Strength, Balance, and Swallowing Skills Appear Predictive of Future Abilities

Past Studies

Past Studies show that traumatic brain injury can affect a person’s ability to take care of his or her daily needs, balance and mobility. Individuals with traumatic brain injury strive to improve their abilities in rehabilitation programs. Those with traumatic brain injury and their loved ones frequently ask the rehabilitation professionals how much function the individual will regain and how long it will take to improve. Likewise, members of the healthcare professionals and insurers ask the same types of questions. Many researchers try to identify ways of determining recovery outcomes for individuals following traumatic brain injury.

This Study

This study sought to examine the association between individuals’ strength, balance, and swallowing abilities at the time they entered and exited inpatient rehabilitation, and also at one year post-injury. By comparing the abilities at these different points in time, the researchers hoped to contribute to outcome prediction. The researchers examined the medical records of 2,363 individuals with traumatic brain injury from the Traumatic Brain Injury Model Systems Database. Based on the records, researchers determined an average score for each individual’s upper and lower body strength, ability to swallow and eat, and skill level for maintaining standing and sitting balance during movement.

The researchers found that about 45% of the individuals who had impaired swallowing skills at the time of rehabilitation entry still needed assistance for eating at rehabilitation discharge. At one year from their injury dates, the percentage still needing assistance improved to almost 16%.

Individuals who entered rehabilitation with poor lower body strength were three to five times as likely to need assistance from others at rehabilitation discharge and at one year after their injury than those individuals that entered rehabilitation with good lower body strength. All individuals made improvements across the time span, but a higher percentage of those individuals that were admitted with poor lower body strength needed help with dressing lower part of the body, walking, stair climbing, and moving their bodies from place to place, such as on and off a toilet.

Individuals who entered rehabilitation with poor upper body strength were up to 2.3 times more likely to need help from others at the time of rehabilitation discharge than those individuals that were admitted with good upper body strength. They were up to 4.3 times more likely than those with good strength to need assistance at one year from their injury dates. Because of poor upper body strength, these individuals needed help with self-care tasks, such as eating, bathing, dressing upper body, and grooming.

The researchers found that the more impaired an individual’s standing and sitting balance were, the greater problems that individual had with all self-care and movement activities. Smaller number of individuals with poor balance were able to perform tasks needed for self-care, such as eating, getting dressed, bathing, and toileting, able to move on and off the bed, chair, and toilet, and also to walk and climb stairs, lacking good balance, these individuals needed the help of another person to safely complete all basic tasks. At one year from their injury dates, all individuals had shown improvements but those individuals who had the poorer balance ratings at admission still were more likely to need help from others.

Who May Be Affected By These Findings

Individuals with brain injuries and their loved ones, rehabilitation professionals, researchers, and insurers.

Caveats

The results of this study support that physical functioning such as strength, balance, and swallowing ability appear to be useful predictors of difficulties at discharge from rehabilitation and at one year after traumatic brain injury. This information is a new finding for performance prediction one-year after injury. Former studies have looked at shorter time periods, such as the use of brain imaging as a predictor of functioning.

Bottom Line

The researchers found that individuals with traumatic brain injury that had greater upper and lower body weakness, impaired swallowing skills, and poor standing and sitting balance when they entered inpatient rehabilitation, tended to still have these limitations one year after their injury dates. These individuals needed assistance from others to complete many if not all basic daily living tasks, such as dressing and eating, at one year from their injury dates. The researchers suggest that rehabilitation professionals modify an individual’s treatment program when a specific weakness is identified.

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