Five years after traumatic brain injury: A study of individual outcomes and predictors of change in function

Issue title: Aging with a Neurodisability: Morbidity and Life Expectancy Issues

Guest editors: Michael J. DeVivo

Article type: Research Article

Authors: Hammond, Flora M.^{a; *} | Grattan, Karyn D.^a | Sasser, Howell^b | Corrigan, John D.^c | Rosenthal, Mitchell^d | Bushnik, Tamara^e | Shull, William^f

Affiliations: [a] Department of Physical Medicine and Rehabilitation, Charlotte Institute of Rehabilitation, Carolinas HealthCare System, Charlotte, NC, USA | [b] R. Stuart Dickson Institute for Health Studies, Carolinas HealthCare System, Charlotte, NC, USA | [c] Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA | [d] Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ, USA | [e] Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA | [f] Department Rehabilitation Medicine, University of Pennsylvania, Philadelphia, PA, USA | Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA

Correspondence: [*] Flora M. Hammond, M.D., Director, Brain Injury Research, Department of Physical Medicine and Rehabilitation, Charlotte Institute of Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, USA. Tel.: +1 704 355 4330; Fax: +1 704 355 0709; E-mail: [email protected]

Abstract: Objective:Study functional changes between one and five years after traumatic brain injury (TBI). Design:Prospective cohort. Setting and participants:TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301). Main outcome measures:Disability Rating Scale (DRS) Level of Functioning and Employability Items. Results:On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 (79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM™-Motor, FIM™-Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening. Conclusions:Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined. There are demographic and functional indicators present at one-year post-injury that may be predictive of subsequent change.

Keywords: brain injury, outcome, function, disability rating scale, prediction, employment

DOI: 10.3233/NRE-2004-19104

Journal: NeuroRehabilitation, vol. 19, no. 1, pp. 25-35, 2004