Between 30 and 80 percent of women who survive intimate partner violence may have a traumatic brain injury — but there's almost no research into how such an injury specifically affects women, according to Angela Colantonio, who helps lead an international task force on girls and women with acquired brain injury.
"It's been a very neglected field," said Colantonio, who is also director of the Rehabilitation Sciences Institute at the University of Toronto.
"We are just starting to research how women's bodies are different in terms of brain injury, and what the implications are for care," she said.
"One injury that is specifically neglected is the injury of women in an intimate-partner violence context."
When women are abused, Colantonio said, "up to 92 percent of the hits are to the head," meaning women suffer repeated injuries that are associated with a wide constellation of long-term effects.
Research looking at more than 100 women five to 12 years after injury found that over half experienced disturbances in their menstrual cycles, had more difficulty in the postpartum period, were less likely to have regular Pap smears, and reported poorer mental health than a control group.
But many women who have experienced intimate partner violence aren't even aware that something could have happened to their brain, Colantonio said.
"A lot of the woman found it interesting that some of the symptoms they were experiencing could be related to blows to the head," she said. "It was news to them that they could actually get help."
Frontline workers with women who had been abused also lack knowledge of the long-term effects intimate partner violence can have on the brain, she said.
"Most frontline workers feel unprepared in terms of dealing with the issue of brain injury," Colantonio said. "They have not, for the most part, received specific training with regard to brain injury, and there is evidence that they underestimate the level of brain injury in this population."
Women frequently aren't diagnosed with traumatic brain injury, in many cases because their symptoms mimic those of post-traumatic stress injury.
"There are significant differences in the neuro-cognitive issues around memory that could potentially be overlooked," she said. "They could be addressed through more brain-injury specific services."
More research is needed into the prevalence of such injuries, whether a diagnosis is helpful or harmful, and the longer-scale consequences, such as how traumatic brain injury might speed the progression of other conditions, including dementia.
One recommendation, Colantonio said, "is to identify allies and foster a network of advocates and people to develop a national plan to address this."
In addition to a toolkit to provide frontline workers with more information, Colantonio would like to see a large-scale study similar to those conducted on football and hockey players.
Part of the problem, she said, is that men tend to be the focus of studies.
"There's an inequity of research with respect to girls and women," she said. "There's almost nothing specifically on how women age with brain injury, on parenting, or the psychological health or emotional health issues unique to girls and women.
"We want to look at what the effects are of these repeated blows to the head and what we can do about it."