[The Early Rehabilitation Barthel Index--an early rehabilitation-oriented extension of the Barthel Index]

The Barthel Index has been shown to be a good measure of reduced activities of daily living which can be applied in routine clinical practice in a valid and reliable manner. However, patients with severe brain damage cannot be differentiated appropriately as floor effects show up with increasing severity of neurological impairment, e.g. in comatose and near- or post-comatose patients in early rehabilitation. Aspects of functional deficits relevant in early rehabilitation patients have been introduced to the Barthel Index in a separate section, the Early Reha Barthel Index (ERI). These aspects are: state requiring temporary intensive medical monitoring, tracheostoma requiring special treatment (suctioning), intermittent artificial respiration, confusional state requiring special care, behavioural disturbances requiring special care, swallowing disorders requiring special care, and severe communication deficits. Experience with the ERI gathered with 210 early rehabilitation patients and 312 patients with severe brain damage demonstrate that the extended scale permits differentiation of patients according to severity and to avoid floor effects. Patients can be allocated appropriately to different phases of rehabilitation, i.e., early rehabilitation of patients with very severe brain damage or rehabilitation of patients with severe brain damage. The ERI is quick, economical, and reliable. Given the high cost of early rehabilitation it is expected to be of special interest also to health care providers to ensure that the right patient is looked after in the right bed.