Functional recovery of patients with moderate and severe traumatic brain injury after extended and standard early rehabilitation.

Abstract

Introduction: Traumatic brain injury (TBI) is one of the leading causes of morbidity, disability and mortality in all age groups. Treatment and early rehabilitation are crucial to the overall level of recovery. The objective is to compare the effects of standard and extended early rehabilitation on the functional recovery of patients with moderate and severe traumatic brain injury.

Material: A prospective experimental study comprised 114 patients with moderate and severe TBI, randomly divided into two groups. The patients of the experimental group had kinesitherapy 7 days a week, twice a day for 45 min, and the patients of the control group had kinesitherapy 7 days a week, twice a day for 30 min. The follow-up parameters were: age sex, clinical characteristics, Glasgow Coma Scale (GCS), Functional Independence Measure (FIM), Barthel Index (BI) on admission and discharge and Glasgow Outcome Score (GOS) at discharge.

Results: 114 patients were randomly divided into two groups of 57 patients each. Males dominate (75.4%), the average age of the sample was Me = 59.0. There was no statistically significant difference between the groups in gender, age and clinical characteristics, GCS on admission; 59(51.8%) patient had severe, 55 (48.2%) moderate TBI, at discharge: 12 (10.5%) had severe, 11(9.6%) moderate and 91(79.8%) mild TBI. FIM of the experimental group was 18 vs. 70 and of the control group was 18 vs. 50, BI of the experimental group was 0 vs. 61 and of the control group was 0 vs. 32. GOS at discharge: complete recovery in the experimental group 9, in the control group 7, mild deficit 22 vs. 15, severe deficit 22 vs. 28, vegetative state 4 vs. 7. Normalized improvement (ratio of achieved progress to maximum possible progress) was higher in the prolonged early rehabilitation group: for FIM (48% vs. 30%), BI (61% vs. 32%) and slightly less for GCS (100% vs. 92%).

Conclusion: Although no statistically significant difference on functional recovery between the groups was found, however, a difference in percentage progress was found in favor of extended early rehabilitation, but for a final conclusion it is necessary to make a follow-up after inpatient rehabilitation.