The Silent Epidemic of Acquired Brain Injury

While Acquired Brain Injury poses a major and increasing public health challenge, as a phenomenon it defies easy categorisation, writes Richard Stables, Information and Support Manager, Headway.

Acquired Brain Injury has a wide range of causes, it results in a huge number of potential consequences for the individual and family and many of its effects may be totally invisible to the outside observer. No wonder then, that it has been dubbed the "silent epidemic".

Headway (www.headway.ie), is one of several organisations in the community and voluntary sector who work together and in partnership with the HSE on behalf of people who have been affected by Acquired Brain Injury. We help to rebuild lives following injury by providing rehabilitation services and support to injured people and their families once they return to their own community following treatment or inpatient rehabilitation.

The World Health Organization defines Acquired Brain Injury as "an injury to the brain which is not hereditary, congenital or degenerative". So rather than a single clinical condition, Acquired Brain Injury is more a collection of conditions with a common presentation resulting from a number of different causes. These are typically: Trauma, of which road accidents and falls would be the largest source; Vascular Disorders including Stroke or Haemorrhage; Anoxic and Hypoxic Injury and Infection.

Worldwide, the statistics about brain injury are bald. According to the WHO, Traumatic brain injury is the leading cause of death and disability in children and young adults around the world and is involved in nearly half of all trauma deaths. In Europe, brain injuries from trauma are responsible for more years of disability than any other cause. If we are to assume that the average European incidence of head injuries applies to the Irish population, we expect to see 10,000 new head injuries each year, a figure which is consistent with data produced by the Hospital Inpatient Enquiry system, HIPE. Stroke is the third most common cause of death and the most common cause of acquired physical disability in Ireland. The stroke.ie website created by the Irish Heart Foundation tells us that 10,000 people in Ireland are admitted to hospital with Stroke each year and that Stroke kills more than 2,000 people a year in Ireland - a higher death toll than from breast cancer, lung cancer and bowel cancer combined. So when we combine the statistics for traumatic injuries and vascular disorders, we can see that in Ireland, Acquired Brain Injury represents a major health burden, with an annual incidence of over 20,000 injuries and an estimated prevalence of disability in the region of 30,000 adults, or 0.7% of the population.

So what are the consequences for a person who acquires a brain injury through any of the various causes? Our service users seek assistance with a range of activities from aspects of daily living through social participation to reintegration into the job market via training and vocational support. Inevitably, when an organ as complex as the brain becomes injured the potential range of consequence is huge and can vary enormously from individual to individual depending on the type and severity of injury, the location of any damage and the course of recovery following treatment and rehabilitation.

For many people, following injury there are obvious physical consequences, such as paralysis, weakness, fatigue, headache or problems with coordination. Many may have difficulty communicating, whether expressively or receptively, or both. For many more, it is the less outwardly visible consequences which nevertheless produce the more severe restrictions to participating in everyday life. Brain injury can affect your ability to maintain attention, to remember, to think, plan and problem solve and can hamper your insight and your ability to manage emotions. Everyday situations can be rendered almost impossible for some people with brain injury through damage to cognitive and emotional skills that the rest of us take for granted.

The psychological impacts of ABI are hard to overstate. As one of our service users put it - "It's having to start again, your emotions, character, your whole makeup has to grow up again. For me, it was like somebody took your memory bank, your filing cabinets, and threw them up in the air, into the wind. And somewhere, and five years on, I'm still catching things out of the clouds and trying to put them together."

And if one person is injured in a family, the whole family experiences the turmoil and upheaval caused by such a sudden and unlooked for event. A significant proportion of the services provided by our team of psychologists, including neuropsychologists and counselling psychologists is aimed at providing support to families, through support groups, psychotherapy, counselling and information.

Despite the obvious challenges dealing with such complex disabilities, our approach is positive and aims to develop potential as far as possible. Taking each person's skills and abilities into account our approach is to develop individual plans informed by assessment and latest research. Rehabilitation programmes then take place in Headway centres around the country and in the person's own local community.

Following his injury, Alan, one of our Community Integration service users in Cork, wasn't able to socialise or participate in any activity outside the home. Now, with the help of the service he works one day a week as a litter warden and attends his local gym. As he reports, "I can see the difference in myself now. My confidence has grown tremendously".

Adjusting to life following a brain injury is a journey that does not end. But people do progress. Gilly is an artist. Seven years after being injured in a horrific car accident, she no longer thinks of herself as having a brain injury, just as a survivor. The years of painstaking rehabilitation and personal struggle to rebuild a life after the shattering event have taught her the value of persistence. "You have to live life, day by day, just working things through....You're dealing with Now, so you just do it...". Maintaining a positive attitude has clearly been of benefit to her in finding solutions to overcome barriers. As she says, "Our brains are so complex, so clever, that an injury affects us all in completely different ways, but the good thing about it is that our brains seem to be pretty good at finding ways around just about any experience."

Fortunately, there are organisations to provide a helping hand along the road. The Headway Information and Support service provides a listening ear and a vital source of information and signposts to other services for people at every stage of the journey following injury. The service is available throughout the country for the price of a local phone call on 1890 200 278 and is accessible also through the Headway website at www.headway.ie

Pictured: Headway Cork participated in a community boat building activity with Meitheal Mara

This article appeared in Health Matters, the Staff Magazine for the HSE in Summer 2010