Effect of Physical Therapy Dosage on Functional Recovery Following TBI

Abstract

Background/Purpose: Evidence supporting neurorehabilitation dosage after traumatic brain injury is limited. High-dose, high-intensity intervention, involving maximal frequency, time, and patient participation, facilitates neuroplasticity and optimizes outcomes. This patient made significant functional progress with the dosage of therapy provided, warranting investigation into the optimal dosage of therapy in this patient population. Case Description: A 27-year-old man with severe, traumatic brain injury defined by the Glasgow Coma Scale received physical therapy in an acute care hospital within a large academic medical center. Due to insurance complications, he was unable to be discharged to an inpatient rehabilitation facility. He remained in the hospital receiving physical therapy until he was safe to be discharged home. Intervention: The patient received an average of 16 minutes of physical therapy, 4 times/week, totaling 320 minutes over 35 additional days spent in the acute hospital setting. Treatment focused on progressing functional mobility, preventing complications, and task-specific functional training. Outcomes: The patient received a 79% lower dosage of physical therapy than expected based on standard requirements at an acute rehabilitation facility. The patient progressed from actively performing less than 25% of functional tasks to performing 100% of functional tasks with supervision for safety. He ambulated with supervision and negotiated stairs with contact guard assistance at time of discharge. Discussion: The patient made significant functional gains. This raises the question of optimal dosage of rehabilitation following traumatic brain injury. We challenge therapists to consider that the optimal dose of rehabilitation in the acute care setting remains unknown and further investigation is needed.