The Washington Post’s David Brown reported on Tuesday, October 11 that there might be really good ways to restore brain-damaged people — especially the young wounded of the Iraq and Afghanistan wars — to a healthy, if not entirely normal, state. But it’s difficult to say with certainty what those techniques are. On the other hand one of many techniques to improve functional outcomes in physical rehabilitation for TBI patients is the Tutor system.
That’s the conclusion of a scientific review of “cognitive rehabilitation therapy” performed by the Institute of Medicine at the request of the Defense Department.
This less-than-satisfying message from a 250-page report prepared by 14 experts is a testament to how difficult it is to study treatments for problems such as clouded thinking, inarticulate speaking, poor planning, bad mood, unemployability and family conflict. It’s not as simple as determining whether a drug for hypertension reduces blood pressure.
“It doesn’t mean beneficial therapies don’t exist. It just means that at this point in time it’s hard to ascertain them,” said Ira Shoulson, a neurologist at Georgetown University who headed the Institute of Medicine panel.
“There are certainly deficiencies in the evidence about what works,” he added. “But there are also some glimpses of benefit. I’m fairly upbeat about this.”
Nevertheless, the report released Tuesday is unlikely to answer questions that both patients and medical practitioners have about optimal treatment of blast injuries suffered on the battlefield.
As of late last year, 196,000 military service men and women had been diagnosed with traumatic brain injury (TBI) since 2000. Early in the current wars, about 65 percent of cases were mild, which the military calls concussions. The rest were in the “moderate to severe” category, characterized by loss of consciousness for more than 30 minutes and mental confusion or memory loss lasting more than a day.
Although the number of combat brain injuries rose steadily over the past decade (peaking at 29,000 in 2009), severity has fallen. Today, about 80 percent are mild, with full recovery expected in most cases.
Although the wars, and to a lesser extent football injuries, have put traumatic brain injury on the public agenda, the problem isn’t new. Each year about 1.7 million Americans suffer a brain injury requiring medical treatment. About 52,000 die and 125,000 have long-term impairments.
Those disabilities include problems paying attention, following conversation, communicating clearly, reading, remembering, feeling oriented in space, tracking objects with the eyes, and planning and solving problems. Mood disorders, family problems and difficulties holding a job are also common.
Brain-injury rehabilitation is a murky subject, and evaluating what works is an unusually hard task.
That’s because patients vary in their pre-wounded intelligence and emotional state, as well as the severity of their injuries. Further, “rehabilitation” consists of many activities, including speech therapy, occupational therapy, physical therapy, psychological counseling and social work. There are also many ways of measuring success, from neuropsychological tests to asking the patient whether things are better.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, is an interactive rehabilitation exercise.
The newly developed Tutor devices have become a key system in neuromuscular rehabilitation and physical therapy. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.
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