Community-Based Interventions

Rehabilitation efforts provided in the community are often proposed as an attractive and cost effective alternative to residential or hospital-based rehabilitation programs. Following hospital discharge, the school setting can only provide so much re-integrative rehabilitation due to the restricted and planned environment. Participation in community based programming reflects real world skill development, such as interactions with others, and can foster more transferable and appropriate interactions for children post-ABI (Agnihotri et al. 2010). Two studies have investigated the effectiveness of community-based, multidisciplinary rehabilitation programs for children following brain injury. 

Individual Study

Table: The Effects of Community-Based Interventions

Discussion

Two studies, one RCT and one pre-post, evaluated the effectiveness of community based therapy for children following an ABI. The RCT used an intervention group with post-discharge to facilitate compliance with medications and attend follow-up visits (Carney et al. 2016). Children that were connected with this community resource coordinator did not improve on functional outcomes compared to a usual care control group by 6 months post-injury. However, children with superior family functioning, as measured by scores on the family impact subscale of the pediatric quality of life, had better functional outcomes than those that did not (Carney et al. 2016). This relationship was correlative and future research is needed to determine causality.

The pre-post study examined the effectiveness of a multidisciplinary, community-based team on general areas of functioning early after (<6wk) a child sustained an ABI (Emanuelson et al. 2003). Motor function and aspects of functional communication and behaviour, but not neuropsychological outcomes, significantly improved by 12 month follow-up (Emanuelson et al. 2003). More research is required with this population, as community-based rehabilitation could provide a support network for children and their families dealing with the impact of brain injury.

Conclusions

There is Level 1b evidence that the allocation of community resource coordinators post-discharge is not superior to standard care to improve functional outcomes in children following a TBI.

There is Level 4 evidence that a multidisciplinary outpatient program may improve functional abilities following brain injury for children.

 

Community resource coordinators post-discharge did not improve functional outcomes in children post-TBI.

Multidisciplinary outpatient programs may improve functional outcomes for children following brain injury.