New International Study Finds Patients with Traumatic Brain Injuries Respond Best to Immediate, Aggressive Therapy

The new study, published by the American Congress of Rehabilitation Medicine, found that traumatic brain injury patients responded better when immediate and aggressive therapy was administered.

“Overall, we wanted to take a look at how we care for each patient and figure out what treatment method works best,” said David Ryser, MD, medical director for the Intermountain Medical Center Neuro Specialty Rehabilitation Unit in Murray, and one of the authors of the study. “We’ve had ideas about which methods are most effective, but we’ve never had data to support those ideas until now.”

Researchers at the 10 centers examined the care and recovery of nearly 2,000 patients with traumatic brain injuries between 2008 and 2011 and then analyzed the data to find the most successful care methods.

A few major findings stood out:

1. The sooner the rehabilitation begins, the better. “The data strongly suggests that starting therapy earlier in the rehabilitation process — especially aggressive therapies like trying to walk — brings better outcomes,” said Dr. Ryser. “The average time it took for patients to begin rehabilitation at Intermountain Medical Center was much shorter than most of the other facilities in the study. Our patients were usually much sicker when they arrived on our unit, but because we started therapy earlier, they recovered faster and made more improvements.” 
   
   The study recommends building therapy into the acute care process. Intermountain Medical Center has already been leading the way in this area by incorporating rehabilitation as part of each patient’s stay when they’re in an intensive care unit.
   
   
2. It’s not the duration of therapy that counts, it’s the type of activity you’re doing. It seems that more aggressive therapies done for short lengths of time may have a greater impact than less aggressive therapies performed over a longer length of time. For example, the study indicates that patients who get up and try to walk as part of their therapy improve faster than patients who do less-demanding therapies on a mat.

“Right now the standard is at least three hours of therapy per patient per day, but this data suggests that a set amount of therapy time may not be as important as what you’re doing with that time,” Dr. Ryser said.


3. Providing good nutrition is important. “We found that when patients got the best possible nutritional support, outcomes improved,” Dr. Ryser said. This includes ensuring that patients who need feeding tubes get them. “Again, Intermountain Medical Center led the way in this area. Almost twice as many patients here use a feeding tube compared to the other locations in the study, and our patients typically did better than similar patients who didn’t have a feeding tube.”

“It’s exciting that we were able to participate in this ground-breaking study alongside many other very good programs, and it was rewarding to see that our outcomes compared very well with them,” Dr. Ryser said. “Many of our patients made more improvements faster and a higher percentage of our patients went home after leaving the hospital. As our colleagues in other hospitals review this study and apply its findings, the things we’re doing here at Intermountain Healthcare will help improve care for traumatic brain injury patients around the world.”