Journal of Rehabilitation Research & Development (JRRD)

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Guest Editorial

Volume 49 Number 7, 2012
   Pages vii — ix

Henry L. Lew, MD, PhD; David X. Cifu, MD;
A. Tamara Crowder, PhD; COL Jamie B. Grimes, MD4

Sensory and communication disorders in traumatic brain injury

Patients with traumatic brain injury (TBI) often present with a constellation of symptoms that may interact, persist, and exacerbate if untreated [1-7]. Recently, clinicians have noted that auditory, vestibular, and visual symptoms were frequently reported by combat returnees during their clinical evaluation and treatment [8-12]. These sensory issues are likely to negatively affect the ability of individuals with TBI to process cognitive information and perform daily tasks such as communication and ambulation. While researchers are still investigating the effects of sensory and communication disorders on rehabilitation outcome, preliminary data have shown that dual sensory impairment may adversely influence functional outcome in patients with TBI [10].

Founded by Congress in 1992, the Defense and Veterans Brain Injury Center (DVBIC) is the TBI operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury ( ) [13]. With its headquarters in the nation’s capital region, DVBIC has been a bridging force between the U.S. Military Health System and Veterans Health Administration, as well as academic and private rehabilitation facilities, all of which share the common goal of providing the best care to servicemembers and Veterans with TBI. As a part of its mission, DVBIC has continued to support educational initiatives and research programs so that clinicians can learn and implement the highest quality of evidence-based practice. This special issue on sensory and communication disorders in TBI represents another endeavor to highlight the latest findings by clinicians and researchers who serve patients with TBI. It contains a wide spectrum of high-quality articles, encompassing innovative research findings, insightful clinical observations, focused reviews, and consensus expert opinions. The following topics are discussed:

  1. Multisensory impairment reported by Veterans with and without TBI.
  2. Sensorintegrative dysfunction underlying vestibular disorders after TBI.
  3. Audiological issues and hearing loss among Veterans with mild TBI.
  4. Central auditory processing by individuals exposed to high-intensity blasts.
  5. Telehealth tinnitus management for persons with and without TBI.
  6. Blast exposure and dual sensory impairment.
  7. Implications of blast exposure for central auditory function.
  8. Visual symptomatology and referral patterns for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans with TBI.
  9. Vergence in mild TBI.
  10. Visual attention in OIF/OEF Veterans.
  11. Relationship of screen-based symptoms for mild TBI and mental health problems.
  12. Mild TBI and pain in OIF/OEF Veterans.
  13. Preliminary framework for a familiar auditory sensory training task during coma recovery.
  14. Preliminary studies on differential expression of auditory functional genes in the brain after repeated blast exposures.

Throughout its preparation process, this special issue has generated enthusiastic responses from a wide range of subject matter experts who have worked diligently with the editorial staff and volunteers to bring this project to fruition. A key focus has been to increase health professionals’ awareness of the diverse sensory and communication disorders that may result from a TBI so that a team-oriented, patient-centered rehabilitation plan can be formulated and implemented expediently, thereby enhancing the likelihood of an optimal outcome [14]. The issue also includes a synopsis prepared by expert speech-language pathologists who work in the military, Department of Veterans Affairs, and civilian systems that summarizes their experience and identifies recommendations for the management of cognitive-communication problems after combat-related mild TBI. As we receive more articles on the expressive communication deficits related to TBI, another special issue may be warranted. We hope that our readers will find these articles to be both academically stimulating and clinically useful.

Henry L. Lew, MD, PhD;1-2* David X. Cifu, MD;1,3 A. Tamara Crowder, PhD;4 COL Jamie B. Grimes, MD4

1DVBIC, Richmond, VA; and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; 2Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai’i at , Honolulu, HI; 3Department of Veterans Affairs, Washington, DC; 4DVBIC, Washington, DC


We gratefully acknowledge the support of Dr. James Jerger, Dr. Sureyya Dikmen, Dr. Alex Ommaya, Dr. Pauline Mashima, Mrs. Dorothy Craven, Ms. Barbara Ward, Mr. Lloyd Tinker, Mr. Tristan Horrom, Dr. Stacie Yuhasz, Dr. William Walker, Dr. Jerris Hedges, Dr. Satoru Izutsu, and Dr. Cheryl Lee.

Disclaimer: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

  1. Cifu DX, Cohen SI, Lew HL, Jaffee M, Sigford B. The history and evolution of traumatic brain injury rehabilitation in military service members and veterans. Am J Phys Med Rehabil. 2010;89(8):688-94.
  2. Lew HL, Pogoda TK, Hsu PT, Cohen S, Amick MM, Baker E, Meterko M, Vanderploeg RD. Impact of the “polytrauma clinical triad” on sleep disturbance in a department of veterans affairs outpatient rehabilitation setting. Am J Phys Med Rehabil. 2010;89(6): 437-45. [PMID:20489391]
  3. Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cifu DX. Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad. J Rehabil Res Dev. 2009;46(6):697-702. [PMID:20104399]
  4. Lew HL, Vanderploeg RD, Moore DF, Schwab K, Friedman L, Yesavage J, Keane TM, Warden DL, Sigford BJ. Overlap of mild TBI and mental health conditions in returning OIF/OEF service members and veterans. J Rehabil Res Dev. 2008;45(3):xi-xvi.
  5. Lew HL, Poole JH, Vanderploeg RD, Goodrich GL, Dekelboum S, Guillory SB, Sigford B, Cifu DX. Program development and defining characteristics of returning military in a VA Polytrauma Network Site. J Rehabil Res Dev. 2007;44(7):1027-34.
  6. Lew HL, Poole JH, Guillory SB, Salerno RM, Leskin G, Sigford B. Persistent problems after traumatic brain injury: The need for long-term follow-up and coordinated care. J Rehabil Res Dev. 2006;43(2):vii-x.
  7. Lew HL. Rehabilitation needs of an increasing population of patients: Traumatic brain injury, polytrauma, and blast-related injuries. J Rehabil Res Dev. 2005; 42(4):xiii-xvi. [PMID:16320135]
  8. Lew HL, Pogoda TK, Baker E, Stolzmann KL, Meterko M, Cifu DX, Amara J, Hendricks AM. Prevalence of dual sensory impairment and its association with traumatic brain injury and blast exposure in OEF/OIF veterans. J Head Trauma Rehabil. 2011;26(6): 489-96. [PMID:21386715]
  9. Lew HL, Weihing J, Myers PJ, Pogoda TK, Goodrich GL. Dual sensory impairment (DSI) in traumatic brain injury (TBI)--An emerging interdisciplinary challenge. NeuroRehabilitation. 2010;26(3):213-22.
  10. Lew HL, Garvert DW, Pogoda TK, Hsu PT, Devine JM, White DK, Myers PJ, Goodrich GL. Auditory and visual impairments in patients with blast-related traumatic brain injury: Effect of dual sensory impairment on Functional Independence Measure. J Rehabil Res Dev. 2009;46(6):819-26. [PMID:20104405]
  11. Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. Arch Phys Med Rehabil. 2008;89(1):163-70.
  12. Lew HL, Jerger JF, Guillory SB, Henry JA. Auditory dysfunction in traumatic brain injury. J Rehabil Res Dev. 2007;44(7):921-28. [PMID:18075949]
  13. Defense and Veterans Brain Injury Center [Internet]. Silver Spring (MD): DVBIC; 2012. Available from:
  14. Lew HL, Cifu DX, Sigford B, Scott S, Sayer N, Jaffee MS. Team approach to diagnosis and management of traumatic brain injury and its comorbidities. J Rehabil Res Dev. 2007;44(7):vii-xi.

This article and any supplementary material should be cited as follows:
Lew HL, Cifu DX, Crowder AT, Grimes JB. Sensory and communication disorders in traumatic brain injury. J Rehabil Res Dev;49(7):vii-x.

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Last Reviewed or Updated  Wednesday, October 24, 2012 1:19 PM

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