Forums » Open clinical » Neurology » Rehabilitation after severe TBI takes at least 300 hours of intensive interventions
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Rehabilitation after severe TBI takes at least 300 hours of intensive interventions
posted at 8/7/2012 7:12 AM BST
on bmj.com
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Posts: 311
First: 7/5/2009 Last: 2/4/2013 |
The duration of neurorehabilitation and whether it will be worthwhile is a major concern in TBI rehabilitation. Different systematic reviews, most notably Rohling et a have demonstrated that in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI is more effective than at-home rehabilitation or no rehabilitation post-injury. Studies by Cicerone et al. and Yu have also shown that a certain degree of spontaneous recovery occurs during the first few weeks, and even months, after injury. A previous study by Leon-Carrion & Machuca-Murga analyzed the course of post-TBI cognitive deficits in patients who did not receive neuropsychological rehabilitation, and endeavoured to establish the point at which cognitive deficits ceased to present signs of spontaneous recovery. This study explores the course and timing of functional recovery in 19 patients who have emerged from coma after undergoing severe traumatic brain injury. The course of cognitive recovery after post-traumatic coma is not uniform, offering a curve with many ups, downs and plateaus. Firstly, the percentage of functional gain in all cognitive areas did not differ between low and high GCS score groups, with the exception of mental control. Secondly, cognitive functions improved significantly from rehabilitation admission to discharge. Thirdly, functional gain was related to the number of sessions the patient underwent during the course of rehabilitation. Fourthly, not all cognitive functions required the same number of sessions to recover statistic or clinical normalcy. Finally, total functional gain and time from injury to cognitive rehabilitation showed an inverse relationship between long-term memory and planning. To achieve a good response and outcome nearing normalcy, a patient needs over 300 h of intensive rehabilitation. Read the full text here Recovery of cognitive function during comprehensive rehabilitation after severe traumatic brain injury.SourceCenter for Brain Injury Rehabilitation (C.RE.CER.), c/ Torneo 23, ES-41002 Seville, Spain. E-mail: leoncarrion@us.es. AbstractObjective: To explore the course and timing of functional recovery in patients who have emerged from coma after undergoing severe traumatic brain injury. Methods: An observational study involving 19 patients with traumatic brain injury recovered from coma who underwent holistic, intensive and multidisciplinary neurorehabilitation. Daily performance in each cognitive function (long-term memory, short-term memory, orientation, calculation, attention, mental control, automation, and planning) was clinically scored and compared at admission and discharge. Results: The course of cognitive recovery after post-traumatic coma is not uniform, offering a curve with many ups, downs and plateaus. To achieve a good response and outcome nearing normalcy, a patient needs over 300 h of intensive rehabilitation. Conclusion: The consolidation of functional recovery in patients with traumatic brain injury requires time and adequate training, and discharge is not recommended until cognitive improvement is established. |
Forums » Open clinical » Neurology » Rehabilitation after severe TBI takes at least 300 hours of intensive interventions
