You don't have to hit your head to injure your brain. A hard enough jolt, such as a car crash, a fall, or other sudden impact, can cause the brain to move within the skull without leaving a visible mark. More than half of people who experience a traumatic brain injury (TBI) never realize it happened. People often do not receive care for injuries they do not recognize, but even a mild brain injury can alter the course of a person’s life.
That's the problem a landmark new set of clinical guidelines is trying to address.
Dr. Monica Verduzco-Gutierrez, a brain injury medicine specialist and chair of the Department of Physical Medicine and Rehabilitation at UT Health San Antonio, was part of a National Academies of Sciences, Engineering, and Medicine working group that published the most comprehensive TBI guidelines update in more than a decade. The recommendations are not primarily aimed at trauma surgeons or neurologists treating severe cases.
They are designed for primary care physicians and frontline providers most likely to see patients who too often go undiagnosed and untreated.
The consequences of a missed TBI can be subtle at first but significant over time. A childhood concussion, years of contact sports, or a car accident can set off changes in the brain that may not surface for years or even decades. Those changes can include physical challenges such as weakness, coordination and balance problems, as well as cognitive changes such as memory loss, difficulty concentrating, slowed processing, and executive dysfunction. Some people may also experience changes in mood, behavior, or personality, and there may be an increased risk of conditions such as hypertension or stroke.
Many people, and their doctors, never connect the dots.
The new guidelines give primary care providers a clearer roadmap: confirm the diagnosis, screen for mental health conditions, guide patients on returning to activity, and include screening for social determinants of health such as housing stability, access to transportation, and financial resources that can affect recovery.
"If we don't identify and address these barriers, even the best medical plan can fall short," she said.
Host Bonnie Petrie reflected on her brother’s experience after a traumatic brain injury in childhood, including ongoing health and behavioral challenges later in life, as well as a seizure disorder he developed as an adult, and ultimately a fatal brain bleed.
Traumatic brain injury, Verduzco-Gutierrez stressed, is not just a single event. It often has long-term effects that may require ongoing care. These guidelines are a step toward identifying more cases earlier so patients can access the care and support they need and improve quality of life, she said.
Living with the effects of a TBI can make it harder to navigate daily life, especially in environments that are not designed with those needs in mind. Organizations that can help include the Brain Injury Association of America, which has national and state chapters. The Centers for Disease Control and Prevention maintains a list of support organizations and resources. In South Texas, survivors and their support systems can start with the Alamo Head Injury Association.
