Effects of inpatient rehabilitation after acute care on motor, neuropsychological and behavioral outcomes in children with severe traumatic brain injury

Shiyao Gao; Amery Treble-Barna; Anthony Fabio; Sue R Beers; M Kathleen Kelly; Bedda L Rosario; Michael J Bell; Stephen R Wisniewski

doi:10.1080/09638288.2023.2297920

Effects of inpatient rehabilitation after acute care on motor, neuropsychological and behavioral outcomes in children with severe traumatic brain injury

Disabil Rehabil. 2024 Jan 3:1-10. doi: 10.1080/09638288.2023.2297920. Online ahead of print.

Authors

Shiyao Gao¹, Amery Treble-Barna², Anthony Fabio¹, Sue R Beers³, M Kathleen Kelly⁴, Bedda L Rosario¹, Michael J Bell⁵, Stephen R Wisniewski¹

Affiliations

¹ Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
² Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
³ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, WA, DC, USA.

PMID: 38166467
DOI: 10.1080/09638288.2023.2297920

Abstract

Purpose: An observational study of children with severe traumatic brain injury (TBI) (Approaches and Decisions in Acute Pediatric TBI [ADAPT] Trial) demonstrated the benefits of inpatient rehabilitation on functional outcomes for those with more severely impaired consciousness when medically stable. We conducted a secondary analysis to assess whether using an inpatient rehabilitation or skilled nursing facility after acute hospitalization was associated with better motor, neuropsychological, and behavioral outcomes compared to receiving only non-inpatient rehabilitation among children with severe TBI.

Materials and methods: We included 180 children who used an inpatient rehabilitation or skilled nursing facility and 74 children who only received non-inpatient rehabilitation from the ADAPT trial. At 12 months post-injury, children underwent tests of motor skills, intellectual functioning, verbal learning, memory, processing speed, and cognitive flexibility. Parents/guardians rated children's executive function and behaviors. We performed inverse probability weighting to adjust for potential confounders.

Results: No significant differences were found in any motor, neuropsychological, or behavioral measures between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation.

Conclusions: Analyses of comprehensive outcomes did not show differences between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation, suggesting a need for more research on specific components of the rehabilitation process.

Keywords: Child; cognitive function; motor skills; neuropsychology; rehabilitation; severe traumatic brain injury.

Plain language summary

Our study showed no differences in motor, neuropsychological, or behavioral outcomes at 12 months after severe traumatic brain injury (TBI) between children using an inpatient rehabilitation or skilled nursing facility and children receiving only non-inpatient rehabilitation after acute hospitalization.Children surviving severe TBI should be evaluated for the need of inpatient and outpatient rehabilitation therapies at discharge from an acute care hospital.Children with rehabilitation requirements after severe TBI should be followed up periodically to ensure the continuity of care and reduce the gaps to the needed rehabilitation therapies.