What Skilled Nursing Facility Rehabilitation Can Offer Patients With Acquired Brain Injury

A study recently published in Frontiers in Rehabilitation Sciences examined functional outcomes and community discharge rates among patients with acquired brain injury who required a skilled nursing facility (SNF) stay following inpatient rehabilitation. Among 218 patients enrolled at a specialized brain injury SNF unit, 88% were discharged to the community, and AM-PAC scores improved across all three functional domains, including basic mobility, daily activity, and applied cognition, for the full cohort, including those who ultimately transitioned to long-term care. Above all, admission mobility score and a diagnosis of ischemic stroke emerged as significant predictors of community discharge.

The study was led by Kristen Harris, MD, attending physician at Hackensack Meridian JFK Johnson Rehabilitation Institute in Edison, NJ, where she serves as Medical Director of the Extended Recovery Unit at the Center for Brain Injuries. Harris is also Associate Program Director of the ACGME-accredited Brain Injury Medicine fellowship and is actively involved in the education of medical students, residents, and fellows.

In this Q&A, Harris discussed what the study set out to find, what drove the high community discharge rate, what the predictive factors suggest for clinical practice, and what she hopes a follow-up study would explore.

NeurologyLive: Give us the big picture. What were you trying to find out with this study, and what was the headline result?

Kristen Harris, MD: Many patients cannot discharge straight home from inpatient rehabilitation and require a stay at a subacute rehabilitation program. We were trying to understand the progress patients made during subacute rehabilitation in areas like walking, bathing, and eating. Nearly 9 in 10 patients were ultimately discharged to the community.

What do you think is driving that number?

Most patients who cannot go straight home after inpatient rehabilitation still have the opportunity to progress with further rehabilitation. A specialized subacute rehabilitation program can set them up for a successful discharge home.

You found that admission mobility score and ischemic stroke diagnosis predicted who made it home. Were those surprises, or did they confirm what you were already seeing at the bedside?

Mobility scores are often good predictors of home discharge because those patients require less physical assistance in the home. We did not necessarily expect to find that diagnosis would be a predictor of home discharge.

Even patients who ended up in long-term care still made functional gains. What does that tell us about the value of SNF rehabilitation beyond just getting people home?

From my perspective, this was one of the most valuable findings. Patients may not be able to go home after their subacute rehabilitation stay for many different reasons, but improving their physical and cognitive independence before long-term care has the potential to directly improve quality of life.

This was a specialized brain injury unit with dedicated physiatry coverage. How much of these results travel to a more typical SNF setting?

I am fortunate to work at a specialized brain injury unit with a fantastic and dedicated team. Our research findings are unique to our setting, and additional research would need to explore outcomes in nursing facilities with other therapy models.

If you could add one thing to a follow-up study, what would it be?

I would love to better understand how therapy intensity plays a role in rehabilitation outcomes at skilled nursing facilities.

REFERENCE
Patel E, Dharani A, Gelman S, Petrosyan H, Harris KA. The impact of continued inpatient therapies on functional recovery and community discharge in patients with acquired brain injury. Front Rehabil Sci. 2026;7:1804358. doi:10.3389/fresc.2026.1804358