Recovery of Cognitive and Behavioural Function During Long-term Inpatient Rehabilitation in Patients with Moderate-To-Severe Traumatic Brain Injury: Evaluation of a Retrospective Case Series

Ryu Kokuwa; Shintaro Uehara; Shoko Kajiura; Hisae Onaka; Kei Yagihashi; Masaki Katoh; Aki Tanikawa; Chieko Sakuragi; Yoko Inamoto; Isao Morita; Yohei Otaka

doi:10.2340/20030711-1000047

Recovery of Cognitive and Behavioural Function During Long-term Inpatient Rehabilitation in Patients with Moderate-To-Severe Traumatic Brain Injury: Evaluation of a Retrospective Case Series

J Rehabil Med Clin Commun. 2021 Jan 12:4:1000047. doi: 10.2340/20030711-1000047. eCollection 2021.

Authors

Affiliations

¹ Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan.
² Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan.
³ Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan.
⁴ Department of Nursing, Fujita Health University Hospital, Aichi, Japan.
⁵ Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.

Abstract

Objective: To elucidate the characteristics of recovery progression during long-term rehabilitation after moderate-to-severe traumatic brain injury.

Methods: Longitudinal changes in consciousness, swallowing disorders, activities of daily living, and psychological and behavioural status were studied in 7 patients with moderateto-severe traumatic brain injury, using scores of the National Agency for Automotive Safety & Victim's Aid (NASVA score), Glasgow Coma Scale (GCS), Dysphagia Severity Scale (DSS), Eating Status Scale (ESS), Functional Independence Measure (FIM), Cognitive-related Behavioural Assessment (CBA), and Neuropsychiatric Inventory (NPI). Scores were collected every month until discharge (median 359 days after injury), or until the study end date for those patients who remained hospitalized (432 days).

Results: Patients were qualitatively classified into those who improved well in the early phase, in terms of consciousness, swallowing, and activities of daily living, and those with less or delayed improvement. Psychological and behavioural difficulties appeared to remain less improved than the other functions for longer periods in many patients. Statistical comparisons that included all 7 patients revealed a significant improvement in NASVA score, GCS, DSS, and ESS, but not in FIM, CBA, and NPI at discharge/at the last measurement compared with scores at admission.

Conclusion: Swallowing function is more responsive to long-term rehabilitation in patients with moderate-to-severe traumatic brain injury, while neuropsychiatric and behavioural difficulties tend to persist for longer periods.

Keywords: cognitive deficit, neuropsychiatric symptom; disorder of consciousness; functional recovery; rehabilitation; swallowing disorder; traumatic brain injury.