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Fluids & Electrolytes
TRAUMATIC BRAIN INJURY can often be associated with long-lasting symptoms and effects on function in a wide variety of areas. Expertise in the assessment and management of chronic physical, cognitive, and behavioral complaints is limited in many geographic areas, especially in rural America. Even in urban and suburban areas, the ability to fund treatment and education may be limited over the long course of recovery from and living with a chronic disorder. However, alternatives to face-to-face visits and therapy may be found through the blossoming of communication technologies. Few are without access to good reliable telephone services these days and, increasingly, Internet access is available through cable and wireless services. Audio and visual contact is possible with individuals and groups through various means. Facebook, Wikis, and Twitter, all new and innovative means of communication, are potentially available to extend the reach of the healthcare provider.
Reaching out electronically to provide treatment and education to patients and caregivers is the focus of this issue of The Journal of Head Trauma Rehabilitation. Dr Bombardier and colleagues report on the results of a telephone-based counseling intervention aimed at educating and improving problem-solving skills of persons with moderate to severe traumatic brain injury with a range of depressive symptoms. Dr Wade and her group present their findings on using Web-based education and therapy to improve outcomes among children, adolescents, and their families. Finally, focusing on caregiver support and education, Dr Sander and her fellow investigators describe the use of videoconferencing technology to provide access to those living at a distance from the brain injury rehabilitation site.
Many pilot research and clinical uses of Web-based communication technology can be found, particularly in the military (eg, http://www.afterdeployment.org) and veterans healthcare worlds. Little is currently known about how and who accesses these resources, how effective they are in terms of education and outcome, or how these electronic resources compare with more traditional avenues of education and treatment. Experience gained in other fields of healthcare will need to be evaluated in light of the special cognitive challenges our patients bring to the process, for both education and therapy. Definitions and measures of "dosing" for interventions delivered by telecommunication methods will require further explication. With respect to currently available funding, only face-to-face education and treatment are generally covered by insurers and healthcare intermediaries, funded by government. As these techniques are researched and further developed, the means of financing electronically mediated interventions will need to be resolved.
We could not present these papers without stretching our own avenues of education and dissemination as well. We will be presenting a Webinar on this JHTR Telerehabilitation issue at 3 PM ET on August 6, 2009. Registration for the Webinar, part of the Mitch Rosenthal Memorial Lecture series, will be available in the bookstore of the Brain Injury Association of America in early July. The path is http://www.biausa.org. Click on Bookstore, and then click on Strauss and Rosenthal Lecture Series to register. More information can be obtained by contacting Marianna Abashian at email@example.com.
Kathleen R. Bell, MD
Associate Professor, Rehabilitation Medicine, University of Washington, Seattle (Bell)
Tessa Hart, PhD
Institute Scientist, Moss Rehabilitation Research Institute, Research Associate Professor, Jefferson Medical College, Philadelphia, Pennsylvania (Hart)
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