Functional outcome following rehabilitation in chronic severe traumatic brain injury patients: A prospective study (original) (raw)
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Brain injury, 2018
The objective of this study was to examine the benefits of long-term inpatient rehabilitation for individuals with moderate-to-severe traumatic brain injuries (TBIs). Retrospective database review of 67 individuals with moderate-to-severe TBI admitted to a specialised inpatient TBI program. Outcome measures are as follows: (1) functional independence measure + functional assessment measure (FIM+FAM; admission, discharge, change scores); (2) discharge designation (community vs. long-term care (LTC)). There was a mean improvement on FIM+FAM of 54.19 points (SD = 35.63) or 67% between admission and discharge (t(66) = -12.45, p < 0.001). Mean time post-injury upon completion of therapy was 409.59 days (SD = 343.93). Upon completion of rehabilitation, 50 (75%) participants were discharged to community and 17 to LTC. Among those returning to community, those with longer length of stays were more severely disabled on admission (t(35.9) = -4.86, p < 0.001). Controlling for admission f...
Rehabilitation results of patients with traumatic brain injury
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2017
Rehabilitation results of patients with traumatic brain injury Objective: The aim of this study is to investigate the effectiveness of neurological rehabilitation in patients with traumatic brain injury. Materials and Method: Forty-five patients who were rehabilitated after traumatic brain injury were included in the study. The sociodemographic characteristics of the patients, the cause of the injury, the duration of coma and posttraumatic amnesia, the duration of stay in the other clinics after injury, the time between injury and admission to the rehabilitation clinic, the duration of stay in the rehabilitation clinic and long-term complications were determined. The functional differences between the admission of the patients and their final control examinations were compared using Disability Rating Scale (DRS), Functional Independence Measure (FIM), and Functional Ambulation Scale (FAS), and cognitive differences were compared using their recent status criteria, with Rancho Los Amigos Scale (RLAS). Results: There was a significant improvement in the functional status of patients after neurological rehabilitation. There were statistically significant changes in DRS, FIM, FAS and RLAS scores after treatment compared to initial status. Better improvement in the functional status was detected in patients with lower initial DRS scores and higher FIM and RLAS scores. Conclusion: The neurologic rehabilitation significantly affects the recovery of functional status after traumatic brain injury.
Rehabilitation of Moderate-to-Severe Traumatic Brain Injury
Seminars in neurology, 2015
Traumatic brain injury (TBI) is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Traumatic brain injury is a leading cause of morbidity and disability and is considered a major public health concern. Traumatic brain injury sequelae can lead to long-term impairments in physical, cognitive, behavioral, and social function. Traumatic brain injury rehabilitation requires an interdisciplinary holistic team approach in the management of medical complications, the prevention of further disability, and helping patients return to their highest level of independence. The authors review TBI pathophysiology, grading severity, common medical complications, cognitive rehabilitation, prognosis, and common outcomes used in TBI rehabilitation.
Trauma Care, 2021
Severe acquired brain injuries (sABI) represent one of the main causes of disability and limitation in social life participation that need an intensive rehabilitation approach. The purpose of this study was to identify a possible correlation between different supposed conditioning factors and the efficiency of rehabilitation interventions. In this retrospective study, data were processed regarding 44 patients admitted to a neurorehabilitation department after sABI. A significant correlation with the efficiency of the rehabilitation intervention (expressed as the variation of the Barthel score between discharge and admittance in relation to the duration of the rehabilitative hospitalization) was found for both the etiology of the brain injury (p = 0.023), the precocity of the rehabilitation treatment (p = 0.0475), the presence of a tracheal cannula (p = 0.0084) and forms of nutrition other than oral (p < 0.0001). The results of this study suggest that improving the management of t...
Rehabilitation outcome after traumatic brain injury
Neurocirugía, 2007
Rehabilitation goals after traumatic brain injury are improving function, increasing the level of independence as high as possible, preventing complications and providing an acceptable environment to the patient. Several complications can be encountered during the rehabilitation period which lead to physical, cognitive and neurobehavioral impairments that cause major delay in functional improvement. This prospective study was designed in order to investigate the complications and their relations with functional recovery in patients that were included in the acute phase of a rehabilitation program. Thirty traumatic brain injured patients admitted to the Intensive Care Units of Uludag University School of Medicine were included in the study. Rehabilitation program consisted in appropriate positioning, range of motion exercises, postural drainage and respiratory exercises. Complications that were encountered during intensive care rehabilitation program were recorded. All patients were evaluated by Functional Independence Measure, Disability Rating Scale and Ranchos Los Amigos Levels of Cognitive Function Scale at admission and discharge. Improvement was observed in patients in terms of functional outcome and disability levels. Pneumonia, athelectasis, anemia and meningitis were the most frequent complications. Deterioration in functional outcome and disability levels was noted as the number of these complications increased. In conclusion, rehabilitation has an important role in the management of traumatic brain injured patients. Reduction of frequency of complications and improvement in functional outcome and disability levels can be achieved through rehabilitation programs. Long-term controlled studies with large number of patients are needed in order to obtain accurate data on factors associated with rehabilitation outcomes.
Updates in Management of Adults with Traumatic Brain Injury: A Rehabilitation Perspective
Austin Publishing group
Introduction: TBI results in significant mortality and morbidity worldwide and represents a global health problem with huge economic burden for healthcare systems due to increased demand for health care, social and vocational services. It is complex and variable, requiring integrated multidisciplinary care. Empirical evidence for various rehabilitation interventions commonly trialed in TBI survivors are growing.
Moderate to Severe Traumatic Brain Injury -An Institutional Experience
Background: Traumatic brain injury (TBI) is a significant public health problem and is a leading cause of mortality in India. Incidence of Head injuries in increasing over the years may be due to increase in vehicular traffic and non adherence to traffic rules. Materials and Methods: This is a retrospective and prospective study of all the patients admitted to Government general hospital, Guntur between June 2019 and August 2019, with TBI and GCS at admission of 12 or less. Results: The Total number of cases admitted with moderate to severe TBI were 136 during period of 3 months. 42.7 years was the mean age of TBI patients and male to female ratio was 6.5:1. Mortality rate was 38.2% and majority(88%) of them belonged to severe TBI group. Conclusion:Most of the TBI's occur among the productive age group males and carry a very high mortality rate. Impact model may not be highly accurate at our institute however can still give a good and objective way of prognostic assessment.
Long-term Mortality After Traumatic Brain Injury Rehabilitation
Journal of Head Trauma Rehabilitation, 2006
Objective: Determine head injury self-reported sequelae/problems, services referral, if services accessed, and service needs. Design: Followup study. Setting: Hospital emergency departments. Participants: Patients (N = 1098) treated/ discharged from 3 emergency departments. Interventions: Provision of head injury information/ referral to services. Methods: Criteria included brain injury ICD-9-CM codes, facial fractures, lacerations, and 1 or more clinical signs/symptoms. Demographics, contact information, cause of injury, radiology/imaging, and discharge codes were provided by staff to project director. Follow-up conducted to determine physical/cognitive/behavioral problems; difficulties performing daily activities; services referral; if services accessed; and who to contact for help with problems. Results: AIS scores indicated that 9% had minor, 91% moderate, and 1% severe injury. Also, 18% had loss of consciousness (LOC), 72% suffered concussion, and 17% suffered nonspecific brain injury. First follow-up postinjury ranged from 2 to 18 weeks. A total of 157 persons (14%) were excluded from follow-up; 368 (33%) were unable to contact with minimum 8 attempts; and follow-up was completed on 573 (52%). Of these, 247 (43%) reported 1 or more problems including headaches (73%), tiredness (41%), neck pain (39%), dizziness (37%), weakness (24%), memory (23%), and vision changes (22%). Factors statistically significant among persons with problems included age, LOC, concussion with LOC, and AIS = 2 (moderate injury). Gender and weeks postinjury followup were not significant. Conclusions: This study found that 23% of patients reported problems at first follow-up and 20% at second follow-up; the majority of patients did not know where to seek services. Emergency department staff should be trained to provide patients at discharge with basic information about short-and long-term effects of traumatic brain injury and services/resources contacts.
Favorable Functional Recovery in Severe Traumatic Brain Injury Survivors beyond Six Months
Journal of Neurotrauma, 2019
Favorable long-term functional outcomes after severe traumatic brain injury (TBI) may be underestimated. We analyzed 24-month functional outcomes from a consecutive series of severe TBI survivors. A prospective, observational database of severe TBI survivors from a single institution was analyzed. Glasgow Outcome Scale-Extended (GOS-E) scores were obtained at 3, 6, 12, and 24 months post-injury. GOS-E scores were dichotomized into unfavorable and favorable outcomes, and the proportion of survivors changing from unfavorable to favorable outcomes was calculated using Wilcoxon signed-rank tests. Surviving adults (N = 304; mean agestandard deviation = 35.06-15.11; 80.92% male; mode of initial GCS = 7) were analyzed. A statistically significant mean increase in GOS-E was noted from 3 to 6, 6 to 12, 12 to 24, and 6 to 24 months after injury (0.65 [p < 0.0001], 0.42 [p < 0.0001], 0.23 [p = 0.020], and 0.61 [p < 0.0001], respectively). Moreover, 43% of survivors from 3 to 6 months, 36% from 6 to 12 months, 38% from 12 to 24 months, and 54% from 6 to 24 months progressed from an unfavorable to a favorable outcome. Two thirds of survivors in the unfavorable category at 3 months had favorable outcomes at 2 years. Overall, 74% of surviving adults with a documented GOS-E at 2 years after injury had a favorable outcome. Severe TBI survivors demonstrated significant improvement in functional outcomes from 3 to 24 months after injury. At 2 years, three fourths of survivors had a favorable outcome. Long-term prognosis in severe TBI is better than broadly appreciated.