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A meta-analysis published in the January issue of Neuropyschology provides evidence that cognitive rehabilitation after a serious brain injury or stroke can help the mind in much the same way that physical therapy helps the body. new meta-analysis. Because the data suggest that treatment may work best when tailored to age, injury, symptoms, and time since injury, the findings may help establish evidence-based treatment guidelines.

Researchers at the University of South Alabama and the University of North Carolina at Charlotte analyzed and updated the data found in systematic reviews of several hundred studies of cognitive rehabilitation. The researchers took those studies whose samples and methods were most amenable to rigorous statistical techniques and documented the extent to which various treatments improve the language, attention, memory and other cognitive problems that appear after acquired brain injury.

The meta-analysis examined 97 articles, comprising 115 studied treatment samples and 45 control samples. These samples collectively included 2,014 individuals who underwent cognitive rehabilitation after brain injury and 870 individuals in a variety of control conditions. The authors of the initial reviews had concluded there was enough evidence to generally support the use of a variety of rehabilitative treatments. To develop specific treatment guidelines, this new analysis documented the extent to which treatment type and timing, origin of the injury, recovery level, and participant age affected the odds of success.

Given the patterns they found, the authors offered initial treatment guidelines:

Generally, it is better to start treating patients as early as possible, rather than waiting for a more complete neurological recovery.
Even older patients (age 55 and up) may benefit from cognitive rehabilitation, particularly if the brain injury is due to stroke.
Clinicians should focus their efforts on direct cognitive skills training in specific cognitive domains (such as attention or visuospatial processing). More holistic, non-targeted interventions appear to be less effective.

Especially if they were treated soon after the event, language training helped older people after stroke with aphasia, problems producing and/or comprehending language. However, language training was still effective, just not as much, when it started more than a year after the stroke.

Attention training helped people with acquired brain injury and seemed to work best with younger patients less than a year after injury. It was the most specific treatment, improving nothing but attention.

Visuospatial training helped stroke patients with visuospatial neglect, the inability to respond or orient to something shown on the side opposite to the site of the injury. Visuospatial training also tended to improve performance in other cognitive domains.

Memory treatment did not produce clear results. Nor did comprehensive treatments that attempted to treat cognitive problems holistically.

The authors also found that patients treated less than a year after injury did better than those treated more than a year later.

There are some very talented experts in acquired brain damage and cognitive rehabilitation in Virginia. The challenge is to get the physicians who first treat victims of acquired brain damage (e.g., ER doctors, family doctors, and neurologists) to recogize the symptoms of TBI and timely refer the patient for cognitive rehabilitation.

Labels: Acquired brain injury Acquired head injury Brain damage Brain injury Brain injury attorney Brain injury lawyer Brain injury litigation Traumatic brain damage Traumatic brain injury Traumatic head injury Virginia brain injury attorney Virginia brain injury lawyer

11/26/2008
Michael G. Phelan
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Brain Injury Association of America Teams Up With Journal of Head Trauma Rehabilitation

The Brain Injury Association of America (BIAA) entered an agreement that designates the Journal of Head Trauma Rehabilitation (JHTR) as BIAA's official scholarly journal beginning January 1, 2009.

"As the nationwide voice of brain injury, our goal is to put timely, relevant research findings into the hands of brain injury clinicians and business leaders as well as policy makers and the media," said Susan Connors, BIAA President and CEO.

The partnership with LWW ensures that each new member of BIAA's Academy of Certified Brain Injury Specialists will receive a one-year subscription to the leading, peer-reviewed publication in brain injury. Renewing certificants will have an opportunity to subscribe to JHTR at discounted rates.

"JHTR has led the way in brain injury treatment research and practice for nearly 25 years," noted Sandra Kasko, JHTR Publisher. "JHTR is ranked #1 in rehabilitation by the Institute for Scientific Information's 2007 Journal Citation Report. LWW is pleased to partner with BIAA to provide this essential resource."

In concert with BIAA's adoption of JHTR, the Association will introduce the Mitch Rosenthal Memorial Lecture Series in 2009. The Rosenthal Lectures, delivered via teleconference and webinars, will be drawn from each issue's content.

John D. Corrigan, PhD, an editor of JHTR noted, "BIAA and JHTR are two of the nation's oldest, most respected names in the brain injury field. This partnership will extend the good work both organizations do to improve care for individuals with brain injury.

Founded in 1980, the Brain Injury Association of America is the premier source of information for victims of brain injury. BIAA and its nationwide network of state affiliates provide help, hope and healing to the millions of Americans who live with a lifelong disability as a result of brain injury, as well as their families and the researchers, clinicians and professionals who provide treatment and long-term care. For more information about brain injury or the BIAA, visit www.biausa.org.

Our local chapter, The Brain Injury Association of Virginia, Inc. (BIAV) can be contacted at www.biav.net or (804) 355-5748. For additional information concerning the medico-legal aspects of brain injury, visit www.injuryboard.com and click on the brain injury section.

Labels: Acquired brain injury Acquired head injury Brain damage Brain injury Brain injury attorney Brain injury lawyer Brain injury litigation Traumatic brain injury Traumatic head injury Virginia brain injury attorney Virginia brain injury lawyer

11/17/2008
Michael G. Phelan
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Tackling Head Injuries Head-on

As student athletes continue to get bigger, faster, and stronger, the incidence of sports-related traumatic brain damage is on the rise. Sports medicine has come a long way in the past 20 years in the treatment and tracking of sports concussions. In the early 1990's, a doctoral candidate at the University of Georgia, Martin Mrazik, worked on the first simple experiments to measure the impact of concussions. Mrazik theorized that if one could measure the athletes' baseline cognitive function before the start of the season, before they suffered a concussion, then one could measure what happens after an athlete suffered a head injury. Mrazik developed written tests of reaction time and processing speed.

A few years later, researchers at the University of Pittsburgh Medical Center computerized Mrazik's crude test, creating the Immediate Post Concussion Assessment and Cognitive Test (ImPACT) system. In the past couple of years, the National Hockey Association, the National Football League, and U.S. Lacrosse (which reports that concussion is the third most prevalent injury among its male and female athletes) adopted ImPACT as an assessment tool. This year, the Canadian Football League followed suit. The goal of ImPACT is to properly diagnose concussion and then to make sure the athlete does not return to action until he or she is fully recovered.

Today, Dr. Mrazik is a professor at the University of Alberta, which applies ImPACT to all of its football, hockey, rugby, and soccer players. Dr. Mrazik is not satisfied. He worries about the lower school and recreational athletes who do not have the benefit of health care professionals who are trained to diagnose and treat brain damage. Mrazik cites the example of Brett Lindros, the younger brother of former Philadelphia Flyers star, Eric Lindros, who was forced to retire from hockey at age 19 because of repeated concussions suffered in junior hockey.

This problem is not limited to junior hockey. Every day in this country, middle school and high school football players return to practice within a day or two of suffering serious, and often serial, concussions. There is no way the school coaching staffs are properly trained in spotting and managing concussions. ImPACT needs to become standard practice in U.S. colleges, high schools, and middle schools.

Labels: Managing concussion Sports concussions Sports head injury Traumatic brain damage Traumatic brain injury Traumatic head injury