In a new paper published in The Lancet Neurology, " Reframing traumatic brain injury and spinal cord injury as chronic multisystem disorders: toward integrated, long-term care ," international experts across institutions and disciplines propose a fundamental shift in how traumatic brain and spinal cord injuries in adults are understood and managed. Sandro Marini, MD , of the Mass General Brigham Neuroscience Institute, is a co-first author, and Saef Izzy, MD , also of the Neuroscience Institute, is one of the co-senior authors, and the primary corresponding author.
Q: What challenges or unmet needs make this study important?
Traumatic brain injury (TBI) and spinal cord injury (SCI) are still frequently treated as isolated events with time-limited consequences. However, many survivors develop cardiovascular, metabolic, endocrine, neurological, psychiatric and functional complications that can continue or emerge years after the original injury. Despite this long-term burden, surveillance is often fragmented or absent once patients leave acute care and rehabilitation. As a result, complications may not be recognized until they cause hospitalization, functional decline or other preventable harm.
Q: What central question(s) were you investigating?
First, we asked whether TBI and SCI should be reframed as chronic multisystem conditions rather than as injuries that end when acute treatment and rehabilitation are completed.
We also examined what a practical, long-term care pathway would need to include and what changes, from clinical to workforce to policy, would be required to implement coordinated care across different health systems.
Q: What methods or approach did you use?
We searched multiple databases for English-language studies published between 2020 and 2026, focusing on prospective analyses of long-term outcomes after TBI or SCI, and consulted international experts and stakeholders. We then integrated this evidence with established chronic-care models — such as those for stroke, diabetes and cancer survivorship — to develop a practical blueprint for long-term neurotrauma care.
Q: What did you find?
The available evidence consistently indicates that neurotrauma can initiate biological, behavioral and social changes that persist for years or decades. These include issues like chronic inflammation, accelerated biological aging and increased cardiometabolic risk, to name a few. Yet most health systems continue to provide episodic support rather than coordinated long-term follow-up.
This Policy View builds on a sustained body of work at Mass General Brigham and elsewhere that has helped define this change in thinking. Over the past seven years, studies led by Izzy, Marini and colleagues, including large cohort analyses published in JAMA Network Open in 2022 , 2024 , August 2025 and November 2025 , showed that survivors of traumatic brain and spinal cord injury face higher rates of new cardiovascular, endocrine, neurological and psychiatric conditions. Those studies helped establish the size and breadth of the long-term risk. This new paper in The Lancet Neurology takes the next step: it translates that evidence into a blueprint for care.
Based on these findings, we propose recognizing adult TBI and SCI as acute-onset, multisystem chronic-risk conditions. We outlined a prevention-first pathway that includes, but is not limited to, neurotrauma care navigators, scheduled multisystem screenings, telehealth-enabled care and direct connections to specialized services. We also identified seven priorities for implementation, spanning health policy (formal recognition of chronic neurotrauma, payment reform and longitudinal registries), clinical care (access to specialized rehabilitation and closer links with stroke, memory, psychiatric and epilepsy services) and workforce development and equity, along with building the economic evidence to sustain these changes.
Q: What are the real-world implications, particularly for patients?
For patients and families, the central message is that recovery and medical risk do not end at discharge. Some later complications may be preventable, and structured follow-up, clear information about long-term risks and a reliable point of contact, such as a care navigator, would help survivors recognize early warning signs, understand the purpose of recommended screening and take a more active role in their own preventive health.
The framework is deliberately tiered, from a core package that can be delivered with limited resources to intensive multidisciplinary care for patients with complex needs, so that every health system can begin with what it has. In lower-resource settings, a minimum dataset, community health workers, mobile health tools and teleconsultation can provide a practical starting point.
Q: Do you have any follow-up studies planned to validate or build on these findings?
Our next step is to characterize people living with TBI more precisely by combining longitudinal clinical information with multiomic data. This will help us better understand why some individuals develop particular long-term complications and identify distinct risk profiles. We then plan to use these findings to tailor prevention more effectively and prospectively test the care pathways and interventions proposed in this work.
Authorship: In addition to Marini and Izzy, Mass General Brigham authors include Joseph Giacino. Additional authors include Andrea Schneider, Abdulrahman Alshaya, Peter Bragge, John Corrigan, Kristen Dams-O'Connor, Cathra Halabi, Kathryn Hendrick, Peter Hutchinson, Tariq Khan, Almas Khattak, Steven Kirshblum, Tarun Lala, Marianne Løvstad, Geoffrey Manley, Saniya Mediratta, Masao Nagayama, Virginia Newcombe, Mary Jo Pugh, Gail Rosseau, Olli Tenovuo, Sara Venturini, Fiona Wilson, Lindsay Wilson, David Menon, Flora Hammond and Ross Zafonte, together with the Global Coalition for TBI as a Notifiable and Chronic Condition.
Paper cited: Marini S., Schneider A.L.C., et al. "Reframing traumatic brain injury and spinal cord injury as
chronic multisystem disorders: toward integrated, long-term care." The Lancet Neurology. DOI: 10.1016/S1474-4422(26)00297-8
Funding: Izzy reports grant support from the National Institutes of Health and the Department of War.
Disclosures: Marini declares no competing interests. Izzy reports royalties from McGraw Hill. Giacino reports institutional support from the National Institute on Disability, Independent Living, and Rehabilitation Research and the University of California, San Francisco, as well as unpaid membership on the TBI Model System National Data and Statistical Center Advisory Board. Additional author disclosures are provided in the manuscript.
