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Traumatic Brain Injury: A Roadmap for Accelerating Progress (2022)

Chapter: 4 Traumatic Brain Injury Prevention and Awareness

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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
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4

Traumatic Brain Injury Prevention and Awareness

This chapter focuses on the importance of preventing traumatic brain injury (TBI) from occurring through analysis of risk factors and the development and implementation of prevention strategies. It also addresses misconceptions about TBI among those who experience it and their families, health professionals, members of the public, and other groups and the need for greater awareness and education to support effective prevention and treatment.

THE ROLE OF PREVENTION

The statement of task for this study (Box 1-3 in Chapter 1) did not explicitly include producing a review of or recommendations for the prevention of TBI. Nonetheless, prevention is an integral part of the landscape of TBI, and any systematic approach to improving TBI care and research needs to address the full continuum from prevention through longer-term care needs and recovery.

The importance and leverage of prevention are great enough that omitting it from consideration entirely would be inappropriate. Effective prevention of injury would dwarf the effectiveness of even an optimal system of acute and long-term TBI care for two simple and

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

obvious reasons. First, an uninjured brain is at least as good as an injured and repaired one, often better. Second, despite decades of important progress in understanding the mechanics, biology, and neurology of TBI, dramatically effective treatments to “cure” TBI remain undiscovered. Instead, available treatments focus on addressing symptoms after injury and on implementing rehabilitation interventions to slow, stop, or help reverse impairments. Patients deserve the best science can offer, but even the best-known TBI treatments to date are not completely restorative; rather, they are supportive and rehabilitative, and buy time for natural healing processes to play out. In short, prevention “works” far better than treatment given the current level of knowledge.

Both theory (such as the Haddon Matrix, described below) and evidence exist regarding the effectiveness of many prevention strategies, such as use of protective equipment, prevention of falls, improved engineering and infrastructure designs, and incentive-oriented policies. Given effective prevention tactics, it is almost certainly less costly at a population level and from a societal perspective to reduce the risk of injury than to treat injury and pay for its downstream consequences.

The types of effort needed to improve treatment and to improve prevention overlap. For example, reducing public and professional misunderstanding of the burden and profile of TBI can increase both proper detection of these injuries and interest in their prevention. Thus, a key to prevention of TBI is to increase public and professional understanding of its nature and consequences and the fact that it can and does occur, and actions can be taken to help avoid it. Such understanding can in turn build will for making the necessary investments in risk mitigation. Moreover, that same understanding can aid in proper identification and management of TBI after it occurs and help avoid costly misclassification of and misperceptions about these injuries. On the high school sports field, for example, a community’s commitment to protecting players from injury through use of proper equipment, management of field conditions, and adherence to rules probably draws on the same base of awareness as the commitment to identifying injuries early, removing injured players from further hazard, and recognizing subtle behavioral and physical symptoms for what they may be—consequences of TBI.

In important ways, then, the committee’s statement of task calls attention to social, educational, and psychological factors that are as important for prevention of TBI as they are for its proper management. At a deep level, the bio-psycho-socio-ecological lens that this report urges for TBI care and research (see Chapter 3) applies equally to the prevention of TBI in the first place, warranting this chapter’s brief review of some of the current science and evidence around TBI prevention.

The Haddon Matrix as a Framework for Injury Prevention

The Haddon Matrix is a widely used model for systematically identifying the factors that contribute to an injury to inform prevention (Haddon, 1980). The three rows of the matrix show different phases—preevent, event, and postevent—while the columns reflect influencing factors related to the person who experiences the injury, the agent that causes the injury, and the physical and social/economic environments in which the injury occurs. Table 4-1 shows one representative example of how the Haddon Matrix has been applied, in this case to brain injuries sustained during baseball and softball. As the table illustrates, the Haddon Matrix is a tool for identifying how and where one could intervene to prevent injuries and mitigate their effects. The matrix supports targeting of precursors that can prevent an injury from occurring in the first place and can thus decrease the number of people who need postinjury care.

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

TABLE 4-1 Example of Application of the Haddon Matrix: Brain Injuries Sustained during Baseball and Softball

Phase Person Agent Physical Environment Social/Economic Environment
Preinjury
  • Velocity of pitch
  • Attitude of athlete (aggressive, competitive)
  • Athlete age and sex
  • Athlete strength
  • Hardness/density of ball and bat
  • Inadequate protective gear
  • Design and type of helmet
  • Maintenance of the field/grounds
  • Weather/time of year
  • Formal/informal setting
  • Public perception of wearing protective gear
  • Costs of protective gear
Injury
  • Unaware of the potential dangers of equipment (i.e., ball, bat)
  • Lack of supervision of younger athletes
  • Lack of education of children
  • Hardness of the ball/bat
  • Association of bat and ball exit velocity
  • Surface hardness
  • Obstacles on the field
  • Personal protective equipment
  • Enforcement of rules and laws
  • Enforcement of protective gear use
Postinjury
  • Knowledge to report symptoms
  • Compliance with return-to-play guidelines
  • Engineering—improved helmet, bat, and ball design
  • Access to a hospital or trauma center
  • Expense/cost of medical system
  • Evaluation of surveillance systems
  • Insurance rates, fines
  • Social support
  • Community response to TBI

Source: Adapted from Cusimano and Zhu, 2017.

Selected Prevention Strategies Relevant to TBI

As detailed in Chapter 2, falls are the leading cause of hospitalization for TBI in the United States (almost 50 percent of cases of people with TBI). In 2017, falls caused roughly three-quarters of TBI-related hospitalizations and were the leading cause of TBI-related deaths among adults aged 65 and older (CDC, 2021). Intentional self-harm was the most common mechanism of TBI-related death among all adults over age 17 in 2016 and 2017, accounting for roughly a third of cases. Other leading causes of TBI hospitalization and TBI-related death in those years included motor vehicle crashes and assaults (CDC, 2021), the latter including such circumstances as fights, child maltreatment, intimate partner violence, and elder abuse. The Centers for Disease Control and Prevention’s (CDC’s) 2016 and 2017 surveillance data do not include TBI-related emergency department (ED) visits. However, approximately 2.5 million such visits were reported in 2014. Being struck by or against an object or person, including sports-related injuries, accounted for approximately 17 percent of these visits and were the second leading cause among children aged 0–17, after unintentional falls (CDC, 2019).

Extensive research has focused on the development of prevention strategies targeting common causes of TBI and how to reduce the likelihood of these injuries by changing factors in the three categories of the Haddon Matrix (person, agent, and physical and social/economic environments). Selected examples of prevention strategies relevant to TBI are highlighted in Table 4-2.

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

TABLE 4-2 Examples of Prevention Strategies for Common Causes of TBI in At-Risk Populations

At-Risk Population Cause of TBI Prevention Strategies
Children, aged 0–14 years Falls
  • Supervise children playing on or near fall hazards.
  • Place guards, gates, and screens around windows and stairs.
Older adults, aged 65 and up Falls
  • Improve home safety to reduce trip hazards, such as by using antislip rugs, in-home lighting, and grab bars along staircases.
  • Discuss fall risk and prevention with a health care provider.
  • Participate in exercises that improve balance, strength, coordination, and gait (e.g., Tai Chi).
Teens and young adults Motor vehicle collisions
  • Wear a seat belt, no matter how short the ride.
  • Wear a helmet when riding motorcycles, scooters, and bicycles.
  • Never drive while impaired.
  • Obey traffic laws, and exercise caution when driving in bad weather.
  • Enact and enforce laws related to impaired and distracted driving and other traffic safety issues.
  • Continue to develop advances in automobile engineering, such as antilock brakes and airbags.
Sports and recreational activity injuries
  • Adhere to safe play, and model a safe sports culture.
  • Wear well-maintained and properly fitting protective equipment, particularly helmets, for the activity.
  • Avoid hits to the head to the extent possible.
  • Implement rule changes (such as those limiting body checking or ball heading).

SOURCES: Adapted from CDC and NHTSA resources (all accessed October 13, 2021):

Awareness-raising and information campaigns aimed at promoting these interventions include CDC’s “Stopping Elderly Accidents, Injuries, and Deaths” (STEADI) and “HEADS UP” efforts focused on youth sports injuries.1 The ThinkFirst National Injury Prevention Foundation has also been a leader in education and awareness to prevent traumatic injuries, operating programs for children, teens, young adults, and older adults on actions to reduce risk.2 And professional societies and sports associations have issued statements in support of prevention efforts and produced materials and toolkits.3

Maas and colleagues (2017) discuss a number of population-based and targeted prevention strategies that may reduce the occurrence of TBI. Strategies for preventing TBIs caused

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1 For information on STEADI, see https://www.cdc.gov/steadi/index.html (accessed September 9, 2021). For information on HEADS UP, see https://www.cdc.gov/headsup/index.html (accessed September 9, 2021).

2 See https://www.thinkfirst.org (accessed November 1, 2021).

3 As just two examples, see the 2019 “Statement on Older Adult Falls and Falls Prevention” by the American College of Surgeons Committee on Trauma (https://www.facs.org/about-acs/statements/119-older-falls [accessed September 9, 2021]) and Sports Concussion Resources, produced by the American Academy of Neurology, including materials created in collaboration with the NFL Players Association (https://www.aan.com/concussion [accessed September 9, 2021]).

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

by falls include improved in-home lighting, use of stair handrails, and assessments of balance and gait in older persons. Strategies for preventing TBIs caused by traffic accidents and collisions include protected bicycle lanes, helmets for cyclists, seat belt wearing for car passengers, and hands-free phone use to reduce distracted driving. In sports and recreation, the risk of TBI can be reduced when participants use appropriate protective gear, especially helmets, and safe competitive play is enforced. In addition, participants who experience a blow to the head should be evaluated for signs of a concussion before returning to play.

A variety of interventions aimed at reducing falls and related injuries have been found effective (Stevens, 2010), and such interventions have the potential to be cost-effective in reducing health care expenditures (Carande-Kulis et al., 2015; Stevens and Lee, 2018).4 Likewise, widespread use of and improvements in helmet design have been shown to reduce severe TBI and mortality. Bicycle helmets reduce the risk of severe TBI by nearly 70 percent (Olivier and Creighton, 2017), while use of helmets reduces the risk of TBI in motorcycle crashes by 69 percent (Liu et al., 2008). With respect to TBI-related deaths due to motor vehicle crashes, CDC (2013) reported an approximately 40 percent decrease, due in part to safety regulations and efforts around such issues as seat belt, helmet, and alcohol use and advances in auto engineering. For military service members, helmets can protect against penetrating head wounds from ballistic weapons. At the same time, it is important to recognize that helmet wearing may mitigate risk but not fully protect against the types of forces that can cause concussion, highlighting the continued importance of engineering advances to improve helmet efficacy in such situations as concussion and blast injuries (NASEM, 2014; Op’t Eynde et al., 2020; Sone et al., 2017).

AWARENESS AND MISUNDERSTANDING OF TBI

Failure to understand the nature of TBI can undermine efforts to prevent and treat it effectively. Misunderstanding, inaccurate information, and lack of awareness about TBI can have a host of deleterious effects on people with TBI during their treatment, rehabilitation, and reintegration into the community. People who experience these injuries may not receive support and accommodations that can support their recovery process, and many TBI survivors face stigmatization and discrimination from the general public, educators, providers of social and community services, and health professionals that can further hamper their recovery. Misunderstanding among survivors themselves and their families and caretakers can lead to feelings of frustration and inadequacy that can worsen treatment outcomes (Gurusamy et al., 2019). Misunderstanding can also undermine efforts to prevent the occurrence of TBI. For instance, a common misbelief is that seat belts cause as many brain injuries as they prevent (Springer et al., 1997).

A substantial body of evidence reveals that misunderstanding, inaccurate information, and lack of awareness about brain injury are common among patients and families, the public, educators, student athletes, health professionals without expertise in brain injury, and other groups. Qualitative interview-based studies, as well as survey-based studies, have assessed knowledge and attitudes about TBI across different groups, nearly all of which reported inaccurate views about various facets of TBI. The “Common Misconceptions about Traumatic Brain Injury” (CM-TBI) 40-item questionnaire developed by Springer and colleagues (1997) has been used across the United States and in other countries to survey respondents’ understanding of TBI. Some of the most commonly held false beliefs about TBI reported in the literature are listed in Box 4-1.

___________________

4 CDC is supporting analysis of the implementation and cost-effectiveness of its STEADI initiative. See https://www.norc.org/Research/Projects/Pages/evaluating-the-cost-effectiveness-of-steadi-older-adult-fall-prevention-in-primary-care-settings.aspx (accessed September 24, 2021).

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

Swift and Wilson (2001) interviewed TBI patients, caregivers, and health professionals and identified several major themes. For example, inaccurate beliefs about the recovery time for brain injuries and the possible extent of recovery were prevalent. Respondents showed a lack of awareness of the range of cognitive and behavioral sequelae associated with brain injuries. Furthermore, people living with brain injury reported encountering misunderstandings about their capabilities often associated with the visibility or invisibility of their injury, including their being misidentified as mentally ill or learning disabled. In another qualitative study, TBI patients reported perceiving a lack of knowledge about TBI among the health professionals they encountered during their care (Dams-O’Connor et al., 2018). For example, certain cognitive and behavioral sequelae of TBI—such as disinhibition and risk-taking behaviors—can contribute to a higher likelihood of substance misuse (Brown and Harr, 2019). Accordingly, TBI patients with a substance misuse disorder benefit from individualized treatment that takes into account the convergence of neurobehavioral factors underlying such symptoms as aggression, low motivation, and cognitive deficits, including difficulty with comprehension and problem solving. However, many professionals providing addiction treatment have gaps in their training that can impede their ability to address these challenges effectively.

Although the public appears to be increasingly aware of the consequences of brain injuries, a qualitative study found that members of the general public still tended to characterize survivors of brain injury using such negative descriptors as aggressive, dependent, and unhappy (Linden and Boylan, 2010). The apparent etiology of a person’s brain injury can also affect the public’s attitudes. One study found that stigmatization and negative attitudes were more common if the person’s behavior was perceived as contributing to the injury—for instance, when the injury was due to a fight rather than a car crash (Redpath and Linden, 2004). These public attitudes about TBI underlie some of the challenges faced by survivors

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

as they seek to reintegrate into their community. A seminal systematic review evaluated 20 studies investigating the public’s knowledge and attitudes about brain injury, finding that survivors tended to be vulnerable to discrimination and stigma (Ralph and Derbyshire, 2013). Misconceptions about survivors’ postinjury symptoms, recovery, memory issues, and vulnerability to subsequent brain injury were common. This study also echoed the finding that public attitudes were more negative toward survivors who were perceived as being responsible for their brain injuries. The authors highlight the need for government and media campaigns to educate the public about brain injury and encourage greater inclusiveness for survivors in society.

Certain racial, ethnic, cultural, and socioeconomic factors have been associated with a greater likelihood of holding mistaken beliefs about TBI, and thus need to be considered when developing educational interventions. For instance, a survey conducted in the United States found that being born outside the United States, being Spanish speaking, having lower educational status, and actively practicing religion were associated with reporting a greater number of TBI misconceptions on the CM-TBI (Pappadis et al., 2011). A single-session educational intervention designed to increase knowledge about TBI among Black and Latinx patients has shown promise in decreasing misconceptions about the recovery process, common symptoms, and strategies for dealing with symptoms (Pappadis et al., 2017).

Despite the prevalence of TBI among children aged <18 years—estimated to include 812,000 TBI-related ED visits, 23,075 hospitalizations, and 2,529 deaths in the United States in 2014 (CDC 2019)—studies conducted in the United States and abroad have found that educators lack knowledge about TBI and may endorse mistaken beliefs about the condition (Ettel et al., 2016; Farmer and Johnson-Gerard, 1997; Hux et al., 1996; Linden et al., 2013). A survey of K–12 educators’ knowledge about TBI found that they demonstrated a “reasonable” understanding of its symptoms and immediate effects (McKinlay and Buck, 2019). However, misunderstandings were common about the emotional, cognitive, and social sequelae, as well as the heightened risk of subsequent injuries. Another survey of educators found that those who had previously taught a child with brain injury had greater knowledge about the condition (Linden et al., 2013). The results of a survey of U.S. youth athletes and their parents indicated that they had a high level of awareness about concussion (Bloodgood et al., 2013), although another study among U.S. high school athletes found that fewer than half of their concussion events had been appropriately reported to a supervising adult (Register-Mihalik et al., 2013). Moreover, fewer than 18 percent of children who sustain a long-term injury due to TBI are referred for special education services, even though it has been considered a special education disability category since the 1990s in the United States (Ettel et al., 2016). Gaps in knowledge about TBI among educators—particularly general educators and speech-language pathologists—have likely contributed to the underidentification of students with TBI, leaving many of them with academic and behavioral needs that are unmet by the education system. These findings suggest that preservice training and professional development for educators about pediatric brain injuries could improve their ability to support the educational needs of students with TBI (McKinlay and Buck, 2019).

CONCLUSIONS

Prevention strategies to decrease the risks of TBI are integral to any system for advancing TBI care and research. Prevention efforts also can increase public and professional understanding of the nature and consequences of this condition. However, the studies cited in this chapter and elsewhere in this report provide evidence of a lack of awareness and

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

understanding about brain injury among many of the people encountered by a person with TBI along the recovery pathway, from acute care, to rehabilitation, to reintegration into the community, highlighting the need for further evidence-informed efforts to

  • increase public awareness about the symptoms and longer-term consequences of TBI through educational interventions and campaigns;
  • inform the design of accommodations to support survivors of TBI as they reintegrate into their community environments—schools, workplaces, and interactions in the health care system with providers who are lacking expertise in TBI; and
  • strengthen TBI prevention efforts by dispelling myths and misunderstandings about how TBI occurs and the consequences of a brain injury of any degree of severity.

REFERENCES

Bloodgood, B., D. Inokuchi, W. Shawver, K. Olson, R. Hoffman, E. Cohen, K. Sarmiento, and K. Muthuswamy. 2013. Exploration of awareness, knowledge, and perceptions of traumatic brain injury among American youth athletes and their parents. Journal of Adolescent Health 53(1):34-39.

Brown, J., and D. Harr. 2019. Perceptions of traumatic brain injury (TBI) among professionals providing drug and alcohol addiction treatment. Journal of Neurology & Neuromedicine 4(3).

Carande-Kulis V., J. A. Stevens, C. S. Florence, B. L. Beattie, and I. Arias. 2015. A cost-benefit analysis of three older adult fall prevention interventions. Journal of Safety Research 52:65-70.

CDC (Centers for Disease Control and Prevention). 2013. CDC grand rounds: Reducing severe traumatic brain injury in the United States. Morbidity and Mortality Weekly Report 62(27):549-552.

CDC. 2019. Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2014. Atlanta, GA: Department of Health and Human Services.

CDC. 2021. Surveillance report of traumatic brain injury-related hospitalizations and deaths by age group, sex, and mechanism of injury—United States, 2016 and 2017. Atlanta, GA: Department of Health and Human Services.

Cusimano, M. D., and A. Zhu. 2017. Systematic review of traumatic brain injuries in baseball and softball: A framework for prevention. Frontiers in Neurology 8:492.

Dams-O’Connor, K., A. Landau, J. Hoffman, and J. St De Lore. 2018. Patient perspectives on quality and access to healthcare after brain injury. Brain Injury 32(4):431-441.

Ettel, D., A. Glang, B. Todis, and S. Davies. 2016. Traumatic brain injury: Persistent misconceptions and knowledge gaps among educators. Exceptionality Education International 26:1-18.

Farmer, J., and M. Johnson-Gerard. 1997. Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study. Rehabilitation Psychology 42:273-286.

Gurusamy, J., S. Gandhi, S. Amudhan, K. B. Veerabhadraiah, P. Narayanasamy, S. T. Sreenivasan, and M. Palaniappan. 2019. Misconceptions about traumatic brain injury among nursing students in India: Implications for nursing care and curriculum. BMC Nursing 18:64.

Haddon W., Jr. 1980. Advances in the epidemiology of injuries as a basis for public policy. Public Health Reports 95(5):411-421.

Hux, K., M. Walker, and D. D. Sanger. 1996. Traumatic brain injury. Language, Speech, and Hearing Services in Schools 27(2):171-184.

Linden, M. A., and A. M. Boylan. 2010. “To be accepted as normal”: Public understanding and misconceptions concerning survivors of brain injury. Brain Injury 24(4):642-650.

Linden, M. A., H. J. Braiden, and S. Miller. 2013. Educational professionals’ understanding of childhood traumatic brain injury. Brain Injury 27(1):92-102.

Liu, B. C., Ivers, R., Norton, R., Boufous, S., Blows, S., and S. K. Lo. 2008. Helmets for preventing injury in motorcycle riders. Cochrane Database of Systematic Reviews (1):CD004333.

Maas, A., D. K. Menon, P. D. Adelson, N. Andelic, M. J. Bell, A. Belli, P. Bragge, et al. 2017. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurology 16(12):987-1048.

McKinlay, A., and K. Buck. 2019. Misconceptions about traumatic brain injury among educators: Has anything changed over the last 20 years? Disability and Rehabilitation 41(12):1419-1426.

NASEM (National Academies of Sciences, Engineering, and Medicine). 2014. Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press.

Olivier, J., and P. Creighton. 2017. Bicycle injuries and helmet use: A systematic review and meta-analysis. International Journal of Epidemiology 46(1):278-292.

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

Op’t Eynde, J., A. W. Yu, C. P. Eckersley, and C. R. Bass. 2020. Primary blast wave protection in combat helmet design: A historical comparison between present day and World War I. PloS One 15(2):e0228802.

Pappadis, M. R., A. M. Sander, M. A. Struchen, P. Leung, and D. W. Smith. 2011. Common misconceptions about traumatic brain injury among ethnic minorities with TBI. Journal of Head Trauma Rehabilitation 26(4):301-311.

Pappadis, M. R., A. M. Sander, B. Łukaszewska, M. A. Struchen, P. Leung, and D. W. Smith. 2017. Effectiveness of an educational intervention on reducing misconceptions among ethnic minorities with complicated mild to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation 98(4):751-758.

Ralph, A., and C. Derbyshire. 2013. Survivors of brain injury through the eyes of the public: A systematic review. Brain Injury 27(13-14):1475-1491.

Redpath, S. J., and M. A. Linden. 2004. Attitudes towards behavioural versus organic acquisition of brain injury. Brain Injury 18(9):861-869.

Register-Mihalik, J. K., K. M. Guskiewicz, T. C. McLeod, L. A. Linnan, F. O. Mueller, and S. W. Marshall. 2013. Knowledge, attitude, and concussion-reporting behaviors among high school athletes: A preliminary study. Journal of Athletic Training 48(5):645-653.

Sone, J. Y., D. Kondziolka, J. H. Huang, and U. Samadani. 2017. Helmet efficacy against concussion and traumatic brain injury: a review. Journal of Neurosurgery 126(3):768-781.

Springer, J. A., J. E. Farmer, and D. E. Bouman. 1997. Common misconceptions about traumatic brain injury among family members of rehabilitation patients. Journal of Head Trauma Rehabilitation 12(3):41-50.

Stevens, J. A. 2010. A CDC compendium of effective fall interventions: What works for community-dwelling older adults. 2nd ed. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Stevens, J. A., and R. Lee. 2018. The potential to reduce falls and avert costs by clinically managing fall risk. American Journal of Preventive Medicine 55(3):290-297.

Swift, T. L., and S. L. Wilson. 2001. Misconceptions about brain injury among the general public and non-expert health professionals: An exploratory study. Brain Injury 15(2):149-165.

Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×

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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Suggested Citation:"4 Traumatic Brain Injury Prevention and Awareness." National Academies of Sciences, Engineering, and Medicine. 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. doi: 10.17226/25394.
×
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Every community is affected by traumatic brain injury (TBI). Causes as diverse as falls, sports injuries, vehicle collisions, domestic violence, and military incidents can result in injuries across a spectrum of severity and age groups. Just as the many causes of TBI and the people who experience it are diverse, so too are the physiological, cognitive, and behavioral changes that can occur following injury. The overall TBI ecosystem is not limited to healthcare and research, but includes the related systems that administer and finance healthcare, accredit care facilities, and provide regulatory approval and oversight of products and therapies. TBI also intersects with the wide range of community organizations and institutions in which people return to learning, work, and play, including the education system, work environments, professional and amateur sports associations, the criminal justice system, and others.

Traumatic Brain Injury: A Roadmap for Accelerating Progress examines the current landscape of basic, translational, and clinical TBI research and identifies gaps and opportunities to accelerate research progress and improve care with a focus on the biological, psychological, sociological, and ecological impacts. This report calls not merely for improvement, but for a transformation of attitudes, understanding, investments, and care systems for TBI.

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