March is Brain Injury Awareness MonthThroughout the month, we'll be sharing selected excerpts from our imprint Demos Medical's title Brain Injury Medicine, Second Edition.

Today's excerpt is adapted from the chapter "History of Acute Care and Rehabilitation of Head Injury," by Graham Teasdale and George Zitnay.

1. The many advances in acute care of head injuries since WWII are built on principles derived from military experiences and expressed through modern scientific, technological, and organizational progress.

2. The dramatic increase in civilian closed head injuries throughout the world in the second half of the 20th century, as a consequence of the growth of road traffic and urbanization, stimulated growing recognition of the importance of head injuries.

3. In the early 1970s the group that formed around Bryan Jennett in Glasgow drew attention to the importance of secondary ischemic brain damage – which occurs in the hours and days following the initial trauma, rather than as a direct result of it - and established assessment of the severity of damage by the Glasgow Coma Scale and the use of CT scanning as the basis of management in the acute stage, and in comparing early severity with outcome.

4. Data acquired by such studies as the North American Traumatic Coma Data Bank study further spurred the advancement of prevention and treatment of intra- and extra-cranial ‘‘secondary’’ insults (the cause of an injury) through organized approaches, based on rigorous guidelines, from pre-hospital to modern neuro-critical intensive care systems.

5. Although successful in limiting brain damage in experimental models, ‘‘neuroprotective’’ pharmacological treatment, which aims to prevent secondary brain damage over time, has so far not been shown to improve outcome in patients.

6. The advances in management since 1960s have reduced mortality significantly, but the persisting incidence of late disability reflects the occurrence of severe primary damage in the most seriously affected survivors.

7. Rehabilitation efforts for brain injury also grew out of treatment of war injuries during World War II with the efforts of Dr. Howard Kessler, a strong advocate of rehabilitation of veterans, and Dr. Howard Rush, an Air Force colonel who demonstrated the effectiveness of physical medicine with injured pilots.

8. In the 1970s and 1980s, pioneers in brain injury rehabilitation such as Henry Stonnington, Sheldon Berrol, Leonard Diller, Anne-Lise Christensen, and Yehuda Ben Yishay developed specialized programs beginning the movement of ‘‘community-based rehabilitation for persons with TBI.’’

9. The 1980s saw the growth of organizations for TBI advocacy, research, and professional association including NHIF (National Head Injury Foundation, today the Brain Injury Association of America), the International Brain Injury Association, the American Congress of Rehabilitation Medicine’s Brain Injury Interdisciplinary Special Interest Group, Commission on the Accreditation of Rehabilitation Facilities, and National Institute on Disability and Rehabilitation Research’s Traumatic Brain Injury Model Systems program, as well as huge growth of rehabilitation treatment programs.

10. The late 1990s and 2000s have come to be seen as a period of cost reduction, accountability, managed care, and the closing or merging of many programs in TBI rehabilitation, as well as a period of growth of research and push to develop evidence-based practice guidelines for treatment and rehabilitation. The large number of injuries associated with the wars in Iraq and Afghanistan after 2001 has been a catalyst to expand efforts in research, prevention, assessment and treatment in rehabilitation of persons with TBI in military and civilian settings.

For more information on TBI, read Brain Injury Medicine, Second Editionavailable now from Demos Medical.

Brain Injury Medicine cover