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Jack Sisson's TBI Blog

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From Scientific American:
Prisoners suffer disproportionately from past traumatic brain injuries. Researchers are hunting for the best tools to treat this population in an effort to help them reintegrate into society--and avoid re-incarceration.

A car accident, a rough tackle, an unexpected tumble. The number of ways tobang up the brain are almost as numerous as the people who sustain these injuries. And only recently has it become clear just how damaging a seemingly minor knock can be. Traumatic brain injury (TBI) is no longer just a condition acknowledged in military personnel or football players and other professional athletes. Each year some 1.7 million civilians will suffer an injury that disrupts the function of their brains, qualifying it as a TBI.

About 8.5 percent of U.S. non-incarcerated adults have a history of TBI, and about 2 percent of the greater population is currently suffering from some sort of disability because of their injury.

In prisons, however, approximately 60 percent of adults have had at least one TBI—and even higher prevalence has been reported in some systems. These injuries, which can alter behavior, emotion and impulse control, can keep prisoners behind bars longer and increases the odds they will end up there again. Although the majority of people who suffer a TBI will not end up in the criminal justice system, each one who does costs states an average of $29,000 a year.

With more than two million people in the U.S. currently locked up—and millions more lingering in the justice system on probation or supervision—the widespread issue of TBI in prison populations is starting to gain wider attention.

A few pioneering programs offering rehabilitation to prisoners—and education to families and correctional staff about TBI—are underway around the country. And several studies aim to ascertain the best ways to handle this huge population. "It's not as cut-and-dry as a lot of people think," says Elisabeth Pickelsimer, an associate professor at the Medical University of South Carolina. Some of the best options so far include cognitive therapy for prisoners and education for the people around them.

The kicker seems clear to many researchers: "If we don't help individuals specifically who have significant brain injuries that have impacted their criminal behavior, then we're missing an opportunity to short-circuit a cycle," says Peter Klinkhammer, associate director of services at the Brain Injury Association of Minnesota.
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One of the big challenges in addressing TBI in prison populations, and beyond, is that it is not as easy to diagnose as a broken bone or a blood-borne illness. Symptoms are by no means unique to the injury and can be co-occurring with other mental healthconditions. To make things even tougher for those hoping to track the disability, no two brain injuries are alike. "Two people can have the same injury and have a totally different set of impairments," Gordon says. "One can be fine, and one can be not so fine—but we don't know why that is yet." He suggests that differential responses could be due to a combination of physical, genetic, contextual and social factors, such as skull thickness, the magnitude of g-forces involved in the impact or past history of more minor, sub-concussive injuries.

Due in part to these variables, not all TBIs result in a medical paper trail. Doctors treating people with serious wounds might miss diagnosing a brain injury, and hospitals do not always code for every presenting condition. Also, many people who suffer a head injury, especially a milder one, such as a concussion, might not seek medical attention at all.

Researchers have started using detailed interviews with prisoners to get a better sense of how many have suffered from a brain injury. In a recent South Carolina survey of 636 prisoners, some 65 percent of males and 73 percent of females reported having sustained TBIs at some point in their lives. Injury counts are likely underestimated. Many people, for example, are unaware of injuries that they might have sustained when they were babies or young children. And even adulthood injuries were not entirely clear to prisoners. "They were told they had their bell rung—they got knocked out," says Rebecca Desrocher, assistant program director at the U.S. Department of Health and Human Services's Federal Traumatic Brain Injury Program.

The very nature of brain injuries can also make tracking them—and figuring out how many an individual might have suffered—especially difficult. As Pickelsimer points out, "after you've had some, you don't remember them as clearly." These injuries are additive, with each assault to the brain compounding damage from the previous ones. The average reported number of TBIs for an individual prisoner was about four, Pickelsimer says. And some reported up to a dozen.

Through these interviews, Pickelsimer says, another thing became clear: prisoners were often not aware that a single event—or a series of them—could be making it harder for them to earn a ticket out of jail, or avoid being sent back in the future.

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