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• Worldwide, brain injury is the leading cause of death and disability, according to the World Health Organistion.
• Approximately 75% of all Acquired Brain Injuries are from physical trauma.
• Traumatic brain injury (TBI) is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to temporary or permanent impairments of cognitive, physical, and psychosocial functions.
• The highest incidence of TBI occurs between the ages of 15-24 years. Persons under the age of 5 or over the age of 75 are also at higher risk.
• In the European Union, TBI accounts for one million hospital admissions per year;

          ⇒ the majority of the 50,000 deaths from road traffic accidents

          ⇒ more than 10,000 people severely handicapped

          ⇒ three-quarters of the victims are children and young adults

• This is a silent epidemic in which the primary focus is on early medical/surgical matters, and early physical rehabilitation. There is relatively very little attention devoted to the long-term emotional, behavioural, social and cognitive problems.
• A person with a brain injury often regains independent mobility, despite problems of hearing or vision, having a clumsy hand, a weak leg, a slurred voice, or epilepsy, (the most frequent physical sequelae), or the person’s impairments may be entirely non-physical….
• Many people who have had brain injury look well but have “invisible” deficits: intellectual, affective and behavioural sequelae affect personal everyday autonomy. This “invisibility” fosters additional difficulties of self-awareness and recognition by others.
• The principal disabilities linked to the invisible handicap are:

cognitive sequelae: in memory and learning, attention and concentration, information processing speed, communication (expression and understanding), orientation in time and space, visual agnosia, reasoning, decision-making, organisation, planning,flexibility,initiative, motivation;

behavioural or psycho-affective sequelae: disinhibition, lack of self-control, inhibition or apathy, and lack of initiative, mood changes, indifference, anxiety, discouragement, depression;

anosognosia – unawareness or underestimation of one’s difficulties;

chronic fatigue.

• Higher quality care is usually available in acute medicine and surgery when the brain injury is recognised (if that is possible, in a triage setting of possible multiple injuries), but later stage difficulties commonly arise if little is done for cognitive rehabilitation and social reintegration of the victim. The family is often alone to support the burden of the "stranger in the house".
• Late onset disability can also frequently result from brain injuries which appear “moderate” or “mild” at the time of hospital presentation. (BMJ 2000;320:1631-1635)
• The total burden of disability from TBI is not well measured. The most recent European estimate of TBI prevalence is the UK’s National Service Framework on Long-Term Conditions – 1.2% of people up to age 65 having long-term problems after TBI, equivalent to nearly 7 times the annual incidence figure.(Epidemiology in Annex 4 of NSF, available online