Inpatient Brain Injury Rehabilitation Research Articles

The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury.

To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes. A retrospective observational case series. A specialist brain injury inpatient rehabilitation service. Consecutive 235 admissions to specialist brain injury rehabilitation following acutely-acquired brain injury between 2019 and 2022. Waiting time from the point of injury to admission, diagnostic category, admission complexity (patient categorisation tool), functional status (functional independence measure/functional attainment measure), care needs (Northwick Park Care Needs Assessment), change in functional status and care needs over duration of admission (efficiency). Subgroup analysis was performed for patients with a tracheostomy, enteral feeding, anticonvulsant treatment and prior neurosurgery. There was no relationship between admission wait and initial complexity (rs = 0.006; p = 0.923), functional status (rs = -0.070; p = 0.284) or care needs (rs = 0.019; p = 0.768). Longer waiting times were significantly associated with reduced efficiency of rehabilitation (rs = -0.240; p = 0.0002) and change of care needs (rs = -0.246; p = 0.0001). Longer waits were associated with reduced rehabilitation efficiency for patients prescribed anticonvulsants (n = 115; rs = -0.243; p = 0.009), with a tracheostomy (n = 46; rs = -0.362; p = 0.013), requiring enteral nutrition (n = 137; rs = -0.237; p = 0.005) or having had intracranial surgery (n = 97; rs = -0.344; p = 0.0006). There was a negative association between waiting times and reduction in care needs for patients admitted on anticonvulsants (rs = -0.319; p = 0.0005) and requiring enteral nutrition (rs = -0.269; p = 0.001). Longer wait for transfer to rehabilitation following brain injury is associated with reduced improvement in functional status and care needs over time. Attention should be given to ensuring rapid transfer into inpatient rehabilitation services.

Exploring the goals and outcomes of adults with severe acquired brain injury participating in an extended inpatient brain injury rehabilitation unit in Australia

Purpose To explore the rehabilitation goals and evaluate goal attainment outcomes of people with severe acquired brain injury (ABI), and investigate the relationship between goal engagement and goal attainment. Materials and methods Mixed-methods cohort study with twenty-nine adults with severe ABI in Australia. Demographic data, goal statements and pre-post program Goal Attainment Scale scores as well as Goal Engagement Scale scores were collected. Goals were coded using inductive content analysis and categorised by ICF component and domain. Goal attainment within ICF categories was described and compared using descriptive statistics. Pre-post program change in goal attainment was evaluated using Wilcoxon signed rank tests and correlations between goal engagement and attainment was explored using Spearman’s (rho). Results 94% of 320 goals were categorised as ICF Activity and Participation. There was significant improvement in goal attainment between admission and discharge (z=-0.47, p < 0.01). There was no significant relationship between goal engagement and goal attainment however there was a positive association between engagement in goal setting at admission and discharge. Conclusions: This interdisciplinary, inpatient rehabilitation program underpinned by key-worker facilitated person-centred, role-based goal setting resulted in goal attainment in chosen goals, which were primarily activity and participation-focused.

Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort

ABSTRACT Background Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. Objectives To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. Design and methods A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. Results Participants were 149 adults (18–70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. Conclusion Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation.

Relationship between Urinary Incontinence, Cognition, Ambulation, and Discharge Destination in Acute Traumatic Brain Injury Inpatient Rehabilitation

Relationship between Urinary Incontinence, Cognition, Ambulation, and Discharge Destination in Acute Traumatic Brain Injury Inpatient Rehabilitation

Traumatic Brain Injury Rehabilitation Outcome Prediction Using Machine Learning Methods

ObjectiveTo investigate the performance of machine learning (ML) methods for predicting outcomes from inpatient rehabilitation for subjects with TBI using a dataset with a large number of predictor variables. Our second objective was to identify top predictive features selected by the ML models for each outcome and to validate the interpretability of the models. DesignSecondary analysis using computational modeling of relationships between patients, injury and treatment activities and 6 outcomes, applied to the large multi-site, prospective, longitudinal observational dataset collected during the traumatic brain injury inpatient rehabilitation study. SettingAcute inpatient rehabilitation. Participants1946 patients aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, and were admitted to 1 of 9 US inpatient rehabilitation sites between 2008 and 2011 (N=1946). Main Outcome MeasuresRehabilitation length of stay, discharge to home, FIM cognitive and FIM motor at discharge and at 9-months post discharge. ResultsAdvanced ML models, specifically gradient boosting tree model, performed consistently better than all other models, including classical linear regression models. Top ranked predictive features were identified for each of the 6 outcome variables. Level of effort, days to rehabilitation admission, age at rehabilitation admission, and advanced mobility activities were the most frequently top ranked predictive features. The highest-ranking predictive feature differed across the specific outcome variable. ConclusionsIdentifying patient, injury, and rehabilitation treatment variables that are predictive of better outcomes will contribute to cost-effective care delivery and guide evidence-based clinical practice. ML methods can contribute to these efforts.

Head Control Contributes to Prediction of Emergence From the Minimally Conscious State in Children Admitted to Inpatient Rehabilitation

ObjectiveTo examine the utility of head and trunk control, assessed using the Physical Abilities and Mobility Scale, for predicting emergence from a minimally conscious state (eMCS) among children with acquired brain injury admitted to inpatient rehabilitation in a disorder of consciousness (DoC). DesignRetrospective study. SettingPediatric inpatient rehabilitation hospital. ParticipantsForty patients (2-21 years-old) directly admitted from acute care to pediatric inpatient brain injury rehabilitation in a DoC (average length of stay=85 days; N=40). InterventionsNot applicable. Main Outcome MeasuresState of consciousness (eMCS vs not) at discharge from inpatient rehabilitation. ResultsForty-five percent of patients emerged from a minimally conscious state during inpatient rehabilitation. Admission state of consciousness and head control (but not trunk control) were significantly associated with eMCS and provided complementary prognostic information. Admission state of consciousness (ie, admitting in a vegetative state/unresponsive wakefulness syndrome) afforded the greatest negative predictive value (93.8%), whereas admission head control ability afforded the greatest positive predictive value (81.8% for any independent head control; 100% for maintaining head-up position for >30 seconds). Fifty percent of patients who emerged during the inpatient stay did not have independent head control at admission, highlighting the importance of exploring head control as a prognostic marker in conjunction with indicators with greater sensitivity (eg, state of consciousness at admission). ConclusionsA brief measure of head control at admission may contribute to identification of a subgroup of patients who are likely to emerge.

Validating the Overt Behavior Scale – In Session for Use in Inpatient Brain Injury Rehabilitation

Validating the Overt Behavior Scale – In Session for Use in Inpatient Brain Injury Rehabilitation

Inpatient trial of a tablet app for communicating brain injury rehabilitation goals

Purpose We examine the use of a custom iPad application, the Rehab Portal, to provide clients in an inpatient brain injury rehabilitation service with access to short videos where clinicians—or the clients themselves—discuss their current rehabilitation goals. Materials and Methods We developed an initial version of the Rehab Portal app based on our previous co-design with service users, their families, and clinicians. This was examined in a field trial with a series of six clients over the course of their stays in inpatient rehabilitation, collecting quantitative data on clinician and client engagement with the Rehab Portal, alongside a thematic analysis of qualitative interviews with clients and clinicians at the point of discharge. Results Engagement with the platform was high for two clients while it was limited with four more. In our thematic analysis we discuss how introduction of the Rehab Portal disrupted practice, changing how things are done, causing deviation from usual routines, adding burden, and threatening professional integrity. At the same time, where it worked well it led to a repositioning of goal planning away from being clinician directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families. Finally, in some cases we identified a reverting to the status quo, with client demotivation having an unexpected impact on clinician behaviour leading to the process being abandoned. Conclusions The current findings do not provide wholesale support for this approach, yet we continue to feel that approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation. IMPLICATIONS FOR REHABILITATION The use of a novel technique to communicate rehabilitation goals via video disrupted practice, changed how things are done, caused deviation from usual routines, added burden, and threatened professional integrity for clinicians. Where it worked well it led to a repositioning of goal planning away from being clinician-directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families. Approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation.

Using Co-Design To Develop A Hospital-Based Vocational Rehabilitation Intervention For Adults With Acquired Brain Injury

<h3>Research Objectives</h3> Although recommendations are for vocational rehabilitation to commence soon after injury, there are acknowledged challenges to commencing this activity during hospitalisation, when clinical goals are more often centred on basic activities (such as self-care and mobility). This study aimed to develop a vocational rehabilitation intervention for people who have suffered brain injury, that is suitable for delivery in an inpatient rehabilitation setting. <h3>Design</h3> Using an action-research design, this study followed a participatory, intervention mapping approach to develop and pilot the intervention. <h3>Setting</h3> Specialist inpatient brain injury rehabilitation unit, Melbourne, Australia. <h3>Participants</h3> Stakeholder participants included n=14 allied health clinicians (including occupational therapists, speech and language therapists, physiotherapists, clinical and neuropsychologists and social workers) who worked in collaboration with researchers (n=2) to co-design the vocational rehabilitation intervention process. An open invitation was extended to clinicians to participate in the intervention mapping process. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Systematic literature review identified the barriers and enablers to providing work-focussed interventions in the inpatient setting. Qualitative focus groups and document review were used iteratively to identify intervention objectives and outcomes, before intervention strategies were developed and trialed. <h3>Results</h3> Early vocational rehabilitation interventions should be delivered in partnership with the patient, clinicians, family and their social network (inclusive of the workplace). A comprehensive, five phase program was developed: (i) orientation to the worker role, (ii) building awareness of work activities, (iii) improving core work skills, (iv) improving job-specific skills, (v) discharge planning from the program. <h3>Conclusions</h3> Co design offered an excellent opportunity to develop an intervention which supported an interdisciplinary team to embed vocational rehabilitation into usual hospital-based rehabilitation. <h3>Author(s) Disclosures</h3> Study is funded by the Transport Accident Commission through the small grants scheme. Natasha Lannin is supported by the Australian Heart Foundation Future Leader Fellowship (102055).

Co-design of a tablet app for communicating inpatient brain injury rehabilitation goals

The design of a tablet app for people with recent severe brain injuries is described, providing short videos outlining their current rehabilitation goals during inpatient rehabilitation. This research explored questions of desirability, functionality and usability. A co-design process was undertaken with clinicians and three current clients of such a brain injury service along with their family/whānau, iterating on a series of prototypes. Clinician, client and family participants responded positively to the concept and guided the design. Many design considerations reflected fairly universal principles—providing graphical/visual cues to complement text-based controls, and striving for a simple user interface and experience. The final design struck a balance between user control and a curated linear flow through app content. A sharp focus on the main objective was key—guiding rehabilitation goal setting best practice. The end result was an iPad app ready for clinical trial. Such tools may be able to contribute to rehabilitation processes through supporting client engagement, raising awareness of the purpose of rehabilitation, and thus potentially contributing to rehabilitation outcomes.

A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia.

Sleep disturbance often emerges in the early recovery phase following a moderate to severe traumatic brain injury, known as posttraumatic amnesia. Actigraphy is commonly employed to assess sleep, as it is assumed that patients in posttraumatic amnesia (who display confusion, restlessness, and agitation) would better tolerate this measure over gold-standard polysomnography (PSG). This study evaluated the agreement between PSG and actigraphy for determining (sleep/wake time, sleep efficiency, sleep latency, and awakenings) in patients experiencing posttraumatic amnesia. It also compared the epoch-by-epoch sensitivity, specificity, and accuracy between the Actigraph device's 4 wake threshold settings (low, medium, high, and automatic) to PSG. The sample consisted of 24 inpatients recruited from a traumatic brain injury inpatient rehabilitation unit. Ambulatory PSG was recorded overnight at bedside and a Philips Actiwatch was secured to each patient's wrist for the same period. There were poor correlations between PSG and actigraphy for all parameters (Lin's concordance correlation coefficient = < 0.80). The low threshold displayed the highest correlation with PSG for wake and sleep time, albeit still low. Actigraphy displayed low specificity (ranging from 17.1% to 36.6%). There appears to be a greater disparity between actigraphy and PSG for patients with increased wake time. Actigraphy, while convenient, demonstrated poorer performance in determining sleep-wake parameters in patients with significantly disturbed sleep. Ambulatory PSG can provide a clearer understanding of the extent of sleep disturbances in these patients with reduced mobility during early rehabilitation. Study findings can help design future protocols of sleep assessment during posttraumatic amnesia and optimize treatment. Fedele B, McKenzie D, Williams G, Giles R, Olver J. A comparison of agreement between actigraphy and polysomnography for assessing sleep during posttraumatic amnesia. J Clin Sleep Med. 2022;18(11):2605-2616.

The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury

BackgroundThis exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes.MethodsUsing a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use. Outcome questionnaire measures were completed via telephone, at 6-months after discharge, and included: the EuroQol-5D; Depression Anxiety and Stress Scale, Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale. Data were analyzed in a heterogeneous treatment effects framework, using Bayesian Additive Regression Trees.ResultsThere was weak evidence that transitional rehabilitation service use was associated with better psychological wellbeing scores. The posterior probability of lower depression, anxiety and stress scores was .87, .81 and .86, respectively (average treatment effect). There was also weak evidence that re-hospitalization was associated with worse independent living skills scores. The posterior probability of worse scores was .87. However, most re-hospitalizations were due to unavoidable medical complications. We did not find that place of residence at discharge, marital status, unmet need, or service obstacles affected the relationship between service use and the studied outcomes.ConclusionsThis study may highlight the importance of participation in transitional rehabilitation, in the 6-months after discharge from brain injury rehabilitation. Replication in a larger sample size is required to confirm these findings.

Normalising interdisciplinary role-based goal setting in inpatient brain injury rehabilitation: reflections and recommendations of clinicians

Purpose Person-centred goal setting with people with brain injury, by interdisciplinary teams has benefits including improved communication between patients, families and clinicians, person-centred care, and improved engagement in rehabilitation. Exploring the experiences of team members who have adopted interdisciplinary, person-centred goal setting may assist in understanding what is needed to implement this complex, core component of rehabilitation practice. This study explored experiences of clinicians working in an extended inpatient brain injury rehabilitation unit about implementing a role-based goal planning approach within an interdisciplinary team. Materials and methods Semi-structured interviews with 13 clinicians working at the rehabilitation unit explored their experiences about the cognitive participation and collective actions required to carry out the practice, with data analysed using inductive content analysis guided by Normalisation Process Theory. Results Three primary themes were identified: putting the person at the centre, accepting the mind-shift to participation focused goals and working collaboratively. Conclusions This study has elucidated some key processes that occurred and were necessary to carry out goal setting. A mind-shift towards holistic, participation-focussed goal setting was described as “unlearning” discipline-specific goal setting. Development and ownership by the team, acceptance of team members and willingness to share, and structured processes and resources were necessary. IMPLICATIONS FOR REHABILITATION Normalising interdisciplinary role-based goal setting in multi-professional teams requires a mind-shift away from traditional, discipline-specific goal setting. Implementation of interdisciplinary, collaborative team goal setting within health service settings requires collective actions including collaborative working by team members, structured processes including organised time for collaborative team and family meetings, practical resources and training to support processes. Clinicians perceived the goal setting approach to put the person at the centre resulting in a deep understanding of the person, shared understanding, and motivation for rehabilitation.

Centering race/ethnicity: Differences in traumatic brain injury inpatient rehabilitation outcomes.

Persons of color have a higher incidence of traumatic brain injury (TBI) and experience disparities in the quality and quantity of interventions received, discharge disposition, functional outcomes, and mortality rate post TBI. To examine racial/ethnic differences in rehabilitation outcomes for patients with TBI. Multiyear (2005-2016) and retrospective cohort using secondary data analysis from inpatient rehabilitation facilities (IRFs) across the United States. eRehabData participating IRFs throughout the United States. Forty-one thousand eight hundred forty-seven adults with a diagnosis of TBI, admitted to U.S. eRehabData participating IRFs. Not applicable. Inpatient rehabilitation functional outcomes and discharge disposition. Participants were 41,847 non-Hispanic Whites (NHWs), Hispanics, non-Hispanic Asians (NHAs), and non-Hispanic Blacks (NHBs) aged 18-107 years. NHWs were used as the reference group. NHBs had the longest length of stay (17.65 ± 14.96). At admission, NHB, Hispanic, and NHA races/ethnicities were significantly associated with 1-3 point lower motor, cognitive, and total Functional Independence Measure (FIM) scores. NHB race was significantly associated with less than 1-point lower cognitive, motor, and total efficiency FIM scores. At discharge, NHB race was significantly associated with 1-2 point lower motor, cognitive, and total FIM scores; Hispanics and NHA race were associated with less than 1-point lower cognitive FIM scores. Compared to NHWs, Hispanic ethnicity was associated with greater odds of a discharge to home (odds ratio=1.16, 95% confidence interval=1.06-1.27). Contrary to established literature on functionality differences 1 year post TBI, the current study found racial/ethnic differences in functional outcomes during inpatient rehabilitation. These findings suggest a need for cultural competence/sensitivity in the care of racial/ethnic persons and centering potential contributing factors for racial/ethnic differences in TBI rehabilitation outcomes.

Development and Evolution of a Comprehensive Mild Traumatic Brain Injury Inpatient Rehabilitation Program: A Nursing Perspective.

The James A. Haley Veterans' Hospital in Tampa, Florida has developed an innovative approach to the unique rehabilitation needs of active duty Special Operations Forces (SOF) and veterans with chronic conditions related to their military service. Tampa's program, the Post-Deployment Rehabilitation and Evaluation Program (PREP), was established in 2008. The interdisciplinary team includes one nurse practitioner and eight staff registered nurses. The Veterans Health Administration (VHA) is using Tampa's established and successful PREP as a model to actively expand the program to other Veterans Administration (VA) Polytrauma Rehabilitation Centers over the next several years. There are several important nursing and rehabilitation team considerations for the successful development of these mild traumatic brain injury (mTBI) inpatient rehabilitation programs.

Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation.

ObjectiveTo examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect.MethodsThis prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect.ResultsThe inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16).ConclusionInpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.

Preinjury Health Status of Adults With Traumatic Brain Injury: A Preliminary Matched Case-Control Study.

To discern whether there is evidence that individuals who sustained a traumatic brain injury (TBI) had the greater odds of preexisting health conditions and/or poorer health behaviors than matched controls without TBI. Brain Injury Inpatient Rehabilitation Unit at Mount Sinai Hospital. Midlife in the United States (MIDUS) control data were collected via random-digit-dialing phone survey. TBI cases were enrolled in the TBI Health Study and met at least 1 of the following 4 injury severity criteria: abnormal computed tomography scan; Glasgow Coma Scale score between 3 and 12; loss of consciousness greater than 30 minutes; or post-TBI amnesia longer than 24 hours. Sixty-two TBI cases and 171 matched MIDUS controls were included in the analyses; controls were excluded if they reported having a history of head injury. Matched case-control study. Self-reported measures of depression symptoms, chronic pain, health status, alcohol use, smoking status, abuse of controlled substances, physical activity, physical health composite score, and behavioral health composite score. Pre-index injury depression was nearly 4 times higher in TBI cases than in matched controls (OR= 3.98, 95% CI, 1.71-9.27; P = .001). We found no significant differences in the odds of self-reporting 3 or more medical health conditions in year prior to index injury (OR = 1.52; 95% CI, 0.82-2.81; P = .183) or reporting more risky health behaviors (OR = 1.48; 95% CI; 0.75-2.91; P = .254]) in individuals with TBI than in controls. These preliminary findings suggest that the odds of depression in the year prior to index injury far exceed those reported in matched controls. Further study in larger samples is required to better understand the relative odds of prior health problems in those who sustain a TBI, with a goal of elucidating the implications of preinjury health on post-TBI disease burden.

A descriptive video analysis of interactions during inpatient brain injury rehabilitation groups

Introduction An advantage of using groups in rehabilitation is the opportunity for peer learning and support. This study aimed to describe and understand the nature of interactions occurring in inpatient occupational therapy brain injury rehabilitation groups, using video-recorded group interactions, to inform recommendations for group facilitation. Method Video recordings of four occupational therapy rehabilitation groups were taken. Twelve adults with brain injury who participated in the groups and four facilitators consented to the study. The data were analysed using a qualitative descriptive approach. Results Interactions were predominantly facilitated by facilitators and shaped by the nature of the group activities. Facilitators used a number of strategies to encourage interaction including knowledge of group participants, activity choice and physical positioning of group members. Conclusion Group facilitators utilise a number of strategies to encourage peer interactions. However, during structured activity-based rehabilitation groups, participants with a brain injury may focus predominantly on achieving the goal of the group rather than initiating peer interactions.

Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes.

Although general physiatry acute-care consultation services are commonplace and improve length of stay (LOS), the benefits of a subspecialty physiatric continuity consultation service targeting patients with severe brain injury have not been reported. Our primary objective was to characterize patient care recommendations from a Brain Injury Medicine (BIM) Continuity Consult Service, and to investigate the effects on acute-care LOS relative to brain injury patients receiving General Physical Medicine & Rehabilitation (PM&R) Consult Services. Our secondary objectives were to examine inpatient rehabilitation (IPR) health care utilization metrics and costs between groups and evaluate clinical improvements during IPR and discharge disposition. Retrospective cohort comparison study. Academic medical center with level 1 trauma center. Adults with severe brain injury admitted to a single-site acute-care facility and subsequently admitted to a single inpatient brain injury rehabilitation unit over the same time period. BIM Continuity Consult Service versus General PM&R Consult Service. Acute-care LOS; unplanned discharges to acute-care. Despite no major demographic or clinical group differences, the BIM Consult Service had more patient comorbidities than General PM&R Consult Service (17.5±5.3 versus 16±5.1;P=.04). BIM Consult Service patients spent fewer days in acute care (30±11.8 versus 36±22.8; P=.008), and early BIM consult (≤7 days after admission) was associated with shorter acute-care LOS (P < .002). IPR LOS was similar between groups when considering unplanned transfers. Unplanned transfers among General PM&R Consult Service patients occurred twice as frequently as in BIM Consult Service patients; average readmission costs were $2778 per patient on the BIM Consult Service and $6702 per patient on the General PM&R Consult Service. More BIM Consult Service (85.7%) than General PM&R Consult Service (27.3%) patients emerged from disorders of consciousness during IPR (P=.02). BIM Continuity Consultation Services were associated with shorter acute-care LOS, fewer unplanned acute-care transfers, and an increased likelihood of emerging from a minimally conscious state during IPR.

Quasi-Contextualized Speech Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge.

To evaluate the effect of providing quasi-contextualized speech therapy, defined as metacognitive, compensatory, or strategy training applied to cognitive and language impairments to facilitate the performance of future real-life activities, on functional outcomes up to 1 year following traumatic brain injury (TBI). Acute inpatient rehabilitation. Patients enrolled during the TBI-Practice-Based Evidence (TBI-PBE) study (n = 1760), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, received speech therapy in acute inpatient rehabilitation at one of 9 US sites, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation. Propensity score methods applied to a database consisting of multisite, prospective, longitudinal observational data. Participation Assessment with Recombined Tools-Objective-17, FIM Motor and Cognitive scores, Satisfaction With Life Scale, and Patient Health Questionnaire-9. When at least 5% of therapy time employed quasi-contextualized treatment, participants reported better community participation during the year following discharge. Quasi-contextualized treatment was also associated with better motor and cognitive function at discharge and during the year after discharge. The benefit, however, may be dependent upon a balance of rehabilitation time that relied on contextualized treatment. The use of quasi-contextualized treatment may improve outcomes. Care should be taken, however, to not provide quasi-contextualized treatment at the expense of contextualized treatment.