Research Reports - Examining acute rehabilitation outcomes for children with total functional dependence after traumatic brain injury

J Head Trauma Rehabil. 2013 Sep-Oct;28(5):361-70

Kramer ME, Suskauer SJ, Christensen JR, Dematt EJ, Trovato MK, Salorio CF, Slomine BS

OBJECTIVE: To examine in a pilot cohort factors associated with functional
outcome at discharge and 3-month follow-up after discharge from inpatient
rehabilitation in children with severe traumatic brain injury (TBI) who entered
rehabilitation with the lowest level of functional skills.
PARTICIPANTS: Thirty-nine children and adolescents (3-18 years old) who sustained
a severe TBI and had the lowest possible rating at rehabilitation admission on
the Functional Independence Measure for Children (total score = 18).
METHODS: Retrospective review of data collected as part of routine clinical care.
RESULTS: At discharge, 59% of the children were partially dependent for basic
activities, while 41% remained dependent for basic activities. Initial Glasgow
Coma Scale score, time to follow commands, and time from injury to rehabilitation
admission were correlated with functional status at discharge. Time to follow
commands and time from injury to rehabilitation admission were correlated with
functional status at 3-month follow-up. Changes in functional status during the
first few weeks of admission were associated with functional status at discharge
and follow-up.
CONCLUSIONS: Even children with the most severe brain injuries, who enter
rehabilitation completely dependent for all daily activities, have the potential
to make significant gains in functioning by discharge and in the following few
months. Assessment of functional status early in the course of rehabilitation
contributes to the ability to predict outcome from severe TBI.

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