Functional Rehabilitation Following TBI: An Analysis of Inpatient Recovery and Community Integration

RESEARCH QUESTION: What is the impact of interdisciplinary rehabilitation on traumatic brain injury (TBI) survivor community participation and life satisfaction as well as family/caregiver coping?

RATIONALE: TBI is a leading cause of death and disability in young adults. Despite advances in medical technology and rehabilitation, the majority of survivors of TBI transition from hospital to community with some residual cognitive, psychosocial, behavioral, and/or physical impairment. Additionally, the significant strain placed on family members caring for injured relatives is well documented in the literature, negatively impacting their physical health and contributing to emotional distress and the likelihood of depression. As experts in functional rehabilitation, it is essential that occupational therapy practitioners understand not only the challenges of TBI rehabilitation but the complexity of factors impacting successful community participation.

METHOD: The poster presentation analyzes the impact of an interdisciplinary inpatient rehabilitation program in terms of both treatment effectiveness and follow-up during postdischarge community reintegration. A longitudinal process is being employed whereby TBI survivors and caregivers are evaluated at initial evaluation, discharge, 90-day follow-up, and 1-yr follow-up.

Initial evaluation, intervention, and discharge evaluation were completed at a California rehabilitation facility. Postdischarge evaluations were completed via phone and/or outpatient visits. Participants had consecutive admissions to a California inpatient rehabilitation facility serving individuals with TBI and other neurological conditions. TBI survivors aged 18 to 65 were included in the study. Determination of treatment program effectiveness is being established through assessment and discharge scores of the Functional Independence Measure, Mayo-Portland Adaptability Inventory, and the Satisfaction with Life Scale. Preliminary findings indicate statistical significant improvement across all functional areas without any accompanying change in self-reported client life satisfaction (n = 18). Community integration following treatment program discharge is being evaluated via the Functional Independence Measure, Caregiver Burden Scale, Community Integration Questionnaire, and Satisfaction with Life Scale. Nonparametric statistics were used to determine differences in assessment scores between testing periods and correlations among variables.

RESULTS: Preliminary findings at 90-day follow-up indicate maintenance of basic activities of daily living (ADL) status as well as a positive relationship between social participation and self-reported life satisfaction (n = 11). TBI survivor life satisfaction was not significantly related to home integration or work, school, or volunteer participation. In terms of the impact of community integration on caregivers, preliminary study findings indicate a significant increase in identified client needs and caregiver tasks from discharge to 90-day follow-up as identified by caregivers (n = 10). The strength of the study findings, including 1-yr follow-up data, will be enhanced through continued data collection.

CONCLUSION: By better understanding rehabilitation and recovery issues across the TBI continuum of recovery, including caregiver issues, occupational therapy practitioners can make more effective, evidence-based clinical decisions.