A New Perspective: A Vulnerable Population Framework to Guide Research and Practice for Persons with Traumatic Brain Injury
Bay, Esther, Kreulen, Grace J., Shavers, Clarissa Agee, Currier, Connie, Research and Theory for Nursing Practice
Recovery from traumatic brain injury (TBI) can be a tumultuous lifelong and expensive process. Guided therapies for community integration within community systems are a focus of treating therapists around the world, yet there are no published discussions concerning the most fitting community context. We propose a theoretical approach for practice and research using Flaskerud and Winslow's conceptual model of vulnerable populations. Using the model constructs of health status, resource availability, and increased relative risk, we offer empirical support for proposed construct relationships applied to persons with traumatic brain injury. We then propose that interventions for health promotion, acute care, and rehabilitation or chronic disease management have a community focus, and we identify relevant goals for community-based practice and research.
Keywords: traumatic brain injury; community interventions; community integration; vulnerable populations; practice; research
Traumatic brain injury (TBI), referred to as a "silent epidemic," is a significant international health problem and is broadly defined as brain injury from externally inflicted trauma resulting from violence or acceleration-deceleration impact injury. An estimated 20 to 50 million people are injured or disabled in road traffic accidents every year with those between ages 18 and 25 experiencing the greatest incidence. According to the Centers for Disease Control (CDC, 1999), individuals over age 75 are at high risk for TBI due to falls. By 2020, the World Health Organization (WHO, 2004) projects that road traffic injuries will be the third leading cause of global disease or injury. Motor vehicle accidents are a major cause of TBI in less developed countries and a leading cause of morbidity and mortality (Jacobs & Aeron-Thomas, 2000). In some African countries, a motor vehicle is over 100 times more likely to be involved in a fatal traffic accident than in the United Kingdom or United States (Afukaar & Ofosu-Amaah, 2003).
More specifically, a report on African road safety in Ghana, a less developed country, estimated 122 fatalities per 10,000 vehicles with 1,646 fatalities reported in 1998 (Jacobs & Aeron-Thomas, 2000). These authors also noted that accidents were seriously underreported by police and that the true number is 7 to 11 times higher. Earlier police data in Ghana (1994-1998) reported that pedestrians accounted for 46% of all road traffic deaths. For every three pedestrian casualties, one was a child under age 16 (Afukaar & Ofosu-Amaah, 2003).
Currently an estimated 5.3 million Americans are living with a TBI-related disability. The U.S. economic burden created by this disability was estimated to be $56 billion in 2000, and it is projected that costs related to annual treatment for mild TBI are $ 17 billion (CDC, 1999; Thurman, 2001). Worldwide, the economic impact of road traffic accidents in developing and developed countries may consume an estimated 1-2% of a country's gross national product (WHO, 2004). The consequences of brain injury include, but are not limited to, significant impairment of an individual's physical, cognitive, and psychosocial functioning (CDC, 1999; WHO, 2004).
Despite the prevalence, costs, and societal burden of TBI, several limitations exist in the state of the science and treatment for those with brain injury. First, there is disagreement about what constitutes a mild brain injury, the most commonly experienced level of injury. second, despite the emphasis on community integration after TBI, which is defined as being engaged in and experiencing satisfaction with community and family living, few studies specifically have focused on communitybased efforts to provide brain-injured persons with comprehensive and coordinated treatment.
The purpose of this article is threefold. First, we provide an overview of the presentation of TBI and propose that regular use of the latest CDC screening tool, with the potential to detect the presence of a previous or present mild injury, can assist health professionals in guiding persons with potential injuries toward earlier intervention. …