Preface

  The move toward evidence-based medicine has affected many areas of medicine, including rehabilitation for traumatic brain injury (TBI).  In the past, rehabilitation interventions for TBI have been guided by common sense and a “best-practices” approach. Persons with TBI generally get better during rehabilitation, and it was natural to attribute much of their improvement to rehabilitation interventions. However, as health care costs have continued to rise at a rate greater than the general rate of inflation, there has been increasing pressure to reel in the costs of health care, particularly the costs associated with catastrophic injury. Health care providers now find that they need to justify expenditures. To be reimbursed, they must document improvement in participants’ health status and quality of life which is the direct result of rehabilitation. Third party payers increasingly will only pay for therapies which have been shown to be effective and cost-efficient.

  As practitioners, payers, and participants looked to the scientific literature to identify therapeutic interventions that worked for persons with TBI, evidence for many interventions was not always easy to identify.  This problem led the National Institutes of Health (NIH) to hold a Consensus Conference on Rehabilitation of Persons with Traumatic Brain Injury in October of 1998. The panel of experts assembled by NIH concluded that, “Although studies are relatively limited, available 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. Well-designed and controlled studies using innovative methods are needed to evaluate the benefits of different rehabilitation interventions.”

  These events highlighted the need to bring into one volume a concise and authoritative account of what is currently known in traumatic brain injury rehabilitation.  To that end, the editors of this volume asked leading experts from various aspects of brain injury rehabilitation to write a “state-of-the-science” review of their particular research area.  The authors were asked to (1) write a concise summary of what is currently known in that specific area of brain injury rehabilitation; (2) critique methodological difficulties with current studies and identify gaps in knowledge; (3) delineate the most pressing research questions that remain unanswered; and (4) recommend directions for future research priorities.

  Rehabilitation for Traumatic Brain Injury is the end product of this effort….It is hoped that this book will serve as a resource and guide for both researchers and practitioners in the field of brain injury rehabilitation. It is anticipated that this volume will serve not only as a reference for what is known about brain injury rehabilitation, but also as a guide for researchers concerning the most important areas for future study.