The Relationship Between Functional Mobility and the Intensity of Physical Therapy Intervention in Children with Traumatic Brain Injury

Abstract

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.

Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and 9 Months Postdischarge

“…This finding was demonstrated across all three of the primary disciplines—OT, PT, and ST—and replicates findings from previous PBE studies for stroke and pediatric rehabilitation populations. 24, 25 Practice-based evidence studies with stroke patients found that therapy that challenges patients with severe impairments, such as therapies targeting advanced gait (negotiating uneven surfaces), home management, and problem-solving, were associated with better outcomes than therapies targeting lower level functions such as bed mobility and basic speech. 24,32,33 Moreover, those studies found that better outcomes were associated with using advanced therapies earlier in treatment.…”

“…The current study and prior discipline-specific studies of therapy intensity suggest: (a) the components of treatment have a stronger impact on outcomes than total time, and (b) patient tolerance and preference in regard to intensity need to be taken into account. 25,35–38 …”

Morbidity

“…43 The National Trauma Data Bank, the leading US trauma registry and most commonly used database for injured children from over 700 facilities, uses only mortality as a hospital discharge outcome for both ICU and non-ICU children even though mortality is substantially less than 3%. 44 In trauma research, most functional outcome studies have been used only in specific age groups, have been performed only among children with traumatic brain injury, or have been assessed in a research setting, e.g., the Pediatric Evaluation of Disability Inventory (PEDI), 45 the WEE Functional Injury Measure (WeeFIM), 46 and the GOS-E Peds. Few studies have evaluated functional measures of injury outcomes across a range of injury types and severity or have been validated across a wide age range.…”

Reliability of the Motor Learning Strategy Rating Instrument for Children and Youth with Acquired Brain Injury

“…Children with moderate or severe ABI typically receive in-patient and out-patient physiotherapy (PT) to regain gross motor, mobility, and balance skills and support re-integration in the home, school, and community environment (Dumas, Haley, Carey, & Shen Ni, 2004;Dumas, Haley, Ludlow, & Carey, 2004;Haley, Baryza, & Webster, 1992;Ibey et al, 2010). A wide variety of treatment options are used to address the diverse impairments and functional restrictions that these children experience (Haley et al, 1992;Teplicky et al, 2005).…”