Chapter 33. Social Aspects

Andrew Hornstein, M.D.
DOI: 10.1176/appi.books.9781585624201.686404



Fifty thousand people die of traumatic brain injury (TBI) every year in the United States, and over 5 million TBI survivors are left with permanent disabilities. Most TBI victims are young, and many survivors require lifelong services (Centers for Disease Control and Prevention 1999; Langlois et al. 2006). These facts highlight a major public health issue that has broad social as well as clinical implications. This chapter reviews some of the social implications. Areas to be covered are legislation affecting TBI patients, advocacy issues, insurance coverage, employment and vocational rehabilitation services, and litigation. Other important social aspects of TBI prevention and broader legal issues are covered in depth in other chapters in this volume (see Chapter 31, The Family System, Chapter 32, Systems of Care, and Chapter 34, Clinical Legal Issues).

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Figure 33–1. Continuum of needs after traumatic brain injury (TBI).Source. Reprinted from Committee on Traumatic Brain Injury, Board of Health Care Services, Institute of Medicine of the National Academies: Evaluating the HRSA Traumatic Brain Injury Program. Washington, DC, National Academies Press, 2006, p. 60. Used with permission.

Figure 33–2. Return to work by severity of traumatic brain injury, by preinjury stability, by physical disability, and by neuropsychological status.Estimated percentage first returning to work by subgroups defined on the basis of initial Glasgow Coma Scale (GCS) (top left), job stability (top right), Abbreviated Injury Scale (AIS) score for the extremities (bottom left), and neuropsychological performance at 1 month after injury, using Halstead Impairment Index (II) (bottom right).Source. Reprinted from Dikmen SS, Temkin NR, Machamer JE, et al.: "Employment Following Traumatic Brain Injury." Archives of Neurology 51:177–186, 1994. Copyright © 1994 American Medical Association. Used with permission.
Table Reference Number
Table 33–1. Conclusions of the National Institutes of Health Consensus Conference on Traumatic Brain Injury (TBI)
Table Reference Number
Table 33–2. Types of traumatic brain injury waiver services available


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