Early Intervention Key to Long-Term Success

Early rehabilitation interventions, long reputed to significantly increase the chances of success in a patient’s recovery from brain injuries, appear to be justified by recent studies conducted by a doctoral student at the University of Gathenburg.

The studies followed 280 Swedish and Icelandic patients, victims of traumatic brain injuries, for 1 – 11 years after the initial causal event to determine the relationship of how quickly they received attention and access to rehabilitation to their recovery success.

‘We found that the functional activity — for example how independent the patients are in their daily activities and how fast they can return to work — is substantially improved among those who are admitted to inpatient rehabilitation care early,’ says Ulfarsson, presenting the results in his doctoral thesis.

The same principal appears to hold true in the case of mild traumatic brain injury, an annual incidence that is estimated to affect 100 to 300 persons in a population of 100,000.

In a retrospective study from data collected on 693 patients admitted to the Early Response Brain Injury Service (ERBIS) between January 2003, and October, 2004, doctors at the GF Strong Rehabilitation Center of Vancouver, Canada concluded that early intervention was a highly significant factor in the recovery success rates of patients with mild traumatic brain injury.

As a result, they formulated an early intervention model to be used by family physicians when presented with symptoms of mild traumatic brain injury. This model provides primary care physicians with the following Clinical pathway for patients with post- concussive symptoms:

Timeline Primary focus Strategy

Month 1
Acute recovery: 0–4 weeks Evaluate and treat symptoms; identify risk factors Provide information, validate experience, and reassure regarding positive outcome Provide short-term medical management of symptoms (headaches, sleep, mood)

Months 2–6
Sub-acute recovery: 4–12 weeks Evaluate rehabilitation needs Refer to rehabilitation services as appropriate (occupational therapy, physiotherapy for multi-trauma, counselor)

They also provided criteria for risk factors in symptom prolongation:

• Positive CT/MRI
• Multi-trauma
• Prior brain injury
• LOC > 10 minutes*
• PTA > 4–6 hours*
• Chronic pain
• Chronic headaches Psychological
• Evolving anxiety/depression
• Pre-injury mental health issues (depression, psychological trauma)
• Pre-injury stress Situational
• Demanding responsibilities
• Lack of social/family support
• Low educational level
• Low socioeconomic status
• Ongoing litigation
• Short time on job
*Loss of Consciousness
* Post-traumatic amnesia

Equipped with criteria supplied by this model, physicians are able to institute early intervention methods that address the individual circumstances of their patients. Given this information , they can better treat those who have sustained mild traumatic brain injuries through a more personalized gradual resumption of activity, medication and cognitive therapy that promotes brain recovery.
There is no doubt that scientific evidence confirms the importance of earlier intervention and treatment in the ultimate success of a patient’s recovery. Regrettably however, financial constraints often preclude their access to these best outcomes. In fact, for most Americans who depend upon third party payers, their options may be severely limited by cost containment policies, a myopic vision of long term benefits.

http://www.sciencedaily.com/releases/2014/01/140128153857.htm http://www.bcmj.org/article/early-interventions-mild-traumatic-brain-injury-reflections-experience

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