NIH Consensus Development Conference Will Address Rehabilitation Of Persons With Traumatic Brain Injury

NIH Office of Medical, Applications of Research, Bob Bock, National Institute of Child Health, & Human Development

The National Institutes of Health (NIH) will hold a Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury, October 26-28, 1998, in the main auditorium of the William H. Natcher Building on the NIH campus in Bethesda, Maryland. A news conference will conclude the 21/2-day meeting at 1 p.m. EST on Wednesday, October 28, 1998.

Traumatic brain injury (TBI) is the leading cause of death and disability in persons under 45 years of age. Each year in the United States, an estimated 1.5 to 2 million people incur TBI, principally as a result of automobile crashes, sports accidents, falls, and acts of violence. The number of people surviving TBI has increased significantly in recent years because of faster and more effective emergency care, quicker and safer transportation to specialized treatment facilities, and advances in acute medical management. TBI strikes people across the age range and is the leading cause of disability among children and young adults.

Recovery is often slow and changes in personality, learning capacity, and human potential are often profound. Cognitive and behavioral effects may appear years after the initial injury and persist for a lifetime-particularly problematic for children who are learning basic educational and social skills. Costs in dollars are estimated in the tens of billions, but cannot begin to address the cost to families who are deprived of a loved one who is replaced with a stranger. Each year, approximately 70,000 to 90,000 individuals incur a TBI so severe that they are left with irreversible, debilitating losses of functioning. The result is frequently a dramatic change in the individual's life, profoundly disorganizing effects on the family, and huge medical and related expenses over a lifetime. Less severe injuries may result in functional problems that are visible only in particular circumstances.

Although TBI may result in chronic physical impairments, the greater difficulties concern the individual's cognition, emotional functioning, and behavior in connection with interpersonal relationships, school, or work. Cognitive remediation, behavior modification, psychopharmacologic management, and individual and family education and counseling are the primary methods of treatment in rehabilitation settings. Those settings may include a rehabilitation hospital or a department in a general hospital and, subsequently, a variety of day treatment or residential programs.

The NIH has organized this 2 1/2-day conference to evaluate the scientific data concerning rehabilitation practices for people with TBI. Particular emphasis will be devoted to practices related to the cognitive, behavioral, and psychosocial difficulties that may be associated with TBI, both severe and mild. The conference will bring together national and international experts in the fields of physical medicine and rehabilitation, neuropsychology, neurology, neurophysiology, epidemiology, clinical psychology, occupational therapy, health economics, and medical ethics, as well as representatives from the public.

After 1 1/2 days of presentations and audience discussion, an independent, non-Federal consensus panel chaired by Kristjan T. Ragnarsson, M.D., Professor and Chair, Department of Rehabilitation Medicine, Mount Sinai School of Medicine, will weigh the scientific evidence and write a draft statement that will address the following key questions:

What is the epidemiology of traumatic brain injury in the United States, and what are its implications for rehabilitation? What are the consequences of traumatic brain injury in terms of pathophysiology, impairments, functional limitations, disabilities, societal limitations, and economic impact? What is known about mechanisms underlying functional recovery following traumatic brain injury, and what are the implications for rehabilitation? What are the common therapeutic interventions for the cognitive and behavioral sequelae of traumatic brain injury, what is their scientific basis, and how effective are they? What are common models of comprehensive, coordinated, multidisciplinary rehabilitation for people with traumatic brain injury, what is their scientific basis, and what is known about their short-term and long-term outcomes? Based on the answers to these questions, what can be recommended regarding rehabilitation practices for people with traumatic brain injury? What research is needed to guide the rehabilitation of people with traumatic brain injuries?

The panel will present its draft statement to the public for comment at 9 a.m. on Wednesday, October 28. Following this public comment session, the panel will release its revised consensus statement at a news conference at 1 p.m. and take questions from the media. Dr. Ragnarsson will moderate the news conference. The consensus statement is the report of an independent panel and is not a policy statement of the NIH or the Federal Government.

The NIH Consensus Development Program was established in 1977 as a form of "science court" to resolve in an unbiased manner controversial topics in medicine. To date, NIH has conducted 108 such conferences addressing a wide range of controversial medical issues important to health care providers, patients, and the general public. An average of six consensus conferences are held each year.

Additional information about this conference, including the meeting agenda, local area hotels, and directions to NIH, is available at the NIH Consensus Development Program Web site at http://consensus.nih.gov. To register for the conference, call 301-592-3320, send e-mail to [email protected], or visit the Web site.

NOTE TO TV EDITORS: The news conference at 1 p.m. on Wednesday, October 28 will be broadcast live via satellite on the following coordinates: Galaxy 6, Transponder 22.

NOTE TO RADIO EDITORS: An audio report of the conference results will be available after 4 p.m. October 28 until 5 p.m. November 4, 1998 from the NIH Radio News Service by calling 1-800-MED-DIAL (1-800-633-3425).