The efficacy of multidisciplinary rehabilitation programs for the traumatically brain-injured: A case study retrospective approach
Putnam, Steven Howard
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Permalink
https://hdl.handle.net/2142/22328
Description
Title
The efficacy of multidisciplinary rehabilitation programs for the traumatically brain-injured: A case study retrospective approach
Author(s)
Putnam, Steven Howard
Issue Date
1989
Doctoral Committee Chair(s)
Zaccaria, Joseph S.
Department of Study
Education
Discipline
Education
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
Biology, Neuroscience
Education, Educational Psychology
Psychology, Clinical
Language
eng
Abstract
The sample consisted of 100 subjects ranging in age from 3 to 87 years (70% under 30 years) who had sustained moderated to severe closed head-injuries in a motor vehicle accident. Subjects were randomly selected from the files of a central catastrophic claims office, a state regulated association established by amendment to Michigan's Auto No-Fault insurance law, and all had legally mandated and unrestricted access to medical and rehabilitation care. On the average, the sample was 6 years post-injury. Nine percent of the subjects had a formal psychiatric history, and 20% had a documented history of substance abuse prior to their accident. Only 49% of the adult subjects were employed on a full-time basis at the time of the accident, and 30% were within the first year of a new job. The study was exploratory and retrospective in nature and attempted to examine the relationship between time since injury, injury severity, treatment duration and cost, and later global outcome. Nine frequently employed treatments for the head-injured were examined, along with total insurance costs. The mean gross total cost for the sample was $236,048.
"Methodologically, the primary emphasis was on regression-based prediction in the following outcome domains: intellectual, neuropsychological, and general functional. Time since injury was found to be inversely related to all outcome domains. In particular, increasing time post-injury was associated with more restrictive-supportive living arrangements and with lower quality of life prognoses. Injury severity parameters explained between 25% and 40% of the variance in certain areas within each of the three outcome domains. The best predictive power was found in neuropsychological outcome areas, especially sensory-motor and speech-language functioning. The number of days in coma was the single best predictor of later outcome in neuropsychological and general functional areas. The duration and cost of multidisciplinary treatment was inversely related to virtually all outcome areas in this extended post-injury time period. Psychotherapy treatment appeared to be associated with the best outcomes and most cost-effective results. Certain treatments appeared to be more efficacious early rather than later, suggesting a possible ""window of opportunity"" phenomenon. The need for conceptual and treatment models more specific to late outcome was discussed. A hypothesis of possible later deterioration of uncertain etiology was proposed, with suggestions for subsequent research efforts to further consider this issue."
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