Rehabilitation of persons with traumatic brain injury

Objective To provide biomedical researchers and clinicians with information regarding and recommendations for effective rehabilitation measures for pe rsons who have experienced a traumatic brain injury (TBI). Participants A nonfederal, nonadvocate, 16-member panel representing the fi elds of neuropsychology, neurology, psychiatry, behavioral medicine, family medicine, pediatrics, physical medicine and rehabilitation, speech and hea ring, occupational therapy, nursing, epidemiology, biostatistics, and the p ublic. In addition, 31 experts from these same fields presented data to the panel and a conference audience of 883 members of the public. The conferen ce consisted of (1) presentations by investigators working in areas relevan t to the consensus questions during a 2-day public session; (2) questions a nd statements from conference attendees during open discussions that were p art 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 Devel opment and the National Institutes of Health Office of Medical Applications of Research. Evidence The literature was searched through MEDLINE for articles from Janu ary 1988 through August 1998 and an extensive bibliography of 2563 referenc es was provided to the panel and the conference audience. Experts prepared abstracts for their conference presentations with relevant citations from t he literature. The panel prepared a compendium of evidence, including a pat ient contribution and reports from federal agencies. Scientific evidence wa s given precedence over clinical anecdotal experience. Consensus Process The panel, answering predefined questions, developed thei r conclusions based on the scientific evidence presented during the open fo rum (October 26-28, 1998) and in the scientific literature. The panel compo sed a draft statement that was read in its entirety and circulated to the e xperts and the audience for comment. Thereafter the panel resolved conflict ing recommendations and released a revised statement at the end of the conf erence. The panel finalized the revisions within a few weeks after the conf erence. The draft statement was made available on the internet immediately following its release at the conference and was updated with the panel's fi nal revisions. Conclusions Traumatic brain injury results principally from vehicular incid ents, falls, acts of violence, and sports injuries and is more than twice a s likely to occur in men as in women. The estimated incidence rate is 100 p er 100 000 persons, with 52 000 annual deaths. The highest incidence is amo ng 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 functionin g and prevalence is estimated at 2.5 million to 6.5 million individuals, TB I is a disorder of major public health significance. Mild TBI is significan tly underdiagnosed and the likely societal burden is therefore even greater . Given the large toll of TBI and absence of a cure, prevention is of param ount importance. However, the focus of this conference was the evaluation o f rehabilitative measures for the cognitive and behavioral consequences of TBI. Evidence supports the use of certain cognitive and behavioral rehabili tation strategies for individuals with TBI. This research needs to be repli cated in larger, more definitive clinical trials and, thus, funding for res earch on TBI needs to be increased.