Brain injury rehabilitation is a relatively new clinical focus for behavior analysts and other professionals who work in the realm of residential treatment. However, the consequences of brain injury had been noted for the past 5000 years. In approximately 3000 B.C. Egyptians recorded the cognitive and behavioral sequelae of a left temporal depressed skull fracture . Today, brain injury has achieved the status of a worldwide epidemic. As a result of scientific and technological advances in motorized transportation, mechanized warfare, and industrial production methods, the incidence of brain injury has steadily increased since the turn of the century .
Recent estimates of the exact incidence of brain injury vary based on definitional criteria. For example, the annual number of severe brain injuries has been estimated from 500,000 (Bartkowski & Lovely, 1986; Vogenthaler, 1987a) to 1,000,000 , whereas the annual number of total brain injuries has been estimated to be as high as 8,000,000 (Conboy, Barth, & Boll, 1986). More specifically, it has been estimated that as many as 1,800,000 persons experience closed head injury as a result of motor vehicle and sporting accidents, assaults, and falls (Traphagen, 1988).
The overall number of survivors of brain injury is greater than ever before and continues to grow (McMahon & Fraser, 1988). A number of factors contribute to this growth, including advances in brain science and neurosurgical techniques, greater availability of shock-trauma centers, advances in emergency medicine, the advent of medevac helicopters for faster transport of accident victims, and increased use of seat belts and airbags.
Increases in the number of survivors of significant brain injury have led to a proliferation of available services. The number of brain injury rehabilitation programs in the United States has grown from a handful in 1980 to over 500 in 1990 (National Head Injury Foundation, 1990).