Study to identify best rehabilitation therapies for patients with traumatic brain injuries

December 15, 2008

CHICAGO -- Rush University Medical Center and 10 other healthcare facilities in the U.S. and Canada have been awarded a $4.3 million grant from the National Institutes of Health to identify which rehabilitation therapies, or combination of therapies, can best help victims of traumatic brain injuries. Rush is the only center in Illinois participating in the study.

"Our aim in this study is to isolate individual components of the range of therapies we use to treat our patients and determine how, and to what degree, each is associated with improved function," said Dr. James Young, chairman of the department of physical medicine and rehabilitation at Rush and an internationally recognized expert in the treatment of brain injuries.

The five-year study will collect the records of more than 2,300 patients who have suffered moderate to severe traumatic brain injuries, including detailed demographic, diagnostic and clinical profiles of each patient. Daily logs will be kept of the individually tailored treatment programs the patients undergo in physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support. Outcomes will be catalogued and correlated with both the patients' characteristics and therapeutic interventions.

The researchers will then analyze the data to determine which therapies were the most successful in improving outcomes for patients with different types and severities of traumatic brain injuries.

Patients will also be followed for a full year after being discharged to assess their quality of life, including whether they were able to live independently, drive a vehicle, and participate in daily activities.

The analysis will involve an unusual research methodology called practice-based evidence for clinical practice improvement, which relies on data from routine clinical practice to determine what works for whom, when, and at what cost. The methodology has been used successfully to improve treatment for stroke.

Traumatic brain injury occurs when the head suddenly and violently hits an object, as in a fall or car crash, or when an object, such as a bullet, pierces the skull and enters brain tissue. Symptoms of a traumatic brain injury can be mild, moderate, or severe, and vary depending on the extent and location of the brain damage. For patients with moderate or severe injuries, symptoms range from headaches and lethargy to convulsions, loss of coordination, confusion, cognitive deficits, and behavior and mood changes.

Research to date has done little to help identify the best treatments for the range of symptoms. Randomized clinical trials of rehabilitation therapies, for example, typically evaluate only specific treatments for a select group of patients. Results are not general enough to apply to the whole population of traumatic brain injury patients.

By isolating individual components of therapy as applied to patients with different degrees of traumatic brain injuries, the researchers expect to be able to prescribe best practices for rehabilitation, raising the standard of treatment in facilities all across the country.

"From the extraordinary wealth of data we'll collect in this five-year analysis, we will be able to offer clinicians the information that can help them evaluate their current treatment practices and select therapies that are most likely to help their patients," Young said. "This is medicine at its best: treatment based on the results of years of clinical practice."
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Rush University Medical Center is an academic medical center that encompasses the more than 600 staffed-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

Rush University Medical Center

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