Improved recovery outcomes for brain injury patients

Monash University researchers have found skills retraining in daily activities can improve outcomes in functional independence for brain injury patients in post-traumatic amnesia (PTA).

Post-traumatic amnesia (PTA) is a transient recovery stage following traumatic brain injury (TBI). Researchers aimed to evaluate the efficacy of skills retraining during PTA, challenging current Australian practice which delays rehabilitation with active participation until after emergence from PTA due to patients’ impaired learning ability and the risk of increasing agitation.

This study evaluated the possible benefits in functional independence through provision of skills retraining in activities of daily living (ADL) during PTA in addition to the usual treatment (daily physiotherapy, speech therapy) compared with usual treatment alone (treatment as usual).

Patients completed simple tasks such as preparing basic meals and hot drinks. They also engaged in personal care tasks such as bathing, grooming, dressing, self-feeding and goal setting.

“It is important that individuals in post-traumatic amnesia following traumatic brain injury receive timely intervention that supports their rehabilitation,” said lead researcher Dr Jessica Trevena-Peters, a clinical neuropsychologist with the Turner Institute for Brain and Mental Health, and an Occupational Therapist, who recently won the 2018 World Federation for Neurorehabilitation (WFNR) Franz Gerstenbrand Award for the study.

Participants in the treatment condition received up to 60 minutes per weekday of ADL intervention provided by trained occupational therapists, with the intervention approach based on task-specific procedural and errorless learning.

Over a three-year period, 104 traumatic brain injury patients with PTA were monitored, with 55 receiving treatment as usual and 49 completing ADL retraining.

Patients were monitored for improvements in functional independence as measured by outcomes in bathing, grooming, self-feeding and meal preparation. Those who commenced ADL retraining during PTA were found to have greater improvements in functional independence compared to those who received treatment as usual.

Findings also showed that the ADL intervention allowed patients to do something for themselves early in their rehabilitation journey and provided opportunities to use time meaningfully.

“There were strong trends towards shorter length of hospital stay and PTA duration in the group receiving ADL retraining. Findings also suggested that agitated behaviour was not increased by delivery of the structured ADL retraining during PTA,” Dr Trevena-Peters said.

“The results of our study have helped to facilitate a change in practice.

“It’s fantastic to see real impact being made. I’m also incredibly honoured to have won the Franz Gerstenbrand Award for this work”.

The research was also conducted by Monash researchers Dr Adam McKay and Professor Jennie Ponsford AO.

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