TBI Rehabilitation Manual

39 The recommended long-term rehabilitation therapy track for patients who did not receive previous rehabilitation therapy will be as follows: First admission for 12 weeks followed by intensive home or OPD program for three months.

First readmission for 4 weeks three months following the first discharge and then intensive home or OPD program for next six months.

Second readmission for 4 weeks, six months following the second discharge and then home exercises program for six months.

Third readmission for 4 weeks, six months following the third discharge and then home and community program for six months.

Fourth readmission six months following the fourth discharge and then home and community program for six months.

Fifth readmission six months following the fourth discharge for final adjustment and recommendations of long term maintenance and management.

Surgical intervention may be indicated, if physiotherapy fails, for the management of chronic contractures after two years from the injury, with appropriate adjustment of a further rehabilitation program.

If the patient receives the above-described course of therapy, his rehabilitation potential can be considered as complete - with a low probability for further improvement in his resulting functional level, after around 53 months from the injury on average.

The further rehabilitation program, especially during the last admission, should focus on assistance to the family, community support and ongoing life with a residual impairment that may be severe.

B/ 2. Time Elapsed from the Injury between 12-24 months / Moderate impairment, Initial FIM on the First Admission 55-90 Patients in this group will in most cases be able to ambulate with assistive devices with minimal to moderate assistance and will require moderate assistance in ADLs. Cognitive impairment will range from mild to moderate; speech impairment may be moderate to severe.

An example of such a case would be a patient with moderate quadriparesis, moderate ataxia or one side spastic hemiparesis, with speech and cognitive impairment. At this stage, the patient may have already developed spastic contractures with limited reversibility, especially on the upper limbs.

Patients at this stage are already past the prime time for rehabilitation and if they received appropriate therapy in the past, their rehabilitation potential will be significantly reduced. If patients received only limited or no rehabilitation therapy in the past, they may still have potential for improvement and functional gain.

During first admission, they should be treated with full intensity. The typical length of stay will be 8 weeks of inpatient program, with 3 hours of interventions 5 days per week. In justified cases, the length of stay can be extended to 12 weeks, if progress in functional recovery is seen according to measurement with evaluation tools.