Does an Early Onset and Continuous Chain of Rehabilitation Improve the Long-Term Functional Outcome of Patients with Severe Traumatic Brain Injury?

Abstract

There are currently no international guidelines regarding treatment in the early rehabilitation phase for persons with severe traumatic brain injury (TBI), and only a few studies have investigated the effect of integrating rehabilitation into acute TBI care. The aim of the study was to evaluate whether a continuous chain of rehabilitation that begins with the acute phase could improve the functional outcome of severe TBI patients, compared to a broken chain of rehabilitation that starts in the sub-acute phase of TBI. A total of 61 surviving patients with severe TBI were included in a quasi-experimental study conducted at the Level I trauma center in Eastern Norway. In the study, 31 patients were in the early rehabilitation group (Group A) and 30 patients were in the delayed rehabilitation group (Group B). The functional outcomes were assessed 12 months post-injury with the Glasgow Outcome Scale Extended (GOSE) and the Disability Rating Scale (DRS). A favorable outcome (GOSE 6-8) occurred in 71 % of the patients from Group A versus 37 % in Group B ( p = 0.007). The DRS score was significantly better in Group A ( p = 0.03). The ordinal logistic regression analysis was used to quantify the relationship between the type of rehabilitation chain and the GOSE. A better GOSE outcome was found in patients from Group A (unadjusted OR 3.25 and adjusted OR 2.78, respectively). These results support the hypothesis that better functional outcome occurs in patients who receive early onset and a continuous chain of rehabilitation.

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

“…This is further supported by a reported average of five PTCs within different domains. Former studies have indicated that moderate and severe TBI patients often deal with various problems, and that rehabilitation physicians are important care providers in long-term aftercare for these patients [16,19]. We observed a relatively low follow-up rate with rehabilitation physicians.…”

Vagus Nerve Stimulation Delivered with Motor Training Enhances Recovery of Function after Traumatic Brain Injury

“…5,6,[44][45][46] Moreover, intensive rehabilitative therapy, which is presently the best available intervention for TBI patients, 19 is optimally effective when initiated early after the onset of injury. [47][48][49][50] In this study the VNS-paired intervention was initiated between 3 and 4 weeks post-injury, and it endured for 5 weeks. Therefore, the lower stimulation requirements and long therapeutic window demonstrate that paired VNS therapy is a promising candidate for patients who are suffering the longterm effects of brain injury.…”

Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury

“…Initial treatment of STBI at a level 1 trauma center may be associated with a greater return of functional independence [37]. Continuous early rehabilitation interventions beginning during acute care and spanning IR and outpatient rehabilitation have been shown to improve outcomes after TBI [38][39][40][41]. Also, an investigation of veterans having nonpenetrating moderate TBI to STBI found that those with a latency of less than 48 d in trauma acute care prior to transfer to postacute IR were 2.4 times more likely to be productive in terms of ability to return to work at 1 yr [42].…”