Traumatic Brain-Injury Rehabilitation Outcome Studies in the United States
D. Nathan Cope
Tremendous expansion of rehabilitation services for survivors of traumatic brain injury (TBI) has occurred in the United States. The expansion is both vertical (through the course of the patients' continuum of recovery) as well as horizontal (geographically more complete). Until recently, data supporting the efficacy of such a continuum of rehabilitation interventions have been lacking. Over the past 5-10 years, such studies have appeared with increasing frequency, and they do support the efficacy of these treatments. The most salient of these studies are reviewed here. Although no blinded, prospective, random-assignment study has been done, the accumulation of other studies with "quasi-experimental" designs now makes it difficult to argue against a true and clinically important treatment effect.
Outcome studies in relation to traumatic brain injury (TBI) tend to follow a few general patterns. The goal of describing a "natural history" of such injuries, with current techniques of medical and surgical acute care, is evident in most early and many current studies. These naturalistic studies have tended to utilize more gross measures of