Analysis of Post-hospital Neurological
Rehabilitation Outcomes
2014
Gordon J. Horn, Ph.D. (Presenter)
Frank D. Lewis, Ph.D. & Robert Russell, B.A.
National Clinical Outcomes
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2013 Research Findings using MPAI-4
Hayden, et al. 2013
Green, et al. 2013
Lewis and Horn, 2013
There are many studies ranging from 2004 to 2012 that established the
validity, reliability, and accuracy of the MPAI measuring post-hospital
functional outcomes. This is the 4th revision of the measure (Malec &
Lezak). Uses 0-4 scale.
The following analyses demonstrate continuous data collection and
research with data mining capacities.
2013 Research Findings using MPAI-4
Mayo Sample (N = 134)
Males/females = 61%/39%
Average age = 38 years
Time since Injury = 5.3 years
Type of injury = TBI (65%), CVA (15%), Other (20%)
Severity: Mild (29%), Moderate (12%), Severe (44%)
National Sample (N = 386)
Males/females = 73%/27%
Average age = 38 years
Time since Injury = 6.9 years
Type of injury = TBI (88%), CVA (6%), Other (6%)
Severity: Mild (5%), Moderate (29%), Severe (39%)
NeuroRestorative Sample (N = 604)
Males/females = 74%/26%
Average age = 40 years
Time since Injury = 3.48 years
Type of injury = TBI (70.1%), CVA (10.2%), Anoxic (4.5%), Tumor (1.5%), Other (11%)
Severity: Severe (72%)
MPAI-4: Abilities Index
•
•
•
•
•
•
•
•
•
•
•
•
•
Mobility (01): walking, moving, balance
Use of Hands (02): strength or coordination in one or both hands
Vision (03): problems seeing; double vision; visual field deficits
Audition (04): problems hearing, ringing in the ears
Dizziness (05): feeling unsteady, lightheaded, or dizzy
Motor Speech (06): articulation, phonation, rate of speech
Verbal Communication (07-A): problems expressing/comprehending
Non-Verbal Communication (07-B): problems expressing thoughts through gestures,
facial expression, or other non-language behaviors or understanding such expressions
from others
Attention/Concentration (08): problems ignoring distractions; difficulty shifting attention
Memory (09): problems learning and recalling new information
Fund of Information (10): information learned in school or on the job or general
knowledge
Novel Problem Solving (11): problems generating solutions or picking the best solutions
Visual-Spatial Abilities (12): problems drawing, assembling things together, being
visually aware of both the left and right sides
MPAI-4: Adjustment Index
•
•
•
•
•
•
•
•
•
Anxiety (13): tense, nervous, fearful, phobic, symptoms of post-traumatic stress
disorder such as nightmares, flashbacks of stressful events.
Depression (14): Sad, blue, hopeless, poor appetite, poor sleep, worry, self-criticism.
Irritability, Anger, Aggression (15): verbal or physical expressions of anger.
Pain and Headache(s) (16): pain complaints and behaviors; if pain originates from
multiple body areas (head, back), then rate overall impact.
Fatigue (17): feeling tired, low in energy; fatigability, that is, feeling low in mental or
physical energy after a relatively low level of mental or physical activity; fatigue may be
a symptom of depression and should not be rated here.
Sensitivity to Mild Symptoms (18): focusing on post-traumatic cognitive, physical, or
emotional problems; this rating is based on how distressed or concerned the individual
is about their functioning.
Inappropriate Social Interaction (19): acting childish, silly, rude; behavior not
consistently fitting to the time and place or age-appropriate.
Impaired Self-Awareness (20): lack of recognition of personal limitations and disabilities
and how they interfere with everyday activities, work or school.
Family/Significant Relationships (21): interactions with close others; describes stress
within the family or those closest to the person with brain injury.
MPAI-4: Participation Index
Initiation (22): problems getting started on activities without prompting
Social contact with friends, work associates, and other people who are not family, significant
others or professionals (23): the frequency of contacts and consistency of relationships with
people who are not related to or have a professional relationship with the person with brain injury
Leisure and Recreational Activities (24): involvement in hobbies, sports, and other active and
passive activities primarily for enjoyment either alone or with others
Self-Care (25): involves eating, dressing, bathing, and hygiene; this considers the amount of
independence with which basic self-care activities are performed
Residence (26): responsibilities of independent living and homemaking (such as meal prep, home
repairs and maintenance), medication management, and personal health maintenance beyond
basic hygiene
Transportation (27): independence in moving oneself outside of the home in the community; in
rating this item, consider ability to perform these activities without assistance as well as
environmental limitations
Paid Employment (28-A): work for pay; you can only rate on 28-A or 28-B; an unemployed person
that is looking for employment is rated on 28-A, but if that person were returning to school or
homemaking, then they are rated on 28-B.
Other Employment (28-B): unpaid work, such as, formal schooling, volunteer work, homemaking,
and retirement for those over age 60.
Managing Money/Finance (29): shopping, keeping a checkbook or other bank account, managing
personal income and investments
2013 MPAI study – comparison of groups
Rehabilitation is provided in many levels of care. Comprehensive posthospital neurological rehabilitation programs have been less available
with limited outcome data to analyze the effects of continued
rehabilitation after the hospital.
This study addressed: 1) whether post-hospital rehabilitation could
reduce disability as measured by the Mayo Portland Adaptability
Inventory-4, 2) whether the level of intensity of post-hospital care leads
to differences in disability reduction, and 3) whether differences in the
MPAI Indices could be found within various levels of post-hospital care.
Demographics
Males/Females %
80%
70%
60%
Axis Title
50%
40%
30%
20%
10%
0%
Series1
Males
75%
Females
25%
Demographics
Injury Types
70%
60%
Percentage
50%
40%
30%
20%
10%
0%
Series1
TBI
68%
Stroke
10%
Anoxic/Hypoxic
5%
Brain Tumor
2%
Medical
14%
Demographics
Average Age
* Significant
Difference
Length of
Stay
Time Since
Injury
Neurorehabilitation
N = 416
(1)
43.78 years
(SD = 15.30)
18.37 weeks
(SD = 32.50)
21.81 weeks
(SD = 53.89)
Neurobehavioral
N = 61
(2)
36.60 years
(SD = 13.86)
(* 1, 3, 4)
41.48 weeks
(SD = 67.85)
75.76 weeks
(SD = 100.57)
Supported Living
N = 39
(3)
47.81 years
(SD = 10.83)
68.20 weeks
(SD = 133.93)
69.05 weeks
(SD = 115.98)
Day Treatment
N = 69
(4)
40.73 years
(SD = 16.96)
16.56 weeks
(SD = 23.96)
29.49 weeks
(SD = 64.20)
Samples
The total sample used was 575 participants in the study
from a larger sample of 676 participants all within the
NeuroRestorative System of care throughout the United
States.
The average length of time from onset of injury to
participation in the NeuroRestorative program was 3.3
years.
Samples and Interventions
1) Neurorehabilitation: received active therapy including PT,
OT, SP, Counseling, CM, Medical Management, and
community integration, 5-7 days p/week.
2) Neurobehavioral: received active OT, counseling and/or
behavioral services, CM, medical management, and
intermittent PT and SP, and community integration.
3) Supported Living Rehabilitation: received medical
management, CM, intermittent therapy services (1 of 3
therapy types as needed), community integration.
4) Day Treatment: services included PT, OT, SP, Community
skills, and social skills. This group had successfully
completed the inpatient residential program and was living
at home when services were provided.
Methods
• Each participant was evaluated with an initial Mayo
Portland Adaptability Inventory – 4.
• The protocol guidelines included having this initial
evaluation completed within 30 days following admission.
This 30 day period was provided as part of the initial
clinical review.
• Each participant was then rated a second time with the
MPAI within 1 day after discharge.
• The MPAI scores were obtained by consensus within the
rehabilitation teams.
Analysis of Findings
Multivariate Analyses of Variance evaluated differences between
the groups on the MPAI admission to discharge T-scores, and with each
Index of this measure (Abilities, Adjustment, Participation).
Main effects were found for time of assessment (admission to
discharge). Each group demonstrated improved scores on the Mayo
Portland demonstrating reduced disability from admission to discharge
(p < .01).
Main effect between groups on the Mayo Portland Indices (Abilities,
Adjustment, and Participation) was also found (p < .01).
Specific Findings
Main Differences from Admission to DC
60
50
T-Score Values
40
30
20
10
0
NR Admit
55.12
NR DC
47.34
NB Admit
53.23
NB DC a
48.56
SL Admit
51.33
SL DC ab
48.49
DTx Admit
49.46
DTx DC
43.01
Adjustment
46.2
40.56
49.19
44.68
45.75
43.28
41.89
35.89
Participation
55.14
47.63
55.76
50.53
56.06
51.98
50.48
43.18
Abilities
Significance was achieved at p < .05 (a)
Significance was achieved at p < .01 (b)
Significance was achieved at p < .001 (all other scores charted)
Multiple Comparisons for Admission Data
Abilities Index
The inpatient residential programs (NR, NB, SL) did not differ from one another
on admission, but differed from the day treatment program on admission
scores.
Adjustment Index
The Neurorehabilitation program did not differ from the Supported Living
program on admission; the Neurobehavioral program had higher adjustment
scores (worst) upon admission compared to all other programs. Day Treatment
had the lowest adjustment scores (best) on admission.
Participation Index
The Day Treatment program had the lowest participation scores (best) upon
admission. Participation was not significantly different upon admission for
Neurorehabilitation, Neurobehavioral, and Supported Living.
Multiple Comparisons for Discharge Data
Abilities Index
The inpatient residential programs (NR, NB, SL) did not differ from one another
at discharge on Abilities, but the day treatment program had lower scores at
discharge on Abilities.
Adjustment Index
The Neurorehabilitation program did not differ from the Supported Living
program at discharge; the Neurobehavioral program had higher adjustment
scores (worst) at discharge compared to Neurorehabilitation, and Day
Treatment, but not Supported Living. Day Treatment had the lowest adjustment
scores (best) at discharge.
Participation Index
The Day Treatment program had the lowest participation scores (best) at
discharge, followed by the Neurorehabilitation program, then Supported Living
and the Neurobehavioral programs. Neurobehavioral program did not differ
from Supported Living on the discharge scores. Despite the complexity of the
behavioral intensity, Neurobehavioral programming showed improvement from
a T-score of 55.76 at admission to 50.53 at discharge (p < .001).
Discussion
• Reduced disability was demonstrated by all of the programs despite
their average length of time since injury of 3.3 years, and program
affiliation.
• The greatest gains were seen in the neurorehabilitation program at
the facility level.
• Day Treatment demonstrated the greatest gains overall. Those who
progressed to the structured Day Treatment program continued
making functional gains in all areas of the MPAI.
• Even participants in the Neurobehavioral and structured Supported
Living Rehabilitation programs showed significantly reduced
disability as measured by the MPAI at the time of discharge.
Discussion
• As the prior literature indicated (Hayden, 2013), greater outcomes
may be achieved when participants are able to access rehabilitation
within 3 months of the time since injury.
• Our sample was able to show reduced disability despite admission to
the program exceeding the initial 3 months of recovery.
• The current findings also suggest that intensity and structure of
programming may be a factor in achieving significant functional gains
from admission to discharge, irrespective of program type or
possibly length of time since injury. This is consistent with a study in
press showing that participants improve even after a year of
recovery before starting post-hospital care (Lewis & Horn, 2013).
Discussion
• The current results appeared contrary to popular belief that
neurological recovery and rehabilitation gains can only be
appreciated within the first year of recovery.
• This notion has been within the literature for many years, but the
current outcomes would suggest that post-hospital recovery may
continue for years beyond the injury onset (e.g., neuroplasticity).
• Structured programming reduces disability and reduces intensity and
need for supervision by the time of discharge.
• Therefore, rehabilitation emphasis may need to be reconsidered for
a longer length of time before indicating that disability or function
has plateaued.
Neurorehabilitation vs. Neurobehavioral Programs
Neurorehabilitation vs. Neurobehavioral
Objectives
This study investigated outcome differences in two post-hospital
rehabilitation program types (Neurorehabilitation [NR] and
Neurobehavioral [NB]). Criteria were established for group affiliation using
the Mayo Portland Adaptability Inventory (MPAI-4) which assesses the
level of functional disability reduction in post-hospital rehabilitation.
The study objectives were: 1) determining differences between groups
using the MPAI-4; 2) determine effectiveness of programming to reduce
symptoms of behavioral dyscontrol among NB individuals; and 3) identify
outcome predictors of independent functioning for each group.
Neurorehabilitation vs. Neurobehavioral
Methods
Subjects:
A total sample of 289 brain injured adults met inclusion criteria. NB
participants (N=70) were identified by 1) obtaining moderate or severe
ratings on MPAI-4 variables (Irritability-Anger-Aggression, Novel ProblemSolving, Inappropriate Social Interaction, and Impaired Self-Awareness); and
2) onset to admission greater than eight months duration. Most (N=219)
met criteria for the NR group including 1) MPAI-4 Irritability score no greater
than mild, and 2) onset-to-admission <8 months duration. The average onset
of injury to admission length was 99.6 months (8.3 years) for NB, and 3.1
months for NR. Diagnoses for both groups were predominately TBI (NB=83%
and NR=60%).
Measure:
The MPAI-4 was completed within 30 days of admission and at discharge for
comparison. Scores were converted to T- scores for direct comparisons.
Neurorehabilitation vs. Neurobehavioral
Results
Repeated Measures Multivariate Analysis of Variance revealed a significant
group main effect [F(1,286)=97.29,p=.0001]. The NR group demonstrated lower
scores than the NB group on the Ability, Adjustment, and Participation Indices.
This analysis also revealed significant within subjects effects
[F(2,286)=98.66,p=.0001].
A follow-up Wilcoxon Z-test for the NB group demonstrated statistical
differences from admission to discharge for each of the four variables defining
behavioral dyscontrol (p<.0001). Lastly, a stepwise multiple regression analysis
using the MPAI-4 variables for each group revealed that Initiation and Novel
Problem Solving significantly predicted Participation T-scores for the NB group
[F(1,69)=20.42, p< .0001; Adjusted R2 = .33)]. Initiation, Length of Onset to
Admission, Fund of Information and Memory significantly predicted
Participation T-scores for the NR group [F (4,213) = 22.86, p< .0001; Adjusted
R2=.29)].
Neurorehabilitation vs. Neurobehavioral
Conclusion
Participation in the comprehensive post-hospital rehabilitation programs lead
to significant reduction in disability for both groups. Significant disability
reduction was demonstrated within the NB group which is remarkable since
this group is chronically impaired, averaging 8.3 years post injury at the time
of study inclusion, with behavioral dyscontrol.
The improvements noted in the NB group were not attributed to time or
natural healing. Prior research demonstrated that time significantly impacts
recovery during the initial 3-6 months of care only. Finally, the MPAI-4
provided different predictor variables for each group. The Initiation variable
demonstrated the strongest predictor of independent functioning for both
groups.
Depression Outcomes
Depression rates through meta-analysis has
been shown to be as high as 34% in studies.
Depression in the general population ranges
from 5-20%.
Depression Findings
Background
The annual incidence of traumatic brain injury (TBI) in the United
States is 1.5 million or 3% (Borlongan et al., 2013). In 2005-2006, the
incidence of depression in the United States was 5.4% for ages 12 and
older (Center for Disease Control, 2012).
Chaudhury et al. (2013) meta-analysis revealed a 30% prevalence rate
of depression in TBI across multiple time points with 33% prevalence
>12 months since injury across samples.
Given this prevalence, the current study focused on the functional
impact of differing levels of depression on TBI post-hospital
rehabilitation outcome.
Depression Findings
Methods
Subjects: The total sample was 903 participants with admission to
discharge measures completed; 435 participants met inclusion criteria for
TBI receiving active post-hospital neurorehabilitation care. Most of the
participants were male (82%) vs. female (18%). Average age was 40 years.
Average length of stay was 5.8 months with an average of 34.06 months
duration from onset of injury to admission for post-hospital care.
Measure: The Mayo Portland Adaptability Inventory-4 (MPAI-4) was
completed within 30 days of admission and at discharge. Scores were
converted to T-scores for comparisons.
Depression Findings
Groups based on Ratings
36%
29%
24%
11%
No Depression
Mild
Moderate
Severe
Depression Findings
Results
A Multivariate Analysis of Variance (MANOVA) revealed a main effect for
depression, Wilkes’ Lambda=.88, F(12,1124)=4.6, p<.001, partial eta=.042. Power
to detect the effect was 1.000. Post-hoc analysis determined the depression
groups differed on the MPAI measures at admission and discharge (p<.01). The
mean differences for Abilities were significant when comparing the severely
depressed group to mildly depressed and non-depression groups (p<.01). The
moderately depressed group differed significantly from the non-depressed group
(p<.01), but not from the severe or mildly depressed groups.
Those in the non-depressed group differed from each of the depressed groups
(p<.01) for Abilities. The mean differences for Participation were significant when
comparing the severely depressed group to other depressed and non-depressed
groups (p<.01). The moderately depressed group differed significantly from the
severe and non-depressed groups (p<.01), but did not approach significance with
the mildly depressed group. Those in the non-depressed group differed from each
of the depressed groups (p<.01) for Participation.
Depression Findings
Discussion
Consistent with Chaudhury et al. (2013), this study found a high
prevalence of depression (34%) among a group of 435 TBI adults.
Those that exhibited the greatest depressive symptomatology
demonstrated the poorest outcomes on measures of cognitive functioning
and overall independence in the home and community.
Therefore, comprehensive assessment and treatment of depression
should be an integral component of post hospital rehabilitation
programming.
Anxiety Outcomes
Anxiety estimates range from 20-70% across
studies based on meta-analysis of findings.
Anxiety has been shown to occur between 520% in the general population.
Anxiety Findings
Objectives: To examine the impact of anxiety on functional
outcomes for Traumatic Brain Injury adults in post-hospital
rehabilitation programs. To measure the effectiveness of anxiety
reduction by post-hospital neurorehabilitation programming.
Design: Prospective cohort pretest – posttest.
Setting: Twenty-three residential post-hospital brain injury
rehabilitation programs in 13 states.
Anxiety Findings
Participants: 378 traumatically brain injured adults divided into 4
groups based on MPAI-4 anxiety ratings.
Groups based on Ratings
36%
27%
20%
No Anxiety
Mild
17%
Moderate
Severe
Interventions: Multidisciplinary treatment by physicians, nursing, PTs,
OTs, SLPs, counseling/psychology.
Main Outcome Measure: Mayo Portland Adaptability Inventory-4
(MPAI-4) T-scores and MPAI-4 anxiety ratings.
Anxiety Findings
Results. Repeated Measures MANOVA revealed a significant main effect for
treatment F(1,374)=419.62, p< .001. Each of the anxiety groups improved
significantly from admission to discharge on the MPAI-4 T-scores. The main
effect for anxiety was significant across groups F(3,374)=35.45, p<.001. Followup Bonferroni pair-wise comparisons demonstrated MPAI-4 T-scores at
discharge at a higher level of impairment in the severe anxiety group than each
of the other groups, p< .001. Wilcoxon-Z post-hoc tests demonstrated the
severe and moderate anxiety groups showed significantly reduced anxiety
scores at discharge (p<.001).
Conclusions: Of 378 TBI participants, those that received the highest anxiety
ratings at admission had the poorest overall functional outcomes at discharge.
The severe group showed significant reduction in anxiety ratings admission to
discharge (mean of 4 vs. 2.58). Even mild to moderate levels of anxiety was
shown to mitigate functional gains achieved in post-hospital rehabilitation
programs. All groups significantly improved from admission to discharge.
Aging and post-hospital care
Aging and post-hospital care
It has long been assumed that the brain’s ability to recover from serious injury
lessens as we age. However, recent research on brain plasticity shows that the
brain has remarkable ability to change in response to stimulating environments
even in persons beyond the age of fifty. This finding poses an interesting
question for post-hospital rehabilitation programs: Can older adults make
functional progress following a TBI as a result of participating in challenging
rehabilitation programs, and if so is that progress comparable to that of younger
adults.
The current study focused on evaluating 413 adults with TBI who were treated
within the NeuroRestorative neurorehabilitation programs throughout the
country. The 413 participants were divided into six age groups: 18 – 24 (n=73), 25
– 34 (n=86), 35 – 44(n=70), 45 -54 (n=97), 55-64 (n=68), and 65+ (n=19).
Each of these participants were evaluated using the Mayo Portland Adaptability
Inventory-Version 4 (MPAI-4) at admission and then again at discharge.
Aging and post-hospital care
The results of the study were somewhat surprising. First, and perhaps the most
notable, they found that no matter the age group, participants showed statistically
significant improvement from admission to discharge on the MPAI-4 Abilities,
Adjustment and Participation Indices. This means that irrespective of age,
participants showed important reduction in disability and greater independence
after completing their program.
The second analysis examined differences between groups in overall functioning.
The expectation would be that the youngest age group would show the greatest
functional improvement. Surprisingly this was true in only one comparison. The
youngest group (18-24) showed significantly greater improvement than the 45-54
year old group in adjustment to disability score. Each of the other age groups
showed improvement that was not significantly different from the youngest group.
The second effect for age was also found in the comparison between the 45-54
group and the 55-64 group on the adjustment score. The 45-54 year-old group
showed greater adjustment to disability than the 55-64 year-old age group. Each of
the other comparisons across age groups revealed they did not differ significantly in
the magnitude of functional gains made at discharge.
Aging and post-hospital care
The take home message is that all age groups improved as a result of
neurological rehabilitation efforts.
This exciting finding illustrates that older TBI survivors (50 and older)
can make improvements in function that are comparable to survivors in
their twenties.
Pediatric Outcomes
Pediatric Outcomes
Injury types and outcomes varies from adults.
Outcomes are age-dependent meaning that success of
outcome may be based on when the
neurodevelopmental process is disrupted
a) injury before age 6
b) injury from 7-10
c) injury from 11-13
d) injury from 14-17
e) injury from 18-24
Pediatric Post-hospital Rehabilitation
Objectives:
This study addressed post-hospital neurorehabilitation outcomes in a
pediatric sample.
The study objectives were to: 1) determine if differences exist from
admission to discharge for the pediatric sample using the Mayo Portland
Adaptability Inventory -4 (MPAI-4);
2) determine if differences exist between pediatric participants in active
rehabilitation vs. behaviorally intense rehabilitation, and
3) provide indication of discharge disposition based on sub-group affiliation
(e.g., active rehabilitation vs. behaviorally intense).
Pediatric Post-hospital Rehabilitation
Methods:
Subjects: The sample consisted of 74 brain injured pediatrics referred to posthospital comprehensive rehabilitation. Forty-one of those participants met
criteria for inclusion in the neurobehavioral intensity (NBI) group: 1) MPAI-4
scores of moderate to severe on Irritability, Novel Problem Solving,
Inappropriate Social Interaction, and Impaired self-awareness, and 2) onset to
admission of greater than eight months. The remaining subjects (33) met
criteria for the active neurorehabilitation (NR) group.
The average age of injury onset was 6.9 years but the average time from injury
onset to admission to the post-hospital program was 8.3 years.
The average age in the program was 13.60 years (ranging from 2-18 years of
age). The average length of stay for the entire sample was 5.25 months.
The total sample was comprised mostly of traumatic brain injury (65%).
Pediatric Post-hospital Rehabilitation
Measure. The MPAI-4 was completed within 30 days of admission and again at
discharge. Scores were converted to T- scores for comparison.
Results:
A Repeated Measures Multivariate Analysis of Variance revealed a significant
main effect for Abilities F (1,73) = 5.609, p = .0001; Adjustment F (1,73) = 5.654,
p = .0001; and Participation F (1,73) = 7.775, p = .0001.
More specifically, follow up analysis revealed no group differences (NR vs. NBI)
on the Mayo Portland Abilities and Participation admission scores. No significant
group differences were found among the Mayo Portland Abilities and
Adjustment scores at discharge.
Significant differences were found between the groups on Mayo Portland
Participation scores at discharge F (1,73) = 4.112, p < .05. At the time of
discharge, the Adjustment scores were not statistically different though the two
groups differed upon admission within this index (F = 11.22, p < .001).
Pediatric Post-hospital Rehabilitation
Conclusion:
Participation in the comprehensive post-hospital rehabilitation
programs lead to significant reduction in disability for both the Pediatric
NBI and the NR groups across the three indices of the Mayo Portland
outcome measure.
While both groups did not differ upon admission with Abilities or
Participation, both groups differed statistically with Adjustment.
However, based on the intervention effect, even those with significant
behavioral impairments were able to show the same Adjustment
outcome at discharge as those without behavioral intensity.
81% of the total sample was able to successfully return home following
intervention within this milieu.
Evidenced-Based Pathways to Rehabilitation
Current Database – Total Sample (N = 1,105)
Participation Scores
60.0
55.0
50.0
54.6
45.0
48.2
40.0
44.2
45.0
3 Month
12 Month
35.0
30.0
25.0
20.0
Admission
Discharge
3 Month Follow up = 131 participants
12 Month Follow up = 47 participants
Current Database – Neurorehabilitation Sample (N = 653)
Participation Scores
60.0
55.0
55.5
50.0
45.0
48.1
40.0
44.1
44.5
3 Month
12 Month
35.0
30.0
25.0
20.0
Admission
Discharge
3 Month Follow up = 79 participants
12 Month Follow up = 28 participants
Current Database – Neurobehavioral Sample (N = 114)
Participation Scores
60.0
55.0
55.5
50.0
51.2
50.9
48.8
45.0
40.0
35.0
30.0
25.0
20.0
Admission
Discharge
3 Month Follow up = 12 participants
12 Month Follow up = 5 participants
3 Month
12 Month
Current Database – Supported Living Sample (N = 89)
Participation Scores
60.0
55.0
57.3
55.3
50.0
52.4
53.3
45.0
40.0
35.0
30.0
25.0
20.0
Admission
Discharge
3 Month Follow up = 10 participants
12 Month Follow up = 3 participants
3 Month
12 Month
Current Database – Day Treatment Sample (N = 122)
Participation Scores
55.0
50.0
49.9
45.0
43.2
40.0
38.3
35.0
39.7
30.0
25.0
20.0
Admission
Discharge
3 Month Follow up = 12 participants
12 Month Follow up = 7 participants
3 Month
12 Month
Steps to rehabilitation programming:
Track A:
1. Hospital Level – acute care, inpatient rehabilitation
2. Outpatient
Track B:
Post-Hospital Programs
1. “Inpatient” Residential program
Neurorehabilitation
Neurobehavioral Intensity
Supported Rehabilitation
2. Day Treatment program
3. Home & Community program
4. Outpatient – single service program
Track C:
1. Nursing Home
2. Skilled Nursing Facility
Questions…
Why is there a goat
in the clouds?
Gordon J. Horn, Ph.D.
National Deputy Director of Clinical Outcome Services
gordon.horn@neurorestorative.com