Research Reports - Traumatic brain injury: analysis of functional deficits and posthospital rehabilitation outcomes

J Spec Oper Med. 2013 Fall;13(3):56-61

Lewis FD, Horn GJ

Background: Advances in emergency medicine, both in the field and in trauma
centers, have dramatically increased survival rates of persons sustaining
traumatic brain injury (TBI). However, these advances have come with the
realization that many survivors are living with significant residual deficits in
multiple areas of functioning, which make the resumption of a quality lifestyle
extremely difficult. To this point, TBI has recently been characterized as a
chronic disease. As with other chronic diseases, TBI is often causative of
persistent disabling symptoms in multiple organ systems. Therefore, posthospital
residential rehabilitation programs have emerged to treat these symptoms with the
goal of helping these individuals regain function and live more productive and
independent lives. Purpose: This study examined the nature and severity of
residual deficits experienced by a group of 285 brain-injured individuals and
evaluate the efficacy of posthospital residential rehabilitation programs in
treating those deficits. Method: Participants consisted of 285 individuals who
had sustained a TBI and, due to multiple residual deficits, were unable to care
for themselves, necessitating admission to residential posthospital
rehabilitation programs. All participants were evaluated at admission and
discharge on the Mayo-Portland Adaptability Inventory?Version 4 (MPAI-4). The
MPAI-4, developed specifically for persons with acquired brain injury, measures
29 areas of function often affected by TBI. Results: From the 29 skills
evaluated, the 12 most often rated as causing the greatest interference with
function were identified. Of these skills, the cognitive deficits including
memory, attention/concentration, novel problem solving, and awareness of deficits
were highly correlated with disruption in performing everyday societal roles. The
impact of treatment for reducing the level of disability in these areas was
statistically significant, t(284) = 17.43, p < .0001. Improvement was significant
even for participants admitted more than 1 year postinjury, t(78) = 8.05, p <
.0001. Conclusions: Skill deficits interfering with reintegration into home and
community are highly interrelated and should be treated with the understanding
that progress in one area may be dependent on change in another area. Cognitive
skills including memory, attention/ concentration, novel problem solving, and
awareness of deficits were highly correlated with measures of overall functional
outcome. Posthospital programs using a multidisciplinary treatment approach
achieved significant reduction in disability from program admission to discharge.
The benefits of these programs were realized even for the most
chronically-impaired participants.

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