Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S77-S84, December 2008

Traumatic Brain Injury in Patients With Traumatic Spinal Cord Injury: Clinical and Economic Consequences

  • Cheryl L. Bradbury, PsyD, CPsych

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Corresponding Author InformationReprint requests to Cheryl Bradbury, PsyD, Toronto Rehabilitation Institute, 520 Sutherland Dr, Toronto, ON, M4G 3V9, Canada
    • ,
  • Walter P. Wodchis, PhD

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
    • ,
  • David J. Mikulis, MD

      Affiliations

    • Department of Medicine, University of Toronto, Toronto, ON, Canada
    • Toronto Western Hospital, Toronto, ON, Canada
    • ,
  • Ephrem G. Pano, BSc, MSc (Cand)

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada
    • ,
  • Sander L. Hitzig, MA

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Department of Psychology, York University, Toronto, ON, Canada
    • ,
  • Colleen F. McGillivray, MD

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Department of Medicine, University of Toronto, Toronto, ON, Canada
    • ,
  • Fahad N. Ahmad, BSc
    • ,
  • B. Catherine Craven, MD

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Department of Medicine, University of Toronto, Toronto, ON, Canada
    • ,
  • Robin E. Green, PhD, CPsych

      Affiliations

    • Toronto Rehabilitation Institute, Toronto, ON, Canada
    • Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada

Abstract 

Bradbury CL, Wodchis WP, Mikulis DJ, Pano EG, Hitzig SL, McGillivray CF, Ahmad FN, Craven BC, Green RE. Traumatic brain injury in patients with traumatic spinal cord injury: clinical and economic consequences.

Objective

To evaluate the clinical and economic burden of traumatic brain injury (TBI) in people with traumatic spinal cord injury (SCI).

Design

Prospective, case-matched control study.

Setting

Inpatient spinal cord rehabilitation program.

Participants

Patients (n=10) diagnosed with traumatic SCI and concomitant TBI matched to an SCI only control group.

Interventions

Not applicable.

Main Outcome Measures

Inpatient rehabilitation length of stay, health care costs (patient care hours), clinician resource allocation, behavioral and critical incidents, FIM, Personality Assessment Inventory, and neuropsychological assessment findings.

Results

Prolonged loss of consciousness, increased rehabilitation costs, and greater demands on clinician recourses (trend) were found in the SCI with TBI group relative to the SCI-only group. Neuropsychological test performance was significantly worse in the SCI with TBI group, while the FIM cognition score did not discriminate because of ceiling effects. Greater evidence of psychopathology was observed in the SCI with TBI group.

Conclusions

The presence of TBI in SCI has a range of clinical and economic consequences. This dual diagnosis has the potential to affect SCI rehabilitation negatively, as well as quality of life and reintegration in the community. Specialized care appears to be needed to improve outcomes and to minimize clinical and economic burden, but further research is required.

Key Words: Brain injuries, Rehabilitation, Spinal cord injuries

List of Abbreviations: GCS, Glasgow Coma Scale, LOC, loss of consciousness, LOS, length of stay, MRI, magnetic resonance imaging, PAI, Personality Assessment Inventory, PTA, posttraumatic amnesia, SCI, spinal cord injury, TBI, traumatic brain injury, WAIS-III, Wechsler Adult Intelligence Scale- Third Edition, WMS-III, Wechsler Memory Scale- Third Edition, WTAR, Wechsler Test of Adult Reading

 

 Supported by the Ontario Neurotrauma Foundation (grant no 2005-ABI-392).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01489-5

doi:10.1016/j.apmr.2008.07.008

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 12, Supplement , Pages S77-S84, December 2008

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