A commentary published in the Journal of Neurotrauma advocates for traumatic brain injury (TBI) to be classified as a chronic condition, akin to diabetes, asthma, depression, and heart failure. This reclassification aims to shift care focus from addressing the immediate aftermath to embracing a lifelong care strategy.
The commentary authors suggest leveraging existing coordinated care models, which have been developed, tested, and implemented for various groups, including older adults and individuals with depression. By adapting these models, they aim to enhance the integration and communication between brain injury specialists, such as physical medicine and rehabilitation clinicians, and primary care physicians. This approach is expected to improve long-term patient outcomes, offering sustained support to TBI survivors and their families.
In the United States, the prevalence of TBI is increasing, with approximately 2.8 million Americans affected each year. Current healthcare and insurance systems focus on the acute phase of TBI, generally covering the first year following the injury. However, for many survivors, the impact of TBI is long-lasting and requires attention beyond this initial period. Unfortunately, options for post-acute care are often limited and inadequate.
TBIs are most frequently caused by falls, particularly among older adults, as well as by blunt trauma, often related to sports injuries, firearms, motor vehicles, and assaults. The damage may be localised to a specific brain area or more widespread. Various factors influence recovery, including the injury’s size, severity, and location, as well as the individual’s age and history of prior brain injuries.
The Centers for Disease Control and Prevention identify several populations at higher risk of TBI, including racial and ethnic minorities, military service members and veterans, homeless individuals, those in correctional and detention facilities, survivors of intimate partner violence, and residents of rural areas.
The commentary challenges clinicians’ common perception that TBI impairments are static after initial recovery has plateaued. Instead, the authors argue that the trajectory of TBI can involve fluctuations, suggesting that the condition is dynamic rather than static. Consequently, they advocate for TBI to be managed as a chronic condition.
Kurt Kroenke, M.D., the senior author of the commentary and a member of the Regenstrief Institute and the Indiana University School of Medicine, emphasises that recognising TBI as a chronic condition and providing coordinated care can significantly improve outcomes. This approach acknowledges that recovery extends beyond the first year and ensures ongoing patient monitoring and support over many years.
The commentary highlights the importance of self-management and the role of coordinated care models in fostering collaboration between the limited number of brain care specialists and primary care clinicians who oversee the care of TBI survivors throughout their lives. Such collaborative care models, developed by institutions like the Regenstrief Institute, offer essential support and coordinated care for patients with chronic conditions. Recently, Medicare acknowledged TBI as one of 18 chronic conditions, setting a precedent that may encourage further recognition and improved care standards.
Dr. Kroenke notes that Medicare’s designation of TBI as a chronic condition could significantly change how the condition is managed in the long term. It encourages better integration of brain injury specialists with primary care providers and may prompt health insurers to cover the extensive care needs of some survivors for many years.
Flora M. Hammond, M.D., co-author of the commentary and a leading figure in physical medicine and rehabilitation, advocates for a proactive, long-term approach to managing brain injury. She suggests that anticipating changes over time and incorporating strategies to promote healthy living through individualised, coordinated care can significantly enhance the quality of life for those with TBI.
The commentary concludes by asserting that recognising TBI as a chronic condition would not only direct more resources towards addressing the challenges associated with living with a brain injury but would also heighten public and professional awareness of optimising the health and well-being of individuals affected by TBI.
More information: John Corrigan et al, Recognition of Traumatic Brain Injury as a Chronic Condition: A Commentary, Journal of Neurotrauma. DOI: 10.1089/neu.2024.0356
Journal information: Journal of Neurotrauma Provided by Regenstrief Institute
