Rusk Institute for Rehabilitation New York
Rusk Institute for Rehabilitation New York
The authors declare no conflicts of interest.
FROM JUNE 13 to 15, 2011, more than 750 individuals involved in traumatic brain injury (TBI) research and service delivery met in Washington, DC, for the Third Federal Interagency Conference on TBI. Five years had elapsed since the second conference was held in 2006 and a number of significant changes have occurred in the field since then. As with the 2 previous conferences, the major sponsoring agency of the conference was the National Institute on Disability and Rehabilitation Research, US Department of Education; newly included in the current partnership were the American Congress of Rehabilitation Medicine, Brain Trauma Foundation, International Brain Injury Association, and the Ontario Neurotrauma Foundation. A complete list of sponsoring agencies is found on the conference Web site (http://tbi-interagency-conference.org/agencies.htm).
Having attended all 3 of these conferences (1999, 2006, and 2011), it is clear that both the quality of research and sophistication of both research and service delivery has increased since 1999. This is in part a function of increased communication and collaboration between all agencies and rehabilitation professionals concerned with TBI. There is a clear recognition that a single agency or group of researchers and/or clinicians cannot bring adequate financial and intellectual resources together to address the complexity of TBI. In 2006, the primary agencies that supported and attended the conference were from the civilian arena; the one exception was VA Rehabilitation Research and Development (VA RR&D). In 2011, in addition to strong representation from VA RR&D, the Department of Defense and VA clinical programs participated in the conference as both presenters and attendees. This was a valuable addition to the conference and represents an increasing interest on the part of the military to collaborate with the civilian sector. Until very recently, there was little outreach or communication between civilian and the military TBI communities (research or service delivery). The 2011 conference was an opportunity for both the civilian and military sectors to recognize that, although the etiology of the mild TBI may differ (a combination of blast injury and blunt trauma in military and blunt trauma in civilian), the challenges facing the individual with TBI and the service delivery systems are quite similar. Identification, classification, and treatment of mTBI is a universal issue. Thus, research on advanced neuroimaging techniques, biomarkers, the cognitive and emotional sequelae that result from all severities of TBI span the civilian and military boundaries and therefore were of interest to all. Designing and providing services, establishing a continuum of care, and delivering interventions are all common issues, and we can learn from each other.
It was also heartening to observe the number of young researchers and clinicians who attended the conference. Early career individuals were given the opportunity to network with persons further advanced in their career. They were also given the opportunity to present their research or clinical activities through short platform presentations or posters. Attempts were made to mix early career and senior presenters in oral sessions to further facilitate interaction. The 3 best early career posters were recognized at the “Mitchell Rosenthal” reception; Ruth Brannon, Director of Research at the National Institute on Disability and Rehabilitation Research and a close friend and peer of Dr. Rosenthal, presented the certificates of recognition. The intellectual power represented by these early career researchers and clinicians speaks well for the future care of individuals with TBI.
The biggest threat to continued improvement of services and care for individuals with TBI, funding, was also a major topic at the conference. Although there are exciting advances in research and service delivery for individuals with TBI, the lack of adequate funding to maintain and continue to build upon the advances to date is a concern to all and is a potential disservice to individuals with TBI. In the current economic climate, the TBI field is struggling to advocate for keeping level funding. The threat of funding cuts is frightening to us all.
Emerging new areas in TBI will further strain resources. For example, the large numbers of individuals who have experienced a TBI in their 20s or 30s will live with the chronic condition of TBI for many decades. We do not know how TBI interacts with the “normal” aging process. Is there a synergistic interaction between aging and TBI such that age-related decline accelerates? In some this may manifest as an Alzheimer-like dementia in others it may manifest as a condition that at present can only be diagnosed upon death, chronic traumatic encephalopathy.
Families are also potentially impacted by common secondary conditions, such as substance abuse or emotional dysregulation that often emerges as domestic abuse. This is a problem that is being unfortunately highlighted by the military experience and is facilitating increasing research and development of services to assist these families. The civilian sector can potentially benefit from the initiatives that are being developed in the military. There is, however, an additional facet that has not been completely explicated: the wives and children who might experience a TBI as a result of domestic abuse by a husband/father who has incurred a TBI in military action. This is a potentially huge problem that will need to be identified and interventions designed to prevent these injuries.
A final area in which the military is providing an additional focus area is gender differences in recovery after TBI. Although males are 1.5 times more likely than females to sustain a TBI in military action, females are being injured in larger percentages than in the civilian sector. The differences between the genders, severity of TBI, and moving through life stages is an area that is developing and the civilian sector can learn from the military.
All of these aforementioned areas will require resources—time, personnel, and funding—over and above current levels. TBI will not go away and the numbers of individuals living with TBI will continue to increase. It is a great disservice to these individuals and their families to hamstring research and service delivery opportunities by a lack of funding. It falls to the multiple federal agencies that provide money to support these TBI initiatives and find ways to increase that support.
As evidenced by the tremendous energy and enthusiasm that pervaded the 2011 conference, the potential for a bright future–-where individuals with TBI are better served, effective interventions increase the potential for recovery, and TBI truly becomes a chronic condition for which compensations exist—is within our grasp. Now, all that is needed is the resources to build toward that future.
—Tamara Bushnik, PhD
Rusk Institute for Rehabilitation
—Wayne Gordon, PhD, ABPP/Cn
Mount Sinai School of Medicine