Medical Rehabilitation System Research Articles

Active Fabrics With Controllable Stiffness for Robotic Assistive Interfaces.

Assistive interfaces enable collaborative interactions between humans and robots. In contrast to traditional rigid devices, conformable fabrics with tunable mechanical properties have emerged as compelling alternatives. However, existing assistive fabrics actuated by fluidic or thermal stimuli struggle to adapt to complex body contours and are hindered by challenges such as large volumes after actuation and slow response rates. To overcome these limitations, inspiration is drawn from biological protective organisms combining hard and soft phases, and active assistive fabrics consisting of architectured rigid tiles interconnected with flexible actuated fibers are proposed. Through programmable tessellation of target body shapes into architectured tiles and controlling their interactions by the actuated fibers, the active fabrics can rapidly transition between soft compliant configurations and rigid states conformable to the body (>350 times stiffness change) while minimizing the device volume after actuation. The versatility of these active fabrics is demonstrated as exosuits for tremor suppression and lifting assistance,as body armors for impact mitigation, and integration withelectrothermal actuators for smart actuation with convenient folding capabilities. This work offers a practical framework for designing customizable active fabrics with shape adaptivity and controllable stiffness, suitable for applications in wearable exosuits, haptic devices, and medical rehabilitation systems.

Examination of pain comorbid diagnoses in the inpatient rehabilitation population across all impairment groups.

Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups. Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation® database using a literature-established framework containing ICD-10-CM pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups. Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one ICD-10 pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis. Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Due to the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.

Theoretical and methodological foundations of the problem of business planning in the healthcare system

Healthcare business planning is becoming a key tool needed to ensure quality, affordable healthcare while maintaining sustainable financial models. It allows you to adapt to changing conditions, strategically allocate resources, optimize budgetary costs, and improve the availability and qualit y of medical care. Target. Scientifically substantiate theoretical approaches and study the features of business planning in the healthcare system. Results. The theoretical and methodological foundations of the problem of business planning in the healthcare system have been studied; the directions of medical rehabilitation activities in the Khanty-Mansiysk Autonomous Region are described; measures were proposed to improve business planning within the medical rehabilitation system. Conclusion. Business planning for medical rehabilitation is becoming increasingly important in the context of pressures on government agencies, changing health care delivery models and the development of the private healthcare sector.

Identifying Racial and Ethnic Disparities in Acute Inpatient Rehabilitation

ObjectiveTo investigate whether racial, ethnic, and linguistic disparities exist at discharge from an acute inpatient rehabilitation facility (IRF) by examining change in Functional Independence Measure (FIM) scores and discharge destination. DesignThis is a retrospective study using our IRF's data from the Uniform Data System for Medical Rehabilitation from 2013-2019. FIM scores and discharge destination were compared between race, language, and ethnic groups, with adjustment for patient characteristics. SettingAn urban hospital with a level 1 trauma center, comprehensive stroke center, and IRF with Commission on Accreditation of Rehabilitation Facilities (CARF) certification. Participants2518 patients admitted to the IRF from 2013-2019 (N=2518). InterventionsNot applicable. Main Outcome MeasuresChange in FIM score and discharge destination. ResultsAfter adjusting for covariates, non-White patients and patients with limited English proficiency had significantly lower functional recovery, as measured by smaller changes in FIM scores from IRF admission to discharge. Additionally, both groups were more likely to be discharged home with home health care than to a skilled nursing facility, compared with White and English-speaking patients. Disparities in discharge destination persisted within patients with noncommercial insurance (Medicaid or Medicare) and a stroke diagnosis but not within those who had commercial insurance or a nonstroke diagnosis. ConclusionsRacial and linguistic disparities were identified within our CARF certified IRF; however, the organization is committed to reducing health care disparities. Next steps will include investigating interventions to reduce disparities.

Prospects for integrating the Far East recreational potential into the medical rehabilitation system

In this article, we generalize the results a research study into natural healing resources in the Far East. The regions of the Russian Far East possess a significant and unique natural potential for comprehensive medical rehabilitation. The main therapeutic resources of the area, including its climate, mineral waters, and therapeutic muds, are characterized. Issues associated with the task of integrated use of natural and physical resources in effective spa treatment and comprehensive rehabilitation are discussed. The major action mechanisms of natural therapeutic factors widely used in spa treatment are outlined, and the possibilities of their integration with the system of medical rehabilitation are substantiated.

International Classification of Health Interventions of World Health Organization as the basis for a new nomenclature of medical rehabilitation services

To analyze the structure of International Classification of Health Interventions (ICHI) of World Health Organization (WHO) and the possibilities of its practical application in domestic medical rehabilitation system. The role of ICHI and its structural logical correlations with other classifications of the WHO international classifications section has been determined. Analysis of ICHI application areas, comparison of ICHI codes and new nomenclature of medical services were performed. Analysis of ICHI and new nomenclature project of medical services in the Russian Federation showed, that ICHI formed the basis for the development of a new medical services nomenclature, including a section on medical rehabilitation. The basic principles of ICHI (structure by axes: aim, action, means; codes uniqueness; hierarchical method of classification formation) and ICHI fragment associated with purposes for systems and organism functions are presented in the new nomenclature of medical services. It has been established that ICHI can be a basis for developing domestic list of rehabilitation services, the formation of which is planned in the near future. The development of medical services nomenclature in the Russian Federation will significantly increase the availability, funding and effectiveness of medical rehabilitation assistance.

Indicators of cumulative disability due to malignant neoplasms of the brain for 2016–2021

Background. One of the major issues of disability is improving the medical rehabilitation system for patients and disabled people due to malignant neoplasms of the brain. It is important to study the patterns of disability to develop effective medical and social rehabilitation methods for disabled people.
 Aim. To study the cumulative disability of the adult population due to malignant neoplasms of the brain in Moscow for 20162021 to develop measures for the prevention of morbidity and disability of this population, recommendations for improving comprehensive medical and social rehabilitation at all stages, and the provider of rehabilitation services.
 Materials and methods. It was a continuous study. The study included patients aged 18 years and older, examined and re-examined at the Bureau of Medical and Social Expertise due to malignant brain neoplasms in Moscow for 20162021.
 Results. Cumulative disability due to malignant neoplasms of the brain among the adult population of Moscow for 20162021 showed an increase in the total number of disabled people with a predominance of persons repeatedly recognized as disabled, the predominance of disabled people of working age with a tendency to rate increase, the predominance of malignant neoplasms of the brain (C71), frontal lobe (C71.1), and overlapping lesions of brain (C71.8); III disability category and males prevailed.

Актуальные вопросы организации профессиональной переподготовки специалистов по физической реабилитации (кинезиоспециалистов) в условиях новой модели медицинской реабилитации.

The system of medical rehabilitation in Russia undergoes significant transformation which is reflected in the Federal Program «Optimal for health restoration medical rehabilitation in the Russian Federation». In such situation the issues of personnel training in the field of medical rehabilitation are becoming extremely relevant. The difficulties that arise along this path are associated with the interdisciplinarity of medical rehabilitation and the necessity to train specialists with medical education (doctors and nurses) as well as with higher non-medical education: physical therapists, ergotherapists, medical psychologists and medical speech therapists (according to the Order No. 788n of 31.07.2020). These allied health specialties are new for Russia but they are responsible for the main practical activity in the implementation of an individual medical rehabilitation plan. The difficulties in training non-medical personnel in rehabilitation largely arise from the requirement for them to have both medical and pedagogical competencies and to have the ability to work independently as well as in a rehabilitation team. This article summarizes the three-year experience of training specialists in medical rehabilitation with higher non-medical education at the National Research Nizhny Novgorod State University named after N. I. Lobachevsky. The article presents the main issues of the professional retraining program «Physical rehabilitation (physical therapy)» with a duration of 1020 hours, defines professional competencies, difficult issues of training, formation of practical skills and assessment of professional competencies in this category of students.

Особенности анализа ЭЭГ-микросостояний при постинсультной афазии

Knowledge about the specificity of changes in the activity of neural networks associated with realization of thought processes can be used to construct the personalized medical rehabilitation systems. This approach is of particular interest for people with the speech function disturbance due to stroke, since the development of aphasia with the loss of speech leads to severe social maladaptation that worsens the disease outcome. The study was aimed to assess the functional activity of individual neural networks based on the theory of combining the EEG microstate identification technique with the method of determining spatial localization by solving the EEG inverse problem in 27 individuals (15 males and 12 females) with an average age of 52 years, who had speech impairment due to acute atherothrombotic stroke. Mathematical analysis of the scalp bioelectrical activity multichannel recording from the system for EEG microstate model isolation was carried out under changing environmental conditions caused by the auditory-speech load together with the EEG inverse problem solution for each subject. It was found that the speech disorder development depends not only on the fact of damage to brain structures, but also on the deep functional restructuring of both neural streams involved in implementation of brain function and the entire speech connectome. The disease with a predominant motor disorder, that has shown the possibility of transferring functions to the intact hemisphere prefrontal structures, in contrast to sensory disorders representing global changes in the entire speech connectome, can probably be considered the most favorable variant of aphasia.

Significance of the second stage of medical rehabilitation after arthroplasty of large joints

BACKGROUND: Until recently, the three-level system of medical rehabilitation adopted in Russia assumed the implementation of each of the stages in various medical organizations. The lack of funding within the budget and the basic compulsory medical insurance program led to limited access for patients to the trajectory of the completed cycle of medical rehabilitation after surgical interventions, which reduced the effectiveness of the provision of profile high-tech medical care.
 AIM: is to demonstrate the effectiveness of the system for organizing rehabilitation care for patients after arthroplasty of large joints of the lower extremities in a stationary (second) stage in a medical rehabilitation center.
 MATERIALSAND METHODS: The data of the medical information system on patients treated for three months at the second (inpatient) stage after arthroplasty of the hip and knee joints in the conditions of the Medical Rehabilitation Center were used. The effectiveness of rehabilitation was assessed by tests and scales: rehabilitation routing scale (RRS), visual analog scale (VAS), Borg exercise tolerance scale, Hospital anxiety and depression scale (HADS), European quality of life questionnaire (EQ-5D); Medical research scale (MRS), index Leken.
 RESULTS: 308 patients (306 operated) were treated after medical rehabilitation measures at the first stage with a RRS score of 4-5 points, of which about 80% after primary and revision arthroplasty of large joints. Upon completion of rehabilitation measures, a statistically significant improvement in all functional indicators was noted. Despite the ambiguous opinion of scientists about the need for inpatient rehabilitation after arthroplasty, according to our data, arthroplasty and the subsequent stage of medical rehabilitation using modern technologies in a hospital significantly improve the clinical status, reduce or eliminate pain, increase motor activity, improve the psycho-emotional background and the patient s quality of life. Stationary (second) stage of rehabilitation was effective in 100%.
 CONCLUSIONS: The results of the work of the medical rehabilitation center proved its organizational feasibility, clinical effectiveness and advantages: continuity and phasing of rehabilitation in a single institution; continuity of observation of the patient during the interaction of multidisciplinary rehabilitation team with the participation of the operating surgeon, an anesthesiologist-resuscitator. The quality of rehabilitation is improved by the concentration of high-tech therapeutic and regenerative agents and experienced specialists, the correction of concomitant pathology, explanatory work with patients to increase compliance.

V

Background: The Functional Independence Measure (FIM), a part of the Uniform Data System for Medical Rehabilitation (UDSMR), examines key gradations in function from full independence to entire support using a 7-level scale to evaluate performance of essential daily living tasks (18 questions). Objectives: The objectives of this study were to develop a culturally adapted Bangla version of FIM and to test its reliability and validity in stroke patients. Materials and Methods: From March 2013 to February 2014, this observational research was conducted in the departments of physical medicine and rehabilitation and neurology at Bangabandhu Sheikh Mujib Medical University (BSMMU). Following recognized cross-cultural adaption techniques that Beaton et al., advised, the FIM was translated into Bangla. The final Bangla version of the FIM was then administered to 48 stroke patients for interviews in order to assess reliability and validity, and the same patients were re-interviewed one week later. Internal consistency (Cronbach's alpha), inter-rater reliability, and the intraclass correlation coefficient were used to evaluate dependability (ICC). Three professional physiatrists assessed the content validity, and construct validity was examined by relationship with the SF- 36's Physical Functioning Subscale (PF-10). Results: The Bangla version of the FIM was easily understood by 85-42% of respondents, whereas 10.42%(5) had trouble understanding one item and 4.17%(2) had trouble understanding two (n=48). All FIM items received responses from all participants. It was determined to contain 100% genuine material. The 35% ceiling effect was only seen in the cognitive score. For the overall FIM score, internal consistency was determined to be Cronbach's a = 0.97, and the estimated total FIM Intra-class Correlation Coefficient (ICC) was 0.95, with 0.92 for the motor subtotal and 0.96 for the cognitive subtotal. When evaluating construct validity, the motor subscale ..........

Effect of Optimizing Medical Rehabilitation System for Patients with Coronavirus Disease 2019 Using the Functional Resonance Analysis Method.

Coronavirus infection 2019 (COVID-19) is an indication for rehabilitation medicine, especially in severe cases. However, there has been no system analysis of safe and continuous provision of medical rehabilitation for COVID-19 patients. The aim of this study was to confirm the effectiveness of rehabilitation for severe COVID-19 and to analyze the optimization of the medical rehabilitation system using the Functional Resonance Analysis Method (FRAM). The subject of the analysis was the medical rehabilitation system itself, which had been implemented by the Rehabilitation Center of our hospital in response to the increased number of COVID-19 patients. In the FRAM analysis, Functions were identified, and their relationships were examined. Functions were established using a hierarchical cross-check by the authors. Patient outcomes resulting from optimization of the rehabilitation system were length of hospital stay, patient independence in daily living, and rehabilitation-related medical costs, and these were statistically validated. In repeated optimizations of the rehabilitation system, the main issues were "handling of infected patients and isolation of usual clinical practice," "staff rotation," and "remote consultation". The modification of the medical rehabilitation system was associated with shorter hospital stays, shorter periods of time without prescription, faster improvement in independence of daily living, and lower rehabilitation-related medical costs. Optimization at each stage of medical rehabilitation resulted in positive effects on patient outcomes. FRAM is useful for identifying and the optimization of key functions.

Current approaches to medical-psychological rehabilitation of military personnel of the Russian Federation Armed Forces. (Literature review)

Improving the medical and psychological rehabilitation system is a priority area for restoring the military personnel's working capacity and combat capabilities after fulfilling special tasks. Changes in the psychoemotional state due to significant psychic and emotional tension can cause mental impairments, which has negative impact not only on military personnel themselves, but also on their combat working capacity. The article presents an overview of forms and methods of medical and medical-psychological rehabilitation used in sanatorium-resort organizations of the Ministry of Defence of the Russian Federation.

Association of Caregiver Availability and Training With Patient Community Discharge After Stroke

To examine the association between committed caregivers and caregiver training with community discharge from inpatient rehabilitation after a stroke. Secondary analysis of data extracted from electronic health records linked with the Uniform Data System for Medical Rehabilitation. Three hospital-based inpatient rehabilitation facilities (IRF) in a major metropolitan area. 1397 adult patients (mean ± SD age: 69.4 [13.5]; 724 men) transferred from an acute care setting to inpatient rehabilitation after an ischemic or hemorrhagic stroke (N=1397). None. Community discharge from IRF. 82.4% of patients had caregivers, 63.4% of patient caregivers received training at the IRF, and 79.5% had community discharge. After adjusting for age, stroke severity, functional status, and other social risk factors, having a committed caregiver and caregiver training were significantly associated with community discharge (odds ratio [OR]=7.80, 95% confidence interval [CI]: 5.03-12.10 and OR=4.89, 95% CI: 3.16-7.57, respectively). Caregivers increase a patient's likelihood of discharge from IRF; the added benefit of caregiver training needs to be further assessed, with essential elements prioritized prior to patients' IRF discharge.

Digital health systems: SMART-system for remote support of hybrid E-rehabilitation services and activities

The top-priority challenges were faced by the medical rehabilitation system in Ukraine. Particularly important tasks include, first of all, the rehabilitation of patients who have recovered from COVID-19 disease and people with Combat stress reaction. This fact is well understood both by the society and the leadership of the Ministry of Health of Ukraine, which is creating a special working group on this problem. Ukraine has a system of medical and prophylactic institutions designed for psychological and physical rehabilitation of military personnel; these use modern rehabilitation technologies. However, long-term rehabilitation in such centers is not available to everyone. Therefore, the use of telerehabilitation technology for patients with post-traumatic stress disorder and similar disorders in com- bination with a means of objective control of the functional state is extremely important. One of the most effective solutions in medical rehabilitation assistance is remote patient / person-centered rehabilitation. Rehabilitation also needs effective methods for the "Physical therapist – Patient – Multidisciplinary team" system, including the statistical processing of large volumes of data. Therefore, along with the traditional means of rehabilitation, as part of the "Transdisciplinary intelligent information and analytical system for the rehabilitation processes support in a pandemic (TISP)" in this paper, we introduce and define: the revised and completed basic concepts of the hybrid e-rehabilitation notion and its fundamental foundations; the formalization concept of the new Smart-system for remote support of hybrid e-rehabilitation services and activities; and the methodological foundations for the use of services (UkrVectōrēs and vHealth) of the remote Patient / Person- centered Smart-system. The software implementation of the services of the Smart-system has been developed.

Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting.

Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting. Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through2019. In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups. Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated. The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group. Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.

Modern approaches to medical rehabilitation of children with upper extremity peripheral nerve injury

The proportion of injuries to upper extremities, accompanied by nerve damage, ranges from 1.5% to 10%. Damage to the peripheral nerves of the upper extremity in children is associated with fractures of the long bones in 10–12% of cases. The high incidence of damage to the upper extremity peripheral nerves and the risk of impairment or loss of function and disability of the patient often require not only active conservative treatment, but also surgical intervention. The purpose of the work is the analysis of literature data and generalization of the results of our own research to determine the optimal technologies for medical rehabilitation of children with post-traumatic neuropathies of the upper extremities. The success of both conservative and surgical treatment of nerve injuries is largely determined by the volume and quality of the diagnostics performed. The goal of surgical or conservative treatment of peripheral nerve damage is to restore the nerve trunks conduction with the highest possible functional result. Physical factors occupy one of the leading places in the system of medical rehabilitation of children with post-traumatic neuropathies. The medical rehabilitation program includes the use of instrumental physiotherapy, robotic mechanotherapy, applied kinesitherapy, massage, soft manual techniques, orthosis, and kinesio taping. The leading technologies are the methods of motor rehabilitation. The kinesitherapy effects are potentiated by neuromodulatory methods of instrumental physiotherapy (magnetostimulation, electrical stimulation). Conclusion. In most cases, peripheral nerve injuries of the upper extremity in children require long-term staged medical rehabilitation. Meanwhile, to date, there are no clear recommendations for rehabilitation of children with damage to peripheral nerves in the postoperative period, and there is no unified algorithm for rehabilitation measures. Motor rehabilitation technologies are key in medical rehabilitation programs for children with post-traumatic neuropathy. Timely start of rehabilitation measures and differentiated prescription of physical factors according to the period of injury ensure the preservation of the surgical treatment result and contribute to the early restoration of the injured limb function.

Cloud-based deep learning-assisted system for diagnosis of sports injuries

At both clinical and diagnostic levels, machine learning technologies could help facilitate medical decision-making. Prediction of sports injuries, for instance, is a key component of avoiding and minimizing injury in motion. Despite significant attempts to forecast sports injuries, the present method is limited by its inability to identify predictors. When designing measures for the avoidance of work-related accidents and the reduction of associated risks, the risk of injury to athletes is a crucial consideration. Various indicators are being evaluated to identify injury risk factors in a number of different methods. Consequently, this paper proposes a Deep Learning-assisted System (DLS) for diagnosing sports injuries using the Internet of Things (IoT) and the concept of cloud computing. The IoT sensors that compose the body area network collect crucial data for the diagnosis of sports injuries, while cloud computing makes available flexible computer system resources and computing power. This research examines the brain injury monitoring framework, uses an optimal neural network to forecast brain injury, and enhances the medical rehabilitation system for sports. Using the metrics accuracy, precision, recall, and F1-score, the performance of the proposed model is assessed and compared with current models.

RESEARCH OF THE INERTIAL DEVIATION MEASUREMENT SYSTEM UAV CARGO FROM ZERO POINT

Inertial measurement units (IMUs) can consist of one or more sensors that collect data designed to measure inertial motions in a specific frame of reference. Acceleration, rotational speed are examples of data that can be obtained from the sensors contained in the IMU. IMUs can be found in a variety of smart devices, medical rehabilitation, general robotics, UAV control and navigation enhancement systems, sports devices, and virtual reality systems. Some engineering solutions and displacement sensors have a number of limitations, such as systems that do not have a clear initial reference point. In such systems, it is difficult to track deviations from the starting point. However, the acceleration of a moving object is usually easy to measure, so the given deflection of the object can easily be obtained using the integral of the acceleration. To solve such problems, a distance measurement system based on a microelectromechanical system (MEMS) accelerometer has been developed. The hardware structure of the system includes a data measurement module and integrated data collection and data processing modules. Due to the physical properties of the sensor, such a system can be used in a small space, with large overloads and other adverse conditions. This article describes a system calibration method and proposes a deviation tracking algorithm based on acceleration integration. Fixed output error caused by sensor mounting position is analyzed. The analysis shows that if this factor is not taken into account, the error will lead to a serious error. The experiment of measurement of the deviation from the zero point is carried out on a horizontal, flat surface, and the calculation results show that the average accuracy of the deviation measurement of this system can reach 99.05%. The results of the experiment indicate the feasibility of the system in the conditions of short-term free fall and the validity of the data processing algorithm. The accuracy of the distance measurement system can meet most engineering needs.

Longitudinal Trends in Severe Traumatic Brain Injury Inpatient Rehabilitation.

The goal of this study is to describe national trends in inpatient rehabilitation facility (IRF) discharges for the most severely disabled cohort of patients with traumatic brain injury (TBI). Data from the Uniform Data System for Medical Rehabilitation for patients discharged from an IRF between January 1, 2002, and December 31, 2017, with a diagnosis of TBI and an admission Functional Independence Measure of 18, the lowest possible score, were obtained and analyzed. Of the 252 112 patients with TBI discharged during the study period, 10 098 met the study criteria. From 2002 to 2017, the number of patients with an IRF admission Functional Independence Measure of 18 following TBI discharged from IRFs annually decreased from 649 to 488, modeled by a negative regression (coefficient = -2.97; P = .001), and the mean age (SD) increased from 43.0 (21.0) to 53.7 (21.3) years (coefficient = 0.70; P < .001). During the study period, the number of patients with the most severe disability on admission to IRF who were discharged annually as a proportion of total patients with TBI decreased from 5.5% to 2.5% (odds ratio = 0.95; P < .001) and their mean length of stay decreased from 41.5 (36.2) to 29.3 (24.9) days (coefficient = -0.83; P < .001]. The number and proportion of patients with the most severe disability on IRF admission following TBI who are discharged from IRFs is decreasing over time. This may represent a combination of primary prevention, early mortality due to withdrawal of life-sustaining treatment, alternative discharge dispositions, or changes in admitting and reimbursement practices. Furthermore, there has been a decrease in the duration of IRF level care for these individuals, which could ultimately lead to poorer functional outcomes, particularly given the importance of specialized rehabilitative care in this population.