Traumatic Brain Injury Rehabilitation: We Need to Study What Works
Last week, we posted a blog about Kim Alvarez, the new mom who survived a rare amniotic fluid embolism while she was giving birth to her daughter but has brain damage as a result (we met Kim and her family when we transported her via air ambulance to a specialized brain injury rehabilitation facility).
With Kim’s story fresh in my mind, I ran across an opinion piece in the New York Times last week (Starting Again After a Brain Injury by Jane Rosett) which illustrates well the particular difficulty associated with traumatic brain injury (TBI). Rosett recounts having to relearn everything – from people and places to skills like writing and experiences like chewing gum.
Rosett writes, “So when you see [people with brain injuries], please don’t be offended if we don’t remember weathering earthquakes with you, baking your birthday cakes or bouncing your babies on our knees. We’re struggling to make sense of a world that seems brand-new – sometimes wonderful, often overwhelming – with all the courage we can muster.”
Clearly, the patient’s hard work to recover from a traumatic brain injury is the most difficult, but caring for a patient or loved one with a TBI can be difficult as well (which is why we’ve been featuring blogs aimed at helping caregivers take care of themselves too – see Caregiver Depression – A Silent Epidemic and 4 Tips for Easing Caregiver Stress).
Then earlier this week the Institute of Medicine released a report, Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence that analyzed the effectiveness of cognitive rehabilitation therapy (CRT) for traumatic brain injuries. The study was conducted at the request of the Department of Defense, given that “TBI is considered the ‘signature wound’ of the conflicts in Iraq and Afghanistan.”
In fact, according to the Defense Department, between 2000 and 2010, more than 200,000 service members suffered traumatic brain injuries. There are 1.7 million civilian TBI diagnoses each year in the U.S. But, as Rosett points out, “very few people with brain injuries receive any sort of treatment beyond acute care.”
The Institute of Medicine study doesn’t prove that cognitive rehabilitation therapy – defined in the report as “a patient-specific, goal-oriented approach to help patients increase their ability to process and interpret information” – works in every case. “CRT interventions are promising approaches, but further development and assessment of this therapy is required.”
But here’s the key point: “The incidence of TBI is rapidly rising, and while the survival rate is rising concomitantly– due to improved protective equipment and more effective life-saving measures – survivors of TBI may experience long-lasting physical and cognitive impairments. These trends point to a growing need to effectively treat the lasting consequences of traumatic brain injury.”
Whether for our service men and women fighting conflicts abroad or for civilians here at home, it’s important to study TBI so we can better help patients rehabilitate. It’s an issue that affects all of us in the medical community, from doctors and nurses to medical transport providers (transporting patients, as in Kim’s case, to specialized rehabilitation facilities) to the on-the-ground caregivers doing the hard work of trying to help their loved ones recover at least some of their old selves.