Cognitive Dependence in Physically Independent Patients at Discharge From Acute Traumatic Brain Injury Rehabilitation

OBJECTIVE

To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation.

DESIGN

Analysis of historical clinical and demographic data obtained from inpatient stay.

SETTING

Inpatient rehabilitation unit in a large, metropolitan university hospital.

PARTICIPANTS

Adult inpatients with moderate to severe TBI (N=226) who were physically independent at discharge from acute rehabilitation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

FIM Motor and Cognitive subscales, discharge destination, and care plan.

RESULTS

Approximately 69% (n=155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n=128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged home, 82% (n=105) were discharged to the care of family members, and 11% (n=15) were discharged home alone. Patients from racial and ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent.

CONCLUSIONS

The majority of physically independent patients with TBI were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the effect of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial and ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, health care policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation.

Survey of internship training in rehabilitation psychology: 2019

PURPOSE/OBJECTIVE

The purpose of this study was to obtain information about psychology internship training programs involving work with individuals with disabilities receiving rehabilitation services in the United States and Canada.

RESEARCH METHOD/DESIGN

The Association of Psychology Postdoctoral and Internship Centers (APPIC) directory was used to identify 426 training programs that listed supervised experience in rehabilitation psychology, and these programs were sent a survey assessing characteristics of their internship. There were 227 program directors who responded (53%), and 114 of them reported that their internship involved working with disabled persons receiving rehabilitation services.

RESULTS

The majority of training programs were at a hospital or subacute rehabilitation facility (Veteran Affairs and non-Veteran Affairs), and 41% of the programs were housed within an independent psychology department. Sixteen programs (15%) had faculty who were board certified by the American Board of Rehabilitation Psychology (ABRP).

CONCLUSIONS/IMPLICATIONS

Interns were exposed to a broad range of conditions, such as brain injuries, orthopedic, and spinal cord injuries, as well as comorbid psychiatric and substance use disorders. Interns were also provided various levels of training in ABRP competencies across programs. Opportunities to improve training with rehabilitation populations at the internship level include increasing didactics related to rehabilitation psychology and increasing opportunities to work with ABRP faculty. (PsycInfo Database Record (c) 2022 APA, all rights reserved).