TBI Related Goals

Introduction to Goal Writing:
- Following the completion of patient history, systems review, task analysis, tests and measures.
- Importance of integrating examination findings and proper PT diagnosis and prognosis into goal writing.

SMART Goals:
- Specific, Measurable, Achievable, Relevant, Time-bound goals that determine expected outcomes for the patient.
- Importance of salience for the patient and the clinical setting.
- Goals should be shared with patients to enhance motivation.

Functional Goals:
- Developed based on physical therapy examination and evaluations.
- Aim to create goals that are both functional and outcome measure-based.

Acute Care Setting:
- Average length of stay for TBI patients is approximately 8 days.
- Up to 5.7% of TBI patients may have extended stays of 24 days or longer.
- Short-term goals are designed for short durations (days) and long-term goals aim for discharge planning (home or post-acute rehabilitation).
- Length of stay in inpatient rehab averages 17 days, related to functional levels at admission. Longer stays correlate with higher assistance needs.
Outpatient Setting:
- Goals focus on safe return to participation levels.
- Short-term goals span 1 month, while long-term goals range from 2 to 6 months.
- Home health typically lasts 2 months, targeting transition to outpatient therapy.

Activity Limitations Focus:
- Short and long-term goals are to be based on activity limitations outlined in the initial problem list of evaluations.
- Example Objective Statement: "Patient completed supine to sit on a therapy mat with substantial maximal assistance."
- Measurement Criteria: Task surface (therapy mat) and GG code level function (substantial/maximal assistance).
SMART Goal Development:
- Analysis of examination findings contextualizes the setting (acute vs. post-acute care).
- Example Goal:
- "In four weeks, Mr. Jones will complete supine to sit on a standard mattress with supervision/touching assistance."
- Basis of expectation involves continued progress in functional capability and address for ongoing assistance necessities.

Participation Restrictions:
- Goals must link activities to restrictions, such as inability to interact or perform in-room mobility with family (e.g., daughter).
- Highlight the connection between activity completion and capability for participation.

Alternative Goal Examples for Limited Capability:
- An early stage patient might have insufficient motor control, hence goals might focus on basic body function rather than activity.
- Example Goal:
- "In 1 week, the patient will improve B Tricep Strength to a 3/5 to support sitting posture for 30 seconds with substantial/maximal assistance."
- Example Goal for Sit-Stand Preparation:
- "In 1 week, the patient will sit at the edge of the bed for 30 seconds unsupported to prepare for sit-to-stand tasks."
Metrics for Body Function and Structure:
- Use outcome measures (OMs) like the TBI EDGE recommendations (e.g., Agitated Behavior Scale, Functional Reach, Modified Ashworth Scale) for objective goal setting.

Example Case:
- Patients reaching independent levels of basic mobility may still struggle to return to prior-functioning capacity.
- Example of a patient with community-level gait independence but low scores on the HiMAT.
- Short-term goals must reflect meaningful change; e.g., improvement by 11 points, exceeding the minimal detectable change of 4 points.
- Long-term goals must aim above normative data (50-54 points for males aged 18-25).

Importance of understanding length of stay to dictate goal writing.
Focus on activity limitations to support progression in participation restrictions.
Balance between attainable activity-based goals and more foundational body function and structure goals as necessary.
Incorporate outcome measures to justify ongoing therapy, especially in patients with potential for greater participation in life activities.