The field of head trauma rehabilitation has seen tremendous growth over the past decade, but continued progress in service delivery requires a consideration of synthesis, accountability, and a future-oriented perspective. A recent National Institutes of Health (NIH) consensus panel concluded that brain injury rehabilitation is generally effective, with evidence supporting cognitive and behavioral interventions that are "structured, systematic, goal-directed, and individualized and [they] involve learning, practice, social contact, and a relevant context." 1^(p.979) Unfortunately, extraction of more specific, empirically based treatment guidelines was not possible because of this literature being marked by heterogeneity of participants, interventions, and outcomes studied, as well as limitations of small sample size, failure to control for spontaneous recovery, and the unspecified effects of social contact. 1^(p.978) The impetus for this special issue of JHTR arose from a desire to glean deeper understanding and direction and to answer a basic lingering question: "What really matters in producing positive recovery after brain injury?"

Two observations framed our approach to this question. First, clinical experience compels acknowledgment that, despite having similar medical profiles of injury, individual patients nonetheless demonstrate a variety of functional outcomes. This suggests that variables distinct from the injury itself importantly modify, or moderate, the recovery trajectory and potentially should constitute a more central focus of rehabilitation interventions. A second observation is that the proliferation of hospital- and community-based brain injury rehabilitation providers over the past two decades means that a significant proportion of brain injury services now occur away from large, academic, research-funded centers. Such providers seek effective, efficient, and practical strategies that can be implemented reliably in their own communities, yet many published studies report programs that may be difficult or impossible to replicate in applied settings. Again, on the ``front lines" of rehabilitation, what really matters in promoting positive recovery and adaptation after brain injury?

The NIH consensus panel report recommended that in addition to our historical (and, in their view, narrow) focus on medically based restorative approaches, additional attention be paid to the importance of environmental modifications as a means to develop enabling conditions for people and families affected by brain injury. Others have also argued that interventions should consider and address those predisposing, precipitating, and perpetuating factors (i.e., moderators) that importantly shape long-term outcome. 2

The articles in this issue examine moderators such as gender, living location (urban versus rural setting), family dynamics, medical status, behavioral health history, and compensation-seeking and their impact on community, vocational, and lifestyle reintegration after brain injury. Collectively, these articles demonstrate the tremendous importance of preinjury and postinjury demographic and psychosocial variables in the recovery of both children and adults with traumatic brain injuries. We anticipate that this collection of articles offers a wealth of information for the researcher and clinician alike. However, the work is not completed yet. An important goal for future research in this field is to determine not only the interactive effects among all these moderating variables but also to explore opportunities for more meaningful and effective intervention, based on this new knowledge of which demographic and psychosocial factors influence outcome after traumatic brain injury.

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