Wherefore Art Thou ABI
The Absence of Acquired Brain Injury from Australia’s Neurological Blueprint Is Not OK
The Neurological Alliance Australia has produced an ambitious Blueprint for a National Action Plan for Neurological Conditions 2025–2031. Its central premise is sound: neurological conditions deserve a coordinated national response. But one major class of neurological disability is barely visible in the document — acquired brain injury (ABI), including traumatic brain injury (TBI).
This is not a complaint that every diagnosis should receive equal space. It is a question of whether a national framework is genuinely representative of the population it claims to cover. The Blueprint explicitly aims to be inclusive, lifelong and person-centred. Yet the phrases “acquired brain injury” and “traumatic brain injury” do not appear in the substantive text at all. The closest references are to “head injury” or “head injuries”.
A coalition can contain more than forty neurological organisations and still fail to represent the neurological population proportionately. Membership breadth is not the same thing as population coverage.
A necessary point of terminology
ABI and TBI are not two separate peer categories. Traumatic brain injury is one cause of acquired brain injury. ABI also includes brain injury acquired through stroke, hypoxia or anoxia, infection, tumour and other causes. For that reason, the policy language that matters is “acquired brain injury, including traumatic brain injury”. That formulation is both accurate and broad enough to encompass the diverse pathways by which a previously functioning brain can be injured.
Where ABI and TBI should appear — and do not
1. The definition of “neurological conditions”
What the Blueprint does: The Blueprint defines neurological conditions broadly as conditions primarily affecting the brain, spinal cord, peripheral nerves and/or muscles. It specifically discusses neuromuscular conditions and rare or complex multi-system conditions. Yet it does not explicitly name acquired brain injury or traumatic brain injury.
What is missing: This is the most fundamental omission. If a national neurological plan intends to include acquired injuries of the brain, it should say so in its definition. A simple addition — “including acquired neurological conditions such as stroke, traumatic brain injury, hypoxic brain injury and brain infection” — would remove the ambiguity.
2. The document’s own list of systemic gaps
What the Blueprint does: The Blueprint identifies fragmented services, inadequate national neurological data, insufficient research, poor coordination, workforce problems and failures of prevention and early intervention.
What is missing: These are not peripheral concerns in ABI. They describe the architecture of the problem. People with significant brain injury commonly move through trauma or acute medicine, neurosurgery, rehabilitation, disability services, primary care and community supports, often without one service retaining responsibility for long-term neurological consequences. ABI should be used as an explicit exemplar of why integration is needed.
3. First Nations and remote communities
What the Blueprint does: The section on First Nations and remote communities names stroke, dementia, epilepsy and Machado–Joseph disease. It notes higher rates of epilepsy associated with meningitis and “head injuries”, but does not discuss TBI as a neurological disability in its own right.
What is missing: This is an odd inversion: brain injury becomes visible only as a possible cause of another neurological condition. A national plan should explicitly consider traumatic brain injury, its causes, its long-term consequences and the particular challenges of culturally safe rehabilitation and follow-up in rural and remote communities.
4. Children and young people
What the Blueprint does: The Blueprint states that neurological conditions may be acquired later in life and may result from “head injury or infection”. It then concentrates largely on genetic, developmental and progressive conditions.
What is missing: This is an obvious place to name paediatric ABI and TBI. The relevant issues include return to school, evolving cognitive deficits, behaviour and executive function, family burden, rehabilitation and the fact that the consequences of an injury may become more apparent as developmental demands increase. “Head injury” is too loose a label for this.
5. Prevention, early diagnosis, intervention and treatment
What the Blueprint does: Strategic Objective 2 gives substantial attention to diagnostic pathways, genetic screening, newborn screening, specialist access and Centres of Expertise for rare disease.
What is missing: Those priorities are legitimate, but they reveal a disease-centred model. In TBI, diagnosis is often not the central difficulty: the injury is already known.
The neglected pathway is prevention → acute survival → rehabilitation → community reintegration → return to work or education → mental health → long-term neurological follow-up.
A truly inclusive national plan needs both models.
6. Lifelong, person-centred care
What the Blueprint does: Strategic Objective 3 promises equitable access to lifelong, person-centred care and seamless transitions across services.
What is missing: Few groups illustrate the need more clearly than people living with moderate or severe ABI. Cognitive, behavioural, psychiatric, vocational and relational consequences may persist for decades. Yet the Blueprint does not identify acquired brain injury as a population for whom long-term follow-up and coordinated care should be designed explicitly.
7. Rehabilitation
What the Blueprint does: The Blueprint argues that scaling rehabilitation and treatment could produce major health and economic gains, and its action tables call for access to therapies, integrated care and multidisciplinary models.
What is missing: For many acquired brain injuries, rehabilitation is not an adjunct to treatment; it is the core treatment after acute survival. Neurorehabilitation, vocational rehabilitation, cognitive rehabilitation and community reintegration should therefore appear explicitly in the national framework, rather than being left inside generic language about “therapies” and “integrated care”.
8. Mental health, social isolation and family impact
What the Blueprint does: The Blueprint recognises depression, anxiety, social isolation, peer support, carers, counselling and financial support.
What is missing: All are highly relevant after significant ABI. Brain injury can alter employment, relationships, identity, behaviour and social participation, while also increasing demands on families and carers. The document sometimes refers to people living with “chronic neurological diseases”. That terminology can itself exclude people whose chronic neurological disability arose from injury rather than disease.
9. Research, data and Neuro Hubs
What the Blueprint does: The Blueprint proposes a Neurological Research Mission, a linked National Neurological Data Repository hosted by AIHW, Neuro Hubs and nationally funded Centres of Expertise. Its research priorities emphasise clinical trials, innovative medicines, precision therapies, prevention and cures.
What is missing: ABI needs a complementary research agenda: long-term outcomes, rehabilitation, cognition, behaviour, return to work and education, suicide and mental health, family outcomes, service models, implementation science and community participation. Likewise, a national neurological dataset should deliberately capture acquired brain injury, and Neuro Hubs should include explicit ABI pathways rather than assuming that injury will be absorbed automatically into a disease-oriented model.
The omission is more striking because brain injury is already inside the Alliance
Brain Injury Australia is shown among the member organisations of the Neurological Alliance Australia. That makes the absence of explicit ABI/TBI language from the substantive framework harder to dismiss as a simple question of organisational scope. The constituency is present at the table, but the injury pathway is largely absent from the policy architecture.
The Australian Institute of Health and Welfare also makes clear that head injury is not a marginal health-system issue. In 2020–21, head injuries resulted in approximately 406,000 emergency department presentations, 142,000 hospitalisations and 2,400 deaths. These figures are broader than TBI — not every head injury is a brain injury — but they demonstrate the scale of the injury pathway that a neurological plan cannot sensibly treat as incidental.
The deeper structural issue
The Blueprint appears to be strongest where neurological advocacy has traditionally been strongest: disease-specific diagnosis, genetics, screening, specialist treatment, medicines, rare disease and disease-modifying research. There is nothing wrong with those priorities. The problem is that they do not describe the whole neurological landscape.
Disease-oriented neurological pathway
Risk → screening → diagnosis → specialist treatment → disease-modifying therapy → monitoring
Acquired brain injury pathway
Prevention → injury → acute survival → rehabilitation → adaptation → disability and participation → long-term follow-up
A national action plan needs both. Otherwise a person whose neurological disability arose through trauma, hypoxia or infection risks becoming conceptually invisible: neither undiagnosed, nor awaiting a cure, but living for decades with the consequences of an injured brain.
What I would change in the Blueprint
The document describes itself as a “living document”, which means these omissions are fixable. At minimum, the next version should:
· Explicitly include “acquired brain injury, including traumatic brain injury” in the definition of neurological conditions.
· Name ABI/TBI within priority populations, including children and young people and First Nations and remote communities.
· Create an explicit national ABI pathway spanning acute care, specialist rehabilitation, community rehabilitation, mental health, vocational support and long-term follow-up.
· Ensure the proposed National Neurological Data Repository identifies and tracks acquired brain injury rather than relying on fragmented injury, hospital and disability datasets.
· Include ABI-focused research priorities alongside genetic, pharmaceutical and disease-modifying research.
· Require Neuro Hubs and Centres of Expertise to demonstrate how people with acquired brain injury will access coordinated multidisciplinary care.
· Use “neurological conditions” or “neurological disability” where appropriate rather than defaulting to “neurological diseases”, so that injury-related conditions are not linguistically excluded.
· Include people living with ABI, families, carers, clinicians and brain-injury organisations in the governance, monitoring and evaluation of the final National Action Plan.
A criticism of the framework, not of the conditions it does include
This argument should not become a contest between neurological conditions. Rare diseases, neuromuscular disorders, epilepsy, Parkinson’s disease, dementia, multiple sclerosis and the other conditions represented in the Alliance plainly deserve national attention. The issue is representativeness: an umbrella organisation seeking a national neurological plan should ensure that its framework reflects the major ways in which neurological disability actually occurs.
The strongest criticism is not that brain injury deserves a bigger slice of somebody else’s pie. It is that the Blueprint’s model of neurology is incomplete.
Conclusion
The Neurological Alliance Australia is right to argue that neurological conditions have been fragmented, under-recognised and insufficiently coordinated. But its own Blueprint risks reproducing a version of that problem.
Acquired brain injury — including traumatic brain injury — should be named, measured and designed into the national plan from the outset. It should not have to rely on being inferred from references to “head injury”, rehabilitation or generic neurological care.
If Australia is going to create a genuinely national neurological strategy, the test is simple: it must work not only for people waiting for a diagnosis or a new treatment, but also for people whose diagnosis arrived in an ambulance and whose challenge is living with the consequences for the rest of their lives.
Sources
Australian Institute of Health and Welfare. Head injuries in Australia 2020–21 (2023).
Australian Institute of Health and Welfare. Disability in Australia: acquired brain injury.
Note: “Head injury” data are broader than traumatic brain injury and should not be treated as a direct estimate of TBI incidence. This article uses those figures only to indicate the scale of injury-related presentations to the health system.
