Home Rehabilitation May Help Those With Brain Injuries
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
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
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
"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 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