Early rehabilitation intervention is associated with significant positive functional outcomes in traumatic brain injury: a retrospective analysis


  • Siddharth Rai Department of Physical Medicine and Rehabilitation, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Mallikarjun Gunjiganvi Department of Trauma Surgery, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Awale Rupali Bhalachandra Department of Laboratory Medicine, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Harleen Uppal Department of Physical Medicine and Rehabilitation, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India




Traumatic brain injury, Neurological rehabilitation, Functional outcome, Developing countries


Background: Traumatic brain injury (TBI) is a global public health problem affecting adversely health care system. While acute trauma care has been documented to improve outcomes, the impact of early rehabilitation on outcome is not well documented especially in the developing world like ours. Predicting functional outcome from admission variables helps in intervention development, and appropriate fund allocation for TBI treatment. Therefore, we accepted a challenge to do a retrospective study on TBI patients admitted in our newly established and resource limited trauma center. The aim of the study was to assess the effect of early rehabilitation on TBI patients on functional improvement and to prognosticate the improvement from early admission variables.

Methods: Study was conducted at Apex Trauma Center, SGPGIMS, Lucknow analysis of prospectively maintained data. Retrospective analysis of records of patients, admitted within 48 hrs of moderate to severe injury, was done after Institute Ethic Committee approval. Statistical analysis used was regression analysis and multivariate analysis was done between possible risk factors and FIM gain.

Results: There was significant FIM score improvement from admission to discharge (p<0.001). Factors associated with a higher FIM gain were admission FIM motor and cognitive scores, GCS score on admission and length of hospital stay.

Conclusions: Our study strongly suggests that a dedicated rehabilitation programme, designed according to the functional needs of TBI patient, helps in improved functional outcome and recovery.


Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987-1048.

Ao B, Brown P, Tobias M, Ameratunga S, Barker CS, Theadom A, et al. Cost of traumatic brain injury in New Zealand: evidence from a population-based study. Neurology. 2014;83(18):1645-52.

Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;1-18.

WHO. World Health Report 2003-Shaping the Future, 2003. Available at: https://www.who.int/ whr/2003/en/whr. Accessed on 30 April 2021.

Murray CJL, Lopez AD, WHO, World Bank, Harvard School of Public Health. Global health statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions. Harvard School of Public Health; 1996.

Kamal VK, Agrawal D, Pandey RM. Epidemiology, clinical characteristics and outcomes of traumatic brain injury: Evidences from integrated level 1 trauma center in India. J Neurosci Rural Pract. 2016;7(4):515-25.

Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res. 2002;24(1):24-8.

Mackay LE, Bernstein BA, Chapman PE, Morgan AS, Milazzo LS. Early intervention in severe head injury: long-term benefits of a formalized program. Arch Phys Med Rehabil. 1992;73:635-41.

Huang ME, Wartella JE, Kreutzer JS. Functional outcomes and quality of life in patients with brain tumors: a preliminary report. Arch Phys Med Rehabil. 2001;82:1540-6.

Teasdale G, Mmxay G, Parker L, Jennett B. Adding up the glassgow coma score. Acta Neurochir. 1979;28:13-6.

Jennett B, Teasdale G, Braakman R, Minderhoud J, Heiden J, Kurze T. Prognosis of patients with severe head injury. Neurosurg. 1979;4:283-9.

Waxman K, Sundine M, Young R. Is early prediction of outcome in severe head injury possible?. Arch Surg. 1991;126:1237-43.

Bishara SN, Partridge FM, Godfrey HP, Knight RG. Post-traumatic amnesia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of patients with severe closed-head injury. Brain Inj. 1992;6(4):373-80.

Narayan RK, Greenberg RP, Miller JD, Enas GG, Choi SC, Kishore PR, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54(6):751-62.

Sandhaug M, Andelic N, Vatne A, Seiler S, Mygland A. Functional level during sub-acute rehabilitation after traumatic brain injury: course and predictors of outcome. Brain Inj. 2010;24(5):740-7.

Demir Y, Koroglu O, Tekin E, Adıguzel E, Kesikburun S, Guzelkuçuk U, et al. Factors affecting functional outcome in patients with traumatic brain injury sequelae: Our single-center experiences on brain injury rehabilitation. Turk J Phys Med Rehabil. 2018;65(1):67-73.

Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD. Performance profiles of the functional independence measure. Am J Phys Med Rehabil. 1993;72(2):84-9.

Okamura K. Glasgow Coma Scale flow chart: a beginner's guide. British J Nurs. 2014;23:1068-73.

Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Relationship between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993;74:566-73.

Cowen TD, Meythaler JM, Vivo MJ, Ivie CS, Lebow J, Novack TA. Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges. Arch Phys Med Rehabil. 1995;76(9):797-803.

Baguley I, Slewa YS, Lazarus R, Green A. Long-term mortality trends in patients with traumatic brain injury. Brain Inj. 2000;14(6):505-12.

Pruthi N, Ashok M, Kumar VS, Jhavar K, Sampath S, Devi BI. Magnitude of pedestrian head injuries & fatalities in Bangalore, south India: a retrospective study from an apex neurotrauma center. Indian J Med Res. 2012;136(6):1039-43.

Greiss C, Yonclas PP, Jasey N, Lequerica A, Ward I, Chiaravalloti N, Felix G, et al. Presence of a dedicated trauma center physiatrist improves functional outcomes following traumatic brain injury. J Trauma Acute Care Surg. 2016;80(1):70-5.

Bullock MR, Povlishock JT. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24:1-106.

National Commission on Macroeconomics and Health, Ministry of Health & Family Welfare, Government of India. Injuries in India: A National Perspective. Background Papers: Burden of Disease in India Equitable Development-Healthy Future. New Delhi: National Commission on Macroeconomics Heal. 2005:325-47.

Gururaj G, Kolluri S, Chandramouli BA, Subbakrishna DK, Kraus JF, authors. Traumatic Brain Injury. Bengaluru National Institute of Mental Health and Neuro Sci. 2005;61.

Lui SK, Ng YS, Nalanga AJ, Tan YL, Bok CW. A pilot project of early integrated traumatic brain injury rehabilitation in Singapore. Rehabil Res Pract. 2014;950183.

Ashley JG, Ashley MJ, Masel BE, Randle K, Kreber LA, Singh C, et al. The influence of post-acute rehabilitation length of stay on traumatic brain injury outcome: a retrospective exploratory study. Brain Inj 2018;32:600-7.

Horn SD, Corrigan JD, Dijkers MP. Traumatic Brain Injury Rehabilitation Comparative Effectiveness Research: Introduction to the Traumatic Brain Injury-Practice Based Evidence Archives Supplement. Arch Phys Med Rehabil. 2015;96:173-7.

Turner SL. Evidence for the effectiveness of multi- disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches. J Rehabil Med. 2008;40:691-701.

Wagner AK, Fabio T, Zafonte RD, Goldberg G, Marion DW, Peitzman AB. Physical medicine and rehabilitation consultation: relationships with acute functional outcome, length of stay, and discharge planning after traumatic brain injury. Arch Phys Med Rehabil. 2003;82(7):526-36.

Guise E, Blanc J, Feyz M, Meyer K, Duplantie J, Thomas H, et al. Long-term outcome after severe traumatic brain injury: the McGill interdisciplinary prospective study. J Head Trauma Rehabil. 2008;23:294-303.

McLafferty FS, Barmparas G, Ortega A, Roberts P, Ko A, Harada M, et al. Predictors of improved functional outcome following inpatient rehabilitation for patients with traumatic brain injury. Neuro Rehabilitat. 2016;39(3):423-30.






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