I'd never call Gabrielle Giffords lucky, given the severity of her gunshot wound or the random cruelty of her would-be assassin. But in the universe of people recovering from traumatic brain injuries, the Democratic congresswoman from Arizona is fortunate in two very powerful ways.

She has access to state-of-the-art care, and her supporters number in the hundreds of millions. That's hardly the norm, to put it mildly. What's more typical is a lonely battle with the insurer for decent therapy -- plus a sense of isolation from friends who want things back to "normal" right away.

"The worst thing about a brain injury is that you look normal and people don't understand that you're suffering," says Sherry Stock, executive director of the Brain Injury Association of Oregon. "You are always, always going to feel like you're alone."

About 1.7 million Americans suffer some kind of traumatic brain injury every year from car accidents, falls, wartime incidents, sporting events, assaults, bicycle crashes and other causes. Most of the injuries are mild concussions that require a brief trip to the emergency room, but the remaining injuries lead to about 50,000 deaths and 275,000 hospitalizations annually, according to the Centers for Disease Control and Prevention.

The numbers add up over the years: In Oregon, roughly one in 10 people has someone with a brain injury in their family or close network of friends. While a gunshot wound to the head is certainly the most graphic kind, the less obvious injuries can be highly debilitating as well. These are the injuries that can be harder to diagnose or understand -- and tempting for insurers to neglect.

For example, a new Oregon law requires insurers to cover medically necessary treatment for traumatic brain injuries. Some insurers still drag their feet, quibble over the meaning of "medically necessary" and insist that best practices are actually unproven experiments.

The upshot is that many patients may find themselves adrift without sufficient occupational therapy, speech therapy, physical therapy, home health care or family support they need to maximize their recovery, says Dr. Danielle Erb, a brain-injury specialist in Portland.

"The big picture is that patients need a lot of initial therapy," Erb says. If the insurance benefits are minimal, then family members struggle to fill in the gaps.

"The injury," she adds, "affects the whole family."

Fortunately, reasons for hope do exist. Improvements in brain-imaging technology make it easier for doctors to diagnose and treat brain injuries. Some insurers do provide excellent benefits. Brain research is getting more sophisticated. Public awareness about prevention is improving, too. Now that the National Football League has finally admitted that concussions can cause lifelong problems, for example, youth coaches and parents are taking brain safety more seriously.

Some good will come of tragedies as well. The staggering number of U.S. service members coming home from war with brain injuries will force the military to improve its standards of care. Giffords' high-profile rehabilitation will further educate the public about the delicate mysteries of the brain and the outer limits of medicine.

Eventually, more insurers will step up their rehabilitation services for newly brain-injured people -- whether because of a government mandate or just the overdue revelation that patients who get excellent initial care are less likely to have costly long-term health problems.

Meanwhile, Oregon patients and their families can take heart in the many support groups and informal services for people dealing quietly with brain injuries. They may never have the clout of a congresswoman, but they do have strength in numbers.

"You may feel alone," says Stock, "but you are not alone."