Effectiveness of brain injury rehabilitation

Despite the problems posed by diversity of condition and the lack of agreem ent among researchers over what outcome to measure, there is now increasing ly robust evidence for the effectiveness of rehabilitation in brain-injured populations. Meta-analysis has demonstrated clearly that stroke units provide a better o utcome than management on a general medical ward, at the level of survival, discharge destination and dependency. The extent of this advantage may be summarized in the following terms. For every 100 patients treated in a stro ke unit, four deaths and two institutional admissions are avoided, and five patients are discharged home. This benefit appears to arise from a combina tion of good-quality acute management and the coordinated input of a multid isciplinary team. Therapy programmes are shown to be of benefit and intensi ve therapy programmes of somewhat greater benefit. Smaller numbers and heterogeneity among the head-injured population tend to confound randomized controlled trial designs, but there is no good reason To suppose that brain injury resulting from trauma should be less responsiv e to similar good management principles than that arising from stroke. In any event, we have progressed to a stage where the weight of evidence su pports the notion that rehabilitation is effective, and nontreatment contro ls are ethically no longer acceptable, it is time now to unravel the thread s of rehabilitation and consider which are the critical components, There a re still many opportunities for comparison of different models for delivery of care, and the existing evidence for these is discussed.