J Head Trauma Rehabil Vol. 22, No. 4, pp. 234–238 Copyright c  2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Traumatic Brain Injury Rehabilitation in the Netherlands: Dilemmas and Challenges G. M. Ribbers, MD, PhD Traumatic brain injury (TBI) is the number one cause of mortality and morbidity in young adults in modern Western societies. This article discusses TBI rehabilitation in the Netherlands. Facts and figures on rehabilitation as well as on the epidemiology of TBI and its silent epidemic in the Netherlands are presented. The Dutch healthcare system is described, and strengths and weaknesses of TBI rehabilitation are discussed. Keywords: Netherlands, rehabilitation, traumatic brain injury I N Europe, approximately 1.6 million patients with traumatic brain injury (TBI) are admitted to hospital annually, and 66,000 persons with TBI die each year. 1,2 The costs related to direct healthcare of TBI in Europe are estimated at 2.9 billion. Nonmedical costs due to the loss of productivity and intangible costs due to the reduced quality of life are not taken into account in this estimation. 3 Furthermore, these figures are based on hospital admissions only. The actual costs related to TBI, including societal costs outside direct health- care and including persons with TBI not admitted to hospitals, exceed these figures by a considerable mar- gin. At the break of the Decade of the Brain, Goldstein pinpointed the silent epidemic. 4 It has since become clear that TBI is the number one cause of mortality and disability in young adults in modern Western societies. However, incidence rates, TBI rehabilitation programs, insurance models, and possibly even awareness of the problem may vary over countries. This article discusses TBI rehabilitation in the Netherlands. The subject is too broad to be covered in total, and therefore this article is biased by subjective choices of the author. The article focuses on “the Dutch perspective” on epidemiology, rehabilitation, healthcare insurance, as well as strengths and weaknesses in the process of rehabilitation of pa- tients with TBI. From the Rijndam Rehabilitation Centre and the Erasmus Medical Centre, Rotterdam, the Netherlands. Corresponding author: G. M. Ribbers, MD, PhD, Rijndam Rehabilitation Centre, PO Box 23181, 3001 KD Rotterdam, the Netherlands (e-mail: g.ribbers@rijndam.nl). TBI IN THE NETHERLANDS: FACTS AND FIGURES I The Netherlands has a population of approximately 16 million people. Each year, nearly 50,000 of them are assessed at hospital emergency departments for TBI. 5 Furthermore, instantaneous death due to head injury explains 60% of mortality in road traffic accidents, ac- counting for 450 instantaneous road traffic accident deaths due to TBI in 2005. 6,7 Twenty-five percent, or 12,500, of the patients assessed at emergency depart- ments are admitted to acute care hospitals with an av- erage admission time of 7.3 days (Fig 1). Approximately 90% of the survivors are discharged to their homes, and less than 10% are followed up as inpatients in nursing homes, rehabilitation centers, or psychiatric hospitals. 8 Many patients with TBI, especially those with mild TBI, are not referred to emergency departments. For this group of patients, the facts and figures concern- ing incidence and prevalence as well as long-term con- sequences remain obscure. Sports injuries are an ex- ample of this category. 9,10 Whiplash injury is another example of a disease that is not represented in these figures. An overwhelming majority (about 90%) of pa- tients with TBI who are discharged at home do not receive any follow-up treatment. 11 These figures seem to suggest that most patients experience good overall recovery. However, a Dutch follow-up study of 15 to 30 years olds, 3 to 7 years postinjury, revealed that 67% of the subject experience situational disabilities (re- duced tolerance of noise, light, and stress), 55% cognitive disabilities (reduced mental speed, orientation, percep- tion, concentration, language, memory, and executive functions), and 45% emotional/behavioral disabilities (resulting from the interaction between primary disor- ders, including organic-related impairment of emotion, 234