Key Points

  • Patients cared for in a Level I trauma center had better outcomes compared to individuals cared for in a Level II center.
     
  • Reducing the time spent in acute care and rehabilitation does not have a negative effect on patient outcomes; although, it can place a greater burden on the family and outpatient rehab services.
     
  • Adherence to Brain Trauma Foundation acute care guidelines results in improved patient outcomes and decreased mortality.
     
  • Level of injury impacts the total cost of care.
     
  • TBI survivors in acute care are as likely to experience medical complications, but less likely to experience neurological complications, when compared to TBI non-survivors.
     
  • Inpatient rehabilitation improves self-care and mobility and significantly improves functional outcome, social cognition and return to work in patients with ABI.
     
  • Readmission to inpatient rehabilitation at more than twelve months post-injury is related to statistically significant improvement in function.
     
  • Over a quarter of patients admitted to inpatient rehabilitation experience good outcome or moderate disability six months post-injury, as measured by the Glasgow Outcome Scale.
     
  • Younger patients with TBI receive inpatient rehabilitation sooner and receive more total hours of occupational therapy, speech therapy and therapeutic recreation compared to older patients with TBI.
     
  • Increasing rehabilitation intensity may reduce length of stay.
     
  • High-intensity rehabilitation is associated with improved outcomes at discharge and at two and three months post-injury.
     
  • Multidisciplinary inpatient rehabilitation may be more effective than a single discipline approach.
     
  • Therapy intensity predicts motor functioning at discharge.
     
  • There is a reciprocal relationship between cognitive function and community integration.
     
  • Early rehabilitation is associated with better outcomes.
     
  • Early rehabilitation has been shown to cost less.
     
  • Rehabilitation results in a higher rate of change on functional measures in younger patients than in older patients.
     
  • Transitional living setting during the last weeks of inpatient rehabilitation is associated with greater independence that inpatient rehabilitation alone.
     
  • Females are more likely to be discharged to care facilities. As well, older patients are less likely to be discharged home than younger patients.
     
  • The type and intensity of outpatient services offered to an individual should take into account the severity of injury, patient characteristics, and patient goals.
     
  • Multidisciplinary outpatient rehabilitation can improve functional outcomes up to one year post discharge. 
     
  • Neurobehavioural and neurohabilitative programs improve behavioural and cognitive functioning post ABI.
     
  • To provide optimal outpatient care there is a need to educate clinicians, in general healthcare settings, about the needs and management of patients with ABI.
     
  • Community resources for patients with ABI are limited and are influenced by the availability of funding.
     
  • A challenge in outpatient rehabilitation is ensuring patients receive timely rehabilitation. Many patients are referred to outpatient services too late or discharged home too early
     
  • Community-based programs for patients with ABI are associated with greater independence, higher social acitivity levels, and less need for care support when they can be sustained for at least six months.
     
  • Programs targeted towards participants with a dual-diagnosis of TBI and substance abuse are challenging due to lack of compliance and an inability to keep them in the program for an extended period of time.
     
  • When direct patient involvement in goal setting is employed, there is a significant improvement in achieving patients' goals.
     
  • Comprehensive day treatment programs can reduce impaired self-awareness and distress, and improve societal participation.
     
  • There remains a need to provide ongoing outpatient or community care and rehabilitation years post injury.
     
  • Cognitive, behavioural, and employment issues can still exist years after discharge from a comprehensive rehabilitation program.
     
  • Vocational rehabilitation results in greater total taxpayer benefits than either total program operational costs or government costs.
     
  • Participants in vocational rehabilitation often have fair or good adjusted outcome, while more than half become gainfully employed or full-time students.
     
  • Individuals with significant cognitive impairments benefit the most from vocational rehabilitation services.
  • Supported employment results in patients being competitively employed more often than if they had not received supported employment.
  • Support groups generate such positive results, such as diminished feelings of hopelessness, coping with depression, and better psychosocial functioning.
  • Further research is required in determining the ideal structure of a complete model of ABI care.