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When it comes to getting our heads bashed in, Arizona is just about tops in the nation.

To put it In medical terms, Arizonans suffer the highest rate of traumatic brain injuries of states surveyed for this devastating problem.

We are getting these injuries — resulting in lasting physical or mental impairment — mostly through car crashes and physical assaults.

Especially tragic is how badly our young people are affected. Infants, teens and young adults in Arizona suffer higher traumatic brain injury rates than in any other state investigated, according to a newly-released survey by the federal Centers for Disease Control and Prevention.

"A disorder of major public health significance" is how the National Institutes of Health describes the problem, noting that the 2 million Americans affected by this every year face "lifelong impairment of physical, cognitive and psychosocial function," resulting in very high rates of divorce, unemployment and substance abuse.

Arizona's problem emerged in a recent two-year study conducted by the CDC in an effort to get an idea of how extensive traumatic brain injury — brain damage caused by an external physical force — is in the U.S.

Among 12 states surveyed in 2002, Arizona's rate of hospitalizations for such injuries topped all others, at 96.7 per 100,000 population. That was well above the average rate of these states, at 79, and almost double the lowest state, Nebraska, at 50.6.

In the most recent year surveyed, 2003, the problem worsened, with Arizona's rate rising to 105 per 100,000 population. Again, that was worst among the nine states surveyed that year, easily beating the average 88, and this time more than doubling Nebraska's low of 51.8.

The suffering behind these numbers is substantial, usually lasting a lifetime. These are people who do not walk away healed after treatment.

"An injury to the brain is unlike any other," Tucsonan Barbara Stahura wrote in an essay about her husband's brain injury from a motorcycle crash three years ago.

"Along with physical functions, the brain controls awareness, personality, temperament, and cognitive processes like memory — all those things that ... form a 'self.'

"So a traumatic brain injury can kidnap the dear self of someone you love, dragging him far from shore as a riptide does a swimmer, sometimes beyond rescue, even though in reality he is holding your hand or smiling at you across the dinner table."

An avid motorcyclist, her husband, Ken Willingham, was fully helmeted when a sedan turned suddenly in front of him, delivering a "sucker-punch" to his brain, as Stahura puts it.

"Helmet striking steel, face smashing into helmet, brain slamming into skull," is how she describes what happened to her husband's head that day.

Shortly after he woke up at University Medical Center, Willingham started talking like a toddler, repeating nonsensical phrases in a sing-song voice, badly frightening his wife. Even after he started speaking in full sentences, his thoughts were completely delusional, his short-term memory shot, his gaze "distant and unconnected," she said.

Her brilliant husband — a computer programmer at Raytheon Missile Systems — had "disappeared," as Stahura describes this horror.

It took nearly two years of intense physical, occupational and speech therapy — paid for by excellent insurance so many victims don't have — to bring Willingham back to reality and to her.

"He's probably 97 percent recovered now. We were very lucky," his wife said.

What lingers, and may for the rest of his life, is some confusion when a lot of people are talking at once, as in meetings, and occasional difficulty finding the right words. Even so, Willingham, now 60, has successfully returned to Raytheon.

"What Ken did not have, but so many do, is the destroyed moods, the ugly emotions that go with this kind of injury," Stahura said. "That would have been very, very hard."

By far, this kind of motor-vehicle accident, involving cars, trucks or motorcycles, causes largest portion of Arizona's traumatic brain injuries — fully 40 percent, according to the Arizona Department of Health Services.

Another 20 percent are the result of intentional violence — assaults and suicide and homicide attempts. About 16 percent happen in accidental falls, especially among the very elderly.

That assaults account for so much of this damage in Arizona is especially alarming, according to the CDC report. In most other states, falls among the elderly are a much bigger factor than assault.

Arizona ranks 15th in the nation for aggravated assaults, and we have the 15th-highest risk of dying in a traffic accident, according to the most recent statistics from the FBI and the U.S. Department of Transportation.

"These findings underscore the need for states to monitor the occurrence, external causes and risk factors for traumatic brain injury, and to design and implement more effective prevention programs," the CDC report concludes.