Rehabilitation after traumatic brain injury

Clinical and political responses to the worldwide epidemic of traumatic brain injury (TBI) need to recognize that the quality of outcome depends on both phases of treatment: acute care and rehabilitation. The growing scientific evidence for neural repair and regeneration has supported growing interest about what rehabilitation can offer to restore function and independence to disabled individuals. Clinicians who treat acutely head-injured patients should develop some understanding of the reality and potential of rehabilitation, to put their own work into perspective. This article reviews the common problems that follow TBI, unpacks the rehabilitation box to see what can be done about them, and considers the scientific evidence for the efficacy of the rehabilitation process.

A Preliminary Exploration of Goal-setting in Community-based Rehabilitation for People with Brain Impairment

Community-based rehabilitation for people with acquired brain injury (ABI) is largely driven by goals set in the course of rehabilitation by clients and service providers. A preliminary study investigating the perspectives and practice of experienced rehabilitation coordinators was undertaken to explore issues that influence goal-setting in community rehabilitation settings. Detailed interviews and subsequent rounds of clarification were conducted with six experienced rehabilitation coordinators. Key themes identified through inductive analysis include cognitive influences, other client influences, service provider influences and the client-service provider relationship in the goal-setting process. Based on the findings, a preliminary descriptive schema of goal-setting in a community-based rehabilitation service for people with acquired brain injury is suggested. Factors such as training, experience, and values of the rehabilitation coordinators are also discussed in terms of their influence on goal-setting. Some strategies to assist a person with ABI to identify and work towards achieving realistic goals are identified. Suggestions for enhancing community-based rehabilitation practices with people with ABI, and scope for future research are noted. This paper constitutes a general overview of goal-setting in community-based ABI rehabilitation.

Return to driving after traumatic brain injury: a British perspective

PRIMARY OBJECTIVE

To identify the current legal situation and professional practice in assisting persons with traumatic brain injury (TBI) to return to safe driving after injury.

METHODS AND PROCEDURES

A brief review of relevant literature, a description of the current statutory and quasi-statutory authorities regulating return to driving after TBI in the UK and a description of the nature and resolution of clinical and practical dilemmas facing professionals helping return to safe driving after TBI. Each of the 15 UK mobility centres was contacted and literature requested; in addition a representative of each centre responded to a structured telephone survey.

MAIN OUTCOME AND RESULTS

The current situation in the UK is described, with a brief analysis of the strengths and weaknesses both of the current statutory situation, and also the practical situation (driving centres), with suggestions for improvements in practice.

CONCLUSION

Although brain injury may cause serious limitations in driving ability, previous drivers are not routinely assessed or advised regarding return to driving after TBI.

Measuring High-Level Mobility After Traumatic Brain Injury

High-level mobility is important for participation in many pre-accident activities after traumatic brain injury (TBI). This review examined which measures are used to quantify physical status and mobility after TBI to determine their appropriateness for measuring high-level mobility. Electronic databases, hand searching of several TBI journals, and citation tracking from retrieved articles were used to identify all TBI outcome studies from 1990 through to May 2004. Preliminary screening identified articles that either reported on physical outcome or mobility after TBI or utilized measurement tools with a physical component. Studies were selected for detailed analysis if they reported on mobility or physical outcomes after TBI. The search identified 175 studies that met the inclusion criteria for further analysis. The FIM instrument is the most frequently used outcome measure, highlighting a trend toward using inpatient measures to evaluate long-term outcomes. Only one study used a measurement tool that incorporated a mobility item beyond independent walking and stairs. High-level mobility is seldom measured using standardized outcome measures after TBI, despite independent mobility being one of the major goals of rehabilitation. A high-level mobility scale is needed to address the ceiling effect of outcome scales currently used in TBI rehabilitation and to extend mobility to age-appropriate levels for return to leisure and sporting activities.