New framework calls for lifelong care after traumatic brain and spinal cord injuries

Traumatic brain injury (TBI) and spinal cord injury (SCI) should be treated as a chronic condition, with long-term treatment plans and follow-up, due to long-term associations with neurological, psychiatric, cardiovascular, endocrine and metabolic diseases, according to recommendations published this week in The Lancet Neurology, co-authored by researchers in the Perelman School of Medicine at the University of Pennsylvania. The proposed framework calls for a fundamental shift in how even milder brain injuries are tracked and treated.

“Our analysis confirms what patients with brain and spinal cord injuries have been telling us for years: these injuries are often not isolated events but lifelong conditions that can affect health in many ways,” said co-first author, Andrea L.C. Schneider, MD, PhD, associate professor of Neurology and Epidemiology. “Instead of treating these injuries as one-time events, we need care pathways similar to those used for diabetes or cancer survivorship that connect patients with long-term monitoring and specialty care throughout their lives.”

Co-developed by members of the Global Coalition for TBI as a Notifiable and Chronic Condition, the framework argues that millions of people worldwide face elevated risks of serious health problems years or even decades after a brain or spinal cord injury, yet most health systems continue to focus care primarily on the immediate aftermath of the injury.

Treatment beyond the brain

The new framework highlights growing evidence that people with TBI and SCI face increased long-term risks not only for neurological and psychiatric conditions, like memory loss, headaches, or depression, but also for cardiovascular, endocrine, and metabolic diseases. Research has linked TBI to elevated risks of stroke, dementia, hypertension, heart disease, diabetes, endocrine dysfunction, and other chronic conditions, with risks persisting for years after the initial injury. Importantly, these risks are not limited to people with severe injuries.

"Many people anticipate the neurological or psychiatric effects of a brain injury, like trouble sleeping, impaired memory, or mood swings. What we’re learning is that individuals across the spectrum of brain and spinal cord injury experience complications across different biological processes not directly related to the brain, and that many providers aren’t yet trained to look for these,” Schneider said. “We need systems that help identify and address those risks before they lead to avoidable disability, hospitalization, or death.”

The recommendations are particularly relevant for populations at increased risk of TBI, including athletes, military veterans, older adults who experience falls, and people injured in motor vehicle crashes.

A new framework for care

The authors propose a chronic-care model that connects patients to long-term monitoring beginning soon after injury. Rather than waiting for complications to emerge, the framework outlines routine screening for conditions commonly associated with brain injuries, conditions that the individual might be already predisposed to, and referrals to specialists when needed.

“Updating pathways to care for individuals after brain and spinal cord injury is an essential part of this new framework,” Schneider said. “Many patients living with neurotrauma are already dealing with cognitive symptoms or executive dysfunction that can make it difficult to navigate a fragmented health system. We need systems that proactively connect people with the care and resources they need.”

For patients who have experienced a brain or spinal cord injury, the authors encourage ongoing engagement with primary care physicians and other health care providers, even years after the injury.

“People who have experienced neurotrauma should understand that their health journey may not end when the initial symptoms improve,” Schneider said. “Regular follow-up and paying attention to new symptoms can play an important role in protecting long-term health.”