Community re-entry of long-term institutionalized brain-injured persons

Although evidence exists for delayed recovery after traumatic brain injury, patients who do not receive rehabilitation early after their injuries often remain permanently in long-term care facilities. Case reports of five severely brain-injured persons who were discharged into long-term nursing care facilities for at least 1 year before initial rehabilitation admission are discussed. After prescreening for evidence of functional improvement, these patients were admitted to a rehabilitation unit with the goal of community discharge. Functional improvement was evaluated using the Functional Independence Measure (FIM) and additional categories of function. Community discharge was successfully achieved in all five patients, who demonstrated particular improvement in bathing, transfers, memory, bowel management, problem solving and independence during waking hours. Further efforts should be made to identify patients in long-term care facilities who might benefit from rehabilitation services, and to identify those factors which contribute to successful community discharge.