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Updated: Jul 11, 2026
Detecting Behavioral Deficits in Rats After Traumatic Brain Injury
Published on: January 30, 2018
The utility of the FIM+FAM for assessing traumatic brain injury day program outcomes
Ronald T Seel1, Greg Wright, Tracey Wallace
1Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA. ron_seel@shepherd.org
Objective:
To evaluate the effectiveness of the FIM+FAM as a primary outcome measure for traumatic brain injury (TBI) comprehensive day programs.
Design:
Retrospective data analysis.
Setting:
Single center, TBI comprehensive day program facility.
Participants:
A demographically and regionally diverse sample of 105 persons with moderate or severe TBI admitted to the Shepherd Pathways comprehensive TBI day rehabilitation program.
Main Outcome Measures:
Functional Independence Measure + Functional Assessment Measure (FIM+FAM).
Results:
Twenty-eight percent or fewer of participants reached ceiling effects on 25 of the 30 FIM+FAM items at day program admission with only 2% of clients rated above ceiling score levels on the FIM+FAM total score. The criteria of Guyatt et al showed that 20 of the 30 FIM+FAM items showed clinically meaningful improvements in 60% or more of clients. On average, clients with TBI improved over 27 points on the FIM+FAM total score. Fifteen of 30 items showed ceiling effects of 33% or less at discharge where only 25% of clients exceeded the FIM+FAM total score ceiling threshold. Discharge FIM+FAM motor scale was a very good predictor of the need for additional single service physical therapy. However, reaching ceiling rating on the FIM+FAM cognitive scale demonstrated poor specificity (0.28) and negative predictive power (0.42) for the need for additional speech/cognitive therapy services.
Conclusions:
The FIM+FAM demonstrated utility as an outcome measure for TBI comprehensive day program treatment in the current milieu. Future research is required to replicate and extend the current findings.
