Brain Patients' Recovery Studied

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By LINDSEY TANNER, AP Medical Writer

CHICAGO (AP) - Many brain injury patients can recover just as well at home,
on their own, as those who undergo intensive rehabilitation in the hospital,
and the cost is far lower, researchers say.

The study involved 120 members of the military who had suffered traumatic
brain injury. Hospital treatment worked better for the more severely injured
patients. But for the others, eight weeks of rehabilitation at home was as effective as eight weeks in the hospital.

More than 1 million Americans a year suffer traumatic brain injury - damage
resulting from car crashes, falls, violence and other physical causes. The annual costs of such injuries are estimated at more than $37 billion, the researchers reported in Wednesday's Journal of the American Medical Association.

The study was led by Dr. Andres Salazar of Walter Reed Army Medical Center
in Washington. He said that while home rehabilitation is cheaper, some insurance
companies are reluctant to pay for it ``perhaps because it's harder to monitor.' ``Maybe this will change their minds,'' he said. Dr. Don Young, medical director for the Health Insurance Association of America, which represents 294 health insurance companies, called the results encouraging.

``Overall we would prefer, where medical condition warrants, to provide the
care in the most cost-effective setting,'' he said. The patients studied all received about five days of initial treatment at Walter Reed, then were divided into two groups. One received comprehensive rehabilitation in the hospital, including lessons in speech, thinking and movement, plus psychotherapy, at a total cost per
patient of $51,840. The second group was sent home after being told to get at least 30 minutes of physical exercise a day and at least 30 minutes of mental exercise, such as playing board games. A nurse checked up on them with a 30-minute phone call once a week. The approach cost $504 per patient.

The researchers thought hospital treatment would be superior - and it was among the 75 patients who had been unconscious for more than an hour. Eighty percent of those who underwent hospital rehabilitation were fit for military duty after a year, compared with 58 percent of those treated at home. For the 45 other patients, this was not the case. A year after treatment, both groups returned to work at similar rates - about 90 percent. About 70 percent in each group were deemed fit for duty a year after treatment, and both groups scored equally well on measures of thinking, mood, behavior and social adaptation.

In an accompanying editorial, neurologist Dr. Barry Jordan, director of the brain injury program at Burke Rehabilitation Hospital in White Plains, N.Y., said that while hospital rehabilitation may be best for the most severely injured patients, the study shows ``that the properly selected patient may be treated at home.' ``Psychologically that might be better for most patients,'' he said.