research report
kaushik reddy
UOWsydneybusinessschool020919.ppsx
Sydney Business School
2nd September 2019
Nick Rushworth Executive Officer
Brain Injury Australia
UNIVERSITY OF WOLLONGONG
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depressingly familiar/ standard disclaimer; not NOR HAVE I EVER BEEN a clinician, a medical researcher, never worked in criminal justice system, former journalist – ability to gather together credible information – prosecute a case.
long service in this role… UNCRITICAL OSMOSIS
divine chicken from egg well above my pay grade…
(…founded in 1986)
"...is the central clearinghouse of information and gateway to nationwide referral for optimising the social and economic participation of all Australians living with brain injury."
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hospitalisations in 2004-5
rough rules of thumb
“…used to describe multiple disabilities arising from damage to the brain acquired after birth. It results in deterioration in cognitive, physical, emotional or independent functioning. It can be as a result of accidents, stroke, brain tumours, infection, poisoning, lack of oxygen, degenerative neurological disease etc..” [2014]
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Glass-bottom SPEEDBOAT tour of policy paper – 8 YEARS’ OLD - downloadable ex BIA website, brought a small number of copies…
No universally agreed def.
National Community Services Data Dictionary, Australian Institute of Health and Welfare, 2014
operative words; “after birth”
FASD – made no sense
…727,000
“activity limitations”
“participation restrictions”
“…gaols and
correctional institutions”
“hostels for the homeless or night shelters”
“very remote areas”
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Australian Bureau of Statistics for their best estimate based on their triennial Survey of Disability, Ageing and Carers, disaggregated for brain injury. From its most recent – 2012 - iteration, they came back with 730,000 - crucially, Australians whose brain injury MEANS daily "activity limitations" and "participation restrictions".
“…gaols and correctional institutions”
homeless (10-30%)
“…except for those living in remote and sparsely settled parts…”
“…may not have reported certain conditions because of the sensitive nature of the condition…lack of awareness of the presence of the condition…”
("miserable minority" ≤ 41%)
"...22,710 hospitalisations involving traumatic brain injury in 2004-05"
"...rates of hospitalisation for males per 100,000 population were two and a half times those for females"
(70% to 85% = "mild" traumatic brain injury)
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hospitalisations in 2004-5
rough rules of thumb
up to 90% return to care of family;
average costs of care for severe TBI - over $100,000 per year;
2 out of 3 people had to make changes to the leisure activities they pursued;
half reported they had lost friends, become more socially isolated since injury;
changes in sexual function – reduced libido, impotence etc.;
over half of all marriages involving a partner with a TBI dissolved within 6 years of injury;
60% likelihood of major mental illness during lifetime…
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"... was aware of the evidence and the risks associated with repetitive traumatic brain injuries virtually at the inception, but deliberately ignored and actively concealed the information..."
"... early-onset of Alzheimer's Disease, dementia, depression, deficits in cognitive functioning, reduced processing speed, attention, and reasoning, loss of memory, sleeplessness, moods swings, personality changes, and the debilitating and latent disease known as Chronic Traumatic Encephalopathy"
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ON THE SECOND COUNT: wouldn’t be here talking on this subject, the paper wouldn’t have written if it wasn’t for the 4,500 retired gridiron players who have been suing their National Football League, the NFL…from the writ issued "... was aware of the evidence and the risks associated with repetitive traumatic brain injuries virtually at the inception, but deliberately ignored and actively concealed the information...“
in regards to the risks from repeated concussions of “early onset of Alzheimer's Disease, dementia, depression, deficits in cognitive functioning, reduced processing speed, attention, and reasoning, loss of memory, sleeplessness, moods swings, personality changes, and the debilitating and latent disease known as Chronic Traumatic Encephalopathy“, or CTE
my two cents on CTE? only diagnosis currently available is post-mortem. (More than 70 brains in the “bank” at the centre at Boston University devoted to its study.) And I just wonder whether it’s always possible to completely disaggregate – DISENTANGLE - the relative LIFETIME contributions of, for example, other non-sports-related neurotrauma (motor vehicle accidents, assaults etc.), alcohol and other drug abuse, anabolic steroid use and ordinary age-related cognitive decline, brain atrophy, family history of dementia etc. Statements as definitive as “CTE is the only known neurodegenerative dementia with a specific identifiable cause; in this case, head trauma” may prove premature.
If the settlement stands, the NFL – with annual revenues of $10 BILLION – might have dodged a bullet/ gotten off lightly - $765 million is around the market value of JUST one - and a LESSER one - of its 32 teams, the Jacksonville [Florida] Jaguars. And the NFL did not admit any wrongdoing in how it had dealt with concussions.
If the settlement stands?…[CLICK] This January ruling the former players’ lawyers had not produced enough evidence to convince the judge that $765 million would cover the potential costs for 18,000 retirees over the 65-year life of the agreement.
2004 - 2005 ≈ 3,000 hospitalisations for concussion from sport
2005 - 90% of concussed patients had not recognised their injury
“Most individuals with concussion - approximately 75% - do not seek attention from a medical facility or medical practitioner unless the symptoms worsen or persist."
2006 (US) - # unreported sports-related concussions ≈ 6-10 X the 1.6 - 3.8 million disclosed p.a.
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(A survey conducted in the emergency department of a major Canadian hospital found nearly 90% of concussed patients had not recognised their injury. Delaney JS et al., “Recognition and characteristics of concussions in the emergency department population”, Emergency Medicine, August, 2005 29(2), p.189-97)
As many as 1 in every 4 people who sustain one or more concussions or mild TBIs do not make a full recovery within expected timeframes – experiencing persistent physical symptoms such as headaches and dizziness, impacts on cognition, behaviour and/ or mental illness. For some of these people, the impairments are likely to be permanent.
Male early 20s "v. good" footballer , unconscious ≈10 secs, laceration R eyebrow, "attended toA" @ sideline, sent back into game. Post-game →ED; laceration stitched, no scans, investigations, returned to work, drove
Day 7 - workplace = "not himself", review at GP w/ headaches, fatigue, poor memory. HI leaflet. No referrals
Day 11 - (new) GP; v. forgetful, poor motor control, vague, headaches. History = knocked out at footy 5-6 times/ this season "alone"
Day 13; GP w/ headaches, blurred vision. Sutures removed. CT normal. Refer brain injury unit. MRI normal
9 mths; res. rehab. 3 days/ week, ["still"] w/ blurred vision, poor bal., coordination, cog. fatigue, problems w/ attention/concentration, difficulty w/ verbal memory, lowered mood = antidepressants. No return to work
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young man aged in his early 20s from regional town. Working as a tradie in his 4th year of his apprenticeship. Very good footballer and played for regional team.
knocked unconscious for about 10 secs during a game and had a laceration on his right eyebrow. He was attended to at the match and sent back onto the field to continue playing. Following the game he was taken to the emergency department of the local hospital, laceration stitched . No other neuroimaging/ no scans or investigations performed. No other referrals completed. He also returned to work and drove to work.
His workplace noticed he was not himself and were concerned, so encouraged him to see GP. Review at GP 7 days post injury, he presented with headaches, fatigue, poor memory. Head Injury leaflet provided. No other referrals or action completed.
Day 11 post concussion, he returned to new GP, very forgetful, poor motor control, vague, headaches. History taken and young man revealed he had been knocked out at footy 5-6 times in this season alone. CT requested.
Day13 post concussion, he returned to GP with headaches, blurry vision, fumbling with things, forgetful. Sutures removed. CT normal. Referred to brain injury unit.
2 mths post injury, young man began residential rehab for brain injury. History taken - described being knocked unconscious at footy at least 4-5 times with no intervention. He experienced similar symptoms to this last time, although nowhere near as severe.
9 mths post injury, he continues to require residential rehab 3 days per week. Still presents with blurred vision, poor balance and coordination, cognitive fatigue and attention/concentration problems resulting in difficulty with verbal memory and lowered mood for which he has to take antidepressants. Has not returned to work to date.
40% / 16,000 victims of DFV attending Victorian hospitals 2006 - 2016 had sustained a traumatic brain injury
1/ 3 victims of DFV were children < 15, 1/ 4 had sustained a traumatic brain injury
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Brain Injury Australia’s report into Australia’s first research into family violence and brain injury funded by the Victorian Department of Health and Human Services…
completed by a consortium led by Brain Injury Australia - comprising Monash University, Domestic Violence Victoria, No to Violence and the Centre for Excellence in Child and Family Welfare – implementation of Recommendation 171 of the Victorian Royal Commission Into Family Violence; “The Victorian Government fund research into the prevalence of acquired brain injury among family violence victims and perpetrators.”
inflicted TBI ("Shaken Baby Syndrome") - leading cause death, disability in abused children
NSW Child Death Review Team - 136/ 10 years, children < 12 months = 16X risk @ 5-15 years [2009]
Australian Paediatric Surveillance Unit - subdural haemorrhage w/ 1350 paediatricians/ 2010-2012 = 169, 124 suspected inflicted TBI
“…for every 1 child less than 2 years of age who sustains a serious or life-threatening injury, another 152 children may be shaken by their caregivers and sustain sub-clinical brain trauma that goes undetected."
telephone survey "potentially abusive behaviours" @ 1435 households in North and South Carolinas ’v’ hospitalised ITBI [2002]
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“All patients included in our study were referred to our clinic from five domestic violence and homeless shelters in the Phoenix, Arizona metropolitan area.”
“In total, 101 of the 115 patients (87.8%) reported more than one brain injury at the hands of their abusers.”
“Of those 101 patients, 93 patients (92.1%) reported too many injuries to quantify.”
“Only 21% of our patients saw a physician or presented to an emergency room because of their injuries, which indicates that the reporting rate for this type of injury may be even lower than previously speculated.”
prevalence?
"entrants reported ever having received" HI w/ LOC = 34%
"entrants who have ongoing symptoms… headaches, or changes in memory, behaviour or mood“ from HI w/ LOC = 13%
HI w/ LOC "while in prison" = 5%
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Numerous meta-surveys of the prevalence of ABI in both adult corrections and juvenile justice
n: Prison population total (including pre-trial detainees / remand prisoners) Australian Bureau of Statistics - Prisoners in Australia, 2018
comprehensive survey - 1/87 adult prisons; Joint Treatment Program, Port Phillip Prison, Victoria (in the interests of full disclosure, 8 years ago…)
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Brain Injury Australia’s report into Australia’s first research into family violence and brain injury funded by the Victorian Department of Health and Human Services…
completed by a consortium led by Brain Injury Australia - comprising Monash University, Domestic Violence Victoria, No to Violence and the Centre for Excellence in Child and Family Welfare – implementation of Recommendation 171 of the Victorian Royal Commission Into Family Violence; “The Victorian Government fund research into the prevalence of acquired brain injury among family violence victims and perpetrators.”
falls…
…the leading cause of injury hospitalisation - 1 in every 3 (126,800) injury admissions in 2003-2004
…leading cause of traumatic brain injury hospitalisations - 42% of all “Principal Diagnosis” TBI hospitalisations in 2004-2005
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hospitalisations in 2004-5
rough rules of thumb
"A Community of Practice (CoP) brings together a “group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.”
The primary purposes of this CoP are to optimise both needs ascertainment and plan fidelity for National Disability Insurance Scheme participants with an acquired brain injury.
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hospitalisations in 2004-5
rough rules of thumb
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COAG Disability Reform Council Quarterly Report; This report is a summary of the performance and operations of the National Disability Insurance Agency (NDIA) for the 3 months from 1 January 2019 to 31 March 2019, as required by Section 174 of the NDIS Act 2013.
…separately disaggregates stroke
…combined = (only) 5% of plans in the Scheme.
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Average committed support by primary disability group (including participants with Supported Independent Living supports)
low REPRESENTATION (either don’t know about the NDIS, or don’t know that they’re “eligible”, would meet the disability requirements of the Scheme)
the challenge of high prevalence (relative to other disabilities) matched by apparent high unmet need, confounded by low service and income and other support uptake.
www.braininjuryconference.com.au
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Brain Injury Australia's 7th National Brain Injury Conference will be held, in partnership with the Melbourne Disability Institute, at The University of Melbourne in Parkville on Monday 28th and Tuesday 29th October, 2019.
Emeritus Professor John Corrigan from the Department of Physical Medicine and Rehabilitation at Ohio State University in the United States. He is Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation and, since 1997, has led the Ohio Regional Traumatic Brain Injury Model System - the longest, continuously-funded of 16 centres throughout the United States, aimed at improving the lives of 1,150 Ohioans who have sustained a traumatic brain injury, their families and communities by creating and disseminating new knowledge about the course, treatment and outcomes relating to their disability. He is also Editor-in-Chief of the most prestigious international journal in traumatic brain injury, the Journal of Head Trauma Rehabilitation. Alongside delivering the International Keynote Address, Professor Corrigan will also participate in panel discussions on domestic and family violence and brain injury, and concussion and “mild” traumatic brain injury.
I have been lucky that two colleagues from Canada - Karen Mason, Executive Director of Kelowna/ COLOGNE-R Women’ Shelter and Professor Paul van Donkelaar from the University of British Columbia -.co-founders and directors of SOAR (Supporting Survivors of Abuse and Brain Injury through Research)
