Outcomes of the rehabilitation process – brain injury

In 2022, 358 adult patients with an acquired brain injury completed their intensive and specialised neurorehabilitation process, 23% of whom were of traumatic origin (TBI, traumatic brain injury), 55% of vascular origin (CVD, cerebrovascular disease) and 22% owing to other pathologies.

Type of Injury	Patients
Traumatic brain injury	83 (23,2%)
Stroke (CVD)	195 (54,5%)
Other non traumatic brain damage	80 (22,4%)
Total	358 (100%)

Population by gender

Among patients discharged in 2022, only 2.1% were readmissions for complications (prior to 2 years after discharge). The complications treated were traumatological surgery and digestive surgery.

Psychosocial situation

To evaluate the outcome of the neurorehabilitation process, we analyse where patients with an acquired brain injury go once they have been discharged from the hospital and also who they live with and their level of interrelation with other people and their environment.

Once the rehabilitation process had been completed, 83% of patients with an acquired brain injury returned to their residence or a new residence, 17% required an institutional alternative on a temporary or permanent basis.

If we analyse the situation of living with others on admission and on discharge, some variations are observed compared to previous years. Cases of people who return to live with their parents after discharge are increasing, and cases of patients that must be admitted to an institution are increasing. On the other hand, cases of people living with a partner, as well as living alone or with roommates, decreased.

We also assess the domestic and social situation of the patient, which helps us detect situations of social risk and make an appropriate intervention based on the social needs of each patient. In 2022, the social and domestic situation of the patient on discharge has improved in 43% of cases, is maintained in 27% and is worse in 30%.

The results have been calculated with the EVSF-IG, an adaptation of the Gijón Social and Family Assessment Scale. This scale allows us to classify patients according to 4 categories: (No social difficulties ≤ 5 points; Slight social difficulties from 6 to 9 points; Major social difficulties from 10 to 14 points and Severe social difficulties ≥ 15 points).

Improved functional autonomy

To measure and evaluate the improvement in functionality of people with ACI, we have to differentiate between those of traumatic, vascular or other pathologies.

TRAUMATIC BRAIN INJURY

Of the 83 patients having sustained a traumatic brain injury (TBI) who received treatment and rehabilitation, 92.7% were seriously impaired on admission according to the Glasgow Coma Scale. Their mean age was 40.

One of the severity assessment scales we use is the Disability Rating Scale (DRS). According to the results obtained, we can state that our patients went from serious disability on admission (almost 12 points) to moderately serious disability on discharge (7.15 points) with a mean improvement of 4.31 points (p<0.01).

The DRS is a scale designed to assess patients who have sustained a moderate to severe TBI. The total DRS score ranges from 0 (no disability) to 29 (extreme vegetative state), therefore the lower the score, the better the patient’s functional status. The following classification in groups is considered: 2-3 partial disability, 4-6 moderate disability, 7-11 moderately severe disability, 12-16 serious disability, 17-21 extremely serious disability, 22-24 vegetative state, 25-29 extreme vegetative state.

CEREBROVASCULAR DISEASE

The mean age of the 195 patients with cerebrovascular disease who received clinical discharge was 52. The Barthel scale was administered to assess their functionality, showing a mean improvement of 17.4 points (p=0.05) on the patient’s discharge compared to admission.

The Barthel scale, widely validated for these patients, measures the patient’s capacity for independence in going about activities of daily living (ADLs). The scale varies from 0 to 100, where 0 is complete dependence and 100 is full functional autonomy in performing ADLs. A classification by Shah et al, Improving Index for Stroke Rehabilitation (J Clin Epidemiol. 1989), was considered as a reference. It considers the following groups: 0-20 total dependence, 21-60 serious dependence, 61-90 moderate dependence, 91-99 limited dependence, 100 independence.

OTHER CAUSES OF BRAIN INJURY

134 patients with other causes of brain injury resulting from tumours, anoxia, infections, etc. completed the rehabilitation process. Their mean age was 48.

Regarding the functionality achieved, the figure below shows how our patients achieved an improvement in functional level in both the cognitive and motor areas (assessed using the FIM scale). In the total score, an improvement of 10 points was achieved on discharge compared to admission.

The FIM scale measures the patient’s capacity for independence in performing activities of daily living (ADLs). The FIM-Cognitive has a range of values from 5 to 35 points, and the FIM-Motor from 13 to 91 points. The FIM-Total is the sum of the two areas (cognitive and motor) and the score ranges from 18 to 126 points – the higher the score, the better the patient’s level of functionality.

Finally, another indicator related to improvement in functionality is the fact that 83% of patients with brain injury who were admitted with a tracheostomy cannula were discharged without a cannula.