Academic journal article Journal of Medical Speech - Language Pathology

Factors Predicting Rehabilitative Service Provision in Adults with Traumatic Brain Injury

Academic journal article Journal of Medical Speech - Language Pathology

Factors Predicting Rehabilitative Service Provision in Adults with Traumatic Brain Injury

Article excerpt

Approximately 300,000 people sustain a traumatic brain injury (TBI) each year; however, a limited number receive formal speech-language, occupational, and physical therapy rehabilitation. Consequently, a large number of individuals may not meet their maximum potential outcomes following TBI. Little is known about the factors that may affect access to rehabilitation, the amount of rehabilitation provided in varying settings, or participation patterns in rehabilitation programs. This project addressed three research goals: defining the relationship between a number of independent variables following TBI and patient access to rehabilitative services, the relationship between the independent variables and the amount of TBI rehabilitative service provided, and the relationship between independent variables and discharge disposition following inpatient care for TBI.

The medical records of 712 adults incurring TBI as a result of motor vehicle accidents were examined. Logistic regression, odds ratio, t-tests, analysis of variance, analysis of covariance, and multinomial regression were used to evaluate the relationship between the independent and dependent variables in the study. Results indicate that admission to the intensive care unit (ICU), diagnosis of orthopedic impairment, and discharge disposition were significant predictors of physical, occupational, and speech therapy service provision following TBI. Gender and primary insurance provider were significant predictors of speech therapy, but not physical or occupational therapies. Admission to the ICU was a significant predictor of the amount of occupational and speech therapy provided following TBI. Age, admission to the ICU, length of stay, and primary insurance provider were significant predictors of discharge disposition following initial hospitalization.

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Traumatic brain injury (TBI) is an increasingly common cause of disability, with an estimated 300,000 people sustaining a TBI each year. Only about 5% of those individuals participate in formal rehabilitation (Horn, Yoels, & Bartolucci, 2000). This percentage is considerably lower than the 25 to 40% of persons with a TBI who report a degree of long-term disability (Greenspan, Wrigley, Kresnow, Branche-Dorsey, & Fine, 1996). Some affected individuals may regain partial function from spontaneous recovery and therefore may not access formal speech-language, occupational, and physical therapy rehabilitative services. For those requiring rehabilitation, participation in rehabilitation services, including speech-language therapy, has been correlated with better functional outcomes (Brzuzy & Corrigan, 1996; Coelho, DeRuyter, & Stein, 1996; Hall & Cope, 1995; Ylvisaker & Feeney, 1994). Because the majority of those experiencing TBI do not receive rehabilitation, a large number of individuals may not meet their maximum potential outcomes. The loss of independent working age persons who do not establish independent living situations or employment after injury results in a significant social and economic cost to the individual and society as a whole (Drake, Gray, Yoder, Pramuka, & Llewellyn, 2000).

Among the rehabilitative services available to persons with TBI are physical, occupational, and speech therapy. Little is known about the factors that may affect access to rehabilitative care, the amount of care provided in varying care settings, or participation patterns in these rehabilitation programs.

Hodgkinson, Veerabangsa, Drane, and McCluskey (2000) reported severity of injury, physical and cognitive disability, and psychosocial disability as significant predictors of rehabilitative service utilization. A significant correlation between the number of services utilized and particular injury characteristics was found. For example, survivors who suffered major injuries, such as orthopedic injuries, in addition to TBI were more likely to participate in rehabilitation than those not sustaining orthopedic injuries. …

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