The proliferation of rehabilitation programs to treat disabled head-injured patients reflects the following: (1) recent advances in emergency evacuation and neurosurgical management that have reduced mortality after severe head injury; (2) dissemination of outcome research documenting that neurobehavioral sequelae are primarily responsible for chronic disability and prolonged dependence of survivors; (3) the rise of advocacy organizations such as the National Head Injury Foundation that have raised expectations by families for a higher quality of life in their head-injured relatives; (4) market forces driven by insurance, workmen's compensation, and litigation that provide funding for postacute care and incentives for development of private rehabilitation programs. In view of the previous neglect of posttraumatic neurobehavioral disturbances by the health care system, it is understandable that families in desperate circumstances were responsive to programs that attempted to restore cognitive function in disabled survivors.
Following this early enthusiastic (and uncritical) expansion of cognitive rehabilitation programs,
Levin HS. Cognitive Rehabilitation: Unproved but Promising. Arch Neurol. 1990;47(2):223–224. doi:10.1001/archneur.1990.00530020131027
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