Traumatic brain injuries (TBI) are caused by sudden jolts, blows, or penetrating head trauma that disrupts the function of the brain. A TBI can happen to anyone. Young children, teenaged boys, soldiers in Iraq, and elderly persons are especially at risk. About 5.3 million Americans are estimated to have a TBI-related disability. The Centers for Disease Control and Prevention estimate that at least 1.4 million TBIs occur in the United States each year.
The long-term consequences of TBI may be altered cognition, personality, and behavior as well as sensory and motor impairments. Because the damage to the brain from a TBI is hidden from view and the consequences are often not obvious to the casual observer, epidemiologists and other researchers often portray TBI as a "hidden" or "silent" epidemic. Many health care professionals, community service workers, and the public are unaware of TBI’s impact.
In 1989, a federal task force reported to the nation that there were serious gaps in post-acute clinical care and rehabilitation for persons with traumatic brain injury. Eight years later in the Traumatic Brain Injury Act of 1996, Congress directed the Health Resources and Services Administration (HRSA) to take on a share of the responsibility for advancing state-based TBI service systems.
In this report, the IOM Committee on Traumatic Brain Injury assesses the impact of the HRSA TBI Program. Established in 1997, the TBI Program is a modest federal initiative with broad ambitions; a $9 million grants program aimed at motivating states to create systems improvement on behalf of persons with TBI and their families.
The IOM Committee concludes that there has been demonstrable improvement in two essential preconditions for improving TBI service systems--state-level TBI systems infrastructure and the overall visibility of TBI have grown considerably.
Nevertheless, substantial work remains to be done at both national and state levels. HRSA should address the TBI Program’s fundamental need for greater leadership, data systems, additional resources, and improved coordination among federal agencies.
The state TBI Programs are now at a critical stage and will need continue federal support if they are to build an effective, durable service system for meeting the needs of individuals with TBI and their families.