TBI crisis: As evidence mounts of effects of brain injuries on children, financing lags and Congress considers a bill

Traumatic brain injuries last decades, and financing lags as congress considers a bill

Published: Sunday, Feb. 26 2012 3:00 p.m. MST

Many of those who are injured don't even know it. That's the "most critical aspect about concussions in sports," Dr. Ricardo Komotar, a noted brain specialist at the University of Miami Hospital, told the Deseret News. "It's important to understand that only 15 to 20 percent of all concussions involve loss of consciousness. The other 80 percent are largely unrecognized."

That has long-term consequences, he says, including cumulative brain damage. "You can present with early Alzheimer's, Parkinson's, dementia. We're seeing it more and more, the hits in sports more violent."

Brain injuries are unpredictable. Just ask Jay Francis.

The executive vice president of the Larry H. Miller Group in Salt Lake City remembers putting his ladder across the top of the mobile home so he could wash it. He doesn't remember the fall. The skull fractures and massive concussion are documented facts. The ride to a hospital near his South Jordan home, then to a trauma center in Salt Lake City are vague flashes.

But after a brief stay at the trauma center 13 years ago, he used all of his marketing skills to convince his care team, "I feel great, wonderful. I want to go home."

He got so sick he had to be readmitted and stayed four days. He's been sternly warned to be careful, that another blow to the head could be very dangerous. Other than that, he thinks the only long-term damage he suffered was hearing loss and ringing in his right ear. "I've been fortunate," says Francis, now 58.

Danger at play

Others, especially long-time athletes and children who were severely injured like Sarah Jane Donohue, don't do as well. Only time heals a brain injury — and only time tells whether there are permanent effects.

That's a concern getting lots of attention because traumatic brain injury is an all-star on the sports scene. Recent news stories include Pittsburgh Penguins star Sidney Crosby, 24, sidelined by lingering symptoms after he was concussed more than a year ago. Or Brian Rolston of the New York Islanders, who didn't know he was hurt until he couldn't answer a basic question. USA Today reports 71 hockey players have missed ice time because of concussions this season. Chicago Bear Brian Urlacher was hurt in the NFL, where head injuries are also common.

Even scarier is what the future may hold, experts agree. Boxer Leon Spinks is only 58 and has dementia. His noted opponent, Muhammad Ali, has Parkinson's disease, and most believe the many blows he took to the head while boxing contributed.

Health experts say 10 percent of all sports-related injuries lead to concussions — a number approaching 4 million. As Komotar notes, that's an undercount.

For those with pediatric brain injuries, one of the biggest challenges is getting appropriate assistance in the school system, says Donohue. His daughter has one of the most documented brain injuries in the world, but she was still listed on school rolls as multiple disabilities, instead of TBI, he notes. "If they can't get Sarah Jane's right, that tells me what's going on around the country," he says.

The other category of care really lacking, he notes, is the transition for brain-injured children into adulthood. The brain doesn't finish developing until about 25. So the last category includes "more than half your veterans coming back with TBI from Iraq, around age 19." For older patients, brain injuries are more likely to be stroke-related.

No big deal

There's a tendency to disregard injuries classified as mild TBI, Donohue says. "Imagine someone saying you have mild cancer." But here's the problem with calling 80 percent of brain injuries "mild TBI," he says. Johnny, 8, falls out of a tree and has a brain injury. He seems OK. Six or seven years later, he's relying on executive brain functions that he didn't have to when he was 8. And it's not working for him.

Many experts believe that 90 percent of children in juvenile detention have brain injuries. "His behavior started changing after he fell out of a tree. It's literally a public health crisis," says Donohue, who can cite case after case: A battered woman. A young man who is hit with a swing and develops behavior problems. That one took 15 years "with the world beating him up" before a scan showed the injury. By then, he was done. He killed himself, Donohue says.

The measure before Congress also looks at rural and frontier help, to extend knowledge and treatment options to areas where lots of brain injuries occur and fewer medical options exist.

EMAIL: Lois@desnews.com Twitter: Loisco

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