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Home Rehabilitation May Help Those With Brain Injuries

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WebMD Health News

June 20, 2000 -- Brain injury is a common cause of disability among young adults in the U.S., causing problems with memory and communication, and sometimes leading to inappropriate behavior. A type of therapy called cognitive rehabilitation can help people overcome these symptoms, and a new study indicates it may work as well when given in the patient's home as it does at the hospital.

Cognitive function is the mental process of knowing, thinking, learning and judging. There are many forms of cognitive therapy, but it generally includes exercises aimed at improving memory, perception, speech, and coping and organizational skills.

A research team led by Andres M. Salazar, MD, of the Defense and Veterans Head Injury Program at the Henry M. Jackson Foundation in Rockville, Md., looked at 128 patients with moderate to severe head injuries.

They were divided into two groups: One took part in an intensive, standardized eight-week cognitive rehabilitation program at a hospital; the other followed a home-based program that consisted of reading magazines and books; doing card and number games and other tasks to enhance cognitive and organizational skills; exercising; watching TV news; and speaking to a psychiatric nurse on the phone each week.

All of the patients were active-duty military personnel, and most were young, white, well-educated men. The study, published in the Journal of the American Medical Association, found that after a year, the percentage of patients who were able to return to work was nearly the same for both groups. And similar percentages in each group were found to be able to return to full active military duty.

Both groups had sustained the same type of injury and had similar symptoms, including headaches, seizures, major depression, and violent behavior.

Barry D. Jordan, MD, MPH, of the Burke Rehabilitation Hospital in New York, says the study patients were relatively healthy and already had recovered significantly by the time the research began. In an editorial accompanying the study, Jordan writes that this may have limited the ability of the study to accurately document the benefits of in-hospital rehabilitation.

David Cifu, MD, who reviewed the study for WebMD, agrees. Cifu, the Herman J Flax Professor and chairman of the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University, says that only patients who got a high score on a standardized evaluation exam were chosen for this study.

"This sample is not indicative of the brain-injured population at large," he says. "This is a very specific population of military active-duty personnel, and all of them were highly functional before entering the study."

The only patients in which a significant difference was seen for the hospital and home rehabilitation programs were those who had been unconscious for more than an hour after their initial injuries. Patients in this group who underwent the in-hospital program returned to work at a rate of 80%, compared to 58% for those who underwent the home program. This may show that hospital rehabilitation is beneficial to a select few of the traumatically brain-injured.

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