Traumatic brain injury is an insult to the brain, not of a
degenerative or congenital nature but caused by an external
physical force, that may produce a diminished or altered state
of consciousness, which results in an impairment of cognitive
abilities or physical functioning. It can also result in the
disturbance of behavioral or emotional functioning. These
impairments may be either temporary or permanent and cause
partial or total functional disability or psychosocial
•A traumatic brain injury occurs when an outside force impacts the head hard
enough to cause the brain to move within the skull or if the force causes the
skull to break and directly hurts the brain.
•A direct blow to the head can be great enough to injure the brain inside the
skull. A direct force to the head can also break the skull and directly hurt the
brain. This type of injury can occur from motor vehicle crashes, firearms,
falls, sports, and physical violence, such as hitting or striking with an object.
•A rapid acceleration and deceleration of the head can force the brain to move
back and forth across the inside of the skull. The stress from the rapid
movements pulls apart nerve fibers and causes damage to brain tissue. This
type of injury often occurs as a result of motor vehicle crashes and physical
violence, such as Shaken Baby Syndrome.
An acquired brain injury commonly results in a change in
neuronal activity, which effects the physical integrity, the
metabolic activity, or the functional ability of the cell. An acquired
brain injury may result in mild, moderate, or severe impairments
in one or more areas, including cognition, speech-language
communication; memory; attention and concentration; reasoning;
abstract thinking; physical functions; psychosocial behavior; and
Acquired brain injury takes place at the cellular level within the brain. Therefore,
injury from acquired brain injury can effect cells throughout the entire brain,
instead of just in specific areas as with traumatic brain injury.
An acquired brain injury is an injury to the brain, which is not hereditary,
congenital, degenerative, or induced by birth trauma. An acquired brain injury is
an injury to the brain that has occurred after birth.
Causes of acquired brain injury can include, but are not limited to:
Near-drowning, throat swelling, choking
Electrical shock or lightening strike
Trauma to the head and/or neck
Heart attack, stroke
Infectious disease, intracranial tumors
Meningitis, certain venereal diseases, AIDS, insect-carried diseases,
52,000 die, 275,000 are hospitalized, and 1.365 million, nearly 80%, are
treated and released from an emergency department.
• TBI is a contributing factor to a third (30.5%) of all injury-related deaths
in the United States.
• About 75% of TBIs that occur each year are concussions or other forms of
mild traumatic brain injury (MTBI).
• Direct medical costs and indirect costs of TBI, such as lost productivity,
totaled an estimated $60 billion in the United States in 2000.
Children aged 0 to 4 years, older adolescents aged 15
to 19 years, and adults aged 65 years and older are
most likely to sustain a TBI.
Almost half a million (473,947) emergency
department visits for TBI are made annually by
children aged 0 to 14 years.
Adults aged 75 years and older have the highest rates
of TBI-related hospitalization and death.
Blasts are a leading cause of TBI for active duty military personnel in
Males are about 1.5 times as likely as females to sustain a TBI.
The two age groups at highest risk for TBI are 0 to 4 year olds and 15
to 19 year olds.
Certain military duties increase the risk of sustaining a TBI.
African Americans have the highest death rate from TBI.
The Centers for Disease Control and Prevention estimates that at least 3.17
Million Americans currently have a long-term or lifelong need for help to
perform activities of daily living as a result of a TBI.
According to one study, about 40% of those hospitalized with a TBI had at
least one unmet need for services one year after their injury. The most
frequent unmet needs were:
Improving memory and problem solving; Managing stress and emotional
upsets; Controlling one's temper; and Improving one's job skills.
TBI can cause a wide range of functional changes affecting thinking,
language, learning, emotions, behavior, and/or sensation. It can also cause
epilepsy and increase the risk for conditions such as Alzheimer's disease,
Parkinson's disease, and other brain disorders that become more prevalent
TBI Act of 1996 (Federal TBI Program) The TBI Act of 1996 launched an effort
to conduct expanded studies and to establish innovative programs for TBI. The
Act gave the Health Resources and Services Administration (HRSA) authority to
establish a grant program for States to assist it in addressing the needs of
individuals with TBI and their families. The TBI Act also delegated
responsibilities in research to the National Institutes of Health, and prevention and
surveillance to the Centers for Disease Control and (Traumatic Brain Injury
The Traumatic Brain Injury Act of 2008 (P.L. 110-206) reauthorized the programs
of the TBI Act of 1996 (Traumatic Brain Injury Program, 2009).
The 2000 Amendments (PL 106-310 – Title XIII of the Children’s Health Act)
recognized the importance of protection and advocacy (P&A) services for
individuals with TBI and their families by authorizing HRSA to make grants to
Federally mandated State P&A Systems (Traumatic Brain Injury Program, 2009).
Subtitle D – Wounded Warrior Matters-Report on rehabilitation
treatment strategies for service members with traumatic brain
injury. The bill includes a provision that would require the
Secretary of Defense to submit to Congress a report setting forth
the evidence to be required from a long-term integrated study on
treatment strategies for cognitive rehabilitation for service
members who have sustained traumatic brain injuries to
determine how receipt of such rehabilitative therapies could be
reimbursed as a health care benefit (Senate Armed Services
Committee summary, 2010).
This Act prohibited private employers, state and local governments,
employment agencies and labor unions from discriminating against qualified
individuals with disabilities in job application procedures, hiring, firing,
advancement, compensation, job training, and other terms, conditions, and
privileges of employment. The ADA covers employers with 15 or more
employees, including state and local governments. It also applies to employment
agencies and to labor organizations. The ADA’s nondiscrimination standards
also apply to federal sector employees under section 501 of the Rehabilitation
Act, as amended, and its implementing rules (Facts About the Americans with
Disabilities Act, 2008).
Medical Examinations and Inquiries
Employers may not ask job applicants about the existence, nature, or
severity of a disability. Applicants may be asked about their ability
to perform specific job functions. A job offer may be conditioned on
the results of a medical examination, but only if the examination is
required for all entering employees in similar jobs. Medical
examinations of employees must be job related and consistent with
the employer’s business needs (Facts About the Americans with
Disabilities Act, 2008).
The National Athletic Trainers Association (NATA), a not-for-profit
organization representing 33,000 members of the athletic training profession,
endorsed the Protecting Student Athletes from Concussion Act of 2010,
which was introduced today by the U.S. House Education and Labor Committee.
The Protecting Student Athletes from Concussion Act of 2010 would require school
districts to implement management plans to ensure students are informed about
concussions and given the support they need to recover. The legislation is specifically
designed to increase awareness of concussion signs, symptoms and risks and improve
concussion safety and management for student athletes. NATA looks forward to working
with Congress for the swift passage and implementation of this legislation
(Special Report: NATA Champions Proposed Concussion Act of 2010, 2010).
IDEA is a law ensuring services to children with disabilities
throughout the nation. IDEA governs how states and public
agencies provide early intervention, special education and related
services to more than 6.5 million eligible infants, toddlers,
children and youth with disabilities.
Infants and toddlers with disabilities (birth-2) and their families
receive early intervention services under IDEA Part C. Children
and youth (ages 3-21) receive special education and related
services under IDEA Part B (Building the Legacy: IDEA 2004,
Brain Injury Association (BIA)- organization specifically for individuals
with a brain injury or a neurological dysfunction. BIA offers basic
information, such as legal advice, support groups pertaining to brain injury
along with testimonials that individuals share in video format. BIA also is a
national organization. (www.biausa.org)
Traumatic Head and Spinal Cord Injury Trust Fund (TH/SCI)- This trust is
for those who suffer from a brain or spinal cord injury. This program is
funded from vehicle violations, DUIs, reckless operation, and speeding.
Office for Citizens with Developmental Disabilities (OCDD) is a branch of
the Department of Health and Human Services (DHH) to determine if
eligibility requirements for individuals with developmental disability.
According OCDD, an individual with a brain injury is considered to have a
developmental disability which entitles those individuals to services.
National Data and Statistical Center for Traumatic Brain Injury- this
organization has information pertaining to TBI along with model systems
of care and conducts research for evidenced-based TBI rehabilitation
United States Department of Health and Human Services- this
organization offers preventative ways to avoid brain injury and how brain
injury affects decision making skills and helpful facts concerning Brain
National Institute of Neurological Disorders and Stroke- offers
treatments, medical advice, newsletters, and programs that offer
research literature. (www.ninds.nih.gov/disorders/tbi/tbi.htm)
The Brain Injury Recovery Network- is a unique website that
offers support to not only BI survivors but loved ones as well.
The website offers legal advice, stories, equipment, and Brain
Training games. (www.tbirecovery.org)
Since 1989, BIS has helped individuals in Northern Virginia
and outlying suburbs.
State and local governments, grants and donations provide
funds for case management. There are a limited number of
slots for services and admissions are based on a priority of
need and least resources.
The Case Manager identifies and coordinates assessments and
treatment as well as offers support with IEP meetings and school re-
Assists the families to utilize these systems, advocate and receive the
services they need and desire.
Provides education to other service providers and they offer ongoing
education for teachers and others in the school system.
The Clubhouses are places for people with Brain Injuries. The
primary purpose of these programs is to assist individuals with
brain injuries to lead productive lives.
Members come together in a positive and supportive environment
The focus is person centered and based on strengths, thus fostering
increased self-esteem, vocational skills, and confidence.
Developed initially out of funding provided by the State Legislature through
a Budget Amendment and The Philip Graham Fund.
It was established to develop a unique model that focuses on individualized
services that contribute to the success of our consumers in finding
meaningful productive activities in the communities of their choice.
The goal is to place all interested consumers in fulfilling volunteer jobs in
order to maintain a productive focus and to give back to their communities.
Often this is a stepping-stone to returning to work.
Fran and Greg Rooker established Brain Injury Services of SWVA, a
501(c) (3) non-profit organization.
This program provides community-based case management (at no cost)to
adult survivors and their families who reside in the Brain Injury Services of
SWVA service area.
Program also includes advocating for and creating community resources
needed to assist survivors in maximizing recovery, optimizing employment or
service potential, and reintegrating into their families and communities.
Additional services either at no cost or on a sliding scale, include independent
living skills training, respite care, specialized clubhouse programs and social
Helping approximately 500 individuals in the region manage the challenges
of living with a brain injury.
This program provides opportunities for survivors of brain injury to connect with
new people and socialize in the community.
This program offers volunteers the opportunity to work with a consumer one on
one to accomplish a goal as decided by the consumer.
Case Managers help consumers identify goals that work within a six month time
Volunteers meet with consumers every week or every other week taking small
steps toward the six month goal.
Goals include learning healthy cooking, taking long walks, learning how to
The program provides intensive, one-to-one training on issues related
to activities of daily living, increased independence, and community
Areas which are frequently the focus of Community Support Service
Training include: Communication and Social Skills, Compensatory
Strategies, Financial Management, Household Management,
Organization and Scheduling, Personal / Self Care, Use of Technology
as an Assistive Device
The Opportunity Project is a “clubhouse model,” a place where people with
brain injuries can get counseling, job training, and socialize with other
people with similar injuries. Members help run the organization and have
membership for life.
The Clubhouse Program is a supportive network of members who
participate in a work-oriented environment where they develop and engage
in practical, functional community work and living skills. The program is
designed to address the vocational, cognitive, behavioral, social and
emotional difficulties which individuals affected by brain injury frequently
experience as they try to resume their lives.
Members and staff work together to plan and carry out the wide variety of
jobs, tasks, and functions needed each day to operate the Clubhouse.
The Communication Unit produces all correspondence, determines
the editorial content of the member newsletter, creates the monthly
calendar, special event invitations and flyers. Members manage our
phone system, faxing, copying as well as monitor our email and
update our website.
The Resource Unit offers fundamental skill development in reading,
writing and cognitive training are offered as well as, community
education and brain injury awareness.
The Vocational Unit Provides Work Evaluation, Work Adjustment
Training and Supported Employment programs. Opportunity
Project is affiliated with local county offices of The Division of
Vocational Rehabilitation (DVR) and provides a 25 day on site and
community evaluation and 90 day work adjustment training to
individuals referred by the DVR as well as to any interested
Individual, Group Counseling and Peer Support Groups
There are also educational groups focused on nutrition, substance abuse,
hygiene and other relevant topics. Special adjustment sessions focus on
many issues, in particular the issue of “acceptance vs. denial” of the life
changes that occur after brain injury.
The speakers have been taught to combine firsthand experience of living
with a brain injury and general knowledge of statistical information to
create and deliver highly inspiring, motivational and informative
In 1984, a small group of families and providers came together to
advocate for services for persons with brain injury and their families.
Case managers provides case management services for individuals who
are on a Traumatic Brain Injury (TBI) or Community Alternative for
Disabled Individuals (CADI) Waiver and have a brain injury diagnosis.
The Waiver funds can be used to pay for services and supports such as
independent living skills, homemaking, personal care services,
supported employment, transportation, behavioral services, or day
A free, statewide telephone service available that provides
persons affected by brain injury with support in transitioning back
to their family life, work, school and the community. How does it
The best way is that upon discharge from the hospital, individuals
are given information about the free service and the option to sign
an authorization form.
Resource Facilitation is funded through a contract with the
Minnesota Department of Health, making it possible for every
hospital in the state to offer this as a free service to their patients
affected by brain injury
OCDD - The Office for Citizens with Developmental Disabilities
Julia Kenny, Assistant Secretary
DHH- Department of Health and Hospitals
Bruce Greenstein, Secretary
BIALA- The Brain Injury Alliance of Louisiana
LaVondra Dobbs, Executive Director & Janet Clark, Chairman
DDC- The Louisiana Developmental Disabilities Council
Sandee Winchell, Executive Director
FHF – Families Helping Families
Jamie S. Tindle, Executive Director
GODA – The Governor’s Office for Disability Affairs
Governor's Advisory Council on Disability Affairs (GACDA)
LaCAN- Louisiana Citizens for Action Now
Rodney B. Hastings, Region 2 Team Leader
LRS – Louisiana Rehabilitation Services
Roseland Starks, Director
Louisiana Assistive Technology Assistance Network
Julie Nesbit, ATP, President & CEO
Capacity development and social advocacy can bring about
change within the Brain Injury population by building on the
strengths of the Brain Injury support groups and programs that
Capacity development within the Brain Injury community would
first need to promote awareness of the problem within the
community. One example may be to show statistics of how many
people have suffered a brain injury within the community and
what the chance of a person suffering a brain injury in their
Gaining more members within your organization or group,
especially those who have a Brain Injury and caregivers/loved
ones who have a strong desire to be involved, is important so that
the community will know the needs that are not being met.
These are the very people who will decide where the support
group, program, or organization will be directed.
It is also important to include people of all ethnic backgrounds to
reach others who may need to be involved in the program. A Brain
Injury can happen to anyone no matter what religion, race, age, or
sex a person is.
It is important that the group/ program has self-determination and
be able to direct itself where it wants to go. Having too many
political people involved may not be helpful to the program
because the politics can direct a program in a direction where the
participants needs may not be addressed.
Rothman, J., Erlich, J.L., & Tropman, John E. 2008. “Capacity
Development and the Building of Community”. Strategies of