The Importance of Length of Stay in Brain Injury Rehabilitation

The usual course of medical interventions involves determining a diagnosis and an appropriate, relevant treatment.  Once a determination is made, treatment options can be considered.  Treatment options are developed over time and often, though not always, have a rigorous science behind them that serves to guide the implementation of that treatment.  For example, an infection might be treated with one of several different antibiotics.  The antibiotic selected must be the most potent drug for the bacterial infection – and it must be administered in a particular dose, a specific number of times per day, for a specific number of days.  Additionally, a drug may come with advisories to avoid certain circumstances or other medications – for instance, a drug can cause increased sensitivity to the sun, and grapefruit juice can interfere with certain types of medication. Finally, few medicines are universally effective for all patients, and most can result in undesirable side effects.

There are very few drugs that have been explicitly developed for traumatic brain injury.  In fact, rehabilitation is the most effective treatment known for reducing disability following traumatic brain injury.  Little has been done to understand the dosing parameters similar to the manner in which medications are prescribed to represent the best use of rehabilitation.

In a research project completed at CNS, we were able to review the response to rehabilitation in nearly 400 people with traumatic brain injury.  We found that response to treatment was different depending upon the severity of injury and time since the injury.  People with mild to moderate levels of disability (who were more than one year since injury) showed improvements due to rehabilitation when treatment extended to 90 days or more.  However, people with severe disability (who were more than one year since injury) required at least 180 days to show improvements.

People with either moderate or severe disability (who were less than one year since injury) showed improvement after 90 days of treatment – while those with severe disability showed even further improvement after 180 days of treatment.

These findings are important as they describe how people with different levels of disability also respond to a standard treatment intervention differently – both related to the severity of their disability and the elapsed time since their injury.  Expectations for how long a person should be treated, what rehabilitation efforts should be, as well as cost, must be similarly adjusted.  A “one size fits all” approach cannot be expected to result in a person achieving their highest level of recovery after a brain injury.

These findings argue for individualized dosing of rehabilitation following traumatic brain injury and, consequently, have implications for how payers and providers view application of rehabilitation following traumatic brain injury.

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