Early Versus Later Admission to Postacute Rehabilitation: Impact on Functional Outcome After Traumatic Brain Injury

• Published in: Archives of physical medicine and rehabilitation Vol. 87; no. 3; pp. 334 - 342
• Main Authors: High, Walter M., Roebuck-Spencer, Tresa, Sander, Angelle M., Struchen, Margaret A., Sherer, Mark
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2006; Elsevier
• Subjects: Adult; Biological and medical sciences; Brain injuries; Brain Injuries - physiopathology; Brain Injuries - psychology; Brain Injuries - rehabilitation; Cohort Studies; Comprehensive Health Care; Delivery of Health Care, Integrated; Diseases of the osteoarticular system; Female; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Miscellaneous; Patient Admission; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recovery of Function - physiology; Rehabilitation; Time Factors; Traumas. Diseases due to physical agents; Treatment effectiveness; Treatment Outcome; Treatment outcome; Treatment effectiveness; Rehabilitation; Brain injuries; Prognosis; Questionnaire; Cognitive disorder; Arrhythmia; Awareness; Cardiovascular disease; Teaching; Disability; Improvement; Reeducation; Education; Heart disease; Cohort study; Ambulatory; Hospital; Productivity; Nervous system diseases; Community home; Reentry; Adjustment; Family study; Independence; Excitability disorder; Discharge; Head trauma; Comparative study
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2005.11.028

High WM Jr, Roebuck-Spencer T, Sander AM, Struchen MA, Sherer M. Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury. To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI). Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design. Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital. Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29). Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community. Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire. All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge. The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.