Scores of Oregonians suffer traumatic brain injuries every year, and now the state is working on doing something about it.
The Oregon Health Authority recently published a dashboard that shows that every year hundreds of state residents die from traumatic brain injuries and tens of thousands seek emergency care. At the same time, the Oregon Department of Human Services is creating a center to help people find the range of services they often require.
鈥淔or far too long, brain injury survivors have not been recognized in Oregon,鈥� said Dave Kracke, brain injury policy coordinator at the Center on Brain Injury Research and Training at the Oregon State University. 鈥淎s a result, services and supports for this huge population have not been provided.鈥�
The federal Centers for Disease Control and Prevention defines a traumatic brain injury as a bump, blow, jolt or penetrating injury to the head. Some people die. Others can suffer debilitating injuries, including difficulty speaking and problems with memory and attention. Brain injuries also can affect movement and balance, cause depression and anxiety and provoke aggression, anger and lack of impulse control.
鈥淲hen you look at all the ways that a brain injury can affect you 鈥� cognitive, physical, behavioral and emotional 鈥� things that people without a brain injury take for granted 鈥� it really is a one, two three, four punch,鈥� Kracke said.
He knows 鈥� firsthand. At 12, his younger brother fell off his skateboard when no one was looking. He came home, skateboard in hand and lay down.
He didn鈥檛 look injured but he was not himself.
鈥淗e had this horrible amnesia,鈥� Kracke said. 鈥淗e didn鈥檛 know me, and he didn鈥檛 know my mom.鈥�
His brother recovered, but some people are injured for life and some land in jail.
鈥淭he lack of impulse control has been shown to be a real significant cause of criminal behavior,鈥� Kracke said. 鈥淭hat aspect of it is just devastating.鈥�
Thousands affected
The dashboard shows that about 4,000 people were hospitalized every year between 2018 and 2022 with a traumatic brain injury, and about 30,000 sought medical care in an emergency room.
Those numbers have been relatively steady, but others have not. Between 2010 and 2022, fatalities from traumatic brain injuries rose from about 750 cases in 2010 to nearly 1,250 in 2022.
Likely many more people have been injured or died because the dashboard only counts traumatic brain injuries listed on death certificates or by hospitals. That means that those who鈥檝e sought primary or urgent care, or seen a chiropractor or physical therapist, are not necessarily counted, nor are those who鈥檝e suffered a stroke or another cause of a brain injury, such as strangulation, a problem in domestic violence, Kracke said.
Kracke is reluctant to estimate the actual number of people with brain injuries, but he said it鈥檚 certain to be much higher than those on the dashboard, which Oregon Health Authority officials plan to expand to include causes and other information.
鈥淭he purpose of the TBI data is to help us better understand the significant frequency impacting individuals and our community as well as higher burdens to different groups of Oregonians,鈥� said Dagan Wright, a senior OHA injury expert.
The current data shows that men older than 65 and rural residents suffer the highest share of fatalities, which are most often associated with firearms. Older men also account for the highest share of hospitalizations, and seniors are most likely to seek emergency care, with rates for women slighting outpacing those of men.
Oregon Health Authority officials also say communities of color and tribal communities are among the most likely to be affected by a brain injury, along with veterans, people who are homeless, rural populations, survivors of partner violence and people in correctional institutions.
Falls are the No. 1 cause of brain injuries, which accounts for the high share of older people affected, experts say. And men are more likely to engage in risky behavior, which likely explains those high numbers, said state Sen. Deb Patterson, D-Salem.
She recently championed legislation to ensure brain injury survivors get needed help.
鈥淚鈥檓 thrilled that the dashboard is up and running and that they鈥檙e collecting this data,鈥� Patterson said. 鈥淭he fact that the numbers are up, particularly among younger men, is a good sign that people are starting to realize how easily this can happen.鈥�
Navigation resource center
His brother鈥檚 injury did not shape Kracke鈥檚 future. But one client he represented as a personal injury lawyer did. During a carjacking, she was dragged across a parking lot by her car and suffered a traumatic brain injury. Kracke tried to get her car insurer to pay damages through her uninsured motorist coverage.
The company refused 鈥� because she was injured by her own car.
That angered Kracke and spurred him into legislative action.
鈥淚 didn鈥檛 let it go,鈥� Kracke said.
By 2005, he succeeded with the passage of a bill that extended uninsured motorist coverage to injuries caused by carjackings. His involvement grabbed the attention of the Brain Injury Association of Oregon, which asked him to join their board.
That launched his career as a brain injury advocate.
Over the past 15 years, Kracke has championed several bills on brain injuries through the Legislature: , which took effect in 2010, requires schools to implement concussion management guidelines for athletes. , which established concussion management guidelines for non-school affiliated athletes in Oregon, took effect in 2014. Six years later, Kracke co-wrote a bill to provide academic, behavioral and social support for concussed students returning to school. took effect in 2021.
His most recent endeavor, with the help of Patterson in the Senate, was passing in the 2023 session. It directs the Department of Human Services to establish a brain injury resource center to help brain injury survivors access services.
DHS is still working on the project. Jake Sunderland, a DHS spokesman, said the agency is hiring a manager and seven other staff, including six case managers. He had no information about when the center will be operational or what exactly it will do.
The law says it will provide service coordination, resource navigation, advocacy and options counseling. Kracke said that means case managers will ensure that survivors are connected with the therapeutic and other resources they need.
A survey by the brain injury research center shows that, on average, brain injury survivors need 12 kinds of services, Kracke said, from diagnostic testing to mental health counseling and occupational therapy to help with things like transportation and social support.
Kracke said the center won鈥檛 merely give survivors lists of services or even numbers to call, which he said would be useless. Rather, case managers will ensure connections are made through three-way chats with the patient, case manager and provider, he said.
鈥淭hey will make sure that that connection is made,鈥� Kracke said. 鈥淎nd ideally, there will be follow ups at whatever intervals they decide.鈥�
That鈥檚 the kind of help patients need to recover, experts say.
鈥淗ealing does happen with proper support 鈥� health care, social support, behavioral support,鈥� said Jonathan Modie, a spokesman for the Oregon Health Authority. 鈥淢ost people recover, living healthy and full lives.鈥�
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