S-3-04-04
REHABILITATION IN TRAUATIC BRAIN INJURY
D.L. McLellan (University of Southampton, Southampton, UK)
Cognitive and behavioural function after brain injury are the main determinants of a patient's ability to resume independent living. Disturbances of behaviour, particularly when associated with aggression or violence, carry a particularly poor prognosis for social outcome.
Despite this, some inpatient Rehabilitation Services concentrate upon the physical aspects of recovery, and even reject patients with cognitive impairments from participation in the rehabilitation process. Families of patients recovering from traumatic brain injury initially feel they are doing reasonably well, but if the injury has beam a severe one, the families report progressively increasing stress and pessimism about the fixture as years pass after the injury.
To what extent is the model of rehabilitation that has been developed for physical impairments appropriate for a service designed to minimise the handicap associated with cognitive impairments? Physical programmes have traditionally concentrated upon an increasing degree of innate function and skill in the patient, making only such changes to the environment as are necessary once the full physical improvement has been achieved. This may not necessarily be the most fruitful approach in relation to cognitive impairments, particularly after the first six to 12 months have elapsed after the injury. Studies in schizophrenia have suggested that changes in behaviour in other members of the family designed to reduce the level of stress and the frequency of confrontations experienced by the patient are essential components in their successful rehabilitation. It is possible that a more pro-active and sophisticated approach to family function after traumatic brain injury might, in many cases, provide a better outcome for the patients than concentrating therapy upon attempts to improve cognitive performance in the individual.
S-3-04-05
REHABILITATION OUTCOME OF POST TRAUMATIC BRAIN INJURY
S. Tongpiputn, N. & C. Kunanusont, S. Panichavat, (Prasat Neurological Institute, Bangkok, Thailand)
Purpose: Traumatic brain injured patients are increasing in Thailand mostly due to traffic accident. This study aims to identify determinants of rehabilitation outcome among post traumatic brain injury cases who were referred to Prasat Neurological Institute.
Method: A total of 41 post traumatic brain injury cases who received intensive rehabilitation from January 1, 1994 to December 31, 1995 were enrolled in the study. Rehabilitation outcome were judged by using the Glasgow Outcome Scale (GOS). The contributing factors were Glasgow Coma Scale (GCS) at the beginning of treatment, GCS at the beginning of rehabilitation, days after trauma, days before rehabilitation, age, gender and other clinical outcomes. Data were processed and compiled for descriptive (univariate) analysis. Association between the good outcome variables (GOS 4 or 5) and important covariates were determined with logistic regression analysis.
Result: Among 41 cases enrolled, most (30,73%) were male, average age was 38 years. A total of 38 cases (93%) received treatment on day of accident Number of patients with GCS equalled to 10 or more were 26 (63%) at the beginning of treatment and were 35(85%)at the beginning of rehabilitation. GCS of 10 or more was significantly associated with good rehabilitation outcome (GOS 4 or 5)(P=0.001, Fisher's Exact test). Each interval increase of GCS at rehabilitation was associated with 3.7 times more likelihood of having good rehabilitation outcome (adjusted O.R 3.7, 95% CI 1.4-10.2).
Conclusion: GCS of 10 or more was significantly associated with good outcome (GOS 4 or 5) Therefore, rehabilitation outcome can be predicted by GCS at the beginning of rehabilitation.
