Early rehabilitation treatment in severe head injury

Background: Acute phase rehabilitation for adults with traumatic brain injury (TBI) takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications (e.g. atelectasis, pressure sore, contractures, etc), and to provide sensory stimulations with the hope of accelerating arousal. The aim of this study was to evaluate the efficacy of TBI rehabilitation during acute care. Method: From medical record we reviewed the courses of 78 severe TBI treated in acute care setting in our hospital between 1998 and 2001 that used an early rehabilitation intervention program (physical mobilization, preventive work for bedsores and contractures, sensory stimulation, respiratory rehabilitation, etc.) for patients with TBI. In all patients we have investigated demographic characteristic (age, sex, etc), admission and discharge measures of severity of TBI Glasgow Coma Scale (GCS), Rancho Los Amigos (RLA) scale, length of coma, neuroradiological findings, ventilation days, tracheotomy, neurosurgeries and associated injured. Main outcome measure: Length of acute care stay and cognitive change level. Results: We have analysed the relative outcomes in 2 groups: those with early initiation of rehabilitation (<10 days post-injury) versus those whose rehabilitation began later (≥10 days post injury). The patients who began rehabilitation early have reported a significantly shortened length of hospital stay (22 versus 40 days) as well as better functional outcome at discharge. In fact the RLA level at discharge from the acute centre was not statistically significant between the 2 groups (p=0.5), however the cognition was better in the patients undergoing early rehabilitation. For patients admitted in coma, the duration had a mean length of 30 days for the early rehabilitation group contrasted with 44 days for the delayed group. No statistically relationship was found in the other variables (neuroradiological findings, ventilation days, tracheotomy, surgeries and associated injured) between the groups. Conclusions: The overall conclusion from this study is that rehabilitation treatment in acute care setting is useful and significantly related with the outcome when it is initiated early. In fact, if the rehabilitation approach is initiated precociously it can reduce length of stay and cost in acute care setting patients after TBI.