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Rehabilitation processes following traumatic brain injury
thesisposted on 2023-05-26, 02:49 authored by Ta'eed, GL
Traumatic brain injury (TBI) may result in significant impairment in an individual's physical, cognitive and psychosocial functioning, and is acknowledged to be the leading cause of long-term disability in young adults (DSM III; 1999). An increasing body of high-quality evidence now exists for the effectiveness of rehabilitation interventions for TBI of all severities (Powell, Heslin, & Greenwood, 2002; Turner-Stokes, 2008; Wade, Crawford, Wenden, King, & Moss, 1997). However, there is a need for a more comprehensive description of the types of care allocated at the end of the acute phase of TBI, and the factors that influence variation in referral and access to services. Much of the literature focuses on people with severe TBI receiving specialist rehabilitation, and considers only hospitalised cases. The aims of the present research were to investigate patterns of referral to outpatient rehabilitation services in a population-based sample, to describe factors related to progress in rehabilitation for those referred to public community rehabilitation, and to increase understanding of TBI and its management, by developing a model of rehabilitation pathways. Study 1 looked at some demographic, injury-related, and post-injury characteristics of the participants of the Tasmanian Neurotrauma Register (TNTR) research project (N = 1226), and examined differences in the groups referred to public and private rehabilitation. Studies 2, 3 and 4 looked at the sub-sample of individuals (n = 175) referred for public multidisciplinary rehabilitation at the Community Rehabilitation Unit (CRU). These three studies considered how a range of variables were related to referral to CRU's clinical disciplines, to the likelihood of being offered appointments, and to attendance or non-attendance at initial appointments, when offered them. Study 5 looked further at how rehabilitation services contribute to TBI patients' recovery by considering the amount and nature of therapy participants received at CRU. This research provides clinicians and researchers with a clearer picture of some of the factors that affect the post-acute rehabilitation process, in a sample of TBI patients that is more representative of adult TBI than those found in the overwhelming majority of studies, which typically consider only moderate to severe TBI and/or hospitalised cases. The rehabilitation pathways and processes outlined will be valuable for rehabilitation clinicians who wish to identify people at risk of poor outcomes. The findings of this research provide a foundation upon which a number of avenues for further research can be based. These include looking at different measures of outcome in TBI samples referred for community rehabilitation, identifying effective interventions that are compatible with existing rehabilitation services, and comparing outcomes in matched samples referred and not-referred for rehabilitation.
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