Functional recovery after brain injury rehabilitation

There is a growing consensus that brain injury results in a wide range ofphysical, social and psychological sequelae which can impinge on the lives of both the survivor and his or her family for many years. However, our knowledge of the natural course of recovery and the impact of rehabilitation interventions remains inadequate. One reason for this has been the lack of adequate measures of the functional consequences that effect the individual on a day to day basis. The need to develop measures pertinent to the desired outcomes in rehabilitation has led to an ever increasing number of tools becoming available in the last decade. However, most research still focuses on the early neurosurgical and neurological consequences with long-term sequelae of brain injury predominately defined in terms of neuropsychological deficits. Until this decade there has been a dearth of research into the functional consequences of such impairments despite increasing awareness that for the individual and family, day to day functioning is ofmajor concern. The thesis therefore has two main goals. Firstly:a descriptive study explored functional status in patients after brain injury following discharge from inpatient rehabilitation to their own homes in the community. Secondly:an intervention study was carried out to explore the role of home based visits as part of post discharge follow-up ofpatients after inpatient rehabilitation to address the findings of the first study. In the first study, 89 patients admitted consecutively for early inpatient rehabilitation following a traumatic or haemorrhagic brain injury were visited at home by the researcher at six weeks after discharge and again at 14 months. Assessment using a number ofmeasures of function characterised the disabilities that the patients experienced and revealed that deterioration in everyday function was common after discharge home. Further, the majority of carers were noted to request information and advice on a range of subjects. These two factors led to the intervention study where 43 patients were recruited to evaluate whether visits to the patient's home in the early weeks after discharge would prevent deterioration and satisfy carers' requests for information and support. Randomisation using the minimisation method led to and experimental group with 22 subjects and a control group of 21. Patients in the experimental group were visited weekly until the sixth week when both groups were assessed using a wide range of functional measures. Both groups were also assessed at 15 months after injury. The experimental group deteriorated less than the control group in the early post-discharge period and patients, carers and professionals valued the service provided. However, this functional improvement was not maintained at the 15 month followup in some cases and factors contributing to this are discussed. This study explores and evaluates measures of function after brain injury rehabilitation, hopefully contributing to a better understanding of the complex nature of disability in that group. The implications for service provision and limitations and constraints in rehabilitation for this population are discussed.