The effect of sleep fragmentation on therapeutic engagement and rehabilitation progress after brain injury in a pediatric inpatient sample.

Abstract

Objective: This study evaluated the effect of sleep fragmentation after brain injury on therapeutic engagement and rehabilitation progress in pediatric inpatients.

Methods: Participants (N = 29) wore a wrist accelerometer for one week to calculate a sleep fragmentation index measuring restlessness during the sleep period. Therapists completed ratings of functional independence (using the WeeFIM) and therapeutic engagement (effort and active participation in physical therapy sessions measured using the Rehabilitation Therapy Engagement Scale).

Results: Controlling for time from injury to rehabilitation admission, sleep fragmentation is negatively associated with therapeutic engagement and rehabilitation progress (defined as improvement in WeeFIM scores from admission to discharge per day of rehabilitation). Hierarchical regression demonstrated a significant negative association between sleep fragmentation and rehabilitation progress. However, when therapeutic engagement was added to the model it accounted for a significant portion of the variance and the effect of sleep fragmentation was no longer a significant predictor of rehabilitation progress.

Conclusion: Findings demonstrate the detrimental impact of sleep fragmentation on therapeutic engagement and rehabilitation progress and also suggest a possible mediating role for therapeutic engagement on the effect of sleep fragmentation on rehabilitation progress.