The Lasting Impact of Brain Injury

by Drew Nagele, MJ Schmidt, and Monica Vaccaro
From PHN Issue 21, Summer 2014

Each year, there are 2.5 million new traumatic brain injuries in the United States. In fact, it is estimated that 13.5 million people—or 4.5% of the population—are living with some type of acquired brain injury.
The number of people who are living with a brain injury in prisons is far greater than we would expect, and most of these injuries were never diagnosed or treated. Recent research suggests that about 60% of people in prison have had an acquired brain injury sometime in their life, most often prior to becoming incarcerated. This is important, because the problems that result from a brain injury make almost all aspects of life harder. Brain injury can make a person more likely to make poor decisions, increasing their risk for getting in trouble with the law and decreasing their likelihood of being successful in everyday life. The effects of brain injuries also can make it harder for a person to succeed in prison education programs or to meet parole conditions.

What is a brain injury?

A brain injury occurs when something happens to disrupt the functioning of the brain. Brain injuries can be caused by an outside force such as a blow or jolt to the head from a fall, a car crash, or a fight—or by a disease, like a virus, stroke or seizures. The most common causes of traumatic brain injuries—those that occur through force—are falls, vehicle crashes, assaults (including gunshot wounds), and recreation/sports injuries. Blast injuries from improvised explosive devices and other war-related experiences are also brain injuries. Some brain injuries are considered more severe than others. For example, concussions are considered “mild” brain injuries. However, the severity of the injury does not always predict how many problems a person may experience as a result. Some less severe injuries result in lifelong effects. The effect of having repeated mild brain injuries can also be cumulative or “add up” over time.

What kinds of problems can it cause?

People most often have changes in their thinking skills. They notice changes in their memory (especially for new information or events) and/or their ability to set goals, plan and organize, get started doing things, and solve problems easily. They can also notice changes in their mood. Some people have trouble controlling their tempers or feel nervous and depressed. There can also be physical changes like headaches, seizures, problems with balance and coordination, and even dizziness.
After a brain injury, people often have trouble on their jobs and in their day-to-day lives. In prison, an individual may be slower to respond to directives, have trouble completing required groups or schooling, and/or have trouble getting along with other people.

Can people get better? How?

People do recover after brain injuries, but they often have some problems that don’t go away completely. For these residual problems, there are treatments, but these are only available if the brain injury is diagnosed and understood. Medications are used to treat headaches, seizures, and some of the more serious changes in mood. Cognitive rehabilitation therapy involves figuring out the breakdowns in a person’s thinking and creating strategies to help get around those problems. Counseling can be used to help a person understand and accept the changes they experience after a brain injury. This is sometimes done individually and sometimes in support groups.

Some simple strategies that most people find helpful after a brain injury are keeping a routine or a schedule, writing things down, and getting some support for big decisions. Getting enough sleep and avoiding alcohol and drugs are also really helpful.

Why are incarcerated people so much more likely to have brain injuries?

A number of the same things that put a person at risk for brain injury also put a person at risk for incarceration. These include being young and male, risk-taking behavior, being a survivor of physical abuse, and having a history of substance use/abuse. Researchers have found that children who have had brain injuries often get into trouble with the law. A brain injury also puts a person at risk for future brain injuries. People with brain injuries are also more likely to be the victim of a crime.

What is being done?

Government agencies like the Centers for Disease Control and the Health Resources and Services Administration are studying the problem and funding research across the country. Projects in many states, including Pennsylvania, Indiana, Minnesota, and Virginia, are focused on helping to:
• identify and assist both adult and juvenile offenders with a history of brain injury
• provide training to people working in the criminal justice system
• educate people in prison about brain injury
• help those with brain injury get connected to appropriate services and supports

If you think you might have had a brain injury (or more than one) at some point in your life that is affecting you now, talk to your health care provider or counselor to find out what help may be available at your facility. For info about brain injury, or if you’re planning for release and looking for services in your area, write the Brain Injury Association of America, 1608 Spring Hill Road, Suite 110, Vienna, VA 22182.

This article was written by members of the Brain Injury Association of Pennsylvania’s team working on the Neuro-Resource Facilitation for Brain Injury project at SCI Graterford to identify inmates who may have had a brain injury, identify their resultant barriers to successful re-entry, and create release plans that include connections with appropriate resources and community supports.

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