Treatment Effect Versus Pretreatment Recovery in Persons With Traumatic Brain Injury: A Study Regarding the Effectiveness of Postacute Rehabilitation

Hayden, Mary Ellen; Plenger, Patrick; Bison, Kier; Kowalske, Karen; Masel, Brent E.; Qualls, Devin

doi:10.1016/j.pmrj.2012.12.005

Cited by 19 publications

(25 citation statements)

References 42 publications

(44 reference statements)

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“…Improvement occurring at this late stage post-injury is an encouraging result for TBI survivors who must live with chronic disability. This finding, consistent with prior research by Lewis and Horn [3] and Hayden et al [4], suggests that along with emotional support participation in physically and cognitively challenging activities can not only maintain functioning but can also reduce disability. These findings offer empirical evidence for the value of post-hospital rehabilitation for TBI survivors late in recovery.…”

Section: Discussionsupporting

confidence: 91%

“…It is well documented that the functional change is the most rapid during the first six months following injury, due largely to the interaction of natural recovery and structured rehabilitation [1] [2]. However, recent studies of post-hospital TBI outcomes indicate that late interval rehabilitation (initiated one or more years post injury) may achieve the significant reduction in disability, although gains are achieved more slowly than for those who receive the early rehabilitation [3] [4].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Chronicity on Outcomes Following Post-Hospital Residential Brain Injury Rehabilitation: Application of Multivariate Statistics and Rasch Analysis

Lewis¹,

Horn²,

Russell³

2017

OJS

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This study evaluated the impact of chronicity (onset of injury to admission interval) on three domains of functional outcomes for a large group of traumatic brain injured (TBI) survivors. Subjects included 528 TBI adults who were treated in post-hospital residential rehabilitation centers. Subjects were assigned to one of three chronicity groups: 1) Early Interval (EI), 2.00 -8.00 months n = 245, 2) Mid Interval (MI), 8.01 -24.00 months n = 129, and (3) Late Interval (LI), 24.01 months and greater n = 154. Functional status was assessed with the MPAI-4. RM MANCOVA was applied to evaluate differences among groups from admission to discharge. Rasch analysis demonstrated satisfactory construct validity and internal consistency (Person reliability = 0.90 -0.94, Item reliability = 0.99) for the admission and discharge MPAI-4s. Controlling for LOS and age, the RM MANCOVA revealed that each chronicity group showed significant improvement in MPAI-4 abilities, adjustment, and participation indices from admission to discharge (p < 0.001). Improvement observed from admission to discharge was the greatest among the EI group (p < 0.001). This study demonstrated the utility of multivariate statistical approaches for understanding the complexities of TBI treatment outcomes. As measured across three domains of functioning, rehabilitation was effective in reducing disability for participants in each chronicity group. Of the three groups, EI participants presented as the most disabled at admission but also made the greatest gains when assessed at discharge.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Impact of Chronicity on Outcomes Following Post-Hospital Residential Brain Injury Rehabilitation: Application of Multivariate Statistics and Rasch Analysis

Lewis¹,

Horn²,

Russell³

2017

OJS

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“…130 These findings apply to in individuals with both traumatic and non-traumatic brain injuries, regardless of severity or time post injury. [139][140][141] However, findings from several Class III studies suggests starting rehabilitation earlier post…”

Section: Accepted Manuscript Cognmentioning

confidence: 99%

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

Cicerone

Goldin

Ganci

et al. 2019

Archives of Physical Medicine and Rehabilitation

424

313

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Objective: To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with TBI or stroke. Data Sources: Online Pubmed and print journal searches identified citations for 250 articles published from 2009 through 2014. Study Selection: 186 articles were selected for inclusion after initial screening. 50 articles were initially excluded (24 healthy, pediatric or other neurologic diagnoses, 10 non-cognitive interventions, 13 descriptive protocols or studies, 3 non-treatment studies). 15 articles were excluded after complete review (1 other neurologic diagnosis, 2 non-treatment studies, 1 qualitative study, 4 descriptive papers, 7 secondary analyses). 121 studies were fully reviewed. Data Extraction: Articles were reviewed by CRTF members according to specific criteria for study design and quality, and classified as providing Class I, Class II, or Class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensiveintegrated interventions).

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“…Rehabilitation paradigms treating brain injury are often implemented in the acute stages post-injury, in an in-patient hospital setting. Rehabilitation based on EE principles in TBI patients results in better general functional outcomes, such as improved cognitive and motor skills (Willer et al, 1999; Powell et al, 2002; Cifu et al, 2003; Boman et al, 2004; Hayden et al, 2013), and better community integration (Zhu et al, 2001; Cicerone et al, 2004). A number of studies have also shown that increasing the duration and intensity of exposure to rehabilitative therapy results in improved recovery times (Blackerby, 1990; Spivack et al, 1992; Shiel et al, 2001; Zhu et al, 2001, 2007; Slade et al, 2002; Cifu et al, 2003; Cicerone et al, 2004).…”

Section: Beyond the Benchmentioning

confidence: 99%

Environmental enrichment and the sensory brain: the role of enrichment in remediating brain injury

Alwis

Rajan

2014

Front. Syst. Neurosci.

108

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The brain's life-long capacity for experience-dependent plasticity allows adaptation to new environments or to changes in the environment, and to changes in internal brain states such as occurs in brain damage. Since the initial discovery by Hebb (1947) that environmental enrichment (EE) was able to confer improvements in cognitive behavior, EE has been investigated as a powerful form of experience-dependent plasticity. Animal studies have shown that exposure to EE results in a number of molecular and morphological alterations, which are thought to underpin changes in neuronal function and ultimately, behavior. These consequences of EE make it ideally suited for investigation into its use as a potential therapy after neurological disorders, such as traumatic brain injury (TBI). In this review, we aim to first briefly discuss the effects of EE on behavior and neuronal function, followed by a review of the underlying molecular and structural changes that account for EE-dependent plasticity in the normal (uninjured) adult brain. We then extend this review to specifically address the role of EE in the treatment of experimental TBI, where we will discuss the demonstrated sensorimotor and cognitive benefits associated with exposure to EE, and their possible mechanisms. Finally, we will explore the use of EE-based rehabilitation in the treatment of human TBI patients, highlighting the remaining questions regarding the effects of EE.

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Treatment Effect Versus Pretreatment Recovery in Persons With Traumatic Brain Injury: A Study Regarding the Effectiveness of Postacute Rehabilitation

Abstract: Postacute rehabilitation is associated with functional gains for individuals with TBI beyond what can be explained by undirected recovery. These findings provide evidence for postacute rehabilitation as effective care after TBI.

Cited by 19 publications

References 42 publications

Impact of Chronicity on Outcomes Following Post-Hospital Residential Brain Injury Rehabilitation: Application of Multivariate Statistics and Rasch Analysis

Impact of Chronicity on Outcomes Following Post-Hospital Residential Brain Injury Rehabilitation: Application of Multivariate Statistics and Rasch Analysis

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

Environmental enrichment and the sensory brain: the role of enrichment in remediating brain injury

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