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PubMed1999

Cognitive rehabilitation: attention and neglect.

Cognitive neuroscience can make a significant contribution towards the development of a scientific basis for the practice of brain rehabilitation. Though rehabilitation is a vast worldwide industry, there is little scientific basis for the training and therapy that are designed to help damaged brain circuits to recover. The systematic application of cognitive neuroscience models to rehabilitation can not only foster better, more theoretically grounded rehabilitation, but the models themselves can be tested and modified by data generated in rehabilitation-oriented research. The example of unilateral spatial neglect is used here to show how non-intuitive but clinically tractable methods can emerge out of systematic application of cognitive neuroscience to the problem of how to foster dynamic change and recovery in the damaged brain. Examples are given of recently developed rehabilitation methods for unilateral spatial neglect that are both derived from theoretical models of cognitive function, and that feed back into these models. These include dorsal-ventral stream interactions, perceptuo-motor interactions, interhemispheric inhibitory dynamics, and arousal-spatial attention interactions. It will be to the mutual benefit of basic cognitive neuroscience and rehabilitation if this type of research is expanded into other domains of cognitive function, in which similar theory-practice interactions exist.

Journal Article↗
PubMed1998

A study of factors facilitating and inhibiting the willingness of the institutionalized disabled elderly for rehabilitation: a United States-Japanese comparison.

The high prevalence of 'bedridden elderly' in Japan is at least three times higher than that of any other industrialized country. To decrease likelihood of being bedridden, it is important to cultivate and maintain the willingness of older disabled patients for rehabilitation, and to preserve functioning in activities of daily living (ADL). The purpose of this study was to identify the factors facilitating and inhibiting the willingness of institutionalized disabled older adults for rehabilitation with respect to physical, goal-attainment, psychological and cultural aspects. The convenience sample consisted of 71 disabled older adults (45 in Japan and 26 in the USA). 46 subjects (64.8%) were identified as 'willing for rehabilitation', whereas 25 (35.2%) were 'unwilling for rehabilitation'. The data were gathered using structured interviews to subjects and administering questionnaires to the nurses. The data were compared between the 'willing' and the 'unwilling', and between those from Japan and from the USA by cross-tabular and correlational analyses. The major findings in this study were as follows: (1) Factors found to facilitate willingness of older persons for rehabilitation included: high independence level in ADL, generalized endurance/stamina, lack of pain, mutual goal agreement between old people and care staff, and no presence of regressive behavior. (2) Factors found to inhibit willingness of older persons for rehabilitation included: lower independence in ADL, presence of pain, generalized little stamina, depression, presence of regressive behavior, and dementia, and expectation of another person's help all the time. Healthcare workers need to be aware of patients who are subject to factors inhibiting willingness, and to promote factors facilitating willingness, in order to prevent the elderly with disabilities from becoming bedridden. In addition, the implications of this study are for a multidimensional functional assessment to be part of the rehabilitation intake in order to better understand each individual and motivate his/her optimum level of functional ability.

Journal Article↗
PubMed2002

The integration of treatment and rehabilitation in psychiatric practice and services: a case study of a community mental health center.

After briefly reviewing the relationship of psychosocial rehabilitation to psychiatric practice, the authors recommend a renewed commitment of psychiatrists to bridge and integrate psychiatric treatment with psychosocial rehabilitation in practice and in the organization of services. They use the case example of an urban, community mental health center to illustrate a strategy for achieving greater integration of these two, relatively independent fields of professional practice. The Center's strategy for integration includes (1) center-wide planning, (2) structuring the medical staff office to support the task of integration, (3) establishing a model of practice and principles of care that supports both domains of intervention, (4) educating medical staff about psychosocial rehabilitation, (5) inter-disciplinary team building, including a definition and discussion of professional roles, (6) expanding services research on psychosocial rehabilitation, and (7) advocating in alliance with rehabilitation colleagues for expanded psychosocial rehabilitation services and their integration with treatment. By taking initiative to forward the integration of treatment and rehabilitation, psychiatrists better serve seriously ill patients and more effectively define their own work and roles.

Combined Modality Therapy↗
PubMed2003

Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury.

OBJECTIVE: To evaluate rehabilitation outcome in a representative sample of older and younger SCI patients. DESIGN: Case series, consecutive sample, survey. SETTING: Tertiary care, spinal cord injury unit (National Spinal Injuries Centre), Stoke Mandeville Hospital. PARTICIPANTS: One hundred and forty-seven male and 45 female newly injured in-patients (consisting of 152 younger adults, age range=16 to 54, and 40 older adults, age range=55 to 85) admitted between 1995 and 1999. INTERVENTION: All patients were actively participating in a comprehensive, multidisciplinary Goal Planning and Needs Assessment rehabilitation programme. MAIN OUTCOME MEASURE: The Needs Assessment Checklist. Specifically designed and developed for the spinal cord injured population, this clinical assessment tool provides a way of assessing and ensuring that rehabilitation programmes are geared toward each patient's individual needs, providing the patient with the skills appropriate to their level of lesion. As part of ongoing psychometric analyses of the Needs Assessment Checklist, internal consistency reliability coefficients are reported for this measure. RESULTS: The type and cause of injury for the older adult group in this study was comparable with previous research. Older adults' rehabilitation gains were comparable to those of the younger age group. Younger adults were more mobile initially after their injury. However, when the two groups were matched for injury characteristics etc. the only differences in final outcome between older and younger adults were in skin management ability. Both groups showed significant improvements in all areas of need in the period between mobilisation and entering the pre-discharge ward. CONCLUSION: These results highlight important considerations for the rehabilitation of older adults and emphasise the need for active, individually tailored rehabilitation programmes. There are specific areas of need (i.e. skin management) where older adults do not achieve comparable levels of independence. Special attention needs to be paid to the problems presented by SCI older adults and efforts should be made to better prepare rehabilitation professionals to adapt to age specific differences.

Adolescent↗
PubMed2001

Conditions for rehabilitation of older patients with dementia and hip fracture--the perspective of their next of kin.

The aim of this study was to describe the conditions for rehabilitation of older patients with dementia and hip fracture from the perspective of their next of kin. Twenty patients at orthopaedic wards were examined postfracture using a short cognitive test. The same number of next of kin answered four open-ended questions about rehabilitation as well as about the patient's physical function. Qualitative content analysis was used to identify categories. The findings indicate that the conditions for rehabilitation of older patients with dementia and hip fracture are related to the patients' competence, specific needs of support in the light of competence, environmental factors and classification of the rehabilitation activities. The study confirms that the conditions for rehabilitation are related to symptoms of dementia disease and arise from a decline in competence making the patient unable to cope with the environmental pressure and to perform rehabilitation activities. Because of difficulties in assessing competence, patients with dementia are being judged as incapable of managing rehabilitation. A supportive strategy is necessary to encourage the recovery process.

Aged↗
PubMed2000

Incidence and risk factors associated with cardiac arrhythmias during rehabilitation after coronary artery bypass surgery.

OBJECTIVE: To evaluate the clinical relevance of cardiac arrhythmias during rehabilitation after coronary artery bypass graft (CABG) surgery. DESIGN: Survey of consecutive patients admitted to an inpatient cardiac rehabilitation center. SETTING: A rehabilitation center acting as a reference for cardiology clinics lacking this facility. The program was performed in the inpatient setting. PATIENTS: Two hundred sixty patients undergoing elective CABG surgery for angina. INTERVENTIONS: Four-week cardiac rehabilitation program. A 24-hour electrocardiographic examination was performed during the first 2 days and, subsequently, on a daily basis. MAIN OUTCOME MEASURES: Incidence and type of cardiac arrhythmias during rehabilitation; identification of factors associated with an increased risk of cardiac arrhythmias. RESULTS: Cardiac arrhythmias were recorded in 33.5% of the patients and were more frequent in patients with hypertension (47%), diabetes (42.4%), and hyperlipidemia (36.5%), compared with patients free from these diseases (15.5%) (p < .05). Arrhythmias were also recorded in patients older than 70 years (49%), compared with those younger (29.2%) (p < .01), and in patients who discontinued amiodarone (64.3%) compared with those who did not interrupt the drug (16%) (p < .005). Arrhythmias precluded rehabilitation in 5% of the patients and caused death in one patient. CONCLUSION: Surveillance for the development of cardiac arrhythmias during cardiac rehabilitation after CABG surgery may allow the early detection and treatment of arrhythmias in a substantial number of patients.

Aged↗
PubMed2001

The effect of variations in applied rehabilitation force on collagen concentration and maturation at the intrasynovial flexor tendon repair site.

The biochemical means by which accelerated rehabilitation alters intrasynovial flexor tendon repair site collagen synthesis and extracellular matrix maturation are not fully understood. We hypothesized that an increased level of applied rehabilitative force in a clinically relevant animal model would hasten the maturation of the repair site extracellular matrix as demonstrated by total collagen and collagen cross-link assessment. Twenty-eight flexor digitorum profundus tendons from 14 adult dogs were transected and repaired. The animals received either low- or high-force rehabilitation and were killed 10, 21, and 42 days after surgery. A 10-mm segment of tendon surrounding the repair site was obtained. Biochemical analysis showed that total collagen concentration was significantly reduced at each time point, that the reducible cross-link ratio of dihydroxylysinonorleucine to hydroxylysinonorleucine was significantly increased at each time point, and that the nonreducible pyridinoline cross-link content was significantly decreased at 10 days in both rehabilitative groups. Total collagen content did not vary to a statistically significant degree with either time or as a function of rehabilitation type. Based on these findings several clinically relevant observations can be made. Increasing collagen concentration and repair site maturation do not explain the previously demonstrated increased tensile properties of tendon that occur between 3 and 6 weeks after repair. Higher force rehabilitation does not alter the biochemical composition of the healing tendon through 6 weeks. Coupled with other recent data these findings suggest that high-force rehabilitation does not stimulate accelerated healing after intrasynovial flexor tendon repair.

Animals↗
PubMed2003

Rehabilitation needs of an inpatient medical oncology unit.

OBJECTIVE: To identify prospectively functional impairments and rehabilitation needs in an acute care medical oncology unit. DESIGN: Prospective cohort study. SETTING: Inpatient medical oncology unit at a Veterans Affairs hospital. PARTICIPANTS: Fifty-five patients admitted over a 6-month period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, functionally based physical examination, Rehabilitation Needs Assessment, and Recreational Needs Assessment. RESULTS: On admission, the mean FIM total score was 105 out of 126, the FIM motor score was 72 out of 91, and the FIM cognitive score was 34 out of 35. The functionally based physical examination did not generally correlate with scores obtained on the FIM. Forty-eight (87%) patients had rehabilitation needs on admission. Forty-six (84%) patients had rehabilitation needs on discharge. Rehabilitation Needs Assessment on admission showed deconditioning in 42 (76%) patients; mobility impairment in 32 (58%) patients; a significant decrease in range of motion in 23 (42%) patients; deficits in activities of daily living in 12 (22%) patients; a need for recreational therapy in 7 (13%) patients; potential for benefit from patient education in 30 (55%) patients; and a need for modalities, edema control, or wound care in fever than 5% of patients. The most commonly requested recreational activity was reading. CONCLUSIONS: Patients admitted to inpatient medical oncology units have many unmet, remediable rehabilitation needs that may not be recognized by nonrehabilitation physicians and other clinical staff. These findings suggest that assessment of medical oncology patients may be enhanced by consultation with rehabilitation medicine specialists.

Activities of Daily Living↗
PubMed2002

[Health economics analysis of prospective payment systems in medical rehabilitation].

The forthcoming introduction of the DRG-system as a new hospital funding system in Germany reinforced the discussion about a reform of the already existing funding system in medical rehabilitation. Experience and concepts from acute medicine, however, cannot be transferred directly to rehabilitation. The development of a patient classification system is a presupposition for prospective payment systems. Initial attempts in rehabilitation-specific patient classification systems already exist, even though a comprehensive approach is not yet noticeable. International patient classification systems scarcely seem to be transferable due to the specific German case-mix. The specific differences between acute medicine and medical rehabilitation relevant for the valuation of funding systems are analyzed. Particularly a reduction of the length of stay as a primary aim for the introduction of the DRG-system does not seem appropriate for medical rehabilitation. The existing funding system in medical rehabilitation is analyzed from an economic point of view. The cost management of the German pension insurance, being one of the rehabilitation providers in Germany, has achieved high quality standard of treatment as well as cost restriction. This funding system has been further developed during the last couple of years. Future developments are shown.

Chronic Disease↗
PubMed2005

[Developing rehabilitation treatment groups for cardiology and orthopaedics -- findings of a research project].

The call for a more specific and transparent service and reimbursement system for medical rehabilitation is not new. However, in practice, the idea was not followed up for a long time. This situation changed with the introduction of German Diagnosis Related Groups (DRGs) for acute care settings. It is now strongly being discussed whether such a sophisticated lump sum reimbursement system might also be a viable alternative in the field of rehabilitation. There still exist different opinions over the suitability of a lump sum-system for medical rehabilitation, but the main direction seems to be clear. There is no doubt that medical rehabilitation requires a needs-adapted, differentiated patient classification system. The benefits of such cost-homogeneous groups are evident. They support medical and management services and are suitable for both internal and external use. The main intent of the project presented was to develop such a patient classification system, adapted to the requirements of medical rehabilitation. The project concentrated on orthopaedic and cardiac rehabilitaton. For these two areas, needs-adapted and cost-homogeneous groups (RBG, Rehabilitationsbehandlungsgruppen - Rehabilitation Treatment Groups) were developed in order to adequately represent the underlying service portfolio and to act as a link between acute and post-acute care. In addition, severity level indicators were identified, in order to explain for different needs and resource volumes and in order to create severity-RBGs representing patients with the same severity level. Based on these groups, a needs-adapted lump sum reimbursement system can be developed, allowing for a differentiated service and cost controlling. The project described formed part of the Research Funding Programme Rehabilitation Sciences defrayed by the German Pension Insurance and the Federal Ministry for Education and Research. As part of the Freiburg/Bad Sackingen research network, it was realised at the University BW, Munich.

Adult↗
PubMed2006

[Effects of work-related medical rehabilitation in patients with musculoskeletal disorders].

A work-related orientation within medical rehabilitation represents concepts with a stronger focus on the patient's individual vocational requirements and is based on different vocationally-orientated strategies of treatment. "Medical Occupational Orientation" ("Medizinisch-berufliche Orientierung", MBO), the model of Klinik Niedersachsen in Bad Nenndorf, places Functional Capacity Evaluation according to Susan Isernhagen (EFL) at the centre of rehabilitation diagnostics and therapy. This study investigates the effects of the MBO model relative to activities and vocational participation of patients with musculoskeletal disorders faced with vocational problems and on management at the interface between medical and vocational rehabilitation. Presented are findings of a randomized follow-up study aimed at evaluating the MBO model. A total of 494 patients of LVA Westfalen, a regional insurance agency, took part. A need for MBO was diagnosed for 222 patients. These patients were randomly assigned either to the MBO model of treatment (experimental group --> U[+]) or to the conventional medical treatment (control group --> K[+]). Patients without a need for MBO (U[-], K[-]) were treated likewise. The written questionings took place at the beginning (t (1)) and end of rehabilitation (t (2)), as well as six (t (3)) and twelve months (t (4)) after the patients' discharge. Currently, the results are based on the 6-month follow-up. Concerning the activities, an MBO-related effect in the experimental group (U[+]) has been found for the Pain Disability Index (PDI), effect sizes being d (u+) = 0.82; d (k+) = 0.17. The risk of unemployment six months after rehabilitation is decreased for MBO(+) patients who participated in the MBO model. In addition, the clinic can make effective prognosis concerning subsequent participation in vocational rehabilitation for both experimental groups (U[+], U[-]). Established for the first time in a randomized controlled trial, the findings presented show that patients with musculoskeletal disorders who are faced with particular vocational problems will achieve significantly better results concerning activities and vocational reintegration if their medical rehabilitation had been based upon an EFL-centred MBO approach.

Adult↗
PubMed2006

[Effectiveness of inpatient pulmonary rehabilitation (AHB). Results of a multicenter prospective observation study].

BACKGROUND AND OBJECTIVE: The value of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) is well accepted. However, there are no data on the efficacy of in-patient rehabilitation instituted within 14 days after an acute disease episode, as practised in Germany. It was the purpose of this multi-centre prospective study to assess changes in lung function, exercise capacity, symptoms and disease-related quality of life (QoL) in patients discharged from hospital for an episode of worsening COPD or asthma, pulmonary embolism, pneumonia or treatment of lung cancer. PATIENTS AND METHODS: 207 patients (mean age 60 13 years) with COPD (n=86), pneumonia (n=42), lung cancer (n=24), asthma (n=14), pulmonary embolism (n=7) or other pulmonary disease (n=34) were included. Measurements of lung function, exercise capacity and disease-related QoL were carried out at the beginning and end of rehabilitation. Socio-economic data and disease-related QoL measurements were recorded again after 2 months. RESULTS: Rehabilitation led to a significant improvement of lung function, exercise capacity and QoL. Patients felt rehabilitation was efficacious (95%), to be recommended (99%) and important (100%). Improvement of QoL was maintained at two 2 months and only 16% of previously working patients had applied for retirement. CONCLUSIONS: The data demonstrate the clinically relevant benefit of in-patient pulmonary rehabilitation immediately after a period of acute illness. In view of these result and the known morbidity and mortality of patients with COPD after hospitalization for a period of acute illness, this form of pulmonary rehabilitation should be considered as standard treatment for these patients.

Adult↗
PubMed1975

The response of hind-limb muscles of the weanling rat to undernutrition and subsequent rehabilitation.

1. Weanling male rats were maintained at constant body-weight for 28 d by feeding them reduced amounts of their normal diet. They were rehabilitated for 0, 3, 7, 10 or 16 d, and compared with two sets of control groups, one set of the same body-weight and the other of the same age. 2. The quadriceps, gastrocnemius and anterior tibialis muscles from the left hind-limb were weighed, and DNA, RNA, extracellular protein and intracellular protein estimated in the quadriceps and gastrocnemius muscles. 3. Each muscle responded differently during undernutrition and rehabilitation if compared with "age controls", but if compared with "body-weight controls" there was a tendency for muscle weight to remain appropriate for body-weight. 4. The amount of DNA did not change in the gastrocnemius or quadriceps muscles during undernutrition, and on rehabilitation did not begin to increase until after 7 d. RNA decreased during undernutrition, but increased rapidly on rehabilitation. The rate of increase in RNA was greatest in the quadriceps during the first 3 d, but in the gastrocnemius was greatest between 3 and 7 d. The peak values for the rate of RNA increase corresponded with the initiation of intracellular protein accretion in each muscle. Extra cellular protein increased during undernutrition, and on rehabilitation, responded in the same way as DNA, that is, it increased only after 7 d. 5. It is concluded that the differences found between muscles of the hind-limb during rehabilitation are due mainly to differences in the rates of DNA and intracellular protein accretion. It is suggested that these differences are the result of a differential response of RNA to rehabilitation.

Animal Nutritional Physiological Phenomena↗
PubMed2003

Early rehabilitation of facial nerve deficit after acoustic neuroma surgery.

OBJECTIVE: To determine whether an early physical rehabilitative program could improve and/or accelerate recovery from a postoperative deficit of facial nerve (FN) function. MATERIAL AND METHODS: A retrospective study of the charts of patients who presented a postoperative FN deficit after surgery for acoustic neuroma (AN) was carried out. Twenty-nine patients were enrolled and divided into 2 groups: 18 who underwent early physical rehabilitation and 11 who did not undergo rehabilitation. All the AN patients underwent translabyrinthine removal and were classified preoperatively according to the House-Brackmann staging system. Physical rehabilitation was performed according to Kabat (i.e. neuromuscular facilitation). FN function was assessed postoperatively and classified according to the House-Brackmann grading system. RESULTS: In Grade IV and V patients, early rehabilitation allowed a faster and better recovery with respect to AN patients for whom rehabilitation was not carried out. CONCLUSION: Early physical rehabilitation has proved to be effective as a helpful tool for recovery from FN deficit and it is therefore advisable to use it soon after surgery, especially for FN deficits worse than Grade IV.

Adult↗
PubMed1998

Postural motor programming in paraplegic patients during rehabilitation.

One of the basic aims in the rehabilitation of thoracic spinal cord injured (SCI) patients concerns the regaining of sitting posture control. This implies the development of new postural strategies requiring the adjustment of motor programming processes. The aim of this study was to investigate the time course of postural reorganization during active, clinical rehabilitation of thoracic SCI patients with different SCI levels. Thus changes in motor programming in sitting balance control were investigated in two groups of complete low or high thoracic SCI patients. At several stages during the rehabilitation process an experiment was held in which sitting posture was perturbed systematically using submaximal reaching movements over four reaching distances. This bimanual reaching task was presented as a visual precue choice reaction time (RT) task in which reaching distance (i.e. grade of postural perturbation) was precued. Results indicated that in both high and low thoracic SCI patients RTs in movements involving postural perturbation became shorter during the course of the rehabilitation period. However, low thoracic SCI patients were generally slower in the programming of balance perturbing movements than high thoracic SCI patients, a phenomenon that did not change over time. Furthermore, initial differences in RTs as a function of grade of postural perturbation disappeared in both groups in the course of the rehabilitation phase. Precue benefit, equally large for both groups, did not change as a function of rehabilitation time. It is concluded that the observed phenomena signify the gradual development of new central postural control processes in both SCI groups during rehabilitation. Low thoracic SCI patients, having more residual sensorimotor functions, seem to adopt more complex strategies in maintaining and restoring sitting balance that take longer to specify and to programme. High thoracic SCI patients seem to rely on simpler strategies using more passive postural support.

Adolescent↗
PubMed2000

Cultural variations in the understanding of traumatic brain injury and brain injury rehabilitation.

Little is known about how people from different cultures experience and understand traumatic brain injury (TBI) and the process of brain injury rehabilitation. The Brain Injury Rehabilitation Unit (BIRU) undertook a qualitative project to research cultural variations in the understanding of TBI and the rehabilitation process, interviewing 39 people with TBI and family members from Italian, Lebanese and Vietnamese backgrounds. The focus was on the reporting of sequelae of the TBI; valued qualities of service providers; barriers to effective communication; the role of the families in the rehabilitation process; and the experience of social stigma. Findings suggest there is a universal experience of TBI that transcends individual cultures. Study participants valued attentiveness, friendliness and guidance from rehabilitation staff. Family support was not always available to the person with TBI due to family conflict. Generally, people with TBI and family members valued the assistance of health interpreters facilitating their communication with rehabilitation staff. People with TBI from all three cultures experienced problems of stigma and social isolation. The findings have a number of implications for how brain injury rehabilitation staff can approach service provision to people from diverse cultural backgrounds.

Adaptation, Psychological↗
PubMed2002

Brain injury rehabilitation: what works for whom and when?

PRIMARY OBJECTIVE: This paper reviewed the available evidence that patient characteristics may determine the type of intervention that works best in brain injury rehabilitation. REASONING BEHIND LITERATURE SELECTION: A broad search strategy was used to identify papers which enabled conclusions to be drawn about patient characteristics which determined rehabilitation effectiveness. Six main areas were considered: severity of the brain injury, presenting problem, complicating factors, rehabilitation readiness, demographic, and socio-geographic variables. CRITICAL ANALYSIS OF LITERATURE: A levels of evidence analysis was used to evaluate the studies. MAIN OUTCOMES AND RESULTS: Very few studies on rehabilitation effectiveness were found which attempted to define the patient characteristics which predict a good response to rehabilitation. The best evidence relates to injury severity; more intense programmes may be unnecessary for those with less severe injuries. There is some evidence that dysexecutive problems, i.e. difficulties with organization and control of behaviour and emotion, interfere with rehabilitation. CONCLUSIONS: Patient characteristics may well determine individual benefits from particular rehabilitation programmes. However, few studies have attempted to provide evidence about this. As health provision focuses on needs-led services, it becomes paramount to investigate effectiveness from the client's perspective.

Brain Injuries↗
PubMed2000

Factors associated with patients' participation in rehabilitation services: a comparative injury analysis 12 months post-discharge.

PURPOSE: To determine key characteristics or factors associated with rehabilitation participation during the first year following discharge for persons with either traumatic brain injury (TBI), spinal cord injury (SCI), intra-articular fracture (IAF), or burn injury (BURNS). METHOD: Medical records and longitudinal survey [telephone questionnaire] data were collected for persons in the four injury groups and analyzed using hierarchical logistic regression procedures for each domain of factors. RESULTS: The only significant predictors with odds ratios greater than one were those for vocational rehabilitation participation. TBI patients lacking private insurance were 2.6 times more likely to participate in vocational rehabilitation; older SCI and TBI patients are about twice as likely to participate in vocational rehabilitation; and finally those with IAF or BURNS who are married at 12 months post discharge are 11.5 and 4.4 times respectively more likely to participate in vocational rehabilitation. CONCLUSION: Those lacking valuable socio-economic resources, such as private insurance (for TBI) and social support systems provided by marriage (for BURNS and IAF patients) are much more likely to be referred to vocational rehabilitation. This is true for older SCI and TBI patients as well. Lacking such resources, patients may be viewed by referral agents as less likely to benefit from in or outpatient rehabilitation.

Adult↗