Advertisement

Functional Recovery After Severe Traumatic Brain Injury: An Individual Growth Curve Approach

      Abstract

      Objective

      To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation.

      Design

      Observational prospective longitudinal study.

      Setting

      TBI rehabilitation units.

      Participants

      Adults (N=206) with severe nonpenetrating TBI admitted directly to inpatient rehabilitation from acute care. Participants were excluded for prior disability and intentional etiology of injury.

      Interventions

      Naturally occurring treatments delivered within comprehensive multidisciplinary teams were recorded daily in 15-minute units provided to patients and family members, separately.

      Main Outcome Measures

      Motor and cognitive FIM were measured on admission, discharge, and every 2 weeks in between and were analyzed with individual growth curve methodology.

      Results

      Inpatient recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower functional levels received more treatment, and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Therefore, effects of treatment on outcome could not be disentangled from effects of case mix factors.

      Conclusions

      FIM gain during inpatient recovery from severe TBI is not a linear process. In observational studies, the specific effects of treatment on rehabilitation outcomes are difficult to separate from case mix factors that are associated with both outcome and allocation of treatment.

      Keywords

      List of abbreviations:

      GCS (Glasgow Coma Scale), IGC (individual growth curve), LOS (length of stay), SCI (spinal cord injury), TBI (traumatic brain injury), TFC (time to follow commands)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shiel A.
        • Burn J.P.
        • Henry D.
        • et al.
        The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial.
        Clin Rehabil. 2001; 15: 501-514
        • Peiris C.L.
        • Taylor N.F.
        • Shields N.
        Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review.
        Arch Phys Med Rehabil. 2011; 92: 1490-1500
        • Bode R.K.
        • Heinemann A.W.
        • Semik P.
        • Mallinson T.
        Patterns of therapy activities across length of stay and impairment levels: peering inside the black box of inpatient stroke rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 1901-1908
        • Kozlowski A.J.
        • Pretz C.R.
        • Dams-O'Connor K.
        • Kreider S.
        • Whiteneck G.
        An introduction to applying individual growth curve models to evaluate change in rehabilitation: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems report.
        Arch Phys Med Rehabil. 2013; 94: 589-596
        • Pretz C.R.
        • Kozlowski A.J.
        • Dams-O'Connor K.
        • et al.
        Descriptive modeling of longitudinal outcome measures in traumatic brain injury: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems study.
        Arch Phys Med Rehabil. 2013; 94: 579-588
        • Forsyth R.J.
        • Salorio C.F.
        • Christensen J.R.
        Modelling early recovery patterns after paediatric traumatic brain injury.
        Arch Dis Child. 2010; 95: 266-270
        • Kozlowski A.J.
        • Heinemann A.W.
        Using individual growth curve models to predict recovery and activities of daily living after spinal cord injury: an SCIRehab project study.
        Arch Phys Med Rehabil. 2013; 94: S154-S164.e1-e4
      1. National Data and Statistical Center. Traumatic Brain Injury Model Systems. Available at: http://www.tbindsc.org. Accessed May 1, 2014.

        • Granger C.V.
        • Hamilton B.B.
        Uniform data set for medical rehabilitation.
        Research Foundation, State Univ of New York, Buffalo1987
        • Linacre J.M.
        • Heinemann A.W.
        • Wright B.D.
        • Granger C.V.
        • Hamilton B.B.
        The structure and stability of the Functional Independence Measure.
        Arch Phys Med Rehabil. 1994; 75: 127-132
        • Heinemann A.W.
        • Linacre J.M.
        • Wright B.D.
        • Hamilton B.B.
        • Granger C.
        Prediction of rehabilitation outcomes with disability measures.
        Arch Phys Med Rehabil. 1994; 75: 133-143
        • Heinemann A.W.
        • Linacre J.M.
        • Wright B.D.
        • Hamilton B.B.
        • Granger C.
        Relationships between impairment and physical disability as measured by the functional independence measure.
        Arch Phys Med Rehabil. 1993; 74: 566-573
        • Raudenbush S.W.
        • Bryk A.S.
        Hierarchical linear models.
        2nd ed. Sage, Thousand Oaks2002
        • Marquez de la Plata C.
        • Hart T.
        • Hammond F.M.
        • et al.
        Impact of age on long-term recovery from traumatic brain injury.
        Arch Phys Med Rehabil. 2008; 89: 896-903
        • Graham J.E.
        • Radice-Neumann D.M.
        • Reistetter T.A.
        • Hammond F.M.
        • Dijkers M.
        • Granger C.V.
        Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury.
        Arch Phys Med Rehabil. 2010; 91: 43-50