Photo by Bill Green Jean Berube is a leading expert and lobbyist in the country on traumatic brain injuries and organized a conference on Capitol Hill. Purchase this photo

"It was months later, in October, when he started slurring his words and showed symptoms that looked like he was having a stroke," Berube said. "My mother knew something was wrong."

Rushed to Virginia Beach General Hospital, Berube's father underwent emergency brain surgery. A subdural hematoma, as a result of brain injury, after weeks of slow, undetected bleeding, suddenly reached a critical mass.

"It took months, but my dad got better and eventually went back to work," she said. "In the end, he was fortunate."

The event changed her life.

A lawyer and legislative assistant working on health care issues, among others, on Capitol Hill for former Virginia congressman Owen Pickett, Berube returned home to Virginia briefly to take care of her family. She, of course, became very interested in what had happened to her dad, and in the nature of brain injury itself.

"I felt like I was really lucky to be a health care lawyer already with dealing with all this information, and with a congressman's office who was calling the hospital on my father's behalf," Berube said. "Not everyone obviously had these resources."

New career direction

In 1997, she left Pickett's office to become director of public policy and government relations for the Brain Injury Association in Alexandria. Since, Berube, who now lives in Frederick , has been an independent consultant and lobbyist for a variety of brain injury organizations, including the International Brain Injury Association and the National Brain Injury Research, Treatment and Training Foundation.

Today she's recognized as a leading lobbyist specializing in work on behalf of nonprofits providing research and care in the traumatic brain injury field. She works with everyone from Dr. Rick Hunt, director for injury response at the Center for Disease Control, to Col. Michael Jaffe, M.D., the national director of the Defense and Veterans Brain Injury Center, to leaders of health care reform and the Wounded Warriors Project, to congressmen such as Rep. Bill Pascrell Jr., a leading advocate for brain injury research, and Frederick Rep. Roscoe Bartlett, who joined the Congressional Brain Injury Task Force last summer.

Last week, Be?rube? served as the lead organizer of the Brain Injury Awareness Fair on Capitol Hill, hosted by the Congressional Brain Injury Task Force.

March is Brain Injury Awareness Month and the all-day fair March 25 featured presentations on mild traumatic brain injuries from the battlefield to the football field, a congressional briefing and reception. The next day an all-day seminar included panels on the costs of brain injury from the National Center for Injury Prevention and Control, health care reform and preventing disparity in civilian, military and veterans health care.

National Guard troops, for example, Berube said, once their tour of duty is done, often visit civilian doctors unfamiliar with diagnosing and treating issues such as mild traumatic brain injury.

Even before actress Natasha Richardson died earlier this month after initially rejecting medical attention following a seemingly minor fall while skiing, traumatic brain injury research and care has been receiving more attention in recent years because of the wars in Iraq and Afghanistan.

"It's often called the signature injury of the war in Iraq," Berube said.

Veterans' issue

An estimated 360,000 troops have returned with brain injuries, according to a Defense Department authorized study released this month. That estimate of injured men and women represents 20 percent of the roughly 1.8 million veterans who have served in Iraq and Afghanistan.

The majority of those injuries are caused by concussions and heal without treatment. However, an estimated 45,000 to 90,000 troops have suffered more severe and lasting symptoms, Brig. Gen. Loree Sutton, the head of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury told The Associated Press in a story on the release of the data.

Sutton added that, as in previous wars, the research and other work being done by the military will eventually benefit the civilian world. Whether the injuries occur while people ride bicycles, play football, skateboard or ski, "we know that this is an issue across the country," she said.

"In the past ... it was difficult to get this on the radar screen," Dr. James Kelly, director of the National Intrepid Center for brain injuries and psychological health, told the AP. "Brain injury was not recognized as a problem ... of any consequence and was, especially in the sports community, often dismissed or trivialized.

"I think that now you're seeing it being taken very seriously," Kelly said. "The wartime experience has been a big part of that."

"Since we invaded Iraq, they have found that the IEDs, are really rattling these guys brains," Berube said. "More and more soldiers are surviving the attacks because their body armor is so good, but they're suffering because of these brain injuries."

Troops with brain injuries, she continued, often come home suffering depression and other symptoms that have been linked to higher rates of unemployment, homelessness, divorce, suicide, alcoholism and substance abuse.

It can be difficult, she said, to distinguish whether their symptoms are connected to mild traumatic brain injury, or post-traumatic stress disorder, which is estimated to afflict 300,000 soldiers.

Berube is lobbying Congress with a consortium of health organizations, seeking $50 million to immediately improve care and deliver needed resources to troops and families struggling with traumatic brain injury.

Raising awareness

The brain can heal itself, as in the case of ABC News correspondent Bob Woodruff who was severely injured covering the war in Iraq and has returned to work. But, said Dr. Carl Valenziano, the brain is also "the only organ that injures itself.

"It is not necessarily the first injury that causes the most harm, but the brain's response," Valenziano said. Swelling, the release of chemical neurotransmitters and a shortage of oxygen can prove potentially fatal in the hours, days, and in Berube's father's case, months later — if proper emergency care isn't received immediately.

Berube said emergency care workers sometimes use the term "Golden Hour" to highlight the importance of getting to trauma victims quickly.

From what he's read of Richardson's case, Valenziano said, a prompt hospital trip, "a CAT scan and simple emergency brain surgery and she would have been released in a couple of days."

Berube pointed out, despite other celebrity deaths from head trauma, including Michael Kennedy in 1997, and Sonny Bono in 1998, also skiing-related, several state motorcycle helmet laws have been repealed in recent years.

Lilliard Richardson, a University of Missouri professor and David Houston, a University of Tennessee professor, compared the changes in helmet laws across all 50 states from 1975 to 2004.

In states where repeals were instituted, the fatality rate increased an average of 12.2 percent. Conversely, in states with universal helmet laws, the fatality rate was 11.1 percent lower than in states without the mandates, Science Daily reported.

One challenge of drawing more congressional action and building public education around traumatic brain injury has been the lack of a public spokesman, Berube said.

"There is a stigma still associated with brain injury" she said. "It's not something many people want to come forward and talk about."