Poster presentation Traumatic brain injury| Volume 91, ISSUE 10, e11, October 2010

*Poster 23: Fluctuations in Performance on the Orientation Log During Acute Recovery Predict Functional Status at Discharge Following Traumatic Brain Injury

      Objective: To investigate the incidence and relevance of fluctuating performance, a required diagnostic criterion of delirium (acute confusion), during the period of posttraumatic amnesia following traumatic brain injury (TBI). Design: Retrospective cohort. Setting: Inpatient brain injury rehabilitation unit. Participants: A sample of 63 TBI patients with confusion. Confusion was defined as 2 or more assessments scoring under established cut-offs. Interventions: None. Main Outcome Measures: The Orientation Log (O-Log), collected 3 times per week, and FIM scores collected at hospital discharge. Results: In the sample, 46 participants (73%) demonstrated fluctuating performance on the O-Log, as defined by any change in direction of scores. Patients with fluctuating performance had significantly lower discharge FIM scores (t=2.05, P<.05) when compared with those patients who did not fluctuate, despite the lack of difference in admission FIM scores. Further, we examined fluctuating performance as a score's distance from a regression line using all O-Log scores as the independent variable and days since injury as the dependent variable. Fluctuating performance, age, and PTA duration were entered into a multiple regression model as predictor variables, with FIM discharge score as the outcome of interest. This model supported our initial results, indicating greater variability in performance was a statistically significant negative predictor of functional status at discharge (R2=.146, F=11.66, P<.001). Conclusions: The results suggest fluctuation is a key dimension of early recovery with prognostic significance. Further, fluctuation is a required diagnostic criterion of delirium (acute confusion) and its prevalence and relevance in this patient sample supports the reconceptualization of early recovery suggested by Stuss and colleagues (1999).

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect