Applicability of traumatic brain injury rehabilitation interventions in natural disaster settings

ABSTRACT

Objective: To evaluate published traumatic brain injury (TBI) clinical practice guidelines (CPGs) and assess rehabilitation intervention recommendations for applicability in disaster settings.

Methods: Recommendations for rehabilitation interventions were synthesized from currently published TBI CPGs, developed by the Department of Labor and Employment (DLE); Scottish Intercollegiate Guidelines Network (SIGN); Department of Veterans Affairs/Department of Defence (DVA/DOD); and American Occupational Therapy Association (AOTA). Three authors independently extracted, compared, and categorized evidence-based rehabilitation intervention recommendations from these CPGs for applicability in disaster settings.

Results: The key recommendations from a rehabilitation perspective for TBI survivors in disaster settings included patient/carer education, general physical therapy, practice in daily living activities and safe equipment use, direct cognitive/behavioral feedback, basic compensatory memory/visual strategies, basic swallowing/communication, and psychological input. More advanced interventions are generally not applicable following disasters due to limited access to services, trained staff/resources, equipment, funding, and operational issues.

Conclusions: Many recommendations for TBI care are challenging to implement in disaster settings due to complexities related to the environment, resources, service provision, workforce, and other reasons. Further research is needed to identify and address barriers for implementation.

KEYWORDS:

• Traumatic brain injury
• rehabilitation
• clinical practice guidelines
• natural disaster

Acknowledgments

We thank the Disaster Rehabilitation Committee (DRC) of the International Society of Physical and Rehabilitation Medicine (ISPRM) and Disaster Rehabilitation-Special Interest Group of the Rehabilitation Medicine Society of Australia and New Zealand (RMANZ) for their support. The views expressed in this article are not of the above-mentioned committees.

Declaration of interest

The authors declare no competing or conflicts of interest. This review was supported from internal resources of the Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia, and no external funding was available. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.