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Cognitive Rehabilitation - Computer Interventions with Traumatic Brain Injuries
Associated Press

BETHESDA, Md., Oct. 28 — Traumatic brain injury is the leading cause of disability in young Americans, but patients have the best chance of resuming active lives if they receive specialized rehabilitation that can literally retrain their brains, a government panel concluded Wednesday. Up to 2 million Americans a year suffer traumatic brain injury.

“THE BRAIN seems to have a remarkable capacity to heal if given the right opportunities,” said Dr. Bruce Wexler of Yale University, describing sophisticated brain exercises that can help.

Up to 2 million Americans a year suffer traumatic brain injury — any injury to the brain resulting from such trauma as car crashes, falls, violence or sports accidents. Around 90,000 suffer severe brain damage that causes long-term debilitation, while others suffer milder injuries with more subtle symptoms such as a personality change or memory problems.

Better trauma care is getting more severely injured people hospitalized in time to save them. But survival doesn’t necessarily mean recovery, and doctors have long debated the best way to treat survivors.


The National Institutes of Health, at Congress’ request, convened brain experts who spent a year studying that question. Wednesday, the panel concluded the best care is a comprehensive treatment program including cognitive, physical and social rehabilitation tailored to each patient, often lasting for many years.

That’s expensive, the panel acknowledged. In some rural areas, rehabilitation isn’t even offered. Some insurance policies won’t cover outpatient rehabilitation or long-term care.

“We can only state what is appropriate care and hope it gets funded,” said panel chairman Dr. Kristjan Ragnarsson of New York’s Mount Sinai School of Medicine. “We know we cannot cure this condition. But there are treatments.”

Take patients in a coma. There is no evidence that the one-time fad of stimulating patients while they’re actually comatose helps, and it may even hurt, said Dr. James Kelly of the Rehabilitation Institute of Chicago. Instead, once patients begin to emerge from a coma, they need special physical and mental stimulation during the time each day that they are fully aware. “You need a sophisticated team that knows when to stimulate, and when to back off,” Kelly said.


Physical, speech and occupational therapy help patients function on their own, but they also need specialized cognitive exercises, the panel said. Computer programs that help patients track moving objects, for instance, can improve attention span, and other seemingly simple exercises can improve the higher-learning sections of the brain, said Wexler.

The panel stressed that much more research is needed. No single treatment fits all patients, and doctors don’t understand enough about how the brain works to know why one person recovers better than another.

Also, primary care physicians must be better educated to spot subtle brain injuries, the panel said. Patients whose doctors don’t link a past concussion, for instance, to headaches, depression or an aggressive personality change can spend frustrating years seeking help, said panelist Candace Gustafson, a Boston nurse who recovered from brain injury. And injured children may need more help in school.

The panel also urged better efforts to prevent brain injury. Half of all cases are related to alcohol use. Others could be prevented by such simple acts as wearing helmets when bicycling or in-line skating.

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