[Subacute intensive rehabilitation after severe traumatic brain injury. Follow-up 6 months after discharge]

Abstract

Introduction: In September 2000 the Brain Injury Unit at Hvidovre Hospital was established, offering subacute intensive rehabilitation to patients with severe traumatic brain injury. Uptake area: Eastern part of Denmark, the Faroe Islands and Greenland. Outcome 6 months after discharge is presented for patients from the first 2 years, focusing on disability and social factors.

Materials and methods: Patients were selected on the basis of the Glasgow Coma Scale after end of sedation to ensure that the most severely-injured were included in the study. Rehabilitation was initiated immediately regardless of the level of consciousness. Patients were assessed using established rating-scales. Local social authorities were involved at discharge.

Results: Of 77 consecutive patients, 5 died before follow-up and 6 patients were not seen at follow up. 79% of the remaining group had post-traumatic amnesia lasting more than 4 weeks. Nonetheless, 4 out of 5 were able to walk independently, 79% were living at home under normal conditions and 76% were independent on a personal level. A majority suffered from cognitive dysfunctions, which was often the major remaining disability. 20% had resumed normal work or education.

Conclusion: The centralisation of rehabilitation in Denmark after very severe brain damage made it possible to conduct a structured plan for treatment and assessment during subacute rehabilitation and 6 months after discharge of patients with very severe traumatic brain injury. This has demonstrated that rehabilitation of even the most severely brain-damaged patients can be valuable.