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October 11, 2000, Vol 284, No. 14 >

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Letters | October 11, 2000

Rehabilitation for Traumatic Brain Injury—Reply

Andres M. Salazar, MD
JAMA. 2000;284(14):1783-1784. doi:10.1001/jama.284.14.1783.
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In Reply: Our study was inspired partly by Dr Prigatano's work,1 and we modeled our program partly after his. Our staff was experienced in TBI milieu therapy, and therapeutic alliances were indeed established with our patients in both groups.2- 3

One goal was to maximize fitness for duty after TBI, which partly dictated the timing of therapy. Despite the severity of their injuries, participants had improved enough to become duty candidates. However, both the less-than-optimal return to duty in this previously fit and relatively high-functioning group and the differential effect of the 2 treatments in a subset analysis argue against our patients being too well to benefit from intensive rehabilitation. Aggressive behavior is a serious problem after TBI, but it is unlikely that our milieu therapy increased it, since our home group had a similar increase.

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