Functional Activity Limitations after Traumatic Brain Injury
By Yelena Goldin, Ph.D., JFK Medical Center
JFK Johnson Rehabilitation Institute is one of 16 Traumatic Brain Injury Model Systems (TBIMS) Centers. Each center conducts independent research with the aim of providing new information that can improve the lives of people affected by moderate and severe traumatic brain injury (TBI). Today, our understanding of TBI is much better than it was several decades ago. However, we still have an insufficient understanding of how people’s ability to engage in important daily-life activities is affected by TBI and how that changes throughout the course of recovery.
The TBIMS project at JFK Johnson aims to evaluate changes in one’s ability to perform functional activities important for independent living after TBI. TBI affects everyone differently, and these differences can result in variability in an individual’s ability to perform functional activities of daily living. Recovery of functional activities can occur over the course of days, months, or even years after injury. Different functions may recover at different rates, and some functions may remain compromised or may even worsen, requiring specialized treatments. In order to develop and select the best treatments for each person, it is important to understand how the ability to perform activities changes over time. Of equal importance is determining and demonstrating that treatment at various stages of recovery helps individuals with TBI live in the community.
Our project aims to track longitudinal changes in functional activities during acute rehabilitation and through the first year of recovery in individuals with moderate and severe TBI. To address this, we are recruiting patients admitted to our inpatient brain trauma rehabilitation unit. We also study treatment-induced changes in functional activities in individuals with TBI receiving outpatient rehabilitation. This is achieved by enrolling individuals in specialized outpatient brain injury rehabilitation at our facility.
To evaluate limitations in functional activities, we are using the Activity Measure for Post-Acute Care (AM-PAC). The AM-PAC was developed for the longitudinal study of activity limitations across the rehabilitation continuum and allows continuous evaluation in both inpatient and community settings. This instrument measures activity limitations in three distinct functional domains: basic mobility (includes functions addressed by a physical therapist), daily activities (includes functions addressed by an occupational therapist), and applied cognition (includes functions addressed by a speech therapist and/or neuropsychologist).
The AM-PAC can be completed interchangeably by patients, therapists, or caregivers. It provides standard scores to help clinicians select interventions and track patient progress. Its functional stage grades also give patients and caregivers a concrete understanding of a person’s level of independence and required assistance in various physical, cognitive, and daily-living activities. We recently conducted a preliminary data analysis on both our inpatient and outpatient samples. Our results show that individuals with TBI continue to make gains throughout their recovery. Among individuals receiving acute inpatient rehabilitation, patients improved from being significantly limited and largely dependent in all domains immediately after injury to being able to function in the community with various degrees of assistance by the time of discharge. When we followed them at six months and one year after injury, they reported slow but steady improvements and were overall functioning at a much higher level of independence. The greatest improvements were in their ability to perform functional daily-living activities. Patients receiving outpatient rehabilitation similarly demonstrated greater functional independence in all domains from before to after treatment.
Our preliminary results are encouraging. They demonstrate that comprehensive rehabilitation, both immediately after the injury and long term, is important in improving real-world functioning in individuals with TBI. In our study, patients regained functional independence, reduced their limitations in performing activities important for community living, and maintained these gains. To learn more about the Traumatic Brain Injury Model Systems research, visit www.msktc.org/tbi/model-system-centers.
This article originally appeared in Volume 13, Issue 3 of THE Challenge! published in 2019.