Each year, 1.4 million people in our country sustain brain injuries, and 9% will end up with lifelong impairments. Causes of TBI include car accidents, playground accidents, falls by the elderly, and domestic violence. According to the U.S. Centers for Disease Control and Prevention, 3.2 million Americans are living with long-term disabilities from brain injuries. This figure does not include the estimated 320,000 veterans from the wars in Iraq and Afghanistan who have TBI, according to the latest statistics. 

You may think you don’t know anyone with a brain injury, but they’re all around you. One could be the person you see lose his temper with the store clerk because sports-induced concussions left him short-fused. Another could be your neighbor who keeps locking her keys in the car or the man who looks healthy but needs a few tries to push a revolving door.

Despite its prevalence, brain injury bears a stigma. To many of the uninitiated, a person with TBI equals “slow” or “retarded.”

While each injury and recovery is as varied as the patient affected, scientists now know that the healing process in the brain can go on much longer than originally believed. For instance, even three-and-a-half years after the bomb blast, Bob’s speech continues to get more fluid.

Innovations in cognitive rehabilitation have played a key role in improving people’s outcomes. Twenty years ago, rehab consisted of memorization, repetition, and trying to get patients to meet certain benchmarks. “One of the advancements in rehabilitation is to make the therapy person-centered,” says Dr. Lori Terryberry-Spohr, brain-injury program manager at Madonna Rehabilitation Hospital in Lincoln, Neb. “We can tailor it to the individual’s goals, strengths, hobbies, interests, and occupations.”

In order to understand how cognitive rehabilitation works, you need to know how the brain functions. Neurons, or nerve cells, in our brains send impulses to one another to facilitate memory, thought, and speech and enable movement. When the brain is injured, the connections between neurons are temporarily or permanently disconnected or stunned.

One helpful analogy is to think of the brain’s neural pathways as highways. A brain injury is like a jackknifed tractor-trailer stopping traffic. With proper medical attention and therapy, the brain repairs itself. Neurons that ran from point A to point B can grow back in different ways and make new roads, and the brain rebuilds new paths to functions like speech and memory. They might not be exactly the same as before, but they’re still effective.

“The more sophisticated the function, like complex thought or writing, the longer it takes,” Dr. Armonda says. “But over 70% of our patients with the most severe injuries are now approaching functional independence after treatment, and that was unheard-of previously.”

“You’d never have a problem getting insurance to cover a broken bone or injured shoulder, but it is routinely denied for therapies that help brains heal,” says Susan H. Connors, president and CEO of the nonprofit Brain Injury Association of America. Her group is working with federal and state lawmakers to raise awareness of TBI and to improve reimbursement for therapy. “Brain injury is often invisible since changes are on the inside,” Connors adds. “Because of this, help and awareness are not as widespread as they should be.”

Families of people with TBI are often advised that their loved one’s recovery will be a “marathon and not a sprint.” Derek Ruth’s mother sees positive change occur in her son almost daily. Still, it’s difficult for her not to have definite answers to him about his future, to be unable to promise him that his life will be back to exactly what it was before his injury.

“Derek works so hard just to make it through one day, tying his shoes and getting dressed,” says his mom. “But brain injury is like no other injury. He can be doing his algebra and the same afternoon be unable to recognize a black spade from a red heart in a card game.”

Lee Woodruff is the author of the recently published essay collection “Perfectly Imperfect: A Life in Progress.” To learn more about TBI, visit the Bob Woodruff Foundation at www.remind.org