AUDIE CORNISH, HOST:
Studies of traumatic brain injury have revealed links to dementia and memory loss among veterans and athletes. It's also linked to PTSD among current and former service members. And another group maybe suffering so largely in silence, survivors of domestic violence. Will Stone of member station KJZZ in Phoenix brings us this report.
WILL STONE, BYLINE: Hundreds of survivors of domestic violence have come through the doors of neurologist Glynnis Zieman's clinic in the past three years
GLYNNIS ZIEMAN: Domestic violence patients are the next chapter of brain injury.
STONE: Zieman begins every new patient visit with a simple question - what are the symptoms you hope I can help you with? For most, it's the first time anyone has ever asked even how they may have gotten injured in the first place.
ZIEMAN: I actually heard one patient tell me, the only person who ever asked her if someone did this to her was a paramedic as she was being wheeled into an ambulance. And the husband was at the foot of her stretcher.
STONE: In fact, about 70 percent of those seen in the emergency room for such abuses are never actually identified as survivors of domestic violence. It's a health crisis cloaked in secrecy and shame, one that Zieman is uncovering through her work at the Barrow Concussion and Brain Injury Center in Phoenix. She runs a first-of-its-kind program dedicated to treating traumatic brain injury for survivors of domestic violence.
ZIEMAN: About 81 percent of our patients had so many hits to the head that they lost count, which, when you compare that to athletes, is astronomical.
STONE: Domestic violence is estimated to affect 10 million people each year. Head and neck injuries are some of the most common. And Zieman is showing just how much traumatic brain injury is a part of that. The lack of recognition has left many survivors in the dark without a diagnosis, often blamed for their cognitive impairment.
ZIEMAN: They've been labeled for so long with all these horrible things. And in the end, it's not only not their fault but there is a true medical reason behind these issues. And there's some things that can be done.
STONE: Zieman works with local domestic violence shelters to identify women who may be suffering from brain injuries. Workers will send them to her clinic where their physical symptoms, like headaches or dizziness, can be treated along with the cognitive and emotional effects of their abuse. Ashley Bridwell, a social worker at Barrow, works hand in hand with Zieman to help survivors manage life with a brain injury.
ASHLEY BRIDWELL: These long histories of emotional and physical abuse - and then you couple that with the cognitive impairment that a lot of these survivors face.
STONE: Bridwell helped start the program six years ago after doing outreach to the homeless community and realizing many had traumatic brain injuries because of domestic violence.
BRIDWELL: Some of these simple things like filling out an application or remembering an appointment - it's close to impossible considering what they're experiencing.
STONE: Patients will sometimes arrive at their clinic with a constellation of seemingly unexplainable symptoms. Bridwell remembers one who lost her job because of her difficulties with memory. The woman thought she had Alzheimer's.
BRIDWELL: And for her to come in and get some information about how multiple hits to the head can impact your memory, your attention, your concentration, your speed of processing - it was incredibly validating for her.
STONE: While many patients initially seek out the clinic because of physical symptoms, Dr. Zieman says their research shows anxiety, depression and PTSD usually end up being the most severe.
ZIEMAN: The significance of the mood symptoms in this population far exceeds what we see in our other patients.
STONE: Zieman says we're still in the early stages of understanding the effects of repetitive brain injury and how we can better treat it. The trauma of domestic violence only complicates the picture. But the survivors she sees remain her favorite to treat.
ZIEMAN: We can make the biggest difference for these patients.
STONE: A difference that can start with a diagnosis and lead to a new life.
For NPR News, I'm Will Stone in Phoenix.
CORNISH: This story is part of a reporting partnership with NPR, KJZZ and Kaiser Health News.
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