Three weeks spent in an early rehabilitation and post-intensive care unit significantly reduce disability of severely brain injured patients discharged from hospital
Dr Lydia OUJAMAAa
a CHU Grenoble
Brain plasticity is a time dependant variable for neurological recovery after acute brain injury.
To quantify functional benefit of a short stay in an early rehabilitation post intensive care unit for severe brain injured patients.
This retrospective cohort study took place in Early Rehabilitation Section (ERS) of Intensive Care Department of Grenoble University Hospital between 2011 and 2013.
It focused on patients discharged from neurocritical care after acute brain injury.
We have recorded Length of stay (LOS) and Functional Independence Measurement (FIM: total score = FIMc: cognitive and social score + FIMm: motor score), at admission and discharge from ERS.
In ERS, rehabilitation took 2 hours per day, five days a week including speech language therapy, occupational therapy, physiotherapy and psychosocial support.
One hundred and sixty two patients were included, with median age 56, and ratio Female/Male 0.6.
Seventy nine had severe traumatic brain injury (TBI), thirty-one had subarachnoid haemorrhage, fifty two had stroke.
The median LOS was 28 days in intensive care, 22 days in ERS.
The median FIM at admission in ERS: 22 points (FIMc 9, FIMm 13).
The median FIM improvement at discharge from ERS: + 20 points (FIMc +6 points, FIMm + 14).
There was no statistical difference between traumatic and non-traumatic brain injured groups.
Considering TBI patients: disorder of consciousness (DOC) was identified for 13, post-traumatic amnesia for 53. Considering vascular brain injured patients: 3 locked in syndrome, 16 akinetic mutisms, 32 severe dysexecutive disorder, and 17 were severe aphasia cases.
If necessary, neurosurgical treatment was planned during ERS stay to accelerate functional recovery (cranioplasty, cerebrospinal fluid shunt). Amantadine was administered in case of DOC. Any medication which could reduce cognitive ability was avoided. Rehabilitation goal was focused on efficient communication, reduction of anxiety and sleep disorder, ability to swallow, wheelchair mobility and removal of all catheters.
Three weeks of early specialized rehabilitation promotes functional recovery for severe acute brain injured patients immediately after intensive care discharge. Patients are thereafter discharged to out-hospital rehabilitation centers with higher safety and lower dependency.
Keywords : brain injury, early rehabilitation, post-intensive care