A commentary, published in the Journal of Neurotrauma, calls for traumatic brain injury to be recognised as a chronic condition as are diabetes, asthma, depression and heart failure.
The commentary authors observe that many clinicians believe that residual impairments due to traumatic brain injury are static once initial recovery has plateaued and do not expect significant changes over the remainder of a person’s life.
In contrast, the commentary authors write that the long-term course of traumatic brain injury involves waxing and waning and thus could be better characterised as dynamic rather than static.
Accordingly, they call for traumatic brain injury to be considered and managed as a chronic condition.
Kurt Kroenke, M.D. of the Regenstrief Institute and the Indiana University School of Medicine is commentary senior author.
He said: “Acknowledging traumatic brain injury as a chronic condition and providing coordinated care will make a difference to patients, their families and to how the healthcare system operates in several ways.
“It recognises that for many patients it’s not over after 12 months and, importantly, provides these patients with a place of care where they can be monitored and helped over many years.
“Recognising TBI as a chronic condition and using coordinated care models support the important role of self-management for both the patient and their family.
“These two steps facilitate collaboration between the limited number of brain care specialists and the primary care clinicians who typically oversee care throughout the TBI survivor’s lifetime.
“Collaborative care models, which we at Regenstrief Institute and others have developed, provide patients living with chronic conditions with the support and coordinated care they need.
“Medicare recently recognised TBI as one of 18 chronic conditions, hopefully others will follow.”
Dr Kroenke notes that the chronic condition designation by Medicare opens the door to change in how traumatic brain injury is managed long-term and may guide healthcare systems to better integrate brain injury specialists — who are in short supply — with primary care providers through collaborative care models.
It may also encourage health insurers to provide coverage for the many years of care needed by some survivors.
Flora M. Hammond, M.D., Covalt Professor of Physical Medicine and Rehabilitation and Chair of the Department of Physical Medicine and Rehabilitation at the IU School of Medicine, is the commentary co-author.
The researcher said: “We can improve life after brain injury with a more proactive approach and a longer-term view of brain injury as a chronic and dynamic condition.
“This approach anticipates changes overtime and incorporates strategies to optimize healthy living with coordinated care that is individualised for the lifetime needs of those living with brain injury.
“Recognition of TBI as a chronic condition would not only focus more resources on problems associated with living with brain injury but would also enhance both the public’s and professionals’ awareness of how to optimise the health and well-being of persons living with the effects of TBI.”
