NIH Consensus Panel Endorses Comprehensive Rehabilitation Strategy For Brain Injury

NIH Office of Medical, Applications of Research, National Institute of Child Health, & Human Development

A consensus panel convened by the National Institutes of Health (NIH) today concluded that people with traumatic brain injury (TBI) have the best chances for rehabilitation if they have access to individualized treatment programs that combine a wide range of components such as medical, psychological, social, and behavioral therapies as well as community-based, nonmedical services.

The consequences of TBI are rarely limited to one set of symptoms. Rather, they typically affect many facets of a person's life, including neurological and psychological impairments, medical problems and disabilities, and relationships with family, friends, and community, the 16-member panel said.

The economic burden of TBI is enormous. "This country spends $9-10 billion a year on acute care and rehabilitation of just new cases of TBI," said panel chair Kristjan T. Ragnarsson, M.D., professor and chair of the Department of Rehabilitation Medicine, Mt. Sinai School of Medicine in New York City. "The consequences of TBI can be lifelong. Given the tremendous toll of TBI and the absence of a cure, this nation's efforts to prevent TBI are of paramount importance," he said.

Traumatic brain injury, broadly defined as injury to the brain from externally inflicted trauma, may result in significant impairment of an individual's physical, intellectual, and psychosocial functions. Each year in the United States, an estimated 1.5 to 2 million people incur TBI, principally as a result of vehicular accidents, falls, acts of violence, and sports accidents. The panel noted that the actual number of TBI cases is likely to be higher, as many mild TBI cases go undiagnosed or unreported. Males are more than twice as likely as females to experience a TBI, and the highest incidence is among 15-24 year-olds and those 75 years of age and older. Alcohol is associated with half of all TBI cases, either in the person causing the injury or in the injured person. An estimated 52,000 people die annually from TBI.

An additional group at high risk for TBI is children under the age of 5, who will have lifelong needs for support and special education. The panel emphasized the importance of schools in serving children with TBI.

The panel underscored their concerns that access to rehabilitation services varies widely. Specifically, there is a discrepancy in the availability of TBI rehabilitation programs across the U.S., and there is a lack of knowledgeable professionals able to provide community-based treatment, which the panel identified as an essential component of long-term care of people with TBI. The panel noted that obtaining rehabilitation services for as long as they are needed is often difficult. In addition, there are overwhelming personal financial barriers that can make access difficult for many persons. The panel estimated the average lifetime cost of rehabilitative care for persons with severe TBI ranges from $600,000 to nearly $1.9 million.

The panel encouraged persons with TBI and their families to partner with health care providers and researchers in guiding their care. Families can provide the ideal support that people with TBI need, but the panel emphasized the importance of support for the families themselves as well. Such support may include counseling, assistance from home health aides, and respite care for family members.

The panel highlighted the need for well designed and controlled studies to evaluate the benefits of different rehabilitation interventions. The panel outlined numerous compelling areas for investigation of TBI, including studies on:

innovative rehabilitation interventions for TBI risk factors and incidence of TBI by gender, race, and age; epidemiology of mild TBI duration, natural history, and long-term consequences of mild, moderate, and severe TBI evaluation and treatment of alcohol and other substance abuse in people with TBI

The panel also stressed the importance of funding grants to train scientists and clinicians in epidemiological and treatment research in TBI.

The panel issued their consensus statement at the conclusion of a 3-day NIH Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury, which came about as a result of 1996 Congressional legislation directing the NIH to conduct a "national consensus conference on managing traumatic brain injury and related rehabilitation concerns." Panel members spent more than a year reviewing an extensive collection of medical literature related to rehabilitation of persons with TBI, including an evidence-based review of the literature provided by the Agency for Health Care Policy and Research. The panel also heard presentations by experts in the field and public testimony from interested organizations, persons who had experienced TBI, and families of people with TBI.

The full NIH Consensus Statement on Rehabilitation of Persons with Traumatic Brain Injury is available by calling 1-888-NIH-CONSENSUS (1-888-644-2667) or by visiting the NIH Consensus Development Program Web site at http://consensus.nih.gov.

The NIH Consensus Development Program was established in 1977 as a form of "science court" to resolve in an unbiased manner controversial topics in medicine. To date, NIH has conducted 108 such conferences addressing a wide range of controversial medical issues important to health care providers, patients, and the general public. An average of six consensus conferences are held each year.

This conference was sponsored by the NIH Office of Medical Applications of Research and the National Institute of Child Health and Human Development. The conference was cosponsored by the National Institute on Deafness and Other Communication Disorders, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing Research, the Office of Alternative Medicine, and the Office of Research on Women's Health of the National Institutes of Health;, the Agency for Health Care Policy and Research; and the Centers for Disease Control and Prevention.

NOTE TO RADIO EDITORS: An audio report of the conference results are available October 28-November 4, 1998 from the NIH Radio News Service by calling 1-800-MED-DIAL (1-800-633-3425) or by visiting http://www.radiospace.com/nihhome.htm on the Web.