Patients with the most severe traumatic brain injury benefit from rehabilitation

Patients with the most severe traumatic brain injury benefit from rehabilitation

Ingrid Poulsen, Anne Norup, Annette Liebach, Lars Westergaard, Karin Spangsberg Kristensen, Tina Haren, & Lars Peter Kammersgaard

Department for Neurorehabilitation, TBI Unit, Copenhagen University, Glostrup Hospital., Hvidovre, Denmark

Objectives: During the last couple of years, studies have indicated that even patients with the most severe traumatic brain injuries (TBI) benefit from rehabilitation despite what initially appears to be dismal prognosis. In Denmark, all patients with severe TBI have had an opportunity for specialized and centralized rehabilitation for the last 12 years. The objective of this study was to describe changes in level of consciousness and functioning in patients with very severe TBI during sub-acute rehabilitation.

Methods: A total of 461 adult patients with severe TBI admitted to sub-acute inpatient rehabilitation during a 12-year period followed an intensive interdisciplinary rehabilitation programme. Severity of injury was defined by Glasgow Coma Scale (GCS) score on rehabilitation admission and duration of post-traumatic amnesia (PTA). Patients were routinely measured with neuropsychological and functional assessment scales from admission to discharge.

Results: Data from 461 patients was collected, 17 patients died during hospital stay. Mean age was 45 years (SD = 18), 77% were male. GCS on admission to the rehabilitation unit was 11 (IQR = 9–14). Duration of PTA days was 53 (median) (IQR = 32–120). Almost half of the patients (45%) were vegetative/unresponsive or minimally conscious on admission, whereas at discharge only 4% remained in these states. More than half of the sample (54%) had a FIMTM total-score of 18 points on admission, while only 10% were discharged with a score of 18 poins. Thirty-nine per cent were discharged home; 46% to further rehabilitation; 1.5% to acute treatment; and 9% to nursing homes.

Conclusions: In this relatively large sample, comprising all patients with severe TBI in the Eastern part of Denmark, nearly all patients improved in both level of consciousness and function. These results emphasize that the prognosis after the most severe TBI is not uniformly dismal. Centralized specialized interdisciplinary inpatient rehabilitation of these patients directly after acute care may to some extent explain these results. These findings may suggest that all patients, even patients with the most severe injuries, should be considered for sub-acute specialized rehabilitation.