Condition or System of Care

What Is Known

What Needs to be Known


Cost data of longitudinal care will soon be available.

Factors such as assertiveness training, education, and advocacy which result in effective interventions should be studied.



Limitation of various categories of insurance for essential services and equipment should be determined.

lesion into a complete lesion, which not only increases impairment but also diminishes the prognosis for recovery (National Research Council, 1985).

Associated Injury Persons with central nervous system trauma often have multiple injuries to other organs, and these associated injuries can contribute to further complications and impairment. For example, recent studies indicate that as many as 82 percent of patients with TBI sustain associated injuries (Bontke, 1989). These associated injuries include fractures of long bones, skull, and spine; chest and abdominal injuries; and peripheral nerve damage (Stover and Fine, 1986). The high incidence of associated injuries is related to the major role that motor vehicle crashes play in causing central nervous system trauma.

Finally, about 10 percent of TBI patients have associated SCI, and 10 percent of SCI patients have associated severe TBI. Compared with those who damage only one organ of the central nervous system, both groups sustain greater impairment and subsequent disability. A recent report indicates that up to half of SCI patients may have a mild head injury, but the incidence of long-term impairment in these cases is not known (Davidoff et al., 1988). A reduction in overall impairment and mortality may be achievable by improving the skill with which TBI and SCI patients are managed (National Research Council, 1985).

Complications (Secondary Conditions) The effect of medical complications on individual function is significant. Patients with SCI and TBI often have similar complications that contribute to impairment and functional limitation, including complications to the cardiopulmonary-vascular, neuromusculoskeletal, and genitourinary-gastrointestinal systems; however, considerably more is known about the incidence and potential for intervention

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