Rehabilitation of TBI Patients

Rehabilitation for Severe Traumatic Brain Injury (TBI) patients from outside of Israel (Greece and Cyprus)
In the department of physical medicine and rehabilitation we treat patients from other countries especially Cyprus, Greek, Jordan and Egypt.

All patients are treated by comperhensive, interdisciplinary inpatient rehabilitation program conducted under the direction of a physiatrist.

TBI patients are treated using a goal-directed approach as accepted for other multiple trauma patients. Each patient received approximately 3 hours of supervised therapy daily from both physical and occupational therapists.

The rehabilitation treatment includes physiotherapy for motor and gait recovery. We use also Robotic device (LOKOMAT) with partial weight baring to improve locomotor function of TBI patients.

In ocupational therapy the main emphasis is on ADL training and Cognitive rehabilitation including computerized programs.

Special speech therapy for brain injury patients is employed in our speech therapy unit. Between October 2002 and July 2007, 24 patients from Cyprus and Greece were treated in our department, among them 10 suffered from TBI.

Rehabilitation outcome was evaluated using the Functional Independence Measurement (FIMTM) and the Glasgow Outcome Scale (GOS). Greek TBI patients started rehabilitation after 120±days, this period is 46 significantly later compared to 30± days of the Israeli TBI group.32 The functional level of Greek TBI patients upon arrival is very low (FIM =39±as compared to Israeli TBI ) 22 FIM=78(patients ±31 ).

Greek patients improve significantly during rehabilitation (FIM=63±25) however they do not reach Israeli TBI patients (FIM=105±A high proportion of Greek .)02 patients (62%) suffered from heterotoic ossification (HO)- bone percipitation inside the muscles which cause severe limitation of range of motion. They needed special orthopedic surgery in order to restore some motor function.

Upon discharged, 62.5% of TBI Greek patients achieved good recovery as opposed to 86.1% of Israeli TBI group.

The rehabilitation of Greek TBI patients required special efforts and techniques due its delayed start and higher complication rate. However, the prolonged comprehensive rehabilitation permitted even severe TBI patients to achieve significant improvement in function and quality of life.