TY - JOUR
T1 - Functional improvement in severe head injury after readmission for rehabilitation
AU - Tuel, Stephen M.
AU - Presty, Sharon K.
AU - Meythaler, Jay M.
AU - Heinemann, Allen Walter
AU - Katz, Richard T.
PY - 1992/1/1
Y1 - 1992/1/1
N2 - Early rehabilitation has been shown to minimize complications and optimize functional outcomes in head-injured patients. Although cognitive, behavioural and vocational issues continue for years after injury, many investigators maintain that physical improvement is limited after 6 months. At 12 months after injury, expectations for physical improvement are generally limited. In addition, although repeated inpatient admissions for rehabilitation are common, gains in self-care and mobility skills during readmissions for rehabilitation have not been specifically investigated. In this retrospective study the records of 49 severely head-injured patients were evaluated. All were readmitted to an inpatient rehabilitation facility more than 12 months after injury. Barthel Index scores were obtained to evaluate physical function. Although previous studies would predict few improvements, in this study 53% (26 patients) showed improvement, and the difference between readmission and discharge Barthel scores was statistically significant (p == 0.0001). Gains were highly correlated with length of readmission, but not with age of patient, age at time of injury, length of coma, time since injury, or duration of previous rehabilitation. Patients with mid-range admission Barthel scores (21-85) demonstrated the largest gains, with 79% showing improvement. Gains averaged 11.2 points on the Barthel Index. Severely head-injured patients may show clinically significant improvement in physical function well after current standards predict a plateau.
AB - Early rehabilitation has been shown to minimize complications and optimize functional outcomes in head-injured patients. Although cognitive, behavioural and vocational issues continue for years after injury, many investigators maintain that physical improvement is limited after 6 months. At 12 months after injury, expectations for physical improvement are generally limited. In addition, although repeated inpatient admissions for rehabilitation are common, gains in self-care and mobility skills during readmissions for rehabilitation have not been specifically investigated. In this retrospective study the records of 49 severely head-injured patients were evaluated. All were readmitted to an inpatient rehabilitation facility more than 12 months after injury. Barthel Index scores were obtained to evaluate physical function. Although previous studies would predict few improvements, in this study 53% (26 patients) showed improvement, and the difference between readmission and discharge Barthel scores was statistically significant (p == 0.0001). Gains were highly correlated with length of readmission, but not with age of patient, age at time of injury, length of coma, time since injury, or duration of previous rehabilitation. Patients with mid-range admission Barthel scores (21-85) demonstrated the largest gains, with 79% showing improvement. Gains averaged 11.2 points on the Barthel Index. Severely head-injured patients may show clinically significant improvement in physical function well after current standards predict a plateau.
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U2 - 10.3109/02699059209034951
DO - 10.3109/02699059209034951
M3 - Article
C2 - 1638270
AN - SCOPUS:0026660141
VL - 6
SP - 363
EP - 372
JO - Brain Injury
JF - Brain Injury
SN - 0269-9052
IS - 4
ER -