Objective To provide biomedical researchers and clinicians with information regarding
and recommendations for effective rehabilitation measures for persons who
have experienced a traumatic brain injury (TBI).
Participants A nonfederal, nonadvocate, 16-member panel representing the fields of
neuropsychology, neurology, psychiatry, behavioral medicine, family medicine,
pediatrics, physical medicine and rehabilitation, speech and hearing, occupational
therapy, nursing, epidemiology, biostatistics, and the public. In addition,
31 experts from these same fields presented data to the panel and a conference
audience of 883 members of the public. The conference consisted of (1) presentations
by investigators working in areas relevant to the consensus questions during
a 2-day public session; (2) questions and statements from conference attendees
during open discussions that were part 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 Development and the National Institutes of Health
Office of Medical Applications of Research.
Evidence The literature was searched through MEDLINE for articles from January
1988 through August 1998 and an extensive bibliography of 2563 references
was provided to the panel and the conference audience. Experts prepared abstracts
for their conference presentations with relevant citations from the literature.
The panel prepared a compendium of evidence, including a patient contribution
and reports from federal agencies. Scientific evidence was given precedence
over clinical anecdotal experience.
Consensus Process The panel, answering predefined questions, developed their conclusions
based on the scientific evidence presented during the open forum (October
26-28, 1998) and in the scientific literature. The panel composed a draft
statement that was read in its entirety and circulated to the experts and
the audience for comment. Thereafter, the panel resolved conflicting recommendations
and released a revised statement at the end of the conference. The panel finalized
the revisions within a few weeks after the conference. The draft statement
was made available on the Internet immediately following its release at the
conference and was updated with the panel's final revisions.
Conclusions Traumatic brain injury results principally from vehicular incidents,
falls, acts of violence, and sports injuries and is more than twice as likely
to occur in men as in women. The estimated incidence rate is 100 per 100,000
persons, with 52,000 annual deaths. The highest incidence is among 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 functioning and prevalence is estimated
at 2.5 million to 6.5 million individuals, TBI is a disorder of major public
health significance. Mild TBI is significantly underdiagnosed and the likely
societal burden is therefore even greater. Given the large toll of TBI and
absence of a cure, prevention is of paramount importance. However, the focus
of this conference was the evaluation of rehabilitative measures for the cognitive
and behavioral consequences of TBI. 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 and, thus,
funding for research on TBI needs to be increased.