Violent assault is rated among the top three most common causes of Traumatic Brain Injury, which is a major cause of disability and death worldwide. In 2004-05 TBI was responsible for around 22,700 hospitalisations, about 980 deaths in hospital, and estimated direct hospital care costs of $184million.

* Overview of Acquired Brain Injury and Assault
* Statistics
* Alcohol & Violence
* Domestic Violence
* Assault and Indigenous Communities
* Legal Issues

Overview of Acquired Brain Injury and Assault

The brain is the seat of our personality, thinking and emotions and in the heat of violent attack is one of the most vulnerable areas to permanent damage. Damage may be inflicted through a blow to the head by an object or body part (punch, kick, elbow etc), fall to the ground and strangulation, resulting in open or closed head injuries. The brain is known to have the consistency of jelly and with a violent blow, brain tissue can be bruised or torn and may lead to haemorrhaging, contusions and/or haematoma. At the microscopic level the complex connections between neurons – the communication pathways - can be stretched or torn.

A single injury to the brain can change the life of a person and their family. People with a brain injury often suffer cognitive, mood and behavioral disorders, which can have long-lasting impacts on social and emotional development, on employment and overall quality of life. Also, a brain injury not only changes the live of a single person, but it impacts on a whole family network.

There are five areas in which people with a Traumatic Brain Injury may experience long term changes:

* Changes in physical and sensory abilities eg. changes in sense of balance, vision, coordination of movement.
* Medical difficulties eg. chronic pain, headaches, epilepsy
* Changes in the ability to think and learn (cognition) eg. ability to plan and organise and remember.
* Changes in behaviour and personality (psychological) eg. mood fluctuations, ability to control emotions
* Communication problems eg. problems with fluent speech.

Due to the effects of a brain injury a person is at an increased risk of experiencing:

* Depression or Post-Traumatic Stress Disorder related to the trauma of violence
* Social isolation
* Employment related difficulties
* Relationship issues

Statistics

* More than 3,000 Australians suffer an assault-related brain injury each year (BIA).
* Assault related brain injury made up 15% of all cases of Traumatic Brain Injury in the 2004-5 year [1].
* Out of the three main causes of TBI, assault contained the youngest age group [1].
* Rates of hospitalisation of TBI due to assault are much higher for males across all aged groups. The rate was highest in the 20-24 age groups [1].
* The rates for males were 5 to 7 times the rate for females from 15-19 years through to 30-34 years.
* The majority of males (66%) recorded the assault as being perpetrated by an unspecified person, compared to 39% of females. For females who indicated a specified perpetrated the highest proportion was for spouse or domestic partner, followed by family member and then friend or acquaintance [1].
* Of all assaults resulting in principal diagnosis of TBI and that occurred in a specified place, the highest proportion (20%) were reported as occurring in a Trade and Service area with a higher proportion of cases reported for males (23%) than females (8%). Of the trade and service area assaults, 82% occurred in a café, hotel or restaurant. Of assaults occurring in the home (13%), the proportion for females (37%) was more than four times higher than the proportion of males (9%)[1].

Alcohol & Violence

Alcohol and drugs are a major contributing factor to assault. There is strong evidence of a link between heavy alcohol use and violence, particularly in younger people. This association is thought to be due to a number of factors. One is the direct pharmacological effects of alcohol, particularly decreased inhibition and impulse control. Other factors involved in the association between alcohol and violence are related to a person’s temperament, risk taking behaviours, the social environment, culture and expectations of alcohol’s effect. Preventative measures should be taken to reduce the incidence of alcohol related violence.

Tips:

* If you are prone to violence when drinking alcohol, consider total abstinence or maintaining your blood alcohol level under the limit.
* Avoid crowded, overheated bars.
* drink only with trusted friends.

Domestic Violence

Traumatic brain injury is often a hidden outcome of domestic violence toward either women or men. A person may still sustain damage even though there has been no loss of consciousness and where repeated blows have occurred. Damage may result from blows to the face/head, violent shacking, strangulation, suffocation and falls. A person who has been a victim of domestic violence may not be aware that they have had a trauma to the brain and may never present to hospital. For those who do present to hospital and who have sustained serious injuries as a result of domestic violence, the injury may be claimed to be the result of other events for fear of the result of their partner finding out.

Some perpetrators may have a TBI themselves due to past violence behaviour and risk related behaviours.

Symptoms of Concussion:

* Headache
* Disorientation (confusion) as to time, date, or place
* Dizziness
* Vacant stare or confused expression
* Speech that is difficult to understand
* Lack of coordination or weakness
* Amnesia (loss of memory) about events just preceding the blow
* Nausea or vomiting
* Double vision
* Ringing in the ears

(Source: http://www.faqs.org/health/Sick-V1/Concussion.html)

Some questions ask yourself or someone else to determine whether they may have received trauma to the brain from previous episodes of domestic violence:

* Have you had a blow or repeated blows to the head?
* Do you have trouble concentrating and organising things?
* Do you have trouble remembering things
* Do you experience frequent headaches and problems with vision/hearing or loss of balance?

Source: http://www.biav.net/docs/domesticviolence.pdf

Indigenous Communities

In the period July 2002-2004, assault was the most common cause for hospitalization for indigenous males and females hospitalised with a diagnosis of injury and poisoning (26% and 37% respectively) in QLD, WA, SA and NT.

* According to one study, Among the indigenous population the rate of head injury due to assault was 854.8 per 100000, while among the non-indigenous population it was 40.7 per 100000 (Jamieson et al., 2008).
* Indigenous people living in both metropolitan and rural/remote locations experienced nine times the rate experienced by non-indigenous.
* The findings indicated that the rate of hospitalization for head injury due to assault among indigenous Australians in four jurisdictions (QLD, NT, NSW & SA) was 21 times that among non-indigenous Australians in the 6-year period 1july 1999 to June 2005 (Jamieson et al., 2008).

Legal Issues

* A person may choose to seek compensation for trauma related to the violent attack through the legal system.
* Legal aid may be able to assist people with this, where financial hardship exists.

Going through the criminal justice system can be a very stressful time for a person who has been a victim of violence. It is important for a person to have the support of family and friends when needed. A person may be trying to cope with the feelings associated with the attack while managing the paper work and legal requirements of going to court. Counselling and support groups for victims of assault  are available. Contact your state Brain Injury Association for options.

If you would like to seek legal advice regarding an assault related incident, see contact below.

Legal Aid QLD

For free legal information Ph. 1300 65 11 88

Aussie Legal (Australia wide)
Ph. 1300 728 200
More Information and References



Help with Domestic Violence related issues:
DV connect Women’s line QLD: 1800 811 811
DV connect Men’s Line QLD: 1800 600 636

Hospital separations due to traumatic brain injury, Australia 2004-05
http://www.aihw.gov.au/mediacentre/2008/mr20080912.cfm
Brain Injury Association of Tasmania http://www.biat.org.au/resources/documents/pdf/Media%20Release%20Assault%20packs%20a%20lifelong%20punch.pdf
Aboriginal and Torres Strait Islander health performance framework 2006 Report: detailed analysis
http://www.abc.net.au/news/stories/2008/09/15/2365128.htm
(Jamieson et al., 2008)
http://www.mja.com.au/public/issues/188_10_190508/jam11393_fm.html