Institutional Variation in Traumatic Brain Injury Acute Rehabilitation Practice

Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge

To evaluate the effect of providing quasi-contextualized speech therapy, defined as metacognitive, compensatory, or strategy training applied to cognitive and language impairments to facilitate the performance of future real-life activities, on functional outcomes up to 1 year following traumatic brain injury (TBI). Acute inpatient rehabilitation. Patients enrolled during the TBI-Practice-Based Evidence (TBI-PBE) study (n = 1760), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received speech therapy in acute inpatient rehabilitation at one of 9 US sites, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation. Propensity score methods applied to a database consisting of multisite, prospective, longitudinal observational data. Participation Assessment with Recombined Tools-Objective-17, FIM Motor and Cognitive scores, Satisfaction With Life Scale, and Patient Health Questionnaire-9. When at least 5% of therapy time employed quasi-contextualized treatment, participants reported better community participation during the year following discharge. Quasi-contextualized treatment was also associated with better motor and cognitive function at discharge and during the year after discharge. The benefit, however, may be dependent upon a balance of rehabilitation time that relied on contextualized treatment. The use of quasi-contextualized treatment may improve outcomes. Care should be taken, however, to not provide quasi-contextualized treatment at the expense of contextualized treatment.

To describe trajectories of functioning up to 5 years after traumatic brain injury (TBI) that required inpatient rehabilitation in the United States using individual growth curve models conditioned on factors associated with variability in functioning and independence over time. Secondary analysis of population-weighted data from a multicenter longitudinal cohort study. Acute inpatient rehabilitation facilities. A total of 4624 individuals 16 years and older with a primary diagnosis of TBI. Ratings of global disability and supervision needs as reported by participants or proxy during follow-up telephone interviews at 1, 2, and 5 years postinjury. Many TBI survivors experience functional improvement through 1 and 2 years postinjury, followed by a decline in functioning and decreased independence by 5 years. However, there was considerable heterogeneity in outcomes across individuals. Factors such as older age, non-White race, lower preinjury productivity, public payer source, longer length of inpatient rehabilitation stay, and lower discharge functional status were found to negatively impact trajectories of change over time. These findings can inform the content, timing, and target recipients of interventions designed to maximize functional independence after TBI.

Traumatic brain injury (TBI) leads to various sequelae that affect the day-to-day functioning of patients. However, there is a dearth of studies investigating these sequelae in complicated mild TBI and moderate TBI patients. The prime objective of the present study was to present the neurocognitive and affective profile of complicated mild and moderate TBI patients along with to compare the neurocognitive and affective sequelae in patients with complicated mild and moderate TBI. Twenty-two patients with complicated mild TBI and 17 patients with Moderate TBI, each with an intracranial lesion were recruited from level 1 trauma center in Varanasi. All patients were assessed with neurocognitive measures, Rivermead Post Concussive Symptoms Questionnaire, and Hospital Anxiety and Depression Scale. The patients' profiles were presented as clinical series using descriptive analysis. Further, comparison was done by using the Chi-square test and Fisher's exact test. Findings revealed that complicated mild TBI patients reported significantly higher psychological distress and post head injury symptoms in comparison to patients with moderate TBI. Further, the complicated mild TBI and moderate TBI groups showed differences with respect to verbal fluency, mental speed, and flexibility tasks. Complicated mild TBI and moderate TBI groups have not differed significantly on most of the cognitive tasks. Furthermore, affective symptoms were found more prominent in complicated mild TBI group as compared to the moderate TBI group.

Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study

Group Therapy Utilization in Inpatient Spinal Cord Injury Rehabilitation

Article 7: Opening the “Black Box”: The Content and Process of Brain Injury Rehabilitation From a Learning Perspective

Disorders of consciousness (DoCs) after severe brain injury are considered to be conditions with dire prognosis. Despite the accumulating evidence, inpatient rehabilitation is often denied by payers referring to the Medicare/Medicaid criteria, under the assumption that such patients will not "actively" participate in therapy or make "measurable improvements." This study aimed to report on the effectiveness and efficiency of a specialized inpatient DoC rehabilitation program based on measurable clinical parameters. A retrospective cohort study was conducted. The cohort comprised 137 patients with DoC admitted to a specialized acute inpatient rehabilitation program between January 2014 and October 2018. Patients were categorized as having been admitted at the acute stage (<=28 days post-injury), subacute stage (29-365 days following a traumatic brain injury (TBI) or 29-90 days following a non-TBI), or chronic stage (>365 days following a TBI or >90 days following a non-TBI). Outcomes included changes in level of consciousness (based on the Coma Recovery Scale-Revised (CRS-R), while also acknowledging scenarios beyond those captured by the CRS-R via Individualized Qualitative Behavioral Assessment and team consensus); Functional Independence Measure (FIM) levels; achievements in decannulation and initiation of oral diet; and time to those achievements. The rates of emergence from a minimally conscious state were 90, 62, and 18% among patients admitted at the acute, subacute, and chronic stages, respectively. Among patients who emerged, 100, 85, and 67%, respectively, had measurable FIM scores. Approximately 60 and 20% of patients at the acute and subacute stages, respectively, required moderate assistance or less in transfer/communication/eating/grooming/upper body dressing by the time of discharge from Phase I admission. The decannulation rates were 94, 67, and 17%. The oral diet initiation rates were 70, 23, and 6%. The time to reach these achievements lengthened as chronicity increased. There was a weak positive correlation (r s = 0.308) in the case of decannulation and a strong positive correlation (r s = 0.606, both p < 0.01) in the case of oral diet between days since injury on admission and days to the achievement after admission. Patients with TBI and hypoxic brain injury had comparable recovery rates when admitted at the acute and subacute stages. Specialized intensive inpatient rehabilitation is crucial and time-sensitive for functional recovery from DoC caused by TBI and hypoxic-ischemic brain injury. Specific goals and different outcome measures need to be developed to appraise the benefits of acute inpatient rehabilitation for DoC.

The purpose of this study was to examine the cost of delivery of inpatient therapeutic services in relation to their influence on change in functional independence (as measured by the Functional Independence Measure [FIM]) of people with spinal cord injuries (SCIs). Participants included adults with SCI (N = 549) who received treatment during inpatient rehabilitation at the study site during a 7-year span. Results from ordinary least squares multiple regression analysis indicated that recreational therapy (RT) significantly predicted both total and motor FIM scores, while occupational therapy (OT) predicted motor FIM change. When costs of service provision and change in motor FIM scores were compared, RT required fewer units of treatment to predict change in motor FIM scores and was less costly per unit than OT. Although not causal, findings provide evidence of the benefits of RT and lend support to the continued use of RT in inpatient rehabilitation programs.

Objective Traumatic brain injury (TBI) proves to be an obstacle for Bangladeshi patients due to the lack of facilities and specialist doctors in regional sections of the country. This study aimed to record different attributes of Bangladeshi TBI patients over a year i.e., their injury characteristics, treatments received and understand their impacts on the severity of TBI. Method This cross-sectional study was carried out among 280 TBI patients treated in a tertiary care hospital in Dhaka. The physicians determined TBI's severity and prognosis as per the Glasgow Coma Scale (GCS) and Glasgow Outcome Score (GOS) respectively. Results Most TBI patients were male (76.1%) and aged between 18 and 50 years (52.2%), as in previous studies in South Asian countries. However, the prevalence of TBI due to road traffic accidents (RTAs) was much higher (67.9%) than in the earlier studies in South Asia. Additionally, more patients suffered from severe TBI (29.3%) and moderate TBI (35.7%), and a higher percentage of patients went through surgery (56.8%) compared to previous studies. A significant association of demographic (residence) and clinical characteristics (consciousness after injury, CT scan findings and treatment type) with the severity of TBI was found in bivariate analysis. It also revealed the significant dependence of clinical characteristics (TBI etiology, post-injury consciousness, treatment type and TBI severity) on TBI prognosis. Multivariate analysis showed that patients who were unconscious after TBI and with evident brain injury observed in CT scans have a substantially higher risk of having moderate or severe TBI than mild TBI. Moreover, patients with TBI due to RTAs or falls, evident brain injury in CT scans, post-surgical seizure, and moderate or severe TBI have a significantly higher risk of getting a more unfavorable TBI prognosis than moderate disability. Conclusions In this study, RTAs were found to be the major cause of TBI. Additionally, some variables were identified as possible determinants of TBI severity and prognosis among Bangladeshi patients. The correlation of these variables with TBI should be further studied with the hopes that steps will be taken to reduce TBI incidents and improve its management to reduce the overall burden.

Early reading comprehension and speed of reading impairments in individuals with uncomplicated and complicated mild traumatic brain injury

The model systems (MSs) of care for traumatic brain injury (TBI) is a demonstration program started by the National Institute on Disability and Rehabilitation Research in 1987 to improve care and outcomes for individuals with TBI, from emergency services through life-long follow-up. Over the next 20 years, the program increased in size, and the emphasis shifted from demonstration to research. The focal point of that research is the National Data Base, a longitudinal database including nearly 9000 individuals who were admitted for inpatient acute TBI rehabilitation. In addition to preinjury, injury, acute care, and rehabilitation information, the database includes reports of outcomes at 1, 2, 5, 10, 15, etc, years postinjury. The National Data Base criteria, main contents, and mechanisms used to improve data quantity and quality are described. The MSs' other research is described: local (site-specific), module, and collaborative, with illustrative glimpses of the content. The impact of the TBI MSs program, through dissemination, knowledge translation, training of clinicians and researchers, as well as consulting with policy makers, administrators, clinicians, and researchers is discussed.

To understand how methylphenidate (MPH) is used in youth with traumatic brain injury (TBI) during inpatient pediatric rehabilitation. Inpatient pediatric rehabilitation. In total, 234 children with TBI; 62 of whom received MPH and 172 who did not. Patients were on average 11.6 years of age (range, 2 months to 21 years); 88 of 234 were female; the most common mechanism of injury was motor vehicle collision (49%); median (IQR) acute hospital length of stay (LOS) and inpatient rehabilitation LOS were 16 (10-29) and 23 (14-39), respectively; 51 of 234 were in a disorder of consciousness cognitive state at time of inpatient rehabilitation admission. Multicenter, retrospective medical record review. Patient demographic data, time to inpatient pediatric rehabilitation admission (TTA), cognitive state, MPH dosing (mg/kg/day). Patients who received MPH were older (P = .011); TTA was significantly longer in patients who received MPH than those who did not (P =.002). The lowest recorded dose range by weight was 0.05 to 0.89 mg/kg/d, representing an 18-fold difference; the weight-based range for the maximum dose was 0.11 to 0.97 mg/kg/d, a 9-fold difference. Patients in lower cognitive states at admission (P = .001) and at discharge (P = .030) were more likely to receive MPH. Five patients had side effects known to be associated with MPH; no serious adverse events were reported. This multicenter study indicates that there is variable use of MPH during acute inpatient rehabilitation for children with TBI. Children who receive MPH tend to be older with lower cognitive states. Dosing practices are likely consistent with underdosing. Clinical indications for MPH use during inpatient pediatric rehabilitation should be better defined. The use of MPH, as well as its combination with other medications and treatments, during inpatient rehabilitation needs to be further explored.

본 연구는 체계적 고찰을 통하여 뇌성마비 아동에게 적용한 작업치료의 세부적인 치료 방법과 치료 효과를 알아보고자 하였다. 연구대상논문은 2003년 1월부터 2012년 12월까지 출판된 논문이었고, 전자데이터 베이스인 PubMed를 이용하여 검색하였으며, 사용한 검색어는 'occupational therapy' OR 'exercise therapy' OR 'activities of daily living' OR 'splints' OR 'self-help devices' OR 'early intervention(education)' OR 'parents/education' OR 'parents/psychology' OR 'professional family relations' OR 'play and playthings' OR 'upper extremity' AND 'cerebral palsy'이었다. 분석대상논문은 총 18개이었다. 뇌성마비 아동에게 적용한 작업치료 방법은 보조기 26.2%, 부모교육 26.2%, 환경조정 9.6%, 감각운동기능 훈련 19.0%, 일상생활활동 19.0%로 나타났다. 뇌성마비 아동에게 적용한 작업치료의 효과는 보조기 40.0%, 부모교육 42.9%, 환경조정 40.0%에서 통계학적으로 유의하였다. 본 연구의 결과는 뇌성마비 아동의 작업치료에 있어서 근거를 마련하는데 중요한 자료가 될 것이다. The purpose of this study was to present results and methods of occupational therapy for children with cerebral palsy using systematic review. This study was searched form papers published from Jan, 2003 to Dec, 2012 using PubMed E-Data base. Key words using on the search were 'occupational therapy' OR 'exercise therapy' OR 'activities of daily living' OR 'splints' OR 'self-help devices' OR 'early intervention(education)' OR 'parents/education' OR 'parents/psychology' OR 'professional family relations' OR 'play and playthings' OR 'upper extremity' AND 'cerebral palsy'. Eighteen studies were included in this review. Methods on occupational therapy for children with cerebral palsy were splint 26.2%, parent education 26.2%, environmental modification 9.6%, training of sensorimotor function 19.0%, activities of daily living 19.0%. Results on occupational therapy for children with cerebral palsy were significant difference on splint 40.0%, parent education 42.9%, environmental modification 40.0%. Results of this study will provide evidences based on occupational therapy.

Proper evaluation of ski helmet designs and safety standards should rely on head impact conditions involved in skiing and snowboarding head injuries. To study these impacts, main crash scenarios involving head injuries are numerically replicated. Multibody models of skiers and snowboarders were developed to investigate five common crash scenarios involved in traumatic brain injury: forward and sideways skiing falls, snowboarding backward falls, collisions between users and collisions with obstacles. For each scenario, the influence of crash conditions on head impact (location, speed, linear and rotational accelerations) and risk of injury are evaluated. Crash conditions were initial velocity, user height, position and approach angle, slope steepness, obstacles, and snow stiffness. One thousand one hundred forty-nine crashes were simulated and three significant levels of impact conditions were discriminated over the investigated crash scenarios: 1) the smallest normal-to-slope impact velocities (6 km·h; 22 km·h) and peak linear accelerations (42g; 75g) were obtained during forward and sideways skiing falls; 2) snowboarding backward falls and collisions between users were associated with high normal-to-surface impact velocities (26 km·h; 32 km·h) and head accelerations (80g; 149g) above one published threshold for mild traumatic brain injury but below the pass/fail criteria of helmet standard tests; 3) collisions with obstacles were associated with high normal-to-surface impact velocities (19 km·h; 35 km·h) and the highest head accelerations (626g; 1885g). Current impact conditions of helmet standard evaluations consistently replicate collisions with obstacles, but need to be revised to better reflect other significant crash scenarios leading to traumatic brain injury.