Where You Live Can Influence Recovery From Brain Injury

Where a person lives can influence their recovery from a traumatic brain injury, a new study says.

Based on their neighborhood’s characteristics, people are less likely to receive home rehab visits or go to a rehab clinic following a concussion or other traumatic brain injury (TBI), researchers report in the March/April issue of the Journal of Head Trauma Rehabilitation.

The results indicate a “need to improve access to rehabilitation services for persons with TBI living in communities with greater social needs,” concluded the research team led by Monique Pappadis, vice chair of population health and health disparities with the University of Texas Medical Branch at Galveston.

For the study, researchers analyzed data on more than 19,000 Medicare patients in Texas treated for a traumatic brain injury between 2014 and 2018.

About 48% of the patients received home health rehabilitation services, and another 14% attended rehab at a clinic. The rest received no rehab at all.

Results showed that:

Patients in higher-income areas or areas with higher unemployment rates were less likely to receive home health visits.
Rural patients and those in areas with lower insurance coverage were less likely to receive rehab at a clinic.
Patients who lived near grocery stores were more likely to have home health visits.
People in areas with severe housing problems were more likely to have outpatient visits.

Overall, some of these factors “were associated with a decreased likelihood of an outpatient visit but an increased likelihood of a home health visit,” the research team wrote.

For example, less use of rehab services in rural areas or areas with high uninsurance rates reflects disparities in access, such as a lack of transportation or an inability to meet copays, researchers noted.

On the other hand, “seemingly contradictory” findings like the lower use of home health care in high-income areas “suggest that access to care may not always be ensured by financial means alone,” researchers added.

“The intricate relationship between healthcare access and community socioeconomic factors necessitates sophisticated strategies to increase equity,” the team concluded.

More information

Johns Hopkins Medicine has more about rehabilitation after a traumatic brain injury.

SOURCES: Wolters Kluwer Health, news release, March 10, 2025; Journal of Head Trauma Rehabilitation, March 2025