Activity and rest in patients with severe acquired brain injury: an observational study

Abstract

Objective To examine activity levels, types of activities and their distribution across the day in patients with severe acquired brain injury including disorders of consciousness admitted to subacute neurorehabilitation. Methods In this observational cross-sectional study, a modified behavioural mapping tool was used to document activity of patients admitted to a specialized rehabilitation ward for three consecutive days from 8.00 am to 8.00 pm. Observers walked a fixed route and returned to each patient every 10 min. Results Complete data was obtained in 1722/1728 observations on eight patients. Patients were registered as being in any activity in 55.6% and resting or sleeping in 30.3% of all observations. Patients were alone for 50.4% and were lying or sitting for 98.5% of the time. The major part (45%) of rehabilitation activities occurred during the morning before noon. The odds of being engaged in a rehabilitation activity were significantly different from afternoon and evening p = 0.02. Patients with higher function were more active. Conclusion Patients with severe ABI were involved in some kind of activity for more than half the day and resting approximately 1/3 of the day. Health personnel and visitors were present in most activities. Implications for rehabilitation Rehabilitation of patients with severe acquired brain injury (ABI) comprises a high level of a broad range of activities and interactions. In order to truly offer round the clock rehabilitation, rehabilitation hospitals need to focus on delivering rehabilitation activities evenly across the waking hours. The long periods of daytime sleep and rest in patients with severe ABI should be further examined as there might be a potential to intensify rehabilitation.