Quasi-Contextualized Speech Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge

The Study

The reason for this study was to see how useful quasi-contextualized ST is in helping patients after having a TBI. Quasi-contextualized treatments (QXT) are strategies taught to patients by therapists to help a patient in tasks they would do at home. For example, this might be ways to remember to take medications, or steps to walking safely outside. Therapists also teach contextualized treatments (CXT)– or therapy that is the same as the tasks they would do at home, and decontextualized treatments – activities that are usually only done in a hospital and are used to lessen difficulties from the TBI. This study loked at amount of time patients spent in QXT to see how it changed patient’s abilities over time. Specific ways change after QXT was measured included how active patients were in their community, patient’s ability to take care of themselves, patient’s feelings of well-being, and other cognitive and physical outcomes.

1760 participants (patients 14 years of age or older with TBI) going through their first inpatient care in a brain injury unit of a rehabilitation facility were in the study. The participants were from 9 treatment centers in the United States. This study seemed to show that participants who spent at least 5% of their time in therapy using this type of ST were more active in their communities 9 months after leaving the hospital (for example being out in the community 3-4 days per week as opposed to 1-2 days per week) than those who did not have as much QXT. In addition, these participants were better able to do self-care tasks (like grooming or problem-solving) immediately after leaving the hospital and 9 months after. Importantly, the results show that having a balance of other types of treatment, especially direct practicing of tasks, is also important.

Who may be affected by these findings? Individuals with TBI.

Caveats: This study is based on an observational study, instead of a randomized controlled trial. This means the study cannot definitively state this therapy caused the improved results, it can only suggest this relationship.

Bottom Line: This study found multiple reasons that QXT are helpful for patients in TBI rehabilitation. For daily or household tasks that would be difficult to practice in therapy, patients may benefit from learning strategies from therapists on how to practice these tasks.