Introduction to the RSA regional brain injury centers - Rehabilitation Services Administration

American Rehabilitation,  Summer, 1993  by L. Don Lehmkuhl

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To stimulate improved care and research for any serious medical condition, at least three key factors are necessary: an interested and concerned medical group, active consumer groups, and government support, encouraged by these meducal and consumer groups. In the past few years, these elements have come together to focus on improved services for the 400,000 to 500,000 people hospitalized each yeat with permanent sequelae from brain[1] injuries. The result has been an advocacy movement for improving the availability and quality of services for people with brain injury and their families. The National Head Injury Foundation (NHIF)--the primary consumer group--played a significant role in this movement by expressing to legislators federal personnel its dissatisfaction with the quality and availability of appropriate Services.

In 1987, the U.S. House of Representatives Committee of Appropriations encouraged the establishment of an Interagency head Injury Task Force to identify the gaps in research, training, and service delivery and to recommend solutions in meeting the needs of people in meeting the needs of people with traumatic brain injury (House-Report No. 100-256, page 81). At the same time, the U.S. Senate Committee on Appropriations encouraged increased efforts among government agencies in these same areas (Senate Report No. 100191, page 103). The task force was established in early 1988 by the Secretary of the Department of Health and Human Services. He appointed as in chairman the Director of the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH).

Thirteen federal agencies provided representatives to serve on the task force. Participating agencies include the Department of Defense, the National Institute of Disability and Rehabilitation Research, the Department of Transportation, the Veterans Administration, the National Science Foundation, the National Institute of Mental Health, the National Center for Health Statistics, the Food and Drug Administration, the Centers for Disease Control, the Health Resources and Services Administration, the National Center for Health Services Research/Health Care Technology, the Health Care Financing Administration, and the National Institute of Neurological Disorders and Stroke.

In carrying out its activities, the task force defined its scope to focus on traumatic brain injury (TBI). The knowledge and understanding of TBI by task force members were enhanced through the solicitation of public comments during a 2-day public hearing (September 8-9, 1988) in Washington, DC. These findings, along with the activities of the task force's three sub-committees, provided the background and framework for examining the problems and addressing their solutions.

The task force noted that the acute and long-term care, rehabilitation, and community reintegration of people with TBI pose unique problems that overlap with many other neurologic disabilities but that are distinct and different. These range from the acute response of the brain to trauma to the long-term consequences of frontal or temporal lobe damage in a child or adult. The gaps in understanding among healthcare providers and the community about the problems associated with TBI often result in counterproductive, long-term management of the survivor in existing care systems designed not for persons with TBI but rather for persons who are paralyzed, mentally retarded, or mentally ill. In addition, TBI poses its own unique problems in children and elderly persons. For these reasons, the task force developed a set of recommendations that would represent the core of a national strategy for dealing with TBI and identified issues to be addressed in the implementation of its six recommendations. These recommendations and issues to be considered are contained in the Interagency Head Injury Task Force Report (February 1989) published by the National Institute of Neurological Disorders and Stroke, NIH, Public Health Service, U.S. Department of Health and Human Services, Bethesda, MD.

These are the recommendations of the task force:

* Establishment "traumatic brain injury" as a category in reporting systems.

* Designate a lead federal agency with responsibility for overall coordination and planning for federal, state, and private sector activities; establish a government/private sector advisory group to assist the effort.

* Encourage the establishment of working groups at the state and local levels to provide leadership and coordination.

* Create a national network of 15 comprehensive regional brian injury research centers, beginning with the immediate establishment of 5 centers and adding 5 additional centers per year for the next 2 years.

* Organize a decentralized system of care networked with regional brain injury research centers to ensure accessibility to appropriate care and inform TBI survivorsand their families about the availability of such services and facilities.