High Walter M, Roebuck-Spencer Tresa, Sander Angelle M, Struchen Margaret A, Sherer Mark
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Arch Phys Med Rehabil. 2006 Mar;87(3):334-42. doi: 10.1016/j.apmr.2005.11.028.
To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI).
Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design.
Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital.
Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29).
Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community.
Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire.
All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge.
The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.
探讨参与急性后期社区重返计划对创伤性脑损伤（TBI）后功能结局的影响。
队列、非随机干预研究。前后测、随访设计。
与一家住院康复医院相关联的非营利性门诊社区重返计划。
三组中重度TBI患者，受伤与入院之间的时间长度不同。第一组在受伤后6个月内进入急性后期康复（n = 115）；第二组在6至12个月之间（n = 23）；第三组超过12个月（n = 29）。
TBI患者参与了一个急性后期社区重返计划（平均4.3个月），该计划强调：（1）教授补偿策略以解决残留的认知缺陷；（2）安排环境支持以最大限度地发挥功能；（3）提供咨询和教育以解决个人和家庭调整问题并提高准确的自我意识；（4）从诊所的模拟活动过渡到社区的生产性活动。
残疾评定量表、监督评定量表和社区融入问卷。
所有组在入院和出院之间在总体残疾、独立性、家庭能力和生产力方面的测量结果均有所改善，并且这些改善在随访时得以维持。对于最早开始急性后期康复的组（受伤后<6个月），出院后独立性继续提高。即使出院后，社区融入总分和家庭能力也继续提高。
结果表明，急性后期康复对于改善TBI后的功能结局是有效的，即使对于受伤后12个月或更长时间已达到稳定神经恢复的患者也是如此。
