Brain Injury Rehabilitation of Children and Youth: Neurodevelopmental Perspectives

Abstract

Traumatic brain injury (TBI) was coined, for many years, as the ‘‘silent epidemic’’ as its frequency and disabling effects were largely unrecognized by the professional community and the public (Ylvisaker, 1985). It was called the ‘‘silent epidemic’’ for two reasons: the public was unaware of its impact, and the cumulative data on incidence and prevalence did not include patients who sought medical attention from physicians’ offices (Langlois, Marr, Mitchko, & Johnson, 2005). Today, TBI is not so silent. We know that of the 1.4 million who sustain a TBI every year in the United States, 50,000 die, 235,000 are hospitalized, and 1.1 million are treated and released from an emergency department. The male to female ratio is about 1.5 and the death rate is highest among African Americans (Langlois, Rutland-Brown, & Thomas, 2004). The latest incidence review from the Centers for Disease Control and Prevention (CDC) covers 2003 and reports somewhat similar results of 51,000 deaths, 290,000 hospitalizations, and 1.2 million emergency room visits for TBI (Rutland-Brown, Langlois, Thomas, & Xi, 2006). These statistics are more revealing when one considers that every 16 s someone in the United States sustains a head injury and every 12min one of these people will die and another will become permanently disabled. Of those who survive each year, an estimated 80,000 90,000 people experience the onset of long-term disability associated with a TBI. An additional 2,000 will exist in a persistent vegetative state. Unfortunately 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 US wars combined (Hatch, 2007). Studies show that 70–90% of treated brain injuries are mild (Semrud-Clikeman, Kutz, & Strassner, 2005). The incidence of mild TBI treated in the hospital is about 100–300 per 100,000 but population-based surveys of self-reported head injury suggest the mild TBI rate is actually above 600 per 100,000 because many do not seek treatment for concussions (Holm, Cassidy, Carroll, & Borg, 2005). Many of the individuals who do not seek treatment have sustained sports injuries. The etiological data category for being unintentionally struck by another person or object or immediately against an object has become the third largest cause of TBI; it includes H. DENNIS KADE Tidewater Child Development Services, Norfolk Department of Public Health. Norfolk, VA and Department of Psychology, Old Dominion University, Norfolk, VA. ELAINE FLETCHERJANZEN San Angelo, Texas 76901.