Factors impacting Participation in Physical Therapy during Post-Traumatic Amnesia

Objective: To examine the impact of agitation, cognitive impairment, fatigue and pain on physical therapy participation and outcomes during Post Traumatic Amnesia (PTA) following traumatic brain injury (TBI).

Design: Prospective longitudinal study.

Setting: Inpatient Rehabilitation Hospital.

Participants: 77 participants with moderate-to-severe TBI, deemed to be in PTA using the Westmead Post-Traumatic Amnesia Scale.

Interventions: Not applicable.

Main outcome measure(s): The Pittsburgh Rehabilitation Participation Scale (PRPS) and time in therapy (minutes) were recorded twice daily following routine physical therapy sessions during PTA. The Functional Independence Measure Motor (select items related to physical therapy) score rated on admission and following emergence from PTA was used to calculate FIM-Motor change.

Results: Agitation was associated with lower participation in therapy. The presence of agitation and pain both predicted lower FIM-motor change at emergence from PTA. Higher levels of cognitive impairment and fatigue were also associated with lower participation and less time in therapy.

Conclusions: During PTA, the presence of agitation, fatigue, pain and cognitive impairment impede rehabilitation success. This study strengthens the case for implementing environmental and behavioural recommendations, such as conducting therapy earlier in the day within a familiar space (i.e. on the ward) and tailoring session duration to patient needs. This is with the aim of minimizing fatigue, agitation and pain, while promoting cognitive recovery and arousal during PTA in order to maximise physical gains. Further research is warranted to examine the factors associated with rehabilitation success across other therapeutic disciplines.

Keywords: agitation; cognitive impairment; fatigue; pain; physical therapy; post traumatic amnesia; rehabilitation; traumatic brain injury.