Kathleen Bell, M.D., Res. ’84, and her colleagues will tell you that brain injuries — there are more than 1 million traumatic brain injuries (TBIs) in the United States every year — are on a spectrum. And that a lot of people go undiagnosed.

“It’s pretty easy to diagnose the more severe injuries, because people are generally in a coma and are hospitalized,” says Bell, UW professor in the Department of Rehabilitation Medicine, director of UW Medical Center’s Brain Injury Rehabilitation Program and project director for UW Medicine’s Traumatic Brain Injury Model System (TBIMS).

“When you look at the majority of brain injuries, which are classified as ‘mild’ — I’m making little quotation marks around the word ‘mild’— it’s a little more difficult for people to understand, to diagnose, and to treat appropriately,” she says.

When “mild” isn’t mild

The reason Bell puts quotation marks around the word “mild” is that even mild TBI may have consequences. People recover completely from mild concussions, for instance, but even slightly more serious injuries can have long-lasting symptoms. To make the situation more complex, different people have different reactions to similar brain injuries. If you’re a doctor, and you’re trying to diagnose, to predict outcomes, or to make treatment decisions, what do you do?

Fortunately, some predictors exist. “It’s clear that a person’s age has an effect on how well patients do after a brain injury,” says Bell. (Those 40 and older, for instance, don’t recover as well.) The part of the brain that’s affected is also important. Interestingly, there are hints early in a person’s recovery, too. The length of post-trauma amnesia, for instance, is an indication of the severity of the injury and the time needed to recover.

Prognosis and resources

Bell and her colleagues at TBIMS are working to uncover other signposts for prognosis. Even now, they’re conducting a “prediction of outcome” study to evaluate a patient’s neuropsychological and emotional status, function (including employment), post-traumatic symptoms and perceived quality of life.

They’re also working with veterans. In conjunction with Fort Bragg, Joint Base Lewis McChord and veterans from Iraq and Afghanistan, researchers are seeing if phone-based counseling therapy can help vets deal with symptoms related to concussion and stress. They’re also investigating post-traumatic headaches, the most common physical symptom after concussion and blast exposure.

There are other ongoing studies, too. TBIMS and two sister sites are seeing if people with moderate to severe TBI will benefit from regular phone contact with research care managers who can provide counsel and resources. Another study examines the efficacy of vocational services for people with TBI.

Focusing treatment and resources, in the clinic and out in the community, makes a great deal of sense in a medical system like ours, not geared to provide long-term care for brain injury.

“People who have brain injuries tend to fall between the cracks in terms of medical funding,” says Bell. “I’m hoping we’ll provide the research evidence to develop means for intervention for brain injury that are cost-efficient.”