braintrn@rehabpsych.com

Head injury is appropriately called "The Silent Epidemic"

                7,000,000 head injuries occur annually in the United States
                500,000 individuals are admitted to hospitals for head injuries each year
                1 in every 220 people in the US is suffering from the effects of a head injury
                Males sustain nearly 2 times as many head injuries as females
                Over 50 percent of those who sustain head injuries 35
                Motor vehicle accidents cause nearly one-half of all head injuries
                Head injuries occur in more than two-thirds of all automobile accidents.

In a split second, the lives of young, previously healthy individuals are tragically and permanently altered.
Families frequently find that they must go through a mourning process where they bury the person they
previously knew and develop a relationship with a new and perhaps less likable stranger. In "head" injury,
the critical damage is done to the brain rather than the head.

The brain, with its protective coverings of hair, skin, and skull as well as cushion of fluid, was sufficiently
protected until we developed weapons which propelled us and other objects at high rates of speed.
Although many people think head injuries only occur when the person loses consciousness, a significant
injury can occur without loss of consciousness and without the injured person's awareness.

The "post-concussion syndrome", characterized by difficulty concentrating, irritability, headache, and
problems with memory after an apparently minor blow to the head or other body part, has recently
received considerable attention from health care practitioners. Generally, the symptoms disappear in
several days to several months and the person functions normally, but some individuals never completely
recover.

As indicated in the statistics quoted earlier, one of the most common sources of head injuries is motor
vehicle accidents; other common causes include bicycle and skateboard accidents, sports injuries, falls
and gunshot wounds. While not all head injuries can be prevented, there is clear and convincing evidence
that seatbelts and helmets can significantly reduce the incidence of head injuries and lessen the severity
of those that do occur.
Until the last decade, most individuals who sustained severe head injuries died. Advances in trauma care
and medical technology have resulted in significantly improved survival rates, although many survivors
have severe deficits. A variety of medical/physical problems may follow head injury, including: seizure
disorders; paralysis or weakness on the side opposite the injury; ataxia (uncoordinated body movements);
increased muscle tone and spasticity; decreased physical endurance; balance disorders; speech/eating
control problems.

However, the major problems are head injury are rarely medical or physical. Instead the survivor, friends
and family members must cope with a wide range of cognitive, behavioral, and emotional deficits. Often,
the person who has sustained the head injury will be unaware that he or she is different and blame others
for problems encountered in daily life. Family members may find that the former easygoing person is
easily angered, strikes out, and behaves very inappropriately in public situations. Most commonly, the
individual who has sustained a significant head injury will have: difficulty learning and remembering new
material; problems organizing, starting and completing tasks; decreased ability to analyze visual material;
and decreased ability to problem solve in new situations. Additionally, the injured person may become
anxious, depressed and/or frustrated when they repeatedly fail at tasks which were easy prior to their
injury. Many individuals who sustain significant head injuries, are unable to monitor their behavior and
lack insight into the effect of that behavior on themselves and others.

Consequently, they find that even long standing friendships do not survive the behavioral, thinking and
personality changes cause by the head injury. Initially the injured individual loses friends; far too often the
rest of the family becomes increasingly isolated because of the time commitment involved in providing
necessary care and supervision.

Head injuries have a devastating impact upon the injured individual, the family and the community. If
society continues to place a premium on intellectual abilities, the situation is likely to become worse for
head injured individuals, with fewer options for employment and satisfying interpersonal relationships,
limited housing, and families unable to cope with multiple demands. Everyone should work toward
prevention of head injuries through community education and

                Always using seat belts and encouraging others to do so
                Supporting legislation requiring use of seat belts and protective headgear
                Supporting legislation aimed at eliminating drunk drivers from the highways
                Supporting the 55 mph speed limit
                Working to develop and require appropriate protective equipment/regulations for sports
                 participants

Unfortunately, unless we are willing to remove all risks from daily life, head injuries will continue to occur.
Given extremely sophisticated medical technology, more individuals will survive catastrophic head injuries
and remain in the community for near normal lifespans.

To accommodate these individuals, we must develop appropriate resources, including:

                Residential alternatives to institutional care which are accessible, supervised, and
                 inexpensive
                Noncompetitive employment settings which meet the unique physical, cognitive,
                 behavioral, emotional and social needs of individuals who have sustained head injuries
                Day care programs to provide supervised recreational and social opportunities
                Low cost respite care for families who provide home care
                A sufficient pool of reliable, trained individuals to provide attendant care and supervision
                Low cost accessible public transportation
                Adaptive recreational programs As an individual, you can make a significant difference in
                 the lives of individuals who have sustained head injuries and their families.
For example, you could:

                Provide transportation to individuals who are not able to use the limited public
                 transportation which is available
                Provide respite for family members by taking the injured individual to community activities
                Maintain relationships with friends who have a head injured family member
                Join and support community groups working on solutions to the problems of head injury

                                           Facts About Brain Injury

Two million head injuries occur each year in the United States. Brain injury causes between 70,000 and
100,000 deaths each year.

500,000 people will require hospitalization each year as a result of brain injury. Every year 70,000 -
90,000 people will suffer life long physical, intellectual and psychological disabilities as a result of their
injury.

Each year more than 30,000 New Yorkers suffer a head injury serious enough to be admitted to a
hospital. It is estimated that 8,000 of these people will be left with serious or lifelong disabilities as a result
of their injury.

Brain injuries are the most frequent reasons for visits to physicians and emergency rooms.

A brain injury occurs every 16 seconds; a death from head injury occurs every 12 minutes.

One out of 80 children born this year are expected to die of a vehicular related brain injury before their
25th birthday.

The typical person with a brain injury is a young male between the ages of 16 and 24 who is injured in a
vehicular accident.

A severely injured person with a brain injury typically requires between 5-10 years of intensive
rehabilitation with long-term follow up.

Brain injury kills more Americans under the age of 34 than all other causes combined and has claimed
more lives since the turn of the century than all United States wars combined.

Some brain injuries are not preventable, such as in stroke, evasive brain surgeries, aneurysms, and such.

It is not realistic for an individual to wear a helmet 24 hours a day, but what an individual we can do is be
diligent in preventing brain injury in as many ways that are possible such as wearing helmets when in
active leisure activities, seat belts when in a motor vehicles, being careful to not to bump our heads into
cabinets or such, receiving the Lyme disease vaccine and if symptoms arise seeking out a physician
immediately for intervention therapy, and when falling down putting out your hands or being conscious of
how you are about to fall to as to cushion your skull.

                                     Myths about Traumatic Brain Injury

Despite many of the scientific and technological advances that have been made in the field of brain injury,
many myths still persist about traumatic brain injury. Whether the myths exist through ignorance or by
intentional design, the real problem is that these myths often prevent legitimately injured people from
receiving the medical care, treatment and therapy that they desperately need and deserve.
There are also too many lawyers who are not able to provide proper representation for their client with
brain injury, often times because they are of the notion that psychiatric consequences of traumatic brain
injury, even though disabling, are not as "serious" as cognitive impairments.

This article will take a brief look at five of the most common myths associated with brain injury particularly
as they relate to the field of law. The article will also offer some suggested questions that may be used to
dispel misleading in formation about these myths in the courtroom setting.

Myth 1: Loss of consciousness is a necessary prerequisite for traumatic brain injury. According to the
book by Drs. Silver, Yudolfsky and Hales entitled Neuropsychiatry of Traumatic Brain Injury, 35
percent of the people studied in scientific literature sustained a traumatic brain injury without a reported
loss of consciousness. This myth has been particular easy to dispel and it has been the author's
experience that the following questions can be in the courtroom.

1) Doctor, would you agree that a person need not lose consciousness or be in a coma to sustain a
traumatic brain injury?

2) Doctor, during your career, have you made diagnosis of traumatic brain injury for patients whose
hospital record indicated there was no loss of consciousness? And

3) Doctor, during your career have you actually provided or recommended care and treatment for
someone with a diagnosis of brain injury who did not lose consciousness as a result of trauma?

Myth 2: When describing a brain injury, the words "mild" or "minor" mean "insignificant." Even so-called
minor brain injuries (i.e.. A minor concussion or a simple skull fracture) may have long term effects on
mental function and quality of life.

In the Society of Automotive Engineers publication entitled Automotive Safety by Jeffrey A. Pike,
there is discussion of traumatic brain injury entitled "Minor Injuries." According to Pike, "a number of
relatively subtle, not as easily detectable neuropsychological deficits may exist after some "minor" head
trauma and may be capable of interfering with an individual's ability to function at a pre-injury level. These
deficits may include: verbal and communicative disorders; deficits in information processing ability;
deficits in reaction time; short and intermediate-term memory difficulties; problems with perceptions and
deficits in concept formation and general reasoning ability."

During testimony, the following questions could help dispel the myth.

1) Doctor, would you agree that the word "mild" or "minor" to describe a head injury, does not mean the
injury is insignificant? And

2) Doctor, would you agree that there is literature and research that suggests that some persons may
develop cognitive or emotional problems as a consequence of what is described as a "minor" or "mild"
brain injury?

Myth 3: The case involving traumatic brain injury is not that serious because it is only "psychiatric
problems." The third edition of the American Psychiatric Textbook of Neuropsychiatry states that unlike
many psychiatric illnesses that have gradual onset. traumatic brain injury often occurs suddenly and
devastatingly. Although some individuals recognize that they no longer have the same abilities and
potential they had before the injury, many others with significant disabilities deny that there have been
any changes.

Psychiatric disturbances associated with frontal lobe injury can include: impaired social judgment; labile
effect; uncharacteristic lewdness; inability to appreciate the effects of one's behavior or remarks on
others; a loss of social graces and a reduced attention to personal appearance and hygiene. After brain
injury, an individual may exhibit behaviors that tend to be more disorderly, suspicious, argumentative,
isolated, disruptive and/or anxious.

These conditions can have drastic and lasting effects on a person with brain injury and should be
addressed in court with questions such as:

1) Doctor, would you agree that a person can develop psychiatric problems as a consequence of
traumatic brain injury? And

2) Doctor, during your career, have you actually determined that someone was disabled from competitive
employment because of psychiatric problems such as depression?

Myth 4: In order to be considered a traumatic brain injury, the head must actually strike or impact another
surface. This is simply not true. There are two basic types of brain injury, open head injury and closed
head injury. Open head injuries are caused by bullets or other penetrating objects. Closed head injury,
the more common of the two is usually caused by a rapid movement of the head during which the brain is
whipped back and fourth bouncing off the inside of the skull.

The stress of the rapid movements pulls apart and stretches nerve fibers or axons, breaking connections
between different parts of the brain. This means that even if the head does not strike or come into contact
with another surface, a traumatic brain injury can occur simply from the brain's movement inside the
skullcap. Concussions and injury caused after a severe neck injury (ie. Whiplash) can also result in brain
injury.

During testimony, the following questions can be utilized:

1) Doctor, would you agree that a person can sustain traumatic brain injury without actually striking their
head? And

2) Doctor, during your career, have you made diagnosis of persons with brain injury who reported that
they did not strike their head during the traumatic event?

Myth 5: The cognitive impairments identified on the neuropsychological testing do not fit any known
pattern of cognitive impairments following traumatic brain injury. Behavioral repercussions of brain injury
vary with the nature, extent, location and duration of the injury; the age; the sex, physical condition and
physiological differences.

Brain injury is a very individualized condition and no two individuals with brain injury will share identical
symptoms and deficits. To make that point during testimony, the author suggests a line of questioning
such as, Doctor, would you agree that different types of cognitive impairments and psychiatric conditions
on different individuals?

Conclusion

The content of this article is for assistance to all individuals as a learning mechanism for understanding
the symptoms of traumatic brain injury. It is with this knowledge that the individuals who has sustained a
brain and their family along with their caring friends and associates to have the empowerment to obtain
the assistance, help, respect, dignity, care and necessary treatment they deserve and are entitled to.

                                              Signs of Stroke
When people have chest pain, they think heart attack. When people feel numb or weak on one side, they
don't think brain attack. That can be a dangerous mistake. Seeking immediate medical care is crucial
because clot- busting medications, if administered quickly, can minimize the disabling and sometimes
deadly effects of stroke by opening arteries and restoring blood flow.

"Within three hours, all our options are open," says George C. Newman, director of the stroke program at
University Hospital and Medical Center at Stony Brook. After three hours, the According to the American
options begin to narrow. After Heart Association, the six, they're starting to close." Too often, patients
don't seek treatment.

They may not recognize the symptoms, or they may simply not be aware of their sudden deficits.
According to a study that appears in this month's Annuals of Emergency Medicine, nearly 40 percent of
stroke patients said they did not decide to seek help themselves, but only at the urging of a friend or
relative. "We have to teach people to recognize the stroke in others and then call 911." And, Newman
stresses, "you can't let the patient talk you out of it."

According to the American Heart Association, the symptoms of stroke are: vision problems, including
sudden dimness, loss of vision in one eye or double vision, unexplained dizziness, including
lightheadedness,vertigo or sudden falls. Communication difficulties, either slurring words or trouble talking
or understanding language. Sudden weakness in arm, leg,face or on one side of the body. Sudden,
unsteady walking as if drunk and headaches.--Geiger LIHIA, Commack, NY

                  The Costs and Causes of Traumatic Brain Injury
                            EVERY 15 SECONDS, ONE PERSON IN THE U.S.
                                    SUSTAINS A BRAIN INJURY

DEFINITION

Traumatic brain injury (TBI): is an insult to the brain, not of degenerative or congenital nature caused by
an external physical force that may produce a diminished or altered state of consciousness, which results
in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of
behavioral or emotional functioning.

Acquired brain injury (ABI): injury to the brain which is not hereditary, congenital or degenerative.

SCOPE

An estimated 5.3 million Americans little more than 2% of the US population currently live with disabilities
resulting from brain injury.

1. It is estimated that one million people are treated for traumatic brain injury and released from hospital
emergency rooms every year.

2. Each year, 80,000 Americans experience the onset of long-term disability following traumatic brain
injury.

3. More than 50,000 people die every year as a result of traumatic brain injury.

4. Vehicle crashes are the leading cause of brain injury. They account for 50% of all traumatic brain
injuries
5. Falls are the second leading cause, and the leading cause of brain injury in the elderly. The risk of
traumatic brain injury is highest among adolescents, young adults and those older than 75

6. After one brain injury, the risk for a second injury is three times greater; after the second injury, the risk
for a third injury is eight times greater.

THE COSTS

The cost of traumatic brain injury in the United States is estimated to be $48.3 billion annually.
Hospitalization accounts for $31.7 billion, and fatal brain injuries cost the nation $16.6 billion each year.

THE CONSEQUENCES

Brain injury can affect a person cognitively, physically and emotionally. Cognitive consequences can
include: Short term memory loss; long term memory loss Slowed ability to process information trouble
concentrating or paying attention for periods of time difficulty keeping up with a conversation; other
communication difficulties such as word finding problems spatial disorientation organizational problems
and impaired judgment unable to do more than one thing at a time

Physical consequences can include: Seizures of all types muscle spasticity double vision or low vision,
even blindness Loss of smell or taste speech impairments such as slow or slurred speech; headaches or
migraines fatigue, increased need for sleep; balance problems.

Emotional consequences can include: a lack of initiating activities, or once started, difficulty in completing
tasks without reminders increased anxiety depression and mood swings denial of deficits impulsive
behavior more easily agitated egocentric behaviors; difficulty seeing how behaviors can affect others

References

1. Guerrero JL, Leadbetter S, Thurman DJ, Whiteneck G and Sniezek JE. A method for estimating the
prevalence of disability from traumatic brain injury, in press.

2. Data from the National Hospital Ambulatory Medical Care Survey, 1995-1996, of the National Center
for Health Statistics. Described in Guerrero JL, Thurman DL and Sniezek JE. Emergency department
visits associated with traumatic brain injury. United States, 1995-1996, in press.

3. Guerrero JL, Leadbetter S, Thurman DJ, Whiteneck G and Sniezek JE. A method for estimating the
prevalence of disability from traumatic brain injury, in press.

4. Unpublished data from Multiple Cause of Death Public Use Data from the National Center for Health
Statistics, 1996.

5. Krause J, Sorenson S. Epidemiology. In J Silver, S Yudofsky, R Hales (eds.). Neuropsychiatry of
Traumatic Brain Injury. Washington, DC: American Psychiatric Press, Inc., 1994.

6. Analysis by the CDC National Center for Injury Prevention and Control, using data obtained from state
health departments in Alaska, Arizona, California, Colorado, Louisiana, Maryland, Missouri, New York,
Oklahoma, Rhode Island, South Carolina and Utah.

7. Annegers JF, Garbow JD, Kurtland LT et al. The Incidence, Causes and Secular Trends of Head
Trauma in Olstead County, Minnesota 1935- 1974. Neurology. 1980; 30:912-919.
8. Lewin ICF. The Cost of Disorders of the Brain Washington, DC: The National Foundation for the Brain,
1992. Special Report CDC Report Shows Prevalence of Brain Injury April 14, 1999 ATLANTA (CNN) An
estimated 5.3 million Americans, a little more than 2 percent of the U.S. population, currently live with
disabilities from traumatic brain injuries, according a to a new report by the Centers for Disease Control
and Prevention.

Each year, approximately 80,000 Americans experience the onset of disabilities resulting from brain
injuries, the report says. The data released in the CDC study is considered the most complete picture of
the impact of traumatic brain injuries (traumatic brain injurys) in the United States. The National Center for
Injury Prevention and Control, a division of the CDC, plans to use the data to assess the availability of
proper medical, social and support services across the country.

Other traumatic brain injury statistics reported by the CDC indicated that each year, 1 million people are
treated and released in hospital emergency rooms, and 50,000 people die. The three leading causes of
traumatic brain injury are motor vehicle crashes, violence mostly from firearms and falls, particularly
among the elderly.

The risk of traumatic brain injury in men is twice the risk in women. The risk is higher in adolescents,
young adults and people older than 75 years. The report was prepared for a meeting this week of 40
experts to discuss public health implications of traumatic brain injuries. A traumatic brain injury takes
place when an external physical force hits the brain, producing a diminished or altered state of
consciousness. It results in impaired cognitive abilities or physical functioning, and sometimes disturbs
behavioral or emotional functioning. traumatic brain injury can affect a person cognitively, physically and
emotionally.

A person might experience memory loss, lack of concentration, slowed ability to process information,
seizures, double vision or even loss of vision, headaches or migraines, loss of smell or taste, speech
impairments, anxiety, impulsive behavior, depression and mood swings.

BIA estimates hospital and fatal injury costs relating to traumatic brain injury in the United States exceed
$48 billion annually.