The position of the Brain Injury Network is that acquired brain injury (ABI) includes traumatic brain injuries (TBI's), strokes, brain illness, and any other kind of brain injury acquired after birth. However, ABI does not include what are classified as degenerative brain conditions such as Alzheimer's Disease or Parkinson's Disease.
As previously stated, there is conflict with regard to the definitions of TBI and ABI and this is causing confusion within our brain injury survivor community. That is why we are calling for consistent application of definition across all medical, legal and other venues.
[Note: As of January 2011 we have noted that some agencies are quietly updating their ABI and TBI definitions to bring them into line with what we (and others) have indicated. However, prominent entities really ought to make a public announcement when they update their own definitions, because many old timers learned the old definitions from these same agencies, and need to be alerted to the updated and/or corrected definitions.] Now, back to the text as of 12-22-08 which is still pertinent.
To back up our contention that there is inconsistency, (as of 12-22-08) here are just a few of the definitions of ABI and TBI from various respected authorities:
The Brain Injury Association in the United Kingdom and entitled Headway says "ABI covers all situations in which brain injury has occurred since birth, and includes TBI as well as tumour, stroke, haemorrhage, and encephalitis, to name a few." ["Tumour" and "haemorrhage" are the spellings used in the United Kingdom.)(The link is http://www.headway.org.uk)
The National Institute of Neurological Disorders and Stroke (NINDS) in the United States of America updated its description of TBI on its fact sheet on 6-1-09. [This agency, the Brain Injury Network, had asked them to change their definition, which formerly stated that TBI was also known as ABI, to stating that TBI was a form of ABI. They agreed.] NINDS now says that Traumatic Brain Injury (TBI) is a form of ABI. The link is http://www.ninds.nih.gov)
As of fall 2010, the Brain Injury Association of America got around to changing its long standing confusing definitions of TBI and ABI. They appear to have come around to our position which is that TBI is a form of ABI.
(However, they still say in another section of their website that although TBI's are technically a form of ABI "in their field" TBI's are different than ABI's. Too bad, because as we said, when it comes to defining these complex terms, we want everybody on exactly the same page across all medical, legal, governmental and other venues.)
[The Brain Injury Association of America had stated for many, many years that TBI and ABI were different conditions. They previously stated that acquired brain injury damage occurs at a cellular level unlike TBI.
They had stated that "Acquired brain injury takes place at the cellular level within the brain. Therefore, injury from acquired brain injury can effect (sic: affect) cells throughout the entire brain, instead of just in specific areas as with traumatic brain injury." So this section of their old definition made a distinction between a TBI and an ABI, and did not classify a TBI as a form of ABI. But then they had gone on to say in a different part of their former web site that "An acquired brain injury is an injury to the brain, which is not hereditary, congenital, degenerative, or induced by birth trauma. An acquired brain injury is an injury to the brain that has occurred after birth." So this portion of their definition would seem to have included TBI's post birth trauma in the definition of ABI. However in 2010 they have finally cleared up this inconsistency that previously existed for many, many years on their web site.]
The American Academy of Neurology stated prior to 2011 that TBI and ABI are equivalent. (The link is http://www.aan.com) [Note as of 3-30-11: In 2010 BIN emailed AAN requesting clarification about their definition of TBI. We suggested that stating that "TBI, a form of ABI" and not "TBI, also known as ABI" would be useful. Representatives of AAN did not bother to email us back about it, but we have noted on 3-30-11 that the AAN has also updated its definition of TBI and now states that TBI is a form of acquired brain injury.] http://patients.aan.com/disorders/index.cfm?event=view&disorder_id=1092)
The American Stroke Association stays off the topic of "acquired brain injury" altogether by just defining various types of strokes. They do not state that ABI is another term for stroke or that stroke is a form of ABI. (The link is http://www.strokeassociation.org/)
The Brain Injury Association in Australia states that "The term Acquired Brain Injury (ABI) is used to describe all types of brain injury that occur after birth." (The link is http://www.braininjuryaustralia.org.au/)
And these definitions are just the tip of the iceberg on what is out there in the way of defining ABI or TBI.
The term "acquired brain injury" is a catch-all term, but what one sees in the medical circles are more specific brain injury subcategories. Threads seen include neurological disorder/stroke, neurological disorder/tbi, neurological disorder/trauma or injury, or neurological disorder/tumor, etc. Somehow what happened, especially in the United States, is that (even professional) people started saying "TBI, also called ABI" without realizing that TBI is just one of the subcategories of ABI. Of course, this mixed up many people who then thought that the two terms were completely interchangeable (which they are not). But then there were some other authorities over the years who used TBI (for the external trauma to the brain) or ABI (for the strokes, etc.). Still others were saying all along that ABI included TBI, stroke, tumor, etc.
As of the year 2011, we at Brain Injury Network are certainly happy that slowly all of the applicable medical and other authorities are coming to a consensus about the definitions, because the brain injury survivor community needs that to happen.
April 18, 2011.
We have noted that the International Brain Injury Association (IBIA) is having an international conference in 2012 regarding acquired brain injury (ABI). They don't define the term. We have contacted IBIA and are hoping they will put more descriptive information about ABI on their web site. We believe that a consensus has already developed that ABI and TBI are not identical and we are hoping they agree with that, but if they don't we hope that they explain why. As usual IBIA fails to answer our email. See also International Standards.
Traumatic Brain Injury (TBI)
When it comes to the topic of traumatic brain injury (TBI), there is less dispute as to its definition. Here is what we at BIN perceive to be a particularly well drafted definition of TBI. This one came from the Assistant Secretary of Defense (USA) in a memo dated Oct. 1, 2007. The subject of this Department of Defense (USA) memo was Traumatic Brain Injury: Definition and Reporting. It was prepared by S. Ward Casscells, MD. Please click on this link: http://www.dcoe.health.mil/research/TBI_Definition_and_Reporting_Signed.pdf to read the actual memo. (Note: as of Sept. 2010, this link does not work. One can't find the memo on a Google search. Too bad. It's still a very informative PDF, so we will keep it posted.)
DEFINITION OF TRAUMATIC BRAIN INJURY
"A traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event:
Any period of loss of or a decreased level of consciousness;
Any loss of memory for events immediately before or after the injury;
Any alternation in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.);
Neurological deficits (weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient;
External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head, a foreign body penetrating the brain,forces generated from events such as a blast or explosion, or other force yet to be defined.” (End of DOD definition citation.)
Birth Trauma and Brain Injury
There is one subject regarding forms of t. b. i. that is the source of some disagreement and that is with regard to the subject of brain injury produced by birth trauma. Generally speaking, brain trauma produced by the process of birth has been specifically excluded from being classified as a form of TBI by medical definitions. However, there are many mothers of babies being born with these birth brain injuries who are upset by that exclusion. They see birth complications that result in these brain injuries as being forms of TBI. Some of these mothers see their children as being survivors of TBI, and they do not like that their children are excluded from this category.
Commentary from BIN regarding TBI and ABI Definitions
Unfortunately, in a some places TBI is being redefined by governmental entities to include conditions such as strokes, and this is wrong. (One state that has done this is the state of Ohio.) If people could remember that the word traumatic in the definition of TBI refers to the cause of the injury, not the result, this might help clear the air. Yes, many people feel traumatized because of a stroke or brain cancer or brain illness such as Meningitis, but this does not make these forms of TBI.
In spite of a few inconsistencies here and there, we don't think there is much dispute about the definition of a TBI. In the present discussion, it boils down to whether or not a TBI is an ABI. (We say yes.) But are ABI and TBI interchangeable terms? (We say no.) This is because in our estimation all TBI's are ABI's, but all ABI's are not TBI's. Look, there is no reason to duplicate a definition for the same condition. So to say that tbi is another word for abi is a redundancy. There must be a distinction in the two terms, and internationally, there is. ABI is the broad category. TBI is one of its numerous sub-classifications. So, the better way to state the connection of the two terms would be, "TBI, a form of ABI".
The flip side of this debate is whether or not strokes, brain tumors, brain damage from brain tumor, brain illness, hypoxia, etc. (in other words all forms of brain injury except for congenital, birth trauma or degenerative brain injury or damage) are also forms of ABI as stated by some authorities. (We say yes.)
Simply put, we at the Brain Injury Network are for the adoption of the definition of ABI that is the most sweeping, in order that we who all have some kind of acquired brain injury, might all band together to fight for our rights. Of course within our community there will continue to be different medical conditions, such as a stroke, TBI or a brain tumor, etc., for which there are numerous associations such as the American Stroke Association, the Brain Injury Association of America, and the International Brain Tumor Foundation. No problem with any of that. It is just that we as the survivor community must work together to get some of our goals met, because, most of our common goals have not been met, that is for sure. We at the Brain Injury Network accept the premise that we have all had acquired brain injuries. So here is the definition (more in line with numerous international authorities) that we have adopted:
Definition of Acquired Brain Injury (ABI): An acquired brain injury is an injury to the brain that has occurred after birth, but is not related to congenital defect or degenerative disease. Causes of ABI include (but are not limited to) hypoxia, illness, infection, stroke, substance abuse, toxic exposure, trauma, and tumor. ABI may cause temporary or permanent impairment in such areas as cognitive, emotional, metabolic, motor, perceptual motor and/or sensory brain function.(Please note our policy statement regarding this definition.)
We know that there is resistance to our definition in some places, but we find it to be the definition that will, in the long run, be the most inclusive, accurate and descriptive of our entire community. It is one of the goals of the braininjurynetwork.org to get everyone, and that includes the medical establishment, to adopt consistent definitions, so that this arguing about what are the correct definitions is finished. It is a waste of our energies to be arguing about something that even the medical community cannot agree upon. We have many other issues to worry about. However, that said, we will continue to promote our broad definition.