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Objective: To determine whether the use of a designated staff person to coordinate and schedule therapy services in a postacute residential rehabilitation program for people with acquired brain lesions results in (1) a higher-intensity treatment and a reduced length of stay; (2) reduced rehabilitation costs; and (3) increased patient and staff satisfaction., Design: This nonrandomized retrospective study from 2009 through 2012 uses data collected relative to 2 different methods of scheduling: (1) self-planning, in which each single team member makes appointments that are then displayed on a shared board; and (2) managed planning, in which appointments are made by a designated staff person., Setting: A residential center for people with postacute acquired brain lesions., Participants: Patients (N=20) with acquired brain lesions who had similar clinical and demographic characteristics comprised the managed planning group (n=10) and the self-planning group (n=10)., Interventions: Not applicable., Main Outcome Measures: Organizational measures (length of stay in rehabilitation, number of treatment hours, total cost of rehabilitation), clinical outcome scales (Disability Rating Scale, FIM, and Barthel Index), perceived quality of treatment by patients (questionnaire), and perceived satisfaction of team members (Job Descriptive Index)., Results: All patients improved on all clinical rating scales at the time of discharge (all effect sizes are large). In the managed planning group, the number of treatment hours increased (Cohen's d=2.15), resulting in reduced length of stay (Cohen's d=.95) and cost of rehabilitation (Cohen's d=1.22). In addition, the quality of treatment perceived by the patients and their families increased, while team member satisfaction did not change., Conclusions: The use of a designated staff person to manage therapy services improves efficiency and efficacy of a patient-centered health care system. The proposed scheduling system results in a remarkable cost saving for the National Health System., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Primary Objective: The aim of this study was to investigate the hypothesis that group rehabilitation is more effective than individual treatments and provides an improvement in clinical outcomes similar to that achieved by individual treatments alone., Research Design: Two groups of patients were placed in different rehabilitation settings treated using the same rehabilitation approach. One received only individual treatments and the second group received a combination of both individual and group treatments. The independent variables were measured both pre- and post-treatment and compared between the two groups., Methods and Procedures: Seventy-four patients treated with a comprehensive rehabilitation approach were divided into two groups: (a) individual treatment only and, (b) combined treatments (both individual and group). The outcome scales were LCF (Rancho Los Amigos Level of Cognitive Functioning), DRS (Disability Rating Scale) and FIM™ (Functional Independence Measure)., Results: The whole sample had obtained statistically significant improvements in all of the outcome scales: LCF (χ(2) = 45.26; p < 0.001), DRS (z = -3.92; p < 0.001) and FIM (z = -4.9; p < 0.001). The comparison between groups did not reveal any pre-treatment difference. Analysis of post-treatment, however, showed a greater improvement in the FIM scale for those in combined individual and group treatment (z = -0.2544, p = 0.01)., Conclusions: Group rehabilitation integrated with individual treatments is more effective than individual treatments alone in improving independence measured by the FIM™ scale. Both groups had obtained statistically significant clinical improvements, the improvement in the FIM™ scale was significantly better in the combined treatment group.

The atypical antipsychotic drug aripirprazole has a partial agonist activity on the dopamine receptors. This characteristic makes aripiprazole different from other antipsychotic agents. In this paper, we aim to describe the use of this drug in the management of three young patients with acquired brain injury: a woman with Wilsons disease, a male with a rupture of an arteriovenous malformation and a male with severe traumatic brain injury. All patients presented behavioural symptoms. One of them presented frequent crises of psychomotor agitation with strong physical aggressive reaction, partial awareness and low frustration tolerance. The other two patients reported a prevalence of negative symptoms, as inactivity, apathy, lack of will and severe perseveration. They were referred to our Unit and were evaluated with a full functional assessment at the moment of admission and at the discharge, depending on their clinical picture. The evaluation included: MMSE (Mini Mental State Examination), LCF (Level of Cognitive Functioning), DRS (Disability Rating Scale) and FIM (Functional Independence Measure). The behavioural assessment was made with clinical interviews. After the introduction of aripiprazole, we found an improvement in the behavioural pattern, moreover neuropsychological and motor evaluation appeared not affected. These results suggest that the use of aripiprazole in patients with acquired brain injury is suitable for its efficacy in reducing psychotic and behavioural symptoms but also for its potential for not affecting motor and cognitive functioning. [Copyright &y& Elsevier]