Assessment of Intensive Inpatient Rehabilitation Program in Acquired Brain Injury Patients using UK FIM+FAM Scale: A Retrospective Study

Introduction: Acquired Brain Injury (ABI) can lead to a combination of physical, cognitive, and behavioural impairments and requires comprehensive and structured inpatient rehabilitation program. A multidisciplinary rehabilitation program can deal comprehensively with all these issues together rather than focussing on a single aspect like motor function. Number of people suffering from Traumatic Brain Injury (TBI) in India has been documented to be between 1.5 million to two million per year whereas out of this approximately one million die due to TBI. The rationale of the present study was to document the outcome of multidisciplinary inpatient rehabilitation program objectively using a standard functional outcome measure. Aim: To determine the change in functional outcomes of ABI patients being rehabilitated with a multidisciplinary inpatient neurorehabilitation program using UK version of Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). Materials and Methods: The retrospective observational study was conducted in Medanta Hospital, Gurugram, Haryana, India, from September 2017 to June 2018. Retrospective analysis of previously maintained data was done from June 2018 to November 2018. Data was collected from the Department of Neurorehabilitation. Demographic data was collected including age, sex, type of injury, time from injury to admission and duration of stay in the neurorehabilitation unit. Functional outcome measure used in the study was the UK FIM+FAM. Data was collected in paper forms and collated in Microsoft Excel and transferred to IBM® Statistical Package for the Social Sciences (SPSS)® version 22.0 (IBM Corp., Armonk, NY) for analysis. The UK FIM+FAM data was analysed as aggregate total scores and motor and cognitive subscales. Non parametric tests were used as UK FIM+FAM is an ordinal scale. The test used to measure the change in score was Wilcoxon Test. The p-value <0.05 was considered statistically significant. Results: Total number of patients who were analysed in the study were 45. Motor subset of scores showed significant improvement from admission (50) to discharge (72) (p-value=0.001). Similarly, the cognitive subset of scores also showed a significant improvement from admission (58) to discharge (68, p value=0.002). Apart from motor and cognitive subscales of UK FIM+FAM, change in score in sub divisions of self-care and transfers showed the maximum change with p-value=0.001. Other sub divisions of locomotion, sphincter, communication, psychological and cognition also showed a significant difference of p-value <0.05. Conclusion: A physiatrist led intensive interdisciplinary inpatient rehabilitation program for patients with ABI may significantly reduce residual disability and improve functional independence. Such a program is not only effective in high income countries but also in Low Middle Income Countries (LMIC).

Download Full-text

Brain Injury Functional Outcome Measure (BI-FOM): A Single Instrument Capturing the Range of Recovery in Moderate-Severe Traumatic Brain Injury

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2020.09.377 ◽

2021 ◽

Vol 102 (1) ◽

pp. 87-96

Author(s):

John Whyte ◽

Joseph T. Giacino ◽

Allen W. Heinemann ◽

Yelena Bodien ◽

Tessa Hart ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Severe Traumatic Brain Injury ◽

Outcome Measure ◽

Functional Outcome Measure ◽

Single Instrument

Download Full-text

Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation

Annals of Rehabilitation Medicine ◽

10.5535/arm.21034 ◽

2021 ◽

Vol 45 (6) ◽

pp. 413-421

Author(s):

Zoe Adey-Wakeling ◽

Laura Jolliffe ◽

Elizabeth O’Shannessy ◽

Peter Hunter ◽

Jacqui Morarty ◽

...

Keyword(s):

Brain Injury ◽

Observational Study ◽

Prospective Observational Study ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Rehabilitation Program ◽

Activity Participation ◽

Activity Levels ◽

Rehabilitation Unit ◽

Injury Rehabilitation

Objective To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect.Methods This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect.Results The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16).Conclusion Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.

Download Full-text

Cognitive and Functional Outcomes following Inpatient Rehabilitation in Patients with Acquired Brain Injury: A Prospective Follow-up Study

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_53_17 ◽

2017 ◽

Vol 08 (03) ◽

pp. 357-363 ◽

Cited By ~ 4

Author(s):

Maitreyi Patil ◽

Anupam Gupta ◽

Meeka Khanna ◽

Arun B. Taly ◽

Amit Soni ◽

...

Keyword(s):

Brain Injury ◽

Functional Outcomes ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Cognitive Status ◽

Functional Impairments ◽

Follow Up Study ◽

Cognitive Retraining

ABSTRACT Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI). Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital. Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared. Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 – 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores. Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.

Download Full-text

Article 19 Older Adults with Acquired Brain Injury: Functional Independence Measures after Inpatient Rehabilitation

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2013.08.037 ◽

2013 ◽

Vol 94 (10) ◽

pp. e9

Author(s):

Vincy Chan ◽

Brandon Zagorski ◽

Daria Parsons ◽

Angela Colantonio

Keyword(s):

Older Adults ◽

Brain Injury ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Functional Independence

Download Full-text

Patient inclusion in goal setting during early inpatient rehabilitation after acquired brain injury

Clinical Rehabilitation ◽

10.1177/0269215511405230 ◽

2011 ◽

Vol 26 (2) ◽

pp. 165-173 ◽

Cited By ~ 27

Author(s):

Catherine Dalton ◽

Rachel Farrell ◽

Annette De Souza ◽

Evelyn Wujanto ◽

Ann McKenna-Slade ◽

...

Keyword(s):

Brain Injury ◽

Goal Setting ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation

Download Full-text

Factors associated with living setting at discharge from inpatient rehabilitation after acquired brain injury in Ontario, Canada

Journal of Rehabilitation Medicine ◽

10.2340/16501977-1243 ◽

2014 ◽

Vol 46 (2) ◽

pp. 144-152 ◽

Cited By ~ 7

Author(s):

A Chen ◽

V Chan ◽

B Zagorski ◽

D Parsons ◽

A Colantonio

Keyword(s):

Brain Injury ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Factors Associated

Download Full-text

Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

Clinical Nursing Research ◽

10.1177/c10n1r5 ◽

2001 ◽

Vol 10 (1) ◽

pp. 40-51 ◽

Cited By ~ 3

Author(s):

Jan Coleman Gross ◽

Stacey W. Goodrich ◽

Mary E. Kain ◽

Elizabeth A. Faulkner

Keyword(s):

Nursing Care ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

Two Factors ◽

Staffing Needs ◽

Care Index ◽

Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

Download Full-text

Right people, right time? a qualitative study of service access experiences of adults with acquired brain injury following discharge from inpatient rehabilitation

Brain Impairment ◽

10.1017/brimp.2020.12 ◽

2020 ◽

pp. 1-16

Author(s):

Michele Foster ◽

Melissa Legg ◽

Eloise Hummell ◽

Letitia Burridge ◽

Kirsty Laurie

Keyword(s):

Brain Injury ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Service Access ◽

Personal Recovery ◽

Structured Interviews ◽

Perceived Needs ◽

Specialist Services ◽

Positive Experiences

Abstract Purpose: The intention of this paper is to develop the personal concept of appropriate access. We report on the service access experiences and opportunities of adults with an acquired brain injury after leaving inpatient rehabilitation. The benefits of appropriate access underpin standards in early and long-term recovery, though users’ access needs are highly personal. Methods: The study used a qualitative design involving 16 semi-structured interviews with Australian adults with an acquired brain injury after discharge from inpatient brain rehabilitation. Data were thematically analysed. Results: Three main themes were derived from the analysis. Theme 1 shows that participants valued being steered to services that providers thought appropriate for them early after discharge from inpatient rehabilitation. Theme 2 highlights the tensions between timing and personal recovery and perceived needs. Theme 3 captures participants’ insights into the challenges of gaining access vis-a-vis what the system offers and the enablers of actualising appropriate access. Conclusion: The positive experiences of being directed to specialist services early after discharge suggest that continuity of care constitutes appropriateness of access for participants in this study. However, it is also clear that continuity should not displace flexibility in the timing of services, to accord with individuals’ perceived needs. This, in addition to enablement of access opportunities, through funding and transport, are important in maintaining a personalised approach.

Download Full-text

Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial

PLoS ONE ◽

10.1371/journal.pone.0245425 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245425

Author(s):

Tomas Vilimovsky ◽

Peii Chen ◽

Kristyna Hoidekrova ◽

Jakub Petioky ◽

Pavel Harsa

Keyword(s):

Brain Injury ◽

Large Scale ◽

Statistical Significance ◽

Inpatient Rehabilitation ◽

Rehabilitation Program ◽

Prism Adaptation ◽

Spatial Neglect ◽

Feasibility Trial ◽

Control Group ◽

Rehabilitation Care

Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.

Download Full-text