Although the magnitude of the correspondence is small, the intensity of PT intervention in an inpatient rehabilitation hospital is related to positive changes in functional mobility scores and the achievement of an MCID. However, initial mobility status is an essential factor in the interpretation of change scores. Future studies are needed to determine whether controlled variations of PT service intensity have a differential effect on mobility recovery during inpatient rehabilitation.
Background and Purpose. Evidence to guide physical therapist prognosis for recovery of the ability to ambulate in children and adolescents with traumatic brain injury (TBI) is limited. The aim of this study was to delineate a predictive model and determine the value of key demographic and clinical variables in establishing a prognosis for ambulation without the assistance of a device or person over 15.24 m on a flat, level surface following inpatient rehabilitation. Subjects and Methods. For this retrospective study, a consecutive series of 95 children and adolescents with TBI (aged 2–18 years) admitted to an inpatient rehabilitation program was assessed using information from medical records. A multiple logistic regression analysis was conducted to identify predictors for ambulation at the time of discharge from the rehabilitation setting. Results. Fifty-six percent of the children achieved ambulation at discharge. Lower-extremity hypertonicity (measured on physical therapist examination as resistance to passive stretch), brain injury severity, and lower-extremity injury together were predictors of the ability to ambulate. Discussion and Conclusion. Impairment and injury-related variables were important in predicting a minimal level of unassisted ambulation after discharge from inpatient rehabilitation. Awareness of predictors of recovery of the ability to ambulate that are gathered as part of a physical therapist's examination may assist in developing a prognosis for ambulation and in establishment of an appropriate plan of care.
Traumatic brain injury (TBI) is a major cause of disability in children. Along with other neurological clinical sequelae, children often exhibit motor skill impairment and limitations in functional mobility following TBI. The purpose of this annotated bibliography is to: (1) familiarize therapists with the literature available regarding motor skill and mobility recovery outcomes for children and adolescents with TBI; (2) assist therapists in the selection of motor skill and mobility outcome assessments for use in clinical practice; and (3) provide therapists with comparisons of outcomes for external benchmarking. A number of reports document motor and mobility recovery outcomes as well as recovery in other domains. Studies vary, however, in design, sample size, number and type of outcome assessments used, time since injury at assessment(s), and the consideration of correlating factors such as age at time of injury and injury severity. Further research is needed to describe clinical, satisfaction and resource utilization outcomes, determine outcome predictors, and provide evidence for therapeutic intervention effectiveness.
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