Almost all of the men and women who report on news events have a distinct aversion to BEING a news event. ABC News anchor Bob Woodruff had no choice. He sustained a serious brain injury from an improvised explosive device while on assignment in Iraq in January 2006.

Woodruff woke up at Bethesda (Md.) Naval Hospital from a medically-induced coma on March 6, 2006. Injured on the left frontal lobe of his brain, he had difficulty retrieving words and remembering things—he couldn’t remember the names of his brothers or his children. The doctors had removed 14cm of his skull to relieve the pressure in his brain after the blast, and his face was raked with wounds and peppered with hundreds of rock bits and dirt from the explosion.

On the military side, Dr. John Booss, a Fellow of the American Academy of Neurology, says “Iraq and Afghanistan created an emerging TBI epidemic among combat veterans,” and TBI is often called the signature wound of the Iraq war.

The U.S. Centers for Disease Control and Prevention (CDC) explains TBI is a blow or jolt to the head, or penetrating head injury that disrupts brain function. Each year, at least 1.4 million Americans sustain a TBI, at the rate of one every 23 seconds, and “this public health concern ranks as the leading cause of death and disability in children and young adults.”

Highest rate
Males are about 1.5 times as likely as females to sustain a TBI, and the two age groups at highest risk are up to 4 years old and 15 to 19 year-olds. Certain military duties (e.g., paratrooper) increase the risk (Defense and Veterans Brain Injury Center - U.S. Dept. of Defense), and African-Americans have the highest death rate from TBI, CDC states.

CDC adds: Brain injuries are caused by falls, motor vehicle crashes, assaults, and sports/recreation accidents. Blasts are a “leading cause” of TBI for active duty military personnel in war zones. This “silent epidemic” affects people in ways that are “invisible” and can lead to problems ranging from balance and coordination issues to loss of hearing, vision, or speech. Fatigue, memory loss, impulsivity, concentration difficulty, depression, anxiety, and impaired judgment are common after brain injury.

One study found about 40 percent of those hospitalized with a TBI had at least one unmet need for services a year after their injury. The most frequent unmet needs were: improving memory and problem-solving; managing stress and emotional upsets; controlling oneۥs temper, and improving oneۥs job skills.

The cost of caring for TBI patients from the two wars could be $14 billion over 20 years, and $35 billion over their lifetimes, and the U.S. Dept. of Defense reports almost 1.5 million troops have been deployed to Iraq and Afghanistan. By some estimates, as many as 10 percent of these soldiers could have some form of TBI. They require specialized care from providers skilled in treating TBI. Non-military direct and indirect medical costs, such as lost productivity of TBI totaled an estimated $60 billion in the U.S. in 2000.

Falls are number one
Dr. Sunil Kothari explains on www.Disaboom.com that “in most cases, the diagnosis of TBI will be obvious. What might remain uncertain, especially early on, is the type and extent of brain damage. The physical examination and special testing can help in making this clearer. Physical examination focuses on determining the depth of coma. This is done with the Glasgow Coma Scale: range of eye response, range of verbal response, and range of motor response.”

Not all blows or jolts to the head result in a TBI, and the severity may range from “mild” (brief change in mental status or consciousness) to “severe” (an extended period of unconsciousness or amnesia after the injury). The CDC, Journal of Head Trauma and Rehabilitation, National Institute of Neurological Disorders and Stroke, and a study titled The Incidence and Economic Burden of Injuries in the United States estimates that TBIs contribute to a substantial number of deaths and permanent disability annually. In the U.S., of those who sustain a TBI each year 50,000 die, 235,000 are hospitalized, and 1.1 million are treated and released from an emergency room. Among children up to age 14, TBI results in an estimated 2,685 deaths, 37,000 hospitalizations, and 435,000 emergency room visits annually.

Leading causes of TBI are falls (28 percent); motor vehicle-traffic crashes (20 percent); struck by/against events (19 percent), and assaults (11 percent), CDC estimates, and it can cause a wide range of functional changes affecting thinking, sensation, language, and/or emotions. It can cause epilepsy and increase the risk for conditions such as Alzheimer’s or Parkinson’s disease, and other brain disorders that become more prevalent with age. Symptoms may not appear until days or weeks after the injury or may even be missed as people may look fine even though they may act or feel differently.

‘Retraining the brain’
For example, Anne F., an economist before her TBI, is now a Brain Injury Association of America (BIAA) volunteer. In March 2007, a respected magazine told her story (I Wanted My Brain Back) about “what happens when you’re a Ph.D. economist and you suddenly can’t remember things or think straight? I couldn’t trust my brain.”

Bill payments lapsed because she couldn’t balance her checkbook. She had a hard time cooking; she’d lose track of what she was doing or make mistakes, like putting mayonnaise on the outside of a sandwich. She’d wear the same outfit day after day; it was hard to match clothes. One day, instead of putting on her pants by sliding in her right leg first, as usual, she had started on the left. She couldn’t remember what came next. She sat on the bed and cried.

“Part of therapy is retraining the brain,” says Melanie R., Anne’s former speech language pathologist. “Say part of the brain used for memory is damaged,” Reynolds says. “There are other parts of the brain close to that part that we try to stimulate by doing memory exercises. Research has shown parts of the brain that were originally designed for one function can take over for another.”

Founded in 1980, BIAA (1-800-444-6443) serves individuals, families, and professionals affected by life-altering, often devastating TBI. Through 40-plus chartered state affiliates, BIAA provides information, education, and support for those with TBI and their families.

Partnership formed
BIAA president/CEO Susan H. Connors asserts: “TBI is the most misunderstood, misdiagnosed, under-funded public health problem our nation faces.” She relates that on Feb. 28, 2007, McLean, Va.-based BIAA partnered with Bob Woodruff and his family to “spread TBI awareness and to administer the newly-created Bob Woodruff Family Fund for TBI.” They plan to assist servicemen and women and their families affected by TBI due to the war in Iraq and Afghanistan.

To “give back” to the people who saved Bob’s life, the Woodruff family set up the Bob Woodruff Family Fund for TBI to raise money through events and other activities. Donations will provide grants to non-profit organizations serving members of the military who have sustained TBI. In some cases, funds may be used to provide direct financial assistance to military personnel and their families and/or grants for medical research, public education, awareness, and prevention of TBI.

Woodruff received superior care, but his wife, Lee, also a journalist, and their extended family recognized many people with TBI don’t get the services and support needed to regain their independence. They also saw the lack of public, private, and military sector funding and wanted to help. BWFF’s Board of Trustees includes Martha Raddatz, chief White House Correspondent for ABC News and BIAA’s Connors.

Michael Jackson's moonwalk
There’s care for the less well-known, too. A split-belt treadmill pushes people at Baltimore’s Kennedy Krieger Institute (KKI) research hospital into versions of Michael Jackson's moonwalk in hopes of training those with TBI to walk again normally. The treadmill may help scientists understand how brain and spinal cord circuitry can rewire itself. The brain must adjust automatically how to walk and not fall down. KKI scientists are tapping into that unconscious adjustment, using a brief workout to jolt patients who usually limp and lurch back into a normal stride, one they retain for a few minutes after the treadmill stops.

Rancho Los Amigos National Rehabilitation Center in Downey, Calif., states that the pace and extent of recovery from brain injury can vary considerably, even between patients with similar injuries. “The majority of recovery from brain injuries occurs within the first six months to a year after trauma, but one study indicates a patient's function following severe TBI can occur for up to 10 years post injury.” The pace of recovery, and even the extent of recovery, can be improved by proper physical and cognitive rehabilitation.

Due to the complexity of brain injury, the need for research becomes more important in an attempt to unlock the mystery of the brain and its functions. New York City’s Mount Sinai School of Medicine is among the facilities doing such research.

In printed form
BIAA and CDC are doing a pilot study of a national, one-call center at 1-800-444-6443 that provides individualized and confidential information and resources for those with brain injury, family members, and caregivers. The study establishes a National Brain Injury Information Center that connects callers directly to the Information and Resources staff in Michigan, Minnesota, and Mississippi. The staff provides brain injury data for quick links to the most appropriate local community services. Callers from other states get connected to BIAA's national office for information, help, and resources.

BIAA also provides brain injury awareness materials with: Behavioral Challenges after Brain Injury booklet; Challenges, Changes, and Choices: A Brain Injury Guide for Families and Caregivers booklet; Driving After Brain Injury: Issues, Obstacles and Possibilities booklet; Falls: The Leading Cause of Brain Injury booklet; A Physician Talks about Severe Brain Injury; The Basics booklet; a poster reflecting the diversity of TBI across the U.S.; four fact sheets outlining personal stories of TBI; CDC’s Facts about Traumatic Brain Injury fact sheet; a directory of BIAA’s Chartered State Affiliates, and Frequently Asked Questions about the Defense and Veterans Brain Injury Program.

Finally, the Brain Injury Recovery Network recommends that family members and/or caregivers take time for themselves. Set up a support system that will gradually build confidence so you feel comfortable letting someone else provide you with respite care. If you have someone offering to help, let them learn how to care for your loved one while you’re there; then, let them do it on their own a few times, but with you still around. Let the TBI patient rest before therapy sessions so they do well in the session. “Try to get some rest, accept all of the help offered, and make sure you relieve the stress. You have to be ready for the long haul because recovering from a brain injury is like a marathon, not a sprint.”

In his wheelchair in Jacksonville, FL, Herb Drill heads Able Me & Associates. His e-mail address is herbdrill@ableme.com. He has Muscular Dystrophy.