Cognitive rehabilitation for traumatic brain injury: A randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group.

Defense and Veterans Head Injury Program, Bldg 1, Room B210, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 07/2000; 283(23):3075-81.
Source: PubMed


Traumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields.
To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI.
Single-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center.
One hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury, manifested by a Glasgow Coma Scale score of 13 or less, or posttraumatic amnesia lasting at least 24 hours, or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging.
Patients were randomly assigned to an intensive, standardized, 8-week, in-hospital cognitive rehabilitation program (n=67) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse (n=53).
Return to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group.
At 1-year follow-up, there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment (90% vs 94%, respectively; P=.51; difference, 4% [95% confidence interval ¿CI¿, -5% to 14%]) or fitness for duty (73% vs 66%, respectively; P=. 43; difference, 7% [95% CI, -10% to 24%]). There also were no significant differences in cognitive, behavioral, or quality-of-life measures. In a post-hoc subset analysis of patients who were unconscious for more than 1 hour (n = 75) following TBI, the in-hospital group had a greater return-to-duty rate (80% vs 58%; P=. 05).
In this study, the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation. These findings emphasize the importance of conducting randomized trials to evaluate TBI rehabilitation interventions. JAMA. 2000;283:3075-3081

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    • "In young adults TBI is considered one of the main causes of death (Hodgson et al., 2000). Moreover, it is a major cause of disability that includes physical and psychological involvement with long-term cognitive, behavioral, and social changes (Salazar et al., 2000; Khan et al., 2003). Neuroendocrine dysfunction has long been recognized as a consequence of TBI (Cyran, 1914), particularly in moderate and severe cases, although the last 10 years have witnessed a better understanding of the frequency of TBI-mediated hypopituitarism and its clinical implications, with the publication of an increasing number of studies (Benvega et al., 2000; Kelly et al., 2000; Lieberman et al., 2001; Agha et al., 2004; Bondanelli et al., 2004; Popovic et al., 2004; Aimaretti et al., 2005; Leal-Cerro et al., 2005; Herrmann et al., 2006; Schneider et al., 2006; Tanriverdi et al., 2006). "
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    ABSTRACT: Neuroendocrine dysfunction, long recognized as a consequence of traumatic brain injury (TBI), is a major cause of disability that includes physical and psychological involvement with long-term cognitive, behavioral, and social changes. There is no standard procedure regarding at what time after trauma the diagnosis should be made. Also there is uncertainty on defining the best methods for diagnosis and testing and what types of patients should be selected for screening. Common criteria for evaluating these patients are required on account of the high prevalence of TBI worldwide and the potential new cases of hypopituitarism. The aim of this review is to clarify, based on the evidence, when endocrine assessment should be performed after TBI and which patients should be evaluated. Additional studies are still needed to know the impact of post-traumatic hypopituitarism and to assess the impact of hormone replacement in the prognosis.
    Frontiers in Endocrinology 08/2011; 2:25. DOI:10.3389/fendo.2011.00025
    • " al . ( 2000 ) —one of the only five RCTs - Class I studies rated in the present review—as an example of what he defines as the " dogma that randomized controlled studies provide the most convincing evidence regarding the efficiency of an intervention " . Prigatano ( 2003 ) stated the following reasons for the putatively misleading con clusions of Salazar et al . ( 2000 ) on the ineffectiveness of MORP in TBI individuals : ( 1 ) the program was designed for postacute rather than acute patients ( within the first month from injury in this study ) ; ( 2 ) the working alliance between the patient and the rehabilitation team as a predictive value for those benefiting from such treatment was neither mention"
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    ABSTRACT: This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies.
    Neuropsychology Review 02/2010; 20(1):52-85. DOI:10.1007/s11065-009-9125-y · 4.59 Impact Factor
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    • "In their exhaustive review, Carney et al [32] concluded that ''specific forms of cognitive rehabilitation reduce memory failures (notebook training/electronic cueing devices—results didn't hold 6 months post treatment) and anxiety, and improve self-concept and interpersonal relationships for persons with TBI.'' A recent Defense and Veteran's Head Injury program study did not find any significant improvement on their measures as a result of cognitive rehabilitation (compared with control group) in patients with moderate to severe TBI [34]. In conclusion, no definitive scientific evidence indicates that cognitive rehabilitation leads to sustained improvements in memory. "
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    ABSTRACT: The application of electroencephalogram (EEG) biofeedback with reading disability and traumatic brain injury (TBI) is relatively recent. There are many studies regarding the effectiveness (improving attention and IQ scores) of EEG biofeedback in patients with attention deficit hyperactivity disorder, who are known to have a high rate of comorbidity for learning disabilities. This suggests the possibility that EEG biofeedback specifically aimed at remediating reading disability and TBI would be effective. This article provides strong initial support for this idea and provides reason to believe that assessment and training under task conditions are likely to be fruitful. Given the significance of these problems and the absence of very effective alternatives for remediation of these conditions, efforts to complete the needed research seem warranted. Clinical use of this intervention seems to be warranted with informed consent.
    Child and Adolescent Psychiatric Clinics of North America 02/2005; 14(1):137-62, vii. DOI:10.1016/j.chc.2004.07.001 · 2.60 Impact Factor
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