Early Versus Later Admission to Postacute Rehabilitation: Impact on Functional Outcome After Traumatic Brain Injury

High WM Jr, Roebuck-Spencer T, Sander AM, Struchen MA, Sherer M. Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury.ObjectiveTo examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI).DesignCohort, nonrandomized, intervention study. Pretest-posttest, follow-up design.SettingNonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital.ParticipantsThree groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29).InterventionsPersons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community.Main Outcome MeasuresDisability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire.ResultsAll groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge.ConclusionsThe results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.