Relationship of speech-language pathology inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

The Journal of Spinal Cord Medicine, 2012 · DOI: 10.1179/2045772312Y.0000000063 · Published: January 1, 2012

Spinal Cord Injury Rehabilitation Brain Injury

Simple Explanation

The study examines the impact of speech-language pathology (SLP) interventions on patients with spinal cord injury (SCI), particularly those who also have traumatic brain injury (TBI) and cognitive-communication limitations (CCLs). It looks at how these interventions affect outcomes at discharge and one year after the injury. SLP treatment factors explain a small amount of variation in cognitive Functional Independence Measure (FIM), participation, and mood. However, the impact of SLP treatments increased when the sample of patients became more homogeneous in the SCI/TBI + CCL subsample. The research highlights the complexity of diagnosing cognitive impairments in SCI patients, as TBI symptoms can be masked by the acute medical challenges of the injury. The study underscores the importance of accurate diagnosis for effective treatment.

Study Duration

2007 to 2009

Participants

1376 patients with traumatic SCI

Evidence Level

Practice-based evidence research

Key Findings

1
SLP treatment factors explain a small amount of variation in cognitive Functional Independence Measure (FIM), participation, and mood.
2
Patients with SCI and TBI who have the greatest need for interventions to address cognitive limitations receive the most SLP cognitive-communication treatment and show the greatest amount of improvement during rehabilitation.
3
Longer rehabilitation length of stay was positively associated with higher discharge cognitive FIM scores.

Research Summary

This study investigates the relationship between speech-language pathology (SLP) interventions and outcomes for spinal cord injury (SCI) patients, with a focus on those also having traumatic brain injury (TBI) and cognitive-communication limitations (CCLs). It analyzes data from six inpatient rehabilitation centers, examining the impact of SLP treatments on cognitive function, participation, and mood at discharge and one-year post-injury. The results indicate that while SLP treatments generally have a limited impact on outcomes for the broader SCI population, their influence is more pronounced in the SCI/TBI + CCL subgroup. Patients with more severe cognitive limitations receive more SLP services and show greater improvement during rehabilitation, though their cognitive function often remains impaired at discharge. The study highlights the challenges in diagnosing cognitive impairments in SCI patients and emphasizes the importance of length of stay in rehabilitation for cognitive outcomes, especially for those with dual diagnoses. It concludes that future research should focus on more comprehensive assessment of individual cognitive differences to better understand the relationship between SLP treatments and outcomes.

Practical Implications

Tailored Treatment

SLP interventions should be tailored to the specific needs of SCI patients with TBI and CCLs, recognizing that this subgroup benefits more from targeted treatments.

Extended Rehabilitation Stay

Rehabilitation programs should consider the importance of longer lengths of stay, especially for patients with SCI/TBI + CCL, to maximize cognitive gains and functional independence.

Comprehensive Assessment

Future research needs to incorporate more comprehensive cognitive assessments to better understand the complex relationships between SLP treatments and patient outcomes.

Study Limitations

1
The participating rehabilitation centers are not a probability sample.
2
Use of the cognitive FIM to identify CCLs associated with TBI may not have been adequately sensitive to identify all cognitive impairment.
3
Physician referral patterns for SLP services vary within and across centers, influencing the receipt of SLP services for study patients.

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