Relationship of speech-language pathology inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

Abstract

Background/objective: Describe associations of patient characteristics and speech-language pathology (SLP) interventions provided during impatient rehabilitation for spinal cord injury (SCI) to outcomes at discharge and 1-year post-injury. Methods: Speech-language pathologists at six inpatient rehabilitation centers documented details of treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary. Cognitive, participation, and mood outcomes for a subsample of patients with traumatic brain injury (TBI) and cognitive-communication limitations (CCLs) were examined. Results: SLP treatment factors explain a small amount of variation in cognitive Functional Independence Measure (FIM), participation, and mood. Variation explained by treatment factors for cognitive outcomes at the time of discharge increased when the patient group was more homogeneous (patients with TBI and CCLs). More time in SLP cognitive-communication interventions had a negative relationship, while longer length of stay was positive. The added explanatory power was not seen for similar outcomes at 1-year post-injury. Conclusion: Patients with SCI who have the greatest need for interventions to address cognitive limitations due to TBI receive the most SLP cognitive-communication treatment and show the greatest amount of improvement during rehabilitation. Their cognitive functioning remained impaired at discharge; this likely accounts for the consistent finding that more hours of SLP cognitive-communication treatment is associated with lower cognitive FIM scores at discharge. Future research on individuals with dual SCI and TBI should include more comprehensive assessment of individual differences in cognitive performance in order to better examine the complex relationships between SLP treatments and outcomes. Note: This is the fifth of nine articles in this SCIRehab series.

The Cognitive-Communication Checklist for Acquired Brain Injury: A Means of Identifying, Recording, and Tracking Communication Impairments

“…Access to speech-language pathology may be further complicated by the fact that, even when referrals are made, speech-language pathology services may not be available on a particular team or within a service (Alexander et al, 2007;Knollman-Porter et al, 2019). Also, the need for speech-language pathology referral may be hidden in subpopulations where ABI-related cognitive-communication difficulties are superseded or obscured by other treatment priorities such as for those with spinal cord injury (Gordan et al, 2012), encephalitis and Lyme disease (Langenbahn et al, 2013), or COVID-19 influenza (Ramage, 2020). When cognitive-communication difficulties appear at later stages such as return to work or school, many are unable to find their way to speechlanguage pathology services due to unclear systems or lack of knowledge of rehabilitation services (Douglas et al, 2016;Gagnon et al, 2008;Grayson et al, 2020;Kennedy et al, 2008;Tran et al, 2018).…”

Description and Functional Outcomes of a Novel Interdisciplinary Rehabilitation Program for Hospitalized Patients With COVID-19

“…We also extracted—at admission and discharge—ambulatory status (yes/no), distance ambulated in feet, ability to breathe on room air at rest (yes/no), and requirement of supplemental oxygen on exertion (yes/no). We chose to investigate the association between age, delirium, and participation in psychotherapy as correlates of functional gain because of previous research indicating that these factors predict rehabilitation outcome in other populations 20–22 . We were particularly interested in evaluating relationships between functional gain and delirium and psychotherapy, because of the high rates of previous delirium in our cohort and because of patients’ significant psychosocial needs.…”

“…We chose to investigate the association between age, delirium, and participation in psychotherapy as correlates of functional gain because of previous research indicating that these factors predict rehabilitation outcome in other populations. [20][21][22] We were particularly interested in evaluating relationships between functional gain and delirium and psychotherapy, because of the high rates of previous delirium in our cohort and because of patients' significant psychosocial needs. We also investigated the association between intubation (as a marker of illness severity) and functional gain.…”