Medical Breakthroughs Bring Hope to Traumatic Brain Injured

Innovations in cognitive rehabilitation have played a key role in improving people's outcomes. Twenty years ago, rehab consisted of rote memorization, repetition, and trying to get patients to meet certain benchmarks. "One of the advancements in rehabilitation is to make the therapy person-centered," says Dr. Lori Terryberry-Spohr, brain-injury program manager at Madonna Rehabilitation Hospital in Lincoln, Neb. "We can tailor it to the individual's goals, strengths, hobbies, interests, and occupations."

In order to understand how cognitive rehabilitation works, you need to know how the brain functions. Neurons, or nerve cells, in our brains send impulses to one another to facilitate memory, thought, and speech and enable movement. When the brain is injured, the connections between neurons are temporarily or permanently disconnected or stunned.

One helpful analogy is to think of the brain's neural pathways as highways. A brain injury is like a jackknifed tractor-trailer stopping traffic. With proper medical attention and therapy, the brain repairs itself. Neurons that ran from point A to point B can grow back in different ways and make new roads, and the brain rebuilds new paths to functions like speech and memory. They might not be exactly the same as before, but they're still effective.

"The more sophisticated the function, like complex thought or writing, the longer it takes," Dr. Armonda says. "But over 70% of our patients with the most severe injuries are now approaching functional independence after treatment, and that was unheard-of previously."

Quantifiable physical evidence that cognitive rehab works does not exist, but experts are confident that it soon will. "We now have MRIs that use neuro-imaging to show all kinds of detail in the brain, and these advancements will continue," says Dr. Steve Flanagan, chair of rehabilitation medicine at the Rusk Institute in New York. "Someday we'll be able to see how certain areas of the brain are wired and to map new growth."

Such hard evidence could be a huge help in making cognitive therapy more widely available. No figure exists of how many facilities offer it, because most health-insurance plans do not cover it. Only the state of Texas mandates insurance reimbursement for cognitive rehabilitation following brain injury.

"You'd never have a problem getting insurance to cover a broken bone or injured shoulder, but it is routinely denied for therapies that help brains heal," says Susan H. Connors, president and CEO of the nonprofit Brain Injury Association of America. Her group is working with federal and state lawmakers to raise awareness of TBI and to improve reimbursement for therapy.

"Brain injury is often invisible since changes are on the inside," Connors adds. "Because of this, help and awareness are not as widespread as they should be."