Ryu Kokuwa, Shintaro Uehara, Shoko Kajiura, Hisae Onaka, Kei Yagihashi, Masaki Katoh, Aki Tanikawa, Chieko Sakuragi, Yoko Inamoto, Isao Morita, Yohei Otaka
Department of Rehabilitation Medicine I, Fujita Health University Hospital, Aichi, Japan
DOI: 10.2340/20030711-1000047

Objective: To elucidate the characteristics of recovery progression during long-term rehabilitation after moderate-to-severe traumatic brain injury.
Methods: Longitudinal changes in consciousness, swallowing disorders, activities of daily living, and psychological and behavioural status were studied in 7 patients with moderate-to-severe traumatic brain injury, using scores of the National Agency for Automotive Safety & Victim´s Aid (NASVA score), Glasgow Coma Scale (GCS), Dysphagia Severity Scale (DSS), Eating Status Scale (ESS), Functional Independence Measure (FIM), Cognitive-related Behavioural Assessment (CBA), and Neuropsychiatric Inventory (NPI). Scores were collected every month until discharge (median 359 days after injury), or until the study end date for those patients who remained hospitalized (432 days).
Results: Patients were qualitatively classified into those who improved well in the early phase, in terms of consciousness, swallowing, and activities of daily living, and those with less or delayed improvement. Psychological and behavioural difficulties appeared to remain less improved than the other functions for longer periods in many patients. Statistical comparisons that included all 7 patients revealed a significant improvement in NASVA score, GCS, DSS, and ESS, but not in FIM, CBA, and NPI at discharge/at the last measurement compared with scores at admission.
Conclusion: Swallowing function is more responsive to long-term rehabilitation in patients with moderate-to-severe traumatic brain injury, while neuropsychiatric and behavioural difficulties tend to persist for longer periods.

Inpatient rehabilitation programmes have been shown to encourage functional recovery in patients with consciousness disturbance after traumatic brain injury (TBI). However, it remains unclear how physical and cognitive functions, including the swallowing function and neuropsychiatric symptoms, change during long-term inpatient rehabilitation. The present study retrospectively investigated longitudinal changes in these functions in 7 moderate-to-severe TBI patients. Patients were qualitatively classified into two groups comprising those who showed improvement in consciousness, swallowing, and activities of daily living in the early phase, and those who showed less or delayed improvements. Psychological and behavioural difficulties remained less improved than the other functions for longer periods in many patients. Statistical comparisons of all the patients revealed a significant improvement only in consciousness and swallowing function. This case series demonstrates that the swallowing function is more responsive to long-term rehabilitation, while neuropsychiatric and behavioural problems tend to persist for longer periods.

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