Rehabilitation of persons with traumatic brain injury

Objective To provide biomedical researchers and clinicians with information regarding and recommendations for effective rehabilitation measures for persons who have experienced a traumatic brain injury (TBI). Participants A nonfederal, nonadvocate, 16-member panel representing the fields of neuropsychology, neurology, psychiatry, behavioral medicine, family medicine, pediatrics, physical medicine and rehabilitation, speech and hearing, occupational therapy, nursing, epidemiology, biostatistics, and the public. In addition, 31 experts from these same fields presented data to the panel and a conference audience of 883 members of the public. The conference consisted of (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussions that were part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and part of the third. Primary sponsors of the conference were the National Institute of Child Health and Human Development and the National Institutes of Health Office of Medical Applications of Research. Evidence The literature was searched through MEDLINE for articles from January 1988 through August 1998 and an extensive bibliography of 2563 references was provided to the panel and the conference audience. Experts prepared abstracts for their conference presentations with relevant citations from the literature. The panel prepared a compendium of evidence, including a patient contribution and reports from federal agencies. Scientific evidence was given precedence over clinical anecdotal experience. Consensus Process The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented during the open forum (October 26-28, 1998) and in the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the internet immediately following its release at the conference and was updated with the panel's final revisions. Conclusions Traumatic brain injury results principally from vehicular incidents, falls, acts of violence, and sports injuries and is more than twice as likely to occur in men as in women. The estimated incidence rate is 100 per 100 000 persons, with 52 000 annual deaths. The highest incidence is among persons aged 15 to 24 years and 75 years or older, with a less striking peak in incidence in children aged 5 years or younger. Since TBI may result in lifelong impairment of physical, cognitive, and psychosocial functioning and prevalence is estimated at 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Mild TBI is significantly underdiagnosed and the likely societal burden is therefore even greater. Given the large toll of TBI and absence of a cure, prevention is of paramount importance. However, the focus of this conference was the evaluation of rehabilitative measures for the cognitive and behavioral consequences of TBI. Evidence supports the use of certain cognitive and behavioral rehabilitation strategies for individuals with TBI. This research needs to be replicated in larger, more definitive clinical trials and, thus, funding for research on TBI needs to be increased.