44.2. Acquired brain injury

A primary goal of TCNL research and development is to improve and optimize the treatment of acquired brain injury, including stroke, and mild and moderate traumatic brain injury (mTBI) from whiplash, sport, and blunt or blast concussive injuries, by using CN-NINM. This new method enhances the brain’s natural ability to repair damage, form new functional pathways, assist the recovery process, and increase and accelerate functional neurorehabilitation.

44.2.1. Epidemiology of Brain Injury

TBI is a common occurrence in the United States in both the civilian and military populations. The Centers for Disease Control and Prevention (CDC) estimates that at least 1.7 million people receive urgent medical care for TBI each year (Coronado et al., 2011). Of these, 80%–90% likely experienced a mild TBI, or concussion, based on symptoms at the time of injury (Binder et al., 2005; Coronado et al., 2005; Guerrero et al., 2000). Unfortunately 12%–35% of the military personnel who have deployed to recent combat operations (2.4 million as of June 30, 2012) have sustained at least one mTBI (Rigg and Mooney, 2011).

Approximately 290,000 individuals are hospitalized and discharged annually, most of whom have moderate or severe injuries. More than 53,000 individuals die before hospitalization or before hospital discharge (McMillan et al., 2011). About 43% of TBI subjects experience long-lasting disabilities (Selassie et al., 2008; Zaloshnja et al., 2008).

Precise measures of prevalence within the population are unknown; however, the CDC estimates that approximately 5.3 million Americans are living with a TBI-related disability, with about 125,000 new individuals annually requiring assistance with activities of daily living at least a year after their injuries (Rutland-Brown et al., 2008; Rutland-Brown et al., 2006; Thurman and Guerrero, 1999; Thurman et al., 1998).

Studies in civilian populations suggest that 10%–30% of individuals experiencing a single mild TBI may develop some long-term implications (Ponsford et al., 2013; Silver et al., 2001; Spitz et al., 2013; Tate et al., 2012; Wilde et al., 2008), and recent studies are now proposing possible long-term adverse health effects emerging years after mild TBI, including the development of chronic traumatic encephalopathy (CTE), thus increasing the importance of prompt and accurate identification of injuries and appropriate intervention (Chen et al., 2011; Goldstein et al., 2012; McKee et al., 2013; McMillan et al., 2011; Omalu et al., 2011).

The economic and social impact of TBI is considered enormous but has not been extensively researched to date. The total lifetime cost for all people who sustained TBI in the United States was $37.8 billion in 1985 (Max, 1991), $56.3 billion in 1995 (Thurman, 2001), and in the year 2000, it was $60.4 billion (Corso et al., 2006). Considering loss of income, and economic impact on the family for caregiving, other researchers estimated that the lifetime costs of TBI in year 2009 dollars totaled more than $221 billion (Langlois Orman, 2011). Charges for acute care and rehabilitation alone in the Model System database averaged about $120,000 per patient, excluding physician charges. In addition to the medical costs, TBI creates a strain in intimate relationships, affects role functioning, fosters economic hardship, and creates a great burden on the family (Cifu et al., 1999; McKinlay et al., 1981; Ponsford et al., 2013; Taylor et al., 2012; Wehman et al., 1994, 2003).

Concussions or mTBIs are a common occurrence in athletes, with an estimated 1.6–3.8 million sport-related concussions annually in the United States (McKee et al., 2009). DeKosky et al. reported that each year more than 1.5 million Americans have mTBI with no loss of consciousness and no need for hospitalization as well as an equal number with consciousness-impairing trauma that is insufficiently severe to require long-term hospitalization (DeKosky et al., 2010). In a 2009 review of CTE, McKee et al. found that of 51 neuropathologically diagnosed cases of CTE, 46 (90%) occurred in athletes. Specifically, athletes participating in American football, boxing, soccer, and hockey comprise the majority of cases. (Baugh et al., 2012; Gavett et al., 2011).

The broader scope of brain injury also includes cerebrovascular accidents, or strokes. A stroke is another mechanism for a brain injury. Those who have had a stroke often experience similar neural disabilities as those with a TBI. Stroke is the leading cause of chronic disability, affecting 500,000 individuals per year. Only 50% of those affected return to the workforce without residual disability. The annual combined cost of health care and lost productivity from stroke is estimated to be between $30 and $40 billion (Baker and Epstein, 1991; Coronado et al., 2005; McGregor and Pentland, 1997; Pai et al., 2012; Schneier et al., 2006; Taylor et al., 2012; Wehman et al., 2003).