The therapeutic value of cranioplasty in individuals with brain injury

Abstract

Primary objective: To examine the effect of cranioplasty on recovery.

Research design: Retrospective cohort study.

Method and procedures: Retrospective chart review conducted in 2011 and 2012 on adult inpatients with craniectomy who completed a continuous episode of inpatient rehabilitation before and after receiving their cranioplasty. Patients were matched 1:1 or age, gender, functional level at admission, injury severity and length of stay with inpatients who completed rehabilitation before cranioplasty. Main outcome measures include FIM^TM (Functional Independence Measure) and FIM^TM efficiency [(FIM^TM discharge - FIM^TMadmission)/number of days in rehabilitation]. To examine within and between group differences, analyses included paired and independent t-tests, Pearson correlations and chi-square analyses.

Results: Twenty-six individuals (13 from the cranioplasty group and 13 from the comparison group) were analysed. FIM^TM efficiency increased following cranioplasty [0.29 to 0.61; t(12) = -2.77, p = 0.017]. The mean FIM^TM efficiency for the cranioplasty group was below that of the comparison group prior to cranioplasty [0.28 ± 0.37 and 0.39 ± 0.32, p = .41], but increased following cranioplasty [0.61 ± 0.71 and 0.39 ± 0.32, p = .32]. An improvement in FIM^TM efficiency following cranioplasty was more commonly seen among individuals with less severe brain injuries (75%, χ² = 3.8, df = 1, p = 0.053).

Conclusion: Rate of recovery increased following cranioplasty and exceeded that of the comparison group suggesting that cranioplasty may contribute to improvement.

Keywords: Traumatic brain injury; craniectomy; recovery; rehabilitation; stroke.