[Evaluation of factors influencing effectiveness of kinesitherapy in patients after traumatic brain injury].

OBJECTIVE OF THE STUDY: To establish the factors, which have an influence on recovery of motor and cognitive functions in patients after moderate or severe traumatic brain injury, when kinesitherapy is applied during the acute stage of injury and early stage of rehabilitation.

MATERIAL AND

METHODS

Subjects were 131 patients (99 men and 32 women) with a mean age of 39.5+/-15.9 years. Patients were divided into two subgroups according to degree of injury: severe injury (103 subjects) and moderate injury (28 subjects). During acute stage of injury, patients were treated at the Unit of Brain Injuries, Kaunas University of Medicine Hospital; thereafter, 80 patients continued rehabilitation at the Unit of Neurorehabilitation, while 51--in another rehabilitation centers. Recovery of motor and cognitive functions was evaluated using Functional Independence Measure: during acute stage of injury (beginning and end) and during early stage of rehabilitation (beginning, day 25, and end).

RESULTS

In order to determine the effect of kinesitherapy, the influence of following factors was evaluated: meningitis, cranial nerves damage, musculoskeletal system dysfunctions, plegia of extremities, speech and cognitive dysfunctions, behavioral changes, sleep disorders, depression, pneumonia, edema, hydrocephalus, epilepsy. The motor score in patients after moderate traumatic brain injury at the beginning of acute stage was 32.4+/-12.7, while in patients after severe injury it was 21.3+/-7.7 (p<0.01). At the end of this stage, the difference between subgroups was insignificant: 61.8+/-24.0 and 60.9+/-22.5, respectively (p>0.05). At the beginning of acute stage of injury, cognitive function score differed significantly: in moderate injury subgroup, the score was 14.2+/-5.5, while in severe injury subgroup - 10.0+/-4.9 (p<0.01). At the end of early stage of rehabilitation, no significant difference in cognitive function scores was found between subgroups: 22.3+/-8.4 and 22.5+/-8.6 scores, respectively (p>0.05).

CONCLUSIONS

Insufficient recovery of motor functions during period of kinesitherapy was influenced by depression, pneumonia, plegia of extremities, speech and cognitive dysfunctions, sleep disorders, dysfunctions of musculoskeletal system, behavioral changes, while the recovery of cognitive functions was influenced mainly by pneumonia, speech and cognitive dysfunctions, and sleep disorders (p<0.05).