Traumatic brain injury: future assessment tools and treatment prospects

Abstract

Traumatic brain injury (TBI) is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging fi eld of complementary and alternative medicine. Keywords: traumatic brain injury, assessments, treatments Traumatic brain injury future prospectsTraumatic brain injury (TBI) is an extremely common condition, accounting for 50,000 deaths and 235,000 hospitalizations yearly (Langlois et al 2004). The prevalence of individuals with chronic TBI-related problems in the US is 5.3 million (Cohen et al 2007; Thurman et al 1999) with many manifesting a combination of physical, cognitive and behavioral problems. Although this fi gure is extremely large, it may underestimate the true burden of TBI, as many individuals with milder injuries are often unknown to the medical system (Krause and Arthur 1999). This is partly because physical impairments, which are easily detectable, are frequently mild or absent after TBI, while the more common disabling problems of cognitive and behavioral impairments are often overlooked or misdiagnosed by medical professionals. However, it is the latter group of problems that prevent participation in expected and desired societal roles and result in the greatest burden associated with TBI. In the coming decades, the aging population will make this problem even worse, as older individuals are at increased risk of TBI and generally have poorer outcomes. This will greatly increase the overall prevalence of TBI and add to the societal burden presented by more individuals requiring both medical and custodial care.Although considerable strides have been made in decreasing overall TBI-related mortality by the application of evidence-based medicine, many individuals develop chronic problems, often resulting in life-long disability. While some pilot projects have reported promising fi ndings, such as decreasing 30-day mortality with progesterone (Wright et al 2007), most studies examining effectiveness of post-acute interventions have failed to defi nitively demonstrate a thera...

Cognitive Sequelae of Blast-Induced Traumatic Brain Injury: Recovery and Rehabilitation

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