Demonstration of functional rehabilitation treatment effects in children and young people after severe acquired brain injury

PURPOSE

To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose.

METHODS

An observational study of children receiving residential neurorehabilitation after severe ABI.

RESULTS

Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists' expectations of recovery.

CONCLUSION

Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.

Amantadine to enhance readiness for rehabilitation following severe traumatic brain injury

PRIMARY OBJECTIVE

To evaluate the association between amantadine and recovery of consciousness from prolonged traumatic coma.

RESEARCH DESIGN

A retrospective cohort study.

METHODS

Subjects included 123 adults with severe traumatic brain injury (TBI) admitted over a 10-year period who remained in coma despite becoming medically stable.

EXPERIMENTAL INTERVENTIONS

Cases received 100-200 mg of amantadine twice daily.

MAIN OUTCOMES AND RESULTS

46.4% (13/28) of cases emerged from coma compared to 37.9% (36/95) of controls (p = 0.42). Somatosensory evoked potential (SSEP) was the only significant predictor of emergence from coma (p = 0.02), while SSEP, age and Glasgow Coma Score (GCS) significantly predicted time to emerge from coma (p < 0.05).

CONCLUSIONS

Although the study and its design do not support the view that amantadine has an effect on recovery of consciousness; it remains safe, inexpensive and has few side effects. The lack of treatment alternatives and anecdotal support for its use may warrant further study. Prospective controlled trials would yield more definitive results.