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BRIEF REPORT| Volume 103, ISSUE 9, P1866-1869, September 2022

Cognitive Dependence in Physically Independent Patients at Discharge From Acute Traumatic Brain Injury Rehabilitation

Published:February 20, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.160
Cognitive Dependence in Physically Independent Patients at Discharge From Acute Traumatic Brain Injury Rehabilitation
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      Abstract

      Objective

      To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation.

      Design

      Analysis of historical clinical and demographic data obtained from inpatient stay.

      Setting

      Inpatient rehabilitation unit in a large, metropolitan university hospital.

      Participants

      Adult inpatients with moderate to severe TBI (N=226) who were physically independent at discharge from acute rehabilitation.

      Interventions

      Not applicable.

      Main Outcome Measures

      FIM Motor and Cognitive subscales, discharge destination, and care plan.

      Results

      Approximately 69% (n=155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n=128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged home, 82% (n=105) were discharged to the care of family members, and 11% (n=15) were discharged home alone. Patients from racial and ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent.

      Conclusions

      The majority of physically independent patients with TBI were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the effect of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial and ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, health care policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation.

      Keywords

      List of abbreviations:

      TBI (traumatic brain injury), UDS (Uniform Data System)
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      Article info

      Publication history

      Published online: February 20, 2022
      Accepted: January 28, 2022
      Received in revised form: January 26, 2022
      Received: August 3, 2021

      Footnotes

      Preliminary information presented in the article was presented orally at American Congress of Rehabilitation Medicine (ACRM), October 7-11, 2014, Toronto, ON, Canada.

      Supported by the following grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Administration for Community Living (ACL), Department of Health and Human Services (HHS): 90DPTB0010 (Rusk TBI Model System at NYU; Tamara Bushnik, Project Director) and 90ARHF0001 (Rusk Advanced Rehabilitation Research Training Postdoctoral Fellowship; Joseph F. Rath, Project Director). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, or HHS, and readers should not assume endorsement by the Federal Government.

      Disclosures: none.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2022.01.160

      Copyright

      © 2022 by the American Congress of Rehabilitation Medicine.

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