Retrospective Cohort Study of Participant Characteristics and Outcomes of Advanced Postacute Brain Injury Rehabilitation for Brain Injury Due to Hypoxia.

Abstract

Hypoxic brain injury (HBI) is associated with substantial cognitive, behavioral, and functional impairments, yet little is known about outcomes following advanced postacute brain injury rehabilitation (APBIR). This study compared admission profiles and rehabilitation outcomes for individuals with HBI with those for traumatic brain injury (TBI) and stroke and examined predictors of functional change within the HBI group. Retrospective data from individuals discharged between 2019 and 2025 were drawn from the multicenter Foundation to Advance Brain Rehabilitation database. Data were obtained from APBIR facilities across the United States serving individuals with brain injury. A total of 3150 participants with TBI (n=1268), stroke (n=1753), and HBI (n=129) discharged between 2019 and 2025 following APBIR. Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and SL programs. Functional status was assessed using Mayo-Portland Adaptability Inventory-4 (MPAI-4). At admission, the HBI group showed greater disability across MPAI-4 indices and subscales compared with TBI and stroke groups (P<.001). All groups demonstrated significant improvement from admission to discharge (P<.001). However, after adjusting for covariates, participants with HBI showed smaller gains than those with TBI or stroke. Exploratory analyses indicated that longer time postinjury predicted reduced improvement for the HBI group, whereas admission disability level was not a significant independent predictor. Individuals with HBI present with more severe disability upon entry to APBIR, yet make meaningful functional gains. Although improvements are smaller in magnitude than those for TBI or stroke, findings support the value of specialized postacute neurorehabilitation for HBI survivors. Given the limited historical referral patterns and funding challenges for this population, results highlight the need for increased advocacy for comprehensive rehabilitation services following HBI.