the first 6 months of publication (Clinical Practice Guideline, 1992). The approach is too new to judge its effectiveness. Thus far, 12 expert panels have been organized to examine content areas. Among the areas that are of relevance is a panel that is considering stroke rehabilitation. This panel examines (a) documented evidence for the benefits of interventions, (b) the validity of the instruments for assessments, and (c) the outcome measures as the basis for providing parameters for care.
With more than 1,500 head-trauma programs in the United States, if the approach is viable there will be considerable pressure to use it to look at rehabilitation in brain trauma.
Rehabilitation of TBI has received a great deal of support from managed care systems that are profit seeking; this has led to a number of abuses that have resulted in congressional hearings and unfavorable publicity. As a result, Congress recently passed laws to correct this: (a) the Brain Injury Rehabilitation Quality Act of 1992, which protects the rights of each brain-injured patient in rehabilitation with a national set of standards and oversight; and (b) a bill to develop a national definition for TBI. This bill, "the TBI Act," mandates all states to add TBI to their data-reporting structures. It identifies the need for federal, state, and local resources to develop services for a defined condition.
Rehabilitation of people with TBI has received increasing attention and support. Structures have been put into place with regard to service delivery and research. An important immediate challenge is to implement the initiatives that have been undertaken in the coordination of efforts at the federal agency level. The steps must capitalize on (a) initiatives of an emphasis on prevention, (b) results from the research on the decade of the brain, (c) heightened awareness of the disabled as a minority group coming to the attention of the public, and (d) how to do this in a cost-conscious atmosphere.
This chapter was supported, in part, by the U.S. Department of Education National Institute on Disability and Rehabilitation Research, Research and Training Center on Head Trauma and Stroke, grant no. H133B80028.