Outcome evaluation and prediction in a comprehensive-integrated post-acute outpatient brain injury rehabilitation programme

Abstract

Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.

Impact of spinal cord injury on self-perceived pre- and postmorbid cognitive, emotional and physical functioning

“…27 Similarly, significant correlations were demonstrated for the postmorbid QOL scales in comparisons with both the QOL enjoyment and satisfaction questionnaire 28 and the Mayo-Portland Adaptability Inventory. 29 Given that the RNBI is unique in capturing multiple functions before and after an illness, no published tests were available for validation of the premorbid scales.…”

Treating reading comprehension deficits in sub-acute brain injury rehabilitation: Identifying clinical practice and management

“…The recovery of reading skills has been linked with cognitive recovery following ABI 18,21 , and reading ability may reflect the level of academic ability for pwABI 21 . In a small study of pwTBI (n=10), the recovery of reading skills was reported as similar to the recovery of intelligence scores on cognitive assessment during the first six months of rehabilitation 18 .…”

“…Reading was identified as one of three predictors of patient outcome for pwABI in outpatient rehabilitation, alongside time post onset and level of severity 21 . Reading comprehension was also a predictor of positive outcomes in vocational ABI rehabilitation, and the highest predictor from a range of neuro-psychological assessments of whether participants received a vocational evaluation 24 .…”

“…Reading comprehension was also a predictor of positive outcomes in vocational ABI rehabilitation, and the highest predictor from a range of neuro-psychological assessments of whether participants received a vocational evaluation 24 . As reading comprehension may predict success in ABI rehabilitation 21,24 , rehabilitation programs that use literacy-based interventions may impact the participation of pwABI with reading deficits 21 and possibly influence their rehabilitation outcomes.…”

“…Reading comprehension deficits can impact the activity, participation and independence of pwABI across many settings, including during rehabilitation 21 , returning home, and in attempting to engage in future work or study 22 . People living in the community with severe TBI reported reduced independence in daily functional reading tasks, including reading newspapers (51.8% independent), magazines (50.4% independent) and books (45.4% independent) 23 .…”