Historically, most medical practices were developed by clinical experience. As acute care and rehabilitation treatment for individuals with brain injury have evolved over the years, the development of practice standards has evolved as well.

Until recently, most practice standards for brain injury (and many other medical conditions) were developed by consensus. A group of experts would gather to share their experiences and expertise and eventually agree on the best course of care. When there is a lack of data about what works and what does not, this process can be very useful in developing steps other clinicians can take in working with people with brain injury.

In the last decade, a newer development in standards of care has evolved known as the Evidence Based Practice Parameter, or the Evidence Based Guideline. The process of developing evidence based guidelines is described on several websites, including: www.ahrq.gov , http://www.ebmny.org/. In summary, evidence based medicine involves the use of existing literature to identify the most effective intervention or interventions.

There are several Evidence Based Guidelines available for brain injury. Some are general, and some are specific. They include:

www.braintrauma.org: this is the website for the Brain Trauma Foundation. On their site, click on the link to “Guidelines”, and there will be the Guidelines for the Prognosis and Management of Severe Brain Injury. This is one of the first evidence based guidelines developed specifically for brain injury.

http://www.ahrq.gov/clinic/epcix.htm - this is the page for Evidence based Practice Guidelines on the Agency for Healthcare Research and Quality. Towards the bottom will be evidence based reviews of traumatic brain injury, and traumatic brain injury in children and adolescents.

There is one important factor to keep in mind when reading these resources. Some insurance companies will say that because a specific therapy is not systematically shown to be effective, it should not be a covered treatment. It is important to understand that just because there is not enough evidence to systematically show effectiveness, this does NOT necessarily mean that the therapy is ineffective.