Effectiveness of a multidisciplinary rehabilitation program for persons with acquired brain injury and executive dysfunction

<p><b>Purpose:</b> The purpose of this study is to explore the effects of a multidisciplinary acquired brain injury rehabilitation out-patient program (5 d/week for 7 weeks) on improvements to participants’ activity and participation outcomes related to meal preparation and to determine whether gains are maintained at 3 and 6 months post program.</p> <p><b>Methods:</b> A single case experimental design with repeated measures pre- and post-intervention with 7 adult participants with ABI and executive dysfunction (4 females, mean age 38 ± 10.1 years) was used.</p> <p><b>Results:</b> A strong improvement effect between pre and post phases was found for number of errors on the Cooking Task for 6/7 participants; four participants showed significant improvement immediately after the program and at 3 and 6 months post. Six out of seven participants improved significantly on the Instrumental Activities of Daily Living Profile and four participants improved between the post and 6 month follow-up. Four out of seven participants showed significantly improved Life Habits scores pre- versus post-program.</p> <p><b>Conclusions:</b> Significant improvements were observed in activity and participation outcomes related to preparing a meal in adults with ABI and executive dysfunction who participated in a 7-week multidisciplinary rehabilitation out-patient program. Treatment gains were maintained for the majority of participants at 3 and 6 months following the program.</p> <p>Implication of Rehabilitation</p><p>A 7-week multidisciplinary rehabilitation out-patient program appears to improve activities and participation; the effects are sustainable after 6 months.</p><p>A detailed description of the therapeutic interventions provided during the cooking activity should help clinicians better understand what specific functions are solicited or required during a particular activity.</p><p>Knowledge from this study may help guide clinicians in their work within this complex area of rehabilitation.</p><p></p> <p>A 7-week multidisciplinary rehabilitation out-patient program appears to improve activities and participation; the effects are sustainable after 6 months.</p> <p>A detailed description of the therapeutic interventions provided during the cooking activity should help clinicians better understand what specific functions are solicited or required during a particular activity.</p> <p>Knowledge from this study may help guide clinicians in their work within this complex area of rehabilitation.</p

Post-acute care referral and inpatient rehabilitation admission criteria for persons with brain injury across two Canadian provinces

<p><b>Purpose:</b> Investigate health care providers’ perceptions of referral and admission criteria to brain injury inpatient rehabilitation in two Canadian provinces.</p> <p><b>Methods:</b> Health care providers (<i>n</i> = 345) from brain injury programs (13 acute care and 16 rehabilitation facilities) participated in a cross-sectional web-based survey. The participants rated the likelihood of patients (traumatic brain injury and cerebral hypoxia) to be referred/admitted to rehabilitation and the influence of 19 additional factors (e.g., tracheostomy). The participants reported the perceived usefulness of referral/admission policies and assessment tools used.</p> <p><b>Results:</b> Ninety-one percent acute care and 98% rehabilitation participants reported the person with traumatic brain injury would likely or very likely be referred/admitted to rehabilitation compared to respectively 43% and 53% for the patient with hypoxia. Two additional factors significantly decreased the likelihood of referral/admission: older age and the combined presence of minimal learning ability, memory impairment and physical aggression. Some significant inter-provincial variations in the perceived referral/admission procedure were observed. Most participants reported policies were helpful. Similar assessment tools were used in acute care and rehabilitation.</p> <p><b>Conclusions:</b> Health care providers appear to consider various factors when making decisions regarding referral and admission to rehabilitation. Variations in the perceived likelihood of referral/admission suggest a need for standardized referral/admission practices.Implications for Rehabilitation</p><p>Various patient characteristics influence clinicians’ decisions when selecting appropriate candidates for inpatient rehabilitation.</p><p>In this study, acute care clinicians were less likely to refer patients that their rehabilitation counter parts would likely have admitted and a patient with hypoxic brain injury was less likely to be referred or admitted in rehabilitation than a patient with a traumatic brain injury.</p><p>Such discrepancies suggest that policy-makers, managers and clinicians should work together to develop and implement more standardized referral practices and more specific admission criteria in order to ensure equitable access to brain injury rehabilitation services.</p><p></p> <p>Various patient characteristics influence clinicians’ decisions when selecting appropriate candidates for inpatient rehabilitation.</p> <p>In this study, acute care clinicians were less likely to refer patients that their rehabilitation counter parts would likely have admitted and a patient with hypoxic brain injury was less likely to be referred or admitted in rehabilitation than a patient with a traumatic brain injury.</p> <p>Such discrepancies suggest that policy-makers, managers and clinicians should work together to develop and implement more standardized referral practices and more specific admission criteria in order to ensure equitable access to brain injury rehabilitation services.</p